ORAL HISTORY PROJECT

Betty A. Lowe, MD

Interviewed by Eileen Ouellette, MD, JD

August 15, 2005 Little Rock, Arkansas

This project made possible by donations through the Friends of Children Fund, a philanthropic fund of the American Academy of Pediatrics.

https://www.aap.org/pediatrichistorycenter

2018 American Academy of Pediatrics Elk Grove Village, IL

Betty A. Lowe, MD Interviewed by Eileen Ouellette, MD, JD

Preface i About the Interviewer ii Interview of Betty A. Lowe, MD 1 Index of Interview 30 Curriculum Vita, Betty A. Lowe, MD 32

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PREFACE Oral history has its roots in the sharing of stories which has occurred throughout the centuries. It is a primary source of historical data, gathering information from living individuals via recorded interviews. Outstanding pediatricians and other leaders in child health care are being interviewed as part of the Oral History Project at the Pediatric History Center of the American Academy of Pediatrics. Under the direction of the Historical Archives Advisory Committee, its purpose is to record and preserve the recollections of those who have made important contributions to the advancement of the health care of children through the collection of spoken memories and personal narrations. This volume is the written record of one oral history interview. The reader is reminded that this is a verbatim transcript of spoken rather than written prose. It is intended to supplement other available sources of information about the individuals, organizations, institutions, and events that are discussed. The use of face-to-face interviews provides a unique opportunity to capture a firsthand, eyewitness account of events in an interactive session. Its importance lies less in the recitation of facts, names, and dates than in the interpretation of these by the speaker. Historical Archives Advisory Committee, 2017/2018 Jeffrey P. Baker, MD, FAAP, Chair Lawrence M. Gartner, MD, FAAP Jacqueline A. Noonan, MD, FAAP Tonse N. K. Raju, MD, FAAP Stanford T. Shulman, MD, FAAP James E. Strain, MD, FAAP

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ABOUT THE INTERVIEWER

Eileen Ouellette, MD, JD

Eileen Ouellette, MD, JD, graduated from Smith College and Harvard Medical School and then completed residencies in pediatrics and child neurology at Massachusetts General Hospital. She has a law degree from Suffolk University Law School, Boston, and is a member of the Massachusetts Bar and the American Bar Association. She has extensive experience advocating for children's health issues at the state and federal level. She is retired from North Shore Children's Hospital in Salem, MA, where she practiced pediatric neurology. Serving as AAP President during 2005/2006, Dr. Ouellette has also been active in the AAP Section on Neurology. She is a member of the Senior and International Child Health Sections, has served on Committees on Women in Pediatrics, Career Opportunities, the Council on Government Affairs, the Section on Senior Members and the Council on Sections and the Council on Sections Management Committee. In addition to her AAP activities, she has held leadership positions in the Child Neurology Society.

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Interview of Betty A. Lowe, MD DR. OUELLETTE: This is Dr. Eileen [M.] Ouellette doing an oral history interview with Dr. Betty Lowe at her home in Little Rock, Arkansas on August 15, 2005. Betty, thank you for allowing us to come and interview you for the Women in Pediatrics American Academy of Pediatrics [AAP] Oral History Project. If we can start by having you just describe a little bit about where you were born, and grew up, and went to high school, and a little bit about your family, that would be really good. DR. LOWE: I was born in Grapevine, Texas, right on the edge of the Fort Worth/Dallas Airport [Dallas/Fort Worth International Airport]. In those days, Grapevine was a small town of about 500 or 600 people. That’s actually where my father’s family had been for 3 or 4 generations. My parents were schoolteachers. My father was too old to go to the Second World War. Besides, he had 4 children, so he worked in defense plants and things like that. My parents very much wanted to get away, so they moved to Arkansas when I was in the sixth grade. From then on, they taught in various and sundry small schools. I never went to a school with more than 400 kids. We moved several times and wound up in a small rural school in Yell County, which is halfway between Little Rock and Fort Smith. DR. OUELLETTE: What county? DR. LOWE: Yell. DR. OUELLETTE: Yell County. Spell it. DR. LOWE: Y-e-l-l, Archibald Yell [former governor of Arkansas]. DR. OUELLETTE: I didn’t think it was Y-a-l-e. DR. LOWE: No, no. DR. OUELLETTE: [Laughs.] DR. LOWE: They wound up there and lived there for about 40 years before they died. I think there were 10 kids in my high school graduating class. The one thing my schoolteacher parents instilled in all 4 of us kids was that education was, essentially, a given. It was not an imperative, it was not a choice, it was a given. They did not care, nor did they express what we would be educated in. That was our choice, but we were going to go. So, I wound up going to the University of Arkansas, which at the time was the largest university in the state. It was my first exposure to all sorts of different kinds

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of people. It was a little bit of a change of experience to go from a high school class of 10 to, I guess at the time, a university with 7,000 or 8,000 students. I was interested in science to some degree, and I liked the pre-med courses, but I really didn’t know for sure what I would or would not do as a vocation. And this was another thing, my parents thought you should have a way to support yourself. Now, in the 1950s, that was not necessarily the prevailing attitude about women, particularly in the South. In the South, women were to grow up and get married, and have children and have a family. The competition was essentially as to what kind of guy you could find to have this family with. By and large, the majority of girls who went to college in those days went to college, basically, to get more selective choices. I mean, the idea of an education was a different thing. Anyway, I found that somewhat interesting, but the thing that probably drove me was that I loved to just learn. I like to learn. I like to learn about things. I like science. While I was at the university, there were about 3 women physicians in the state of Arkansas. At the same time, I think there were 5 pediatricians. So we were pretty small and rural. Dr. [Ruth Ellis] Lesh, who was a practitioner in Fayetteville, and Dr. [Pearl] Waddell, who was a pediatrician at Fort Smith, and Dr. [Louise] Henry, who was an ophthalmologist got together and had this dinner for “women in the university who were interested in medicine.” We all went, all 7 or 8 of us, from the entire campus. At that meeting, Dr. Wadell, in particular, offered me the chance to come down to Fort Smith and spend a day in her pediatric practice. I suppose the day at her practice, and she herself as a person is really what hooked me on medicine. At that point I thought perhaps I could actually achieve going to medical school. My older sister, at the same time, had become a chemist and was a graduate student getting her PhD [doctor of philosophy] in chemistry. So, the idea of pursuing higher education was okay in my family. Although I must admit that when I went home and told my father, he sort of swallowed hard, because Arkansas school teachers were notoriously poorly paid. They really had very little income. I don’t think my 2 parents combined ever made more than $10,000 a year teaching school. How we were going to pay for this, I really didn’t know. I asked my dad about that, and offered to borrow money, and he said he would talk to the bank. There was a banker in Yell County who was very generous to anyone whose kids wanted to go to college. He and my father obviously had ongoing negotiations every year trying to get all 4 of us through school. But that’s actually how we started, and that’s how I got started in medicine. I went to the University of Arkansas for medical school [University of Arkansas for Medical Sciences – College of Medicine] and kind of went from there.

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DR. OUELLETTE: How many women were in your class in medical school? DR. LOWE: We started with 6 and graduated 3. DR. OUELLETTE: Out of how many in your class? DR. LOWE: Ninety. We had 90. There were 6 girls to start, and like I say, we graduated 3. It was interesting. One girl quit because she was married, and her husband couldn’t tolerate the fact that she made better grades than he did. One girl had come to medical school because her parents wanted her to, because her brothers were physicians. She didn’t want to, and so she just couldn’t cope with it. And interestingly enough, the third girl, Betsy Berry, was an excellent student and did very well, but then somehow the clinical activity got to her. Betsy later became a bacteriologist and was a bacteriologist in Dallas for years. Then there were 3 of us left, yes. DR. OUELLETTE: Okay. Now, tell me a little bit about your internship after you finished med [medical] school. DR. LOWE: Well, we were fortunate because Arkansas had hired Katie [Katharine] Dodd as department chairman of pediatrics. At the time, the department of pediatrics had been in place about 15 years and was very small. I think Katie had 3 or 4, 4 or 5 faculty members, but she was a superb teacher. The minute she walked in the door, she was a teacher, and of course the students just flocked to her. At the same time, we also had Richard [V.] Ebert in internal medicine. So, we were blessed with probably 2 of the most outstanding clinicians in the country as our teachers. But nevertheless, Katie was a great person. As I went through medical school, it became obvious to me that as a woman you were not going to have much success at treating men in those days. It seemed to be an imposition then to do family practice or something in which there would be men. And I liked the kids. I loved the children. And so between the fact that I liked kids, and Katie Dodd as a teacher, I picked pediatrics. It was interesting. There were a couple of professors in peds [pediatrics], and I really didn’t think the two of them would take me as an intern. Dr. Dodd had only 3 slots, so I applied for an internship in internal medicine with Dr. Ebert, which was excellent. As I got nearer and nearer to the start-up time, I was sitting in the medicine clinic one day, and I had a wonderful elderly lady as a patient. I’ll never forget her. She had about 5 things wrong. She had diabetes, and she had arthritis, and something else and something else. Every single medicine at the time that you could prescribe for one of her problems was contraindicated by one of her illnesses. I threw

