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Bard Lindeman and Dr. Quentin Young discuss medical care

BROADCAST: Feb. 17, 1975 | DURATION: 00:52:51

Synopsis

Bard Lindeman and Dr. Quentin Young discuss medical care, medical reform, medical insurance, and pharmaceutical companies. Includes a clip of an elderly woman talking about the price of drugs.

Transcript

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Studs Terkel Medical care, I suppose, is as discussed as war, weather, taxes, and more and more, I think, people in our society, particularly older people, of people of the incomes that is not multimillion, realize that somehow it's a right and not a privilege. It's a right. Medical care. In other countries there is national medicine, national health. And the question is, without fooling around, "When will it come here?" So, more and more, people wonder about what happens to the family income when someone gets sick, insurance or no insurance. Now, Bard Lindeman, for five years editor of "Today's Health", which is an organ of the AMA, and wrote a series that recently appeared in "The Chicago Sun-Times"--

Bard Lindeman "Daily News".

Studs Terkel "The Daily News", I beg your pardon. One of the Field papers in town. And as a result of the series was asked to leave his job as editor at the AMA by his superior. And Quentin Young is my guest, too. Quentin Young is a doctor who is now the Department of, Chairman of the Department of Medicine at Cook County, and has been something of a dissenter as far as AMA hierarchical regulations are concerned, and one of the founders of the Medical Committee for Human Rights, and they will be our two guests this morning, and after we hear this message you'll hear the voice of an elderly Chicago woman talking about the--who has very little income--talking about the price of drugs. In a moment after this message.

Margaret Person My husband, a few years ago, when our drugs were $85 a month, he'd go in about every 10 days and spend $30 in our local drugstore getting prescriptions filled, getting 10 days' supply. And, so, he finally said to the druggist, he got so tired of handing over all this money every month, you know, he said to the druggist, he said, "What do poor people do who have these things, heart conditions, diabetes, and whatever? What do they do when they can't afford these drugs?" And the druggist said, "Die. What else?" And this is the very attitude of the pharmaceutical giants all over. I mean, at every level, this is their attitude. Die! What else? They hold with brand name prices and they hold the drugs so far out of the reach of the average senior citizen that they have to go without the medication they need. They have to go without it. Now we're fighting for generic equivalency drugs. Right now, the lobbyists for the pharmaceutical companies lobbied to keep a bill--or a law, in the State of Illinois, an anti-substitution law. So even if your druggist knows you, and your doctor orders the most expensive brand name of the diabetic drug, and the druggist knows that maybe another pharmaceutical house has the same thing under another name a little cheaper, he cannot substitute for you because of this anti-substitution law. He can lose his license, and we feel that we should be able to get the generic drugs.

Studs Terkel Explain that, Margaret, explain--[pause in recording]. Well, that's Margaret Person, and she's talking about what seems to be a daily experience on the part of a great many people and Quentin, Dr. Young, Bard Lindeman, thoughts on hearing this. Your piece, your first article of the series, is called, "Can You Afford to Get Sick?"

Bard Lindeman Well, it began, Studs, with a doctor we met. He's a good friend of mine and he was exercised because he had this patient, a patient of whom he'd grown fond, she had serious kidney disease, she had had long-term arthritis, and now she'd been in the hospital two weeks, and with heroic medicine they had saved her life not once, but twice. They had arrested the kidney disease and then she went into cardiac arrest, and they saved that. Now, at one of the leading medical centers in Chicago, in two weeks they had twice saved this woman's life. The cost now is ten thousand dollars. And he was discharging her against his better judgment so that she could go home to sell the farm in order to pay the bill. And he said to me, and he was really distraught, he said, "Being a doctor at times like this," he said, "is terribly difficult." And I hasten to add that not one penny was his bill on this. And he, you know, what he was saying was society must come to grips with this problem. We saved the woman's life but we bankrupt her and her family. Where is the right? Where is the justice? What shall we do?

Studs Terkel Well, Quent, Dr. Young, I know you've heard this many times, you've encountered it, too, and I'm thinking of Marge Person, the old woman in the price of drugs and what Bard Lindeman said about his friend, this doctor.

Quentin Young Well, there's a shared estimate and vision here. What we're seeing is that using a system of rewards that, as you observed at the very outset is more or less replaced throughout this world, it's amazing the U.S. is about the last nation in the world that hasn't seriously come to grips with the problem of cost of care. The point I'd like to make is that the arrangements we have, particularly in the case of drugs, are self-defeating because while your recording at the outset emphasized the cost of drugs that this lady and her husband needed to keep going, there's the other side of the coin of the enormous stimulus to use drugs unnecessarily, and I think those twin evils both drive up costs and deny people the medication they need. I think I've talked to you before about the soaring utilization of very active drugs, the psychoactive drugs, abuse of antibiotics which is not merely the waste of costly medications, but as you know, can harm people. The iatrogenic, that's from the Greek word "doctor-induced" or "doctor-generated," somebody coined a pun in two languages called iatrogenocide, which is a little harsh and, yet, the rise in iatrogenic disease is a big part of what we're getting--

Studs Terkel Now, what would iatrogenic disease be?

