John W. Simmons, M.D., oral history interview, April 29, 1994

              Dr. Brown: This is an interview today with Dr. John W. Simmons who served as President of the state medical association during 1990 to '91 and the interview is being conducted in Charleston, South Carolina during the One Hundred and forty-sixth meeting of the state medical association. Dr. Simmons is here and the interview is being conducted by Dr. Laurie Brown. And I want to welcome Dr. Simmons to the interview and tell him first thing to answer what you want to and to tell me what you want about the Past Presidency or anything that you would like. Uh, first, I'd like to sort of just ask you where you were born and where you received you undergraduate education and sort of just a little of your earlier life. Dr. Simmons: Well, I was born in Atlanta at Emory. University. I grew up in my early childhood in the Atlanta area. After going through public schools, I went to Georgia Tech for undergraduate school and then to the Medical College of Georgia for graduate school. My family still lives in Atlanta. My boys have all gone to Georgia Tech and they are in now in Atlanta. Dr. Brown: They're in Atlanta, too. Right. And, you care to name your wife and boys? Dr. Simmons: My wife, Patsy, was Patsy Tinsley and she grew up just south of Atlanta in a Methodist preacher's family there where we were and that's how she and I met. She taught school and after going to get her education at Emory University, gave up teaching after our children started coming. They are John, Todd and Andrew: twenty-eight, twenty-five, and twenty-three. John 's a stockbroker now. Todd worked for a couple of years as an engineering management consultant for hospitals, but is now working on an MBA at the University of Chicago and Andrew 
is in his third year at Georgia Tech.  
Dr. Brown:  It sounds like they are all successful.  That's  
a  .  
Dr. Simmons:  Well, so far.  
Dr. Brown:  So far, so good.  Uh, now what were some  of the  

sort of early influences in your life. Any particulate people? How did you decide that you were going to become a doctor, a physician? Dr. Simmons: Well, I guess I was always sort of scientifically oriented. Uh, there were some influence in my life. One of my father's brothers was a physician. Earl Samms was my family doctor when I was growing up. And Samms certainly enjoys a great deal of notoriety in South Carolina having received an honorary doctorate at MUSC just this past year. I still see him occasionally. I had lunch with him last fall and may parents are still patients of his. Dr. Brown: Well, good. Dr. Simmons: He's clearly one of the influence. He has stuck with the traditional medicine model, being almost a 
country doctor most of his life, although heÕs in a big multi-specialty clinic now. But not to name him as one of the influences would be significant. Uh, I've got to admit I'm not sure. I canÕt remember when I was not interested in it. Some time or two I was attracted to other things, but I always came back to it. Dr. Brown: Always thinking about medicine, then. Well, can understand how Dr. Samms might have influenced you a lot in your life because I was delighted when you brought him her. Dr. Simmons: That was good entertainment. Dr. Brown: That was good entertainment. Of course I had read at least one of his books at that time and then I was present when he got his degree from the medical university. It was a real privilege to see that. I understand how Dr. Samms could be a great influence in your life. And you went to medical school where? Dr. Simmons: Where? In Augusta, Georgia, at the Medical College of Georgia. I was there from sixty-four to sixty-eight. From there I went up to Spartanburg to my internship. I actually thought I'd do a one-year internship in North Georgia and just be country doctor. Dr. Brown: Yeah? Dr. Simmons: You could still do that at that time. That was twenty-six years ago and I never have gotten back to North Georgia. I wound up staying and doing a family 
practice residency. Except for two years in the army, I've been right in Spartanburg since. Dr. Brown: How was you time in medical school. Was it how 
Dr. Samms describes it in one of his books? Samba is so eloquent and articulate in his writing, that, uh. Dr. Simmons: It was probably similar to that in a lot of ways. I can't recount it as well as, uh, he can. Some 
interesting thins to remember about my class : unlike today's classes, in our class of a hundred, there were only three women . Uh, to my knowledge, only six people left that class intending to do family practice. My guess is that's significantly higher today, the number of students who intend to do family practice. There's a residency at the Medical College of Georgia in family practice. Dr. Brown: Right. Dr. Simmons: We, uh, we had some pretty interesting professors there. Dr. Raymond Alford (unintelligible) was the professor of pharmacology and he's one of the ones who did a lot of the work in (unintelligible). He's sort of one of the pillars in pharmacology. We had t hat kind of experience, uh. If I went through today and could go through all of the things that occurred then, I 'm sure would see, sort of, two very different experiences, so 
Dr. Brown: There's, uh . . . I'm sure practice has been just as rewarding as you though it was going to be. 
