THE CURIOUS CASE OF DR. KNOWLES

A CONSTANT cross that leaders must bear is deciding whether to fight, compromise or yield on a given issue. For Richard Nixon, who received only a minority of the popular vote in November and who faces an opposition majority on Capitol Hill, the burden is especially heavy. His own party is divided on some questions. His attention is dominated by the twin crises of the war in Viet Nam and inflation at home. His determination not to pressure legislators has resulted in a lack of clear communication with Congress even on routine matters. Out of what some of his own men regard as an excessive desire to avoid party and factional conflict, the President frequently seems to end up practicing the politics of zigzag.

Last week, as the G.O.P. adopted a new, stolid-looking elephant silhouette as a party symbol to convey strength, Nixon again allowed himself to be put into a posture of vacillation and weakness. The issue, in isolation, was hardly a major one --the appointment of an Assistant Secretary for Health and Scientific Affairs in the Department of Health, Education and Welfare. But the job had been vacant since the new Administration took office, though HEW Secretary Robert Finch had selected Dr. John Knowles in January. After a final week of embarrassing indecision, the Administration yielded to the concerted pressure of organized medicine and a handful of conservative Congressmen. Knowles was dumped and Finch humiliated.

Logical Choice. Shortly after Finch was appointed Secretary of HEW, he dutifully checked with the American Medical Association about whom it would prefer for the Assistant Secretary's job. The association proposed Dr. Clarke Wescoe, outgoing chancellor of the University of Kansas. When Finch called Wescoe, he found that he was unavailable. Having done the A.M.A.'s bidding --and miffed that the A.M.A. had not checked to see whether its candidate was willing--Finch contacted Knowles.

Knowles' superb credentials made him a logical choice. A graduate of Harvard College and Washington University Medical School (cum laude), Knowles is a forward-looking doctor-administrator who became general director of Massachusetts General Hospital seven years ago at age 36. His reputation in the public health field is excellent. He has written four books--one of them considered a classic in pulmonary physiology--and teaches at Harvard Medical School.

Knowles is also an outspoken critic of some present medical practices, and it is this quality that led to his rejection. At times he has criticized doctors' fees as excessive, and his concern for the poor has led him to suggest the need for all-inclusive health insurance. He preaches preventive medicine.

The A.M.A., whose staunchly conservative leadership opposes what it considers Knowles' too-liberal medical philosophy, immediately presented three more candidates and backed its suggestions with political muscle. Last year the American Medical Political Action Committee contributed more than $2,600,000 to political candidates, most of them Republicans. Richard Nixon's campaign was one beneficiary. Illinois Republican Everett Dirksen, whose 1968 re-election campaign reportedly received $150,000, became the visible leader of the dump-Knowles drive.

Nobody Else. As the months passed and the White House withheld the nomination from the Senate, Finch made it clear that he admired his candidate's plan to shake up American medicine so that it would better serve the poor. "I'm going to hang in there," he told Knowles. "I've got nobody else. I want you." "I'm not going to back down," Knowles said. "That's what they want me to do." One Senate head count showed that no more than 25 members opposed the nomination; another estimate put the opposition at ten. Finch assured Nixon that his appointee had the pluck and wit to ride out the storm. Meanwhile, the A.M.A.'s lobby operation was not idle. Hints began to circulate that Knowles proposed socialized medicine. Congressmen found that the A.M.A. was even propagandizing their family doctors.

Nixon promised a resolution of the matter by last week, saying that the decision would be Finch's. On Tuesday, the White House agreed to go ahead with the nomination. Knowles later told a friend: "It was all signed, sealed and delivered." Then, unexpectedly, the opposition gained fresh strength and pressed with renewed vigor for the White House to withdraw Knowles. House Republican Leader Gerald Ford, who had been quietly opposing the appointment, and Texas Republican Senator John Tower reminded Nixon of the A.M.A. campaign contributions. Other Republicans echoed Ford's opinion that "there must be somebody less controversial who is equally qualified." It was also pointed out that this was a bad time for the President to antagonize usual allies on Capitol Hill. In the Senate, a shift of a single vote could affect the outcome of the anti-ballistic-missile controversy. In the House, Nixon needs conservative votes for his tax package.

Another Secretary. At midweek, as word began to circulate that the nomination might be off again, Finch was at home relaxing when the phone rang. It was a reporter from the Los Angeles Times, who asked him what he would do if Knowles was rejected by Nixon. "He'd have to find another Secretary," Finch was quoted as saying. (He subsequently denied making the remark; still later he admitted having said it, but insisted that he had not really meant it as a serious statement.)

The next day, in the course of episodic conversations during a five-hour White House visit, Finch found himself losing the argument over Knowles. Finally the President gave his old friend and longtime political partner the word: Knowles was not worth the bitter fight. Finch issued a statement in which he loyally--if not convincingly--took "full responsibility for the delay of this appointment."

In Boston, Knowles reacted with unanticipated restraint--especially since he had threatened to write an expose about the affair if rejected, and had never minced words about his bitter feelings over the delay. After absolving Finch, he suggested that the political activities of the A.M.A.--of which he is a member --should be investigated. As for the President, the doctor said: "I think that President Nixon has maintained his political integrity, and if he has had to meet certain promises and debts made during his campaign, I think that it is only fair that he should."

In place of Knowles, Nixon named Dr. Roger O. Egeberg, 65, dean of the University of Southern California Medical School. The ebullient, articulate, 6-ft. 3-in. Egeberg described himself as a loyal Knowles admirer who had supported the Bostonian from the beginning. He is also a firm believer in the sanctity of the doctor-patient relationship, one of the A.M.A.'s most rigid dictums. Egeberg was not one of those suggested by the A.M.A. earlier, though the association praised his selection at week's end.

Pressure Points. If the Knowles debacle were an isolated case, it might be dismissed as one of those blunders from which no Administration is immune. Instead, it seems to be part of a developing pattern. Earlier this year the President publicly backed away from the nomination of Cornell University Chemist Franklin Long as director of the National Science Foundation because of Long's opposition to the ABM program. After protests by Long's fellow scientists, the offer was renewed. To the Administration's embarrassment, Long thereupon turned down the job.

On other issues as well, the President has sometimes seemed too ready to alter course at the first sign of pressure. The Administration has changed positions from con to pro on the need for legislation bearing on campus unrest. There has been uncertainty and lack of clear direction from the top on the question of federal guidelines for enforcing school desegregation. The Treasury's tax-reform proposals were brought out only with reluctance after it appeared that the House of Representatives would force the Administration's hand. An accelerated food-distribution program for the poor emerged only after liberals attacked the Administration's earlier, less ambitious approach.

Each of these decisions, and others taken under varying degrees of duress, can be argued on its individual merits. Any President is sometimes justified in exchanging quids for quos. If Nixon really felt, as Democratic Senator Walter Mondale charged, that sacrificing Knowles could obtain Southern and conservative support for the tax surcharge extension, which is vital to the nation's economic health, then the swap probably was worth it. Over an extended period, however, the dangers of this way of doing business could outweigh the advantages. The big risk of vacillation is the eventual dilution of the President's power to lead.

This file is automatically generated by a robot program, so reader's discretion is required.