Quentin Young Those are illnesses that are caused by some action of the doctor. Now I hasten to point out that if I give you a penicillin injection which cures a serious illness, and you get a rash, that's a doctor-induced disease, but it's a good tradeoff. But all too often, penicillin is given unnecessarily.

Studs Terkel By the way, Bard, in one of his articles, in his five pieces in the "Daily News", does speak of the attitude of doctors that, indeed, can cause us the coldness, the impersonal aspects, and involving--you're probably aware of Quentin Young's edict as Chairman of Medicine at Cook County. Cook County, by the way, not to have, what is it, not to have sedatives offered?

Quentin Young We have a large clinic, some 250, 300 people come every day to our general medical clinic. That's the battle line, and it's exemplary of the enormous responsibilities we have there. And I and others in the hospital group and this includes both the attending physicians and the house officers are well, were concerned about the role that tranquilizers, sedatives, soporifics, hypnotics, all those drugs that affect the way the patient feels mostly to drug him were being exchanged for a real patient care transaction. Since, incidentally, I've done this, I've learned there's an awful lot of interest in this throughout the world, not our adventure, but people have done this in different ways. Well, indeed, last July we issued the order after consultation with a lot of people that there will be no prescribing of these drugs with obvious exceptions. For acute grief, they were allowed to prescribe a few such medications, for specific indications, for example, epilepsy requires phenobarbital, is wisely used, but excluding that, the drug was not supposed to be prescribed without additional consultation with the attending physician, and please, we said, spend more time talking to your patients. Now I hasten to point out before we could even do this much at County, we had to give these young doctors an appointment system, give them enough time to talk to their patients, make sure the charts were there. I know those sound like elementary things, but those things had to be accomplished. I can now report, Studs, what the results are. In that clinic, the use of those medications went down on an average between 60 and 89 percent, enterprising pharmacists estimated that 1,000,000 dosage of these, of just four of these medications will not be given this year if you annualize the seven-month experience and we're all very excited by it, and when we went to test patient reaction and doctor reaction, the really amazing thing is that there's no dissatisfaction. In fact, some are feeling more content now that there's a closer bond.

Bard Lindeman I had a similar experience with a elderly grandmother was in a nursing home and she had arthritis and she had a manifest case of hypochondria, as well maybe she might have, at 84 and living alone in a nursing home, but it was a good nursing home. And I watched, I paid the bills, and I paid the drug bills every month. And finally I called the doctor and I said, "What are these drugs for, specifically?" And he said, "Well, you know, the diagnosis is arthritis." And I said, "Yes, and I know there's no cure for arthritis as yet." And he said, "Correct." And I said, "Do these drugs do her that much good, and why, you know, is the bill $84, $67, $73 a month? Can't we find, you know?" He said, "Take it up with the nursing home. They're the ones that buy the drugs." But he admitted that he could not guarantee me that my grandmother was receiving any benefit from these drugs. Now you referred to a quote of Dr. Meninger in which he said that he thought some of the rise in malpractice cases filed against physicians was due to ineffectual communication between the patient and the doctor.

Quentin Young I'm certain of that.

Bard Lindeman And the patient winds up with a certain amount of distrust or hostility because of the unavailability of the physician or the physician isn't listening closely enough. And I'm a strong believer in compassion in the art of medicine as well as the science of medicine.

Studs Terkel Well, it leads to a question before we, you know, go any further, of course, with Quentin Young and with Bard Lindeman and the basis of Bard's series, Lindeman's series that appeared in the "Daily News" on the high price of medicine, on the new breed of doctors, are there public-oriented doctors with the wars during the '60s there are less of them today, that's a question that concerns Dr. Young very much, and the question of quackery, of course, but that's an old one. But more than that, the nature of doctors and patients and prices and medicine. Now, you had difficulty with the American Medical Association with the series, and that's the part I can't understand. I have the impression that AMA was now trimming its sails to the prevailing winds in which people are more and more realizing there must be national health. Bard, how did this come about, you got canned. Or that you were forced to resign your position as editor.

Bard Lindeman The same, the same thing. Yes, I'm a little bit at a loss to explain it, too, but I think there was a time a year or so ago, a year and a half or so ago, when there were soft winds of change within organized medicine and within the AMA and I'm afraid the wind has changed again. It's a very uptight place now, they are concerned about membership, about the soaring number of malpractice suits. They're concerned about government interference and all of these problems, legitimate problems that they should be concerned about are making them very harsh and very uptight and it's too bad. I'm sorry to see it.

Studs Terkel Well, I'm thinking, Quent, you and the founders of the Medical Committee for Human Rights that in a way is, became an answer on the part of young doctors answer to the rigidity of the AMA.