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up my hands and went to the internist who was running the clinic that day, and I said, “Is this the way internal medicine is?” He said, “Unfortunately it is.” And I said, “I can’t do this.” So, I went across and asked Katie Dodd if I could switch. I did switch, and was forever grateful, because that meant I stayed at Arkansas as a pediatric intern, and again, probably got as sound a clinical education as you could possibly have. But she was going to have to retire because she was 65. That was an Arkansas rule. So, she was leaving, and I knew I really didn’t then want to stay. And besides, Katie had kind of said, “You know, you ought to see other things.” So, I applied around to various and sundry places for the possibility of a residency, and Dr. Dodd wrote letters of recommendation for me. Four of us drove from Little Rock to Philadelphia, New York and Boston. This was my first time going east of the Mississippi River. I got to Boston [Children’s Hospital Boston], and I never will forget, I was interviewed by Dr. [Louis Klein] Diamond, who was such a formidable figure. Of course, everyone knew him, but I’ll never forget. He was not very keen on women, but he was a fair individual, and he said to me, “This is no place to come and look for a husband. You will have to really work hard, and you just may not want to do that.” My rebuttal was, “Dr. Diamond, social life at Arkansas is really quite fine, and that’s really not what I’m interested in coming for.” Interestingly enough, I did get on. I was picked. In those days, they had 6 first-year juniors, 6 second-year juniors, and I suppose 6 third-year seniors. I was picked as a junior, and I spent a couple of wonderful years in Boston. It was really good. It was interesting, because they obviously had their pick of people from around the country, and they had kids from every imaginable school. My clinical preparation was just better than most. The only thing we lacked was a little bit of the theoretical, which I found out you could get out of a book fairly quickly if you had to. But our clinical education was so much more than, for instance, the kids from Harvard [Medical School], that we had no problems fitting in in terms of house staff and training, that sort of thing. DR. OUELLETTE: Who were some of the people in your residency program with you when you were there? DR. LOWE: Mary [Ellen] Avery was a fellow in neonatology, and Jackie [Jacqueline Anne] Noonan was a fellow in cardiology. Then in our set, we had Joel [J.] Alpert, a guy named [Nicholas] Nelson, and George Segal. Jimmy [James] Simon was a senior resident at the time. There were 5 or 6 more, but then, of course, at that time, in retrospect, it was not a large service. We also had people like Howard [A.] Pearson, who was a fellow in hem/onc [hematology/oncology], and of course, really Dr. Diamond and —

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The leader of the Jimmy Fund [the fundraising arm of the Children’s Cancer Research Foundation], the old pathologist? His name escapes me, but he was something else. [Dr. Sidney Farber] That was the star fellowship program. 5 or 6 guys, who were from there, became leaders in hematology around the county. Audrey [Elizabeth] and Anna Mitus were the 2 women who were in oncology, and they were great. Of course, these people were so different. Audrey was British and Anna was Polish. Anna came out of the Second World War and had some absolutely horrid tales to tell. A fellow named [Rudolph] Toch was the senior in hematology. DR. OUELLETTE: Was that Rudy Toch? DR. LOWE: Rudy, yes. Rudy Toch. He was kind of German, which made an interesting situation. Sherwin [V.] Kevy was chief resident one year, and Andrew Rigg was chief resident the next, and a fellow named Allen was senior resident. Tom Adams was one of my fellow fellows, and Bob Brodell. It was a great bunch of people. There were only 3 or 4 of us women. The one I really remember the best was Floy Helwig, who was from Chicago. She was a big, redheaded Midwestern gal. The two of us were probably a little bit different from everyone else, so to speak, and so we could kind of hang out together and present a concerted front as far as Sherwin Kevy was concerned. Those were great years. The teachers, of course, were just superb. You had Dr. [Charles A.] Janeway, and you had Dr. Diamond, and you had [John Fielding] Crigler [Jr.], and you had [Alexander Sandor] Nadas. Also you had [Edward Blaine Duncan] Neuhauser in Radiology, and you had [Robert Edward] Gross in pediatric surgery, and interestingly enough, [Luther A.] Longino, Luther Longino, in pediatric surgery. Luther Longino was from Magnolia, Arkansas, which I found out after I got there. What was also interesting just as a tale was that when I first got there, they parceled out your rotation. They said, “Well, this is too bad, but you’re on surgery as a rotation.” And I said, “Well, that’s good. Okay, that’s fine. How does that work?” They told me, “They make rounds at 6:00 in the morning, or 7:00 in the morning,” so I said, “Well, okay.” So every morning I got up at 6:00 or 7:00 am and made rounds with the surgery residents and looked at all the surgery patients. Of course, about all you got to do was carry the order books and you got to work up an occasional patient in surgery clinic. I was in the fifth week of the 6-week rotation, and Bobby [Robert G.] Allen and Tom [Thomas M.] Holder were the chief residents in surgery. Bobby came to me and said, “Okay, we’re going to let you scrub with Dr. Gross.” I

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said, “Is that part of it?” And they said, “Oh, yes.” Of course, they felt this was a tremendous honor. For me, I wasn’t too interested in scrubbing one way or the other, but nevertheless I did indeed get to scrub with Dr. Gross. I asked Bobby why, and he said, “Well, you’re the first medicine resident in 10 years who ever got up and made rounds with us.” And I said, “Oh, did I not have to?” [Laughter] “Did I not have to?” Apparently, you would not have had to. Nevertheless, we did scrub with Dr. Gross a couple of times. He was certainly a fascinating character, as they all were. That was great. You made friends, and you met people who then you knew throughout your professional career. It gave you such a different viewpoint on everything. Number one, the most important thing is, and I highly recommend this to young people, don’t do all your medical training in one place, because if you do, you kind of get the attitude that there’s only one way to do things. If nothing else, the years in Boston showed me there are a lot of ways to do a lot of things. That was fascinating. DR. OUELLETTE: Tell me a little bit about what kinds of sleeping arrangements they had for you. DR. LOWE: They didn’t really anticipate women residents, to be honest. So, although the men’s sleeping quarters were horrible, they at least were in the hospital, and they also had what they called a snack room. For women, though, they had to hunt for places. They gave us rooms which were across the street above Bob [Robert J.] Haggerty’s continuity clinic. In the first place, this meant that in the wintertime the snowplows would wake you up cleaning the streets. Then we’d get calls in the middle of the night and have to come out of our place, down the front steps, across the snow into the slush, through the piles of snow, and then go in the back door of the emergency room and into the hospital. That was pretty bad, because I wasn’t used to snow. Then the second year they decided they needed those rooms because they were going to get more pathology residents, men. They called me up one day and said, “We’re moving you down to the nursing quarters at the House of [the] Good Samaritan.” I said, “You mean House of Good Samaritan that’s 2 blocks away?” And they said, “Yes.” I said, “You mean that at night I’m going to go 2 blocks?” They said, “Yes.” And I said, “I’m not moving.” I just said, “I’m not moving,” because I figured I’d just see what happened next. It threw the hospital into a tizzy because this was the hospital administrator. No one had ever said that to him before. There was a lot of controversy, and a lot of discussion went on in the higher echelon, and it finally came down to Charlie Janeway saying, “The woman has a point. Leave her alone.” Well, I had men residents all around me. There was one other girl, Jane [C. S.] Perrin, who also had a room there, and I think maybe Nan Kreigsman, who was from the Netherlands. The 3 of us women had

