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Hear that? That's what it sounds like when you plant more trees than you harvest. Work done by thousands of working forest professionals like Adam, a district forest manager who works to protect our forests from fires. Keeping a forest fire-resistant is synonymous with keeping a forest healthy. And we do that through planting more than we harvest and mitigate those risks through active management.
It's a long-term commitment. Visit WorkingForestsInitiative.com to learn more. This is Lee Habib, and this is Our American Stories, the show where America is the star and the American people. And we'd love to hear your stories, send them to ouramericanstories.com about your family, about the town you live in, about the country you love. Your stories are some of our favorites.
Up next, the story of how identical twin brothers, a doctor and a lawyer, Collaborated with scores of unsung heroes to modernize emergency medical services, help create the physician assistant profession, help write the model law for organ donation. and develop other programs that save thousands of lives every year. Here's Alfred and Blair Sadler. with their story.
Okay. Thank you very much. It's a pleasure for Blair and me to Have an opportunity to be with you today and tell our story. I'm Alfred. Saddler, I go by Fred.
And my identical twin brother, who was born four minutes after me in New York City in 1941, is Blair. And I am a physician. And Blair is a lawyer. Blair and I were medical students and law students, respectively. in Philadelphia in our early twenties.
And this led to the idea that we might actually collaborate together. The first issue that we addressed was the Good Samaritan problem. And what I'm referring to is that Christianity and the American Bible talk about the Good Samaritan who is encouraged to Stop at the scene of an accident and help someone who is injured, even if it's someone. of another Persuasion. But the law may have a different view of the matter.
If, for example, we stop and the patient doesn't do well or dies, the family in our litiginous society might be encouraged to sue us.
So we looked into the laws relating to this. They were different in different states, and that is what launched our collaborative career. When I reflect back on how did we get started, How did this idea actually take off to collaborate? We talk in the book about four green lights. Four green lights.
Four things that happened. that had they not been giving us a green signal. We never would have done this. Fred's already mentioned the first one of those, which was A joint presentation we did at Mass General Hospital. As part of his surgical rotation on the Good Samaritan problem.
the legal and ethical issues. and stopping to render aid and an accident. And the chair of the Department of Surgery afterwards saying, This is one of the best presentations we have had. That really led a spark. and we decided to pursue the idea.
of collaborating and law and medicine. We developed a paper describing a variety of medical legal issues, such as informed consent, human experimentation, euthanasia. organ transplantation and definition of death. I called Anthony Amsterdam, a leading Penn Law professor and a mentor of mine who frequently argued cases before the Supreme Court. I asked if we could meet with him about our idea and he said, Sure, let's have dinner.
Fred and I came to the dinner with two questions. First, did our medical-legal collaboration idea make any sense? And second, should we pursue such collaboration now, or should we wait until we're further along in our careers? He reviewed the paper and said, you know, this is a great idea. Even more important, he thought we should pursue it immediately.
That provided a major booster shot to proceed. But where and how? We were aware that the U.S. Public Health Service had opportunities to become commissioned officers, but they were. typically for MDs and PhDs in science.
So Fred took a chance. He called Dr. Luther Terry, the former Surgeon General who had become well known. by fighting the tobacco industry. over cancer risks and placing the warning on every pack of cigarettes, smoking may be hazardous to your health.
Fortunately, he was now dean of the medical school at the University of Pennsylvania of all places. He agreed to meet with us. and reviewed our position paper. He exclaimed, You know, this is a great idea. I wish I had had a doctor-lawyer team working with me.
On the tobacco issues, it is He put us in touch with the current Surgeon General. and the current director of NIH. We soon arranged for three days of interviews in Bethesda and Washington. and received invitations to apply for jobs. We did, but just four months had passed with no response, and I was running out of time.
My judicial clerkship in Philadelphia was ending in July, and I had to decide. whether to accept an offer from a Philadelphia law firm.