Quentin Young Well, there's no question that in the '60s reflecting the activist movement and the Civil Rights Movement and the student movement that there was among young and a few not-so-young doctors a concern for recapturing some of the humane values of the health professions. And it took many forms. Some of them idealistic adventures, the formation of free clinics. Whole reaction, if you please, to organized medicine and it's perceived as being preoccupied with doctor prerogatives, doctors' advantages. And I think the soft winds that Bard just mentioned were in no small part generated by a real concern of what was, if not a mass, a very large segment of young doctors looking to different pipers to follow. And it got significant because AMA membership declined. It was a historic moment two or three years ago, when for the first time the AMA--

Bard Lindeman Went

Quentin Young below 50 percent. Fifty percent of all doctors.

Bard Lindeman Page One story in the "Times".

Quentin Young Yes. And there's nobody who has 50 percent of everybody; no union, no craft, but the AMA for years they had this, it was in the '60s and '70s, and it wasn't just an across-the-board decline, Studs, it was a decline of the young doctors just weren't joining. And they've taken, I'm sure you're aware, Bard, extraordinary measures to woo the young doctor. Well, many things have happened this country in the last five years. Watergate, the decline of--

Bard Lindeman My Lai.

Quentin Young The civil rights movement and all the

Bard Lindeman rest-- Nixon. Watergate.

Quentin Young So I would be incomplete to state that those strong passions, those strong dedications among young doctors have persisted in medicine any more than in other sectors. Nevertheless, I think it's fair to say that that was not a period that was just a blip across the screen, so to speak. There are many sectors, I like to think that some of the things that are happening at County are reflective of some serious life career decisions along these lines. If I may, I'd just like to illustrate one. A young man, whose name I won't call, he'd be embarrassed if I did, he was very active in the Student Health Organization, has completed his training. This young doctor has an M.D. and a Ph.D., which I assure you would allow him to go anywhere he'd want and do very well. He's not only trained at County, he's now one of our attending physicians, but he took what I consider the toughest job I have to offer anybody. He's the head of Health Services in the County Jail. Now, we could take this whole program discussing the problems of penal medicine, I'm not going to do that. But what I can tell you is that this young doctor, by working 12 and 14 hours a day, every day, has begun to make some history in penal medicine, and while it's a long way from where we want it, the element of humanity of service, that sort of stuff is what's going on there now.

Studs Terkel Which leads to the second article of Bard Lindeman, "The New Breed Doctor". Now, as you pointed out, Quentin Young has been involved with this movement in the '60s, of course, and now when you point out this particular case and, yet, Bard's article indicates something that many of us feel as observers that there was that moment in the '60s of pro bono law, pro bono medicine, free clinics, that many of the young medical students now were thinking in old terms. That's a tight job market of making it, and less and less of a [unintelligible].

Bard Lindeman One of the other things I pointed out was that the doctors now are looking for not necessarily patient care, they want something exotic, something exciting, rare blood disorders, and so, they are into not secondary medicine, but as one older physician I talked to said, "Tertiary medicine," but let us quickly add that these are very, very bright and aware and aggressive and ambitious men who are reflecting the rest of the country and reflecting all the other social trends, and they have every right to want to carve out careers for themselves in areas that they feel are just or right. But one of the sources that I talked to, Dr. Ed Cohen of the University of Chicago, he held out, he added a note of optimism because he said, "Now, what we're seeing in medical school is the so-called pura fellow with, you know, eminent qualifications and the scholarship money is available." And, so, he thinks that maybe some of the newer younger people coming from a lower economic scale will want to return, you know, some service to the areas from which they came.

Quentin Young Studs, let me comment on that, it's something very, very important and very close to my heart. It seems to me we have a recipe, you know, you bake a cake, and the recipe in this country has the following ingredients: One, unquestionably, the physician is the most well- rewarded class, group of people, in the history of mankind apart from those who own the means of production or the land. It's unprecedented. These roughly 350,000 beneficiaries of a system that has and continues to reward them at an ever-accelerated rate. You then add into this mix the tightening economic situation at home so that alternative graduate education careers in physics, and engineering, and so on are overcrowded. You know that. Then you have a competition whereby by their own very high and very rigid standards medical schools admit, allowing for duplication, at the bottom line they have three times the number of qualified applicants and applying each year for their schools. In other words, a cut-throat competition, which incidentally, sometimes takes on cutthroat qualities. I remember a particularly poignant article in "Science" where a medical student wrote for science how students were actually hurting each other in their chemistry unknowns, contaminating them to get better grades. That's how cutthroat it has gotten certain settings. Okay, you have this overwhelming number of people of high standards at least by the admission requirements, competing for this Bauble, doctoring, and finally a third of them get in, and then they're put through what is unquestionably the most effective conditioning and socializing process than any graduate education I know. In a word, they start at the beginning of their medical school and come out not at the end of med school, but sometimes three to five years later after their additional postgraduate training, and you've got a uniform product. And what's the characteristics of the product? Going in, he was very altruistic. Every test we have shows that, sure, they're looking for a comfortable living and they have every reason to expect that if they get through that training, but they're always at service mode in every test we have. And over the years, in a very effective way, not by the whip or the knout, but by just holding up peer models of highly specialized people. All the people who are teaching them are very affluent. It becomes clear that there is no way that the doctors will not, under our present arrangements, end up into two sectors: in the affluent parts of our society, in other words, the rich suburbs of the rich parts of the city, with a steady stripping away of services to the inner city or the countryside, America's farm country is bereft of doctors, and what Bard stressed, this endless surge towards specialism because of its excitement and high rewards. And the net result is the incredible disarray we have today, where we are we spending well over 100 million--100 billion--

Bard Lindeman Hundred billion.