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guys all around us, whom we just ignored. I mean, the young fellows in pathology, they were really something else. But, yes, they did finally let us stay there, which was apparently a coup. DR. OUELLETTE: Now then, you decided to come back to Arkansas after you finished your pediatric training. DR. LOWE: Yes. It never occurred to me not to “come home” in many respects. I never will forget that at the time I left, Dr. Diamond said, “We’ve got a spot here. You could stay in the lab.” Which was Dr. Diamond’s way of saying, “Stay on. Why not be a fellow in hematology?” I was a little bit interested in that, but I said, “No, I really need to go home.” So I came home to Arkansas and was chief resident one year for Dr. Ted [Theodore C.] Panos, who was chairman at the time. Then after that I decided to go into private practice. I had several conversations with Dr. Dodd about this through the years. Early on, she was insistent you should specialize. She was big on specialization, because she said that was the wave of the future, and that was probably what needed to be done. I never will forget, she went to Kentucky and taught for years, and she also taught in Atlanta. After I’d been in practice a couple of years, Dr. Dodd wrote me a note and said, “You know, in the long run, you were right in staying with general pediatrics, because after all, that’s where you can make the biggest impact on the biggest number of people. So your choice really wasn’t bad.” I was really kind of proud of that at the time. That was good. That was good, yes. Dr. Dodd had taken me on, I suppose, as a project to work on. At one point in time, I was coming home from Boston, and she was going to be in Washington, DC. She insisted I stop in Washington, DC and spend a day with her and a friend of hers. Katie deliberately took me to every single national monument, particularly the Lincoln [Memorial] as he was her favorite person, to make sure I had little added bit of cultural tone. It was hilarious in retrospect, but I had a wonderful time, yes. DR. OUELLETTE: You told me previously that she objected to your use of a non-medical term once when you were presenting to her. DR. LOWE: Well, growing up in Arkansas you used Arkansas vernacular and had an Arkansas accent, which truly did get me in quite a bit of trouble over the years. We used words such as “mash,” which I used one day in a description of an examination of a child. She was adamant. “Well, you just don’t mash. You mash potatoes. You don’t mash your patients.” She was constantly trying to correct me. Her last kind of word of advice to me as I was going to Boston was, “Now, pay attention to the language.” And I said, “Okay.”

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Well, I got to Boston, and it was really something. The year I was a senior resident, you took all the phone calls from referring physicians. I was talking on the phone to a guy who was trying to send us a child. I was getting it lined up for the child to come. He stopped in the dead middle and said, “Where are you from?” It was just amazing, because at the time Dr. Janeway was into what we called the “United Nations.” There were people there from all over the world, and they had all sorts of accents and very little command of English. But nevertheless, there I was, and apparently I stuck out like a sore thumb. There was a wonderful guy from Korea named Kwang Wook Ko. Kwang was a terrific guy. He was a fellow, and he was very much involved in patient care and presentations. We went to this conference one day, and Kwang presented a patient. Everything went quite smoothly. Then I presented my patient, and Dr. Janeway sat there and asked me, “What did you say? Repeat that. What was that word?” Several times. I was so exasperated. Finally, after the conference I said, “You know, Dr. Janeway, I just don’t understand it. I really don’t. You understand Kwang Ko with his Korean accent and all of that, and here I am, an American, and you don’t understand my language.” I’ll never forget Charlie Janeway said, “Kwang speaks in English.” [Laughter] So, I don’t know, I guess, through the years you tone it down a little bit, but Midwest people certainly do have a twang, yes. DR. OUELLETTE: Now, you were in practice for several years, but then you went back into the hospital. DR. LOWE: Right. I joined a group. I joined a group practice in Texarkana [Texas], and it was a wonderful set of physicians. I really thought the world of them. They did wonderful, superb medicine, which is the reason I went there. I practiced there for 9 or 10 years and would have stayed. I enjoyed the practice, but it was becoming more and more apparent you were not going to be able to take care of your patients as you had in the past. It was the time of the growth of neonatal intensive care. Pediatric intensive care was on its way. You could live with hem/onc, and the cancer patients and referrals, and that sort of thing. And neurology. Neurology was always a big referral issue, and that worked out well. But it was just that in practice, you could keep up with the knowledge, but you could not apply it to your patients because of the constraints within hospitals. I suppose I didn’t like hospital administration. It was a constant battle over trying to get the hospital to do things like add intensive care equipment, et cetera, et cetera. It became obvious to me we were going to lose that battle in the community hospital. When hospital administration spent $40,000 for an orthopedic operating table for one particular procedure, yet wouldn’t let the local auxiliary spend $5,000 for an isolette, I said, “I can’t stand this for another 30 years.”

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I have always loved to teach. I was sitting at my desk one day working on data about a patient who had asthma. I was working it out in a way that if I were teaching students, this is what I would do. At about that time, Tom [Thomas A.] Bruce, who was then dean of the school [University of Arkansas College of Medicine], came down to see me. Arkansas Children’s Hospital was just a small chronic-disease hospital with only 50 beds, and was not very much. The entire pediatric department at the university was 40 beds, and that meant medicine, surgery and everything. Tom had the idea they could work with Children’s Hospital. The Board of Trustees said, “We’ll build a new hospital if we can find the physicians.” The private physicians weren’t interested, but Tom said, “If you’ll let us teach there, we’ll provide the physicians.” That’s when Tom came to see me and talk about it. It was a fascinating kind of possibility. I bought it and came back into academics. I went to Children’s, and interestingly enough, they offered me a job as director of education, from which I’d come. Had they offered me the job of medical director, which is what I became, I’d have never come, because I did not like that aspect of things. Anyway, so I came, and it was a fascinating venture. They had 50 beds, and it was terribly low key. It was staffed by residents on just a gratis basis. There was no specific rotation, et cetera. I had been there probably a couple of weeks when an infant about 6 months old came into the emergency room. The child was modestly ill with pneumonia, but in those days she was ill enough that you would want to keep her. So, I said to the resident, “Why don’t we admit this child?” He went to the phone and dialed the university, which is 4 blocks away. I asked him, “Why are you dialing the university? Why don’t we just put the baby in the hospital here?” This kid looked at me, and he said, “Well, you know, Dr. Lowe, you just really don’t understand. This hospital doesn’t have what it would take to take care of this baby.” And I thought, “Oh my God, we are in trouble.” We did start at a rather low key, but from then on it was a matter of constantly trying to build the service. Fortunately, we had a tremendous administrator. Leland McGinnis was a visionary. He had this vision of having a children’s hospital, and he was very much supportive. He would do anything he possibly could. He had absolutely no money, and the hospital had no money, but he very cheerfully would say to the cardiologist, “Yes, we’ll buy you a pediatric cardiac cath [catheterization] table. Yes, we will. You can count on that.” I noticed he never said exactly when, because he knew it might take 6 months to get the money together, it might take 9 months. But the point about Leland was that he would get the money together. Then they recruited Bob [Robert H.] Fiser [Jr.] as chairman of the department. Bob was also a most interesting guy. He also was a visionary in what he would do. His enthusiasm was contagious, he recruited excellent

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faculty promising them all sorts of “perks” and then tell McGinnis what the hospital needed to cover. His major recruiting was house staff. They have become outstanding pediatricians all over the USA. END OF TAPE 1, SIDE A DR. LOWE: Bob Fiser was just a constant recruiter. So, it worked out beautifully, because we wound up with a hospital, initially, of about 100 beds. The pediatric department at that point was about 60 or 70 people. We were teaching well, and we were recruiting wonderful house staff, so we were rolling along quite well. Then we hit about 1985, or so. We had started in 1975. So about 1985, Bob and I were talking one day, and I said, “We’re doing pretty well on teaching clinical care. Now let’s talk them into research.” That was one heck of a project, because we had members of our board who objected to research on rats. I mean, they were so afraid of the public opinion. But we recruited Don [Donald E.] Hill, who was a superb guy, and who really got us off the ground and up and running. The whole venture of Children’s and the University was that it was a venture that was due. It was at the right time, and it offered a place for Arkansas children to get good medical care, which they really never had before. The Board of Trustees insisted on children being able to come regardless of ability to pay, a policy which they still maintain, which again helped tremendously when you figure that 35 to 40 percent of the children in Arkansas live below the poverty level. We couldn’t get them all on Medicaid. To this day, that’s really very true. It has become a wonderful place with better than 200 beds. This past year, and this has been a goal of everyone’s, they were recognized as the 25th children’s hospital in the county [U.S. News and World Report “America’s Best Hospitals” 2005], which we felt truly was a tremendous thing. It doesn’t really mean anything, but nevertheless, at least we are recognized. Basically, we’re recognized because we do good care, and we do offer some cutting-edge technology in many of the things we do. We’ve got particularly pediatric faculty who are well respected throughout the nation in terms of their specialties. So, in the long run, it’s been a tremendous project. I would not have given up my 10 years of practice, and I still to this day see grandchildren of people whom I saw back then. Nevertheless, the Children’s - University venture has just obviously been a fantastic thing. DR. OUELLETTE: When did you become medical director of the hospital? DR. LOWE: About 1977. As I said, they gave me the job of director of medical education, but it became apparent in those early years that either we must have someone from the medical side deeply involved in hospital

