Posts Tagged ‘Ernest Saward MD’

KP Northern California marks half a century of stellar research

posted on August 14, 2012

By Lincoln Cushing
Heritage writer

Ellsworth Dougherty, MD, one of Kaiser Permanente’s earliest researchers, studied the worm that eventually led to the mapping of the human genome. This photo is from a research trip he took to Antarctica circa 1959.

Kaiser Permanente has a well-deserved public reputation for providing top quality health care, but less known is the health plan’s long and illustrious record for conducting high-caliber medical research. Kaiser Permanente is widely considered the leading non-university-based health research organization in the United States, with Kaiser Permanente Northern California’s Division of Research amassing more than $100 million in 2011 to conduct research.

This research has a direct effect on health care in this country, influencing the way physicians care for patients and refining broader policies that support medical services. Kaiser Permanente researchers, often partnering with academic institutions, successfully compete for federal research grants, and develop lines of research whose results translate to improved patient outcomes at the local, state and national levels.

Centers for Disease Control and Prevention (CDC) Research Director Jeffrey Harris, MD, put it this way: “If you look at who the leaders in research are and who the folks are that have been doing research… to improve care, it’s a very short list.  And Kaiser Permanente is clearly at the top of that list.” [i]

This year, The Permanente Medical Group, the oldest of the eight Kaiser Permanente regional medical groups, celebrates the 50th anniversary of the founding of its Division of Research.

In the past five decades, Kaiser Permanente researchers have conducted thousands of studies and helped to solve many medical mysteries – from the best way to cure pneumonia in the World War II shipyards, to making discoveries leading to the mapping of the human genome, to learning the most effective use of drugs to prevent heart attacks.

Gary Friedman, MD, led the Division of Research from 1991 to 1998. This image originally appeared in the KP Reporter, 1987.

The DOR (under its original name, Medical Methods Research, or MMR) was established September 21, 1961, by the Northern California medical group’s Executive Committee. Morris F. Collen, MD, one of the Health Plan’s founding members and a pioneer in the emerging discipline of medical informatics, led the group, which occupied offices in the old Kaiser Permanente headquarters at 1924 Broadway in Oakland.

Ten years earlier, Dr. Collen had met with Lester Breslow, MD, then a public health officer in San Jose who had recently completed a trial of “multiphasic screening.” This battery of thorough and efficient examinations was a practical solution to the problem of providing care to large populations despite the post-war shortage of physicians.

This approach was put to the test when labor leader Harry Bridges insisted that all members of the International Longshore and Warehousemens Union (ILWU) be given annual check-up exams as part of a negotiated care package with the Permanente Health Plan. Importantly, this exam approach provided a critical evidence base to empirically determine what screening methods are and are not clinically beneficial for patients.

Morris Collen, MD, was the first director of the Northern California research department, established in 1961.

In 1962, Kaiser Permanente Northern California received its first grant from the U.S. Public Health Service to develop, automate, and evaluate the multiphasic exam. Within three years, the Health Plan’s Oakland and San Francisco clinics began offering the Automated Multiphasic Health Testing to all members. In 1968 Dr. Collen dismissed some of the resistance to this use of technology:

“Many physicians are concerned that the computer is depersonalizing medical care,” he said. “Just the opposite is true. Because of the computer, the physician will have more individualized information about his patient—more complete and more accurate than he could possibly have gathered before.”[ii]

Antecedents to Permanente medical research

Even before the Health Plan went public in 1945, Henry J. Kaiser articulated research as one of its goals at the August 21, 1942, dedication of the Permanente Foundation Hospital in Oakland.  As former Kaiser Permanente historian Tom Debley observed:

Illustration for article on medical research, Kaiser Foundation Medical Care Program Annual Report 1968

“From prepaid dues it collected, the Permanente Foundation paid for the medical care of Health Plan members and accumulated funds for such charitable purposes as medical research and the extension of medical services to larger population. . .The idea that research would be a tool to bring advances in medicine to the plan’s dues-paying members thus was embedded in the medical care program from the outset.”[iii]

In 1943, founding physician Sidney R. Garfield received $25,000 from the Permanente Foundation to study new methods of curing syphilis[iv] and he launched the Permanente Foundation Department of Medical Research under the leadership of Franz R. Goetzl, PhD, MD. He also started the research journal Permanente Foundation Medical Bulletin, edited by Dr. Collen from 1943–1953.

