American Journai of
Obstetrics and Gynecology volume 122
number 2
MAY
15, 1975
Transactions of the Forty-second Annual Meeting of the Central Association of Obstetricians and Gynecologists
The abundant life Presidential address
RUSSELL
J.
PAALMAN, M.D., M.S.
Grand Rapids, Michigan
I N 1 9 2 9 , a high school classmate of mine wrote a short poem entitled "Pessimist." 1
this room have a lifelong devotion to relieving the wants and miseries of women. Certainly the annals and accomplishments of the Central Association speak to this point. By this devotion, we provide for "the abundant life" for our patients. We need this devotion to conquer many remaining challenges. Let us first take a brief look at a few of the wants and miseries of women which have been relieved by obstetricians-gynecologists in our lifetime, the past 30 years. A want for every woman is control of childbearing. Those who are infertile want to get pregnant. We now are better abie to supply this need. In recent years, laboratory studies of hormonal status have become common. Drugs like Clomid* and Pergonalt have been developed. The laparoscope helps us pinpoint certain problems. However, the improvement of the husband's sperm still taunts us. Those who think their family is complete can control fertility. Before 1960, this was just a taunt to both women and the medical profession. Zero population growth is represented by the figure 2.1. The figure for 1973 in the United States was 1.9.
Life is like a sea Forever stretching endlessly Each tide, a taunt; Each wave, a want; Each cairn, a broken mi.sery4
Taunts, wants, miseries! The phrases of this pessimistic poet are painful to the ears; certainly they are not a cheerful way to start an address. But we have all been trained to listen to, and treat, the taunts, wants, and miseries of the women we see daily. Let us use these words as a framework to talk about some of the challenges facing us in the next few years.
Optimism, not pessimism, has been my life-style. So, in an entirely different mood, we can consider the Bible, which speaks about having life more abundantly. 2 Christianity has had a marked influence on the ideals and value judgments of most physicians. I trust that all of the doctors here in Presented at the Forty-second Annual Meeting of the Central Association of Obstetricians and Gynecologists, New Orleans, Louisiana, October 3-5, 1974.
*Wm. S. Merrell Co., Div. Richardson-Merrell, Inc., 110 E. Amity Rd., Cincinnati, Ohio 45215. tCutter Laboratories, Inc., 4th & Parker Sts., Berkeley, California 94710.
Reprint requests: Dr. Russell ]. Paalman, Towus Medical Building, Suite 720, Grand Rapids, Michigan 49502
139
:\m.
This has been achieved with modern birth control measures, though these are still cumbersome and fraught with slight hazards. We are grateful for the pioneers in this field, such as John Rock. We thank conununity organizations, such as planned parenthood. Their slogan, "Every baby a wanted baby," can be achieved today. We can even thank the Supreme Court for a realistic decision regarding abortion. Better methods of birth control challenge us. Will the refinement of prostaglandins help? Will the immunologists create vaccines to control fertility for men and/or women? Are new developments forthcoming for us? Another want is a healthy baby. What is the most common question by the mother in the delivery room? You all know it: "Is my baby all right?" Next come the questions about sex and weight of the infant. Medicine has made rapid strides in this area since 1940. Rh problems can be controlled. Amniocentesis helps us predict certain congenital anomalies and fetal rnaturity. Fetal monitoring helps us decide between immediate delivery and watchful \vaiting ...t\nd our program this year explains ho\v computers are being used to evaluate the parameters of labor. Antibiotics are in common use, yet I practiced medicine for six years beforP the first aqueous penicillin was available. I used to treat syphilis with intramuscular injections of bismuth! Neonatal intensive care units are our latest developments. All of these tools, and many more, help the mother in her deepest want: a healthy baby. A misery is monilial vulvovaginitis. Before nystatin we painted the vagina twice weekly with that "horrible purple stuff," gentian violet, used only occasionally today. Another misery is trichomonas infection. Teii me, what were your results in treating trichomonas vaginitis before Flagyl*? And there is still a g-reat misery: the tragedy of pelvic cancer. Early diagnostic techniques, such as the cytologic smear, improved surgery and irradiation, chemotherapeutic agents, and education have reduced this problem tremendously. But the prevention and cure of cancer stiil taunt us. This problem is complex. So the challenge continues: Much more time, money, and energy must be directed to the study of pelvic malignant disease. If this problem could be conquered, a great misery would *G. D. Searle & Co., P. 0. Box 5110, Chicago, Illinois 60680.