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administration, or we would never get what we needed. It also became apparent to me that, well, this was a job perhaps I ought to try to do and see how well it works out. I had in mind that I’d do this for 5 or 6 years, and then I’d switch back. Bob was constantly thinking I should return full time to the department and run general pediatrics. As I had developed a specialty niche in rheumatology, he said, “Oh, you can just come over and run rheumatology.” But it never got to the point where we really could do without that particular medical input in the administration. I’m always a little leery of administration. Perhaps that’s bad. DR. OUELLETTE: I know, in general, pediatrics is usually not a money-maker in the hospital, and many times it’s hard to get things for pediatric departments. Do you find you had some difficulty other than the thing with the isolette? DR. LOWE: Well, yes, in a community hospital, in a general hospital, yes. But you see, this is the beauty of a children’s hospital, and this is why I think children’s hospitals have done so well throughout the country. If you remove the children to their own bailiwick, and you’re not competing directly with adults, then it becomes a realistically easy thing to do to parcel out care. It’s not nearly as hard to bounce ideas off pediatric surgeons and pediatric specialists and get what you need for kids across the board. Sure, you run into a few people. We had guys who insisted they must have 12 totally designated orthopedic beds, to which you just really had to reply, “No, we’re not going to do that, because if the next kid downstairs has meningitis, they’re going to use the bed if it’s empty. I will not have this business of holding a bed for nothing.” You had people, and you had that sort of thing, but if you get kids off to a children’s hospital, you can then give the entire care to kids. You can set up all your approaches, et cetera, that way. And to be honest, you have much better success in shifting resources — neonatology, cardiology, surgery — and possibly making money. You have to have some kind of agility in overall administration to be able to spread that across the board, because general medicine, infectious disease, and mental health don’t make money, they drain. So, you have to have some way to level that financial impact, and in a children’s hospital you can do that. You can set up your administration and your professional leadership in such a way that if you’ve got hospital administration, plus medicine, plus surgery, plus a couple of the others — and you have to include the hematology — and if they’re all sitting around the table discussing what needs to be done, then they’re much more likely to vote their conscience, not their pocketbooks. And that’s what you have to do to make it work. That, to me, is the beauty of children’s hospitals. DR. OUELLETTE: Now, let’s shift a little bit. When and how did you get involved with the Academy of Pediatrics?

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DR. LOWE: When I was in private practice, they sent around things in those days which asked such things as, “Would you like to be on committees, et cetera?” I was interested in maintaining some affiliation with the Academy, and I’d been to a couple of Academy meetings and enjoyed the education, et cetera. A little thing came around, and I’ll never forget this, I told the district chairman I’d really like to be on a committee, and at the time it was education. He, of course, went into long, elaborate detail on why I couldn’t, why I couldn’t, why I couldn’t. So, I said, “Well, okay, that’s fine.” Not much came along then except for neonatal intensive care and the business of stratification in Level I, Level II and Level III. We went to the original meeting in Oshkosh, Wisconsin where they discussed the rationale of I, II, and III, and it became obvious that in our hospital — we had 2,000 deliveries a year — we would have to be a Level II, which was going to be difficult. But the point was, the neonatologists were so powerful they were pushing the button to the point that they were trying to put all resources into Level III. They were ignoring the concept, really, of Level II and what it would take. At that time, I became Arkansas state president of the Academy [Arkansas AAP Chapter president], which was okay, and so I was becoming more and more interested in the mechanics of how you make these things work. And I never will forget that then they put out their oxygen use requirements. What they said was that you had to use blood gases to measure oxygen. The rule until that time had been that if you kept your oxygen at 40 percent or less, and were prudent and didn’t use it too long, you were at the least risk. But we all knew we were at risk. But they came out and made the statement that unless you used blood gases, you were essentially what, incompetent? You shouldn’t use oxygen? You know, Eileen, at the time they made that statement, there were, I think, something like 8 laboratories in the country that could honestly measure blood gases in premature infants. What that statement did was it just left all of us in practice hanging, and there was really no way out. I talked to Alice [G.] Beard, who was chief of neonatology in Little Rock, and I said, “Alice, we’re going to have to transfer patients.” She said, “Betty, I can’t take patients from you. You all do a decent job. I’ve got all the rest of the state with general practitioners, and I have to take their patients first.” Well, that was rational, I suppose. And we had no recourse. We were also 150 miles from Dallas. The chairman at Dallas at the time was something else. The neonatologist was a fellow named Jacob [L.] Kay. He would help you any way on God’s green earth he could, except the way they’d set their hierarchy was, they couldn’t accept patients. They wouldn’t accept patients, and I would say definitely wouldn’t.

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So, there we were. So, what do you do in a situation like that? Well, you do the very best you can. We were very cautious, and we were rigid about our 40 percent or less. Even so, our nursing care was such that we had women who knew how to nurse. They weren’t educated, but we had the best mortality rate. We had a better mortality rate than Parkland [Health and Hospital System], and Houston and Little Rock, basically because we had this set of nurses who would help us. And we did the very best we could. Well, we had kids who were surviving, whom many times before we would have lost. And it was only a matter of time before the plaintiff’s lawyers moved in from Dallas, gained access to our medical records room, and began to pick up our cases. So, we had several malpractice cases over retrolental fibroplasia and use of oxygen. The one that hurt the most was a baby in 1973 or 1974. The baby weighed 1,100 grams. At the time she was born, she had eyes that — I’ll never forget my partner saying, “Well, she’s got kitten eyes. She can’t open them.” And you couldn’t retract them, so we knew she had deformities of some sort. The baby had a horrible, stormy course. It took us 40 days to get this baby to birth weight, and we did. I mean, it was all sorts of things. She had moderate respiratory distress. Then she had a bleed, a GI bleed, and she did this, and she did that, and she had apneic spells. The nurses sat with her incubator, isolette, and resuscitated her. And if we made one trip in the middle of the night, we made 100 trips. Finally, the baby survived, but was blind, and so we were sued. We were sued when the child was 7 years old. We’d not seen her in years. This child had an IQ of about 130. She was doing extremely well with a blind typewriter in Texas public school, in something like the third grade. They admitted that one eye was congenitally malformed, but they couldn’t really say dead sure one way or the other, so they assumed the other one was retrolental fibroplasia. And these guys, these lawyers — that was my first experience with the law — took that statement, and it was over and over and over and over and over. You could read the statement and interpret it that it was all right to use 40 percent or less, but that didn’t really help us. And the thing in many respects that killed us was that the chairman of the department of Dallas came and testified against us, testifying that without a doubt we were probably the worst nursery he’d ever seen. He testified that he had discussed the case with Jerry [Jerold] Lucey, and that Dr. Lucey had said this was the most atrocious mismanagement he’d ever seen. Well, in the first place, I knew Jerry Lucey a little bit from the old days at Children’s, and I didn’t think he would have said that. But we called Jerry Lucey, and we talked to him and told him about the case, and he said, “Number one, I never told him that. Number two, I would not have told him that. And if you can get me subpoenaed, I will come and testify.” Of course, again the lawyers. So that did not come about, and we lost the case. In the long run,

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we lost the case not so much because of medical testimony, but because the judge was mad at the hospital, to make a long story short. In Texas, they apportion out percent responsibility. The hospital was found to be 80 percent at fault, my poor partner was 10 percent, and another partner and I were 5 percent each. At that point, I became much more interested in things such as the fact that you have to be careful about the ramifications of what you say and what you do. When the Academy makes statements, they really should be a little more attuned to what that is really going to mean across the country. At that point, I was state chairman [then-AAP District VII Chair] and got involved in district affairs, et cetera, and got elected to the [AAP National] Nominating Committee. I stayed on that committee for the proverbial 6 years, and then moved up to vice chairman, and was chairman. At the time, the chairman from the South was Bill [William A.] Daniel [Jr.], who was a wonderful guy from Alabama, a great guy. He was Carden Johnston’s mentor in many respects. But it intrigued me, and I appreciate the Academy, because it was obvious it was really trying hard in terms of education, et cetera. But in those early years, that early administration in the Academy was not too much. It really wasn’t. It left a lot to be desired. The shining light at the time was Jean [D.] Lockhart, who ran the Department of Education, I guess, or — DR. OUELLETTE: Maternal and Child Affairs [Department of Maternal, Child and Adolescent Health]. DR. LOWE: Yes. She was great. She was truly moving the Academy in a positive direction. Then we had Jim [James E.] Strain, who was national president at the time of Baby Doe and all of that. When Jim came back as executive director, that is, in many respects, when the Academy really took off as a meaningful organization which did try to respond to children’s needs, practitioners’ needs and pediatricians’ needs. In my estimation, it has become one of the more effective, outstanding medical organizations in the country. I really do believe that. You talk to people who do dermatology, or do surgery, or do this or do that, and it’s amazing the things the Academy does in regard to advocacy, not only for its patients, but also for its practitioners, its people, in contrast to what some of the others do. But that’s how I got started. Anger would have been a mild descriptive word for our feeling about that initial statement. It was something else. It really was. DR. OUELLETTE: Now, what years were you president?