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Dr. Simmons: Actually, probably more than I had  anticipated.  Dr. Brown: Yeah.  
Dr. Simmons: I did family practice for eighteen to twenty  years after I got through my residency. About five years  ago, I went to work at Spartanburg Regional as the Vice  President for Medical Education and I've been doing that  full time.  Dr. Br own: Right.  
Dr. Simmons: in the past five years. Both experiences, the private practice of medicine and as a hospital administrator have been very rewarding and very exciting. I had a very busy practice, a lot of Spartanburg's "Who's Who," if you will. People that were very good friends of mine and remain good friend today. And you know all those kinds of relationships that can build. Spartanburg, fortunately, has remained a town of practitioners. There's a lot of small town atmosphere about it. Uh, but, I was sort of caught up in the politics of the association and everybody was concerned about health care being reformed, and the job at the hospital gave me an opportunity to be involved in an area where I though it would have a more direct impact . . . Dr. Brown: I see. 
Dr. Simmons: designing a delivery system that what I would in the role of private practicing physician seeing thirty, forty, fifty people a day. Dr. Brown: Are there any particular highlights in your general practice career that you might like to mention? Out of your whole career as a highlight? I know it's awfully difficult to pick out one or two instances that are particularly interesting highlights, but is there anything you would care to mention? Dr. Simmons: I guess I need to be careful not to start naming the names. Dr. Brown: Right. Dr. Simmons: But all of us who have had a rewarding practice remember patients, episodes that patients had where we were able to participate in a process that lead to a diagnosis and led to a successful therapy and sometimes those activities occurred in rapid order. When one of your really close friends comes into your office having chest pains and that sort of thing . . . Again, we've all had those experiences where we walked through the path of despair with folds when there was not . . . Dr. Brown: Sure. Dr. Simmons: ... a therapy to deal with the diagnosis that we came up with. As discouraging and depressing as that can be sometimes, the relationships that you have with the people and the families coming through those times, uh, is often rewarding is way that can't be established in any other mechanism. We've obviously has those kinds of experience. When your peers, uh, ask you to work on a project by appointment to a committee or to office, I've found that to be very rewarding. Dr. Brown: That's a highlight, isn't it? Dr. Simmons: Oh, yes, And I had the opportunity to the President of my county medical society as a medical staff officers in a hospital during the development of various initiatives. IÕve had a lot of support from my colleagues and that ' s been, uh You know when you your peers in your profession ask you to do a job, I've taken that as a . 
Dr. Brown: It's very good. Dr. Simmons: ... very big compliment. Dr. Brown: It's a real compliment. You've he d several offices in the state association, too. How did you get interested in organized medicine, a term that I never have liked, uh, but some will say, call it "disorganized medicine" when you get a lot of people working together sometimes. But how did you get interested in and started in that part of medicine? Dr. simmons: Well, the first office, I guess I ever held was Vice President of the Spartanburg County Medical Society. again, I ' m not sure I could remember where or how it came to be, but once I was elected to that office, there was a natural progression to become the President of the society and the medical society officers in Spartanburg have always been pretty active in the South Carolina Medical Association. So early on I was asked to it, or appointed to the SCMA as a delegate and I guess it's just 
in me to not want to sit idly on committees and offices, but to be active and I have enjoyed, I guess now fifteen years of participation, first as a delegates then on up to 
I guess the third or fourth year that I was a delegate was the first time I ran for office at the SCMA and we had a First Vice President, a President-Elect, a lot of officers than that we don't have now. I held the office of First Vice President and Second Vice President, Secretary, Trustee for my district I may have held more offices. Dr. Brown: You had something to old, uh? Well, that has been rewarding, I'm sure. What were some of the issues that were facing us in medicine and facing the, uh, about the time you became and just before you became President? Dr. Simmons: The, uh, leading up to the year that I was President, there were a number of issues that sort of started at about the same irne that I got involved with the medical association. There were a lot of monies being transferred from state government to federal government and a lot of those monies involved health care and the medical association was obviously interested in how those monies 