J. Oh:, ..
(..,m
t me tell you a story. In a certain mission hospital in Afrira, they trained young men with almost no education to become "dressers." 4 After six to eight weeks, these men went out "into the bush," to their
native villages, to give pnmitJve m~:>dical care. A drug salesman provided them with about twenty bottles of medicines, bandages, sutures, etc. The blue capsules were for "dysentery," and the white tablets were for "fever." The green ointment was for a "scaly skin condition." Two years later, a Medical Survey Team from the World Council of Churches visited one of these ''dressers" in the bush. They found that 70 per cent of the time the "dresser" was using the right drug for the specific disease! I do not advocate sending "dressers," paramedics, or nurse-midwives to our depressed or rural areas. But there are many places in this country with more doctors than are essential, such as select urban societies and medical centers. Either our sick should be transported to these centers, or our medics should be better distributed. We must seek and provide answers to both horns of this thorny dilemma! The problems of depressed areas in our large cities are mostly social, those of jobs, housing, food, and drug addiction. But these areas need medical care also. Not only organized medicine but also, much more critically, the Government should seek ways to solve this problem. Perhaps an incentive system would be best. By an incentive system I mean high pay, topquality working conditions, fringe benefits, and protection of life while on the job for specified time periods. Now that we all have almost eliminated internships, perhaps medical school graduates could be enticed to spend one or two years in these areas before entering a residency. Experience in our hospital shows that doctors who have completed two years in the Armed Services have significant advantages over those who enter a residency directly from internship. An experience in the depressed or rural areas would provide valuable broad training. Young physicians would learn about the needs of the "whole person," medical, personal, and spiritual. They would learn of the total needs rather than a specific need in a limited field. They could learn something about providing "the abundant life." The depressed and rural areas could be served by either experienced or neophyte physicians, although those with residency training completed might function better. Pay them well and provide proper fringe benefits, and the distribution problem might be solved. Dollars spent here would pay many more dividends than the 55 million dollars proposed to be spent on Professional Standards Review Organizations in 1975.
!\fay ljJ 19/:J \ .... - ..-
Let us look at another alternative: Bring the sick patient to a center. With modern transportation, this portion of the solution could be extensively developed. Obstetric care can be used as a specific example. Top-quality obstetric care is available in most centers. Sophisticated equipment is in use. In 1944, Dr. Jennings Crawford Litzenberg, Chairman of Obstetrics and Gynecology at the University of Minnesota, stated that, "The maternal mortality rate is at its lowest in the United States. Further reduction in n1aternal mortality can come only from the personal integrity of the attending physician." Laudable words! But little did he suspect that we would have so many fine new tools a scant 30 years later. Nor did he consider the concept of delivering babies only at top-quality centers, instead of in every hospital across the land. Today this can be accomplished. Almost every prenatal patient can find means of transportation for 50 miles for antepartum care and delivery. By 1980, or before, we should have an adequate number of obstetricians to provide this care. We must provide means for obstetric patients to get to them. All hospitals with obstetric facilities should have blood banks, Rh programs, availability of amniocentesis, capacity to analyze amniotic fluid, excellent anesthesia, fetal monitoring, nearby neonatal intensive care units, and other related parameters of top-quality care, all of these in addition to the basic requirements of the local Departments of Health. Closely supervised medical inductions of labor should be available. The University of Iowa has for many years proved the safety of labor induction. An excellent paper on medical inductions of labor has been provided for this meeting. I firmly believe that any hospital that cannot provide all these services and is within 50 miles of one that does
should cease delivering infants! I suspect that the problem of Professional Standards Review Organizations is our biggest taunt in 1974. Millions of words have been written, opinion is divided from full support to total opposition, and the debate continues. The American Society of Internal Medicine said it will assist in the orderly implementation of Professional Standards Review Organizations. But the County Medical Society of Chillicothe, Ohio, refused to contribute to their State Political Action Committee, a satellite of the American Medical Association. Instead, most members joined the .Association of .4-.merican . Physicians and Surgeons, the group that is pressing a lawsuit
·~·-,._ ··~·.
