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Interview with Dr. Michael DeBakey
Date:  August 17, 1991 
Interviewer:  Dr. Donald A.B. Lindberg
Location:  Houston, Texas
Transcriber:  Techni-type Transcriptions/DDR



Lindberg:  I am Director of the National Library of Medicine.  It
is my privilege today to interview Dr. Michael DeBakey, who has
kindly consented to give us his views in connection with an NLM
project studying the history and legislation of Regional Medical
Programs in the United States.  
     Mike, thanks so much for taking the time to be with us.

DeBakey:  It's a pleasure to be with you again.

Lindberg:  I can see you're interrupting a usual busy schedule
today, and we really thank you for it.  
     The Regional Medical Program almost surely began with your
report to President Johnson as Chairman of the President's
Commission on Heart Disease, Cancer, and Stroke.  At least that's
what we're told.

DeBakey:  I think it did.  As you know, among the thirty-odd
recommendations that the commission made, this was one of the
major ones.  It concerned this so-called cooperative arrangement
between institutions, creating a regional network across the
whole country.  The idea behind this, of course, was to promote
better care for patients with heart disease, cancer, and stroke,
and to bring to the people the latest, you might say, medical
information as available in providing them with the management of
these three major diseases.  The idea behind it was that if we
could create regions, both geographic and population regions, in
which there existed a complex of medical institutions and at
least one major medical center, and create cooperative
arrangements among these institutions, that we would be able to
enhance the care of these patients.

Lindberg:  May I ask you some questions that only you can answer? 
I think the history bears out what you've just said.  But I
wonder.  This idea was announced by the president in the State of
the Union Address to Congress.  Incidentally, we earlier
interviewed Paul Rogers, and he pointed this out.

DeBakey:  Yes, that's right.

Lindberg:  In fact, he used the terminology I was a little bit
surprised at.  He said the president, of course, brought it back
and handed it up to the Congress.  

DeBakey:  In that connection, if I may interrupt for a moment, I
might tell you that when I first was asked by the president to
head up the commission, this was in May or June, something like
that.  He asked me how long the thing would take.  I said, "About
a year."  He said, "We've got to do better than that.  I want to
be able to include a message from this commission in my address
in January."

Lindberg:  Put the heat on you.

DeBakey:  He put the heat on us.  As a consequence, he wanted to
have the report by sometime in October.  So we had really to, in
a sense, accelerate the whole process.  Fortunately, we were able
to get good support from the president's office and through staff
that was loaned us, and I almost worked full time.  I was in
Washington most of the time working on this.  
     We divided the commission into various committees,
subcommittees, who took on responsibilities with some of the
staff people, and we were able to collect information and data
and finally to bring together the concept of the report and the
recommendations.  As a consequence, he did get the report in time
for the presidential address.

Lindberg:  And I'm sure it bore fruit.  Just to remind our
audience, we're studying Regional Medical Program at the moment. 
Another result of this very report was the creation of the
Medical Library Assistance Act and the Regional Medical Libraries
Program.

DeBakey:  Yes.  In fact, as I look back on the report, you might
say historically, I think it's probably the most important, you
might say, result of the report, because most of the other
recommendations did not bear full, complete fruit we expected. 
But the Regional Medical Libraries really, I think, flourished.

Lindberg:  That's been a wonderful thing.

DeBakey:  It certainly has.

Lindberg:  It traces its origin directly back to your report and
recommendation.

DeBakey:  Absolutely.

Lindberg:  One of the things people have commented on is the
differences that the program took on when he exited as a
presidential commission report and then the legislation.  You
made reference to this yourself.  

DeBakey:  Yes.  Unfortunately, as time went on and we began to
work with the congressional committees and their staffs to try to
hammer out legislation that would reflect the committee's
recommendations, we got into some controversial areas, largely
because organized medicine began to look upon the report as a
wedge for socialized medicine.  There was great fear at that
time, particularly, because there were individuals who felt
strongly that we should move towards socialized medicine, perhaps
even greater than exists today.  So they looked upon this as
another effort, like Medicare, to move towards socialized
medicine.  
     So compromises were made in the legislation, compromises
that I personally regretted seeing develop, but I remember so
well going to see the president myself about some of the things I
was concerned about, hoping that he would help to move the
legislation more towards what we wanted, and he said to me,
"Well, Mike, you know, it's better to get part of a loaf than get
no loaf at all."  [Laughter]  So in that sense, I guess we had to
go along with the compromises.  But I think that also is a factor
in the ultimate demise of the program.  