Quentin Young A hundred billion dollars, we're looking at 125 billion, I think, this year, and we'd be happy to spend it, would we not, if we were getting our dollars' worth. But what happens is the lady who spoke at the beginning of this program, this great gap between what medical services could be and what they are.

Bard Lindeman The catastrophic illness which just strips a family of its, not only its funds but emotionally, and then what? Thirty million poor who do not have, you know, ready access to the system, and who listen to people who say, "Yes, health care is a right. There's no question about it, it is not a privilege, it is a right." And then they have to take three buses and wait an hour or two hours if they're fortunate, and.

Studs Terkel Tell me about this gap. There's something else that Quentin mentioned here about the young med students have this feeling of service, the Hippocratic oath taken seriously, but as they go along, these peer models, what others say--yet, you mention in your, in this particular sequence on the new breed, this young guy, Robert Geggel, 22, Yale graduate, now first-year medical school at Pennsylvania medical school, who wanted to be a GP! He wanted to serve the poor people in the farm community. And what happened to him?

Bard Lindeman I mean, well, he finds he goes to class in this fine medical school and he's come through all of this competition and he does have the altruism, and he hears the GP put down. He doesn't have the respect of his peers, not nearly what it should be, and he hears his classmates talk about specialties they want to go into, a surgery or something, and so he has his doubts now, he's not so sure.

Quentin Young There's another aspect of this that I think doesn't get a lot of attention, and that is, as this country moves toward basic health policy, I'm struck by the assault, and I use the word advisedly, on the public sector. Now, the public sector in America has always been used traditionally as the dumping ground for the unwanted patient, and that unwanted patient may be the alcoholic, the addict, the poor, the Black, and there's no question that that's was the overt function of the public hospital, the city or county hospital over the years. Indeed, not too many years ago it was further exploited as a quote "place for teaching material and research material." Happily, because of the enlightened public and the overwhelming moral considerations, I think one can be more reassuring about that abuse. But I have to say it wasn't that many years ago before there was that kind of exploitation of the people in the public hospitals. Well, we come into an epoch when with national health insurance looming and already with Medicare and Medicaid sort of guaranteeing payment for these patients, they suddenly become attractive to the private sector. Because while there seemed to be in the past some kind of, if not acceptable, a reasonable position not to want these unfortunates, these unattractive people in their offices and in their private hospitals, turns out that it was just a question of money. Imagine that. And now there's a real competition which has taken strange forms. Boston City in New York, in Boston, one of the most famous of city hospitals, has been reduced, from one time a thousand beds, it's now about a 400-bed community hospital. Charity in New Orleans, a famous hospital, reduced. California once boasted the best array of county hospitals, including Los Angeles County and San Francisco General. One by one, these are being turned over to the private sector. And I believe even in Chicago our hospital has been the object of criticism. And my point is not that we shouldn't be criticized, I think every public--

Studs Terkel And Cook County.

Quentin Young Yeah, and private institutions should be held up to public scrutiny and criticism and everything that has to be corrected must be. But I sense in this onslaught that's coming regularly with increasing intensity a practical plot to break down the public sector here.

Studs Terkel Let's proceed further with this, we'll pause for a message and we'll proceed with Bard Lindeman's thoughts about what Quent just said. You know, there's a phrase Galbraith used some 15 years ago about private affluence and public squalor very now more pervasive than ever, let's understand, perhaps find out why and what's to be done, in a moment after this message. Resuming the conversation with Bard Lindeman, who had five years editor of "Today's Health", which was a magazine, a rather light one, too, might I say, of the American Medical Association, and recently had to resign because of a series of articles that ultimately appeared in the "Chicago Daily News" dealing with the nature of health and the public. And we'll ask about that too. AMA. And Quentin Young, my other guest, who's head of the Department of Medicine at Cook County and one of the founders of the Medical Committee for Human Rights, and Quent a moment ago was speaking of the--

Bard Lindeman Well--

Studs Terkel The, you know, the inroads, you know, what's happening to public health and in contrast, you know.

Bard Lindeman My eyes widened and my ears went wider when he talked about public criticism and criticism brought to bear. I think this is one of the points at which the AMA and I just, you know, disagreed violently, we got into a spitting match and they went last, and the articles were not directed against the AMA, in no way could these be criticized as, you know, a vendetta or--

Studs Terkel No, it's not, it's a mild series, that's the part that [attracts me?]--

Bard Lindeman What I did was, what I'm trying to say, is that the system is not perfect, it's far from perfect, and what the system needs is more heat and more light, and, you know, the old journalistic maxim, bring heat, bring light to a subject, and this is what must be done and when you have--I mean, no one would deny the AMA the right to have its own lobby group and its own union if you can call it that. But when they spend 37 million dollars and they're all, they've all taken the Hippocratic Oath and they all should be concerned about compassion and treating the 30 million poor who don't have direct access, then I think that we all have a perfect right to call--

Studs Terkel Thirty-seven million dollars on what?