The Department began to receive national recognition for outstanding work in the study of peptic ulcers, human appetite, and pain. By 1949 the name was changed to The Permanente Foundation Institute of Medical Research to clarify that the research was not only a department within the hospital.

 

Ernest Saward. MD, medical director of Kaiser Permanente Northwest from 1945 to 1970, launched the region’s research center in 1964.

In late 1958, research involving basic medical sciences was shifted to the Kaiser Foundation Research Institute (KFRI), established by Kaiser Foundation Hospitals to coordinate long-term basic research projects supported by grants from sources other than the Kaiser Foundation Medical Care Program.[v] At first this just covered Northern California’s MMR and the Northwest research center (established in 1964.)

Today, all Kaiser Permanente regions – Hawaii, Georgia, Ohio, Colorado, Northwest, Northern and Southern California, and Mid-Atlantic States, conduct research under the auspices of the KFRI.

By 1961 KFRI’s domain included more than 50 long-range clinical research studies exploring such medical problems as cardiovascular and renal diseases, adenovirus infections, cancer, diabetes mellitus, and psychosomatic medicine. More than 70 staff physicians and residents conducted these investigations, often in collaboration with laboratories at nearby medical and scientific institutions.

Clifford H. Keene, MD, chief executive officer of Kaiser Foundation Hospitals and Health Plan, was named director of KFRI.[vi] A wing of Kaiser Foundation Hospital in Richmond was remodeled to bring together several disparate research projects under the KFRI umbrella.

Laboratory of Comparative Biology Annex, 1301 Cutting Blvd., Richmond, CA, October 1961.

These included a Laboratory of Comparative Biology (under Ellsworth C. Dougherty, PhD, MD) studying the basic physiology of microorganisms; a Laboratory of Medical Entomology (under Ben F. Feingold, MD) investigating the role of insects in causing human allergies; a Laboratory of Human Functions; a study of the Epidemiology of Human Cancer; and a Child Development Study and Blood Grouping project that investigated congenital abnormalities and childhood diseases.

KP Northern California research evolves

During the late 1960s Edmund Van Brunt, MD, a project director for MMR, piloted the San Francisco Medical Data System, a computer-based patient medical record system with a database that supported both patient care and health care delivery  research. By 1973, Health Plan members in San Francisco had a computerized “lifetime” medical record, and pivotal work was conducted to begin to understand the safety of prescription drugs.

But by the early 1970s researchers were forced into a different avenue of research when the Nixon Administration abruptly canceled the department’s funding. The loss of $500,000 per year led to shutdown of the hospital computer system in San Francisco, but the application of computers and databases in medicine and health research continued, supporting new investigators and new areas of research.In 1979 Dr. Van Brunt succeeded Dr. Collen as the second director of the research department (MMR), and in 1986 he changed the name to the current Division of Research (DOR) to more accurately reflect the expanded mission and scope of clinical and other types of research that were being conducted there. Recently he described his vision of the program:

Mary Belle Allen, a basic scientist, conducted her studies in the Richmond KP laboratory along with Ellsworth Dougherty, MD. This photo is from the KP Reporter, 1959

“[We] conducted high quality health services and biomedical research, epidemiologic and vital statistical analysis of the whole variety of medical care processes. . . of different collections of people drawn . . . from the Health Plan membership and by different collections of people . . . males, females, different ethnic groups, young and old.”

Van Brunt continued: “. . . The mission is to use these resources to conduct the kinds of health services research that we feel are important not just to the organization but important in a larger sense.”[vii] Dr. Van Brunt expanded DOR’s research agenda by adding a department of Technology Assessment headed by Director Emeritus Collen.

In 1985 Kaiser Permanente Northern California opened its first research clinic to support the heart disease research study CARDIA (Coronary Artery Risk Development in Young Adults). Within a year it was looking at a group of 5,115 black and white men and women aged 18-30 years in four centers – Birmingham, Chicago, Minneapolis and Oakland. Also in 1985, MMR began the Vaccine Study Center as a way of responding to numerous requests to use Kaiser Permanente’s large population for vaccine efficacy studies.

The center currently operates 31 sites in Northern California and collaborates with Kaiser Permanente’s Northwest, Hawaii, and Colorado regions and participates in several Centers for Disease Control and Prevention and National Institutes of Health studies.