Lindberg:  Yes.  Monty DuVal suggested that what happened is that
there was an original focus on structures and a mechanism to
route patients, and that what emerged was legislation that really
dealt with moving information.  I hadn't thought of it quite that
way.  Is that a fair way to characterize it?

DeBakey:  I think that's a factor.  When we first conceived the
program, we wanted both.  In other words, we wanted to take care
of patients, but as we indicated in the report, we also wanted
not to interfere with the patterns of practice.  Well, it became
increasingly difficult to do both.  You either had to interfere
somewhat with the patterns of practice or you would not be able
to create or implement the concept.  But as soon as you started
interfering with the patterns of practice, then you got a lot of
objections, and that's why the compromise took place more and
more towards informational aspect, continuing education, things
of that sort.  
     As you know, [Caspar] Weinberger was very strongly opposed
virtually to the whole program.  His attitude, once he came in,
was really to get rid of it.  By that time, to be perfectly
honest with you, I really think the experience had demonstrated a
great deal of what I call bureaucratic ineptitude in the
management of it, both on the part of Washington and on the part
of the Regional Medical Programs themselves.  

Lindberg:  I'm sure it must have varied quite a bit from site to
site.

DeBakey:  Well, it did, you see.  There was a great deal of
variations.  Unfortunately, the medical schools, for the most
part, began to use it as a means of supporting their sort of core
staff.  Medical schools, as you know, always need money, and this
is a way of finding funds to support their administrative core. 
So they were using it to a large extent for that.  In fact, I
remember one report, in analyzing this, showed that about 40
percent of the funds that were being used, that were granted to
certain regions, were being used by medical schools for
administrative costs.  

Lindberg:  There's sort of an odd number in there--40, 45
percent, but that may just be the statutory overhead.

DeBakey:  I think that was a factor, no question about it. 
There's another factor that I think also interfered with the
implementation of the concept.  Over a period of about ten years,
during which the program existed in terms of legislative
authorization, the directorship of the program was interrupted by
individuals who would last only about two years.  Well, you
hardly had an opportunity, really, for the directorship to
understand and implement a program within a year and then to
resign or retire within a year, so you had four or five people
over that short period of time.

Lindberg:  Of course, you were on the Advisory Committee once it
was implemented.

DeBakey:  Yes, I was on the original committee, and we had a
great deal of difficulty in those early days, because during that
period there was a great deal of effort being made in a sense to
learn how to do it.

Lindberg:  Sure.

DeBakey:  So they were planning grants, more than anything else. 
I think that the whole concept, you see, was never fully realized
and fully understood.  With the legislation being developed the
way it was developed, the regulations, therefore, had to carry
out the legislation.  That limited, in a way, the scope of it. 

Lindberg:  It changed direction a couple of times.

DeBakey:  Yes.

Lindberg:  Changed from a categorical focus to a general focus.

DeBakey:  That's right.  Exactly.

Lindberg:  Which was the right way?

DeBakey:  Well, you see, if you go back to the original report,
you'll see that the concept of the Regional Medical Program
involved more than one institution and also more than one, you
might say, philosophic concept of how to carry it out.  The
concept originally, as developed in the report, involved not only
a regional group of institutions, but in addition to that they
were supposed to have diagnostic stations, they were supposed to
have centers of excellence, they were supposed to have
developmental grants.  All of these things never got into it.  So
in a way, the Regional Medical Program, as it was legislated and
implemented, never carried out the concept which the report
originally described.  

Lindberg:  No, it was quite different.

DeBakey:  We even indicated that number of geographic regions. 
That never was carried out at all.  In each region, the idea was
to have a center of excellence which would have all of the best
technology, the best facilities, the best personnel, the best
training, and then surround that center of excellence with
individual diagnostic stations and even station hospitals, so to
speak, which would relate to the center of excellence for the
more highly technical work.  That never came about.

Lindberg:  Mike, is M.D. Anderson an example of the sort of thing
you had in mind?

DeBakey:  Yes.  M.D. Anderson is an example of what we had in
mind, you see, and is, in that sense, a center of excellence in
carrying out the concept.  Unfortunately, as you look around the
country, you have very few.  The reason, of course, is that the
legislation never authorized them.  

Lindberg:  Categorically ruled out building of any kind, didn't
it?

DeBakey:  You see, part of the problem also, in a situation like
this, I guess you could expect it, but there were also turf
problems.  The different institutions--National Institutes of
Health--never really supported the concept.

Lindberg:  Is that why it got moved over to HSHMA?