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DR. LOWE: Somewhere around 1991, 1992 [Dr. Lowe was vice-president of AAP in 1992, and president in 1993 & 1994], because I followed Howard [Pearson]. It was curious, because Howard was president the year Bill [William Jefferson] Clinton became president. I became president the year they tried so desperately to get health care reform through. So that was a big issue. DR. OUELLETTE: And would that be the issue you were most involved with that year? DR. LOWE: Oh, yes, that was totally time-consuming. Well, it had been as vice president to some degree from July to January. I guess it was about January when it became obvious they were not going to vote it in. It was the compelling issue when Don [Donald] Schiff was president. He had established the whole concept of health insurance and access to care, and had built a tremendous base. I mean, we had a tremendous base to work from, and that was basically because of Don Schiff. It wasn’t that hard for us to compare what we wanted at the Academy in terms of health insurance to what they were coming across with in Clinton’s health care plan. We got to make a few recommendations. It wasn’t easy. We had parts of the country who were very much opposed to the Clinton health care plan. At the time they were all saying, “Oh, this is just a step toward single pay. This is government control, way too much control,” et cetera. But you know, that was before we all were subjected to the health insurance companies and HMOs [health maintenance organization. I don’t know how many people have said, and physicians have now said, “If we only knew what HMOs and the health insurance industry were going to become, we would have taken the Clinton health care plan in a shot, because you would have only had to deal with and argue with essentially one authoritative body, instead of being caught between all these entities.” In the Clinton plan there was enough control or oversight by the lay public that you could have taken your case, or whatever it was you needed changed or wanted, to lay people. My experience has been that if you’re doing the right thing, and you have a chance to argue your medical, health care case before the general population, almost 9 times out of 10 they will go with what you do, if you’ve got a sound plan. So, it would have been better. But anyway, that was the consuming concern. We had some activity on health education in public schools. That was the era when public school clinics were just beginning. There was a lot of opposition to the public clinics because people linked clinics and health education together. They said, “It’s just sex education in public schools, and we don’t want that.” So that was a hard struggle, but we made some inroads. That was probably the second most important issue for me.

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DR. OUELLETTE: And what have you done since you stopped being Academy president? DR. LOWE: I came home and immediately became involved in Children’s Hospital, University, (my old job) et cetera. We were in the process of changing not only department chairman, but also CEO [chief executive officer] of the hospital, and that was a reasonably strenuous 2 or 3 years to work our way through that. I spent a lot of time there, and I also spent a lot of time trying to get my rheumatology practice back up to speed and get back into teaching. Of all the things I did in my career, I will tell you teaching was my favorite thing. I love to teach. So, to get back where I could do rounds for a month and that sort of thing was very satisfying. That’s mostly what I did. Plus, I can say the intensity of what I used to call “the project,” which was to keep Children’s afloat and growing, took a lot of my time. My pulmonary disease caught up with me in about 1998 or so, which slowed me down quite a bit, but since then, interestingly enough, I’ve done a little better. I was “pretty worn out,” to “make a long story short.” I mean, I was at my wit’s end. The new hospital administration was difficult for me to deal with. I got to the point where I just couldn’t quite do the job I thought I should. I was doing clinical rheumatology, which was full time by academic standards, and I was also doing administration. Medical administration had become much more intense with quality improvement and quality care, and then here came the government and HIPPA [Health Insurance Portability and Accountability Act of 1996], and that became just a huge morass. So anyway, since I retired, I have been very involved with our camp for handicapped kids, and I write little biweekly articles for the statewide weekly newspapers, et cetera. A little of this and a little of that. DR. OUELLETTE: Now, you and I spent yesterday afternoon at the [William J.] Clinton Presidential Library [& Museum], and while we were looking at the exhibits, I suddenly said, “Betty, your name is in here.” Would you talk a little bit about what you were doing, interacting with the Clintons when they were here as governor and first lady? DR. LOWE: When Bill Clinton was first governor, Hillary [Rodham] Clinton was “not involved in politics.” She was a partner in the Rose Law Firm, but she was heavily involved in statewide advocacy for children. She was interested in the legalities of children’s issues, and Arkansas kids didn’t really have any legal status. I think it was her idea, in most respects, to get together this group of individuals who were interested in children, and we established an organization called Arkansas Advocates for Children [& Families]. We later added “& Families.” We were initially involved in

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getting that up and running. It’s turned out to be a fabulous organization. Through the years they have maintained their posture and have really been able to achieve a lot of good stuff. For instance, they were able to convince Governor [Mike – Michael Dale] Huckabee to accept the CHIP [Children’s Health Insurance Program] program in Arkansas. That was a venture of the Arkansas Advocates at the time, and they were able to pull it off. The Clintons were very easy to work with and easy to know. We had just developed a comprehensive review of neonatal care in Arkansas, which was pretty bad. We had come up with a plan whereby we could stratify the hospitals around the state into Level Is and IIs, and develop one major intensive care nursery, which we were going to put at Children’s, as it was essentially nonpartisan. We had this plan, which we did with Governor [David H.] Pryor. Then he left. We had a wonderful plan, but nowhere to go. And so, we decided, “What the heck,” and we took the plan — I guess that was really the first time I’d ever met Bill Clinton — but we took it to the governor and gingerly asked him if he would consider looking at a plan which had been developed under the auspices of the previous governor. Didn’t bother him at a bit. He said sure, he’d be glad to do it. He looked at it, and Hillary read it. They obviously were always for children. They thought that was a wonderful idea, and they helped us essentially get the whole structure in place. The state legislature appropriated a million dollars a year to support the Level III neonatal intensive care nursery, and through the years we had one vote one time against that, only one. In the Arkansas legislature, that’s a record. It was interesting, because somebody in this old guy’s district thought he had lost his pickup truck over a bill at Children’s, which was not true, but you know how that goes. But anyway, that’s when they started. This was in, oh, the late 1970s. So, we got Hillary interested in the Children’s Hospital venture as a whole. It took us a little bit of time to convince the Board of Trustees that Hillary would make a good board member, because she wasn’t from Little Rock. I mean, she was an outsider, and that’s not too good in Arkansas. None the less, she did become a board member, and she worked tirelessly. We had the telethons[Children’s Miracle Network], and Hillary Clinton would come and be our spokesperson on those telethons for 18 hours at a time. And she did it every year. Anything we asked her, she would do. We needed this bond issue desperately, and we were going to have to go to New York City and talk to the bond people. We put together what little financial resources we had, and she went with us to Wall Street, down into these massive, marble buildings. It was most impressive to me. We went to Standard & Poor’s, and we went to the other rating agency, Moody’s [Investors Service] and we made our pitch.

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What we had was just our group and Hillary. Hillary was there as the governor’s wife. This guy from Standard & Poor’s said, “You people have the most invigorating, positive program that we have ever heard considering the fact that you have no financial resources.” [Laughs.] Well, to us, that’s why we wrote the bond issue, and interestingly enough, those guys gave us an A1 bond rating. DR. OUELLETTE: That’s fantastic. DR. LOWE: It was utterly fantastic, and it was simply because, I suppose, we had tremendous support. They said to the Board of Trustees representative, “You’ve got a conflict of interest. How can you make this presentation?” And this guy said, “Yes, I do. I have a longstanding conflict of interest. I was an orphan when Children’s Hospital was an orphanage. They raised me, and they took care of me, and so I’ve always thought I should pay them back. And if that’s a conflict of interest, so be it.” Anyway, it worked. The Clintons were always very interested. Hillary was 9 months pregnant with Chelsea [Victoria Clinton] at the time, and I just kept thinking, “Oh, my God, we’ll have labor right here in this little airplane coming home.” Children’s had a reputation of being nothing more than a little chronic disease, crippled children’s hospital, and so people didn’t think they should bring their children there. I mean, they’d help us, but they wouldn’t bring their children there. But in their support of our hospital, Hillary and Bill Clinton always brought their child there. The pediatric department looked after Chelsea. This is not “out of school,” but Chelsea had to have her tonsils out, and we offered Bill and Hillary Clinton exactly the same thing we offered every other patient. We said, “Now, here’s a chair. You can sit by her bed.” And believe me, Bill Clinton never left until she was obviously awake and halfway ready to go home, and Hillary barely left. They were wonderful parents. They would do exactly what you said, and they were just totally involved and committed. So, it was a great relationship, and they were a tremendous help to us. They tried to do the same sort of thing in education for kids. In the long run I suppose I’m “a flaming liberal,” but nevertheless, probably not. It’s my firm belief that we owe the children of our country decent health and decent education. Then when they reach 18 to 21 years of age, we can say to them, “Okay, young people, we’ve done everything we can for you. Now go out on your own.” But I firmly believe this is something we ought to do for every one of them. END OF TAPE 1, SIDE B