were going to be utilized in the delivery of health care to patients. That obviously goes on to this very day. Dr. Brown: Sure. Dr. Simmons: We also had at about the time that I became involved with the medical association the sudden emergence, particularly in this part of the county, of the organizations like HMOs and PPOs, IPAs and all that sort of thing . That's come to maturity today, not in the penetration of patients and the patient marketplace, but in acceptance on the part of the medical community of those kinds of organizations. Now with both in mind, the year that I was President was the year when we had finally gotten into sort of a crisis situation with the non.availability of patients, uh, physicians will to see Medicaid patients and one of our thrusts during that year was to try to gain for the Medicaid popu ation access to the provider community. Of course, during all that time, we debated and fussed about tort reform and fortunately, the medical association leadership prior to my year in the presidency had done a very good job with us in South Carolina. Dr. Brown: I think one of t e main t ings was getting physicians to take care of the Medicaid patients and I know that you wrote about that, mentioned in you PresidentÕs Pages . . . Dr. Simmons: Right. 
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Dr. Brown: in the state medical journals . And, uh, how did you think that worked out, and looking back from right now, looking back to that time , do you see that as a change , uh, better change . Dr . Simmons : Well , what we specifically asked physicians to do was to have twenty-five active families in their practice or be willing to take care of two new families once every other month . And we enjoyed a lot of success . The Health and Human Services Finance Commission indicated to us in reporting on the success of that that they had been able to get their Medicaid beneficiaries placed with physicians in numbers not ever before achieved . Did that solve all the Medicaid problems? Bo, it did not solve all of them. And, as you know, today, the Governor and the Finance Commissioner are working on some sort of plan to have the entire Medicaid population in some sort of managed care delivery model . Dr . Brown: Right . Dr. Simmons: I think that'll be helpful. Unfortunately, in the past we ' ve had a situation where the Medicaid beneficiaries were thought of as socially different from our other patients and were unwilling to see them, no matter what the compensation was . I hope that arrows back on them . I costs too much not o take care of folks Dr. Brown: That surprises me . 
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. not to take care of folks and have them 
Dr . Simmons: 
use the emergency room or have them use the hospital when they've got an in-stage disease instead of having access at a time that they have a preventable disease . They costs are just phenomenal for not taking care of those folks . 
Dr. Brown: It is still it is. There's several other  things . Your thing about access and costs of care , of  course , every President of the association has had to deal  with the rising costs of care and I know that your health  
Care 2000 , you talk about that in you Past President ' s  Pages a fair amount . How did that work out?  
Dr . Simmons : Well , actually, I had (unintelligible) . I had the opportunity to participate in that with Dr . Brake, the President of the SCMA right before me, so it' s 
difficult to say what impact Health Care 2000 has had. The effort was worthwhile, though, because it brought many of the stakeholders to the table and by stakeholders, uh...
You know we are not the only ones interested in health 
care.  Dr. Brown: Right. Right.  
Dr. Simmons: Certainly, there ' s the legal community, the government, the employers, there are a lot of people who are interested in health care. The hospitals in our community and . . . In my opinion, solutions to the 
problem, uh, have always been . . . resulted in better 
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accomplishments when you get all of those people to the 
table. Dr. Brown: Uh-hm. Dr. Simmons: We are bit about to trust the hospital association to solve the problem. They are not about to trusts us. We and the hospital association together are not going to trust the insurance companies. Nobody's going to trust the government. But, yet, all of those entities have a say and I think getting them all to the table is going to be important. And Health Care 2000 created the opportunity for us to do that. Dr. Brown: It did and I think you mentioned the benefits of that operation on almost all of your President ' s Pages. Talking you talked about the change in health care and, uh, medical care that was coming. Now, I might ask you now, you think it's still coming do you? Dr. Simmons: Well, except then I thought...I think in one of my President's Pages, I made some comment about looking at the delivery model at the end of this decade and recognizing that you look at it from what we see today. Dr. Brown: Right. Dr. Simmons: Uh, the difference in the way I feel about that now and the way I felt four years ago, I think it 's going to be the end of the decade before we see that. I ' m not sure there ' s going to be a political answer to this problem, or a political solution. I think the payers are going to set the pace of reform today as much as the politicians are. Fortunately, the provider community is responding. There are groups being put together all over everywhere. Here in Charleston, up in the upstate, in order to participate in delivery through a managed car model and I think that does offer a lot of hope for two things. One, giving access to people who don ' t presently have access. Secondly, controlling costs by being sure that we are providing appropriate care. Always. 