DeBakey:  I think part of the reason it got moved was because it
was considered--and I remember fighting this myself because I
wanted it at NIH--a program which did not, in a sense, concern
itself primarily with research.  Now, you see, if you look back
at the report, you'll see that that was a basic aspect of it. 
Clinical investigation was the basic aspect of the program, and
yet Jim Shannon did not think it belonged in the NIH, just like
he didn't think the library belonged in NIH.  So we never got the
support, and the institutes themselves, the directors of the
various institutes, never liked the program because they thought
it, in a sense, overlapped some of their areas of concern and
interest.

Lindberg:  You were definitely shaking the cage, everybody's
cage.

DeBakey:  That's right.  [Laughter]  Well, unfortunately, the
concept, as we envisioned it, never was implemented.  Legislation
which was supposed to reflect it never did completely reflect it,
and then it got into all kinds of bureaucratic difficulties, as
well as adversaries outside of the realm of the bureaucracy that
imposed their will on it.

Lindberg:  Even though different from the report, the programs
had some merit.  Can you think of any good achievements of RMP?

DeBakey:  Well, I think there were a number of things that came
out of it that were worthwhile. For example, you take the
widespread stature of the coronary intensive care units.  That
really came directly out of the RMP program.  That's a good
example.  I would say that the Cancer Institute's program largely
was developed as a consequence of this report.  Even though the
Regional Medical Program failed, the Cancer Institute took off
and adopted many of these recommendations.  So there were some
good things that came out of it.  And, of course, the Regional
Medical Libraries.  
     But the Regional Medical Program, I really believe--and I
became, myself, disenchanted with it by the time I finished my
service on the Advisory Council.  I was pretty well disenchanted
by the way it was going, and I'm sure a good part of it was due
to the fact that the concept, as we envisioned it, was never
fully implemented.

Lindberg:  Do you think it would have been possible to execute a
successful program, given the legislative background, or do you
think it was kind of doomed from birth, so to speak?

DeBakey:  I think it may have been possible had we been perhaps a
little more specific in terms of our recommendation particularly
for the concept and in terms of its implementation, rather than
try to get the whole country to do the thing at one time.

Lindberg:  Try a model.

DeBakey:  Try a model.  Exactly.  Try to set up some models and
try to learn how to do it.  You've got to remember that this came
as a new concept.  The center concept was not new.  A large part
of the center concept really was derived from my experience in
World War II when we were forced to find ways and means of using
our scarce personnel more efficiently.  By creating centers, we
were able to do that.  They were so successful that when the war
ended, many of us who had had this experience in World War II
became convinced this is the way to go.  So we immediately set up
centers in our various activities, particularly as the
developments from research expanded our knowledge in terms of
taking care of patients.  We needed to have intensive care units,
for example, in the centers, both for surgery as well as for--

Lindberg:  One of the elements that both the report and the
legislation stresses is the so-called gap between the laboratory
and the bedside, what's known and then the way it's actually
practiced.

DeBakey:  Well, as you know, we still have that gap.  I don't
think it's as bad now as it was, largely because of the library. 
But part of the reasons for the gap is the lack, in a sense, of
the information getting out to the doctors in practice in time. 
I mean, in time they do get it, but there is a gap between the
time it becomes available and the time it is being fully
practiced.  It takes a certain amount of time for that to filter
out.  We were trying to enhance and accelerate that and get it
out faster.  The Regional Medical Program concept would have done
that, but, unfortunately, there were concerns about its impact
upon the patterns of practice.  
     Now, I think if you look back and sort of review the
patterns of practices that have taken place, you'll see that to
some extent we have adopted those patterns of practice.

Lindberg:  Absolutely.

DeBakey:  So in a sense, we have gradually moved into Regional
Medical Programs.  In each region of the country now, certainly
in each geographical population region of the country, there are
centers of excellence.

Lindberg:  Yes.  It may have been an idea a little bit ahead of
its time.  

DeBakey:  Yes.  [Laughter]

Lindberg:  You've played with quite a few of them.  

DeBakey:  Yes.  Yes.

Lindberg:  Can I ask you one other question that again only you
can answer?  This is a transcript of interviews that you gave
back in 1969 at the LBJ Library in Texas.  In reading over that
transcript, I found a fascinating piece of information about the
program that you did and a committee for President Jack Kennedy
on heart disease and cancer, and then you stated in this
interview with you delivered the report to them and picked the
Bay of Pigs day to deliver the report.  [Laughter]  That must
have been a mess.  

