Bulletin of the Medical Alumni AssociationThe University of ChicagoDivision of the Biological SciencesThe Pritzker School of Medicine l\1edicine�on the MidwayI� 1 " ��....... f�� i.-.:- .: � -. to, ': 'I;'� ?:i" If'/) .,.,' - '. ., .. ' ,',-., iiDEe z� lYBO '�IUlUO"� _------- +.:,.1';,( __ , - ,'"Vol. 35, No.2President's Letter... remembrance of things past ...The New HospitalOn October 16th, the cornerstone of our new hospital wasunveiled (see inside). For those who recall Alving, Barron, Bay,Block, Buchanan, Buey, Cannon, DeLee, Dick, Dragstedt,Hodges, Huggins, Humphreys, Kenyon, Kirsner, MacLean, Miller,Palmer, Phemister, Richter, Ricketts, Robertson, Rothman, andothers in a rare assemblage, it is a moment for a "remembranceof things past." Billings Hospital was the anvil on which theseteachers helped shape most of us; and, with the other hospitalsthat followed, served well the ill and all of us. This will continue,but in new ways.Now it is time to provide anew for the school's increasingtasks. But while doing so, there must be not only aremembrance, but also an understanding of things past to guidethe future. No one must forget that it required unique people witha selfless purpose to make this school great. This requirementremains. But toothpicks and string are not enough. The schoolmust continue to provide the best in clinical care, education andresearch. To do so, the proper tools and place are needed. Thiscomes now in the form of a new hospital, provided with the helpof benefactors of uncommon quality, who understand thatgreatness does not mean cutting purpose or principle to thisyear's fashion.What is our role as alumni in all this? That role is what it hasalways been: to care for our alma mater and try to return to itmore than was received; to help insure that "what is past isprologue:'Louis Cohen ('53)2Bulletin of the Medical Alumni AssociationThe University of ChicagoDivision of the Biological SciencesThe Pritzker School of MedicineVol. 35, No.2, Autumn 1980Editor: Scott NewtonAssociate Editor: Kathe CrowleyContributing Writers: Barbra Armaroli,Deborah MacFarlanePhotographers: Paul Zakoian, MichaelAbramson, Kathleen AngularChairman, Editorial Committee:Robert W. Wissler ('48)Members: Robert Hazelkorn, Julian Rimpila(,66), Francis Straus (,57), Peter Wolkonsky(,52)Medical Alumni AssociationPresident: Louis Cohen ('53)President-Elect: Sumner C. Kraft ('55)Vice-President: Robert L. Schmitz ('38)Secretary: Randolph W. Seed ('60)Director: Katherine Wolcott WalkerCouncil Members:Fredric Coe (,61)Walter Fried ('58)David G. Ostrow ('75)Robin O. Powell ('57)Jerry G. Seidel (' 54)Francis H. Straus ('57)Copyright 1980 by the Medical AlumniAssociationThe University of Chicago 4 Medicineon the Midway18Cornerstone Ceremonies Mark Startof New Hospital Construction7 Ethical Dilemmas in the Care of the IIILeon R. Kass (,62)24In MemoriamThe New University of Chicago Hospital:Yesterday, Today, TomorrowDr. Joseph B. Kirsner11 26Alumni NewsEyes on the Future:An Interview with Dr. David A.Kindig16 30Departmental NewsComprehensive Medicine in Industry:Update 34News Briefs3CORNERSTONE CEREMONIESMARK START OFThe cornerstone unveiled. Left to right: Robert Reneker, Chairman of the Board of Trustees; David Bray, AssociateVice-President for the Medical Center and Executive Director, University Hospitals and Clinics; A. N. Pritzker; BernardM. Mitchell; President Hanna H. Gray; Weston Cristopherson, Trustee and Chairman, Renewal Campaign; DeanRobert B. Uretz.On a mild October evening, faculty, alumni, and friends of theUniversity and the Medical Center gathered under a festive yellowpavilion across from the construction site to celebrate not the cor­nerstone-laying, but the cornerstone-unveiling of the replacementhospital and intensive care tower which are the focus of the Uni­versity Hospitals and Clinics' ambitious new Modernization Pro­gram. The occasion also marked the launching of the RenewalCampaign, a $35 million fundraising drive to help finance the program.Robert B. Uretz, Dean of the Pritzker School of Medicine andthe Division of the Biological Sciences, presided. He greeted theguests warmly and in his opening remarks noted, "This is a dayfor optimism, reaffirmation, and also for some soberness as weface the challenges and opportunities before us." He went on tospeak of the special traditions of the University and the MedicalCenter and of how these will be strengthened by the physical set­ting of the new hospital. "It is an extraordinary building-modem,attractive, cost-efficient, and flexible to a degree never beforepossible. Part of a much larger effort, it is the heart of the mod­ernization program." Dean Uretz then introduced President HannaHolborn Gray, saying "no person has played a more pivotal role inhelping us reach our goal. "President Gray observed that whereas the placing of a corner­stone usually marks a beginning, this particular celebration markeda continuation and one that is of great significance to the Universityof Chicago. She spoke of the historical purpose of the MedicalCenter:4 From the earliest days .. presidents have envisioned the role of themedical sciences here as distinct in purpose from that defined at manyother institutions. For William Rainey Harper, the emphasis was to be onresearch and on the training of physician-scientists who would devotethemselves, as he said, "to the mitigation of human suffering, for theamelioration of human life." The idea that grew was that the biomedicalenterprise should be integral to a great university. As President Burtonstated it four years before the Billings Hospital opened, "The peculiarexcellence of our opportunity consists not in the possession of enormousamounts of money-there are others that have more-but in the oppor­tunity to construct a medical school with a full-time staff in close connec­tion with the departments of the University doing advanced research workof the highest quality-the departments of physics, chemistry, and the var­ious fields of biology. " It is to this intellectual richness that our MedicalCenter, the Division of the Biological Sciences and the Pritzker School ofMedicine have addressed their aspirations. The ties are vital and they ex­tend not only through the basic biological sciences and the Division ofthe Physical Sciences but to the other areas of the University .... And soin undertaking the hospital modernization program we are building morethan a hospital. We are strengthening and building programs which areintegral to this University. Our attention is not confined to clinical careand service alone but also to their quality in a University whose missionis research, teaching, and training, the most crucial type of professionaltraining for this world, where critical acuity and judgement are the essen­tial tools.Mrs. Gray went on to acknowledge the immense debt of grati­tude owed the many friends and benefactors of the Medical Centerwho had made this enormously complex and enormously significantr�EW HOSPITAL CONSTRUCTIONA. N. Pritzker and Dr. Joseph B. Kirsner.undertaking possible. She mentioned Bernard Mitchell and A. N.Pritzker in particular as the two outstanding donors. "None of usand none of our works including our hospitals and our universitiesare freestanding in this world," she noted. "Our University has al­ways depended on this kind of understanding of the unique charac­teristics of this medical enterprise by our friends to make possiblethe search for new knowledge, to strengthen the qualities of ex­cellence among our faculty and students."Dean Uretz proceeded to introduce Weston Christopherson, Uni­versity Trustee and Chairman of the Board of Jewel Companies andNational Chairman of the Renewal Campaign, as "part of the lega­cy of trustees who have stepped forward to exercise leadership atcritical moments, a man possessed of broad knowledge of hospitaland health care issues and the rare and indispensable quality ofleadership. "In his remarks Mr. Christopherson spoke of the collective deter­mination of those present' 'that this great institution with its world­wide impact shall maintain its tradition of excellence in patientcare, in education, and in research." He stressed the significanceof the Medical Center to Chicago as one of its largest providers ofhealth care and then went on to discuss the Campaign in some de­tail: Bernard M. MitchellOur challenging $35 million fundraising project not only will helpunderwrite the construction of this new six-story hospital, but $20 millionwill be targeted for the renovation of vacated space in the existing hospi­tal and academic buildings, space for laboratories, classrooms, outpatientclinics, faculty offices and even student amenities-and for the construc­tion of a new science library and for the endowed support of faculty re­search and student aid programs. To raise these funds we have calledupon men and women who are well known for their business sense, theirphilanthropic interests, and their commitment to higher education and tomedicine. We already have leadership gifts of special importance: fromthe U. of C. Cancer Research Foundation (1.5 million), Mother's Aid ($1million), the CLI Board of Directors ($250,000), Johnson PublishingCompany ($50,000), Borg-Warner Corporation ($100,000), Jewel Com­panies ($100,000), Goldblatt Brothers Employees ($250,000), and theNathan and Frances Goldblatt Society ($150,000). But finally there aretwo very special gifts which have set the pace for the Campaign. BernardMitchell who is Chairman of the Board of Jovan and Vice-President ofthe Gastrointestinal Research Foundation here at the University and hisfamily have given $14.5 million to the new hospital. His gift is excep­tional not only in terms of dollar size but also in terms of expressing hisfaith in the excellence of the Medical Center. A. N. Pritzker and his fami­ly have, over the past twenty years, given extraordinarily of their time,energy, and money to the Medical Center. In the late sixties they contri­buted $12 million to endow the Medical School which now bears theirname. They are making an additional gift of $3 million to our RenewalCampaign and for their enormous and continuing generosity we are mostgrateful.5Dr. Paul J. Patchen ('30 Rush), Dr. Leonidas H. Berry ('30Rush), Mr. Norman Webb, Mrs. Patchen.Mr. Christopherson then introduced Bernard Mitchell and A. N.Pritzker, who each spoke briefly. Mr. Mitchell alluded to the spe­cial nature of the Medical Center as a world-renowned center notonly for patient care but for medical education and research. "Be­fore making the commitment," he said, "I did a great deal of sear­ching for as you all know there is no shortage of extremely goodcauses looking for funds in the city of Chicago and elsewhere.After reviewing all of them, 1 chose the University of ChicagoMedical Center, the project we are launching today. What Chica­goan wouldn't be proud to be a part of this vital and necessary re­building program?" Mr. Pritzker recalled his family's longstandingcommitment to the Medical School as a result of their recognitionof its international reputation as a teacher of teachers and a sourceof future leaders in medicine. He noted that the Medical School isbut part of a larger whole. "Today, twelve years later," he said,"we have made a renewed commitment to this institution becausewe recognize that having a first-rate hospital is absolutely essentialto having a first-rate medical school. The members of the Pritzkerfamily are proud to be a part of this project and we join with all ofyou in extending our appreciation and gratitude to Bernie Mitchellfor his magnificent gift."The speeches concluded, Dean Uretz asked President Gray,Messrs. Christopherson, Reneker (Chairman of the Board of Trus­tees), Mitchell, Pritzker and Bray (Associate Vice-President for theMedical Center and Executive Director of the University Hospitalsand Clinics) to join him on the platform for the unveiling of thecornerstone. The cornerstone was unveiled rather than placed be­cause it is not part of the foundation proper: the new hospital is tobe constructed of glass and steel. Instead, the "cornerstone"(actually a block of polished granite) will be placed in the lobby ofthe new hospital. Etched on its surface will be the names of thebenefactors. The block will contain a time capsule modelled on oneplaced October 12, 1925 for the Albert Merrit Billings Hospital.The new time capsule comprises letters of pledges from the donors,photographs of the donors and of the six University Presidentssince 1925, copies of the physical and financial feasibility studyfor the new hospital, the latest Report on Research in Progress inthe Biological Sciences. the roster of the faculty in the Division ofthe Biological Sciences and the Pritzker School of Medicine, copiesof Dr. T. W. Goodspeed's history of the University and Dr. C. W.Vermeulen's history of the Medical Center, and copies of the Chi­cago daily newspapers.6 Class chairmen Jerry Seidel ('54), Asher}. Finkel (,48) andHenry De Leeuw (,47)As the eomerstone (lobbystone?) stood revealed, Dean Uretz de­livered a final exhortation: "It is my hope that we will have theknowledge and the wisdom to use these structures well. For thereis much to be done. The Medical Center of this University has ahistoric mission to teach, to discover new knowledge and to pro­vide the very best of patient care. Never has this mission beenmore important for our University and for our society."Later in the evening some 300 invited guests attended a celebra­tory dinner in Hutchinson Commons. In his toast, Robert Renekermade "a special pledge of our own time and energy to extend thecenter's tradition of excellence into the twenty-first century."Weston Christopherson announced that a gift of $100,000 hadjust been received from Maurice Goldblatt. This brought the totalcontributions from Goldblatt interests to $500,000. At the conclu­sion of the meal, President Gray introduced the evening's keynotespeaker, Dr. Joseph Kirsner. She mentioned the symbolic signifi­cance of the cornerstone and continued, "There is another symbolof what this is all about and indeed of what ultimately representsand best represents our University to the extent that anyone sym­bol can serve such complex purposes. I speak of the individualscholar and teacher, the individual scholar-physician, the teacherwho has inspired others to teach and to do research and to providehealth care at the highest level. ... It might be said that Dr. Kirs­ner's career epitomizes the goals of the faculty in the PritzkerSchool of Medicine-those of research, of teaching, and of clinicalcare. He spends 16-18 hours a day, 7 days a week in their service.Each week he sees some 40-50 patients and has as many as 10new patient consultations and that is what this citizen of the Uni­versity of Chicago has been about. He cares about every minute ofhis time on this earth and every minute is devoted to clinical care,to his patients, to the patients of other physicians as well as to hisstudents. Those students now people the medicine departments ofmost major institutions in this and other countries. In '76 when Joestepped down as Chief of Staff, there was an article about himwhich quoted Paracelsus as follows: "Medicine is not merely a sci­ence but an art. It does not consist in compounding pills and plas­ters and drugs of all kinds but it deals with the processes of lifewhich must be understood before they can be guided." I think thatall of us who know Joe Kirsner know also the practitioner of theart and the teacher of artists. "Dr. Kirsner's address, reprinted entire, follows.The New University of Chicago HospitalYesterday, Today, Tomorrow1927 - 1980 - 2030Or. Joseph B. Kirsner is the Louis Block DistinguishedService Professor of Medicine. He came to the Universityin 1935, eight years after Billings Hospital opened. Hiscareer here was both as teacher and as student, for in1942 Or. Kirsner was one of the few candidates at thattime who was recommended by the Department of Medi­cine for the Ph. D. He was promoted to Professor ofMedicine in 1951 and named to the Louis Block Profes­sorship in 1968 and the Louis Block Distinguished Ser­vice Professorship in 1974. He served as Head of theGastrointestinal Service, Chief of Staff, and Deputy Deanfor Medical Affairs from 1971-76. He is a member ofseventeen leading medical societies and associations, andhe has served as President of the American Gastroenter­ological Association, the American Gastroscopy Society,and the Chicago Society of Internal Medicine. He hasalso served on eleven national medical committees and isa member of seven editorial boards. He has publishednearly 500 articles and book chapters as well as two text­books.Homines ad Deos nulla re proprius accedunt , quam salutemhominibus dano.-CiceroThere is nothing by which man approaches nearer to the perfec­tion of the Deity than by restoring the sick to the enjoyment of theblessings of health.Mr. Christopherson, President Gray, Mr. Reneker, Dean Uretz,Mr. Mitchell, Mr. Pritzker, Ladies and Gentlemen, Friends of theUniversity, I am deeply honored to speak to you this evening. Thebuilding of a new University hospital is a special event, undertakenno oftener than every 50 or more years. It is a personally satisfyingoccasion for each of us, since a new hospital to better care forsick people expresses the most noble of human instincts. Tonightwe celebrate more than a new structure; we also re-affirm a fun­damental precept of the University, i.e. the essential harmony ofthe science of medicine and the art of medicine on behalf of thepatient.Fifty-five years ago (on May 7, 1925) at the ground-breakingceremony for the Albert Merritt Billings Hospital, Dr. Henry A.Christian, Physician-in-Chief of the Peter Brent Brigham Hospital,Boston, spoke as follows:"The laying of a cornerstone is an occasion on which one'sthoughts naturally tum toward consideration of the probable futureactivity of the building being erected ...."All great hospitals have three functions: care of the sick, inves­tigations of disease and to educate practitioners as teachers andinvestigators. . . . "As I imagine the future, I picture two general types of hospi­tals: the one primarily concerned in the expeditious care of manypatients; the other chiefly devoted to medical education and inves­tigation, with special types of disease admitted for study ... Theideal must be that nowhere else will patients receive bettercare .. .It is of this second type that the Albert Merritt BillingsHospital proposes to be. .The University of Chicago intends totry a great and a new experiment in medical education "The success of this great experiment today is a matter of record.But success was not guaranteed, and the risks in the 1920' s wereconsiderable. How did it all begin?In the words of Carl Sandberg, "Nothing happens unless first adream," and so it that William Rainey Harper, first president ofthe University, envisioned "a medical institution which will drawfrom all parts of the world men and women who shall find incen­tive and opportunity to do something for the mitigation of humansuffering, for the amelioration of human life." With the leadershipof Dr. Frank Billings, and the encouragement of President Burton,ground for the Billings Hospital was broken on October 2, 1925.The hospital opened two years later, in October 1927, with Dr.Franklin C. McLean as Director of the Clinics.The Chicago experiment consisted of the full-time system, thecomplete academic status of the clinical faculty, and incorporationof the clinical activities within the Division of Biological Sciences,on the central campus-a drastic departure from conventionalapproaches and therefore one that attracted national attention. TheUniversity's leaders had chosen well and the original faculty, in­cluding McLean, Emmet Bay, Paul Hodges, Louis Leiter, Oswald7Robertson, C. Philip Miller, Paul Cannon, E. V. L. Brown, DallasPhemister, Lester Dragstedt, Percival Bailey, Walter Palmer,Charles B. Huggins and Joseph B. DeLee-soon influenced thecourse of medicine significantly. The faculty, united by a commongoal, made rapid progress. Research flourished, ranging from asep­sis in childbirth, the nature of surgical shock, treatment of malaria,safer x-ray machines, new anesthetics, the physiology of digestion,to Huggins' Nobel prize-winning hormonal control of cancer of theprostate. Clinical activities gradually increased and the Universityof Chicago program because synonymous with quality medical careand quality medical education.When I came to the University in the fall of 