Dr. Brown: Always. Yeah. But limiting some of the inappropriate
Dr. Simmons: 
care that we provide and that our patients demand from us sometimes. Dr. Brown: Oh, yeah. Well, I think access to care and good 
access to care that can make a tremendous difference sometimes. Dr. Simmons: Absolutely. Dr. Brown: Yeah, well, what else would you care to say about that subject. Uh, what were other things that came up and you handled during your Presidency. Dr. Simmons: Well, one thing that, uh . . . I don't think medical associations and medical societies have always been or always will be the best entity to deal with some of those issues. The medical association is a trade association. I don't say that as something that I've got to apologize for. We have been advocates for ourselves as 
much as we have been for our patients. But, uh, getting 
physicians to participate in other kinds of entities provider networks, physician-hospital organizations, those kinds of things uh, still give us a lot of worry today. They other that occurs to me is that we all think about us that if we cam just get this problem solved, we can relax for a while. And I don't think that that's true. You 
know, back in the early part of my participation in the South Carolina Medical Association, we thought that if we can just get the tort liability issue solved, every thing will be all right. Right now, just in our midst is a problem with some infectious disease situations with hepatitis and, uh, AIDS, that we didn't even think about the year I was Dr. Brown: (unintelligible) Dr. Simmons: ... got involved in the medical association. Fifteen short years ago those were not issues we have already heard. That there is a very real possibility within the next very few years that antibiotics that we currently use today have no effect in the organisms we are using it to treat. Uh, that we'll have a situation where there's resistance to most of the antibiotics that we have.  Well, how are we going to deal with that, particularly as the world population increases and pockets of population become very dense? I think we've got some medical, ethical issues that will make the Jack Kevorkian 

issue look pretty pale. I happen to think Dr. Kevorkian is a pretty brave person and it's time we come to grips with that, but the major medical issue that we have dealt with and accomplished something with is the enactment with some legal substance of the living wills or advanced medical directives. But now we've got some people that can do gene splicing and gene therapy and bioengineering and those sorts of thins. Those are ethical issues that transcend medicine, transcend the environment, the ecological concerns. The anthropologists are all upset about what might happen if we start setting the course of genetic progression instead of allowing the natural selection to do that. That 's a tough ethical issue for us to deal with. As we become able to transplant more things, we've got the black market trade going on the acquisition of those that we've got to deal with. Dr. Brown: Right. 