r ... ...,"rr,·.
to repeal the Professional Standards Revie \\' () rg:mi · zation law. The Illinois State Medical ~nrie1;· ha:; recently committed its total membership I•> .1 $7'· assessment to combat Professional Standarcb REvJev, Organizations to the bitter end. Others p.an suit:; also. Despite the opposition, many hearings, and many suggestions to modify the law, the Department of Health, Education, and Welfare is determined to go ahead. As of April 30, the deadline for 1974 funding proposals, over 125 groups had applied for Professional Standards Review Organization grants in all but four states. As of June 1, seven Professional Standards Review Organization plans had been approved, from Massachusetts to California, with Utah the first to sign a contract. When these plans are ready for implementation, the fireworks should start. If 10 per cent of the physicians affected register their opposition, the medical profession must be polled, a painful, prolonged procedure. A majority of physicians must approve the plan, or the Department of Health, Education, and Welfare cannot, by iaw, move ahead with a contract. Of course, they can still send their own appointees to administer a program. Let's get involved in the affairs of government. Plato said, "The punishment of wise men, who refuse to take part in the affairs of government, is to live under the government of unwise men.'' Where do the members of the Central Association stand? Is this not the time to pause and think of goals, such as "the abundant life for women"? Will Professional Standards Review Organization plans help achieve this goal? If so, let us give them wholehearted support. Or will the Professional Standards Review Organization law be just an expensive government mistake and only take a small nibble at our goals? If so, let us all strive to modify the law. Best of all, in regard to the taunt of an impending Professional Standards Reviev/ Organization, you can all still exercise the American right to vote. When the time comes, I urge you to exercise that right. Speaking of rights, we recently have been taunted by the term. Dr. Perry Greene recently talked about rights.'' There are civil rights, consumer rights, and legal rights. The ''Patient's Bill of Rights" recently has had a great deal of publicity. National figures have stated that, "sound health, freedom from sickness and pain, is not a privilege but a ri[.;ht that belongs to every American." No one can be expected to believe this. The con-
Volume 122 Number 2
stitution of the United States says nothing about the right to good health. Good health is a gift from God. No government can legislate good health. The Kennedy plan will fall far short. We all do have a right to strive for good health, a right to try to prevent accidents and diseases, just as we have the right to leave our seat belts unfastened or overindulge in the delights of New Orleans! In talking about rights, let me tell you that I believe physicians have rights too! We have a right to practice medicine or not; we have a right to be generalists or specialists. We can choose to be solo or in a group. We can be self-employed or work for an institution. If we pledge our services on contract, obviously we lose some rights. The private physician has the right to decide not only where he will practice but also how many hours a day he will work. He has the legal right to see all the patients who come to him, or he can refuse anyone that he chooses for diagnosis and treatment. The physician has a right to set his own fees for services and earn what his productivity wiii yield. If patients complain about fees, just quote them your malpractice rates. That alone will make them gasp, and publicity may help solve this problem. All other segments of society have this right. Are we to be denied? The physician has the right to expect cooperation from the patients he treats and prompt payment of fees. He also has the right to decide whether he will participate with third-party health insurance carriers or not. He has the right to advocate health measures, but he is not obligated to do so. At present, Doctors are obligated only to report bullet wounds and communicable diseases. That's where things should stay! The government speaks of the "health industry" as if it were a mechanized service in some kind of factory. What the government pays for, it regulates and controls. But the private practice of medicine in the United States has given, and continues to give, better health care than any government-controlled program anywhere in the world. We physi-