So I called the office of the Associate Director of NIH, who agreed to meet with me. Just a month later, on March 28th, our 26th birthdays, we received telegrams. offering us commissions in the U.S. Public Health Service. stationed at NIH, in the director's office.
in Bethesda. We enthusiastically accepted. began work On July 1st. When Blair and I arrived on day one on July 1st of 1967, in the director's office of the NIH. We met with Mr.
Joseph Murtaugh, who was the outstanding leader of the planning office for Dr. Shannon of the NIH and he was our boss. And he said, gentlemen, we have a problem, and put two newspaper clippings in front of us, one from the L.A. Times and one from Minneapolis, where pituitary glands were being taken. from cadavers.
Who were being examined by the medical examiner to determine the cause of death? and the medical examiner in every state has the authority to do that when there is suspected homicide. or foul play or if there's a pandemic. for example. And he has authority to do that whether the family objects or not.
But there is no authority. as part of that statute in any of the states, which allows him or his assistants to take other tissues that have no relevance to the cause of death, in this case pituitary glands. And you're listening to the unlikely collaboration of identical twins, want a lawyer? You don't want a doctor. who forever changed how we view certain things about the medical and legal professions and the intersection of both.
When we come back, more of the story of Alfred and Blair Sadler here on Our American Stories. Uh Here at Our American Stories, we bring you inspiring stories of history, sports, business, faith, and love, stories from a great and beautiful country that need to be told. But we can't do it without you. Our stories are free to listen to, but they're not free to make. If you love our stories in America like we do, please go to ouramericanstories.com and click the donate button.
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And we're back with Our American Stories. And we've been listening to the story from Fred and Blair Sadler, identical twin brothers, a doctor and a lawyer, who helped innovate and change American emergency medical services. We last left off with Fred sharing the story of how pituitary glands were being taken without consent from cadavers by medical examiners in California and Minnesota. Let's return to Fred and Blair. Um That had happened in those two states.
The press had found out about it. where assistance to the pathologists were taking pituitary glands and sending them back to Baltimore, Maryland, which is where the headquarters of something the NIH was funding called the National Pituitary Agency was located. And they were doing this because although at only $2 per gland, if you send enough of these and the NIH was collecting 72,000 pituitary glands from cadaverage. from around the country, you can make some money. The reason that the NPA, the National Petitary Agency, was established was very straightforward.
We're all familiar with unfortunate children who are born with a pituitary tumor or a pituitary problem which prevents them from making adequate human growth hormone that we all need to grow to our full height. And if we don't, we end up being very short.
So by grinding up the cadaver pituitary glands and obtaining human growth hormone. then enough could be administered to the dwarfs by injection over a crucial period of time in their growth. Uh A noble purpose, to be sure, but it seemed clear that some people in at least some coroner's offices were not following the law. Uh We were complete rookies on this issue. Whether it's medicine or law, when you are confronted with a new issue, step one is do research.
We went to the Georgetown Law Library and we read everything available on the variety of state laws dealing with autopsies and organ donation. We also got advice from the leading authorities on this topic. the eye banks, the kidney foundation, the heart association, the tissue banks, even the funeral directors. During our research we discovered That the Commissioners on Uniform State Laws, now the Uniform Law Commission. had actually created a committee that had been at work for a year on drafting a model state organ donor law.
Amazing. We met with Professor Blythe Stason, the former dean of the Michigan Law School. who chaired the committee. We reviewed the many connections we had already made to healthcare organizations. and that we had a mandate from NIH to explore these issues in depth.
He asked us to serve as official consultants to the commissioners. What an opportunity. And then just two months later, Dr. Christian Bernard. performed the first human heart transplant in South Africa.
Front page news. Time Magazine, Man of the Year. There was tremendous public interest and concern. A Gallup poll showed 70% of people, if asked, would be an organ donor. But Two New Yorker magazine cartoons sent a different message.
One of a patient in a hospital bed with a large sign on top of him. breathing patient asleep. not a heart donor. And another was a bumper sticker cartoon that read Drive carefully. Dr.
