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Public Papers - 1990

Remarks at the Centennial Celebration of the Johns Hopkins University Medical Institutions in Baltimore, Maryland


Thank you very much, Dr. Muller. Just before coming out, Steven asked me to get one thing right: the name of the university. [Laughter] It's Johns Hopkins. I don't know why he thought an elitist from Yale would miss that one, but nevertheless. [Laughter] Now, he was given his great-grandmother's last name as his first name. I told Dr. Muller: ``You don't need to explain family names to somebody called George Herbert Walker Bush.'' [Laughter]

I am so glad that Dr. Louis Sullivan, our distinguished Secretary of HHS, could be here with me today. I am very proud of him. And it's always good to be with my admired friend -- wrong political party, but admired friend -- Governor Schaefer, who's doing an outstanding job for this State; and of course my dear personal friend, with whom I've served in the trenches, Maryland's great Congresswoman, Helen Bentley, with us here today; and of course my fellow honorees, so many distinguished scholars and guests, here to honor both the founding of this historic institution and the 100th anniversary of Johns Hopkins Medical Institutions.

I'm very pleased to be here, and I want to salute the society of scholars -- the new ones, the old ones -- and this distinguished group. And if I could be permitted one anecdote: When I heard the citations of my fellow honorees, this distinguished five, I was reminded of the story of the kid that threw a rope around his mongrel dog and started heading over to Madison Square Garden. And they said, ``Well, where are you going?'' He said, ``Well, I'm going to enter him in the Madison Square Garden pet show.'' And they said, ``Well, do you think he has a shot at winning?'' He said, ``No, but he's going to be in some damn fine company.'' [Laughter] When I listened intently to those citations, I'll admit I didn't know what half the words meant. [Laughter] But I know excellence when I see it, and I am very honored.

I was a bit nervous when I heard I'd be in a gown before a group of doctors. [Laughter] At least this one buttons up the front, though. [Laughter]

Gathered up here and out there are some of the best health-care professionals in America. And best in America means best in the world. You know, sometimes when we talk about the best of anything, we add the phrase ``that money can buy.'' But in medicine, that doesn't quite fit. There's an unease in the health-care community that for all this nation's wealth, for all the money put into the system, American medicine still faces unprecedented problems.

Medical malpractice. Uninsured families. An aging population. Cancer, heart disease, AIDS, drug addiction, Alzheimer's, mental illness -- the price tag is staggering. Today over 11 percent of our gross national product goes to health care, and we rank number one in the world in per capita health-care expenditures. Yet we do remain behind other industrialized countries in life expectancy. And in the developed world, we rank 22d in infant mortality rates -- 22d.

Clearly, we have our work cut out for us. And yet because of great institutions like Johns Hopkins, we can face these challenges with a sense of optimism and a sense of confidence. Those who think our medical problems today are unsolvable or solvable only by money ought to understand how far we've come.

For example, 19th-century hospitals were not so much centers of healing as of horror. And medical schools of the 1880's were deplorable and dangerous places -- no labs, no patients, no questions permitted. Rookies became doctors after just 18 months, often without ever seeing the inside of a hospital.

Today's date marks Washington's birthday, but some scholars here today may recall his death. Diagnosed with a sore throat, the doctors bled him four times before he succumbed to its effects, thus depriving our young nation of perhaps years of service from its most revered statesman.

In the primitive days of early medicine, change did come slowly until Johns Hopkins revolutionized the way medicine was taught for all time and launched a movement that brought America from medical backwater to world leader. Hopkins' influence was completely out of proportion to its age or resources. It found its wealth at the source of America's wealth: in its ideas, in its people. New and powerful ideas, dedicated and farsighted people, linking a medical school with a hospital, teaching at the bedside, developing new methodologies to fight terrible disease, bringing scientific research to medicine, seeing what works -- Johns Hopkins demonstrates what one biomedical research establishment can do to change and improve health care in thousands of hospitals for millions of people.

Yet in our country today, there is a growing awareness that to make this country as healthy as it can be, all of us -- all of us -- must accept a share of the responsibility: government, the health-care profession, and the American people themselves. First, the Federal Government. In my State of the Union Address, I asked Dr. Louis Sullivan to lead a Domestic Policy Council review of options on the accessibility, the costs, and the quality of America's health-care system. This administration is committed to health-care policies that improve health-care quality while trying to restrain the costs. For example, last December we enacted significant new Medicare physician payment reform, and recently, we announced the first large-scale program to study medical treatment effectiveness. But better, more affordable health care must also be more accessible. Expanded efforts to reduce infant mortality and expanded Medicaid eligibility to cover more women and infants are just two of the steps that we are taking to help.