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DR. OUELLETTE: You were just starting to say, Betty, as the tape ran out, that you were looking at how we do internationally, compared to other countries. Why don’t you talk a little about that? DR. LOWE: It just seems absurd to me that our country cannot do more for our children, especially when you see what all the other civilized countries around the world do for theirs. You know, some African countries have better rates of immunization. Neonatal death rates are worse in New York City than they are in some of the Caribbean countries. This is atrocious, and as far as I’m concerned, it should be an unacceptable point to society as a whole. It makes no difference whether you’re a republican or democrat or liberal or fundamentalist, or what have you, children are our future. That’s a cliché, but it is so true. It’s disheartening to see people currently chipping away at benefits for children, saying, “Well, we don’t want entitlement programs, we don’t want this, we don’t want that.” Routine immunizations for all the children in this country should not be an entitlement program. It’s a public health program. Different parts of the country have different ideas, but I’ll never forget one man who said, “Well, I just don’t see me paying for a rich 7-foot basketball player’s kid to have shots.” To me, the point is this. To have all the children immunized is a public health measure for the benefit of everyone, so it should then become a public health program. It’s not an entitlement. If we give immunizations to a few people who can afford them, so be it. That’s fine. After all, in our country, it would seem to me that we should be able to provide some basic services to everyone, regardless of their ability to pay or not pay, because it’s for the benefit of the whole. I’ll never forget [Senator] Dale Bumpers once said that you could immunize all the kids in the country for the cost of either 1 or 2 of the big-time new bombers at the time. How do we justify telling our young people at 18 or 21 they must go to war, that they must fight, if at the same time we have refused to provide solid education and at least health care? “We have no leg to stand on.” We have no moral principles. I’m not a fundamentalist. That’s probably painfully apparent to everyone. But I do believe in fundamental moral principles which have more to do with man’s humanity to man and the whole idea of care of the children. Care of the elderly? Yes, that also is a unique stage in which we should also be of help and support. But if we’re going to survive as a country, we’re going to have to do differently with our children, because they are the future. If we continue the kind of education we have today, and the kind of health care we have today, we’re not competing. China is producing more scientists, India is producing more engineers, and that’s great for them. But, if we maintain our pace, in 10 years I think we’re going to see ourselves as a second-rate country in this world.

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DR. OUELLETTE: One of the big issues right now is the push against some of the vaccines we have by some parents who have concerns about the immunization of their children, especially things like mercury and thimerosal in vaccines. Is this something you were dealing with early on, or do you feel this is something that’s really new? DR. LOWE: No, we didn’t have to deal with that. Actually, what we dealt with was the whole concept of the vaccine compensation law [National Vaccine Injury Compensation Program (VICP)]. That was there a little bit in our era, and that was fantastic, but I went into private practice in, like, 1959 or 1960. Oral polio vaccine had just become available, and it was the year of the national attempt to immunize everyone. I never will forget the county medical society saying to me, “You’re young, honey. You don’t have much practice. You do this.” So okay, we undertook 2 county-wide oral immunizations, one in Arkansas and one in Texas. We set up on Sundays. I had a wonderful guy, a drug rep who helped me, and we set this stuff up. We were immunizing on Sunday afternoon at the churches, because it was where you went to get the kids. So, the first Sunday went pretty well. DR. OUELLETTE: Did you go to the churches? DR. LOWE: Yes. DR. OUELLETTE: Or did they come to you? DR. LOWE: No, we went to the churches. We had all the county health nurses, and we had nurses from the hospital. We got everybody involved, and we carried oral vaccine to the churches. The first Sunday, we did pretty well. We felt like we’d probably given 40 percent of the doses we wanted. That next week a story broke at a national level in which there was a child in Alabama or someplace who became paralyzed, and of course, that immediately raised all the horrors of polio. Young people today have no idea how bad that was, polio. There was no proof at all that the child’s paralysis had had anything to do with the vaccination. There were all sorts of other possibilities. But I will never forget that I went to the editor of a local paper and requested, “Would you please give us 24 hours to find out the truth about what really happened with that child, so when you publish this story it will be correct?” I reassured him, saying, “If it was due to the vaccine, our vaccine program is gone, and so be it.” And, you know, he wouldn’t wait overnight. He said that would be interference with the news. So, much to our chagrin, he printed this story, and not only did he print it, but he made a tremendous headline out of it and immediately made the assumption that it was proven that it was due to the vaccine. Obviously, immunizations dropped off

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tremendously. So, our early attempts with immunizations involved coping with those fears — the possibility that you could have paralysis from polio and brain damage from whooping cough. Brain damage from whopping cough became one of the major medical liabilities of our time. We had a great deal of problem with that and, of course, got caught up in that controversy where you had people who had otherwise been perfectly legitimate came out with all this irrational testimony. So, we dealt with those kinds of issues, but not thimerosal. The real question is why are we having more children with autism than we used to? They always say, “Well, y’all just didn’t pick it up. You just didn’t diagnose it.” That’s not true. I had 2 perfectly classic examples of severe autism in my practice. I also had a fair number of kids about whom we just said, “They’re unusual.” We did not know exactly what their mental diagnosis was, but they were “unusual.” Certainly, I think there has been an increase in autism and the autism spectrum. Now, what caused that? Again, I think that should be one of the major endeavors of the NIH [National Institutes of Health] child health-related issues. Work on obesity. I’m fine with that, but nevertheless, these things that happen like autism ought to be clarified. It’s hard for me to believe it is thimerosal, because when I started, we used mercury. Mercury was the only diuretic we had. All of the vaccines then had it, so why would it not have been apparent for many years, instead of just recently? So, the issues over vaccines were different. Establishing the vaccine compensation law was a tremendous thing. If we had not gotten that through, there wouldn’t have been 2 manufacturers in the country making vaccines anymore. I thought it was absolutely absurd when this past year we were trying to get the flu vaccine encompassed into that. At the time, we had a tremendous shortage. Congress had passed the bill, and it was lying on the president’s desk, unsigned. I mean, to me, that’s just not paying attention to things that are important. DR. OUELLETTE: How do you think pediatrics is going to change in the next 10 years or so? DR. LOWE: I doubt if it changes very much. I think for the next 10 years we’re probably going to consolidate what we’ve got. I think we’ll have more and more practices. We’ll have general pediatric practices in which they’re going to learn how to, for instance, utilize some nurse practitioners and be able to extend themselves. They’re going to contract with psychologists, et cetera. They’re already paying a tremendous amount of attention to psychosocial issues in pediatrics. They’re going to figure out ways to do that and to make it pay. They will continue to take care of routine illnesses, but I think we will continue to see this trend that illnesses like

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glomerulonephritis get referred to the specialists, and things that really don’t need to be are being referred. I think that’s going to continue. If you could have your wishes, you would wish there would be a better working relationship and esprit de corps between specialists and hospitals, and specialists and the general practitioners. Your children could go in, see the specialist, the specialist would make a diagnosis, establish a game plan, send game plan and child back to the practitioner, and they could communicate back and forth about the care of that child. That will be a long time coming, because finances for care at the present time are set up in such a way that the specialists have to see those children over and over to make their office pay. On the other hand, pediatricians are saying they have to turn over so many patients in their office that they don’t have time for the real complicated cases. I’m hoping that’s going to work itself out. My gosh, they’ve got electronic records, they’ve got digital x-rays. You can take an X-ray in Springdale, and it’ll be read in Little Rock in 10 minutes. You’re going to have all these fantastic advantages. You can carry a pediatric formulary in your pocket. Don’t tell me you don’t have time! I mean, in comparison to how we spent our time, we didn’t have time either. But in comparison I think we were okay. I’m hoping we will see consolidation of these sorts of efforts. Pediatrics will remain a major, leading specialty. Family practice is not going to truly make inroads into pediatrics, because they’re going to become more committed to the elderly. That’s just “the nature of the beast.” They’re shifting to the elderly. Internal medicine deals with a great deal of chronic disease. Pediatrics is going to continue to be an outstanding specialty. DR. OUELLETTE: Now, one of the big changes since you went into pediatrics is the feminization of pediatrics. When you and I both went in, women were only 5 or 6 percent of the classes. DR. LOWE: Yes. DR. OUELLETTE: Now they’re 50 percent of classes. What changes do you think that’s going to make in pediatrics? DR. LOWE: Well, it already has. I mean, it has changed work habits a great deal. We now see much better call schedules, et cetera. You don’t take call every other day and every other night. Things are spread out a little bit. You’re probably going to find that women who go into pediatrics are going to spend a fair amount of time raising their family, and they’re going to practice medicine in a part-time way. What we call part-time practitioners are probably going to be the standard of the day. That will necessitate an increase in the total number of pediatricians, because they’re

