Nation: 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.