Bard Lindeman That's their annual budget.

Studs Terkel Annual budget.

Bard Lindeman That's right.

Studs Terkel On what? On, on--

Bard Lindeman Well, that takes in a number of things; some scientific activities and meetings and conventions and--

Studs Terkel Public relations.

Bard Lindeman Public relations, yes. Yes. And a high style of going.

Studs Terkel This is, these is the big question, doesn't it, Quent and Bard? You know, you a doctor, he a medical journalist. That's the question of whither to, doctors and patients and us in our society. Let's stick with this new breed, Bard Linderman's piece is not a happy one, is that less and less of the young guys and young women, we'll come to women in a moment, who are practicing public medicine or poor people's medicine and now have given up more or less and they want to make it in this aggressive society.

Bard Lindeman I think our incentives have to be better, don't you, Quent?

Quentin Young That's exactly the point. Please go ahead.

Bard Lindeman Well, I'm not so sure what the incentives should be or how strongly the federal government should be into it. But there's no question that the altruism that the young man brings into medical school must be maintained, it must be preserved and encouraged. And, so, we've already begun with a small federal program of taking the doctors into the rural areas and into the ghetto and now this just has to become in some way mandatory. The VISTA program, the Peace Corps, has to be, you know, that same application or principle has to be applied here, and let the doctor give his service upfront, and then he can go bloody well do as he wants into his late 40s and 50s.

Quentin Young That proposal, as you know, there are about three or four reforms at the national level, and I think we're going to be seeing them. They all have the weakness of being arbitrary and legislative fiat instead of inspirational, if you please, and taking the excitement of medical practice which is, if I may say so as an aside, one of the most gratifying options a human can have in our society. I've said to you, Studs, more than once that I consider the consultation room the last refuge of love outside the family, and I've had too much experience there not to know how important that is and, indeed, as Bard mentioned in passing, it's the loss of that important encounter that makes a, patients unhappy, breeds malpractice suits, and of course, makes doctors in turn maybe very, very comfortably wealthy, but also unhappy, too. Our profession, I don't think I'm stretching things or misrepresenting, is in itself in sort of an emotional [health crisis?].

Studs Terkel Is it really, isn't it, you think this is not your imagination?

Quentin Young You can describe the AMA, and the point here, I would like to say so, you know, the listeners won't misunderstand, the thrust of what I'm saying and I'm sure Bard, the question isn't that Doctor X or Doctor Y is a really bad guy or he's malign or he's greedy. My point is and remains that we have a system that takes good guys and makes bad guys out of them.

Bard Lindeman The doctor, the friend of mine who gave me that marvelous anecdote to open the series is, you know, is strained and stretched and has been embarrassed by things that have been written and when he comes forward to speak out. And that's entirely it. This is a beautiful human being and is being chewed apart and turned into a bad guy by the system. And the, one of the reasons the system is now so vicious is this terrible malpractice problem, where the doctor must add on these needless costs, both in and out of the hospital, in order to protect himself. And this strains the dialogue and strains the compassion and the love and the consultation to a breaking point, and I said, the doctor and the patient are screaming at each other and, you know, the one does not want to hear what the other says, and the patient is saying, look, you know, I have to pay a terrible price, but I don't want to lose my dignity when I come into your system, and the doctor is shouting back even as he's not listening to that, and he's saying, "Don't come to me in your early 50s when you have not dieted properly and you have not exercised and you've smoked and abused yourself with alcohol and drugs and say to me, make me a well, young, vital man." Now there's justice on both sides and there's injustice on both sides.

Studs Terkel You know, there's something involved here, that's two aspects attract me very much. One is the nature of educational system. You say as you point out and Quentin, of course, citing chapter and verse, this young student who wants to practice because it means something to him, more than just money, and as he goes through school becomes more and more the predator without meaning to, education high levels, medical school. Yet, we know the same thing applies to education low level to the very nature of educational system eventually leads toward a predatory approach toward life.

Quentin Young I'd like to comment on that because I think that in many ways maybe the real issue is one that really isn't talked about a great deal. The whole effect of our rapidly evolving technology on the relationship between people, particular people who, particularly people who are professionals relating to patients or clients. I think this is going to have to have a lot more scrutiny. Having been active in the practice and intervening in people's health, so to speak, or illness, for a long time, I've come to believe increasingly that autonomy and self-reliance is something that we have to restore to people, that they--indeed, the biggest criticism I can make of the fee arrangement is that it stimulates more service. It stimulates the sale of more drugs that profit rewards and drug manufacturer creates behavior on the part of drug companies which we're all acquainted with. What is it now? Twenty percent of their money goes to detailing. They're spending $4500 per physician per year to stimulate the use of their drugs. All of these activities are inappropriate in a situation where we're trying to deal with what could be, arguably, is pretty close to the patient's, the person, there I said patient, the human's self-expression, their control over their lives, and that we intervene in all these ways. And this, it seems to me, has to be given more and more attention, the restoration of wholeness and autonomy to the individual. And I don't see the particular arrangements we have resulting in that, including, Studs, the passage merely of a national health insurance. It just would make the, mean they'd open the spigot on the trough.

