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

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Some of our favorite story of how identical twin brothers Dr. and award are collaborated with scores of unsung heroes to modernize emergency medical services create physician assistant profession help write the model wall organ donation and develop other programs that save thousands of lives every Alfred and Blair set with their store.

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 was born four minutes after me in New York City and 1941 is where I am a physician, and Blair is Moyer Blair and I were medical students and law student, respectively, and Philadelphia. In our early 20s, and this led to the idea that we might actually collaborate together first issue that we addressed with the good Samaritan problem.

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 was 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. Reflect on how did we get started this idea actually take off to collaborate we talk in the book about four green lights four green lights for things that happened that had they not been giving us a green signal. We never would've done this Prince 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 in stop and render aid in an accident and the chair of the department surgery after which I this is one of the best presentations we have had that really let a spark and we decided to pursue the idea of collaborating on 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 pan- law professor and mentor of mine who frequently argued cases before the Supreme Court asked if we could meet with him about her idea and he said sure. Fred and I came to the dinner with two questions. First of our medical legal collaboration idea make any sense.

Second truly pursue such collaboration now or should we wait until were further along in our careers. He reviewed the paper said you know this is a great idea. Even more importantly thought we should pursue it immediately. That provided a major booster shop to proceed where and how we were aware that the US Public health service and opportunities to become commissioned officers but they were typically for MDs and pastries in science so Fred took a chance.

He called Dr. Luther Terry, the former Surgeon General, who would 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 partially. He was now Dean of the medical school of the University of Pennsylvania, of all places. He agreed to meet with us and reviews our position papers.

He exclaimed you know this is a great idea. I wish I had a doctor or 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 arrange for three days of interviews in Washington and received invitations to apply for jobs we did just four months had passed with no response and I was running out of time by judicial clerkship in Philadelphia was ending in July and I had to decide whether to accept an offer from a Philadelphia law firm. I called the office of the associate Dir. of NIH who agreed to meet with me just a month later on March 28 or 26th birthday, we received telegrams offering us commissions in the US Public health service station at NIH in the director's office in Bethesda. We enthusiastically accepted, began work on July 1 and Blair.

I arrived on day one on July 1, 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 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 in the medical examiner in every state has the authority to do that when there 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 gland, and you're listening to the unlikely collaboration of identical twins one employer and one a doctor forever changed how we view certain things about the medical and legal professions in the intersection of when we come back more of the story of Alfred and Blair set on our American stories American stories we bring you inspiring stories of history, sports, business, faith and love stories from a great and beautiful country need to be told we can't do it without you are stories are free to listen to with her not free to make you love are stories in America like we do. Please allow American stories.com click the donate button give a little development help us keep the great American stories coming to our American stories.com fall is here, which means it's time to refresh your closet and sex affect is the perfect place to do just that. Let your style take off the spa and chic faux leather jackets, cool, chunky boots, trendy totes and more. Update your wardrobe now designer names like Stella McCartney, Chloe Stewart Weitzman Vince machine.

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Let's return to Fred and Blair that had happened in those two states. The present 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 finally called the national pituitary agency was located in doing this because although at only two dollars.

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, were all familiar with unfortunate children who are born with a pituitary tumor are 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 gland and obtaining human growth hormone then enough could be administered to the dwarfs by injection or crucial period of time in their growth and noble purpose. To be sure, but it seemed clear that some people in at least some coroners offices were not following the law complete rookies on this issue. Whether it's medicine or law when you're confronted with a news issue.

Step one is to research we went to the Georgetown law library and reread 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 Ibex, the kidney foundation, 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 actually created a committee that had been at work for a year on drafting a model state organ donor law amazing. We met with Prof., blood states and the former Dean of the Michigan law school, who chaired the committee to review the many connections we had already made healthcare organizations and that we had a mandate from NIH to explore these issues and that 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 manner. The year was tremendous public interest and concern for Gallup poll showed 70% of people if asked would be hard but to New Yorker magazine cartoons so different message. One of the patient in a hospital bed with a large sign on top of him reading patient to sleep. Not a hard to and another was a bumper sticker cartoon that read drive carefully. Dr. Bernard washing her humerus. They revealed an underlying concern that people trust healthcare system not to give up on them prematurely. If there were circular potential.

We worked on multiple drafts over the next several weeks and review them with station that is committee and other experts. Ultimately they approved it and recommended it to the commissioners at its core, the uniform is a gift statute based on voluntary informed consent 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, family could make the gift and it provided a specific definition of eligible family members. Third, and stated that the donor's position could not be the same as the recipient's position to avoid any conflict of interest that provided permission for definition of death to include brain death but did not include any specific definition because we knew that his science evolved medical criteria would to 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 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 about all 50 states and the District of Columbia, and three years.

