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The Twin Brothers Who Helped Change The Medical Practices We Now Take For Granted

Our American Stories / Lee Habeeb
The Truth Network Radio
October 14, 2022 3:01 am

The Twin Brothers Who Helped Change The Medical Practices We Now Take For Granted

Our American Stories / Lee Habeeb

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October 14, 2022 3:01 am

On this episode of Our American Stories, we learn about 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.

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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.

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 Sadler. 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'm a physician and Blair is a lawyer. Blair and I were medical students and law students respectively in Philadelphia in our early 20s 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 litigious society might be encouraged to sue us so we looked into the laws relating to this there 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 in 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 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 26 birthdays we received telegrams offering us commissions in the US 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 LA 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's 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 one a lawyer and one 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. 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 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 give a little give a lot help us keep the great American Stories coming that's OurAmericanStories.com Fall is here which means it's time to refresh your closet and Saksa 5th is the perfect place to do just that let your style take off this fall in chic faux leather jackets cool chunky boots trendy totes and more update your wardrobe now with designer names like Stella McCartney Chloe Stuart Weitzman Vince Moschino and more so you can get everything you want at Saksa 5th all at a price you'll love discover all of the fall fashion essentials at up to 70% off at Saksa5th.com or at a Saksa 5th store near you 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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 two dollars per gland if you send enough of these and the nih was collecting 72 000 pituitary glands from cadavers from around the country you can make some money the reason that the npa the national pituitary 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 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 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 blight stason the former dean of the michigan law school who chaired the committee we reviewed the many connections we had already made to health care 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 reading patient asleep not a heart donor and another was a bumper sticker cartoon that read drive carefully dr bernard may be watching drive carefully dr bernard may be watching while humorous they revealed an underlying concern could people trust the health care 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 or 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 it provided permission for 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 blithe station 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 50 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 science's 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 realize it 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 bio-ethical alternatives should we set up a system which we did which was voluntary which would allow us to donate and the next of kin could 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 saddler 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 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 and blair's book pluck lessons we learned for improving health care 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 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united healthcare helping people live healthier lives and we continue with our american stories on 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 yale trauma 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 as 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 haul pick up the trauma patient take them to the nearest hospital and hope for the best 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 in the state working with nine mph students we canvassed 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 at and t declared it was available but only a few systems had been established in connecticut for example it served only 14 percent 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 six thousand 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 health care 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 ingles 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 sted was deeply disappointed as was professor ingles professor ingles left duke and went to the rockefeller foundation and did marvelous work over the next 40 years around the world dr sted looked for an alternative to nursing and found it with the returning military corpsman 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 sted decided to use four of these returning corpsmen 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 practice 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 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 pa's 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 in our crown and a terrific job on the storytelling and editing by greg hangler and a special thanks to fred and blair saddler their terrific book pluck lessons we learned for improving health care 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 all 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 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Whisper: medium.en / 2022-12-05 23:40:26 / 2022-12-05 23:51:40 / 11

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