The abundant life
143
cians have a nght to be proud of this and a right to let our neighbors, friends, and others in this great country know about it. So I taunt you with this challenge: Exercise the right of free speech and tell all about the top-quality medical care available in the United States. As our distingu.ished past-president and dear friend, Dr. Thomas W. McElin, told us three years ago, "You must not be late." 6 Life is like a sea Forever stretching endlessly
Purposefully, I left the openin.g lines of our pessimistic poet for my conciuding remarks. W.hen properly applied, these lines show optimism and hope. We owe a tremendous debt to our ancestors. The generations before us have made many contributions to medicine, to the "abundant life for women," and to each of us. We were endowed with much basic knowledge, building blocks to which we have added. Life did stretch from the previous generation to ours. We need it to stretch to the next, and the next, in the words of the poet, "endlessly." Our stay on earth is short, yet it can be productive. As briefly alluded to earlier, fantastic advances in medicine have taken place since 1940. The 1920's are remembered as the "Golden Age of Sports," with many famous figures. Will the last three decades be remembered as the "Golden Age of Medicine"? If so, the heroes are too many to list. Our generation can be proud of our accomplishments. Yet there are many taunts, wants, and miseries which remain to challenge us. Only some of the most important ones have been discussed. We must face them forthrightly, so that the generations to come will benefit by our efforts. Life does stretch endlessly, here in this world and the wondrous world beyond. Let us keep our goals high. May the members of the Central Association continue to strive for the "abundant life for women." If we pursue these goals, we will be rewarded with an abundant life for ourselves.
REFERENCES
1. Johnson, R.: Interlochen, p. 7, 1929. ~. The Bible: John 10, verse 10. 3. Pearse, W.: Personal communication. 4. McGillivray, J.: Personal communication.
5. Greene, P. W., Jr.: Bull. Kent. Co. Med. Soc. 60: 8, 1974. 6. McElin, T. W.: AM. ]. 0BSTET. GYNECOL. 112: 1, 1972.
Obstetrics and Gynecology volume 122
number 2
MAY
15, 1975
Transactions of the Forty-second Annual Meeting of the Central Association of Obstetricians and Gynecologists
The abundant life Presidential address
RUSSELL
J.
PAALMAN, M.D., M.S.
Grand Rapids, Michigan
I N 1 9 2 9 , a high school classmate of mine wrote a short poem entitled "Pessimist." 1
this room have a lifelong devotion to relieving the wants and miseries of women. Certainly the annals and accomplishments of the Central Association speak to this point. By this devotion, we provide for "the abundant life" for our patients. We need this devotion to conquer many remaining challenges. Let us first take a brief look at a few of the wants and miseries of women which have been relieved by obstetricians-gynecologists in our lifetime, the past 30 years. A want for every woman is control of childbearing. Those who are infertile want to get pregnant. We now are better abie to supply this need. In recent years, laboratory studies of hormonal status have become common. Drugs like Clomid* and Pergonalt have been developed. The laparoscope helps us pinpoint certain problems. However, the improvement of the husband's sperm still taunts us. Those who think their family is complete can control fertility. Before 1960, this was just a taunt to both women and the medical profession. Zero population growth is represented by the figure 2.1. The figure for 1973 in the United States was 1.9.
Life is like a sea Forever stretching endlessly Each tide, a taunt; Each wave, a want; Each cairn, a broken mi.sery4
Taunts, wants, miseries! The phrases of this pessimistic poet are painful to the ears; certainly they are not a cheerful way to start an address. But we have all been trained to listen to, and treat, the taunts, wants, and miseries of the women we see daily. Let us use these words as a framework to talk about some of the challenges facing us in the next few years.
Optimism, not pessimism, has been my life-style. So, in an entirely different mood, we can consider the Bible, which speaks about having life more abundantly. 2 Christianity has had a marked influence on the ideals and value judgments of most physicians. I trust that all of the doctors here in Presented at the Forty-second Annual Meeting of the Central Association of Obstetricians and Gynecologists, New Orleans, Louisiana, October 3-5, 1974.
