Doing Better and Feeling Worse: Health in the United States
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The articles deal with a wide range of problems and que...)
The articles deal with a wide range of problems and questions, from the soaring costs of medical care, medical manpower and training, biomedical research, ethics, delivery systems, technology, and insurance to the very meaning of health.
This is a book that will generate debate, discussion, controversy, conflict, and perhaps some legislative reform when the impact of its arguments begins to be felt. Twenty doctors, economists, and political and social scientists were asked by the Rockefeller Foundation to write on health and medical care in the United States. A clue to their opinions about the state of the nation’s health is the title of their volume. Doing Better and Feeling Worse.
John Hilton Knowles was an American physician, physiologist, and administrator. He was associated with Massachusetts General Hospital for over 20 years and served as a president of the Rockefeller Foundation from 1972 to 1979.
Background
John Hilton Knowles was born on May 23, 1926 in Chicago, Illinois, United States, the son of James Knowles, a business executive, and Jean Laurence Turnbull, an artist. His father had been a World War I flying ace and eventually retired as vice-president of the Rexall Drug Company. Many of the Knowles's ancestors were physicians, including his grandfather, Frederick M. Turnbull, a psychiatrist at Massachusetts General Hospital (MGH); but it was the influence of Dr. George Klinkerfuess, a general practitioner in Normandy, Missouri, that settled the eight-year-old on a career in medicine. The family had moved to Normandy when Knowles was an infant; when he was about twelve, they moved to suburban Belmont, Massachusetts.
Education
Knowles was a star athlete in several sports at Belmont Hill School, as well as a fine pianist, but was not distinguished for his academic achievements. The same was true at Harvard, from which he received his Bachelor of Arts degree in 1947. Knowles won letters as a baseball pitcher, a hockey goalie, and a squash player. With his classmate Jack Lemmon, the future Academy Award winner, he played jazz piano, composed show music, and acted in a Hasty Pudding revue. Ten of the eleven medical schools to which Knowles applied, including Harvard, rejected him. Although his academic record at Harvard was poor, he did very well as a medical student at Washington University in St. Louis (1947 - 1951), receiving his Doctor of Medicine cum laude and winning awards in both internal medicine and pathology. This change in his academic success can be ascribed to his newly serious attitude; he applied himself diligently to the scholarly pursuits that his many extracurricular activities had previously enticed him to neglect. Knowles served his internship at MGH from 1951 to 1952.
Career
Knowles worked at MGH for twenty years, working his way up through the ranks except for service from 1953 to 1955 as a lieutenant in the Naval Reserve Medical Corps, administering the cardiopulmonary laboratory at the Portsmouth (Virginia) Naval Hospital and from 1956 to 1957 as a postdoctoral fellow in physiology at the universities of Rochester and Buffalo. He was assistant resident in medicine from 1952 to 1953, resident in medicine from 1955 to 1956, chief resident in medicine from 1958 to 1959, chief of the Pulmonary Disease Unit from 1959 to 1961, director of medical affairs from 1961 to 1962, and general director from 1962 to 1972 the youngest in MGH's history. All the while he taught intermittently at Harvard Medical School, becoming professor of medicine in 1969.
In the late 1950's, Knowles's primary interest shifted from clinical medicine to the social, political, and economic aspects of medicine. He soon became an outspoken and controversial critic of the health-care establishment in speeches, press interviews, articles (both popular and scholarly), and books. He was especially critical of the private sector and was an early supporter of Medicare to alleviate the callousness of the health-care delivery system. He also advocated that hospitals and other health-care institutions emphasize preventive rather than curative medicine, which was potentially more beneficial to patients, but more difficult to administer and less profitable for individual physicians. Such attitudes did not endear Knowles to the American Medical Association (AMA), although the American Hospital Association strongly endorsed him.
The notorious "fight" between Knowles and the AMA was in reality a dispute between Secretary of Health, Education, and Welfare Robert H. Finch and the AMA, with Knowles caught in the middle. Just before President Richard Nixon's first inauguration in 1969, secretary-designate Finch told both Nixon and Knowles that Knowles was his first choice to be assistant secretary for health and scientific affairs. Nixon promised Finch that he would appoint Knowles to this post if Finch could garner sufficient support for Knowles within the health-care community. Nearly every important professional medical association supported Knowles except the most important one, the AMA, a very conservative group and traditionally a heavy contributor to Republican coffers. The AMA never disclosed publicly its specific objection to Knowles. It merely presented a list of its own recommendations for the position, conspicuously omitting Knowles's name. Depending upon which source one consults, the AMA opposed him either because of his views as such, however he presented them, or because he was flamboyant and a gadfly, whatever his views. Nixon finally succumbed to pressure, both from the AMA and from members of Congress who were beholden to the AMA, and in June 1969 selected Roger O. Egeberg instead of Knowles. Apparently Egeberg was more acceptable to the AMA because he was more subdued. The irony was that Egeberg and Knowles held similar ideas about the role of medicine in society.
From 1972 until the end of his life, concurrent with being professor of medicine at New York University, Knowles was president of the Rockefeller Foundation. He loved this work best of all. In retrospect, even though he would have accepted the federal appointment if it had been offered, Knowles doubted he could have survived long as a Washington, D. C. , insider, and after government service the trustees of the Rockefeller Foundation probably would not have been interested in him. As a philanthropic administrator, Knowles's main goal was to increase the leadership and participation of the private sector in socioeconomic change. Knowles died at MGH in Boston after a brief struggle with pancreatic cancer.
Achievements
John Hilton Knowles was recognized as an international medical leader in the 1960s and 1970s. Under his guidance, the Rockefeller Foundation undertook projects in international agricultural development, energy conservation, and peacemaking. He was also known as an author of Respiratory Physiology and Its Clinical Applications (1959) and the editor of Hospitals, Doctors, and the Public Interest (1965); The Teaching Hospital (1966); Views of Medical Education and Medical Care (1968); and Doing Better and Feeling Worse: Health in the United States (1977).
Knowles was an ardent proponent of the individual's responsibilty in personal health care. He believed in the people leading themeslves, not in the government leading the people, but also that if the people did not lead themselves, then the government would have to step in and take them by the nose. In order to prevent this kind of intervention, Knowles looked for ways to encourage private citizens to help make health care more equitably delivered and of better quality. His focus was always on what the individual could do if given the right tools and the right motivation, not on what the group could do for the individual. John was also a strong opponent of unnecessary operations and pressed for more attention to social and economic matters.
Connections
Knowles and Edith Morris LaCroix were married on June 13, 1953, and had six children.