Bernard may be watching.
Well humorous They revealed an underlying concern. Could people trust the healthcare system not to give up on them prematurely if they were sick and were a potential donor? We worked on multiple drafts over the next several weeks and reviewed them with Stason and his committee and other experts. Ultimately, they approved it and recommended it to the commissioners. At its core, the Uniform Act is a gift statute based on voluntary informed consent.
It provided, first, an individual could decide to donate all our part of his body for transplantation or research upon being 18 years of age. Second, if no decision had been made by the individual, the family could make the gift. And it provided a specific definition of eligible family members. Third, it stated that the donor's physician could not be the same as the recipient's physician to avoid any conflict of interest. That provided permission for the definition of death to include brain death, but did not include any specific definition of death because we knew that as science evolved, medical criteria would too.
In June 1968, just less than a year after arriving at NIH. With Blythe Stason, we presented the Uniform Anatomical Gift Act to the full body of the 100 commissioners assembled for their annual meeting in Philadelphia. It was approved unanimously. The American Bar Association approved it one week later. The model law was enacted with little or no change by 41 states in the first year.
and by all fifty States and the District of Columbia in three years. We testified before at least 10 different state legislatures during this period as well as before the U.S. Senate. at hearings commissioned by Senator Walter Mondale. Uniform donor card was another key step.
The law specifically provided that a gift could be made by any written document including a card carried on the person. But what if the cards were different and conflicting? As members of the National Academy of Sciences ad hoc committee, we convened what turned out to be a pivotal meeting. of 21 organizations with just one goal. Develop a donor card that could be used by all in every state.
The meeting was a success and produced a simple legal document, the size of a driver's license, that streamlined the consent process and could be used by all organizations. A potential crisis of confusion and conflict had been avoided. We did not really. Realized that at the time that we were working on the organ transplant law with the Uniform Law Commission. And writing the Uniform Anatomical Gift Act, that we were essentially.
Dealing with very important bioethical alternatives. Should we Set up a system which we did, which was voluntary, which would allow us to donate. and the next of kin can also donate. Or, as a pair of professors at UCLA, one of whom was a physician and one of whom was a lawyer, argued that you'll never get enough organs. Through voluntary donation, and therefore, we should switch to what some people call presumed consent or opting out, which says that all of us are organ donators unless we object.
So, the burden is on the citizen to object to donating. And we felt that this approach went against. all American values. particularly altruism, autonomy, and trust. We argued our position in law review articles and in New England Journal of Medicine articles.
And this helped support the movement in all the states and in the District of Columbia. to pass the Uniform Anatomical Gift Act. And we've been listening to the story of Fred and Blair Sadler, one a doctor, the other a lawyer. And how they collaborated and innovated and changed all of our worlds forever. That organ donation card that we all take for granted.
My goodness, without that idea, without that work that they did. what a different world we'd have and how many less people. would be alive. And by the way, what a thing to do, that dialogue about getting the citizen to opt out. Of organ donation, what a terrible idea.
It would have ruined everything and there would have been great resistance, this assumption that we're just giving away our organs, but to fight to do it right and to get people to voluntarily do this and make this the status quo. What a remarkable achievement by these twin brothers. And by the way, you can pick up Fred Ann Blair's book. pluck lessons we learned for improving healthcare. And the world, and you can get it at your local bookstores, at Amazon, or any place you buy your books.
When we come back, more of the remarkable story of Fred and Blair Sadler. Twin brothers, a doctor and a lawyer. who changed how we live. and how we die. Here.
on our American stories. Then the space hamster flew his hot air balloon all the way to the bottom of the ocean. Where did that story come from? Book? Dream?
Nope, it came from a conversation. Meet Miko Mini Plus, the AI companion that co-creates personalized story adventures with your child in real time. What color was the hamster's cape? And what did he pack for lunch? Unlock your child's imagination.