*Wm. S. Merrell Co., Div. Richardson-Merrell, Inc., 110 E. Amity Rd., Cincinnati, Ohio 45215. tCutter Laboratories, Inc., 4th & Parker Sts., Berkeley, California 94710.
Reprint requests: Dr. Russell ]. Paalman, Towus Medical Building, Suite 720, Grand Rapids, Michigan 49502
139
:\m.
This has been achieved with modern birth control measures, though these are still cumbersome and fraught with slight hazards. We are grateful for the pioneers in this field, such as John Rock. We thank conununity organizations, such as planned parenthood. Their slogan, "Every baby a wanted baby," can be achieved today. We can even thank the Supreme Court for a realistic decision regarding abortion. Better methods of birth control challenge us. Will the refinement of prostaglandins help? Will the immunologists create vaccines to control fertility for men and/or women? Are new developments forthcoming for us? Another want is a healthy baby. What is the most common question by the mother in the delivery room? You all know it: "Is my baby all right?" Next come the questions about sex and weight of the infant. Medicine has made rapid strides in this area since 1940. Rh problems can be controlled. Amniocentesis helps us predict certain congenital anomalies and fetal rnaturity. Fetal monitoring helps us decide between immediate delivery and watchful \vaiting ...t\nd our program this year explains ho\v computers are being used to evaluate the parameters of labor. Antibiotics are in common use, yet I practiced medicine for six years beforP the first aqueous penicillin was available. I used to treat syphilis with intramuscular injections of bismuth! Neonatal intensive care units are our latest developments. All of these tools, and many more, help the mother in her deepest want: a healthy baby. A misery is monilial vulvovaginitis. Before nystatin we painted the vagina twice weekly with that "horrible purple stuff," gentian violet, used only occasionally today. Another misery is trichomonas infection. Teii me, what were your results in treating trichomonas vaginitis before Flagyl*? And there is still a g-reat misery: the tragedy of pelvic cancer. Early diagnostic techniques, such as the cytologic smear, improved surgery and irradiation, chemotherapeutic agents, and education have reduced this problem tremendously. But the prevention and cure of cancer stiil taunt us. This problem is complex. So the challenge continues: Much more time, money, and energy must be directed to the study of pelvic malignant disease. If this problem could be conquered, a great misery would *G. D. Searle & Co., P. 0. Box 5110, Chicago, Illinois 60680.
J. Oh:, ..
(..,m
t me tell you a story. In a certain mission hospital in Afrira, they trained young men with almost no education to become "dressers." 4 After six to eight weeks, these men went out "into the bush," to their
native villages, to give pnmitJve m~:>dical care. A drug salesman provided them with about twenty bottles of medicines, bandages, sutures, etc. The blue capsules were for "dysentery," and the white tablets were for "fever." The green ointment was for a "scaly skin condition." Two years later, a Medical Survey Team from the World Council of Churches visited one of these ''dressers" in the bush. They found that 70 per cent of the time the "dresser" was using the right drug for the specific disease! I do not advocate sending "dressers," paramedics, or nurse-midwives to our depressed or rural areas. But there are many places in this country with more doctors than are essential, such as select urban societies and medical centers. Either our sick should be transported to these centers, or our medics should be better distributed. We must seek and provide answers to both horns of this thorny dilemma! The problems of depressed areas in our large cities are mostly social, those of jobs, housing, food, and drug addiction. But these areas need medical care also. Not only organized medicine but also, much more critically, the Government should seek ways to solve this problem. Perhaps an incentive system would be best. By an incentive system I mean high pay, topquality working conditions, fringe benefits, and protection of life while on the job for specified time periods. Now that we all have almost eliminated internships, perhaps medical school graduates could be enticed to spend one or two years in these areas before entering a residency. Experience in our hospital shows that doctors who have completed two years in the Armed Services have significant advantages over those who enter a residency directly from internship. An experience in the depressed or rural areas would provide valuable broad training. Young physicians would learn about the needs of the "whole person," medical, personal, and spiritual. They would learn of the total needs rather than a specific need in a limited field. They could learn something about providing "the abundant life." The depressed and rural areas could be served by either experienced or neophyte physicians, although those with residency training completed might function better. Pay them well and provide proper fringe benefits, and the distribution problem might be solved. Dollars spent here would pay many more dividends than the 55 million dollars proposed to be spent on Professional Standards Review Organizations in 1975.