Dr. Simmons: There are challenges out there yet untold, 
think. Dr. Brown: I agree with that. I've seen a lot of changes and there's always challenges and there are many, many of them on the horizon now. Dr. Simmons: I guess the biggest challenge I see for physicians and individual physicians is to determine to his own satisfaction or her own satisfaction the autonomy we are willing to give up. You know, most of us are first 
born children. We are very independent. The medical 
school and residency experience makes us more independent. We go into practice and we enjoy success pretty quick in our practices. We are just as independent and autonomous as we can be, yet belonging to a network or organization that 's going to negotiate contracts on your behalf requires you to give up some of that autonomy. Uh, professionalism 
If you look up the definition of profession, a lot of words in that definition relate to independence and autonomy. How can we fin ways to maintain the best for our professionalism, and, at the same time, join together to gain some efficiencies and some quality in the system? Tough issue. Tough issue. Dr. Brown: It 's gotten to be a difficult, difficult area, but, it 's like it's got to be done. Dr. Simmons: I don't think there's any question but whether it has to be done and you know, four or five hundred years from now, the historians will look at this thing and be amused and curious about the scientific pinnacle we have arrived at there with the t hings that we are able to do, and yet we've done it with what's essentially a cottage industry. Dr. Brown: Uh-hm. Dr. Simmons: And now that we've got all these technological tools and medication and procedures and processes that we can do, the most difficult task may be to 
take that cottage industry and forge it into a system that 
does meet the needs of a population. Uh, and, I hop I live long enough to see how the historians treat us n our attempt to do t hat. Dr. Brown: I hope you will too. I 'd like to, but I don't want to, intend to live too many hundred more years. Dr. Simmons: Well, you know, in the fifteen years since I've been in the medical association, you know the average life span has gone up significantly. Dr. Brown: Right. It has. Well, that was going to be one of my questions for you. You mentioned Dr. Jack Kevorkian who is the, quote, assisted suicide doctor at the moment. Now, do you foresee any, any way of rationing medical care and determining, in a nut shell, who loves and who dies or when he lived and he dies, and how much are we going to spend on a life that has been lived and has ended except for a bunch of machineries. The living will, as we are talking about. Dr. Simmons: There has already been a lot of work done on that and I t hink we are on the threshold of being able to solve that problem for most people. I t turns out that one of Dr. Kevorkian's cases was a twenty-three year old with a demilenating (? -unintelligible) disorder. There was really no hope for any cure. A number of people have said that we spend ninety percent of our total lifetime health care expenditure in the last year of our life and that we 
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spend forty percent of our total lifetime health care expenditure in the last thirty days of our life. Dr. Brown: Right. Dr. Simmons: In a recent study done a couple of months ago in Florida, patients who were previously diagnosed with malignancies that have had a treatment failure and with the reoccurrence they are admitted to intensive care units, over half of the patients die in the Intensive Care Unity, three-fourths of them are dead in ninety days. For the hematologic tumors, the annualized cost of that care is forty-five thousand dollars. For solid tumors, the annualized cost of that care is ninety-nine thousand dollars and those patients are going to be dead in spite of that. And yet in South Carolina, fifty percent of our children who are two years of age are inadequately immunized. In our community of Spartanburg, we are at nine thousand pediatric visits by twenty-five percent of the women in Spartanburg who deliver babies that have five or fewer pre-natal visits and I think the problem is they use four hundred to four hundred sixty thousand dollars on a hematologic lesion that's already had a treatment failure and allocate those resources to the kids who are inadequately immunized. It that's what you mean my rationing, yes, I think we are going to have to ration care. To me, that means providing appropriate care where it's needed. 
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Dr. Brown: Right. Dr. Simmons: Appropriate care. Dr. Brown: Right. Dr. Simmons: Now the implication if that to provide intensive care for the treatment failure in cancer patients is inappropriate care and I guess that sounds harsh and cruel. In terms of the outcome of that care, you don't get good outcomes and so, uh... Dr. Brown: There, so that ' s (unintelligible) another subject which we could sit hear and discuss for another hour easily. A pediatric transplant that was done recently, what was it, a newborn, giving a newborn a new heart. These are all questions that have to be answered some way and some day. Dr. Simmons: Well, you know, what I think we have to ask ourselves, is the defective heart in a newborn a pediatric problem? A reproductive problem? A lifestyle problem? What really is the problem that causes that newborn to have a defective heart? Uh, we know some of the answers to those questions. Uh, there are lifestyle issues related to substance abuse and that sort of thing. Uh, fortunately, it ' s bee a while, but we both remember a time when prescribed medications that caused so e of those types of problems. Dr. Brown: Right. 