Discover Miko Mini Plus and the magic of AI exclusively at Costco. Come for the Black Friday seasonal savings. Stay for the award-winning reporting. For a limited time, access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks.
That's a great deal for the first year. After that, it'll cost $12 every four weeks. You can cancel any time. But don't wait, this Black Friday seasonal offer won't be here for long. Go to Washington Post dot com slash iHeart and grab this deal before it's gone.
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Nordic Track. Train anywhere? Explore everywhere. And we continue with our American stories and the story of Fred and Blair Sadler. Let's continue where we last left off.
We've talked a lot about organ transplantation and bioethics. But emergency medical care as well was a similar remarkable experience. We were now at Yale running the the LTRAMA program and It's remarkable to reflect on where emergency care was in 1970. As hard as it is to believe, There was no 911 number. There were no EMTs or paramedics.
Ambulances were glorified station wagons, sometimes doubling his hearses. There were no residency programs in emergency medicine. There was no system of trauma centers. Every day on the battlefields of Vietnam, well trained medics were taking wounded soldiers to well equipped trauma centers. Their cardinal rule was the golden hour.
The Golden Hour. Get the patient to a well-equipped trauma center in one hour and they had a chance. Ironically, No such goal existed back home in the States. It was Scoop and Hall. pick up the trauma patient, take them to the nearest hospital.
and hope for the best. Mm-hmm. No wonder that a 1966 study by the National Academy of Sciences called Accidents. The neglected disease of modern society. We began our comprehensive study in Connecticut by learning everything we could about EMS.
And the state. Working with nine. MPH students, we canvass the state. Connecticut had 35 hospitals and 179 ambulances, but there was no coordination between them. In 1968, a presidential commission had recommended a single telephone number, 911, and ATT declared it was available, but only a few systems had been established.
In Connecticut, for example, it served only 14%. Of the population.
So we created and co-chaired the state's first EMS advisory committee. and developed a 700 page report, which we distilled to a 52 page summary, submitted it to the governor, entitled Emergency Medical Services in Connecticut, a Blueprint for Change. Key legislative support followed and funding and in just five years six thousand ambulance personnel 6,000. completed the new 81 hour EMT course. in Connecticut.
Our next problem found us, and that was that the Assistant Secretary for Health. Wanted someone to look into the legal issues of the fact that there were new types of health professionals called physician assistants being trained to help. the problem with the acute Doctor shortage that existed at that time. This is 1969. Medicare and Medicaid had been passed in 1966, which enfranchised millions of additional Americans for healthcare.
Be it the elderly or be it poor people below a certain poverty line.
However, there were nowhere near enough physicians and nurses to do so, and to train additional doctors would have taken seven to ten years to do.
So, very. Bright. and creative physicians and nurses. decided to solve this problem. And at Duke, Professor Gene Stead and Professor Thelma Ingalls from the nursing school.
got together to teach nurses. to learn a lot more about medicine. and give them a certificate as specially trained. And The plan at Duke was to This was in the late 50s and early 60s. Was to train additional nurses at Duke, and then hopefully this would become a national model.
There was one thing that had to be done to make this happen. And that was that the program had to be accredited by the accrediting body of Nursing, which was the National League for Nursing. The NLN arrived at Duke and surveyed the program and did not accredit the program. They said there was too much medical input, it was more of a medical program than a nursing program, and therefore refused to grant. its stamp of approval.
Naturally, Dr. Stead was deeply disappointed, as was Professor Ingalls. Professor Ingalls left Duke and went to the Rockefeller Foundation and did marvelous work over the next 40 years around the world. Dr. Stead looked for an alternative.
to nursing. and found it with the returning military corpsmen. There were 6,000 Very well trained. Military Corpsman. Who?
Over a year and a half of training at major medical hospitals were working in Vietnam. And on the battlefield. helping to save lives with bullets often flying over their head. They were starting IVs. giving blood.
and stopping major injuries and helping to transport these. Wounded soldiers back to the base hospital, as well as then helping out at the base hospital.