!\fay ljJ 19/:J \ .... - ..-
Let us look at another alternative: Bring the sick patient to a center. With modern transportation, this portion of the solution could be extensively developed. Obstetric care can be used as a specific example. Top-quality obstetric care is available in most centers. Sophisticated equipment is in use. In 1944, Dr. Jennings Crawford Litzenberg, Chairman of Obstetrics and Gynecology at the University of Minnesota, stated that, "The maternal mortality rate is at its lowest in the United States. Further reduction in n1aternal mortality can come only from the personal integrity of the attending physician." Laudable words! But little did he suspect that we would have so many fine new tools a scant 30 years later. Nor did he consider the concept of delivering babies only at top-quality centers, instead of in every hospital across the land. Today this can be accomplished. Almost every prenatal patient can find means of transportation for 50 miles for antepartum care and delivery. By 1980, or before, we should have an adequate number of obstetricians to provide this care. We must provide means for obstetric patients to get to them. All hospitals with obstetric facilities should have blood banks, Rh programs, availability of amniocentesis, capacity to analyze amniotic fluid, excellent anesthesia, fetal monitoring, nearby neonatal intensive care units, and other related parameters of top-quality care, all of these in addition to the basic requirements of the local Departments of Health. Closely supervised medical inductions of labor should be available. The University of Iowa has for many years proved the safety of labor induction. An excellent paper on medical inductions of labor has been provided for this meeting. I firmly believe that any hospital that cannot provide all these services and is within 50 miles of one that does
should cease delivering infants! I suspect that the problem of Professional Standards Review Organizations is our biggest taunt in 1974. Millions of words have been written, opinion is divided from full support to total opposition, and the debate continues. The American Society of Internal Medicine said it will assist in the orderly implementation of Professional Standards Review Organizations. But the County Medical Society of Chillicothe, Ohio, refused to contribute to their State Political Action Committee, a satellite of the American Medical Association. Instead, most members joined the .Association of .4-.merican . Physicians and Surgeons, the group that is pressing a lawsuit
·~·-,._ ··~·.
r ... ...,"rr,·.
to repeal the Professional Standards Revie \\' () rg:mi · zation law. The Illinois State Medical ~nrie1;· ha:; recently committed its total membership I•> .1 $7'· assessment to combat Professional Standarcb REvJev, Organizations to the bitter end. Others p.an suit:; also. Despite the opposition, many hearings, and many suggestions to modify the law, the Department of Health, Education, and Welfare is determined to go ahead. As of April 30, the deadline for 1974 funding proposals, over 125 groups had applied for Professional Standards Review Organization grants in all but four states. As of June 1, seven Professional Standards Review Organization plans had been approved, from Massachusetts to California, with Utah the first to sign a contract. When these plans are ready for implementation, the fireworks should start. If 10 per cent of the physicians affected register their opposition, the medical profession must be polled, a painful, prolonged procedure. A majority of physicians must approve the plan, or the Department of Health, Education, and Welfare cannot, by iaw, move ahead with a contract. Of course, they can still send their own appointees to administer a program. Let's get involved in the affairs of government. Plato said, "The punishment of wise men, who refuse to take part in the affairs of government, is to live under the government of unwise men.'' Where do the members of the Central Association stand? Is this not the time to pause and think of goals, such as "the abundant life for women"? Will Professional Standards Review Organization plans help achieve this goal? If so, let us give them wholehearted support. Or will the Professional Standards Review Organization law be just an expensive government mistake and only take a small nibble at our goals? If so, let us all strive to modify the law. Best of all, in regard to the taunt of an impending Professional Standards Reviev/ Organization, you can all still exercise the American right to vote. When the time comes, I urge you to exercise that right. Speaking of rights, we recently have been taunted by the term. Dr. Perry Greene recently talked about rights.'' There are civil rights, consumer rights, and legal rights. The ''Patient's Bill of Rights" recently has had a great deal of publicity. National figures have stated that, "sound health, freedom from sickness and pain, is not a privilege but a ri[.;ht that belongs to every American." No one can be expected to believe this. The con-