1935, the hospitalalready had negotiated numerous problems, including the depress­ion of 1929. In the 1930's and 40's, we paid little attention tofiscal matters: new patients were charged $4.00, return patients$2.00 or nothing, laboratory tests were free, and professional feeswere miniscule. The change from a medical environment of privatephysicians to the academic world at the University of Chicago wasa revelation. There was an air of opportunity, of inquiry, and ofpurpose; and a strong sense of unity. I was so proud to be even asmall part of this program that I forgave the Chairman of the De­partment of Medicine when, in 1937, he substituted a Parker foun­tain pen for a salary increase, keeping my yearly stipend at $1,000.Association with such outstanding clinical faculty and access to sci­entific luminaries such as Carlson and Luckhardt in Physiology,Geiling in Pharmacology, Bensley in Anatomy, Barron in Biochem­istry, Gail Dack in Microbiology and Eleanor Humphreys inPathology, was an exhilarating experience. They were individualswhose ideals and whose perseverance, even more than the full timesystem, ensured the success of the Chicago experiment; individualswho set the patterns for all of us who followed.The advances in Medicine since Billings opened its doors canonly be described as extraordinary-probably the most productivefifty year period in all of Medicine's history.The disappearance of smallpox, diptheria, scarlet fever,poliomyelitis, and rheumatic fever; the discovery of insulin, ofvitamin B12 for pernicious anemia; blood groupings and successfulblood transfusions; the development of antibiotics, new drugs forthe mentally ill, beta blockers, and H-2 blockers; kidney trans­plantation, the reimplantation of severed extremities, advances incardio-vascular brain and abdominal surgery, and the diagnosis offetal chromosomal abnormalites, the development of head and bodycomputerized scanners, endoscopic instruments, and artificial joints,and now, the medical dissolution of gallstones and a possible newvaccine to protect against hepatitis: these are only some of Medi­cine's impressive achievements, and University of Chicago physi­cian-scientists contributed to this progress.Today, these accomplishments continue. Here, for example, arethe achievements of some of the present faculty, among manyothers who maintain the Chicago tradition.L. Jacobson - Discovery of nitrogen mustard, the hormoneErythropietin and the scientific basis of bone marrow transfusions:A. Dorfman - The chemistry of connective tissue and its geneticdefects.E. Jensen - Estrogen receptors in breast cancerB. Roizman - Type 2 Herpes virus and Ca cervixR. Wissler - The nature of atherosclerosisJ. Mullan - Neurosurgical relief of pain.I. B. Kirsner - The nature of inflammatory bowel disease8 L. Goldberg - Discovery of dopamineP. Harper - The radioactive isotope needleD. Freedman - The pharmacology of psychological disordersA. Rubenstein - The metabolism of insulin .D. Steiner - The discovery of proinsulinS. Weiss - The transmission of genetic informationA. Herbst - The effects of estrogens during pregnancyA. Moscona - The successful growth of retinal and brain tissuesin the test tube.Most of these patient-benefitting achievements originated in basicscience research, by physicians and scientists with freedom to workon their individual interests and ideas. Chancellor Kimpton wrote25 years after Billings opened: "I believe that no other medicalinstitution has accomplished more in so short a time."The national prominence of the University of Chicago today isreflected in its designation as a National Cancer Research Center,National Diabetes Research Center, National Sickle Cell Center,Special Research Center for Ischemic Heart Disease, National Clin­ical Nutrition Center, Regional Burn, Peri-Natal and EmergencyMedicine Centers. The basic sciences, the nine clinical departmentsand the various inter-disciplinary committees include recognized au­thorities in every sphere of the medical and biological sciences.Many of the University'S medical school graduates, proportionatelymore than any other school, teach on faculties, and serve as depart­ment heads or deans. Ten of the forty-eight Nobel laureates associ­ated with the University at one time or another worked in themedical and biological sciences here.As Medicine has changed, so have hospitals and physicians.Once an institution for the isolation of communicable diseases, or aplace for people to die; with the advent of protection against infec­tion, refinements in anesthesia, and improved surgical techniques,the hospital gradually assumed a more constructive role. The pro­gress of medicine during the past half-century enormously increasedthe hospital's diagnostic and therapeutic capabilities. As the hospi­tal became more complex and more involved treatment was under­taken, more people were attracted to its doors, and the administra­tive and fiscal responsibilities expanded greatly. The hospital today,inpatient and outpatient, is the focal point of all health care activ­ity. In 1978, more than 37,243,182 Americans were admitted to ahospital; with more than 260 million outpatient visits. At Billings,the number of hospitalizations in 50 years rose from less than 100in 1930 to 23,000 in 1979; outpatient visits approximated 300,000.The professional staff has increased from perhaps 50 in 1930 toover 300, not including 350 housestaff and Fellows; the number ofhospital personnel has risen from approximately 500 in 1930 to4,000.There are more than 7,000 hospitals in the United States today.Less than 150 have University affiliations, fewer than a dozen haveappreciable numbers of fulltime staff and only one hospital, Billings,has had a virtually complete fulltime staff for its entire existence. Herethe students and young physicians acquire the perceptual and cogni­tive skills required for clinical judgments and they learn how tocare for sick people. Here, the interaction between physicians, sci­entists, and students in the university environment enhances thesearch for medical truth. Here the problems of the patient are in­vestigated in the laboratory and the new insights are returned to thebedside. For medicine based upon research and upon science hasan inherent self-correcting quality; clinical approaches are modifiedwith each new advance.The doctor also has changed-from a superficially informed, in­dependent entrepreneur with limited resources and far removedfrom the hospital, to a highly trained professional, fully dependentupon the hospital's clinical and technological resources. Today'sAmerican physician is the best educated and best equipped medi­cally in the world. Some limitations notwithstanding, the Americanpeople today receive the best medical care in the world; certainlyfar better than in earlier times when only humanism without knowl­edge was available for the care of the sick.You will perceive by now that the University of Chicago Hospi­tal is no ordinary hospital and that University of Chicago physi­cians are not ordinary doctors. Indeed, the place, its traditions andits objectives continue to attract special people: dedicated, inquisi­tive, thoughtful, dissatisfied with incomplete or uncertain knowl­edge, proud of each small addition to medical understanding, andnot interested in personal material gain. Despite the responsibilitiesof research and teaching, they devote much time to their patients,since they deal with difficult clinical problems. The University ofChicago physician understands the technology of modem healthcare, and therefore is not dominated by it. He can interpret newtypes of laboratory data and therefore utilizes the laboratory judi­ciously. He is receptive to new knowledge and participates in itsacquisition; therefore, his patients receive the most up to date carepossible. Such people are rare-they are not to be found in everyhospital. You wui find them at the University of Chicago. Thus,when a patient arrives with a complicated clinical problem, the fullresources of this medical center promptly are applied to its solu­tion. As in the patient from Central America with an anemia unre­sponsive to treatment elsewhere, in whom a new cause of anemiaand a new cure were identified, and a new concept of disease wasevolved. Or the successful reconstruction of an esophagus in a manfrom Cleveland who had been unable to eat or drink. In the clar­ification of a mysterious hypoglycemia, utilizing a new C-peptidetest developed at the University, in a patient who had confoundeddoctors elsewhere. Or in the patient from North Africa with jaun­dice, fluid in the abdomen and enlarged liver, following a gallblad­der operation in Paris; baffling physicians on two continents; pre­senting such questions as: to operate or not to operate? how to con­trol the abdominal fluid? what to do about the sick liver? The com­plex situation required numerous specialists, as well as time: twomonths. The questions were answered, without operation, and to­day the patient is well. For at this University hospital, the patient ismore important than time and more important than costs; the prob­lem must be resolved, if at all possible.The University has been equally fortunate in the remarkablyunderstanding and generous benefactors, too numerous to mention,who have contributed so greatly over the years-support withoutwhich we could hardly have accomplished so much. You alreadyhave heard from two of them today. We at the University are eter­nally grateful to these magnificent human beings who have pro­vided enormous strength to our medical center.Every age in the history of Medicine has been characterized byproblems that appeared insurmountable, and yet history documentsthe steady progress in our understanding of human illness and theimprovements in health care. In every age, the difficulties besettingMedicine also reflected problems of the existing society. Today,we live at a time of dramatic and often disturbing changes in hu­man affairs: a decline in moral precepts, distorted priorities; preoc­cupation with the possible carcinogenicity of saccharine but notwith the harmful health effects of tobacco, drugs, excessive alcho- 101, or environmental pollution; a society characterized by disrup­tion of the family, deterioration of discipline, erosion of loyalties,and a general decline in human caring.Today, in the 1980's, as we build the new University hospital,we face new challenges that again will test our ideals and our de­termination. The increasing complexity of. medical care, the needfor more sophisticated equipment and for specialized skills, whileenhancing the quality of care, also has increased its costs in an ex­panding, longer-lived population, less able individually to bear suchexpenses. The increased numbers of people seeking medical atten­tion today and the high, possibly unrealistic expectations of thepublic have generated criticism about the access to medical care,its high costs, "machine medicine" and unnecessary surgery.Concerns for the patient with cancer, the dying patient, and for theaging, the logistics of kidney dialysis and of organ transplantation,have created new dimensions to the moral and ethical aspects ofmedicine. The direction of Medicine has changed from an earlierbiological science orientation toward sociologically-oriented prog­rams with emphasis upon community health needs, family practiceprograms, and the increasing participation of government. Somehealth planners have suggested that the academic medical centermodify its activities in favor of programs more compatible with a"super community health center." Words such as "consumer" and"provider" now characterize health care discussions, adversarialterms that are inappropriate to the beneficient profession of medi­cine.The ultimate justification for the existence of all hospitals, of anyhospital, is the patient and the patient's care. The criticisms ofmedicine today, while perhaps valid in a few areas, are excessive.All hospitals seek the best care possible, for their physicians aremotivated by what George Bernard Shaw has characterized as a"divine impatience" with ill health. Furthermore, there is no in­compatibility between the science of medicine and the art of medi­cine. Indifference and impersonal attitudes reflect the limitations ofindividuals and of today's society, not of scientific medicine. In itsfullest extent, Medicine is a humanizing experience, for its focus isman, his/her strengths and weaknesses, as well as illnesses. Physi­cians, nurses and hospital personnel are indeed touched by the pa­tient's emotional experience with sickness and with hospitalization.The anxiety, the inner panic, the separation from home and family,the helplessness, the dependency upon others for the most routinetasks of daily life, the possibility of invalidism or death-suchemotions are inseparable parts of all human illness, and their sensi­tive consideration is an indispensable part of good patient care.I will never forget the meeting with Dr. DeLee and Dr. GeorgeDick, Chairman of Medicine, one Sunday in 1937, as they soughtto reassure me about my wife's then serious illness. Or Dr. DallasPhernister walking from his home late one night in 1941 to help medeal with an acute appendicitis. Or Dr. Walter Palmer's moving re­view of the events surrounding the death of a new intern fromTexas who, weeks after his arrival, had succumbed to ulcerativecolitis. Such experiences, involving scientists, yes, but also truephysicians, indelibly engraved in me the fundamental truth that thecare of the patient involves caring for the patient.Dean Mellinkoff of U .C.L.A. has phrased this fundamental prin­ciple elegantly: "Medicine is a heritage not to be abandoned light­ly. It is not a commodity to sell to consumers. We are still humanbeings, not things. It is the sanctity of life we seek to understandand to defend. It is still true, as when Hippocrates wrote long ago:'Where there is love of man, there also is love of the art.' "9Today's health care problems are critical and compelling issues.They require thoughtful examination and determined, cooperativeefforts towards their solution. As history has indicated repeatedly,these problems will be resolved and adjustments in Medicine willfollow. But should the university medical center, in response togovemmental and other pressures, modify its goals and dilute itsintellectual activities?Sir George Pickering of England has phrased the issue as fol­lows: "The profession of medicine is now facing a dilemma whichmay destroy it, unless the nature of the choice is seen clearly andis faced with insight, courage and resolution. Should medicine be­have as a learned profession or as a technical trade union?" I shallleave to others the complete response to this important question.For the University of Chicago, for our new hospital, the answer, ofcourse, must be no. We must avoid trade school perspectives. Wemust maintain our special blend of extraordinary patient care, crea­tive research and skillful teaching. For this has been and remainstoday our greatest contribution to the health care of this country.What of the next 50 years? Will the University of Chicago pro­gram endure? Will it survive society'S anti-intellectualism? Thenew University of Chicago hospital, the one we celebrate this eve­ning, with its superb professional, technological, and intellectualresources and its great traditions, will rise to even greater heights,and will pioneer in even more amazing health-restoring activitiesthan are known today. As to the future: the medical know ledge of1980 by the year 2030 will seem as primitive as the knowledge ofthe 1930's appears today. New scientific disciplines will emerge asthe understanding of human illness grows. Medical costs will becontained, not by denying to sick people the benefits of medicalprogress, but in the earlier resolution of health problems and by amazingly innovative diagnostic techniques. The prevention of dis­ease will be emphasized increasingly. More people will recognizethat personal health is a personal responsibility and that it cannotnecessarily be imposed or bestowed by external agencies. Despiteingenious efforts to computerize clinical judgment, the approach tohuman illness, involving as it does moral and ethical values as wellas knowledge and experience, will remain an essentially human re­lationship, involving the personal interaction between patient andphysician; an encounter enhanced by both humanity and research,as well as honesty and sincerity.The ingenious architectural design of the new hospital, the latestequipment, the most modem conveniences-all of these will maxi­mize the efficient functioning of the medical center. However, oneadditional, vital ingredient will be required without which no hos­pital can be truly great: the complete, the absolute commitment ofeveryone associated with this medical center to the finest patientcare possible, as proclaimed by Henry Christian 55 years ago.If the past 50 years at the University of Chicago Medical Centerhave demonstrated one fundamental truth, it is the essential unityof the science of medicine and the art of medicine in the best in­terest of the patient. Tonight, as we reaffirm this principle, and aswe look ahead to the next 50 years, I renew this commitment toyou!I close as did Yale President Angell at the University's convoca­tion on October 31, 1927, dedicating the new University hospitalof 53 years ago: "Let us, therefore, look to it that we measurejustly the values which lie at the heart of this university; that we,its friends, may play our part discerningly and courageously tosafeguard and perpetuate its undying service to mankind."10Eyes on the FutureAn Interview withDr. David A. KindigOr. David A. Kindig (M.D., Ph.D. '68) was a medicalstudent at Chicago during the turbulent sixties. He man­aged to crowd into a six-year span, in addition to therigors of standard medical training, a rich research ex­perience (in the days before the M. S. T. P.) and a career ofdedicated sociel activism which culminated in his elec­tion, to a national presidency of the Student AmericanMedical Association. His professional career since thattime has embodied his firm commitment to social ideals.As a resident at Montefiore Hospital in the Bronx, he de­veloped the first internship and residency program thatcombined hospital training with practice in a neighbor­'hood health center and formal training in social medi­cine. At the time he also served as Acting Medical Direc­tor of a neighborhood health center in the South Bronx. From Montefiore he went on to become Director of theDivision of Professional Services for the National HealthService Corps at HEW, where he was responsible for theassignment and supervision of health professionals in 770rural and inner city manpower shortage areas. In 7974 hewas appointed Deputy Director of Health Manpower forHEW, and in 7976 he returned to Montefiore as Director,a position he held until last summer. He was justappointed Vice-Chancellor for Health Sciences at theUniversity of Wisconsin at age 40. He was interviewed inMadison upon the occasion of this his latest achievementby the Editor of Medicine on the Midway. Here he ar­ticulates his unique vision and the forces that helpedshape it.IIYou evidently initially had intentions of pursuing a career in re­search. How did you come to find yourself in administration?That's the story of my years at Chicago. I was interested in medi­cine from high school-in life sciences generally. I had really got­ten interested in research in the last two years of college and Iseriously thought about going into graduate school in molecularbiology rather than into medical school. I decided on medicalschool. I was happy to get accepted at Chicago: I wasn't planningto do a combined M.D.-Ph.D. (there wasn't an established pro­gram at the time), but certainly the fact that it was a strong researchschool was one of the main reasons I had applied there. I did re­search the summer before I started medical school. I worked initial­ly with Ben Spargo and Werner Kirsten and eventually becameWerner Kirsten's first Ph.D. student. That was a very exciting timefor me. Since there was no lock-step program for M.D.-Ph.D. 