Studies to better understand HIV/AIDS impact

During the AIDS crisis in the 1980s, DOR proved its worth in analyzing the impact of the disease. Kaiser Permanente Northern California was second only to San Francisco County’s public health services in the number of people with AIDS it treated in the initial years of the crisis.

Consequently, Kaiser Permanente researchers knew how many patients were actively seeking treatment, but they didn’t know how many of its members were infected yet untreated.  Anonymous analysis of blood samples taken during routine checkups of 10,000 Kaiser Permanente patients in late 1989 told DOR researchers that 1 in 500 of its members was infected with HIV/AIDS.[viii]

Gary Friedman, MD, succeeded Dr. Van Brunt as director in 1991. During Dr. Friedman’s seven-year tenure, the DOR conducted important research on the etiology, prevention and early detection of cancers; on prevention and treatment of cardiovascular disease and diabetes; on the determinants of health care utilization; and on population approaches to chronic diseases.

Early research on the effects of socioeconomic status, race and ethnicity on health care and outcomes laid the foundation for the DOR’s ongoing involvement in health disparities research.

In 1994, Kaiser Permanente Northern California became a founding member of the Health Maintenance Organization Research Network (HMORN), ushering in an era of large-scale collaborations seeking to integrate research and practice for the improvement of health and health care in diverse populations.

Long chain of clinician-researcher leaders

Joe Selby, MD, MPH, took the helm in 1998, and former research investigator Tracy Lieu, MD, MPH, was appointed director in 2012, continuing DOR’s unbroken line of leadership by clinician-researchers.

Currently, 58 researchers and over 500 research staff continue DOR’s work in health care delivery research, outcomes research, clinical trials, epidemiology, genetics/pharmacogenetics (how individuals react to drugs), effectiveness and safety research, sociology, qualitative research (conducting patient interviews to better understand study data), and quality measurement and improvement.[ix]

Kaiser Permanente’s massive member database and consistent medical record keeping, maintain medical informatics as the cornerstone of Kaiser Permanente research in fields such as cardiovascular disease, cancer, metabolic disorders, dementia, autism, infectious diseases, osteoporosis, maternal and child health, chemical dependency and mental health. Dr. Friedman, Division of Research scientist emeritus, touts Kaiser Permanente data as offering “the best epidemiologic workshop in the world.”

Kaiser Permanente Northern California research also leads or co-leads several national research collaboratives sponsored with federal funds involving multiple Kaiser Permanente and non-Kaiser Permanente organizations, including the Cardiovascular Research Network (CVRN), Cancer Research Network (CRN), Vaccine Study Datalink (VSD), Developing Evidence to Inform Decisions about Effectiveness (DEcIDE), Accelerating Change and Transformation in Organizations and Networks II (ACTION II), among others.

Overall, DOR has a remarkable history filled with contributions to the health of Kaiser Permanente members and the broader community. DOR is committed to expanding its impact through better understanding of the underpinnings of risk factors and diseases, determining methods for effectively preventing and detecting these conditions, delineating the natural history of diseases, identifying ways to improve outcomes and the overall delivery and organization of health care.

 

Thanks to Alan Go, MD; Maureen Mcinaney; and Marlene Rozofsky Rogers at DOR for their contributions in the preparation of this article.

For an introduction to DOR research scientists and their work, please visit:
www.dor.kaiser.org

For more information, including all of the published work of DOR authors, please visit The Morris F. Collen, MD Research Library, 2000 Broadway, Oakland, CA.

Also see “Something in the Genes: Kaiser Permanente’s Continuing Commitment to Research,” by Robert Aquinas McNally, Permanente Journal, Fall 2001
<http://xnet.kp.org/permanentejournal/Fall01/genes.html>

short permalink to this article: http://bit.ly/RM39iE

 


[i] “Perspectives – Research,” [videotape] [Oakland (CA):] Kaiser Permanente MultiMedia Communications; 1998, quoted in “Research in Kaiser Permanente: A Historical Commitment and A Future Imperative,” Robert Pearl, MD, Permanente Journal, Fall 2001.

[ii]Kaiser Foundation Medical Care Program Annual Report 1968.

[iii] The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, by Tom Debley, The Permanente Press, 2009.

[iv] Correspondence November 1, 1943 from E. E. Trefethen, Jr., Trustee of the Permanente Foundation, to Dr. Garfield; letter is an appendix to the Cecil C. Cutting Regional Oral History Office interview 1985 by Malca Chall, <http://www.oac.cdlib.org/view?docId=hb8p3006n8&brand=oac4&doc.view=entire_text>

[v]Kaiser Foundation Medical Care Program Annual Report 1961.

