August 17, 2022


Health for a better future

Sadler brothers revolutionized health care from organ donation to emergency medicine

Twin brothers Blair and Alfred Sadler authored the nation’s organ donation system, helped create a new class of health care workers and pioneered a more effective system of emergency medicine — all by their mid-30s.

It’s an astounding amount of work to cram into a 10-year span, and the details are now available in “(P)LUCK,” the pair’s new book, which published Tuesday.

As the punctuation in the title cleverly illustrates, successful pluck often contains a little luck. That was certainly the case for the Blair brothers in the late 1960s and early 1970s when wins were a function of moxie and opportunity, of speaking up when a mixture of chance and determination put them in rooms with powerful people.

“It’s starting where you are, starting somewhere, and having a voracious sense of learning and seeing where it takes you,” Alfred Sadler said. “But it’s also about asking for help, knocking on doors, making cold calls and saying, ‘we have an idea, could we talk to you about it?’”

“We discovered that being sincere and prepared and believable made a difference that people generally wanted to pay back,” Blair Sadler added.

Stacks of the new book (P)LUCK by twin brothers Blair Sadler Alfred Sadler at Warwick's Bookstore San Diego.

Stacks of the new book (P)LUCK by twin brothers Blair Sadler Alfred Sadler at Warwick’s Bookstore San Diego, CA on Tuesday, June 28, 2022.

(Adriana Heldiz/The San Diego Union-Tribune)

Part memoir and part instruction manual for social policy change, (P)LUCK published less than a week after the U.S. Supreme Court overturned Roe v. Wade, which legalized abortion.

Now living in separate California cities, Blair in San Diego and Alfred in Monterey, the pair has spent the past four and a half decades pursuing their professional specialties. A physician, Alfred is well known as a leader in medicine in Northern California while Blair’s local contacts run deep due to his helming Rady Children’s Hospital in San Diego from 1980 through 2006. He is now on the faculty at UC San Diego’s Rady School of Management and, like his twin brother, is heavily involved in social causes one year past his 80th birthday.

The pair’s most sweeping moments came when they were working together as what they called a medical-legal team in the late 1960s and early 1970s, operating on the East Coast, largely in Pennsylvania, Washington D.C. and Princeton, New Jersey.

Their pluckiest moments in those particular places range from sitting in the office waiting room of a key official at the National Institutes of Health who the brothers convinced to let them work as an unheard of doctor-lawyer team, to a chance encounter, and subsequent intellectual relationship, with Chief Justice Earl Warren after finding the courage to speak to the legendary jurist on a D.C. squash court.

Those quick moments of serendipity mix with long stretches of relentless work, with the pair reading legal and medical canon side by side, then pursuing the sources of those musty papers and reports in the flesh.

The approach paid off first with organ donation. After jointly doing their research, the pair asked to author the nation’s Uniform Anatomical Gift Act which was adopted by all 50 states from 1968 through 1967. That initial system endures today, though it was recently updated and modernized to make organ allocation more equitable.

They again found themselves helping to change laws in the late 1960s, this time advocating for and convincing state legislatures to add a single sentence to their medical practice acts, allowing doctors to delegate their most common duties to a new type of worker called a physician’s assistant. It took about three years to get those updates added in most states, and more years, working with Yale University and many others, to help create a curriculum and testing infrastructure that made today’s widespread use of PAs commonplace.

Revolution in emergency medicine was less about changing the law than about pushing for more science-based practices on the front lines. At the time, ambulances in most places were little more than station wagons driven by workers with little medical training. In a world still decades away from cellphones, calling an ambulance meant finding a pay phone, dropping a dime, and searching through the yellow pages for an ambulance company. There were usually many listed, each covering a specific territory.

Back then, accidental injury was the leading cause of death for people younger than 38. Many died on the way to hospitals, which generally didn’t know ambulances were inbound because radios were not routinely used to call ahead.

Already working with Yale on the physician assistant program, the Sadler brothers found themselves pioneering a more coordinated and better trained emergency medical system in Connecticut. The program managed to drive down death rates from accidents by using more modern communication methods, including a single unified telephone number to report emergencies and get ambulances rolling quickly. Training, and creation of an emergency medical technician designation, was also a big part of the initiative, as were proper supplies and equipment in better-designed vehicles.

The initiative quickly grew when the pair were hired by the newly minted Robert Wood Johnson Foundation, which was looking to spend its massive endowment revenue on innovative programs capable of changing health care nationwide. Through individual grants to cities across America, emergency programs gradually improved their work, gradually adopting and promoting 911 as the single simple set of digits that quickly brings help no matter where a person wanders from Atlantic to Pacific.

It is surely a lot to get done in a decade, especially for two guys fresh out of legal and medical school with little actual work experience in their fields.

Of course, all that action happened nearly 50 years ago. With the civil rights movement, Watergate and the Vietnam War all in play, there are obvious parallels to the unrest experienced over the past three years. But it’s also clear that there are fundamental differences.

Back then, communication was not nearly so instant, and the populace tended to see facts as absolute, rather than negotiable.

Nonetheless, the Sadler brothers say they can see how their experiences bringing about change so many decades ago can apply today.

The first point they make is about focus. Digital communication brings a level of distraction that would have been unimaginable in the 1960s and 1970s, and both men say that making change happen requires a ruthless ability to keep one’s attention on the main objective.

“I think you need to be strategic about what you focus on, but also how you say it,” Blair Sadler said. “Sometimes it’s as simple as geography, moving to a particular neighborhood, a particular problem in a neighborhood, a particular message that is tailored to a particular population group and leveraging that.”

The Roe v. Wade decision is the latest national flashpoint in health care policy.

The decision that came down on June 24 was the result of focused efforts, with those who wanted Roe overturned focusing intently for decades, eventually getting judges appointed who would interpret the law as they thought it should be understood.

If protests in the streets are any indication, there are many who are motivated to enshrine the right to abortion in federal law, and the Blair brothers say they see that as a possibility, but only with an ocean of tenacity and an understanding that big changes start in small actions.

“Pluck would say, how can I help five women in the next month? What can I do?” Alfred Sadler said.

“Pebbles in the pond have a ripple effect,” Blair Sadler added. “I would challenge people and say, ‘What pebble do you want to put in what pond?

“How do you have a ripple effect on one kid, one family, one woman?”