Studs Terkel You know, we come to so many aspects of the other, the other part that attracts me is often it's true, the patient does misbehave. You know, I thought of the auto industry and the medical industry. Forgive me for saying industry here, that it's true, behave yourself. You smoke too damn much, your diet--all this may be true. But how often that could be the reservoir of guilt. And, so, the automobile, the driver, he's careless in his driving, you know, he does not watch out for the other. And this is, what about the auto itself and its manufacture, is there a parallel here, would you say, or am I stretching a point, am I unfair to medicine?

Bard Lindeman Well, perhaps not, but it is true that too many Americans, most of the doctor visits are the "worried well," you know, the office visit is the "worried well," and the art of medicine is much needed there to take care of these problems, and organized medicine, the AMA, the structured doctor, understands that, you know, if you live right and live well it will, you know, help you immeasurably. It will do more for you then he can do for you. And, so, I'm all in favor of anything the patient can do. Talk of self-reliance, anything the patient can do to, you know, better his own condition, it's just common sense. One of the doctors I interviewed was Alton Ochsner, who is 87 years old and runs up and down the stairs, who will not use the elevator and does a total of 100 pushups. I wanted to watch him do 100 consecutive pushups, but he admitted that he cheated and took rest in between his pushups. But that's not bad for 87, and when so he was giving medical advice, I was listening very closely.

Quentin Young It's interesting that the really great doctors and great human beings, I think of Paul Dudley White, used to bicycle. I didn't know this about Ochsner, but he's certainly one of the really greats of this century. And they have learned, if nothing else from their vast experience the importance of self-care, self-reliance.

Bard Lindeman I'll tell you a funny story in that area. Dr. Alton Ochsner of New Orleans and the Ochsner Clinic, has for 35 years been a vicious enemy of smoking, and cigarettes, tobacco. And he's gotten some notoriety and some publicity, but he was ahead of the vogue on the thing. Well, just recently he did for "Today's Health", when I was there as the editor, a story on sex and smoking, and how smoking can indeed, he believes, interfere with your sex life, particularly with a woman in pregnancy. And the story was well-received. The "Reader's Digest" bought it from "Today's Health", ran it, did commercials, television commercials upon it, put it as a tip-on in front of the magazine. And I said to him, "Well, Dr. Ochsner, now you know 15 million people have read your advice." And he said, "All I had to do was use the magic words 'sex and smoking' and I could have gotten all of that publicity 35 years earlier."

Studs Terkel By the way, I think I should end this by playing Muggsy Spanier, "Relaxin' at the Touro". Of course, Spanier was a patient of Dr. Ochsner way back at the Touro Sanatorium, that's [sad?], some I should do that. But there's one new-breed doctor we haven't talked about, that's the third article by Bard Lindeman in the series, that's women. Now, during the past 10 years this has happened, hasn't it, the number of women doctors.

Quentin Young The characteristics of the American medical profession, I think, cannot be overlooked as being contributory to the part of the dilemma we're talking about. And as you know, even at this late date, but certainly up 'til very recently, it was an all-white, all-male, the exception being two percent of the physicians being Black and another one or two percent Oriental, six percent of all physicians were women. And that was it. And then they weren't merely white males, they were white males who, my favorite figure, not more than 10 years ago, 40 percent of all doctors were sons or nephews of doctors. So it was a guild in that hierarchical and hereditary sense. Well, there it is changing, legal pressures as well as, I trust, some common sense have opened doors. There's been significant increases in the number of Black youngsters being trained for medicine, and while they're not near even the percentage of the population they represent, there's been, I think, some progress. Women, being a majority, of course, had much to be concerned about, not the least because all over the world, as you probably know, countries have found women to be doctors usually at the 30, 40, 50, 60 percent level. And in this country we have but six percent. Doors are opening, and I believe it will be an excellent, ameliorating, humanizing, balancing experience for the profession to have more women in our ranks. Not too many years ago, the rare woman in each class was the object of scorn and ridicule. It really is a dark chapter in American medicine.

Studs Terkel There's one here, Therese Southgate, a doctor/editor of the journal of the American--AMA.

Bard Lindeman Yes.

Studs Terkel A former organization, the organization which our friend Bard worked. Bard said, "'I don't like women,' said her, the professor who was her teacher." This is how many years ago? "He said, 'If you come to my service, you come on my service, I'll give you a C. If you earn an A, I'll give you a C. I give only C's to women.'" How long ago was that?

Quentin Young It was only five years ago or 10 years ago, when she was a beginning student and, you know, it sounds like something out of the Dark Ages. And she also said it was like taking a vow for the church, and among the vows was, I, you know, "I will not cry. I will not get in the way. I will mind my place. I won't speak up," and--

Studs Terkel "I'll laugh at the doctor's dirty jokes."