's,we went about it however we pleased. I took a year out after mysophomore year of medical school and did most of the course workfor my Ph.D. Then I took a year out after my junior year to finishmy thesis. It was a very rich research experience. My research hadbeen sponsored jointly by Pathology and Pediatrics. I was reallycontemplating a research career in pediatrics, going into academicpediatrics. However, throughout this period, something else hadbeen going on which ultimately determined my career choice in adifferent direction, and that was-the sixties.I graduated from college in '62 but because I was up in North­field, I had missed much of the social ferment that characterizedthose years. A lot of the other students who joined me at Chicagohad been on the East Coast, in the urban centers. They'd beendown in the South; they'd been freedom riders; they'd been in thecivil rights movement. I found myself exposed to the critical socialissues of the day really for the first time at Chicago--both throughmy association with my colleagues who had been much more in­volved and by my being in the center of the city of Chicago. Icould spend days reminiscing, but to make a long story short, myinterest in social issues developed in tandem with my research in­terests while I was at Chicago. It also had to do with my wife whowas a student at SSA. She was plunged more directly early on intoday-to-day contact with the community, the ghetto. As aframework for my developing social interests, I basically used thelocal Student Ameican Medical Association (SAMA, now AMSA)chapter. I took the SAMA chapter at Chicago and tried to tum itinto a group that would address more immediate concerns. I triedto get health clinics started on the South Side. There was alsoanother movement that was developing in parallel at that timecalled the Student Health Organization-a newly-emerging, moreradical group. I was involved with them as well, but I've alwaysbeen a person who works more within the system. I decided Iwould work for the same goals as my more radical friends, butthrough trying to reform an existing organization. I ultimately ranfor National President of SAMA and was elected in my senioryear. The campaign for that election was essentially a referendumon the question, "Is SAMA going to be more activist? Are wegoing to change this organization, make it more responsive to so­cial needs?" My election symbolized that change. It's still a muchmore activist organization than it was before my election, thoughthe eighties are of course different from the sixties.As a result of those experiences at Chicago--working at the loc­al level and the political exposure that I received coming intoprominence in a national organization-I developed strong interests12 in the public policy aspects of medicine, interests that began tocompete in my mind with my research interests as a possiblecareer choice. It was early in my internship that I made the choice.It was a tough decision because, as I said, I loved my research andthe academic life, but these other things were calling. I decided notto stay on at Chicago and finished my residency in the SouthBronx. That experience was a trial for me. I said, "Let me trythis." I had wanted to complete my residency anyway so as to be­come board-eligible in pediatrics, but I thought: why don't I do itin a different kind of setting-an intensely different kind of set­ting-to see if there's something in a career in social medicine forme? If that turned out not to be the case, I could always go back toresearch.There's no question that my academic experience was vitally im­portant as instruction in my thinking, my approach to problems. Ifound I could make use of it as an administrator, and apply someof the scientific rigor even beyond that of clinical medicine inwhich the graduate program of research had disciplined me. Thatexperience has proved invaluable both in my policy work inWashington and in running a major hospital in New York with anacademic and research component-and of course here at Wiscon­sin. The University has a major research and teaching tradition. Idon't see myself as just a physician who's risen to a position ofadministration. I would not argue that I was a super-researcher, butI had a seven-year experience. I knew what it was like to sit at abench and cry when things didn't work out or to be excited whenthey did. I know what that's all about, and I think that's stood mein good stead. I still get a twinge when I walk around the labshere. I'm trying to carve out a small piece of my time here foracademic work which I hadn't been able to do in New York orWashington, but even that would be health services research, poli­cy research, not basic scientific research.The way you describe it, the transition from research to policy andadministration makes a great deal of sense. It seems almost a natu­ralone.It's been gradual for me. At the Neighborhood Health Center, thesituation was such that I was able to acquire substantial managerialexperience even while I was a resident. I started there and thenwent to Washington. I managed to get an administrative positionsetting up the National Service Corps. That was another managerialexperience and a very rich one. I then went back to Montefiore torun it. That was a major private-sector managerial experience. Ihad had substantial public-sector experience in Washington, but Ihad never had any formal training in hospital administration-I justpicked it up on the side. Montefiore is, I believe, a unique hospitalin this country. It is a major teaching hospital with academic andclinical care programs, while at the same time it sees itself-andhas historically seen itself-as having a broader social mission, ofresponsibility to society and to affairs outside the walls. For thatreason, and because of my previous training there, I went back. Ifelt it was a unique opportunity to get a substantial private-sectoradministrative experience at a relatively early stage of my career. Itwas the richest and most intense time imaginable. Just take a 1200bed teaching hospital in the Bronx with unions and financialproblems and social problems-and try to maintain a budgetand keep academics happy at the same time. I went there on June15,1976. On July 1, there was a major Local 1199 strike-43oopeople on the bricks for thirteen days. I didn't have to do it alone,but I was in charge-without any previous experience. I learnedfast. I still consider myself basically a public-sector type, but theprivate-sector experience was invaluable. There are flexibilities, adegree of independence, which a private institution has and whichcan't be had elsewhere.I suppose you have a far greater degree of independence in policy­making than you would in the public sector.In all things-policy-making, financial investment, programs. Youonly answer to your board. Obviously in the past there have beenabuses of this kind of flexibility. On the other hand there are cer­tain aspects of public management, public administration whichmake for rigidity-institutions can't respond as effectively, espe­cially in times like these. The flexibility in a private institutionmakes a lot of difference.It seems to me that from your private-sector experience you'd beable to sort out the intrinsic difficulties in problem-solving fromthose which are simply due to bureaucratic inertia. I have the feel­ing that many times problems are given up as insoluble simply be­cause of the bureaucratic context. I guess there's no way of know­ing that until you've actually gone ahead and solved problems in asituation where you have the requisite flexibility.That's absolutely right. I think it's a fundamental problem in socialpolicy for the future of our society. It's a problem in the rela­tionship of government and its institutions, particularly in the hu­man service sector. After all, public administration and public in­stitutions exist for reasons. They exist because the private sectorhistorically has not addressed some of the basic human serviceproblems which need to be addressed. City hospitals exist becausethere has to be a place of last resort for people to go because theprivate sector hasn't picked up on them. Private institutions, Ithink, as a general statement, probably aren't very interested;they've got other things to do. They can define their missions asthey want them. That's a nice flexibility, but it tends to ignoretough pieces of business. On the other hand, the public sector,which has the express responsibility to take care of these toughpieces of business and which is more likely to attract people withsocial commitments, has built into it managerial inflexibilitieswhich seriously vitiate its effectiveness. That's a paradox.At Montefiore we were exploring with the City of New Yorkplans for collaboration that had some real potential. The city hos­pitals had developed affiliations with medical schools or teachinghospitals during the sixties for reasons of quality. The medicalschool or teaching hospital had an affiliation contract with the cityto provide the professional services while the city ran the hotelpart. A new city hospital was to be opened in our area. We prop­osed that in place of an affiliation contract we would put in a man­agement contract. We showed the city that through economy ofscale and our private sector managerial flexibility and skill, wewould be able to save the combined operation $15-20 million ayear and provide a level of health care consistent with our own.We were also ready to agree under contract to meet the social com­mitments and public obligations which the city had for certainambulatory visits, etc. We weren't able to pull it off, basically be­cause of the political situation. I would predict that in the next fiveyears some of those arrangements will be institutited. Unfortunately it will probably be owing to financial considerations, not those ofquality. However, when I got to be 35, I said I would accept theright thing for the wrong reasons, rather than to insist always onthe right thing for the right reasons. In any case, it was very goodfor me to be able to see both sides. I was very fortunate to havethat experience at Montefiore. That was an unusual appointment forhistorical reasons.I take it that you were the youngest director?I was not younger than the previous director when he took thejob--that's probably part of the reason why I got it. He was com­fortable with my appointment because he'd done it that way him­self. You know, you have to be prepared. I mean it just doesn'tfall into your lap. You have to be ready, and have interests andskills-but there's also a lot of luck and serendipity. I've been ex­tremely fortunate. Also, I've been open to change. I think that hasstood me in better stead than anything else. I'm very comfortablewith change. There are people who have observed that there is adisproportionately large number of pediatricians among physician­administrators. I don't know this for a fact although there is someanecdotal evidence. I think there could be a reason. To be success­ful in these kinds of administrative jobs, you've got to be comfort­able with change, with inner relationships, and with growth.Pediatrics is about change and growth and development. It is alsoabout cooperation-you can't do it on you own. You've got towork with mothers and fathers. I think a good pediatrician learnsnot solo entrepreneurship, but working with people. He developsskills at working with people-that's in the nature of the clinicalrelationship. I certainly feel that those attributes have been helpfulto me. We'll see when I'm 55 whether there are any ideas whichneed to be discarded but which I can't discard. I like to think I'mnot that rigid.What is involved in your new position here at Wisconsin?The Center for Health Sciences is an administrative unit that in­cludes a number of organizations: four professional schools (Medi­cine, Nursing, Allied Health, and Pharmacy), the University Hos­pital, the Health Service for the entire University, and the StateLaboratory of Hygiene (run under University auspices). In the earlyseventies this University (at about the same time as a number ofothers) decided that it would be important to establish an adminis­trative position over its entire academic health center (the termacademic health center has come into vogue in the last five yearsand refers to an organization that includes a medical school, ahospital, and at least one other professional school). By and largeuntil then either the medical school or the hospital had taken theleadership role of coordinating the various components. Becausethe health sciences are in some ways very different from the rest ofa university's operations-you have to do business in order toteach-presidents and chancellors were finding themselves bom­barded with problems and difficulties relating to the health scienceswhich could easily have occupied their entire attention. A lot ofpositions like this one were established specifically to handle them.I have responsibilities for the management of the various health op­erations and I'm the intermediary between the Health Sciences andthe rest of the University-it goes both ways.13I suppose you are also charged with adjudicating among competinginterests with the Health Sciences.I have to spend a lot of time on problems with individual units­resolving disputes and so forth. Problems of coordination are goingto be the problems of the next ten or twenty years. The new chal­lenges don't fit very neatly into the older boxes of medicine/nurs­ing/allied health/pharmacy/hospital. Take for example a major prob­lem like geriatrics. It's just too many-faceted and complex tofit into the traditional categories. It even extends beyond the bound­aries of health-into social work, education, psychology, thoughbasically it has to do with medicine as seen from the city hospital.We're going to have to find novel ways of addressing this kind ofproblem. I see myself as having a role in locating the opportunitiesfor concerted, interdisciplinary approaches and pulling peopletogether. Public health education is another such area. There arereasons for the established units (the schools and the hospital) tokeep doing well what they've done traditionally and within tradi­tional bounds, but there are problems which need to be formulatedin larger terms. A person in a position like this is uniquely situatedto point out opportunities for interdisciplinary problem-solving.I've also got to deal with a large outside world. The health sci­ences are a very large, visible part of a university's operations, par­ticularly in a state like this where the university is located in thestate capital and where because of the political and historical tradi­tion it plays a statewide role of public service. My job is verymuch concerned with statewide issues. I'm involved in devisingpublic programs, in interfacing with the state legislature and execu­tive, with the community, and with the federal government.I feel as though I have a fair amount of flexibility to look to thefuture. There was no incumbent in this position for the last yearand a half. In some ways that's nice for me. I've come at a verygood time. The last five years saw the construction of the new Clin­ical Sciences Center which houses the Medical School, the Nurs­ing School, and the Hospital. It was the largest capital project inWisconsin's history and very controversial. I feel I can now moveahead on the strength of what's been achieved and really look atthe next ten or twenty years of what Wisconsin will need from thisresource-how we can be more responsive to the public both in theeducation of health professionals and in the provision of traditionalservices, and also in our academic role. We need to consider ques­tions of health policy, health services research, cost containment,and education innovation, bringing our academic resources to bearon them for the good of other institutions in the state and elsewhereas well as our own.It seems that from your point of view you really couldn't ask foranything more-you have an ample field for action.I think it's going to be very exciting. I am obviously still on a hon­eymoon. I'm enjoying it a lot; I haven't had to make any toughdecisions yet. It feels good to me. I'm ready now. I've had a num­ber of interesting three-or four-year administrative experiences. It'svery clear to me now at age 40 that if you want to make change inbig institutions you've got to commit longer periods of time--eightto ten years as a minimum. I'm willing to make that kind of com­mitment. I'm really taking the long view-I think that's a veryhelpful perspective.14 What you say is immensely reassuring. From the outside one hasthe tendency to despair when contemplating large and complex in­stitutional problems; they seem insoluble. I guess when you're inthere working with them you have a different perspective.Of course it's not just a matter of putting a few smart peopletogether in a room and letting them go to work, only to have ev­erything tum out all right. This is an immense social organizationwith all the attendant problems. But we can make a difference ifwe decide that's what our goal is. And making a difference is whatit's all about, not just holding things together. I'm not disparagingdoing traditional things well-that has real social value and is byno means easy in times like these where there is no growth. ButI'm not satisfied with that alone. The doctors we're training aregoing to be practicing in the twenty-first century. That's a heavyresponsibility. What is that going to mean and are we preparing forit?There are other challenges in addition to those I've already men­tioned. I think that here in this context in Wisconsin we absolutelyhave to do something about rural health. There are problems bothin manpower and in the organization of services that have to beaddressed. We're attacking that now. Then there is the matter ofoperating efficiency. I happen to be a nut on productivity and cost­containment from inside the establishment. I think there are reasonswhy our kind of business costs a lot-we teach and get the toughcases. But that's no excuse why we shouldn't be going about thesethings with maximal efficiency and effectiveness. From the stand­point of our academic responsibilities, we ought to be leading theway, using our schools of Industrial Engineering and Business andFinance to figure out the most cost-efficient ways of doing things. Ithink that's a public responsibility we have. I have a goal. I wantto be able to say to the state legislature-"Yes, we are expensive,and for these reasons. But we are engaged in the most effectiveprogram of productivity and cost-containment around, and what'smore, we are teaching these practices to the physicians and nursesand the hospital administrators of a future generation. That's one ofthe reasons you invest in a medical center."I didn't tum out as I thought I was going to-e-or my teachersdid. But that cauldron of scientific and political experiences in thesocial context of the South Side of Chicago from 1962-69 in someway produced me.The value of a scientific education as preparation for social andinstitutional problem-solving seems not to have been generally re­marked. It's always seen as an end and not a means.It's unfair and certainly incorrect to put down most seriousacademics as irrelevant because they're not. Progress is built onbasic research and applied research. You can't know what findingsare going to be important down the road. But it's also OK for peo­ple to say-"For me that's not enough. I'd like to take this pieceof it and apply it in the real world." There is a great opportunityfor putting together in a creative way disparate kinds of thinking.THE UNIVERSITY OF CHICAGODATE September 23, 1980To Katherine W. Walker, Director DEPARTMENT Medical Alumni AssociationFROM Joseph J. Ceithaml, Dean ofStudents DEPARTMENT School of MedicineIN RE:The Henry J. Kaiser Family Foundation Matching Challenge GrantAs you probably know, approximately 75% of our medical studentswill require some level of assistance this year. I would like tosuggest how our alumni may be able to help me meet the financialneeds of our students this year.The Henrv J. Kaiser Family Foundation has given the MedicalSchool $100,000 to be used for s c ho La r s h i ps over the next fouryears. In addition, and this is where the alumni can really help,the Foundation has offered to match new or increased gifts to aloan or scholarship fund. The mechanics are somewhat complicated,but I will try to explain the operation of the match. The matchis based on the average of the gifts alumni have made to a loan orscholarshio fund in fiscal '78 and '79. The Foundation will contrib­ute $1 for every $2 alumni give to a scholarship fund over theiraverage of '78 and '79 gifts; $1 for every $3 given to a loan fund;and $1 for every $4 given to an endowed scholarship fund, up to