We testified before, at least 10 different state legislatures. During this period as well as before the U.S. Senate hearings commissioned by Sen. Walter Mondale uniform donor card was. Another key step law specifically provided that a gift could be made by any written document including a card-carrying 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 and every state. The meeting was a success and produced a simple legal document. The size of a drivers license to streamline the consent process and could be used by organizations potential crisis of confusion and conflict have 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 uniform anatomical gift act we were essentially dealing with very important bioethical alternatives. Should we set up a system which we did it, which is voluntary, which would allow us to donate and the next of kin can also donate or as pair of professors and 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 are opting out which says that all of us are organ donators unless we object so that the burden is on the citizen to object to donating and we thought 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 helps support the movement and all the states and in the District of Columbia to pass the uniform anatomical gift and even listening to the story of Fred and Blair Sadler want a doctor the other lawyer and how they collaborated and innervated and changed all of our world 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 have and how many less people would be alive by the way. One thing to do that that dialogue about getting the citizen to opt out of organ donation. What a terrible idea would've ruined everything in the great resistance's assumption that which is giving way, our organs to fight to do it right 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 could pick up Fred and Blair's book what lessons we learned in improving healthcare in the world and you can get in your local bookstores and Amazon anyplace 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 changed how we live and how we die. Our American story.

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The story of Fred and Blair Sadler. Let's continue. When we last left off to talk a lot about organ transplantation, bioethics emergency medical care as well is 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. There were no EMTs or paramedics. Eminences were glorified station wagon. Sometimes doubling as hearses. There are 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.

The cardinal rule was the Golden hour the Golden hour.

Get the patient to a well-equipped, center in one hour and they had a chance.

Ironically, no such goal existed back home in the states. It was scoop and all pick up the trauma patient take him to the nearest hospital and hope for the best. No wonder that in 1966 study by the National Academy of Sciences, 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 9 mph students.

We canvassed the state Connecticut had 35 hospitals of the hundred and 79 ambulances, but there was no coordination between 1968, a presidential commission had recommended a single telephone number 911 and AT&T declared was available but only a few systems have been established in Connecticut, for example, it served only 14% of the population. So we created and cochaired the states first EMS advisory committee and developed a 700 page report, which we distilled 52 page summary submitted to the governor, entitled emergency medical services in Connecticut, a blueprint for change key legislative support followed and funding in just five years 6000 and personnel 6000 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 call 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. The elderly or bid 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 7 to 10 years to do so very bright and creative physicians and nurses decided to solve this problem and it Duke Prof. Jean Stead and Prof. Donna Ingalls from the nursing school got together to teach nurseries to learn a lot more about medicine and give them a certificate has specially trained and the plan that Duke was to this is in the late 50s and early 60s was to train additional nurses at Duke and then hopefully this would become a national model. There is one thing that had to be done to make this happen and that is 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 and put it was more of a medical program, nursing program and therefore refused to grant its stamp of approval. Naturally Dr. Stead was deeply disappointed as well as Prof. Ingalls, Prof. Ingalls left Duke and went to the Rockefeller foundation and did marvelous work over the next 40 years around the world. Dr. Stead looking for an alternative to nursing and found it with the returning military corpsman. There were 6000 very well trained military corpsman who over a year and 1/2 of training at major medical hospitals were working in Vietnam and on the battlefield helping save lives with thoughts 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 corpsman 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 healthcare practitioners in the face of the increased demand, and we were asked to travel and got a chance therefore to see these programs of action, but he specifically wanted to know what the law should be.

How would these people be allowed to practice after thorough study and working with her 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 on this is 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 PAs as they are known in the vernacular to practice under them hospices 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 ambience is the transport patients directly to trauma centers, emergency medical care in the US today is really actual in our crown and a terrific job on the storytelling and editing by Greg Engler. A special thanks to Fred and Blair Sandler there terrific book club lessons we learned from proving healthcare in the world is available in bookstores and Amazon.com were ever you get your books. My goodness, it's unimaginable to think back in the 1970s when these guys were just getting going. If there were no EMTs, no system of trauma centers ambulances while they were just glorified station wagons the past versus scope and whole.

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 step. 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. The great story about the intersection of law and medicine and problem solvers to great solvers twin brothers, both the sadness here on our American story. Bottomless margaritas going whenever I want and how everything in Tori spelling is you singled out there looking for live companionship real connection you got a tribe on both lots of people who are members and absolutely love it. It's easy to use and best they feel safe when you're using bumble is serious about safety features that let you know when someone is being shady or is trying to send you an you know I think as a matter fact, research shows 80% of US bumble members say they feel safe using which is awesome because let's face it is hard enough without worrying about creepy people you like to learn more Donatist safety center in the bumble you are ready to get out mandate download number this October. XFINITY flex is a monster lineup of TV shows and movies with our Halloween collection make some magic with family favorites like hocus-pocus and hocus-pocus do jumping to scare us with Halloween ends and keep reading or at last year screens with loss as booties in my best friend's exorcism and dance like you're possessed with Halloween radio from iHeartRadio stream the best spooky entertainment with XFINITY flex say what to watch in your XFINITY voice remote