DeBakey:  Well, President Kennedy asked us to give him a report
on that particular day.  We had finished our report and we were
ready to give it to him, and he wanted to personally get it and
have the television there.  I remember we met in the old Hay
Adams Hotel, the committee did, and we waited to get the word to
come over.  We waited and waited, and finally we did get the word
to come on over.  So we went into the White House where the press
usually has its--I've forgotten the name of that particular
room--and we sat there and waited and waited.  After a while
somebody came in and said, "President Kennedy wants to express
his regrets in being delayed meeting with you, but if you'll be
kind enough to wait, he's busy with matters of an urgent nature." 
We didn't know at the time about the Bay of Pigs until later.  So
we kept waiting and waiting, and finally we'd been there two or
three hours. In the meantime, we had waited at the Hay Adams for
several hours.  Finally, someone came in.

Lindberg:  I suppose they were selling newspapers on the street
by then.  [Laughter]

DeBakey:  He said he was sorry that the president would have to
cancel his meeting with us, so we left the report, you see. 
Never heard another word.  [Laughter]  And that was the end of
it.

Lindberg:  Where does one get a copy of this report nowadays?

DeBakey:  Gee, I must have a copy somewhere in my files.  Yes, I
have a copy of it somewhere.

Lindberg:  Does it resemble this one at all or the embryonic
version of it?

DeBakey:  No, it's nowhere near.  In the first place, it was not
published like this.  It was in loose-leaf form, and it was, I
think, Xeroxed, if I remember correctly.

Lindberg:  But were the ideas along the same line?

DeBakey:  Pretty well.  

Lindberg:  But you'd be off and running, anyway.

DeBakey:  This included, I would say, an expansion of the
concepts, but it did have some of the concepts we have here, yes.

Lindberg:  I think to get this out in less than a year is
remarkable under any circumstances.

DeBakey:  Yes.  You know, this is the condensed version of the
report.  As you know, we have a thick part that includes all the
data and the materials that backs up those.  

Lindberg:  A good way to do it.

DeBakey:  Yes.  We knew if we gave them a report that big, nobody
would look at it.  But giving them a report like this, they could
at least quickly go through it.  No, that was an interesting
experience with President Kennedy.  I don't know whether it's in
here or not, but in Medicare--I think that was referred to in
here--when President Kennedy was trying to get Medicare through,
he--

Lindberg:  He wanted you to rally some medical groups.

DeBakey:  Yes, that's right.  I've forgotten whether it's Doug
Cater [phonetic], one of his executive assistants.  I think it
was Doug Cater called me on the phone.  Of course, they knew that
I was supportive of Medicare, and asked would I call some friends
of mine in surgery, professors of medicine and surgery, around
the country and see if I could get fifteen or twenty of them to
join with me to meet with the president in the Rose Garden, and
he would like to have a press conference with television to
counter the AMA's assertion that there was nobody, no medical
people, supporting Medicare.  So I called twenty, twenty-five
friends of mine across the country--professors--and not a single
one of them could come.  Each one of them had something and
couldn't possibly make it on that day.  So I showed up.  I called
Doug Cater and said, "I can't get anybody to come."

Lindberg:  A one-man army.

DeBakey:  Yes.  He had about eight or ten people there, but I was
the only practicing doctor.  [Laughter]  So I stood out like a
sore thumb.  You can imagine.

Lindberg:  You didn't wear scrubs for that occasion, though, did
you?  [Laughter]

DeBakey:  No.  I was in a suit, a regular suit.  I really felt
embarrassed, though, to have to tell him that I couldn't get any
of my friends to show up.  They were all afraid to do it.

Lindberg:  Sure.

DeBakey:  Amazing, really.  And you know, it's interesting.  They
would say to me, "I'm supporting it.  I think it's a good thing,
but, unfortunately . . ."

Lindberg:  "We're behind you.  Way behind you."  [Laughter]

DeBakey:  Way behind you.  [Laughter]  That's exactly right.  

Lindberg:  Mike, some of the people on this commission, it's an
extraordinary set of names.  I wonder if you'd share any
reminiscences about some of these amazing people on here.  For
instance, Florence Mahoney.  She's still presiding grandly in
Washington.

DeBakey:  Yes.  Florence Mahoney was--

Lindberg:  A good participant?

DeBakey:  A very good participant and really took an active role. 
Also, after this report was submitted, one of the good things
that happened, in contrast to what happened when we presented the
Kennedy report and then never heard any more about it, was the
fact that both the president supported it and, secondly, that we
were able to get some congressional leaders to support it.  So as
a consequence, we took advantage of some of the names that you
see here.

Lindberg:  Was Charlie Mayo a good participant?

DeBakey:  He was not necessary a good participant, but he did
support it and he helped in the lobbying, you see.

