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THE WAY IT WAS: YOU CAN LOOK IT UP JOHN L. DUSSEAU* I do not teach; I only relate. [Montaigne, Of Repentance] There is universal agreement by all hands that preventive pubUc medicine is not simply the nut but the very kernel ofwhat medicine must become if it is to fulfill its function of serving the greatest need of the greatest number. Of course, there may be here and there a querulous voice ofdissent asking that this greatest need be more precisely defined, for it cannot go altogetiier unchallenged that mere survival is what we are all after and all about. It is in this connection that I am able to offer a firsthand account of die proceedings of the Twenty-first Internation Conference on International Health held at Lausanne in May of 1980. Everyone remembers the conference and its duly bulletins of far-reaching conclusions, but there was even at the time a curious neglect in reporting of its final paper, perhaps because it was presented at four-thirty in the afternoon of Saturday. Up until die last paper was given, tilings had gone in what might be called an edifying but expected pattern. There were calls for greater American government support ofresearch and for stringent economy in federal expenditures to halt the erosion of inflation; fascinating charts were displayed demonstrating computer analysis of health care problems (with only one or two instances of charts being shown upside down and dieir upside-downness going unrecognized); and at the university, honorific marks of distinction were handed out with well-calculated abandon in impressive ceremonies (many handsome structures have been built by degrees). There were too the customary denunciations of cigarettes, strong spirits, cranberryjuice, bacon, quackery, milk and honey, fats saturated *W. B. Saunders Co., West Washington Square, Philadelphia, Pennsylvania 19105.© 1978 by The University of Chicago. 0031-5982/78/2104-0039$01.00 Perspectives in Biology and Medicine ¦ Summer 1978 \ 561 and un, cigars, aspirin tablets, saccharin, coffee, birth-control piUs, overpopulation , strip mining, neglect to provide petroleum substitutes, accelerating costs of crude oil, dangers of nuclear energy, public indifference to research findings, public meddlesomeness in research, dangers of pesticides, failure of farmers to increase crop yields, disregard of the spiritual trauma of abortion, abuse of die unwanted child, callous indifference to endangered species, lamentable failure to do anything about restricted grazing areas in underdeveloped countries, excessive health care costs, stubborn resistance tojust union demands of hospital employees, rigidity of copyright laws, escalating costs of journal publication, and so on. These denunciations were couched in the official, deceptively restrained terms offanaticism, all being documented by intensive multidisciplinary studies in the socioeconomic context of deviation from truth and established Tightness. There was no neglect either to appeal for support of what might be called, for lack of a better term, highly Ulusioned psychologic studies of all the matters under review. As usual, too, penny pinching in support of these studies was excoriated. There were favorable comparisons made between the costs of the three Great Pyramids of Egypt along with those of maintaining a minor-league farm system and those expected for research facilities to be erected in the hometown ofwhoever happened to be president ofthe United States at the time. It was only at this point in die well-managed discussions that a certain asperity of tone became evident. There is no ox more bloodüy gored than one whose funds have been cut offor none more anguished than one whose tail has been twitched by a thoughtless public still finding occasion for laughter in the face of onrushing doom. As always, with no political side taking, dutiful resolutions were carried by acclamation denouncing terrorism and applauding Prime Minister Begin's authorized bombing of Lebanese hospitals as antiterroristic in their effect. Watergate and Waterloo, witchcraft and wizardry were condemned by voice vote. Large pharmaceutical houses were beseeched for funds and berated for profits. In fact, all was as usual, and it could be said that there was satisfaction on all sides. Certainly every speaker agreed that everyone except himself had to give a Utde, that priorities had to be set so long as there was no neglect of the obviously important...


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