amaximum of $50,000. During the last two years, I understand thatapproximately 36% of our alumni have made contributions. It seemsto me, therefore, that there is a large group of alumni whichhasn't made a commitment and whose gifts would totally qualify forthe Kaiser match.Let me give you some examples of how the match wouldwork:If a graduate of ours gave $25 in fiscal '78 and $75in '79, the "average gift" amount would be $50. If thatgraduate gave $100 this year to a scholarship fund,Kaiser would match on the basis of the $50 increase overthe "average gift" amount of $50. Since this years'sgift is going to a scholarship fund, the match would beone-to-two, and Kaiser would contribute an additional $25.Another example would be if a graduate of ours has notgiven at all during either fiscal '78 or '79, but gives$75 this year, and designates the qift for a named loanfund; the base "average" would be $0. Kaiser would matchthe gift on a one-to-three basis, and contribute anadditional $25.We must raise approximately $150,000 in additional loan and scholarshipfunds to generate the maximum of $50,000 in Kaiser matching money. I'moptimistic that our alumni will respond to this opportunity to help ourstudents. The majority of funds should be received before December 31,1980 so we would be in a position to help our students in the winterand spring quarters of this academic year.I hope that you will be able to get this message to our alumni in thevery near future.15Comprehensive Medicinein Industry: UpdateDr. Peter Wolkonsky ('52) has been director of Medical Servicesfor Standard Oil Company (Indiana) since 1966. Five years ago wereported on the medical programs and facilities under Dr. Wolkon­sky's direction in the Standard Oil headquarters itself. Now we dis­cuss the company's nation- and worldwide medical services.'l1li, ..16 The responsibilities of the director of Medical Services of Stan­dard Oil Company (Indiana) extend far beyond the medical depart­ment on the 38th floor of corporate headquarters on RandolphDrive in Chicago, where his offices are located. Dr. Peter Wol­konsky administers one of the most comprehensive and geographi­cally extensive medical programs in industry. This program addres­ses the medical needs of same 45,000 employees in this countryand another 6-7000 in 45 foreign countries, most of whom are em­ployed by one of the several Amoco operating subsidiaries of theparent company.Though the extent of medical services offered varies over Stan­dard Oil's worldwide operations, the basic purpose of the programremains two-fold. For many years, employees have been encour­aged to take advantage of the strictly voluntary preventive medicineprogram which seeks to detect and check incipient pathology. Morerecently, company and/or government regulations require occupa­tionally-related services such as pre-employment physical examina­tions, periodic testing of workers with hazardous materials, andemergency service for illness or injury on the job.In the United States, there are some 24 medical departments incompany plants and in the larger offices, such as Houston, Tulsa,and Chicago. The Chicago department is the largest and most com­prehensive, with a broad range of diagnostic and therapeutic equip­ment, since it serves the needs of 5,000 employees, the largestconcentration anywhere. The Chicago department is staffed profes­sionally by five full-time internists, a retained radiologist, threeregistered nurses and a technician. The staffs of the other domesticmedical departments vary in size from a full-time nurse, and aphysician who makes thrice-weekly visits, to several nurses andone full-time and one half-time physician.Though Standard Oil's medical services abroad are necessarilyless uniform than those in the United States, because of variationsin local laws and conditions, they conform to a general pattern. Nofull-time company physicians are appointed abroad; instead localdoctors are retained or appointed as fee-for-service physicians."The old days when the oil company would move in and buildschools, hospitals, and roads and send American doctors are gener­ally American-, French-, or British-trained, though. They are hiredto provide certain designated services for the company--examina­tions of employees and their families, and of household help in cer­tain areas, immunizations, and so forth. Employees remain free toconsult their private doctor for their personal needs. They are alsooffered the chance to participate in the voluntary preventive medi­cine program, as in the United States. At some of the larger opera­tions-in Egypt and Italy, for instance-medical facilities arehoused within the residence area or the plant, and the doctor comesto visit. Elsewhere, employees go to the physician's private office.In countries where Standard Oil pays tax to a national healthscheme under which its employees are covered, the companyunderstandably does not feel obliged to provide voluntary preven­tive medical examination service of its own, but does provide itsother customary services. Where local facilities are simply inadequ­ate, as in some of the more remote "hardship posts" in underde­veloped countries (where such operations as seismic exploration ormineral-prospecting are undertaken), or where a dire emergencyovertaxes local resources, arrangements are made to fly sick or in­jured employees out to the nearest major medical center.One of Dr. Wolkonsky's major duties is to assess the level oflocal health care wherever Standard Oil has operations. Typically,if the company is moving to a new area, he will go and spendsome time canvassing the community, gauging what level of care itcan be relied upon to supply, and where it must be supplanted. Hetries to meet with as many as he can of those doctors interested inhelping the company, and determines the likeliest candidates amongthem. "I try to make some judgment as to who might be most suc­cessful in taking care of our people for their normal day-to-dayneeds, not only for emergencies-if a child gets a sore throat,which doctor will be willing to take care of it," Dr. Wolkonskysays. Once he has made his determination, a formal designation ofone or more physicians as "panel physicians" is made. There aresome 30 of these overseas.Dr. Wolkonsky and his staff feel that they have a unique oppor­tunity to compare levels of health care globally, though he prudent­ly refrains from specifics. "All I can say is that they vary widely."Generally, though, in third-world countries, even where facilitiesare locally regarded as modem and advanced, they may not be soby American standards. The level of nursing care in particular isoften not what it is in this country, sometimes simply because nurs­ing is viewed differently in other cultures. So, for instance, inmany countries it is the family which is expected to provide nurs­ing care for the patient. In such cases, one family member willgenerally stay with the patient and attend to his needs--even pre­paring meals where there is no hospital-supplied food. "There maybe something to this," Dr. Wolkonsky confesses. "Getting thefamily involved provides comfort and reassurance to the patient,cuts way down on expenses and takes a load off the nursing staff."He nonetheless is responsible for trying to secure levels of nursingcare comparable to domestic ones. Care must be taken not to slightthe health care in a given place or to offend local sensibilities.However, Dr. Wolkonsky finds most local physicians are quite can­did and acutely aware of the limitations of their particular circum­stances.From a more purely scientific point of view, Dr. Wolkonskyfinds his work fascinating. He has the opportunity to come acrossdiseases in his "practice" (sensu Jatu) which most American doc­tors only read about. Remarks Dr. Wolkonsky, "Some of thesecountries really are laboratories of tropical diseases, so it's bothfascinating and scary. Some countries literally see more cases ofrabies in one week than are seen in a decade in this country."Another of Standard's medical staff's roles is dispenser of adviceto Americans and third-country nationals (generally Australians andWestern Europeans) sent to third-world posts. They must try toeducate families in the realities of the local situation and impressthem the need for taking hygienic precautions. So, for instance,where the local water supply is contaminated with organisms towhich the local populace may appear to be resistant, newcomersmust be reminded to boil water before they use it; children must betaught not to wade in fresh-water canals, and to take their "shots"and malaria pills religiously. Sometimes household servants mayunwittingly thwart the good intentions of the hygiene-conscious,who must be made aware of this possibility. Employees sentabroad from this country are well indoctrinated before they leave,thanks to Standard Oil programs. Epidemiologic concerns occupy Standard Oil's central medicalstaff's attention more than they would that of most doctors not inPublic Health. Dr. Wolkonsky and some of his associates serve ona number of professional and trade association scientific groups.For example, the American Petroleum Institute and the Organiza­tion Resources Counselors both have medical and biological com­mittees which support research projects by such groups as the AirPollution Research Advisory Committee and its medical wing, theMedical Research Advisory Committee, and by universities and pri­vate consulting laboratories. Standard Oil frequently undertakes"public service" projects, studying industry-related health prob­lems. "That's perhaps one difference between the physician who'sbasically seeing patients and what I do: I spend a lot of time goingto this kind or scientific or committee meeting, dealing with thesesorts of problems."No good epidemiology has been done, in the past by academics,by industry or by government, Dr. Wolkonsky contends, becausean adequate data base just didn't exist. Standard Oil hopes toaddress this lack, and has developed its own computer system de­signed especially to do epidemiology. Other companies are follow­ing Standard Oil's lead. The possibility now first arises, Dr. Wol­konsky points out, for pooling a great wealth of information on, forexample, benzene workers from many companies. It is now possi­ble to follow a big cohort for a long period with sophisticated ex­aminations to measure subtle changes.Standard Oil is now cooperating in studies with epidemiologistsand bio-statisticians at Rush-Presbyterian/St. Luke's in Chicago,who are starting to look over the data base which Standard Oil hasbuilt up. The computer system at Standard Oil is also helping toprovide data for general medical studies not directly related tooccupational illnesses. For example, Standard Oil has participatedin a number of studies on the evaluation of coronary disease pre­vention programs and on hypertension with Dr. Jeremiah Stamlerof Northwestern University. Says Dr. Wolkonsky, "When he wantsto find men between 30 and 45 with cholesterols over 250 and di­astolic blood pressures over 90 and uric acids under 9, we can plugthe requirements into the computer and get out a list of names.Then ask the individuals if they'd like to participate in a study."Dr. Wolkonsky has two assistant directors and eight or ninechief physicians across the country. These doctors are all on thefaculty of a medical school or teaching hospital, Dr. Wolkonskynotes. "We want our people to be connected to the academic lifein some way--otherwise it's a good way to become useless in fiveyears, sitting here in this ivory tower (which Standard Oil Head­quarters quite literally is)."Discussing the Standard Oil voluntary preventive medicine pro­gram-perhaps the most distinctive feature of Standard Oil's totalapproach to employee health care-Dr. Wolkonsky notes, "As acompany we're not great believers in the lunch-hour movie onhypertension; we rely mainly on personal communication." Thismay be more costly, but the whole justification for the Standard Oilpreventive program is the unprovable assumption that there is apayout. "If we do find pathology or incipient pathology in time forit to be corrected, then the employee can remain healthy and pro­ductive instead of becoming an early disability case-it's a benefitboth to him and to the corporation." Every United States employeehere and overseas, regardless of rank in the company. has the op­tion to participate in the voluntary program.17ETHICALDILEMMASIN THE CARE OFTHE ILLLeon R. Kass (S.B. '58, M.D. '62)How does one usefully speak to medical practitioners aboutethical matters?In more than ten years of discussing questions of medical ethicswith physicians, I have been impressed by their reluctance togeneralize the principles of their conduct. They counter philo­sophical argument of principles with anecdotal accounts of cases."Every case is altogether unique," they frequently insist. Forseveral years, I must confess I was impatient with this approach. Itseemed to me then that my physician interlocutors were too lazy orthoughtless to articulate the tacit premises of their conduct (premis­es which seemed, to me at least, quite accessible through analysisof their cases), or else too frightened to subject those premises tocareful scrutiny and criticism. And it just isn't true that the ethicalaspects of each case are in every respect unique, any more than arethe medical aspects. Why not seek the same clarity and precision inthinking about medical ethics that we seek about disease, which,after all, also manifests itself only in particular cases, each in somesense unique?This article might be said to be a reflection on this question andon the peculiar antipathy of physicians to formal and abstract ethic­al reasoning. I have come in large measure to appreciate the practi­tioners' point of view. Indeed, I am inclined to believe that theattempt to replace the inarticulate yet prudent judgments of discern­ing physicians with explicit rules or procedures will not lead to bet­ter decisions.Yet the superiority of trusting in the prudence or discernment ofthe practitioner in specific cases presupposes that the practitioneralso understands in general what his practice is and what it is for.In an effort to contribute to your general reflection on the nature ofmedicine, I have decided to consider two general and unavoidableperplexities regarding the doctor's proper business, rather than anyspecific ethical dilemmas, e.g. abortion, confidentiality, or theallocation of scare resources.18 What does the doctor serve?Does the doctor serve the patient's needs or his desires andwishes? Or again, does the doctor serve the patient's good or hisrights? Can it be simply true, without qualification, that the goodphysician is the servant of the patient?Let me illustrate with some examples. When cosmetic surgeonslift faces, inflate bosoms, and straighten noses, are they servingneeds or desires? When the obstetrician agrees to determine the sexof the unborn child by amniocentesis and abort fetuses of the un­wanted gender, does he serve need or desire? When the internistgives in to a mother's request to tranquilize her teen-aged daugh­ter's anxiety before her first cello recital, does he serve need orwish? And what of the psychiatrist who has sexual relations withhis patients in the office as part of his treatment of frigidity?Honoring so-called patients rights may also conflict with servingthe patient's good. It is now claimed that patients have a right toknow the whole truth about their diagnosis and treatment, includingin detail an account of all possible complications and untowardconsequences of proposed therapies. There is said to be a right ofaccess to medical records, a right to refuse treatment as well as a.. _1" .. _," .. -1 ..... 'right to obtain treatment (especially for persons involuntarily com­mitted for mental illness), a right to health care, a right to deter­mine the fate of one's body, even a right to die or to be mercifullykilled. Some of these claims seem to me to be dubious, whileothers touch on important matters that could be accommodatedwithout resorting to the uncompromising and contentious talk of"rights." But be that as it may, the main point is that physicians in­creasingly face the uncomfortable choice of either risking harm topatients by catering to their rights or risking suit from patients byignoring their rights in order to serve their good.One suspects that these difficulties and tensions will increase, forthey seem to be related to powerful tendencies of modem life. Themassive increase in sophisticated means for intervening in the hu­man body and mind has also produced new ends for the use ofbiomedical technique. And it has been noted often that the triumphof technique, fueled initially by rather modest and unexceptionablegoals, itself gives rise to an inflation and proliferation of desires,which in tum breed the further growth of technology needed fortheir satisfaction. This is especially true under conditions of greatfreedom and prosperity, and in cultures such as our own thatesteem comfort and safety, and in which a highly literate and de­manding populace comes to expect a technical solution to all life'sdifficulties. The swelling of demands and desires for goods and services isparalleled by the rising stress on personal autonomy in the face ofdeclining influence of the authority of tradition and traditional au­thorities, and often a frank attrack on all authority, including thatof the professions, medicine among them.There is no doubt that physicians will have to make their peacewith these tendencies that require them to serve patient desires andrespect patient rights. The AMA's new Code of Medical Ethicshas, perhaps unwittingly, made clear concessions in that direction.It says, for instance, that "A physician shall be dedicated to pro­viding medically competent service"-without specifying anywherein the code the end to be served by medical competence. Indeed,the word "health" occurs in the Code only twice, both times as anadjective in the phrase "other health professionals." The Code alsosays that" A physician shall respect the rights of patients" withoutspecifying what rights patients are deemed to have, and who willdetermine them. It would be most instructive, if we had time, tocompare the understanding of the doctor-patient relation implied bythe notion "respect the rights of the patient" with the more tradi­tional understanding implied by the Hippocratic Oath's "I willkeep (him) from harm and injustice," the former emphasizing thepatient's autonomy, prerogatives, and rights, the latter the patient'sneediness and the overarching norms of good and of right; the for­mer presupposing a physician who needs to be exhorted not toviolate his patients, the latter presupposing a benevolent healer whomust keep the oft intemperate patient from violating himself.But the medical profession should be wary of conceding toomuch in making its peace. For as with the first perplexity, there aresome fundamental matters at stake, matters that again strike at theheart of the healing relation. If we could recover a deeper under­standing of this relation and of the art of medicine generally, wemight be more alert to the dangers that threaten it. One danger iscontained in the pressures to treat medicine not as an art or a pro­fession that is practiced but as a technical service that is delivered,like auto repair or plumbing, in this case, a service "provided" bydoctors or the "health care delivery system" and "consumed bypatients." This new understanding shifts the focus to the buyingand selling, to the relation of exchange, and away from the myste­rious activity of healing and the crucial and incomparable interper­sonal bonds of the healing relation-far beyond what the psychia­trists call transference and counter-transference. Many in the so­called consumer movement, not particularly sensitive to fine dis­tinctions, would replace an understanding of the healing relationfounded on ideas of covenant or vocation or philanthropy or fidelityand trust or devotion to the art with a new view: a relation of con­tract, with explicitly defined items contracted for exchange. Such anotion both presupposes a lack of trust and further exacerbates it,thus interfering with the healing relation. Indeed, it simply mis­understands and hence denies the essence of the healing activity,which depends on hope and confidence, care and trust, no less thanon technique. It is an activity whose nature and effectiveness areshrouded in mystery, and whose outcome is always uncertain