1998 Larson Lecture

Senator Mark O. Hatfield
Roger G. Larson Memorial Lecture
American Hospital Association
February 2, 1998
Washington, DC

I. Introduction
It's wonderful being back in Washington and driving by the Capitol as a sightseer… liberation is invigorating.

Since leaving Washington a year ago, I have had the privilege of resuming my life as a private citizen. President Truman said, upon leaving office in 1953, that it was the happiest day of his life because he was being elevated back to the rank of private citizen. My title these days is professor.

I am very pleased to be a part of your program, which honors one of Oregon's own-John King-as AHA's new Chairman of the Board of Trustees. In addition, having the opportunity to remember the contributions of Roger G. Larson is an honor; he was also from my home state, and today's lecture was established in his name to present important issues impacting health care systems to health care professionals.

Oregon, like many of the states you represent, has a rich history of lending excellent health care professionals to the public good. This year, if I may brag for a moment, marks a high point for us as four Oregonians are inducted into national leadership positions in health care: joining John King is Dr. Peter Kohler, the next chairman of the Association of Academic Health Centers; Tim Goldfarb, the next chairman of the Council of Teaching Hospitals and Health Systems, both from the Oregon Health Sciences University; and Dr. Thomas Reardon, chairman of the American Medical Association. Now that is a quadrant of power!

II. Historical Perspective of Hospital
As I thought about joining you today, I recalled the first frontier of medical treatment was homes. Hospitals originally were informal affairs-homes were converted into hospitals. In fact, the word hospital comes from the Latin word hospitalis, which means house for guests.

The early hospitals didn't necessarily save lives-patients who did not die from the shock of surgery often died of postoperative infections.

  • When I was a child, my grandmother used to tell me about President Garfield's assassination. The President was shot in July of 1881, but did not die immediately of his gunshot wounds. He died two months later, in September, from the infection caused by the doctor's probes for the bullet.
  • Hand washing was a relatively new idea-it did not become commonplace in surgery until the late 1800s.
  • We did not have access to penicillin-now our major tool for combating infections.

Today's frontier of medicine is in community-based hospitals and health care systems that treat people and send them back to their loved ones to recover. The delivery of treatment has changed.

  • In the past, patients stayed two-to-three weeks in the hospital. Today, they usually stay less than three days, and more than half of all activity is outpatient.
  • Early diseases: measles, smallpox, tapeworm, diphtheria, and whooping cough. Today, major work is childbirth, cataracts, and wellness activities.

III. Quality of Care Depends on Medical Research
Whether in our homes years ago or in the modern hospitals of today, the quality of care we deliver in health care is driven by medical research. Research produces better treatments and cures, while advances in telecommunications give us new health care delivery options we have only dreamed of previously.

The results of medical research have cured dreaded diseases like childhood leukemia and polio.

  • Former Oregon Senator Richard Neuberger died of testicular cancer in 1960. Now the disease is 95 percent curable.

I have devoted a major part of my public life to advocating for increased resources for medical research. It gives me great pleasure to see hospitals like those in Oregon, which are the modern "homes" in which the best treatments we have today are delivered. We must continue to make sure that we provide the tools by which our medical profession can make people well particularly in light of the financial pressures driving the restructuring of health care delivery. The essence of an improved quality of life comes from finding answers for diseases and easing the suffering of those who are ailing.

Funding for medical research was one of my top priorities while I served in Congress. It is one of the few areas that the federal government does very well-in fact creating a medical research enterprise that is the envy of the world at the National Institutes of Health.

But funding for medical research in America is under long-term threat. While at the moment the horizon looks bright for increased federal spending, the dollars likely to come from Congress do not come close to matching the opportunity that exists in science today. Currently, fewer than 20 percent of research projects deemed worthwhile by the National Institutes of Health can actually be funded. Not too long ago, the percentage was 50 percent, which translates into a significant gap of research not being done.

Congress provided a strong 7.1 percent increase for the NIH last year, and both Republicans and Democrats seem to be headed to agreeing that the same level of increase can be accommodated this year. But to meet the level of scientific need, we need increases of 15 percent a year-a figure that would double the NIH budget in five years. This may be possible if the predicted budget surpluses emerge and/or the tobacco settlement becomes real money to the federal government, but the competition for these funds will be fierce.

IV. Add Your Voices to the Debate
I call upon you, the hospital and health system industry, to join the battle for more medical research. Even though managed care and a growingly competitive health care market argue against an investment in a long-term endeavor like research, add your voice to the debate. Become partners with the citizen advocates who have cancer, rare diseases, sleep disorders. This is an issue that cross cuts all segments of the health care industry and needs every partner to advocate.

We need a national disease defense buildup similar to the national defense buildup we saw during the Reagan years. For far less cost that our military arsenal, we can stage a full-on war against microbes and emerging diseases with no known cures. Most of these are breaking through in the international scene, but we all know it is just a matter of time before they arrive on our shores. We are beginning to see that our weapons for standard infections, for example, are not as effective on some of these new foes.

V. Funding First
I am continuing my work in this area by chairing a three-year campaign designed to increase the national commitment to medical research. Called Funding First, this effort was launched by the Albert and Mary Woodard Lasker Foundation in tribute to Mary-the mother of medical research. Mary was a philanthropist in New York who had many resources of her own, but she spent her time and influence urging Congress to find the cure for cancer. As a result of her efforts, the National Cancer Institute now exists and is one of the top three funded research institutes in the country receiving over $1 billion in federal funds.

My work with Funding First focuses on the long-term future for medical research funding and has three primary goals:

  1. Building the economic case. Currently we know that for every dollar invested in medical research, $13 is saved in the economy. This is one of the best returns on federal investment I saw in my entire congressional career, if not the best. But this figure has not been updated for many years. Funding First will make the case in today's dollars. Once the data have been developed, it will serve as the basis for our public outreach effort to educate the public, the media, and policy makers about the threats and opportunities to this field.
  2. Increasing the pool of leadership spokespersons. We intend to "grow" a pool of new high-profile leaders from nontraditional sectors to attract new support to medical research and bring attention from new audiences. We must tell our stories and inspire policy makers to keep providing hope to our families by searching for the cures on the horizon.
  3. Developing a long-term funding model. We will sponsor forums to consider the options that may exist to take funding for medical research beyond the annual appropriations process. We will look for opportunities to partner with policy makers to achieve a longer-term solution.

Together, we can ensure that disease and disability take on a minority status in this country. I would be amazed if there were a person in this crowd who had not watched a loved one suffer from a debilitating disease, or who had not lost a friend or an associate to disability. These scars are not easily healed, but through our suffering we had the hope that a cure could be found through research. For the over 3,000 orphan diseases in this country, where no registry or research project exists, hopelessness and despair accompany the ravages of disease. Medical science provides our hope.

It has been said that Mary Lasker used to whisper in the right ears … the whisper now needs to come from all of us across the spectrum of health care. Let us count on you and your health systems as full partners.



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