Lindberg:  That's good.

DeBakey:  And Mahoney was very good at that, you see.  Lee Clark
was very active, both in lobbying and in participating in the
report.  Ed Dempsey was very active.  Sidney Farber, extremely
active, very strong supporter.

Lindberg:  We've tried to get an interview with Dr. Dempsey, but
unfortunately he's just deceased.  We were a little bit too late.

DeBakey:  Yes, I heard he died. 

Lindberg:  I understand that he actually helped translate some of
this report to legislative language.

DeBakey:  That's exactly right.  He did.

Lindberg:  So it would have been a wonderful opportunity.  

DeBakey:  He was a very fine person, very helpful.  Sidney was,
too.  Sidney was very strong.  Dr. Fay was helpful, but not as
strong about it.  Mr. Folsum, I must say, really did help a great
deal.  And Foote, as you know, wrote a section of the
communication.  He was very, very helpful because of his
expertise in public relations.  He was a member of a very
successful public relations firm in New York and, as you know,
wrote the section dealing with--

Lindberg:  Foote Cohen Belding.

DeBakey:  That's right.

Lindberg:  He writes marvelously, and we're glad to know that's
who he really is.

DeBakey:  Exactly.

Lindberg:  Well, you have a star-spangled cast of characters.

DeBakey:  WE had an excellent--

Lindberg:  Mrs. Truman.  Did she show up at any of the meetings?

DeBakey:  No, but she was ill part of that while, too.  But she
supported it, and I think some of these names gave their moral
support more than anything else.  Phil Handler, even though he
was a basic scientist, was supportive.

Lindberg:  Was he president of the National Academy?

DeBakey:  Yes, that's right, and he came to the meetings pretty
regularly.  Arthur Harnish happened to be a patient of mine.  He
was head of a large pharmaceutical firm in California, but took a
very active role in supporting this.

Lindberg:  I understand that some of the California people sort
of staffed the commission.

DeBakey:  Yes.  And you know, they were quite active in the early
days for the establishment of the program.  They quickly got into
it and developed regional programs.

Lindberg:  Why is that?  Did the ideas fit their own?

DeBakey:  I think so.  I think so.  The medical schools in
California, as you know, took quite an active role in the
program.  Willis Herse was very active.  Dr. Hugh Hussey, who
represented the AMA at the time, was on it and was helpful,
although from time to time he had to strike a blow, so to speak,
for the AMA.  But we finally won him over in terms of--

Lindberg:  Did you encounter Bill Ruhe at that time?  He would, I
suppose, have been younger than Dr. Hussey, and Dr. Ruhe has
written some notes about this and remembrances of the time.

DeBakey:  Yes.

Lindberg:  I wonder did he come to any of the meetings or would
it have been at that level?  

DeBakey:  Yes, but I don't remember the activities that he was
involved in.

Lindberg:  I suppose this was broken in groups, as well.

DeBakey:  Oh, yes, sure.  We had subcommittees.  John Meyer was
reasonably active, particularly in the stroke area.  Manny Papeau
was very active.  Howard Rusk, in the rehabilitation area.  Paul
Sanga, he was a surgeon from North Carolina.  He was quite
active.  Sonoff was not active at all.  Taussig came to one or
two meetings and generally, as I say, was not particularly
active.  Irving Wright was very active and wrote part of the
section.  
     Then the staff, I can't tell you how much support we got
from the staff.  They were excellent, a very, very good staff. 
WE were lucky in a way.

Lindberg:  I think I just encountered a taped interview somebody
else did, and I think he mentioning this man, Dr. Mahoney.  

DeBakey:  Yes, he's a cardiologist.

Lindberg:  He's a California person.

DeBakey:  He's in California now, yes.  He's on the faculty, I
think at UCLA.

Lindberg:  Roger Egeberg was speaking about him.  He had helped
them establish the California Regional Medical Program.

DeBakey:  Yes, he took quite an active role, no question about
it.  But every one of these people were very active in the
staffing of the reports, because we had to accelerate our whole
effort to try to get this in to him by October or November.

Lindberg:  I'm sure of that.

DeBakey:  WE had less than six months to work on the whole thing. 
You see, what we would do, we'd prepare segments of the report
and go over them and send them to everybody, send copies, and
then at the next meeting of the full group, we would have maybe
two- or three-day sessions to try to work it all out.

Lindberg:  Several people who were experienced in these programs
have commented that they thought in some respects the best
functions of RMP were planning, the convener function, bringing
together all the different elements in medicine in an area to
work together for a common cause.