Bard Lindeman Yes.

Quentin Young "I'll suffer humiliation at my expense all the time."

Studs Terkel But this is altered. Now, this is one aspect.

Bard Lindeman One-third of the new classes at some of the prestigious schools next fall will be women and this same very bright and capable woman doctor who is an editor of JAMA, she brought up the point that, perhaps, there'll come a day when the doctors will all be specialists, the male doctors will be specialists in rare blood disorders and whatnot, and the women will be the caregivers, since this has been traditionally their role through history, and she pointed out this is a case, mainly the case in Soviet Russia.

Quentin Young Studs, I want to tell you a story on myself. My daughter just finished her internship, and trying to ingratiate myself with her a couple of years ago while she was in med school, I told her that when I talk on this subject I always make the point that the profession is very deficient in women by just inspection of the figures and it's particularly bad because characteristics of women, patience, nurturing, caring, etc., make it very logical that they should, as they are in many countries, form the majority of professionals. I looked up to see a really angry daughter. She said, I won't repeat the language, she talked very harshly to her father, she said, "We don't know that. We know that women have a different set of genitalia. They reproduce and they menstruate. Aside from that, all we want is equal opportunity and stay away from those sexist formulations." And she had me.

Studs Terkel Here's a woman, using Bard Lindeman's article, based this third article on women in medicine, Dr. Nina Woodside, director of the Center for Women in Medicine in Pennsylvania, quoting here, "Women traditionally have been the caretakers"--your daughter won't like this--"and the caretakers, the healers. There's a common feeling that women, perhaps because of social conditioning, will make medicine a more compassionate enterprise." You think so?

Quentin Young Well, I really thought so, and if you want the truth, even though I still want to enjoy my daughter's favor, I believe that. I believe, and I'm probably opening a big controversy, that the physiologic differences in women, the fact that they do have a nurture role in gestation and in nurturing the young, does affect their skills and their temperament. I find that--

Bard Lindeman

Quentin Young Patience. Reasonable. Yeah. To believe that. But my daughter wasn't ready to concede. I was willing to retreat to her position, give them equal opportunity and we'll see what happens. But it seems to me worthy of discussion.

Bard Lindeman Well, this Dr. Southgate made the point that money, the earning of money, the achieving of money, is not the measure of success for the woman that it is for the male, and I had never given it--

Studs Terkel I wonder if that's, I mean, this is a question--

Quentin Young They are socially conditioned--

Studs Terkel I wonder if that is so in this dog-eat-dog society.

Bard Lindeman I don't know.

Studs Terkel It doesn't--

Bard Lindeman It wouldn't seem so, listening to your daughter but you have to understand the place she was standing when she was talking this way, she had just, you know, come through a very competitive period, there's another competitive period ahead of her and is certainly a reflection of her time and her--

Studs Terkel Another reflection in your, in that same sequence, of women in medicine, Bard Lindeman, it was quite your thoughts on this, Dr. Martha Granger, 35-year-old psychiatrist in Alexandria, Virginia, says, "In surgery, for example, it may turn women have finer motor coordination than men. In psychiatry, women do well because they have more patience, more willingness to wait for results." Now.

Quentin Young It's interesting that these women are making the point I was trying to make and didn't do too well in my controversy with my daughter. I would say this: the feminist position legitimately is worried about emphasis on differences because all too often it's the old, the one about the Blacks and they should have got rid of them, right.

Studs Terkel Well, this is the argument against ERA, obviously, too.

Quentin Young Right. And I said, therefore, I accept the politics of that, and until we have a lot more evidence, the science of that position. I would argue and hope that my daughter and any other person in the discussion would be interested in a more humane environment to explore whether there are not sexual differences beyond the ones that are obvious: physical size, muscular development, and so on.

Bard Lindeman I would imagine the college of physicians and surgeons will give that psychiatrist some static over the fact that they might have better dexterity, but it will be interesting to see the impact of women on medicine.

Studs Terkel Your last two articles deal with quackery, the nature of quackery, and of course the hope and desperation, the part of making open to this. You know, arthritic cures, cancer cures, and you cite those cases and your last article, "Disease: Yesterday's Nightmare", the question of preventive medicine. We come to that, don't we? Is there enough really done? Now, this is the big question, isn't it? As to where dough goes, this is avoiding the big question. Most of our money goes to, in this society, to means of destruction. Most of our money does. You know, there's a madness that Dr. Albert Szent-Gyorgyi talks about.

Quentin Young And the medical equivalent, the treatment of illness, the end product of life rather than prevention or early detection.

Bard Lindeman Right. And the movement towards HMOs and health maintenance organizations and the prevention of it is, according to what I was reading the other night, is foundering, it is not doing well at all.