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not going to work — well, not only women, but young people today are not going to work the 120 hours a week we did when we were in practice. And that’s fine. I mean, it’s just a change in culture, and change of the times. They’re not able to work 120 hours a week. We have house officers today who are truly worn out if they have spent one day and one night on duty, which in our day was fine. It’s just a difference in the way you’re brought up. It’s tradition. So, it’s a change. I see that women are going to have a tremendous impact in terms of those kinds of changes in pediatrics. Now, in quality, it’ll be just as good if not better. Women usually add a sense of empathy for children, which will be good. I think more and more women will enter academics, because they’re going to realize there are ways to structure your time better, and I think that’s going to be good. I think it will be interesting. I used to worry about this, because at the time when the women’s movement just started, the only thing we had to compare with was Russia. As you remember, when women physicians became dominant in Russia, Russian medicine became second class. Now, I don’t think that’s going to happen to us, and I don’t think that’s going to happen to pediatrics as a specialty. Pediatrics as a specialty, regardless of women, continues to struggle a bit for recognition as a whole. You’ve been around medical schools, but I have always said surgeons are the hotshots, they show off, and they’re all the big-time guys. Internal medicine sells itself as the intelligentsia of medicine, et cetera, et cetera. That kind of leaves pediatrics — where are they? I think America doesn’t really honor their children as much as they say they do, and therefore, they also don’t necessarily honor their children’s physicians as much as they should. The only people who truly honor pediatricians are parents of a really sick child. They respect a pediatrician who has helped a family through difficulties. This is a terrible thing to say, but I mean, that’s, in a way, the truth. So, one of the big challenges to me in pediatrics is to somehow gain equal professional standing with the other specialties of medicine. DR. OUELLETTE: Do you have any ideas on how to do that? DR. LOWE: No. [Laughter] No, I really don’t. I think it’s beyond us, because, like I said, I think if we truly begin to honor kids more, and we truly respect children, then it will all fall in place. But we still have this attitude of, “Listen, I’ll educate my child, you educate your child. We don’t care about your child.” And then we have this tremendous number of kids who don’t have anybody, or they have parents who are ineffective, or they have parents who are financially ineffective. That’s not those kids’ fault. Until we can develop an attitude in our country where we say no matter

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where the child comes from, he gets an absolute equal shake, then we’re going to have trouble. It will be fascinating to work on. DR. OUELLETTE: One of the groups that is the most disenfranchised right now is the children in the foster care system. DR. LOWE: Oh, yes! As a shining example, we’ve been working on foster care in Arkansas now for 15 years, and we’ve had several people who truly try to make strides, but they apparently are overwhelmed. They don’t have enough people in the government system to really look after the children. This is one of those things where, unfortunately, in spite of what people say, their bottom line is, “Why should we worry about those kids?” And that’s terrible. We’re having exactly the same thing, perhaps, with some of our Hispanics. That’s a big issue in Arkansas right now. “What do we care whether those kids go to college or not? After all, we’re sending our kids.” It’s that attitude. To me, we’re getting more and more foster kids because we’ve got all the abuse kids. Methamphetamine is a horrible problem in Arkansas, and that just leads to more and more kids in the foster care system. We have some archaic rules in foster care. For example, if you’re a foster parent, you’re not supposed to adopt, but that’s crazy. If you’ve been taking care of a child for a year and a half, and you have formed this family bond, you should be able to adopt the child. He has no other place to go. So, yes, the issue of foster children is a real problem whose solution will require a philosophical change in society. We’re struggling with public schools, and we’re making some headway there, but we’ve had such an influx of private schools — perhaps this is a southern phenomenon — but we’ve had such an influx of private schools that we have many people who really are not interested in public schools anymore. So, it is, therefore, very difficult to make a move, and it’s going to be exactly the same thing as with foster children, yes. DR. OUELLETTE: Now, another area the Academy is getting increasingly involved with is the whole issue of health equity and health disparity. DR. LOWE: Yes. DR. OUELLETTE: Do you feel we’ve made progress in this area over the years in which you’ve been involved in medicine? DR. LOWE: Oh, we have, we have. We’ve gone all the way from when I was in private practice, if I had a child who couldn’t pay, the nurses would help me admit the child at 1:00 AM in the morning. We ran on the assumption that we could admit at 1:00 AM and by the time the hospital

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administration found out they didn’t have any money, it would be 4:00, 5:00 the next afternoon. And maybe by then, if the child had an infection, we’d have him three-fourths well anyway. They would certainly kick him out. Had they known about it ahead of time, they would have flat shut the door and said we couldn’t admit them. We’ve been blessed in Arkansas because, again, our hospital, Children’s Hospital’s Board of Trustees, has been able to let anybody come. They limit mental health, which I think is terrible, but no one else, and so we offer the very same care to any kid who walks in our door. That’s such a tremendous change from what it was 20 years ago. I think around the country, more and more children are having access to care. I think you still have pockets, though, where a Medicaid child will kind of get put in a slightly different category, which I’ve never understood, but it’s there. That, we have to get rid of. Health care as a whole is in a tremendous bind. You’ve got an industry that employs better than 30 million people in the United States [of America]. It’s outstanding. If you were to say that General Motors was growing at 10 percent a year, everybody would just be “tickled to death.” When you say health care is growing at 10 percent a year, everybody is upset with the cost. If we break down what we want to spend our money on, if we Americans wish to spend 15 percent of our gross [domestic] product [GDP] on health care, well fine, because, for instance, we spend much less on food than foreign countries. We have been spending much less on energy, although that may change. So how we proportion our dollars, I think, is up to us. But I think we have to go ahead and create a system, or move toward a system in which there’s a unifying force. You can’t cope with the different insurance companies, the different payment systems, et cetera. You can say we’re going to cut the payment to doctors tomorrow, then the cost of equipment goes up. We’re going to cut hospitals tomorrow, then the cost of drugs go up. So, you need to have a unified system in which you can say, “Tough, it will be a 10 percent cut across the board — physicians, hospitals, nurses, druggists, drug companies, equipment companies, everything.” You buy hospital equipment, and you can look these people in the face and say, “We can’t pay $1.5 million for your MRI [magnetic resonance imaging]. Now, what is your real bottom line?” And it may very well be no more than $1 million. They get everything they possibly can out of health care dollars. Insurance companies that are spending 30 percent of their dollar on administration have the nerve to call what they pay out for patient care their “loss leader.” I never will forget that I was just flabbergasted the first time I sat with insurance people, and they were talking about their loss leader. They were saying, “We had to pay X amount of dollars in true care of patients, and that’s our loss leader.” Thirty percent of overhead for management, et cetera. Hey, Medicare’s not perfect, but they do it on what, 10 percent or less?

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You can’t have those discrepancies. You can’t have health care running on a system in which you’ve got to have a profit that goes to investors. To me, that’s just wrong. It’s a wrong premise. So, until we get some kind of unified system of health care delivery, where everybody has to be subject to the same rules, so to speak, I don’t think we can address some of these disparities, and I don’t think we’ll ever have universal access to care for everyone. We might make it on children if we can just flat shame them enough. We might make it. I doubt it. And it would be a way to go. For instance, our biggest problem in Children’s Hospital is we have the only burn unit in the state, and we run the burn unit so we can take care of burned kids. When we started, it was 70 percent kids and 30 percent adults. We were perfectly willing to do the adults to get the expertise to take care of the kids. Now it’s shifted, and with meth [methamphetamine] labs, et cetera, it’s 70 percent adults and 30 percent children. Probably 50 percent of the adults are meth lab blow-ups. Now, none of them have any money, and that’s a burden we’re not going to be able to sustain. But, again, Arkansas is a crazy place, and I must admit I like it. We went to the legislature 3 years in a row, and this year they said, “Yeah, y’all got a problem that’s really not your fault,” and they have now appropriated — I don’t know how much — but a sum of money each year to help sustain the burn unit. But those sorts of things ought not to have to come up. I mean, we’ve got to go now to — well, whether it’s “a traditional single-payer system,” I don’t know. I have no patience with the people who say, “Ooh, we don’t want the British system, we don’t want the Canadian system.” Well, in the first place, when I used to go back and forth and visit in Canada, I talked to cab drivers and secretaries, et cetera, and they loved their health care system. The doctors were fretting, but they were doing okay. But the point is this, that’s fine with me. If we had a single-payer system, haven’t we got enough smarts to set up a system that isn’t like Canada, and isn’t like Britain, and would address the issues everybody is concerned about? Don’t just stand there and wring your hands and say, “Oh, woe is me.” I don’t like “woe is me.” I think we have to get there. I really do. DR. OUELLETTE: Betty, I’ve been asking you questions here for the last hour and a half or so. Are there any things I haven’t asked you that you would like to say and put into the record? DR. LOWE: One of my major concerns at the present time is not only where are we going in the system as a whole, but where are we going in medical education. I’m really concerned that our whole health care educational system has become so intertwined with worry about malpractice, worry about payment, et cetera, that we’re developing physicians who are totally too dependent on technology. I believe in technology, and I think we should use technology, but I do not believe that every child who needs a