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Dr. Simmons: But there are other issues, I think, now that 
we are learning to map the human gene. You are al most going t o be able to predict who is going to have those. Well, do you manipulate the genes? Do you do genetic counseling to keep people with the recessive 
(unintelligible) from coming together? I just, I see that as a challenging situation. And yet, to do that on that newborn child is going to cost thousands and thousands of dollars. I those kinds of monies are avail able, but if we can allocate thousands of dollars to that and cannot find the money to provide prenatal care to all women, I think we are just going to be seeing more and more and more of those kinds of problems. Dr. Brown: There are a lot of problems. In other words, all of then weren't solved when you were President of the state association. Dr. Simmons: No, sir. Bit I never intended to be the last President of the medical association. If we had solved all the problems, the medical association could have folded up. Dr. Brown: That would be it. Anything else you'd like to say about your year as President? What have we not touched on? We are real interest in the schools, in education, in health education and such as that, working with the auxiliary, I believe. Dr. Simmons: Right. We worked hard on that. Another thing that has concerned me and perhaps, maybe we've gotten 
some relief, is who's going into medicine today? During 
the year that I was President, there were barely two qualified applicants for every position in the medical schools. Now Dr. Edwards told us yesterday morning, or early this morning, for one hundred and sixty-five places they had thirty-seven hundred applicants.  Dr. Brown: Three thousand, seven hundred applicants.  Dr. Simmons: I find that extremely delightful that we now  are back up to reasonable numbers in the applicant pool for the positions in medical school. Those of us like me and  you, we t end to get set in our ways and are inflexible and resistant to change and as new delivery modes come into place, if we are not training new physicians to come into the delivery system, to work in these new models, then I think, we are going to be in serious trouble.  Dr. Brown: Serious trouble.  Dr. Simmons: I really think, not just because we are going to be gone and they are going to be here, but younger physicians with some of their idealism, some of their fearlessness of new models, their willingness to accept new paradigms much quicker than we will provides a lot of hope.  
(unintelligible)  Dr. Brown: I feel the same way.  Dr. Simmons: I think that whatever we do with health care  reform, we've got to continue to maintain our productivity for younger and younger people to come into our profession.  
Dr. Brown: Well, do you think that there's anything that you might have done different or would like to have done different during your year as President, simply looking back on it after these few years? Dr. Simmons: I could give a selfish answer to that question. I, uh, as you can see from one of my President's Pages, the comment I made while ago about the health care delivery system looking different. Physicians Care Network that we are developing in this state now is one of those things that looks very different. I don't think we could have done that five years ago. But, in trying to look ten years ahead of time and seeing what kind of models are going to be out there, I really think we could have done it during my year. I've had the opportunity to be very much involved with that and I enjoy that sort of thing. Physicians are going to have to lead the way. We have let insurance companies, and hospitals, and governments, and lawyers dictate too many times. Dr. Brown: Yeah. Dr. Simmons: I think the physicians are going to have to lead the way and Physicians Care Network is one of those things that demonstrates leadership by physicians. I think the whole country is looking at what we are doing in South Carolina on that. Dr. Brown: Would you mention briefly what the Physicians Care Network is? 
Dr. Simmons: It's an organization sponsored by the medical association to get as many physicians as we can enrolled into an entity that can contract with the paying community to make sure we are delivering health care as efficiently as possible, and as appropriately as possible, and as economically as possible, and we will contract with payers. We are about to sign a contract with an organization to bring eighteen thousand members in to see if their next year's cost can't be controlled at the same time that their members get very high quality, very appropriate care. It doesn't mean they'll get everything. Dr. Brown: No. Dr. Simmons: It doesn't mean they'll stay in the hospital five days instead of three. Dr. Brown: Right. Dr. Simmons: There are ways to carve some monies our of the system that exists today and provide new services. That's one of the problems with the Hunt Plan. 
Dr. Brown: Uh-hm.  Dr. Simmons: There's not more money to do some of the  things that he want to do if you were talking about raising  
new money.  Dr. Brown: Right.  Dr. Simmons: if you control costs, that mean there's some money in the system today to meet some of the un-medicated.  
Dr. Brown: Well good. Are there any special physicians 
that you would like to mention who helped you tremendously when you were President or I know there's so many that you might not want to mention any of them. Dr. Simmons: Well, there are a large number and the opportunity that anybody has to work with physicians that have been on the board the fifteen years since I've been associated with he medical association is an opportunity that ' s one of the highlights of their life. There's one that has been a mentor and a source of encouragement, as source of stimulation, a source of support, a sounding board when things didn't go well, and that's Dr. Euta Colvin who's right up there in my community. 