[vi]KP Reporter, September 1959.

[vii] Interview June 13, 2012 by Bryan Nadeau, Senior Producer Northern California Multimedia.

[viii]AIDS research among Kaiser’s quiet studies,”Carolyn Newbergh, Oakland Tribune, 10/8/1991.  The published medical research finding is: Hiatt RA, Capell FJ, Ascher MS.; Seroprevalence of HIV-type 1 in a northern California health plan population: an unlinked survey.; Am J Public Health. 1992 Apr;82(4):564-7.; PubMed PMID: 1546773; PubMed Central PMCID: PMC1694106.

[ix] http://www.hmoresearchnetwork.org/members.htm#dor

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Third world nations seek Kaiser Permanente expertise

posted on February 23, 2012

By Ginny McPartland
Heritage writer

First in a series

Construction workers at Ghana job site, circa 1963. Volta River Authority photo

In the 1960s, dubbed the “Development Decade” by the United Nations, Henry J. Kaiser’s enterprises were literally all over the map. Kaiser’s companies were mining bauxite for aluminum in Jamaica, manufacturing cars in Argentina and Brazil and working on a huge hydroelectric project and aluminum smelting plant on the Volta River in the emerging West African country of Ghana.

Kaiser Engineers were also building a dam on the Bandama River in Ivory Coast, West Africa, as well as undertaking projects in various parts of India, including construction of a dam, hydroelectric plant, an aluminum plant, a steel mill and a cement facility. Kaiser Engineers were involved with the Snowy Mountain project – construction of tunnels, aqueducts, dams and hydroelectric plants in the mountains of eastern Australia.

As in his American ventures, Henry Kaiser’s enterprises on foreign soil developed medical services for workers at the job sites and often in the community. In many places, including Australia, India, and Ghana, the government required Kaiser to build hospitals at each of the construction locations.

Children began to go to school once Ghana became a republic in 1960.

“In a sense, this was a recapitulation of the early experience of our domestic medical care program, which had its origins in providing health care for workmen and their families at construction sites in the Western United States,” wrote James P. Hughes, MD, Kaiser Industries vice president of Health Services in 1972.

KP executives tapped to develop health facilities abroad

Clifford Keene, MD, Kaiser Permanente president at the time, was thrilled to participate in the launching of medical care projects in foreign lands.

“I went to Australia several times because Kaiser Engineers were involved in the Snowy Mountain Project and I was involved in the location and construction of hospitals there. . .I went to India twice, once for a period of almost a month. I found myself in places with exotic names, Uttar, Pradesh, Mysore, and Jamshedpur.

Kaiser companies helped design and equip this hospital in Akosombo, Ghana.

“So all of this was going on and it was just a big, spreading, challenging, wonderful, exhilarating kind of existence. While we were having all the troubles in the Permanente Medical Program (in California), getting reorganized, I was involved in these other challenges, which gave me satisfaction and sort of balanced the scales against the frustrations of dealing with the Permanente program.”

Ernest Saward, MD, medical director of Kaiser Permanente’s Oregon Region, traveled to Argentina in 1960 to help establish a medical care program for Kaiser automobile workers in Cordoba and Buena Aires. Saward said the Argentines didn’t trust the Kaiser organization initially and expected the company to superimpose a foreign health system on the community.

“The reaction back from Argentina was, ‘You folks in California put some millions in this and build us a hospital and everything will be all right.’ From what I’d already learned, I saw that if (Kaiser in partnership with the Argentines) put any millions in a hospital it would be confiscated within months. That was the nature of Argentina at the time. They play rough. Now I never personally got shot at; I was only threatened with a saber,” Saward said with a laugh in a 1986 oral history.

The river above the Ghana dam site was treated to eliminate the Black Fly that carried a debilitating disease. Volta River Authority photo

Saward and his artist wife managed over time to infiltrate the Argentine culture and make essential contacts for Kaiser. “They saw that we were somebody they could relate to, that (we) wanted to understand them and to understand what I would call their general, cultural events, and not be an isolated colony.

“They began to entertain us, and I spent hours lying on the living room floor, drinking red wine in front of a fireplace with these guys, until they finally understood what it was we were trying to do, and once they really got a feeling for what we wanted to do, they said, ‘Let’s do it’. We did it with the best medical group in town and with the best hospital in town, and it’s still going (1986) and it cost us in toto, $55,000.