andso subject to the vicissitudes of conditions and circumstances as tomake contractual promises unreasonable. It is an activity much likechild-rearing or teaching, activities also grossly misunderstood bythose who would reduce these as well to a species of contract.A second mortal danger is contained in the now popular notionthat a person has a right over his body, a right that allows him todo whatever he wants to it or with it. Civil libertarians may ap­plaud such a notion, as an arguably logical expansion of right of19privacy, of the right to be free from unwanted or offensivetouchings of one's body. But for a physician, the idea must be un­acceptable. No physician worthy of the name would honor a pa­tient's request to pluck out his eye if it offends him, nor lop off abreast to improve a lady's golf swing. Medicine violates the bodyonly to heal it. Doctors respect the integrity of body not only be­cause and if the patient wants or allows them to. They respect andminister to bodily wholeness because they recognize-at least tacit­ly-what a wonderful and awe-in spiring-not to say sacred-thingthe healthy living human body is. They know or should know-orare at least in a profession whose very foundation presupposes-theprecariousness of human life and the dependence of all good thingson a well-working body, whose great powers and frailty both com­mand respect and modesty. No doctor who understands the profes­sion should be guilty of the contempt for the body or arrogance ofthe will that declares "my body" to be a mere thing to be disposedof or carved up at "my will."Now to be fair, one must concede that medicine has not itselfbeen sufficiently mindful of these matters. The assertion of pa­tient's rights and the move toward increasing patient autonomy, itmust be acknowledged, are in part in response to excessive author­itarianism and mystification--even arrogance-on the part of physi­cians. If patients stridently insist on being treated as persons, de­mand that their wishes be honored, and occasionally show con­tempt for the body, it is perhaps because physicians have all toooften shown a forgetfulness of the soul, of the human aspects ofpatients and patient care. Sad to say, one can even learn contemptfor the body from some physicians, who in their eagerness to treatthis or that abnormality forget about the well-working of the bodyas a whole, or prescribe dangerous drugs to remedy trifling com­plaints. Thus, while it is true that the physician has been rightlycommitted more to patient good than to patient rights, to patientneed than to patient wish, it is also true that doctors frequently nowhold too narrow a view of need and of good, too shrunken a viewof the integrity of the human organism, and almost no view at allof the riches and mysteries of the human soul. Modem science andmodem medicine have not taught our culture well on most of thesematters.Can we find a way out of this perplexity regarding the doctor­patient relation and the object of medical service, and the dilemmasit creates? Even in thought, there is no simple answer. It is not al­ways easy to distinguish a need from a desire, or a reasonable froman unreasonable desire, or to decide which even reasonable desiresand wishes deserve the services of a doctor. Patients do have aneed for respectful treatment and for by-and-Iarge truthful and pa­tient counsel, and it is good for them to take as large a role in theirown health-maintenance as is possible--even if these needs andgoods are not owed them because they claim them as rights. Thereis truth in the slogan that patients are first of all persons, and onlysecondarily patients to the doctor's ministrations.Practically speaking, there are likewise no simple rules forbalancing these considerations in deciding what to do in patientcare. Certain virtues seem to be required: moderation in the doc­tor's view of what he can and cannot accomplish, gravity beforethe awesome mysteries of human being, understanding of the hu­man aspects of the lives, hopes, and fears of the ill, courage toresist unwarranted demands for pills or procedures, and prudentjudgment to discern the warranted from the unwarranted. These arenot the virtues of the servile. And though it is true that the doctormust not seek to be a master, so also must he not stoop to be aslave.20 Indeed, to close this section, it is worth reconsidering whetherwe have not been mistaken in the very posing of our questions:Whom and what does the doctor serve? Is the doctor really a ser­vant? In a way he is, providing we remember that one can servenot only people but also ideals, not only a wordly master but also anoble calling. One way of stating the conclusion of this part of thearticle is to assert that the doctor's loyalty to his patient must bedecisively qualified by the doctor's loyalty to his art and to itsnorms and goals, or again, that the doctor serves not the patientsimply but rather the good of the patient. At a deeper level, onecould say that in healing the human body the physician is alsoassisting and serving that innate power of nature that is manifestedin each patient, but is greater than all of them, a power that allancient peoples acknowledged in regarding medicine as a sacred orholy art.Yet, the language of service is also not quite right when appliedto the relation between doctor and patient. For service implies mas­tery or lordship, and the doctor is, in truth, neither a master nor aservant of the patient. With respect to the patient's body, he is ahelper, a co-worker with nature and with the patient himself in pro­viding the ill body its proper aid. With respect to the patient asperson, one of his main functions, oft neglected, is to be a leaderand a teacher, one who leads the activities of healing and one whoteaches patients and the community about regaining and maintain­ing healthy functioning. The word 'doctor' literally means teacher,from the Latin verb docere, to teach, in this case one who teachesthe wisdom and wonders of the body to patient and pupil alike.What is the patient's good?Our next perplexity follows directly: what is the patient's good?More precisely, of the many things that are good for the patient,which is it the doctor's business to promote? We are no longerasking about medicine's foreign or domestic relations, but about itsvery constitution: what is the purpose of medicine?This is, in a way, a strange question to be asking, since most ofthe time physicians can go about unreflectively doing their properbusiness, tacitly if silently clear about their goals. But because newtechnological powers permit physicians to serve multiple ends, andbecause new technological powers so fragmented and specialized,there is today some confusion and uncertainty about the nature andlimits of the purpose of medicine. In an article published a fewyears ago, "Regarding the End of Medicine and the Pursuit ofHealth," I argued that health was the proper end of medicine,whereas other albeit worthy goals such as pleasure, contentment,happiness, civil peace and order, virtue, wisdom, and truth werefalse goals for the healing art. Against the narrow perspective ofthe high-technology, highly specialized therapy-centered predilec­tions of recent decades, I also tried to outline a functional notion of"health" and argued that health, understood as the well-working ofthe organism as a whole, is not just the absence of disease, but apositive good and the proper norm for medical practice, one thatimplies that there is more to healing illness than curing disease. Iwill not repeat that part of the argument here, and will trust thatfew of you would deny that health is the main purpose of medi­cine, or that some tacit notion of the norm is latent in your everyattempt at healing, "healing" meaning literally, "a makingwhole."Instead, I want to consider a quandary that arises even if we allagree not only that health is the doctor's primary business, but alsoon the meaning of healthiness: What to think and what to do in theface of incurable disease and unhealable illness? What good doesthe doctor seek to promote when healthy functioning is out of thequestion? What should medicine's goal be for the comatose, theterminally ill, the irretrievably dying, the irreversibly deteriorating,especially in mind and awareness, and others irremediablyanguished and miserable?To be sure, easing of pain and relief of suffering, along withsupporting and comforting speech, are always in order, all themore so in the presence of incurable and progressive illness. Reliefof suffering stands, next to health, as a crucial part of the medicalgoal, and medicine has always sought to comfort where it cannotheal. The real quandaries concern activities for prolongation or pres­ervation of life. When, if ever, is it appropriate to withhold or in­terrupt treatments that might be life-preserving or life-prolonging?How to think about this problem? I confess I find it enormouslydifficult. Indeed, perhaps the most important lesson to be drivenhome by the medical profession and to its members is just howcomplicated a matter this is. It simply will not yield to simple for­mulae such as "death with dignity," or "life is sacred," or "dis­pense with extraordinary means." Terms like "incurable,""dying," "terminal," and "hopeless" are notoriously vague, notto speak of "dignity." "Ordinary" and "extraordinary" some­times mean only "customary" and "unusual", sometimes are re­lativized to the particular circumstances of each patient, so thatwhat would be ordinary for one patient would be extraordinary foranother.The distinction between an action and an omission, which I finduseful in some cases, is neither always obvious nor obvious to all,especially if judged only from the result. There are notorious prob­lems in discerning the patient's own judgment regarding his state ofbeing and suffering, or his desire to be treated or not. For at leastthese reasons, the attempt to solve these dilemmas-by generaliza­tions embodied in rules, guidelines, or statutes, or even by courtdecisions-seems fraught with dangers, some of which I will indi­cate soon. In no other area is there a greater need for sober andprudent judgment of the man-on-the-spot and yet, in no other areais there more reluctance and resistance to leave matters simply toprudence. When it comes to the utter finality of the end of a life,we all long to proceed with certitude and clear conscience.The easy way out is to adhere always to the principle "Sustainlife regardless," and there is much to be said for the sentiment in­volved (if not for the practice), reverence for life being a constitu­tive yet fragile principle of decent human community. Neverthe­less, it seems to me that a true reverence for life might include per­mitting it to end, free from further assaults on life's sanctity com­mitted in its name. This, I submit, has been the traditional view ofthe medical profession, and, I might add, of Christian religioustradition.The ground of this view is in part the recognition of humanfinitude. Even the most healthy human being must someday die,despite all efforts of the most competent physician. Such it is to bea mortal being, and such it is to have but very limited powers.Doctors need to accept these lessons no less than laymen. If medi­cine takes aim at death prevention, rather than at health and reliefof suffering, if it regards every death as premature, as a failure oftoday's medicine, but avoidable by tomorrow's, then it is tacitlyasserting that its true goal is bodily immortality. Once it is put thatway, it should be clear that physicians must teach themselves and their patients to make their peace with finitude. Medicine has tradi­tionally refused to make prolongation of life its goal, not only be­cause the goal was finally unreachable, but also because it recog­nized that efforts in that direction often produced more harm thangood-in pain and discomfort, as well as anguish and anxiety.These thoughts suggest a useful beginning for thinking about theconcrete cases in which healing is impossible and interventions arebeing contemplated. The first question should not be "Will this in­tervention prolong life?" but "Will this intervention increase or de­crease this patient's discomfort, pain, and suffering?" The concernof the physician should be the condition of the life to be sustainedand not especially its duration. This means, e.g., being willing-ifthe circumstances are correct-to give high doses of narcotics ifneeded, even at the risk of respiratory depression, or to forego re­suscitation or antibiotics in the face of underlying terminal illnessor severe debilitation of mind. To judge if the circumstances arecorrect, here and now, is the work of prudence or practical wisdomor discernment-a virtue not teachable in medical school and notreplaceable by computer programs.Now, against this view there are important arguments. Some willsuggest that I am urging that physicians begin to make judgmentsof so-called "quality of life." It may be argued that such a movealso invites considerations of "social worthiness" or other alienmatters to contaminate medical decisions, with not only individuallives but our very reverence for life in' the balance. The considera­tion in medicine of "quality of life", it is correctly said, was thefundamental error of the Nazi physicians. These are serious con­cerns, not to be taken lightly. I too am made uncomfortable bybreezy talk about "quality of life," and even by the terms in whichthe sanitized notion of "quality" is substituted for "goodness,"with the attendant implication that quality is a readily measurablematter. Nevertheless, I do believe consideration of the condition ofthe individual patient's health and activity and state of mind mustenter these decisions, if the decision is indeed to be for the pa­tient's good. I think one can walk between the extremes of vitalismand "quality-control" and uphold in so-doing the respect that lifeitself commands for itself. For life is to be revered no only as man­ifested in physiological powers, but also as these powers are orga­nized in the form of a life, with its beginning, middle, and end.Thus, life can be revered not only in its preservation, but also inthe manner in which we allow a given life to reach its terminus.For physicians to adhere to efforts at indefinite prolongation notonly reduces them to slavish technicians, without any articulablegoal, but also degrades and assaults the gravity and solemnity of alife in its close.Fortunately, protection against the dangers of callous indiffer­ence, patient neglect, and the intrusion of alien considerations isavailable, if the physician assesses the patient's condition from thepatient's own point of view. This usually means open and frankdiscussion with the patient, where that is possible. Delicate ques­tions of truth-telling emerge-how much to say, and when andhow-never to be settled by an inflexible adherence to principle.Even more difficult is to discern truly from the patient's wordswhat he actually believes and feels. Discerning the patient's truesentiments and outlook is often a matter of tact and care and sub­tlety. Physicians will soon need to be sensitive in detecting press­ures applied to patients because of the emerging climate of opin­ion that trumpets cessation of treatment, that romanticizes "deathwith dignity," or that trivializes death' s meaning by turning dyinginto a management problem for death-experts called thanatologists,just as they should have been sensitive in the past to how their own21bias for "prolongation regardless" also subtly manipulated patientattitudes. The doctor must know each patient if he is to teach himappropriately.To be frank, the record of the profession as a whole in its treat­ment of the untreatable has left many dissatisfied, and there aregrowing movements, from several quarters, to remove the matterfrom the discretion of individual doctors and to bring practiceunder some form of external and uniform guidelines. We shallprobably see more of this in the future, and the prospect is not en­couraging. Consider, e.g., the California Natural Death Act, passedin 1976. This well-intentioned status permits a person prospectivelyto execute a written directive to his physician to withold or with­draw life-sustaining procedures in the event of a "terminal condi­tion," but the operating clause indicates that such instruction isvalid only in cases in which "death is imminent whether or notsuch procedures are utilized." In other words, the law permits thepatient only to instruct the doctor to desist from useless procedures,a halt that should be regarded by doctors not as a legally grantedprivilege but rather as a professionally-based duty. By implication,the law seems to cast some doubt on whether withholding treatmentunder any other conditions is acceptable, or whether any patientwho has not written such a directive must be assumed to desirefull-scale and recurrent prolongation efforts. Could the doctor de­cline to resuscitate a senile woman with crippling arthritis, but withno terminal illness, either with or without such a directive? Doesthe law silently forbid---or discourage-what it does not explicitlypermit?Or consider the Saikewicz case in Massachusetts, which hasbeen followed by a spate of other cases, brought to court by physi­cians who mistakenly believed that they now need a judicial direc­tive to cease treatment, if the patient is incompetent. To be sure,they need a judicial opinion in advance if they wish to obtain im­munity against possible legal action for their decision, but what arewe to think of the self-understanding of the profession if it willpractice only under the promise of immunity for its errors?Moreover, the risk of penalty is almost non-existent. I believe it isstill true that no American physician has been sued or prosecutedfor terminating treatment of a dying patient, competent or incompe­tent, for whom there is no hope of cure.Guidelines set by the profession may also needlessly tie physi­cian's hands. A widely discussed article in the New England Jour­nal of Medicine, "Orders Not to Resuscitate," proposes that ordersnot to resuscitate are appropriate if the disease is irreversible, thephysiological status of the patient is irreparable, and death is immi­nent, "in the sense that in the ordinary course of events, deathprobably will occur within a period not exceeding two weeks." Arethere no conditions of the patient other than imminent death withintwo weeks that could justify a refusal to defibrillate? And can adoctor now no longer write orders not to resuscitate such patients?While there are pitfalls at every tum, sure footing will not behad as a result of statutes, court decisions, or professional guide­lines and regulations. Indeed, here is an area where dilemmas can­not be neatly solved but only soberly faced, where the desire forcertainty and the cleanest conscience must give way to the satisfac­tion that a grave decision was conscientiously made, with utmostseriousness and adequate consultation, and in the interest of doingthe most good and causing the least suffering to the individual pa­tient, as that patient himself would wish. Written directives, rules,and guidelines are no substitute for sobriety, common sense, anddiscernment in the search for the patient's good.22 Yet I would make one qualification, and propose one rule, wellstated already in the Oath of Hippocrates: "I will neither give adeadly drug to anybody if asked for it, nor will I make a sugges­tion to this effect." There is a difference between permitting to dieand directly killing, if not in the result for the patient, then certain­ly in understanding the activity of the agent. This age-old ruleagainst mercy-killing by physicians, though supported by Judaismand Christianity, and by Anglo-American law, has its true roots inthe very idea of the physician as healer. Hans Jonas has put thematter well:"The law forbids it, but more so (the law being changeable) it isprohibited by the innermost meaning of the medical vocation,which should never cast the physician in the role of a dispenser ofdeath, even at the subject's request."CodaThere is notion abroad that there is, or that there can and shouldbe, a science of medical right and wrong or at least of proper deci­sion making, to which doctors can tum for expert help to solvemedicine's ethical dilemmas. This is worse than an illusion. It rep­resents a declaration of moral bankruptcy on the part of the profes­sion, which once understood the ethical as integral to the medical,and which never supposed that the "dilemmas