DeBakey:  I think in many respects, in looking back, as you can
see, you've got some strong personalities here, and not all of
these people were, you might say, liberal minded.  

Lindberg:  Sure.

DeBakey:  Some of them took a rather conservative attitude
towards it.  SO you had to overcome a lot of this.  You know,
when the report was finally made, we had absolutely unanimous
approval.  

Lindberg:  A lot to attribute to its chair.

DeBakey:  There was nobody that--they could have easily said,
"Well, I'd like to put in a minority," but they didn't.  Nobody
did.  They all supported it.  When we presented it to the
president, most of the members of the commission were present at
the time of presentation.  So when I presented it to the
president, I gave him a briefing, a very rapid briefing, of the
report, I said to him--first I thanked the staff and I wanted to
thank him for allowing us to have such a wonderful staff, and
then I expressed my appreciation to all the members of the
commission.  I said, "I would like to have an opportunity for any
of these people to speak their minds."  I think everybody that
did speak up thanked the president for the opportunity they
enjoyed in having been on the commission and in making this
report.  SO the president got the feeling the commission was
giving him a unanimous report, enthusiastic.

Lindberg:  How did he handle it?  Was it at the Rose Garden or
Oval Office?

DeBakey:  In fact, I don't know whether you remember the story,
but they tell this story.  [Unclear] tells this story.  He was--

Lindberg:  Oh, that's the Duke of Windsor.

DeBakey:  Yes.  That was when I was up there to get the--

Lindberg:  Maybe you should tell our audience.

DeBakey:  You see, what happened was he called me to tell me he
wanted me to do this, and at the time, the timing that I was
supposed to see him, he was on the phone, so he said, "If you
don't mind waiting."  So while I was waiting outside the Oval
Office, somebody came in and said, "There's a call from New York. 
A doctor wants to talk to you about the Duke of Windsor, who
needs an operation that he wants you to do for him.  Could you
come and take it?"
     SO I went to the telephone to get it.  In the meantime, the
president finished his call and was waiting for me.  [Laughter] 
SO they tell the story that I kept the president waiting.  I did
express to him--I told him what had happened, and he laughed.  
     You know, I must say this about President Johnson.  When we
gave him this report--and he was very good at this--on a one-to-
one basis, you know, he actually charmed you.

Lindberg:  I'm sure.

DeBakey:  And when we gave him this report, he expressed to all
these people his appreciation for what they were doing for the
American people, things of that sort, you know.  He had them all
just completely charmed, absolutely.  WE met with him for about
fifteen, twenty minutes, something like that.  He also gave us
the feeling he was not in any great hurry.  He was just relaxed
and he wasn't pushing the time.

Lindberg:  That's bedside manner.  [Laughter]

DeBakey:  Yes, absolutely.  He was very good at that.  He really
was.  In all of my dealings with him, he was.  And he didn't
hesitate at all.  He'd get on the phone and once in a while I'd
get a call from him, and he'd be calling me about some matter. 
One time he got on the phone to give me hell, because he had
heard I had just testified before one of the appropriations
committees, and he said, "Mike, what are you doing busting my
budget?"   
     I said, "What do you mean?"
     He said, "Well, I just heard that you came up before the
appropriations committee and asked that more money be given to
this research program."
     I said, "Well, Mr. President, I was just trying to indicate
to them my set of priorities, that's all."  [Laughter]  He
laughed.

Lindberg:  Can't hit a guy for trying, huh?

DeBakey:  Yes.  But he was very, very, very good at charming you
and making you do what he wanted you to do.  

Lindberg:  You make the point in the interview you did at the LBJ
Library that he had actually a longstanding in health.  I think
most people don't realize that.

DeBakey:  No.  That's exactly true.  If you look at the health
legislation that was passed during his administration, you'll see
that he passed through Congress more health legislation than all
other presidents put together.  

Lindberg:  That's remarkable.

DeBakey:  So he did have a longstanding interest in health.  He
was really very much concerned with the average citizen and
making sure that they could get as good health care as possible. 
He was a great believer that your health was a very important
aspect.  As you remember, the one statesman that stands out in
that regard was [Benjamin] Disraeli when he made the point that
all the powers and capabilities of the state is dependent upon
the health of the paper.  Most statesmen have never concerned
themselves, you might say, as much certainly with health matters
as President Johnson.  With all due respect to Nixon, who also
had a health problem--and you see I've got his picture up there--
he really . . .

Lindberg:  One of many pictures.

DeBakey:  He really didn't give health a great priority.

Lindberg:  No, certainly not.  