“What had to be done in Argentina was to make an indigenous plan and not a foreign plan and (to make it go) it had to be done as an indigenous plan by what were respected elements in the community. (That’s how) we did it,” Saward said.

Requests for help from international community multiply

As Kaiser Industries continued to work abroad into the 1960s and 1970s, the challenges for providing health care kept coming.

Ghanaian physician at Akosombo Hospital, early 1960s

This was a period when African nations were gaining their independence, and the international community was interested in promoting industrial development to improve the economies of all underdeveloped countries. With new industry and its attendant growth, the budding nations were struggling to provide essential services to their citizens, both natives and newly arrived workers and their families.

To address these issues, seven hundred industrialists from 70 nations gathered in the San Francisco Bay Area in September of 1969 to figure out how to close the gap between the “have” and “have not” nations.

“There was much talk about the responsibilities of private enterprise in developing countries; about the need for more effective allocation of resources; about the need for business to interact with the society in which it finds itself,” noted KP President Clifford Keene in a talk to the Industrial Council for Tropical Health at the Harvard School of Public Health in Boston in 1969.

Kaiser’s people learned the hard way what this meant. In Ghana on the Volta Dam project, Kaiser leaders discovered pretty quickly that – despite the government’s well-laid plans – the company needed to initiate environmental programs to ensure safe water and pest-control measures to protect workers from the spread of debilitating disease.

Once the dam was completed, Kaiser began construction on a smelter plant to manufacture aluminum. “. . .the first responsibility was to provide care for the work injuries, since the existing health care facilities in the town were grossly overburdened,” wrote Hughes.

Health planners forced to improvise

For these foreign projects, many necessitating brand new cities or towns, Kaiser’s goal was to establish health care facilities for its workers, their families and often for the community at large. Hughes said in most countries where Kaiser had developments health care services had to be introduced in waves, depending on available services. Often, sanitation and safe water needs and the dire need for training of locals in basic care methods were the first priorities.

To provide health services, Kaiser Industries initially engaged the Kaiser Permanente Medical Care program. By 1964, however, Kaiser leaders realized the need for a separate entity and established the not-for-profit Kaiser Foundation International (KFI) to administer the foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence.

Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. By 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah and West Virginia.

Next time: Kaiser Foundation International gets contracts to resurrect a hospital devastated by the Nigerian civil war, to train Peace Corps workers for African rural health projects and to consult on many foreign health care projects.

 

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Sunnyside physician publishes story of Permanente Northwest

posted on January 20, 2012

By Lincoln Cushing

Heritage writer

Permanente in the Northwest fills a large gap in the history of Kaiser Permanente – the unique contribution made by the Northwest region, especially in the early years.  Author and retired Northwest internist Ian C. MacMillan, who served 14 years as chief of medicine at Kaiser Permanente Sunnyside Medical Center, demonstrates an insider’s insight and enviable access to details that thoroughly enrich this account.

Before there was a Kaiser Permanente, there was Permanente Metals, the division of Henry J. Kaiser’s construction consortium that built ships during World War II. The medical services offered to those civilian workers was the kernel of what would eventually grow to become one of the nation’s largest not-for-profit health plans, and with two vibrant shipyards in Portland, Oregon, and Vancouver, Washington, the Northwest was a key participant.

The prologue provides a history of the medical care options in the area before 1941 as well as the story of how Sidney Garfield, MD, and industrialist Henry J. Kaiser came to collaborate on their successful model of prepaid industrial medical care. This is followed by a detailed account of the wartime boom – shipyards, housing, and health care rolled into one.

Wartime shipyards in Oregon and Washington

Notable events include the then-new practice of treating civilian tuberculosis patients with streptomycin, the model day care program for workers’ children endorsed by Eleanor Roosevelt, and a rich art community.

Clipping about the completion of Bess Kaiser Hospital, July 1959, Oregon Journal

The demand for medical facilities soon outstripped the capacity of the first aid stations in the yards, and the first Northern Permanente Foundation (NPF) Hospital was built in Vancouver, Washington, in 1942, followed by a second one across the Columbia River in Vanport, Oregon, a temporary community built for shipyard workers, the following year.

That hospital was kept out of the nearby metropolis of Portland through stiff resistance by the local medical establishment, an example of a contentious relationship that would last many years.