So, Dr. Stead decided to use four of these. returning Corman in 1965 to start a new program called the Physician Assistant Training Program. and it was highly successful. We were asked by the Assistant Secretary of health.
Was this a solution to the national shortage of health care practitioners in the face of the increased demand? And we were asked to travel and got a chance therefore to see These programs in action, but he specifically wanted to know what the law should be. How would these people be allowed to practice? And after thorough study and working with our Colleagues at Duke, who were looking at the same issues, we came up with a simple amendment to the Medical Practice Act. Which is the law that allows a physician to practice in each state.
And the Medical Practices Act defines that a physician can operate, diagnose, treat, and prescribe. Which no other health professional can do. But there's nothing in the law, and this was our amendment, which would prevent. A physician from delegating to specially trained nurses or physician assistants. Those tasks for which the Assistant was a Well trained and that fell within the scope of practice of the physician.
And finally, that Both. The assistant and the physician would be responsible for that care. This law took off. and was passed in most all of the states within a matter of a couple of years. and allowed physician assistants or PAs as they are known in the vernacular.
to practice under the auspices of the Medical Practice Act.
So, from trained 911 dispatchers to highly skilled EMTs and paramedics to thousands of emergency care physicians and nurses, to sophisticated ambulances that transport patients directly to trauma centers, emergency medical care in the U.S. today is really a jewel. and our crowns. And a terrific job on the storytelling and editing by Greg Hengler. And a special thanks to Fred Ann Blair Sadler.
Their terrific book, Pluck, Lessons We Learned from Improving Healthcare and the World is available in bookstores, on Amazon.com, or wherever you get your books. And my goodness, it's unimaginable to think that back in the 1970s, when these guys were just getting going, that there were no EMTs, no system of trauma centers, ambulances, well, they were just glorified station wagons that passed rehearses. scoop and haul.
Well that's what they did with trauma patients scoop and haul. The idea of treating them?
Well, one groundbreaking study in the 70s. called accidents the neglected disease of modern society. and into the breach stepped these two men. And kudos to all the state legislators who fight back and forth, left versus right, to get together and solve this problem and solve it fast. A great story about the intersection of law and medicine.
And problem solvers, two great problem solvers, twin brothers, both, the Saddlers. Here on Our American Stories. Hehehehehehehe Shhh! You won't believe what my new friend just told me about dinosaurs! Is your child having conversations you never imagined?
Are they learning without realizing it? It's not a tablet. It's not a toy. It's Miko Mini Plus, the AI-powered companion that turns curiosity into endless learning. Hear the future of playtime.
Meet the extraordinary Miko Mini Plus. Only at Costco. Come for the Black Friday seasonal savings. Stay for the award-winning reporting. For a limited time, access to The Washington Post is just 99 cents.
That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that, it'll cost $12 every four weeks. You can cancel any time. But don't wait, this Black Friday seasonal offer won't be here for long.
Go to Washington Post dot com slash iHeart and grab this deal before it's gone. That's Washington Post dot com slash iHeart. This holiday season, give the gift to everyone will gather around. A Visio Smart TV now available at Walmart. From a supersized 100-inch TV to QLED TVs of all sizes, Vizio delivers breathtaking color and crystal-clear picture quality that takes entertainment to the next level.
Plus, with Watch Free Plus built-in, they can enjoy free live and on-demand TV right out of the box. Have a music lover on your list? They can stream their favorite music on the iHeartRadio app, ready to go on every Visio TV. The perfect gift is waiting. Head to walmart.com and discover Vizio TVs today.
The only thing between you and your best self is a start button. This Cyber Monday, explore the world with Nordic Track. From the peaks of Peru to the streets of Paris, every workout moves you somewhere new with iFit trainers leading the way. The equipment's amazing, smooth, quiet, and those screens make it all feel real. Ready to start your next workout adventure with the number one treadmill brand in the U.S.?
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