DeBakey:  If you look back, most of the presidents didn't. 
Eisenhower didn't give it any priority at all.  I remember one
time I went to see him with Sidney Farber, as a matter of fact,
to try to get him to support more research funds.  He turned us
over.  He was very polite, but he almost indicated he was not
interested.  He said, "I don't know anything about that.  You see
my aide."  He turned us over to one of his aides who happened to
be at one time in the Army.  We knew him, a fellow by the name of
Snyder, who had no more interest in supporting research than a
man in the moon, didn't know anything about research.  
     So I think President Johnson had greater interest in health,
but I don't think it was because of his personal health problems,
even though he did have them.  All the presidents have had
personal health problems.  I think it was because of his sort of
general philosophy.  As you know, he came from a very poor family
and he was very much concerned about poor people and their
ability to have good health, and I think sincerely so.

Lindberg:  I thought that's what RMP was all about, myself.

DeBakey:  That's exactly what he was trying to do here.  He
embraced the program thoroughly.  

Lindberg:  Mike, what are the lessons for the future?  Once again
the country is seriously considering major health legislation. 
What can we learn from this experience?

DeBakey:  I think one of the things we should learn from this
experience is that once a program is evolved, develops, it's very
important to try to keep it directed along the lines of its
initial conception if it has good basis, if it's intellectually
developed properly.  
     The second thing that I think is important is that the
planning for the legislation be very thoroughly developed to make
sure that the legislation does reflect the program and not allow
compromises to, in a sense, erode the program's integrity,
because this is what happens.  
     You see, right now we are in a very difficult situation
largely because both the Congress and the administration are at
odds about a health policy.  With cost containment being so
firmly in the minds of both the administration and members of
Congress, it's going to be extremely difficult to develop a
program that I think is both intellectually sound and efficient
and effective.  If you allow cost containment to be the primary
factor in designing a program, you're going to reduce the
accessibility of care, not increase it.

Lindberg:  Sure.

DeBakey:  And you're going to make it more inefficient.  The
quality of care is bound to go down.

Lindberg:  Do you think it's possible to do experiments on a
regional basis?

DeBakey:  Well, I think it is, yes.  In fact, to some extent, you
might say, some states are trying their best to develop
priorities for the use of funds for care.  But they're not, in my
opinion, taking advantage of the existing facilities and
personnel.

Lindberg:  Like that helicopter taking off, that would have been
just a dream when we were [unclear].

DeBakey:  Exactly.  That's right.

Lindberg:  All the Emergency Medical Service centering around
this center, reaching out, I suppose, probably all over the
state.

DeBakey:  It has a radius about a little over 200 miles.  I think
an experimental program, with modification of this concept, would
be very worthwhile doing.

Lindberg:  It sounds like we can't afford an experiment
countrywide, but maybe regionally.

DeBakey:  You take, for example, here's a medical center.  We
have in this medical center enough in the way of resources to
take care of a great deal more patients than we're taking care
of.  We could bring into this medical center, particularly for
the high technology and the high risk patients, a lot more
patients to take care of within this medical center.  We've got
over 4,000 beds in this medical center.  

Lindberg:  What percentage occupancy?

DeBakey:  Well, the true occupancy is way down, way down.  And
the reason for that is that the way Medicare and the way the
insurance or third-party payers have forced the hospitals to
reduce their bed occupancy.  In other words, we have, for
example, in this hospital now, at the Methodist Hospital, the
capacity for 1,500 beds, but we're actually operating 800 beds,
almost half.  The reason for that is that if we tried to operate
the approximately 1,500 beds, they would go broke, you see,
because they cannot possibly take care of these patients on the
basis of the Medicare payments, which is about 75 percent of what
it costs.  
     I don't know whether you saw the program not long ago on
"Prime Time" about the Humana Hospital.  I didn't see the whole
program; I saw part of it, but I read about it.  What they did
was to take the hospital of Humana in Louisville, which is one of
the better hospitals, and they showed the cost of various drugs,
various instruments that they use, various syringes, needles, and
so on, and the mark-up on the cost of these was anywhere from
1,000 to over 2,000 or 3,000 percent.  One needle, for example,
that is used in an operating room costs about $80; the mark-up on
it charged to the patient was $450.  Things like that.  
     Well, one of the reasons for this is that this is the only
way they can make a profit.  Humana makes about a 15 percent
profit.  But here in this hospital the same thing is taking
place.  They're doing mark-ups in order to take care of the
losses.  Well, that's a very inefficient way to run the system,
and in a way it's not an honest way to do it.  
     I think something along the lines of the concept of the
Regional Medical Program, but allowing the region or that area to
develop and agree upon the--well, I'll show you what I mean.  We
have open heart surgery in this hospital as one of our centers of
excellence.  We have ten operating rooms for open heart surgery. 
We do, on the average, anywhere from twenty-five to thirty a day. 
We could easily double that.  We have the resources to do it. 
Yet all around us there are peripheral hospitals that are doing
open heart surgery very poorly, but nonetheless doing it, and at
the same time increasing the cost, very inefficiently done.  You
see?  Well, within just this region.  So you could increase the
efficiency and the quality at the same time, decreasing the cost
by bringing those patients to the medical center instead of
having them done on the periphery, where they will do one, two,
or three cases a week and can't possibly do good work.