Yet if American medicine is to continue to do the job, we must maintain our world leadership in medical research and development. It was Hopkins that first isolated a substance that American Government and medicine can always use: adrenaline. The clock is ticking, and medical breakthroughs tomorrow depend on action today. This administration has committed itself and this nation to not only the largest overall R D budget but the largest biomedical research budget in our history. We must encourage the development of new technologies to prevent disease and avoid the expense of long-term treatment. A good example of this occurred right here at Johns Hopkins, where the discovery of three types of polio virus made the polio vaccine possible. Ultimately, this high-tech solution, the vaccine, costs only a few cents per patient, versus the tens of thousands of dollars that might be required for a lifetime of care in an old iron lung.

Of course, here at Hopkins you are the leading recipient of Federal research dollars, more than 0 million in the last fiscal year. You won that support the Johns Hopkins way, the American way, the same way that your lacrosse team makes the rankings: by being the very best.

But to keep American medicine the best in the world, individual health-care professionals and institutions must make our medical system responsive and responsible. You are the guardians of your profession -- its ethics and its quality. Your standards must be high, and they must be enforced. The same sense of fiscal discipline that we must apply to government you must apply also to the medical world in a time of rising costs.

And I ask you today to avoid the understandable urge to practice ``defensive medicine,'' where doctors, fearing litigation, too often dictate treatment that is unnecessary, where the threat of lawsuits threatens the very research that is so desperately needed to save lives. In return, we've got to restore common sense and fairness to America's medical malpractice system. I have directed the Domestic Policy Council to determine steps that the Federal Government can take to help alleviate this serious situation. We've got to remember a simple truth: Not every unfortunate medical outcome is the result of poor medicine. You cannot make life risk-free. No risk means no progress, and that's not the American way.

One of Hopkins' founders, Dr. William Halsted, was the gifted surgeon who introduced rubber gloves. In an age of surgical slashing, he used his scalpel carefully, reducing shock and trauma -- a kinder, gentler surgeon, if you will. [Laughter] But he was not without boldness. And Halsted conceived and perfected a daring feat of surgery, the radical mastectomy, that to this day saves the lives of thousands of women afflicted with breast cancer.

The procedure in that time was unprecedented -- unprecedented in its time. And yet in today's atmosphere of fear of malpractice, it probably would never have been attempted. This fear has not only hurt medical innovation and treatment, it also hurts medical voluntarism. Many doctors used to give a day a week to the needy, and I'm convinced that if not for the liability issue many more would donate time today. And I also worry that the fear of malpractice limits the access of too many Americans in our rural areas to quality medical care, particularly those with high-risk cases. Clearly, we must find a fair and reasonable solution to the malpractice crisis.

But government and health-care professionals alone cannot make this the healthy and productive country we want it to be. America's health-care system will be best in the world only when every American cares about his own health. It is estimated that 40 to 70 percent of the causes of premature death in America are preventable deaths -- unnecessary deaths. And common sense tells us what that means. It's not complicated. Eat sensibly. Exercise. Wear seatbelts. Don't smoke, and if you do smoke, stop. Don't abuse alcohol, and don't use illegal drugs.

We're not talking about lifestyle: We're talking about life. And the best prescription for better health in America is a strong, daily dose of individual responsibility. This sense of responsibility is nothing new. Not far from here, I'm told, is the famous John Singer Sargent painting of the founding fathers of Johns Hopkins medicine. Sargent began by painting the four doctors, but something, he said, was missing. It came as an inspiration. He knocked down a studio wall to get his new props in, and he added a huge Victorian globe and, above the globe, a painting within a painting: St. Martin giving his cloak to a beggar. The globe should remind us of the global responsibilities of American medicine, reaching out to relieve the terrible suffering of innocents like the AIDS babies in Romania or the children of famine in Africa. And St. Martin's gesture should remind us of the special responsibilities of the medical community to reach out to those most in need.

We live in an age of miracles. We really do -- medical miracles as dramatic as the artificial heart, everyday miracles as commonplace as the healing power of love. I believe in miracles and that wondrous accomplishments, wondrous breakthroughs, wondrous days are ahead. And I am privileged to be honored at a place where those wonders will continue to unfold. God speed you in your work, and God bless medicine and those who practice. And God bless the United States of America. Thank you for this esteemed honor. Thank you from the bottom of my heart.

Note: The President spoke at 4:02 p.m. at Shriver Auditorium. In his opening remarks, he referred to Steven Muller, president of the university.

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