of caring for the ill"could be neatly solved. The call for rules, guidelines, and proce­dures, the convening of ethics committees, and the encouragementof statutory regulations are a search for yet one more technicalsolution-this time a technical ethical solution-for problems pro­duced by our already foolish tendency to seek technical medicalsolutions for the weighty difficulties of human life. If a doctorwould be a physician and not merely a body technician, he mustalso be a knower of souls, those of his patients and, not least, hisown.Dr. Leon R. Kass is the Henry Luce Professor in the Lib­eral Arts of Human Biology in the College. An alumnus ofthe University, Dr. Kass received the SB. degree in biol­ogy with honors in 1958, and the MD. degree with hon­ors in 1962. He received the Ph.D. in biochemistry fromHarvard University in 1967, where his faculty sponsor wasKonrad Bloch, former University of Chicago biochemistand Nobel laureate. Originally a bacterial enzymologist,Dr. Kass became increasingly concerned with social andethical questions in medicine-so much so that he de­cided to devote his career to them.This article is adapted from a speech given at the Medi­cal Symposium, "Controversies in Internal MediCine,"presented by the South em California Permanente MedicalGroup and Kaiser Foundation Hospitals, Los Angeles, Oc­tober 5, 1979. It was published in the Journal of theAmerican Medical Association, vol. 24, nos. 16 and 17,Oct. 17 and 24-30, 1980, and is reprinted here with thepermission of JAMA.a good time was had by all ...1980 American College of Cardiology MeetingHouston, TexasJafar AI-Sadir, Pablo Denes, Frank YanowitzIvan D'Cruz, Rene Arcilla, Andrew Griffin ('67) Ed Murphy ('77), Gerard Parent, Kathy Flohr('74)Bandu Karunaratne, Mrs. Fennel, Mukesh Jain,Bill FennelForty-three alumni and housestaff and their guests attended the Medical AlumniReception at the American College of Cardiology Meeting in Houston.23In MemoriamHuberta Livingstone1905-1980Huberta Livingstone was born in Hopkin­ton, Iowa in 1905, graduated from the Uni­versity of Iowa School of Medicine in1928 and then moved to Chicago to internat Presbyterian Hospital. She joined thefaculty of the University of Chicago as aninstructor in the Department of Surgery in1932, became Director of the Anesthesiolo­gy Service and in 1944 was promoted toAssociate Professor of Surgery, a post sheheld until she retired in 1952.During the many years she served on theUniversity of Chicago faculty, this unusualwoman inspired many students, advancedthe field of anesthesiology, published morethan 150 scientific papers and won the re­spect and admiration of patients and staff.She was the first diplomate of the Amer­ican Board of Anaesthesiology in Illinois.She established the first approved trainingprogram for residents in anesthesiology inIllinois. Her research covered a wide field.She investigated the pharmacology of an­esthetic gases; she aided in the develop­ment of ear oximetry for monitoring theanesthetized patient. She developed equip­ment used for mechanically assisted ven­tilation. She even experimented with theuse of music as an aid to combating patientanxiety before surgery.After her retirement from practice andthe onerous duties of administering anacademic department she continued to lec­ture and to teach both in the USA andabroad. She received honorary membership24 in medical SOCieties in Mexico and Cuba.Huberta may have retired from the Uni­versity of Chicago but she certainly did notretire from medicine or from the multitudeof extra-curricular activities she hadassumed as a busy faculty member. Sheserved organized medicine in many electedoffices: assistant treasurer of the AmericanSociety of Anaesthesiologists and presidentof the Chicago Society of Anaesthesiolo­gists, Midwestern Association of Anesthe­tists and the Illinois Society of Anaesthe­siologists. In 1975 she helped organize theAmerican Retired Physicians Associationand served on its board until her death.Huberta left active anesthesia practice butnever left medicine; she was a regularattendee at major medical meetings in Chi­cago and served as assistant editor of Thelournal of Anaesthesiology from 1940 to1966.Although she went by the title DoctorLivingstone, she was also Mrs. Adams,wife of Dr. William E. (Bill) Adams, thedistinguished thoracic surgeon. BothHuberta and Bill held full-time facultyappointments in the same department ofsurgery but never seemed to be in conflictor competition with each other. They werea wonderful and unusual husband and wifeteam, admired and loved by all the stu­dents and residents who were privileged tospend time with them.They played an important role in myown life for while Bill Adams was Head ofthe Section of Chest Surgery, I was Headof the Section of Chest Medicine at Bill­ings Hospital and my wife Margaret wasan anesthesiologist in the same departmentthat Huberta founded and developed.Throughout the years of our associationBill and Huberta served as a professionaland family model for us to try and emu­late. My best memories of Huberta are ofher as a beautiful and charming hostess atthe parties she gave her staff residents andfriends. She always seemed to light up thewhole room with warmth and friendliness.Huberta compressed many lives into oneseventy-four-year lifetime: she was a finephysician, a dedicated teacher, a scientificinvestigator, a civic leader, a wife and amother. I am sure that all who rememberHuberta Livingstone as a teacher or col­league, or as Mrs. Adams the graciouswife of one of America's great surgeons,do so with affection. My memories of this wonderful couple are vividly refreshedeach time I see their daughter, Diana, whois a member of lAMA's editorial staff.The passage of time may inexorablysteal our friends and colleagues but happilyit sometimes leaves their children and withthem our happiest memories.William R. Barclay, M.D.Faculty'51-'70She arrived at the University of Chicagoat a time when there were very few womenin her profession and she was well suitedto initiating change in the field of anesthe­siology as well as the medical school.When she came down the hall instarched whites the surgical day could begin.She was competent, skillful and readilyavailable to assist and teach her staff. As agood teacher she had the welfare of the pa­tient uppermost in her mind. She wasfiercely loyal to her profession, her staffand friends. She was a woman of great de­termination and persistence in asking ofothers the same high standards she set forherself. Her department excelled under herstrong leadership.I first came under Dr. Livingstone's in­fluence when she provided a job for meduring my sophomore and junior years.She saw that as one of the "gas men" Iwas paid for changing of oxygen and anes­thetic agents tanks on a regular basis,which enabled me to make a few extra dol­lars at a time when they were needed.During my internship my first rotationwas on Dr. Livingstone's service. This wasfollowed by a second rotation when theAnesthesia Department was short-handed.The experience proved to be importantwhen, upon my return from the service,there were too many returning orthopedicresidents. Dr. Livingstone agreed to takeme on as an anesthesia resident for sixmonths with primary assignment to theorthopedic surgery operating room. I shallbe forever grateful to Dr. Livingstone forpermitting me to gain valuable experienceat the head of the operating table. Wemaintained close contact during the ensuingyears.She was a most unusual woman. I countmyself lucky to have known her at theUniversity of Chicago as her student, col­league and friend and when she later re­turned to Iowa as her orthopedist.Michael Bonfiglio, M.D. '43Resident '43-'49Dr. Livingstone could be described inone, all-encompassing word-perfection­ism. She strove to be perfect in everythingshe did, and as a result, no matter to whatshe applied herself, she did it well. It iseasy to use the term "perfection," but howdifficult it is to attain. It requires a life ofdiscipline, sacrifice, study, and dedication,of which very few are disposed to give.The greatness of her exemplary life wasthat she had only one true objective-totalcommitment to her fellow human beings.If one analyzes her performance at theUniversity of Chicago, it is apparent thather professional life was given over to thetotal care of her patients. She was excep-Alumni Deaths, 11 Eleanor E. Whipple Peter(S.B.'07), May 16, Port Republic, Mary­land, age 97, Specialty: Internal Medicine.Dr. Peter had served as a medical mission­ary in China from 1911-1926., 11 Louis D. Smith, June 23, Chicago,Illinois, age 91. Specialty: Urology. Dr.Smith served as past president of theSouth Chicago Branch of the ChicagoMedical Society, and former Councillor-at­large of the Chicago Medical Society. Atvarious times in his career, he served onthe staffs of South Chicago, South Shore,Jackson Park, Illinois Central, and ChicagoWesley Hospitals. He is survived by hisson, Paul C. (Ph.B.'34), and daughter,Mary Smith Devoe (A.B. '42), his grand­son, Dr. Lawrence D. Devoe (M.D. '70),Assistant Professor at the University ofChicago School of Medicine in the Depart­ment of Obstetrics and Gynecology, andhis granddaughter, Linda Devoe (A.B. '80).'16 William Burk (S.B.'14), January17, Chicago, Illinois, age 90. Specialty:General Practice and Surgery.'22 John R. Montague, July 23, Port­land Oregon, age 83. Specialty: InternalMedicine. Dr. Montague had specialized ininternal medicine and diagnostics for overfifty years until his retirement in 1975. Hewas noted throughout the country for hisyears of dedication to the treatment ofalcoholism. For thirty-four years he wasMedical Director for the Raleigh HillsAlcohol Treatment Center in Portland, tional in her sense of responsibility andhumanitarianism. She motivated all of herresidents to be meticulously careful, evenat the risk of sometimes incurring their dis­pleasure, since she called their attention toseemingly insignificant details. The resultsachieved were impressive; even in the mostdelicate and critical cases the mortality ratewas practically nil. Her anesthetic tech­niques were simplicity itself. She used theleast possible amounts of drugs, allowingfor immediate recognition of cause, shouldcomplications have arisen. She was conscien­tious and saw to it that the life and security ofthe patients took precedence over the con­venience and preferences of the surgeons.Oregon; and was well known for his highsuccess ratio in arresting the disease. He issurvived by his son, Malcolm; a sister, andsix grandchildren.'22 Leo M. Zimmerman, June 28, Chi­cago, Illinois, age 81. Specialty: Surgery.Dr. Zimmerman had taught Surgery atNorthwestern University Medical Schooland Cook County Graduate School ofMedicine, and was Professor and Chairmanof the Department of Surgery at ChicagoMedical School from 1948-1973. He pub­lished many books, including A History ofAmerican Medicine in 1967, and was apast president of the Chicago Society forthe History of Medicine. Surviving are hiswife, Sally; a son, David; and a daughter,Judith.'23 Rex E. Graber (S.B.'20), June 6,Chippewa Falls, Wisconsin, age 81. Spe­cialty: Public Health and Preventive Medi­cine.'25 Eugene W. Demaree (S.B.'23),May 12, Three Rivers, California, age 79.Specialty: Oncology Surgery and Research.Dr. Demaree went to Korea as a medicalmissionary in 1929 as one of two physi­cians licensed to practice medicine in theJapanese Empire. He returned to theUnited States in 1941 to join Dr. GeorgeSharp at the Pasadena Tumor Institute, spe­cializing in the treatment of cancer. In1972 he retired to Three Rivers, where heremained in private practice. He is sur­vived by his wife, Elsa; sons Michael and This sometimes led her into difficulties, butshe would remain adamant. Those occa­sions served as some of the more importantlessons received by us, her residents.Her much esteemed and loving husband,the late Dr. William E. Adams, was an ex­ceptional leader and friend. They have,separately and together, left a great legacyin their teachings, works, and their human­ity. Their shared life-story will serve as anexample for generations to come.Her death has left me profoundlymoved, but there is consolation in knowingthat she is not lost to me. Her counsel andteaching will always be an essential part ofme.Jesus Saldamando, M.D.(Anesthesiology Resident' 48-' 50)John; and daughters Elsa Mitchell andSusan Bobbitt.'27 Eustace L. Benjamin (S.B. '23),May 27, Santa Barbara, California, age 85.Specialty: Pathology.'28 George D. Tsoulos, September 19,Chicago, Illinois, age 80. Specialty: Gener­al Practice and Pulmonary Diseases. Dr.Tsoulos was on the staffs at Loretto andSt. Mary of Nazareth Hospitals and hadprivate offices in Chicago. He also servedas past Vice-Chairman of the Garfield ParkCommunity Hospital. He is survived by hiswife, Katherine; and two sons, Dr. Nicho­las G. (M.D. '66), and Dr. Demetrios G.(M.D.'62).'29 Grace Hiller, April 24, Baltimore,Maryland, age 83. Specialty: InternalMedicine.'29 Philip C. Noble, January I, Ana­cortes, Washington, age 82. Specialty:General Practice.'30 Albert Tannenbaum, September 4,La Jolla, California, age 79. Specialty:Oncology Research.'36 William D. Warrick, July 21,Birmingham, Alabama, age 68. Specialty:Urology. Dr. Warrick joined the BaptistMedical Center staff in 1940 and served asChairman for the Medical Staff ExecutiveCommittee-Montclair from 1969-1972. Healso had served as deacon for the SouthsideBaptist Church in Birmingham. He is sur­vived by his wife, Alice; a brother, Dr.George Warrick (M.D. '34); and two25daughters.'53 Alexander Z. Breslow, July 20,Washington, D.C., age 52. Specialty:Pathology. At the time of his death he wasDirector of Anatomical Pathology andChief of Surgical Pathology at the GeorgeWashington University Medical Center. Heheld the academic rank of Professor ofPathology. Dr. Breslow was active inmany professional organizations and servedas president of the Washington Society ofPathologists in 1970. He was international­ly famous for his work on melanoma. Hewas the first to demonstrate that the inva­sive potential of melanomas could be quan­titatively determined by the depth of the le­sions as measured by an ocular micro­meter.Although he found his research stimulat­ing, he was also a respected teacher. Hislectures at George Washington UniversityMedical School were always well receivedby his students. Unfortunately, his terminalillness prevented him from fulfilling hisappointment as Visiting Professor ofPathology on the Midway this spring.His hobbies included reading, camping,music, and bird watching. He was fortu­nate in having strong family ties whichsustained him at times of adversity. Heleaves his wife, the former Ruth Weiler­stein (A.B. '63), and three daughters: FaithR. of Boston, Abbey Breslow-Kellogg ofSouth Hadley, Massachusetts, and RachelD. He is also survived by his brothers: Lawrence Breslow, M.D., of Glencoe, Illi­nois, David Breslow, M.D., of Wilming­ton, Delaware, and a sister, Mrs. MildredNovick of Patchogue, New York.'58 Colette M. Rasmussen (A.B. '51),June 29, Chicago, Illinois, age 48. Special­ty: General Preventive Medicine and PublicHealth. Dr. Rasmussen was AssociateMedical Director of the Blue Cross andBlue Shield Plan, and had previously beenChief of Preventive Medicine at CookCounty Hospital. She had been an activemember of the Hyde Park Co-op, most re­cently completing a three year term on theBoard of Directors. She was also a mem­ber of the Co-op Planning and ExpansionCommittee. She is survived by her hus­band, Richard (A.B. '49), and childrenMichelle and Jonathan.Divisional AlumniDavid M. Kamsler (A.B.'69, M.S.'71Biology), March 1, Norristown, Pennsylva­nia.Former StaffSamuel J. Beck, June 10, Chicago Illi­nois, age 84. (Professorial Lecturer Emer­itus in the Departments of Psychiatry andBehavioral Sciences '50-'75.) Dr. Beckwas a past president of the American Orthopsychiatric Association and receivedthe first annual Distinguished PsychologistAward of the Illinois Psychological Asso­ciation in 1969.Huberta M. Livingstone, June 30,Hopkinton, Iowa, age 75. (General SurgeryIntern and Resident Fellow '28-'33, Facul­ty, Department of Anesthesiology '35-'52.)FriendsMrs. Golden Siwek Lamport, May 12,Westport, Connecticut, age 69. Mrs. Lam­port was the widow of the late Dr. HaroldLamport, a pioneer in aviation medicineand Research Professor in the Departmentof Physiology and Biophysics at Mt. SinaiSchool of Medicine, New York, from 1966until his death in 1975. Mrs. Lamport'sstrong feeling for the struggles of youngmedical students encouraged her to sustainthe interest of the Lamport Foundation ingifts for excellence in research papers. Shehad established a research fellowship at theUniversity of Chicago in the Department ofBiophysics and Theoretical Biology andendowed the annual Dr. Harold LamportBiomedical Research Award for the bestdissertation in biomedical research by agraduating senior. She is survived by herson, Anthony Lamport; and daughter,Stephanie L. Nohrnberg.Alumni News1924Samuel J. Meyer has retired and is liv­ing in Highland Park, Illinois.1925Pat Bronstein was awarded the title ofHonorary Chairman from the Departmentof Pediatrics, Illinois Masonic MedicalCenter, Chicago on June 28, 1980. Thehonor is awarded in recognition of manyyears of service.26 1933The Illinois Society of Physical Medi­cine and Rehabilitation has established theLouis B. Newman Distinguished ServiceA ward in honor of his outstanding achieve­ments in physical medicine and rehabilita­tion. Dr. Newman served as President ofthe American Academy of Physical Medi­cine and Rehabilitation from 1958-59, andreceived the Gold Key Award from theAmerican Congress of Rehabilitation Medi­cine in 1963. He is currently a Professor ofRehabilitation Medicine at NorthwesternUniversity Medical School and a professo­rial lecturer at Abraham Lincoln School of Medicine-University of Illinois and at theChicago Medical School-University ofHealth Sciences. Dr. Newman is also aconsultant in rehabilitation medicine forVeteran's Administration Medical Centersin the Chicago area.1937Martin P. Vanden Bosch, MedicalDirector of Professional Services at Dallas­Ft. Worth Hospital Council, writes, "Aftereight years as a surveyor for the JointCommission on Accreditation of Hospitals,I accepted a part-time position with Dallas­Ft. Worth Hospital Council as consultanton accreditation."1940Dwain N. Walder has been appointedDirector of Medical Operations for the In­diana State Board of Health, Indianapolis.1941Meyer H. Rolnick, Staff Physician forthe Department of Medicine, Veteran'sAdministration Medical Center in LongBeach California, has been named Assis­tant Clinical Professor in the Department ofMedicine at the University of California,Irvine.1953H. Hugh Fudenberg is the recipient ofthe Carl Neuberg Medal, presented by theVirchow-Pirquet Society at the New YorkAcademy of Sciences on May 7, 1980. Hehas also co-authored the third edition ofBasic and Clinical Immunology (LangePress).Robert S. Levine and his wife, Mar­garet, write from Phoenix, Arizona, whereDr. Levine will be working in the Depart­ment of Surgery for the Arizona HealthPlan.1954John E. Kasik, Professor in the Depart­ment of Internal Medicine at the Universityof Iowa College of Medicine, has beenappointed Associate Dean for Veteran'sAdministration Medical Center Affairs inthe University of Iowa College of Medi­cine. Dr. Kasik was a resident in internalmedicine at the University of Chicago. Hewas a Fulbright Scholar at the Sir WilliamDunn School of Pathology in Oxford, Eng­land from 1966-67. He then moved toIowa to head the Tuberculosis Unit at Oak­dale Hospital, and became a staff physicianat the Veteran's Administration MedicalCenter in Iowa City. Dr. Kasik has sinceserved as Director of the School of Inhala­tion Therapy, an educational program ofthe Veteran's Administration Medical Cen­ter and Kirkwood Community College, inCedar Rapids, which he helped establish in1972. He also served as the President ofthe Johnson County Tuberculosis and Res­piratory Disease Association and the IowaThoracic Society.Marvin S. Weinreb, of Castro Valley,California, was elected President of theSan Francisco Dermatological Society. 