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lumbar puncture in the emergency room has to have an MRI first. I’ll go to my grave thinking that. I lost that argument at our hospital. They get CAT scans. I don’t think that just because you bring a patient into the hospital and you do an EKG [electrocardiogram], serum enzymes, echocardiogram and cardiac cath, you can say to the patient, “You’re fine.” That’s not the answer. That was me in a recent hospital admission in which I had some problem, which in the long run, when I got out of the hospital and I called one of my good friends in immunology, she said, “Oh, yes, I agree with you. You had a reaction to gamma globulin.” We’re not talking about establishing true physician-patient relationships and care. Our young people have grown up in a society in which they don’t really quite know how to establish patient-physician relationships and have empathy. Now, you can carry that too far, that’s true, but I’m worried about that. I’m very worried about that in terms of medical education, because if we don’t sustain that, we will have lost our position as a profession. To me, again, if medicine is not a profession, it’s kind of like, “Lord help us all.” So that’s really my big concerns. Where are we going in education? We do a better job of that education in pediatrics, perhaps, than we do some of the other fields. But again, even in pediatrics we’re seeing way too much total dependence upon technology. The ability to solve a problem and think your way through a problem is being lost. I’m hoping that’s not true all over the country, but I’m afraid it is, yes. The other thing that is a concern, again, is that we’ve let malpractice and the threat of malpractice drive us now for quite a few years. Granted, what else can you do if malpractice insurance is a couple of hundred thousand dollars a year? Nevertheless, I think we must begin to work toward a solution, and I think the solution comes from some combination of a program like the vaccine compensation program that is coupled with true surveillance of physicians by physicians. I think we have to establish a network in our hospitals and in our practices where we evaluate errors. We were doing pretty well in our sentinel events. We were able to line up our physicians and say, “Now, tell us what happened.” We could evaluate what happened and come to conclusions. But we have to be able to do that as a profession as a whole, where we can evaluate errors in what happened and respond accordingly. The response could be all sorts of things. We had a physician one time who really couldn’t do a procedure very well, and unfortunately, it was probably his very favorite procedure. As director of the hospital, it was my chore to sit down and say, “You know, I’m really very sorry, but you’re not to do that procedure anymore.” Well, he took it, which was very good, because had he

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decided to fight me on it, it could have been a horrible thing. But we have to have that ability to say, “You can’t do that procedure anymore,” or “If you’re going to do that procedure, you go away and you bring back evidence that you have learned,” or “Well, yes, this was an error, and really you’re not at fault. Go with grace, and try not to do it again.” END TAPE 2, SIDE A DR. LOWE: We have to address our medical care among ourselves, because if we don’t do it as a medical profession, the outside world is going to do it for us. But if we couple something like that, and could prove we were doing it, at the same time, doing things like vaccine compensation, I think we could get out of the malpractice hole. Until we do something like that, we’re not going to. Malpractice cases don’t do well in ordinary court. I learned that “the hard way.” I mean, it was amazing. We could not testify as to how small this premature baby was. We had a little doll that was that size. And the judge said, “Well, that’s just so grotesque, that’ll upset the jury.” Yet we were expecting this jury to determine what had happened. And it’s just an example of, “Hey, it won’t work.” So, I don’t know. But that’s an issue, I suppose, for medicine as a whole. But I think pediatrics should begin to be perhaps a major force by really pushing their quality initiative even further to begin to encompass some of this stuff. What they’re doing in teaching is good. A caring physician’s office is fabulous and is really a step in the right direction. They should begin to be involved in how you manage, how you detect errors, how you correct errors, what’s good, and move forward into getting the medical profession to really pay attention to this. I think that’s our biggest crisis, and I’m very concerned about that. Very few faculties get involved in stuff like the IOM [Institutes of Medicine of the National Academies] and its errors thing [To Err is Human: Building a Better Health System]. Everything they said about those errors is absolutely true. They’re there. They’re there all the time, and 9 times out of 10, they’re really not detected. Of course, once they’re detected, what do you do? We adopted the policy that, well, you talk to the family, you tell them what happened and let the chips fall. It’s true that we had a small, constant, ongoing number of malpractice suits, but they didn’t increase. They did not increase. We had very good advice from a young female lawyer who was fantastic. But I don’t know, what do you do about things like that? DR. OUELLETTE: Okay, good. Anything else you want to mention? DR. LOWE: No, not really. It’s been a fun time. You get this question all the time about would you do it over. I’d do it over in a shot.

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Now, might I do it exactly the same way? I might make a change or 2, but nothing big. DR. OUELLETTE: Great. DR. LOWE: It’s been a great life. DR. OUELLETTE: Thank you, Betty. This has been wonderful. Thanks for allowing us to do this. END OF INTERVIEW

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Index

A Adams, Tom, 5 Allen, Robert G., 5 Alpert, Joel J., 4 American Academy of Pediatrics, 1, 11, 12, 14,

15, 16, 24 American Academy of Pediatrics, Arkansas

Chapter, 12 American Academy of Pediatrics, National

Nominating Committee, 14 Arkansas Advocates for Children & Families,

16 Arkansas Children’s Hospital, 9, 10, 16, 18, 25 Avery, Mary Ellen, 4

B Beard, Alice G., 12 Berry, Betsy, 3 Brodell, Bob, 5 Bruce, Thomas A., 9 Bumpers, Dale, 19

C Children’s Hospital Boston, 4 Children's Health Insurance Program, 17 Children's Hospital Boston, 4, 6, 7, 8 Clinton, Chelsea, 18 Clinton, Hillary Rodham, 16, 17, 18 Clinton, William Jefferson, 15, 16, 17, 18 Crigler, John Fielding, Jr., 5

D Daniel, William A., Jr., 14 Diamond, Louis Klein, 4, 5, 7 Dodd, Katharine, 3, 4, 7

E Ebert, Richard V., 3

F Farber, Sidney, 5 female pediatricians, 22 Fiser, Robert H., Jr., 9, 10, 11 foster care, 24

G Grapevine, Texas, 1 Gross, Robert Edward, 5, 6

H Haggerty, Robert J., 6 Helwig, Floy, 5 Henry, Louise, 2 Hill, Donald E., 10 Holder, Thomas M., 5 House of the Good Samaritan, 6 Huckabee, Michael Dale, 17

I immunizations, 19, 20

J Janeway, Charles A., 5, 6, 8 Jimmy Fund, 5 Johnston, Carden, 14

K Kay, Jacob L., 12 Kevy, Sherwin V., 5 Ko, Kwang Wook, 8 Kreigsman, Nan, 6

L Lesh, Ruth Ellis, 2 Little Rock, Arkansas, 1, 4, 12, 17 Lockhart, Jean D., 14 Longino, Luther A., 5 Lucey, Jerold, 13

M malpractice, 13, 26, 27, 28 McGinnis, Leland, 9, 10 medical education, 26 Mitus, Anna, 5

N Nadas, Alexander Sandor, 5 National Vaccine Injury Compensation

Program, 20 Nelson, Nicholas, 4

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neonatal intensive care, 8, 12, 17 Neuhauser, Edward Blaine Duncan, 5 Noonan, Jackqueline Anne, 4

P Panos, Theodore C., 7 Pearson, Howard A., 4, 15 Perrin, Jane C. S., 6 Pryor, David H., 17

R Rigg, Andrew, 5

S Schiff, Donald, 15 Segal, George, 4 Simon, James, 4

Strain, James E., 14

T Toch, Rudolph, 5

U University of Arkansas, 1, 2, 9, 10, 16

W Waddell, Pearl, 2

Y Yell County, Arkansas, 1, 2

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33

34

35

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