Volume 122 Number 2
stitution of the United States says nothing about the right to good health. Good health is a gift from God. No government can legislate good health. The Kennedy plan will fall far short. We all do have a right to strive for good health, a right to try to prevent accidents and diseases, just as we have the right to leave our seat belts unfastened or overindulge in the delights of New Orleans! In talking about rights, let me tell you that I believe physicians have rights too! We have a right to practice medicine or not; we have a right to be generalists or specialists. We can choose to be solo or in a group. We can be self-employed or work for an institution. If we pledge our services on contract, obviously we lose some rights. The private physician has the right to decide not only where he will practice but also how many hours a day he will work. He has the legal right to see all the patients who come to him, or he can refuse anyone that he chooses for diagnosis and treatment. The physician has a right to set his own fees for services and earn what his productivity wiii yield. If patients complain about fees, just quote them your malpractice rates. That alone will make them gasp, and publicity may help solve this problem. All other segments of society have this right. Are we to be denied? The physician has the right to expect cooperation from the patients he treats and prompt payment of fees. He also has the right to decide whether he will participate with third-party health insurance carriers or not. He has the right to advocate health measures, but he is not obligated to do so. At present, Doctors are obligated only to report bullet wounds and communicable diseases. That's where things should stay! The government speaks of the "health industry" as if it were a mechanized service in some kind of factory. What the government pays for, it regulates and controls. But the private practice of medicine in the United States has given, and continues to give, better health care than any government-controlled program anywhere in the world. We physi-
The abundant life
143
cians have a nght to be proud of this and a right to let our neighbors, friends, and others in this great country know about it. So I taunt you with this challenge: Exercise the right of free speech and tell all about the top-quality medical care available in the United States. As our distingu.ished past-president and dear friend, Dr. Thomas W. McElin, told us three years ago, "You must not be late." 6 Life is like a sea Forever stretching endlessly
Purposefully, I left the openin.g lines of our pessimistic poet for my conciuding remarks. W.hen properly applied, these lines show optimism and hope. We owe a tremendous debt to our ancestors. The generations before us have made many contributions to medicine, to the "abundant life for women," and to each of us. We were endowed with much basic knowledge, building blocks to which we have added. Life did stretch from the previous generation to ours. We need it to stretch to the next, and the next, in the words of the poet, "endlessly." Our stay on earth is short, yet it can be productive. As briefly alluded to earlier, fantastic advances in medicine have taken place since 1940. The 1920's are remembered as the "Golden Age of Sports," with many famous figures. Will the last three decades be remembered as the "Golden Age of Medicine"? If so, the heroes are too many to list. Our generation can be proud of our accomplishments. Yet there are many taunts, wants, and miseries which remain to challenge us. Only some of the most important ones have been discussed. We must face them forthrightly, so that the generations to come will benefit by our efforts. Life does stretch endlessly, here in this world and the wondrous world beyond. Let us keep our goals high. May the members of the Central Association continue to strive for the "abundant life for women." If we pursue these goals, we will be rewarded with an abundant life for ourselves.
REFERENCES
1. Johnson, R.: Interlochen, p. 7, 1929. ~. The Bible: John 10, verse 10. 3. Pearse, W.: Personal communication. 4. McGillivray, J.: Personal communication.
5. Greene, P. W., Jr.: Bull. Kent. Co. Med. Soc. 60: 8, 1974. 6. McElin, T. W.: AM. ]. 0BSTET. GYNECOL. 112: 1, 1972.
