By Brenda L. Mooney
WASHINGTON – A half-century ago this month, the first issue of U.S. Medicine was published and sent to 23,000 physicians practicing within 24 government agencies.
The publication was the creation of Frank M. Best, who recognized that federal physicians had a need for the clear and impartial presentation of information.
In the debut issue, Best stated “it will be the policy of this paper to contribute rather than carp, to inform rather than inflame, and to concentrate on accomplishment rather than adversity.”
While much has changed in federal medicine during the last 50 years, the mission of U.S. Medicine, which now is mailed as a print edition to 35,000 federal healthcare professionals and viewed online at www.usmedicine.com by thousands more, remains the same.
In 1964, the VA consisted of 168 hospitals, 214 outpatient clinics, 18 domiciliaries and two restoration centers. With about 137,000 employees, the healthcare system treated 738,583 veterans that year.
In contrast, nearly 6 million veterans used VA services in 2014, served by 280,000 employees working in more than 1,700 facilities.
Overall, federal medicine, including the VA, DoD and the U.S. Public Health Service, is responsible for the care of more than 20 million Americans — veterans, military personnel and their dependents, Native Americans and others, treating more patients with chronic diseases than any other healthcare system in the country.
In 1964, in the pre-Medicare era, the VA — which was more than 20 years away from achieving presidential cabinet-level status — received $1.1 billion in funding, although virtually any veteran could seek care there. (In 2015, VA receives more than $150 billion with eligibility for free care narrowed in 1986.)
Back in the mid-1960s, World War I veterans were approaching their late 60s, far past their average life expectancy. World War II veterans were generally in their 40s and 50s, and veterans who served in Korea were in the prime of life, generally in their 30s.
According to the VA’s 1964 annual report, the number of war veterans in civilian life fell below 22 million (21,866,000) for the first time since 1955; Of the more than 22 million eligible veterans, 70% were WWII veterans, 10% were WWI veterans and 1 out of 100 were Spanish-American War veterans. Adding in Korean War veterans, the average age of war veterans in 1964 was 45.
Women made up a relatively paltry percentage of those — only 414,000 were female, the vast majority having served in WWII. As of 2012, 1.6 million of the 21.2 million military veterans in the United States were women.
Interestingly, surviving veterans in 1960 were fairly evenly divided across the country — 29% of them in the Midwest, 27% in both the Northeast and South and 17% in the West. By 2010, 40% of veterans were from the South, 27% from the Midwest, 22% from the West and 11% from the Northeast. Some VA advocates have expressed concern that the area with the greatest concentration of financial and governmental power has the fewest veterans.
In 1964, the military, meanwhile, was grappling with how to provide care to servicemembers’ dependents, eventually creating the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966 after passage of the Military Medical Benefits Amendments.
An event that had occurred only a few months before U.S. Medicine’s launch, however, was on the verge of changing the military’s focus and nearly everything else about federal medicine.
In early August 1964, two North Vietnamese torpedo boats allegedly attacked U.S. Seventh Fleet vessels in the Gulf of Tonkin without provocation. A few days afterward, Congress passed a resolution to approve and support the determination of the president, as commander-in-chief, in taking all necessary measures to repel any armed attack against the forces of the United States and to prevent further aggression. It also declared that the maintenance of international peace and security in Southeast Asia was vital to American interests and to world peace.
Eventually, 2.7 million Americans served during the Vietnam War, creating new healthcare issues — such as Agent Orange exposure — and escalating known problems such as post-traumatic stress disorder (PTSD) into virtual epidemics.
Chemical and environmental exposures as well as PTSD and traumatic brain injury (TBI) continued to be issues in the Gulf War and the engagements in Iraq and Afghanistan. In addition, the widespread use of improvised explosive devices (IED) created new types of injuries.
The Vietnam era also began a period of almost unimaginable advances in battlefield medicine. For example, during the Vietnam War, the ratio of wounded-to-killed was 6-to-1 but dropped to 10-to-1 about a half-century later in Iraq and Afghanistan. One of the greatest challenges for the VA and DoD today could be considered a good problem to have: Caring for the countless injured veterans, many with polytrauma, who would not have survived previous wars.
Yet, the groundbreaking changes in federal medicine involve far more than injuries received in action. The advances in care of chronic diseases, which mainly plague older veterans, have been nothing short of miraculous over the past half-century.
The list of what was not available to physicians in 1964 could fill every page of this publication but includes everything from pneumonia vaccines to CT scans.That is what U.S. Medicine has documented regularly since 1964. Although Mr. Best died in 2007, the publication he founded has continued its mission as the “Voice of Federal Medicine” by providing a unique mix of governmental and clinical management news tailored for the healthcare professionals who depend upon it.