Lindberg:  In the category of making the world rational.

DeBakey:  That's exactly right.  That's the problem.  

Lindberg:  Mike, I thank you for taking the time with us, and I
must personally express my admiration to you for the wonderful
contributions you've made to modern medicine, particularly your
kindness to the National Library of Medicine.

DeBakey:  Thank you very much.  It's been a real pleasure.  One
of the great satisfactions that came out of the program is what
we've been able to do with the library.  I think it's remarkable,
it really is.  

[End of interview]
                           Addendum to Interview

DeBakey:  If you go back to that period, we were pretty well
developed in terms of cardiovascular surgery, whereas prior to,
let's say, 1953, there was very little in the way of
cardiovascular surgery.  So that patients with coronary disease,
patients with aneurysms of the aorta, were simply allowed to die. 
There was nothing you could do for them, you see. 
     By the middle of the sixties, we had accumulated enough
experience to establish the fact that we were able to change the
course of these diseases and to relieve patients of their
suffering and to make them survive from a deadly disease,
including many of the congenital diseases and so on.  
     So we had definite evidence that we could do this.  However,
patients were still dying of ruptured aneurysms of the aorta, as
an example.  The gap existed between where the centers were doing
this work and out in the periphery, doctors in practice not
picking up patients who had these diseases, and referring them
for operation.  So there was a gap in the knowledge available to
treat patients and the patients who were being treated by doctors
who did not have that knowledge.  That's what we called the gap.

Q:  What has happened?

DeBakey:  I think the gap has been reduced and contracted
considerably, because information now is more readily available
and actually gets out to the doctors more quickly than it has in
the past, to some extent because of the National Library of
Medicine and what it has done.  No question about that.  You take
med laws [phonetic] and other means of communication and
information availability for doctors, this has made a tremendous
difference.  
     Secondly, the continuing educational processes have greatly
been accelerated.  So I think while there's still a gap, it's
more in the area of--you take, as an illustration, right now
there's a gap in the knowledge about the risk factors, and the
doctors utilizing those risk factors in the care of their
patients in prevention.  All the studies would indicate, from the
standpoint of polls and so on, perhaps no more than 50 percent of
the doctors are really truly carrying out risk factor prevention
and maintenance.  There's obviously a gap, you see.  

Q:  The fact that we've closed the gap a little bit, can you give
an input to the Regional Medical Programs, brief though they
were?

DeBakey:  I don't think there's any question that one of the
Regional Medical Programs' associated contributions was the
regional medical libraries, because it came out of the same
report.  That undoubtedly had an influence upon this gap.  

Q:  I'll skip the question of how do you feel about the
dismantling of the RMPs by the Nixon administration in 1973. 
[Laughter]

DeBakey:  Of course, I must say I have to indicate that I was of
two minds about it, almost split personality about it.  First, I
was disappointed that it was abandoned, so it stopped completely. 
But on the other hand, I had to agree that the way it was going
was not good at all and wasn't effective.  So while I was
disappointed it was stopped, at the same time I felt very
strongly that there was a need to change it, because the way it
was going was not effective at all.  In fact, in some respects I
thought the money was being wasted.

Q:  How do you feel about the repackaging of RMP?

DeBakey:  I think that there is a need for, yes, some form of
modification of the program for current developments and for
current needs.  I think we're in the process of trying to develop
a health policy right now.  I think to meet the needs of the
population for good medical care, we're going to have to set up
something like this.  To some extent, you see, we have in place a
form of Regional Medical Program.  Unfortunately, it's not well
structured.  It varies greatly in different parts of the country. 
In some areas, it's very well done.  In other areas, it's very
poorly done.  So there is, I think, a need to reconsider
something along these lines in the development of a health
policy.

Q:  Cut.  Send a copy of that to Teddy Kennedy.  [Laughter]

[End of recording]