1958WaIter Fried has been named ActingChairman of the Department of Medicineat Michael Reese Hospital, Chicago.Carl H. Gunderson has been appointedChief of the Neurology Service at WalterReed Army Medical Center, and Consul­tant in Neurology to the Surgeon Generalof the Army.1961Robert L. Anderson, currently Vice­Chairman in the Department of Obstetricsand Gynecology at the Naval RegionalMedical Center, Portsmouth, Virginia, willretire this December after more than twentyyears of active duty. He will join the staffin the Department of Obstetrics and Gyne­cology at Eastern Virginia Medical School,Norfolk. Duties will include coordinatingresident and student programs, and geneticcounseling and prenatal diagnosis in thebirth defects program.Dennis Wentz, Alumni Class Chairmanfor the Class of 1961, has been appointedDirector of Medical Services at VanderbiltUniversity Hospital and Associate Dean forClinical Affairs, Vanderbilt UniversityMedical School.1964Carrie K. Schopf has been namedCommissioner of Health for the city ofLakewood, Ohio. She is currently theDirector of Ambulatory Care at LakewoodHospital, Ohio.1967Frederic R. Kahl has been promoted toAssociate Professor in the Department ofMedicine at the Bowman Gray School ofMedicine, Wake Forest University, NorthCarolina. Dr. Kahl received the BordenAward at the University of Chicago foroutstanding research as a medical student.He completed residency training in medi­cine and fellowship training in cardiologyat the University of Pennsylvania Hospital,and joined the Bowman Gray faculty in1975.1968Daniel S. Blumenthal has been namedAssociate Professor and Director of Com­munity Projects of the Department of Com- munity Medicine and Family Practice atMorehouse College School of Medicine,Atlanta. He was previously with the De­partment of Preventive Medicine and Com­munity Health at Emory University Schoolof Medicine, Atlanta.1970Paul H. Rockey has been namedAssociate Director for Clinical Affairs atthe U.S. Public Health Service Hospital inSeattle. He is also an Assistant Professor inthe Department of Medicine at the Uni­versity of Washington. His wife, Linda, isthe medical writer for the Seattle Post­Intelligencer. Paul and Linda have threechildren: Laura, Joseph, and Brian.1971Mark Batshaw is Associate Professor ofPediatrics at John Hopkins UniversityMedical School.1972Eric and Lucille Lester, Class Chairmenfor the Class of 1972, have returned to theUniversity of Chicago from Bethesda,Maryland. Eric is now Assistant Professorin the Department of Medicine (Hematolo­gy) and Lucille is an Assistant Professor inthe Department of Pediatrics at the Uni­versity of Chicago.1973Kenneth R. Diddie has been promotedto Associate Professor in the Department ofOphthalmology at the University of South­ern California, Los Angeles.Richard F. Gaeke, Class Chairman ofthe Class of 1973, and his wife, MaryEllen B. Gaeke (M.D. '75), have opened aprivate practice in gastroenterology in Mid­dletown, Ohio. Richard was an AssistantProfessor in the Department of Medicine atthe University of Chicago from 1978-80.Joel E. Kleinman and Dushanka Ves­selinovitch Kleinman (Zoller Dental ClinicIntern '73-'74) became parents of a daugh­ter, Alexa V. Kleinman, on February 10,1980. Dushanka is working with theNational Institute of Dental Research andJoel is currently working with the NationalInstitute of Mental Health.Hywel Madoc-Jones has been appointedProfessor and Chairman of the Departmentof Therapeutic Radiology at Tufts Uni­versity, Boston.271974Irma J. Bland has opened a Chicagooffice for private practice in psychiatry,specializing in the treatment of adults andadolescents. She has been promoted toAssistant Professor of Clinical Psychiatryat Northwestern University MedicalSchool and has married Edward J.Haynes, Jr., a Chicago stockbroker andprivate pilot.1975Marilyn McCoy Cebelin is DeputyCoroner and Associate Pathologist for theCuyahoga County Coroner's Office inCleveland.Richard B. Kurzel has been namedAssistant Professor and fellow in maternal­fetal medicine, Department of Obstetricsand Gynecology, at Tufts University, Bos­ton.1976Andrew I. Brill has completed his res­idency in obstetrics and gynecology atWomen's Hospital, University of SouthernCalifornia Medical Center. He will beassociated with Stanford University Medi­cal School as a clinical instructor, andplans to be associated with the RedwoodMedical Clinic in Redwood City, Califor­nia. He and his wife will reside in PaloAlto.Kevin P. Hunstman has finished hisresidency at the University of SouthernCalifornia Medical Center, Los Angeles,and is now with the Ross-Loos MedicalGroup in Orange, California.Reginald T. Puckett has completed hisresidency in obstetrics and gynecology atCornell Medical Center, New York, andhas opened a private practice in New YorkCity.David O. Staats is now a fellow ingeriatric medicine at the University of Ore­gon Health Sciences Center and PortlandVeteran's Administration Hospital.David Strayer has completed his res­idency and fellowship training at BarnesHospital, St. Louis; and is now AssistantProfessor in the Department of Pathologyat the University of California, San Diego.28 1977Jean Akpan is a National Health Ser­vice Corps. doctor in Kankakee, Illinois.Michael A. Bauer is a medical officerfor the National Institute for OccupationalSafety and Health in West Virginia.George Kim Bigley, Jr., is a chief resi­dent in neurology at the University of Cali­fornia Hospital in San Diego, California.Shirley A. Browner is a hematologyfellow at the University of ColoradoMedical Center, Denver.Robert Doroghazi finished his residencyat Massachusetts General Hospital and isnow a cardiology fellow at Barnes Hospi­tal, St. Louis.Robert Dubroff has finished his residen­cy in internal medicine at the University ofIllinois Hospitals and is now in privatepractice in California.Jon Matthew Farber is a fellow in de­velopmental pediatrics at the John F. Ken­nedy Institute, Maryland.Joel M. Feinstein has completed hisresidency at Rainbow Babies and Chil­dren's Hospital, Cleveland; and is now afellow in ambulatory pediatrics at the Uni­versity of Chicago.Ira E. Felman is now a fellow inmedical oncology at the University ofSouthern California Medical Center, LosAngeles.Russell B. Hall is chief resident in theDepartment of Medicine at the Universityof Chicago.Mariel Harris will finish her residencyin internal medicine at Michael Reese Hos­pital in June, 1981. At that time, her hus­band, Daniel Cooperman (M.D. '74) willbegin a fellowship in Pediatric Orthopedicsat Newington Children's Hospital inConnecticut. He is now Instructor inOrthopedics at the University of Chicago,having completed his training in 1980.Jeremy J. Hollerman is the Director ofthe Emergency Department, St. Mary'sHospital, Saginaw, Michigan.Jerri Jenista is now a Robert WoodJohnson Clinical Scholar in GeneralAcademic Pediatrics at the University ofRochester, New York.David Kapelanski is a surgical researchfellow in Houston, Texas.Bruce M. Koeppen was previously atthe Department of Physiology and Biophy­sics, University of Illinois, Urbana; and isnow in the Department of Physiology atYale University.William J. Kovacs is a fellow in theDepartment of Endocrinology at the Uni- versity of Texas Southwestern MedicalSchool at Dallas.Ralph W. Kuncl was a resident at theUniversity of Chicago from 1977-80, andis now a clinical fellow at Johns HopkinsHospital.Patricia Kurtz has finished her residen­cy and is now an instructor in the Depart­ment of Medicine and full-time attendingphysician at Michael Reese Hospital, Chi­cago.Donald Leung is a fellow in pediatricallergy at Children's Hospital Medical Cen­ter, Boston.Steven A. Lukes is a second year resi­dent in neurology at the University of Cali­fornia, San Francisco.Steven E. MacBride has finished hisresidency and is now Assistant Professor inthe Department of Medicine at the Uni­versity of Chicago.George William Moll, Jr. is a fellow inpediatric endocrinology at the University ofChicago.Michael F. Press is a chief resident inthe Department of Pathology at the Uni­versity of Chicago.Alan R. Rushton is a pediatrician inclinical genetics in New Jersey.David J. Sales is a fellow in gastroen­terology at the University of Chicago.Patricia Simmons is a fellow in pediat­ric endocrinology at the Mayo Clinic, Min­nesota.Joseph Soffer is a fellow in cardiologyat the University of Pennsylvania Hospital,Philadelphia.Burton Vander Laan is a chief residentin the Department of Medicine and fellowin the hematology division at MichaelReese Hospital, Chicago.Frederick D. Williams is a resident inthe Department of Ophthalmology atLoyola Medical Center, Chicago1979Tom Vander Laan is now a surgical res­ident at Los Angeles County Hospital,University of Southern California.Former Staff News itus Award from McGill University, and anhonorary Doctor of Medicine degree fromthe University of Edinburgh, Scotland." Divisional AlumniNews1954Theodore Rasmussen ('47-'54, Profes­sor, Neurological Surgery), Professor inthe Department of Neurology and Neuro­surgery at McGill University, and DirectorEmeritus, Montreal Neurological Instituteand Hospital, writes, "During the past yearthe Ambassador Award of Epilepsy Inter­national was presented to me in Florence,Italy. I also received the Professor Emer- 1970 1977Basil Rodansky ('67-'70, StudentHealth Service) is a major in the UnitedStates Air Force and is working in theChief Primary Care Department, GrissomAir Force Base Clinic, Indiana. Huei-Mei Tsai (Ph.D. '77, Anatomy) isAssociate Professor in the School of Den­tistry at National Taiwan University. Shewill present "The Mechanisms of Cranial­Facial Anomalies" at the annual meetingof the Taiwan Medical Association inNovember.LOST ALUMNIHelp us locate our lost alumni!Rush Medical School1919 Dr. Flavia May DotyDr. Halford E. Patton1920 Dr. Thomas J. AylwardUniversity of Chicago Medical School1937 Dr. Charles C. Scott1941 Dr. Frank S. Gray1948 Dr. William H. Olson1952 Lt. Col. Paul M. Grissom1966 Dr. Christopher R.' Hopps1967 Dr. Nehemiah O. NwankwoDr. William Porcher1975 Dr. William M. F. LeeDr. Miroslava Zednikova1976 Dr. Thomas Theodore PaukertPlease forward any information regarding the addresses or whereabouts of the alumni listed above to:"Lost Alumni", Room 400 Culver Hall, 1025 E. 57th Street, Chicago, lllinois 60637.29Departmental NewsAnatomyDr. Francis J. Manasek, AssociateProfessor in the Departments of Anatomy,Pediatrics, and the Committee on Develop­mental Biology, presented an invited pap­er, "Unique Characteristics of EmbryonicOutflow Tract Cell Surfaces," at theWorld Congress of Pediatric Cardiology inLondon, June 2-6. He was co-chairman ofthe scientific session on embryology.AnesthesiologyAppointments:Dr. Romeo Baltazar-Assistant ProfessorDr. Han-Min Chiu-Assistant ProfessorDr. Johanna Chookaszian-InstructorDr. Pretap S. Kurra-Assistant ProfessorDr. Byung Ho Lee-Assistant ProfessorDr. Sharlet Sheno-InstructorBen May laboratoryDr. Charles B. Huggins, Wm. B.Ogden Professor Emeritus in the Ben MayLaboratory, was awarded honorary degreesof Doctor of Science from WilmingtonCollege of Ohio, and from the Universityof Louisville, Kentucky.BiologyStuart A. and Jeanne AUmann havebeen appointed members of the board ofdirectors of the Karisoke Research Cen­ter for the study of mountain gorillas in theRepublic of Rwanda. Jeanne Altmann isacting chairperson of the board.Stuart Altmann is Professor in the De­partments of Anatomy, Biology, Commit­tee on Evolutionary Biology, and the Col­lege. Jeanne Altmann is Research Associ­ate in the Department of Biology.Biophysics & TheoreticalBiologyDr. Stuart A. Rice has been nominatedby President Carter for membership to theNational Science Board. Dr. Rice is theFrank P. Hixton Distinguished Service Pro­fessor in the James Frank Institute, andProfessor in the Departments of Chemistry,Biophysics and Theoretical Biology, andthe College.30 Emergency MedicineAppointments:Dr. David Arnow-Assistant ProfessorDr. Steven J. Koenigsknecht-AssistantProfessorDr. John R. Lumpkin, Assistant Pro­fessor in the Department of EmergencyMedicine, has been appointed to serve onthe Emergency Medical Services TaskForce'In Chicago. The Task Force will re­view and suggest revisions for the currentemergency system in Illinois and Chicago.MedicineAppointments:Dr. Michael Becker-ProfessorDr. Philip Hoffman-Assistant ProfessorDr. Eric P. Lester 'n-Assistant Profes­sorDr. Steven E. MacBride , 77-AssistantProfessorDr. Laura Mumford-Assistant ProfessorDr. Edward Shapiro-InstructorDr. David Tartof, Ph.D. '78-AssistantProfessorDr. Joseph Traube-Assistant ProfessorDr. Alan B. Weder-Assistant ProfessorDr. Michael O. Blackstone, AssistantProfessor in the Department of Medicine,lectured on "Endoscopic Diagnosis of Ear­ly Gastric Cancer" at the Seventh WarrenH. Cole Symposium sponsored by the Uni­versity of Illinois Medical Center and theCook County Graduate School of Medicinein Chicago.Dr. Victor S. Fang, Associate Professorof Medicine and Psychiatry, and Directorof the Endocrinology Laboratory, con­ducted sixteen lectures on "Progress in En­docrinology" at the Shanghai EndocrineResearch Institute. He has been chosen tobecome the first Adjunct Professor of theShanghai Second Medical College.Dr. Ernest Page, Professor in the De­partments of Medicine and Pharmacolog­ical and Physiological Sciences, has beenappointed editor of the American Journalof Physiology: Heart and Circulatory Phys­iology. The editorial offices of the journalwill move to the University of Chicagocampus January I, 1981.Dr. John W. Rippon, Associate Profes­sor in the Department of Medicine (Der­matology), Editor of Mycopathologia, andDirector of the Mycology Service Labora- tory, presented "Petriellidiosis: ClinicalSpectrum of Diseases from Mycetoma toSystemic Opportunist" at the 5th PanAmerican Conference on the Mycoses,World Health Organization in Caracas,Venezuela.Dr. Janet Rowley, (M.D. '48) Professorin the Department of Medicine, and JamesShapiro, Associate Professor in the De­partment of Microbiology, addressed theInternational Symposium on Aging andCancer (ISAC) on September 21-26, inWashington, D.C. Dr. John E. Ultmannis Vice-President of the ISAC.Dr. Arthur H. Rubenstein, Professorand Associate Chairman of the Departmentof Medicine, presented "Rationale forTight Control of Diabetes" to the SeventhSymposium on the Care of the Diabetic,September 9th, in Chicago.Eric Simmons, Dr. Clifford Gurney,(M.D.'51), Evelyn Gaston, and BarbaraMalcolm, Department of Medicine, havepresented "The Effects of Androgens orHypoxia on Hypoplastic Anemia in MiceFollowing 89Sr Administration" to the 28thannual meeting of the Radiation ResearchSociety in New Orleans, June 1-5.Dr. John E. Ultrnann has been reap­pointed by Governor James Thompson as amember of the Illinois Advisory Board ofCancer Control for a two-year term that ex­pires September 30, 1982. Dr. Ultmann isProfessor in the Department of Medicine,Associate Dean for Research Programs inthe Biological Sciences Division and Pritz­ker School of Medicine, and Director ofthe University of Chicago Cancer ResearchCenter.Obstetrics andGynecologyAppointments:Dr. Elizabeth Alenghat-InstructorDr. Michael M. Makii-InstructorDr. John Sholl '75-InstructorPathologyAppointments:Dr. Larry F. Kluskens '76-InstructorDr. Michael F. Press '77-Instructor andResidentYOUR MONEY WORKS FOR YOU... and for the University of Chicago Medical Center, too!We have a Plan whereby you cantransfer to the Medical Centercash, securities, or propertywhich has appreciated. The Uni­versity will manage the invest­ment of these assets and will payyou, or your designated benefi­ciaries, income for life. In addi­tion, you may receive significantcapital gains tax savings, a charit­able income tax deduction, andpossible estate tax and probatecost savings. And at the sametime, you'll be supporting privatemedical education and researchat the University of Chicago Med­ical Center.For more information, pleasewrite or call:Ted Hurwitz or Tom GelderOffice of Gift and Estate PlanningThe University of Chicago5757 Woodlawn AvenueChicago, Illinois 60637(312) 753-493033News BriefsSteiner Receives 1980Borden PrizeDonald F. Steiner (M.D., M.S., Bioche­mistry '56), A.N. Pritzker Professor ofBiochemistry and Medicine, and AssociateDirector of the Diabetes and ResearchTraining Center at the University of Chica­go, has recei ved the 1980 Borden A wardof the Association of American MedicalColleges for outstanding research in medi­cine by a member of a medical schoolfaculty. Dr. Steiner is honored for his workshowing that insulin is made via a series ofsingle chain precursors and the impactthese discoveries have had in the fields ofbiology and medicine.Until 1965, there was little informationregarding the biosynthesis of insulin. It hadbeen widely believed that the two chains ofinsulin were synthesized separately andthen linked together at an unidentified(post-ribosomal) site within the cell. In thatyear Dr. Steiner began his studies on thebiosynthesis of insulin in slices of an isletcell tumor removed from a patient with se­vere recurrent hypoglycemic episodes. In aseries of now classic experiments he de­monstrated that insulin was made by wayof a single chain precursor which containedthe complete insulin molecule within itsstructure.34 This protein, which he named proinsu­lin, had the B-chain of insulin at its amino­terminus, the A-chain at the carboxyl­terminus, and a connecting segment linkingthe ends of the two chains. He then pro­ceeded to demonstrate that similar biosyn­the tic mechanisms are present in normal ratbeta cells, that pro insulin crystallizes withinsulin and can be separated and purifiedfrom first crystals of the extracted hor­mone, and that fragments of proinsulinsuch as the C-peptide are retained after itsconversion to insulin. Dr. Steiner and hiscollaborators determined the amino acidsequence of bovine proinsulin and of theC-peptides of a number of species includ­ing man. This work provided sufficientpurified material for a wide variety of im­munological and biological experiments,and led to further important discoveries byhis associates, e.g., the discovery by Dr.A.H. Rubenstein that pro insulin and C­peptide are normal secretory products ofthe pancreas and circulate along with in­sulin in the blood.The impact of this work led to the sub­sequent realization that many other hor­mones and secretory proteins are made byway of larger precursors (prohormones andproproteins). The field of intracelluar pro­teolysis was significantly expanded as otherworkers explored the mechanisms involvedin the conversions of procollagens to col­lagen, proopiocortin molecules to beta­MSH, ACTH and endorphin, and theactivation of various protein toxins. The in­sulin findings also paved the way for otherexperiments which have established that anadditional sequence of amino acids is in­itially present at the amino-terminus ofthese preprohormones, and is removed asthe protein passes through the rough endo­plasmic reticulum into the cisternal space.Dr. S.J. Chan and Dr. Steiner were thefirst to show that proinsulin is preceded bysuch a precursor form which they namedpreproinsulin. Recently Drs. Chan andSteiner and their colleagues have clonedcopies of the genes the code for preproin­sulin from several sepecies including aprimitive ancestral vertebrate, the hagfish.Steiner's discovery of proinsulin is wide­ly regarded as one of the more significantdiscoveries of the past two decades. Thefollowing examples are just highlights fromthe large number of advances stemmingdirectly from Dr. Steiner's work: the signi­ficant improvement in the purity of insulin available for treatment of diabetic patients;the development of the C-peptide assay tomeasure pancreatic beta-cell function in in­sulin-dependent diabetics; the basis for rec­ognizing genetic defects (viz. familialhyperproinsulemia) in the proinsulin mole­cule of diabetics; the potential for purifyingpreproinsulin mRNA, making cDNAcopies, identifying the insulin gene and theincorporation of the preproinsulin gene intobacteria which may then make insulintogether with other proteins.These advances have profoundly influ­enced both clinical and basic research inthe fields of endocrinology and biochemis­try, as well as providing immediate andsignificant benefits for diabetic patients.Among his numerous honors, Dr. Stein­er received the 1956 University of ChicagoBorden A ward for outstanding researchduring medical training for The Formationof Antibodies in Vitro; the 1969 LillyAward of the American Diabetes Asso­ciation; the 1970 Ernst OppenheimerAward of the Endocrine Society, the 1971Gairdner Award; and the 1979 PassanoFoundation Award.Kathe CrowleyNew Student Program toAddress ChallengingIssues of Medical SchoolThis year two second-year students havedeveloped a trial program designed to helpentering students adjust to the complexitiesof life as a medical