&TO. Fred R. Harris The Urban Coalition 1819 H Street, N, W. Washington, D. c. 20006 Dear plra. Harris, If I have not answered your letter of July 15th a8 early as I 8hould have, the reason is mainly that I have found it difficult to fowulate a sesmfble reply. I do not know what Whitney Young, Jr. ia referring to whan he alludes to "insulting and damaging reports on black people", so I am just ignorant of what this hassle is apecif ically about. I do wonder whether invoking "racism a8 the number one public health problem" i8 particular helpful In trying to work out solutions. It may do good 8ervSce 88 a slogan to help awaken many obtuse Americans about the pervasfvsnesa of the racist eyrtem but we should not then deceive ourselves by our own slogan8. Ona could after all argue rather cogently that number one health program la poverty, or ignorance, the lndffferanca of Congress and the public, the arm race mtd the Ah&l, or man'@ original sin and hia, inherent viciousness.There is a 8en8e in which these stateDaent6 are all true. But I also think that to belabor this puiat is nneraly to get in the way of pragnatic efforts to find constructive fmlutfons. , My own experience and specgal knowledge ier 80 far removad from community merdictne that I heeltata to push any particular patterna of action 8nd I am 8ur8 that any porrltive ideas I might have have already been worked over extenoirely by other8. L may, however, be able to perform 8me critical function in revfewing the euthuslasms of others and If I can be helpful in that way, pleaee call upon me. Furthermore, Dr. Count Gibron is shortly coming to Stanford to start our ovn academic program8 in community Paedlclne and I will consult withhhim and recoeanend that you do the 6-e if you have not already done 80. Pinally let me Indicate that I believe that a great deal more reoearch doe8 atill need to be done (regardless of Mr. Wow's ex- po8tulatioa8) bafora we c&n do a good and cost-effective job of coaaaunity medicine. All the main point8 that must be gotten over IS the naed for commitment - no matter what wa do to do ft right will be quite expen8ive. There have, of cour8e, been come lueucusable abuses but to lay the inflation of coate of care on the doctors and over the drug manufacturers 8eema to ~lg to bliss the essential point and that 18 that a good medicine is going to require a couaiderably larger investment than Congress has so far been willing to make. I am very much concerned that getting the job done is going to be badly entangled with all kinds of ideological problem8 like community participation, but I auppoee that is the fact of life today. Obviously, it i8 not going to be easy to make enormous advances in community medicine without at the same time coping with such prablema aa educatfonal and job opportunity - if for no other reason than liean a honky really deliver good medicine to a black?'" Obviously I am afraid that the unremitting emphaaia on "racism as the problem" can only lead to a deepening polarization along these lines. 1 believe that the meet important otep to good community medicine is the e8tablishment of a right to health as a prerogative of citizen- ship and putting tax dollars behind the implementation of indivfdual claims to that prerogative. I am enclorfng for your attention a copy of a memorandum that I had fOrUWly 8ent to Mr. Gardner outlining certain research areas that deeeme greater emphasis. Sincerely yours, Josshua Lederberg Professor of Genetic8 Enclosure 3XJrr :-.-_ i A quick review of topical areas suggests some of the subjects that would be given much stronger emphasis for urban health purposes. They include (4 (b) (4 W (4 w Safer and more generally acceptable methods of contraception The evaluation of prenatal health and a better understanding of what optimal prenatal should consist of The continued development of improved antibiotics that can properly be given on a mass distribution basis; and self-administered teats for antibiotic-sensitivity. The same for vaccines Improvements.in techniques of laboratory diagnosis for mass survey purposes and for prompt mechanized examination of individual cases A better understanding of nutritional needs in various circumstances of life, and methods of determining what the actual requirements are of peep le , expecially infants, manifestly suffering from malnutrition.