Studs Terkel Can I cite this case? Not too long ago, it'll be on PBS soon. I visited Dr. Albert Szent-Gyorgyi at Woods Hole, Massachusetts, the discoverer of Vitamin C, Nobel laureate. Dr. Szent-Gyorgyi thinks he's made a great breakthrough. He thinks he has. Now, he has credentials to be wrong, that is, he has the right to be wrong, since he did discover Vitamin C, done some remarkable work in muscular research, muscle. He thinks in cancer he's made a certain kind of, another--nothing to do with virus, another aspect of it. Now his and the result of our conversation brought forth this, and I hope it causes some sort of furor, his funds have been cut off. He discovered one day while watching TV news that, as three billion dollars was added to the Pentagon expenditures, his hundred thousand dollar Wood Hole fund was cut off, and so he's flat broke right now and may have to give up his laboratory, though he feels he's on the verge of a breakthrough, so isn't this a reflection--

Bard Lindeman Pathetic. That even as we gather to send new funds to Southeast Asia on the premise that a faltering democracy quote unquote needs these funds, that we don't have them for this type of research, nor to find a way to better distribute the world's finest health care. It doesn't do any good for the AMA and all of the other public relations people to talk about the fact that we have the best care in the United States. No question! Betty Ford, Mrs. Rockefeller, their mastectomies were handled marvelously, beautifully, and they'll make magnificent recoveries. We can take some pride in that. But what about the 30 million poor who don't have the--

Studs Terkel What about Marge Person, whose voice opened this program?

Bard Lindeman Right. And what about these funds for this man who believes that he's on the edge of a discovery?

Studs Terkel The irony is Szent-Gyorgyi is a Nobel laureate, and has disc--and they told him he was wrong way back then, he turned out to be right. So he certainly has, would seem to have the credentials even to be proved wrong, you see.

Quentin Young There's no question that the priorities are all wrong, and another favorite tragedy of mine is the Framingham study in Boston, which was giving us enormously important prospective data on the incidence of heart disease in particular, but many other things, wiped out by one stroke of the pen by the unlamented President Nixon. I feel with Bard Lindeman that the test of this society is its willingness to take care of those who are most excluded, and having been at County now for nearly three years, I find myself very suspicious of the assaults on the public sector that are mindless, that seem to me sensationalist, that don't attempt to assist in bringing health services to the people who are excluded.

Studs Terkel Perhaps during the last few moments, thoughts in which you, Bard Lindeman, this series of five articles you wrote, and AMA's suggesting that either you retract the articles or quit the job, you quit the job. Thoughts now? Whither to? Medicine, patient, doctor.

Bard Lindeman Well, I just, I have a simple message, and that is a message which John Kennedy used to use when he campaigned in 1960, he said, you know, "I'm here to ask for your help. I'd like to see the country get moving again. I think we can do better." I think we can do better. I think we must do better. I think we've got to, get a better hold on our priorities and, certainly, what is imminent and should be high on our list of priorities is one, a better distribution of the system, and two, let's do something about the catastrophic illness. And I'm not sure that national health insurance will do these things, but I think something must be done. And I would, you know, cry out to the leaders of medicine, whether they be closer to government or politics or closer to organized medicine, that horrible cliché, the house of medicine, friends of medicine, they've got to work harder, have a better list of priorities and talk up louder so that these problems do get the heat and the light, and a subject for a future show of yours should be the medical establishment's reluctance to come forward and speak clearly about occupational and health diseases, and along with the right to make this inordinate amount of money and in order for them to have the high prestige and high visibility in our society there comes a strong responsibility to protect the public.

Studs Terkel Quentin Young, M.D.

Quentin Young Well, I come up with a paradox. Of all the social problems we have of importance, be they ambient pollution, crime in the streets, housing, education, only health and health services have all the ingredients for their solution at hand. The money, the 125 billion dollars is enough, more than enough perhaps, rationally distributed it's way more per capita than any country in the world, and as a percentage of our gross national product, big as that is. Second, we have the technical and technological skills, we have the hospitals. We have a, I believe, a popular acceptance, political if you please, that healthcare is a human right. Now, in contrast to that, we have every one of the iniquities and inequities we've been talking about. I particularly want to salute Bard's last remark about occupational safety and health, and we've said a good deal about the excluded 30 million and it may increasingly be the excluded 50 million, considering the economic situation. I submit that nothing less than a radical restructuring of the system which starts interestingly enough with another paradox, with the restoration, I say restoration, at least the giving to people autonomy, enormous increases in health education, teaching people what they can do for themselves, restore their self-reliance. It does, indeed, call for what I guess the Chinese would call a "cultural revolution" in terms of the motivation of the doctors in particular. Interestingly enough, this kind of motivation is much more ubiquitous among the salaried sectors of our professions: the nurses, the technical people, although they, too, are bitten by the bug ever increasingly, and we have to structure our services so that they're accessible, so that at the point of delivery there is no money barrier, that the terrible story that this program started with of denied medications comes to an end. So, it's a big recipe. I would say any halfway measures, including national health insurance, offer us no respite.

Studs Terkel So. Questions. Questions are offered and solutions, perhaps just around the corner, if, and the if comes back to people's sense, the awareness of what it's about, and more and more awareness, perhaps, thanks to people like Bard Lindeman and Dr. Quentin Young. Thank you very much.