student. The program,conceived by Ron Anbar and Doriane Mil­ler and sponsored by Dr. Chase P. Kim­ball, Professor in the Departments ofPsychiatry and Medicine, will approachissues which previous classes have felt tobe challenging. It will consist of panel dis­cussions given three times during the Au­tumn Quarter by University faculty mem­bers and former interns. The panel will befollowed by small group discussions con­ducted by second-year students. The sched­ule includes the following topics: HowMedical School Affects Students-HowMedicine Affects Doctors; CulturalApproaches to Death and Dying-Students'Reactions to Anatomy Laboratory; AnimalExperimentation: Pro and Con-Its Placein Medical School.GMENAC Panel PredictsSurplus of Doctors by1990Predicting a surplus of 70,000 doctors by1990, a Graduate Medical EducationNational Advisory Committee (GMENAC)panel urged that medical schools limit en­rollments and encourage new doctors toforego glamorous surgical specialties infavor of general practice.Dr. Alvin R. Tarlov, (M.D. '56) Chair­man and Professor in the Department ofMedicine at the University of Chicago andChairman of the GMENAC advisory panel,delivered the voluminous report to Secret­ary of Health and Human Services PatriciaR. Harris on September 30."There will be substantial imbalances insome specialties," the panel predicted."There will continue to be a marked un­evenness in the geographic distribution ofphysicians. "The report stated the ratio of physiciansto population, which was 171 per 100,000in 1978, will jump to 200 per 100,000 in1990, and 247 per 100,000 in the year2000.With 67,000 students now in the na­tion's 126 medical schools, the reportadvised that no new schools should beopened; and that by 1984 the schools cutnew enrollments at least 10 percent fromthe 1978-79 class, or 17 percent from thisfall's class. This would allow approximate­ly 15,500 entering positions in 1984.The report suggested the entry of foreignmedical school graduates allowed to prac­tice in this country be severely curtailed bythe elimination of the Fifth Pathway andguaranteed student loans to U. S. citizensstudying medicine abroad.To encourage students to become pri­mary-care physicians rather than surgicalspecialists, the early phase of medicalschool should emphasize "a broad-basedclinical experience" and put "a morevigorous and imaginative emphasis ... onambulatory care."Graduates in the next decade should beurged to enter either specialties where shor­tages are expected by 1990-such as childpsychiatry, emergency medicine, preven­tive medicine, and general psychiatry; orthe primary-care fields of pediatrics, inter­nal medicine, and family practice. The panel recommended extra federalfinancial rewards, such as tax credits orhigher reimbursement rates, to encouragepractice in areas with a shortage of doc­tors. It also urged that government fees forgeneral practioners be the same as for spe­cialists, who are currently paid more.Kathe CrowleyKauvar to RunNew York CityHealth and HospitalsCorporationAbraham J. Kauvar (M.D.'39), creditedwith transforming the Denver General Hos­pital into one of the country's best muni­cipal hospitals, was named president ofNew York City's Health and HosptialsCorporation on August 8th and given amandate by Mayor Koch to restructure thecity's municipal hospital system. Dr.Kauvar accepted a three-year contract mak­ing him the state's highest-paid public of­ficial and reportedly the highest-paid muni­cipal official in the country. John V. Con­nortum, Jr., a board member, said Dr.Kauvar's high salary was justified because"New York City deserves the best and heis the best."Dr. Kauvar takes over a beleagueredmunicipal hospital bureaucracy regarded bythe Mayor as so wasteful and inefficientthat he has said he would abolish it if hecould. Since it was created ten years agoas a semi-autonomous city agency to re­place the Department of Hospitals, the cor­poration has been bitterly criticized for per- petuating the failings it was supposed tocorrect.Dr. Kauvar will enjoy more power thanany of his four predecessors who resignedunder criticism, since he will have the au­thority to choose a new cadre of top healthofficials to work under him. "I want to getthe smartest people and generate a newsense of excitement." Kauvar said. "I in­tend to get all of the medical schools be­hind us and attempt to unite the public be­hind what we want to do."Attempting to explain why he had lefthis comfortable post for the risky job inNew York, several of Dr. Kauvar's col­leagues recalled an award they created forhim three years ago on a Denver squashcourt. What makes him tough to defeat,they said, is his determination to win. Sothey gave him the first Dick ButkusAward, named for one of the most fero­cious middle linebackers ever to play pro­fessional football and given in recognitionof Dr. Kauvar's "immense determinationand bull-dog tenacity."Kathe CrowleyMedical Student/AlumniHost ProgramInauguratedThis year the Medical Alumni Associationhas developed a Student/Alumni HostProgram in an effort to broaden both theprofessional and social experiences of ourmedical students. Attempting to extend thestudent's contact beyond that of theacademic health center, active Universityof Chicago and Rush non-faculty graduatesfrom the Chicago area have been loosely"matched" with each of the 104 enteringstudents. Alumni hosts and students wereintroduced to each other at a meeting justbefore the Wine and Cheese Party of theMedical Alumni Association for the enter­ing class on November 12. Under the newprogram, the alumni hosts invite the stu­dents to visit their offices and clinics, andwhen appropriate, to participate in extra­curricular activies such as the specialevents sponsored by the medical and pro­fessional societies. Most importantly, thehosts serve as informal counsel and profes­sional friends to the freshmen. For furtherinformation about the program, contact theMedical Alumni Association at 947-5443.35Brain Stimulatorto RelieveDeepImplantedChronic PainDoctors at the University of ChicagoMedical Center are using a deep brainstimulator to alleviate chronic, intractablepain. Electrical stimulation to electrodesimplanted deep in the brain releases endor­phins, a naturally occurring substance simi­lar to morphine, but without the typicalmorphine-like side effects. Patients send asignal to the implanted electrodes via apocket-sized transmitter; endorphins are re­leased and pain is relieved in a matter ofminutes. Patients with chronic pain canfind relief without drug dependency."Many patients come to us after under­going several back operations," said Dr.Frederick Brown, neurosurgeon at the Uni­veri sty of Chicago Medical Center. "Scartissue which builds up along the spinalnerves leaves them in constant pain.Another operation will only result in addi­tional scars. If other less invasive forms oftreatment, such as physical therapy or ster­iods injected into the spine, offer no relief,a deep brain stimulator could help," hesaid. The device may also aid those in painfrom slow growing cancers, such as cancerof the breast or prostate and those withatypical facial pain.Regardless of the source of their pain,all patients must undergo at least sixmonths of traditional treatment andobservation to be certain that the pain willnot respond to other types of therapy ordiminish of its own accord. "We frequent­ly consult with psychiatrists to ensure thatthe pain is organic and not of psychologi­cal origin," Dr. Brown said.Implantation of the device takes place intwo steps. In the first procedure, four elec­trodes are precisely inserted into a prede­termined portion of the brain. The wiresand receivers are temporarily placed out­side of the body.The temporary stimulator is tested over aperiod of approximately five days duringwhich time patients are encouraged to trydifferent frequency and voltage settings onthe transmitter.If the patient responds with significantpain relief, a second operation permanentlyinstalls the device entirely under the skin.This second operation usually requires ageneral anesthetic. The wires are passed36 down through the neck and a receiver isimplanted just below the collar bone. Onlya tiny scar identifies the location of the re­ceiver.To use the device, the patient places aflat, circular disc housing an antenna overthe implanted receiver and adjusts the con­trols on the attached transmitter. Patientsneed to have the antenna in place onlywhile activating the deep brain stimulator,typically three or four times a day forfifteen minutes. At other times, when theantenna is not in use, the device is notvisible. It places no restrictions on a pa­tient's activities; he or she can even showerand swim.Just as morphine is not effective for alltypes of pain, neither are endorphins.Stroke victims and those with injuries ofthe spinal cord or other diseases of the cen­tral nervous system causing pain do not re­spond to endorphin release. Still, they canbe helped to some extent by a deep brainstimulator. In such cases, the electrodes areplaced in the thalamus, the section of thebrain where pain is registered. Instead ofreleasing endorphins, the electronic signalalters the perception of pain. Stimulation ofthe thalamus brings significant relief, up tofifty percent, but endorphin release via thedeep brain stimulator can relieve up to100% of a patient's chronic pain."The deep brain stimulator is a liberat­ing alternative to those faced with a choiceof narcotics addiction or unbearable pain,"said Dr. Brown. "Patients are often able toreturn to a full and normal life."The University of Chicago Medical Cen­ter is one of the few hospitals in the nationwhere this procedure is done and the onlyone in Chicago.Deborah MacFarlaneU. of C. to ConstructP.E.T. ScannerThrough the efforts of the Brain ResearchFoundation, an affiliate of the University,funding will be provided for a researchteam at the Medical Center to construct aP.E.T. (positron emission tomography)scanner, a diagnostic imaging device whichwill allow physicians to pinpoint and moni­tor chemical activity in the brain. The Brain Research Foundation workedin cooperation with several philanthropicorganizations to fund the project, includingThe Chicago Community Trust, the KresgeFoundation, the Field Foundationof Illinois, and the Frederick Henry PrinceTrusts.The University's P.E.T. scanner will beone of only a handful in the country andthe first in the Chicago area.In contrast to its cousin the CT scanner(computerized tomography), which is usedto detect structural changes such as tumorgrowth, the P.E.T. scanner will provide in­formation on brain function. Physiciansand scientists at the Medical Center will beusing it to study psychiatric problems be­lieved to be caused by chemical abnormali­ties, and to look at neurological diseasesthought to be related to chemical imbal­ances. Even metabolic activity associatedwith verbal skills, creativity and thethought process can be detected by the in­strument, which will help scientists mapthe location of various brain functions.Purchasing the P.E.T. scanner wouldprobably cost in excess of $1 million.However, a team of physicists, electronicsengineers and machinists from the MedicalCenter's Franklin McLean Memorial Re­search Institute (FMI) will be constructingthe instrument at an estimated cost of$650,000, based on a state-of-the-art de­sign from Washington University in St.Louis. Renovations in FMI, near the cy­clotron and radiopharmaceutical laborator­ies, will be made to house the instrumentat an estimated cost of $167,000. Con­struction is expected to require one year."The project is ideally suited for theMedical Center," according to Robert N.Beck, co-director of the P.E.T. projectwith radiologist Dr. Malcolm Cooper."We're one of the few hospitals in thecountry with a cyclotron on site and this isessential for the production of short-livedradioisotopes used in positron emissiontomography. We are also extremely fortu­nate to have the personnel capable of con­structing our own scanner," he said.P. E. T. scanning requires the patient tobe injected with a substance containing asmall amount of short-lived radioactivematerial. The substance is chosen to indi­cate the distribution of blood flow,metabolic activity or some more specificfunction of the area of the brain under in­vestigation. Such brain functions arealtered where the thought process or chem­ical imbalance occurs.An array of 288 highly sensitive cesium­fluoride crystals placed all around the pa­tient's head detects the photons emittedeach time a positron from the injected sub­stance combines with an electron from thebrain tissue. These detectors are connectedto a computer which creates a picture ofthe chemical activity. A series of theseslices taken over regular intervals can indi­cate metabolic and chemical changes asthey occur. Seven such slices will be im­aged simultaneously with the new instru­ment.Because only the short-lived radioiso­topes can be injected into the patient, acyclotron is essential to P.E.T. scanning.The FMI cyclotron produces radioisotopesof carbon, nitrogen, or oxygen byaccelerating protons or other particles in acircular path and directing them against astable target element. Since the half-life ofthese positron emitters range from two totwenty minutes, the cyclotron and P.E.T.scanner must be located near each other."The implications of P.E.T. scanning forthe future of clinical and research programsin psychiatry, neurology and biopsychologyare very exciting," Beck said. "The scan­ner will undoubtedly provide new insightsinto the brain, our most vital organ andabout which we stand to learn so much onthe basis of such direct, noninvasive According to Dr. Antel, there are be­tween five and six hundred ALS victimS inthe city of Chicago alone. "Alleviating thecramps, drooling, stiffness of limbs, andother symptoms that often accompany ALSincreases tremendously the quality of thepatient's life," Dr. Antel said. "While theaverage life expectancy for ALS victims isthree to four years, 30% of all our patientsare now living between eight and tenyears." Dr. Jack Antel is Assistant Profes­sor in the Department of Neurology at theUniversity of Chicago Medical Center.Besides providing the latest in medicalcare, the clinic will respond to the psycho­logical and social needs of the ALS pa­tient.The clinic's staff includes neurologists, anurse clinician, a physical therapist, and asocial worker, all specially trained to workwith ALS victims and their families. Theclinic will serve as a resource for commun­ity groups, personal physicians, therapists,and nurses seeking the latest informationon the disease. Dr. Antel will head theclinic.Current research projects under the su­pervision of Dr. Antel include the develop­ment of a test to predict how fast the dis­ease is progressing, investigation of possi­ble toxic agents in the blood of ALS vic­tims, isolation of growth factors in motornerve cells, and testing of mice with dis­Barbra Armaroli eased motor nerve cells.measurements. "ALS Foundation to FundMedical Center ClinicVictims of amyotrohic lateral sclerosis(ALS), (Lou Gehrig's Disease) will soonreceive care from a regional ALS Clinic atthe University of Chicago Medical Center.A $25,000 grant from the National ALSFoundation will be used to start the clinic,the second of four planned for the countryby the Foundation."ALS is one of the worst diseasesknown to mankind," said University ofChicago neurologist Dr. Jack Ante!. "Vic­tims watch themselves become paralyzed inthe prime of life, usually around age fifty.They gradually lose the use of their limbsand become unable to swallow. Althoughwe are currently caring for ALS patients,the grant will allow us to evaluate and treatlarger numbers of ALS patients and to de­velop methods to provide the best possiblecare for them," he said. "If we can learn more about normalmotor cell biology and the progression ofthe disease," said Dr. Antel, "we can bet­ter understand the effects of currentmedications and treatments, and hopefullyone day develop a cure. In the meantime,the benefits of an ALS clinic are three­fold. We will be able to provide good sup­portive care to ALS patients. The patientswill recei ve a tremendous psychologicalboost just from knowing there is a clinicestablished solely to care for them. Andpatients will have the chance to participatein an active research program which hope­fully will provide answers to some of themysteries of the disease."Deborah MacFarlane Continuing MedicalEducationDecember 1-4International Society for the Study ofHypertension in PregnancyCairo, EgyptDecember 4--4iPsychiatry Board Preparation: Part IICCEDecember 5-6Problem Solving in Gynecologic Endocri­nology and InfertilityRitz CarltonFebruary 16-20Tutorial on Neoplastic HematopathologyCCEMarch 4Ophthalmology Alumni MeetingCCEMarch 9-14Comprehensive Psychiatry ReviewCCEMarch 15-17Psychiatry Board Preparation: Part IICCEMarch 25Frontiers of MedicineProgress in CardiologyCCEFor additional information contact the Con­tinuing Medical Education Office (312)947-5646.37MAKE YOUR 1980 GIFTCOUNT DOUBLE:MEET THE KAISER CHALLENGEThis year, for every new or increased giftto the Medical Center Annual Fund loansor scholarships, the Henry J. KaiserFamily Foundation will provide up to$50,000 in matching funds. TheFoundation will contribute $1 for every$2 given for scholarships, $1 for every $3given to a loan fund, and $1 for every $4given to endowed scholarship funds;We must raise approximately $150,000 in.additional loan and scholarship funds togenerate the maximum amount ofmatching monies. The majority ofdonated funds should be received beforeDecember 31, 1980, to enable fundingfor students in the winter and springquarters of this academic year.Approximately 75% of our medicalstudents will require some level ofassistance this year. We can help meetthe financial needs of our students byrising to this challenge. Your contributionwill insure that the University of Chicagowill continue in its tradition of academicexcellence.Your Alma Mater Needs You-38 Now More Than EverThe Medical Alumni Council met for dinner at the Palmer Houseon Tuesday, July 22, 1980. Present were: Dr. Louis Cohen, Pres­ident; Randolph Seed, Secretary; Kathy Walker, ExecutiveDirector; Councillors: Robert Schmitz, David Ostrow, Jerry Seidel,and Peter Wolkonsky.Appointments were made for three committees. Randy Seedhas been appointed to chair social programs, and Peter Wolkonskyto chair educational programs for the Reunion Committee. LouisCohen and Kathy Walker were named ex-officio members. SumnerKraft has been appointed chairman of the Awards Committee.Members are Julian Rimpila and Peter Wolkonsky. Louis Cohenand Kathy Walker are ex-officio members. The Nominating Com- Alumni MinutesJuly 22 Executive Committee Meetingmittee will be chaired by Jerry Seidel. David Ostrow is a member;and ex-officio members are Louis Cohen and Kathy Walker.Mrs. Walker announced the formation of the Student/AlumniHost Program to be chaired by Dr. Cornelius Vander Laan(M.D. '44), establishing an alumni host for each entering freshmanmedical student. Letters were sent to all active Chicago area Uni­versity of Chicago and Rush Medical School graduates, asking ifthey wish to participate. The alumnus would be expected to invitethe student to his or her office and a medical society meeting, aswell as to attend Medical Alumni events.The Council agreed to hold the Alumni Reunions the week ofMay 12-15, 1981.Dobson Endows AnnualStudent PrizeDean Joseph Ceithaml receives a checkfrom Dr. Catherine L. Dobson (Rush'30) to endow the prize in her nameawarded annually to the non-Ph.D.student who makes the best oralpresentation at the Senior ScientificSession.39Medicine on the MidwayThe University of ChicagoThe Medical Alumni-AssociationThe Pritzker School of Medicine1025 East 57th StreetChicago, IL 60637•Address correction requestedReturned postage guaranteed.,Inside this IssueCornerstone Ceremoniesfor New Hospital . . . . . . .. 4Eyes on the Future 11Comprehensive Medicinein Industry: Update 16Ethical Dilemmas inthe Care of the III . _ 18 CalendarMarch 4, 1981Department of Ophthalmology AnnualAlumni Day.April 7, 1981Alumni Reception-American Coll.ege ofPhysicians, Kansas City, Missouri.April 27-30, 1981Alumni Reception-American College ofObstetricians and Gynecologists, Las Vegas,Nevada.May 12-15, 1981Medical Alumni Reunions.June 11, 1981Graduation Banquet Class of 1981.For additional information contact theMedical Alumni Office (312) 947-5443. NON-PROFIT ORG.U.S. POSTAGEPAIDPERMIT NO. 9666CHICAGO, ILL.