IT IS A SAD FACT of our times that 1) professionals and specialists are increasingly called upon to deal with the public/political/managerial aspects of their fields and that 2) often as not they tend to end up double losers -- diminished in professional stature as popularizers and dropouts, and revealed to have been no great shakes as public managers. We bring this up by way of noting the great contrary distinction of the physician-writer-public man John Hilton Knowles, who died of cancer on Tuesday at the age of 52. Dr. Knowles, whose brilliant career in medicine led him to a keen interest in medical care as a national (and international) issue, somehow managed to remain always the intensely concerned and knowledgeable doctor, even as he was going on to become head of the Rockefeller Foundation and a man deeply engaged in public affairs.
We don't use the word "brilliant" loosely. John Knowles' career took off like a spaceshot in the Harvard-Boston medical world of the 1950s and early 1960s. By 1962, at the age of 35, he was made the youngestever director of the highly respected Massachusetts General Hospital. He remained there for 10 years, in the course of which he became a full professor of medicine at Harvard and, most notably, introduced a variety of improved medical techniques and systems at Mass General, which were widely emulated elsewhere. During the same period, his concern with the non-clinical aspects of his profession -- making adequate medical care at once more available and less intimidating to people -- intensified.
None of this made him very popular in those tradegroup redoubts of the profession where acknowledgement of any failings of American health care is regarded as betrayal of the cause. And as a consequence there was the protracted several-months long dispute within the Nixon administration, in its early years, over whether or not to make Dr. Knowles assistant secretary for health and scientific affairs in HEW. The antis, led by the late senator Everett M. Dirksen, prevailed in this vaguely comic-opera dispute, which, in retrospect, looks much more marginal and ridiculous than it did then. But what has lent it this aspect of triviality is not so much the passing of time as the subsequent career of Dr. Knowles. For a smaller man, the episode would have been big enough to dominate and distinguish any obituary. For John Knowles, who went on from there, it became a minor skirmish in the past.
There is of course a paradox in the biography of John Knowles. His insistence on the public obligations of the medical profession, his refusal to swallow any easy left or right political line on the subject, his crafting of his own distinct approach (as heavy on individual responsibility as on society's duty), his inability ever to forget that the medical profession was meant to help people and not the other way around -- all this made him anathema to considerable numbers of his colleagues. They felt he was doing their profession, well-being and good name some unspecified harm. That, we judge, is only a measure of how badly out of touch some people can be. John Knowles and doctors like him are what redeems and distinguishes the practice of medicine.