As happened in California, the exodus of shipyard workers after the war forced the Northwest medical care program to expand to the broader community. Ernest Saward, MD, who had administered the wartime health care plan for DuPont plutonium workers at Hanford, Washington, became the medical director of the physician group and the Northwest health plan in 1947.

Changes after World War II

Dr. MacMillan explores some of the fractious cold-war dynamics of the medical partnership at that time, including debates about how KP internist Charles Grossman’s political activism was affecting the medical group’s relationship with the community.* (See note below.)

Beaverton (Oregon) medical office building groundbreaking, June 1968

By 1950 relationships had deteriorated to the point that Edgar Kaiser (Henry J. Kaiser’s son) fired them all and formed a new partnership. Dr. MacMillan details other challenges to the Northwest region, including its struggle for legitimacy with the American Medical Association and ostracism by private practitioners.

The first major postwar facility in the Northwest was the Bess Kaiser Hospital in Portland, completed July 7, 1959. (There would not be another until the 1975 Garfield-designed Sunnyside Medical Center at Clackamas, Oregon). Named for Henry Kaiser’s first wife, the state-of-the-art facility featured air conditioning, telephones and televisions in every room, pneumatic medical records delivery, and a drawer bassinet allowing newborns to slide through the wall between mother’s room and the nursery.

Tumultuous times for KP Northwest medical group

The Kaiser Permanente health plan expanded into Hawaii in 1958, and the Northwest physicians played a significant role in helping that region survive a rocky start. Dr. Saward was called out to apply his management skills when friction within the physicians group exploded. Dr. MacMillan explains some of the complex background that led to the struggle, and he chronicles the eventual maturation of the region.

Frank Stewart, administrator; George Wolff, architect, Dr. Wallace Neighbor (pointing); Northern Permanente Foundation Hospital, circa 1942.

A large portion of the book is devoted to the history of various medical specialties of the Northwest medical group, detailing medical arcana more likely to be of interest to practitioners than a lay audience.  The last three chapters trace significant chronological events in the region from the 1970s to the present.

Among these topics are the challenges of recruiting and retaining good doctors (he outlines the need for robust medical infrastructure, clear work policies, and adequate pay), the deep impact of the 1988 nurses’ strike, and the erratic steps taken by KP to institutionalize an effective electronic medical record system.

In all, this is a much-needed historical survey of a major region in the Kaiser Permanente constellation. Dr. MacMillan does not shy away from exploring awkward and complicated events in the Northwest Permanente history, and he writes with an insider’s viewpoint that enriches the accounts.

Permanente in the Northwest should be of interest to anyone interested in modern American health care policy, health practice, and the broader history of medicine.

Permanente in the Northwest
Ian C. MacMillan, MD, The Permanente Press, 2010
313 pp, with illustrations, bibliography, and index
To order the book, go to permanentejournal.com

KP Northwest historical materials brought to Oakland

Preservation of the rich history of Kaiser Permanente’s Northwest Region (KPNW) got a boost at the end of 2011 when staff of the national Heritage Resources department in Oakland packed up over 100 cartons of Northwest photographs, clippings, newsletters, and files to fold into the KP archives. These materials will be selectively processed over time and added to the existing collection, greatly enhancing our research capacity. The photographs accompanying this review were drawn from that collection.

Special thanks to KPNW Community Benefit and External Affairs staff Jim Gersbach and Mary Ann Schell for their help.

 

*After leaving Permanente in 1950 Dr. Grossman continued to practice medicine privately, and his political activism continued throughout his life (a path respectfully footnoted in MacMillan’s book in his Afterword titled “What Happened to the Pioneers?”). He was arrested in 1990 during a peaceful demonstration organized by Physicians for Social Responsibility, challenging the presence of a nuclear-armed battleship berthed near the Portland Rose Festival. His court testimony describes the scene:

“I was standing silently with several other doctors and a few others with a sign in my hand saying ‘Rose Festival is a fun time, we don’t need nuclear weapons.’ About 2:30 p.m. three or four policemen approached and asked us to leave. I asked why and was told that we have no right to stand in a city park carrying a sign. . . I put my sign down and said ‘O.K. I am not carrying a sign.’ His response was that if I did not leave within 30 seconds I would be forcibly removed. I said we were creating no disturbance and again asked why such a confrontation was necessary.  While I was writing [down his badge and name] my two arms were forcibly seized, forced behind my back and handcuffs were applied.”

 

 

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