Dr. Brown: Yeah. Dr. Simmons: But there's never been a time when Dr. Colvin was not interested in what I was doing, in how I was doing. He's been very, very helpful to me. I'm sure all the people that you have interviewed have named the same name of one person that I'm going to name; however, I'd be derelict in not doing that. This year celebrate the twentieth year that Bill Mahon has been with us at the South Carolina Medical Association. Bill is not a physicians, but itÕs fine with me to call him "Doc." Certainly in terms of diagnosing and prescribing a treatment for participating in a plan that treats some of the problems that the medical association has had to deal 
with, Bill has no peers. He's held in highest esteem around the country. He's held in highest esteem by anyone who's ever been President of the medical association or served on the board or any of the communities. Bill is one of those people that, uh, that is a reason . . . Bill is one of the factors that has made my life richer. I continue to enjoy his friendship. Bill and I are together a number of times each year at meeting. We sneak to go fishing once a year. He's as good for medicine as any person I know. Dr. Brown: Well, I'm delighted to hear you mention his name because he certainly should be a part of our medical history. Dr. Simmons: And, uh, I hope it's not just my brief comments, but many others and perhaps an extended effort similar to this one can include Bill prominently in the annals of the history of medicine in South Carolina. Dr. Brown: What are our major issues today, the major issues facing medicine. We've been over it, but if you'll give a brief summary. Dr. Simmons: The major issues facing medicine today. My answer to that is not going to be some new, as yet unheard of, insightful (unintelligible) where reforming the system is the major issue today. And that reform needs the heaviest participation that physicians have ever given to anything and it needs some soul-searching by physicians for 
a transition from a cottage industry to a system model. 
I've got to think still that that's going to be the biggest issue that we ... we've got. That's not going to be easy. There are other issues: the ethical issues related to genetic engineering, death with dignity, those sorts of things. And they are issues that are going to require pretty significant and intensified research. We look for new ways to deal with old diseases, new ways to deal with new diseases and continue to search for mechanisms with those physical and health problems that we have as yet not found the cure for. Some of the degenerative diseases, some of the malignant diseases still allude us as we look for a cure. A lot of research has to be done. I hope doesn't get p t on hold too much as we are attempting to do the reform. And then, finally, but not of little importance is our need to continue to educate and keep bright young people coming into the health care system. Dr. Brown: Well, our number of applicants, like you say, for the number of positions in medical school now for next year is, to me, a real good sign. Dr. Simmons: Absolutely. And let me say, when you say that you are not going to live too many hundred years, hope we don't How can I say this without it coming out wrong? There are those . . . You imply that you are already at an advanced age and an advanced point in your career, uh, if you look at the Earl Samms of the world, 
who's in his seventies now, the Lewis Thomases of the world, uh . . . If we abandon the wisdom of people like that, I think we are giving up one of the best resources that we have. In many ways, if reform takes place, we are going to have a system that takes care of every patient the way the Earl Samms of the world took care of every patient, regardless of that person's ... Dr. Brown: Right. Dr. Simmons: We also are going back to, I hope, a system where we stress the importance of caring as much as we stress the importance of curing. If we get all tangled up in our technologies and . . . We have a doctor who thinks that a heart gets up and goes to work every day the way patients get up and go to work very day and take their heart with them. So I hope that the wisdom of some of those people who are some and have been some of the leaders of medicine will continue to be a resource and help us keep the best that we had in medicine while we move into new models. And I appreciate people like you who have been one of those people. Dr. Brown: Thank you. I appreciate that. Uh, anything else that you can think of that you would like to mention for our history? Dr. Simmons: John Simmons is not a native Sandlapper. Grew up. I guess I'm a Georgia cracker, but I've been gone from over there for twenty-six years and the prospect 
of leaving Spartanburg is one that would not be very positive to me. I never occurs to me t o leave South Carolina and I do in so many ways feel adopted in friendship with the South Carolina community. To have had the opportunity to participate with the medical association in he leadership of the medical association and ultimately as president during one of its years is an experience that's been dear to me. And, you know, if the historians want to compliment the short red-headed guy even though he didn't grow up in this state, well, that will be fine. 
Dr. Brown:  Well, great. Thinking about that, I think I'll  
ask you one more question. Looking back on things, would  
you do it all over again?  
Dr. Simmons: Absolutely.  
Dr. Brown :  In a skinny minute.  
Dr. Simmons:  Absolutely.