A Historical Look at the Department of Veterans …

A Historical Look at the Department of Veterans Affairs Research and Development Program

Acknowledgement to Author

This book was compiled and written by Marguerite T. Hays, M.D., for the VA Office of Research & Development (ORD). ORD is grateful to the author, Dr. Hays, for her relentless work and dedication to make this publication possible. Her outstanding efforts as a physician, researcher, and writer have produced a lifetime of invaluable information about the inception of VA research. We are proud to present this book to the VA and non-VA community alike.

Copyright

Marguerite T. Hays, M.D. authored this book, at first in the course of her duties as a federal government employee, then as a contractor for the federal government. This book is hereby irrevocably dedicated to the public domain by the Department of Veterans Affairs and Marguerite T. Hays, M.D. This dedication is intended to be an overt act of relinquishment in perpetuity of all present and future rights under copyright law, whether vested or contingent. It is understood that relinquishment of all rights includes the relinquishment of all rights to enforce (by lawsuit or otherwise) those copyrights in this book. It is recognized that, once placed in the public domain, its works may be freely reproduced, distributed, transmitted, used, modified, built upon, or otherwise exploited by anyone for any purpose, commercial or non-commercial, and in any way, including by methods that have not yet been invented or conceived.

Table of Contents

Table of Contents

i

Preface

iii

Introduction

iv

Commonly Used Acronyms

vi

Part I, Ancestral roots, 1925-1945 1. Origins 2. The VA Research Program Before 1946

Part II, Beginnings of the modern program, 1946-1953 3. Postwar Progress: Modern VA research begins 4. Research Cooperation between NAS and VA 5. The Tuberculosis Treatment Trials 6. The Atomic Medicine Program and

the Birth of Nuclear Medicine

1

3

25

87

89

123

143

167

Part III, The VA Research Program Takes Off, 1954-1959

181

7. The Intramural Research Program, 1954-1959

183

8. VA Psychopharmacology Trials lead revolution in

Psychiatric Practice

209

9. The Hypertension Studies

227

10. Smoking and Lung Cancer

241

11. Radioimmunoassay ? a revolutionary advance in medicine 249

Part IV, The roaring sixties, 1960-1967

263

12. The Intramural Research Program, 1960-1967

265

13. The Cooperative Studies Program of the 1960s

299

14. The Research Career Development Program

317

Part V, Maturation, 1968-1981

327

15. Transition years, 1968-1973

329

16. VA Medical Research comes of age, 1974-1980

349

17. Meeting funding challenges: "Project Scissors"

379

18. The Cooperative Studies Program of the 1970's

391

19. Beginnings of Health Services Research and Development

in VA

405

20. VA Research in Rehabilitation

419

Epilogue

437

i

Appendices

439

Appendix I. Middleton Awards 1960-1995

I

Appendix II. Review groups

a. Committee on Hospitalization (White Committee)

VII

b. The Medical Council

XI

c. Committee on Veterans Medical Problems (1946-59)

XXIX

d. Central Advisory Committee on Radioisotopes

XXXI

e. Advisory Committee on Research, 1955-1960

XXXIII

f. Advisory Committee on Research, 1961-1968

XXXV

g. Research Program Committees active in FY 1964

XXXVII

h. Program Evaluation Committees, 1967-8

XLI

i. Cooperative Studies Evaluation Committee (CSEC)

XLV

j. Career Development Committee

XLIX

k. Institutional Research Program Evaluation Committees

LIII

l. Merit Review Boards, members appointed 1972-1980

LV

m. NAS committees evaluating prosthetic and sensory aids rsch XCIII

Appendix III. Medical Bulletins, 1946-1955

XCV

Appendix IV. Contracts evaluated by National Academy of Sciences

a. VA research contracts, 1947-1953

XCIX

b. VA Prosthetics and Sensory Aids contracts begun before 1950 CIX

Appendix V. Radioisotope programs

a. 1962 radioisotope units

CXI

b. Clinical uses of radioisotopes in VA hospitals, 1962

CXIII

Appendix VI. Special laboratories active during the 1950s and 60s

CXV

Appendix VII. Publications by VACO Research Service,

1950s and 1960s

CXVII

Appendix VIII. Research Career Scientists appointed before 1980

CXIX

Appendix IX. Alcoholism scholars, 1979-1983

CXXXI

Appendix X. Persons interviewed

CXXXV

Appendix XI. Organization of research within the VA

CXLI

Index

583

ii

Preface

In 1988, I was having lunch with Ralph Peterson, M.D., a prominent endocrinologist who was then the Director of the VA's Medical Research Service, a position I had held during the 1970s. As I told him about events from before he joined the VA, he was struck how little information had been written about earlier times in the VA research program. A few days later, he called to ask me to give a talk on the history of the VA research program.

Challenged by this opportunity, I began to interview some of the earlier participants in the program and found their stories fascinating. I explored the VA Central Office library in Washington, DC and discovered another side to the dark memories of the early Veterans' Bureau, evidence that the early veterans' doctors strived for excellence and looked for ways to improve their care of sick veterans.

As opportunities arose, I interviewed people associated with the VA research program. I collected the materials they gave me, some of it lovingly stored in their garages for years. Many in the VA, in Central Office and in the medical centers, participated in this effort ? there is no way I can thank them individually here, but I am grateful to each of them.

This work continued to be encouraged and supported by those who came after Ralph Peterson in leading the VA research program. In particular, I should mention Martin Albert, M.D., Ph.D., who, as Director, Medical Research Service, 1992-1996, was especially helpful. John Feussner, M.D., Chief Research and Development Officer, 1996-2002, supported this effort with his usual enthusiasm. He contracted with me to bring the work to fruition after I retired from my VA clinical position. Philip Lavori, Ph.D., Chief of the Palo Alto VA Cooperative Studies Program Coordinating Center, provided space and facilities for the project and has been of great personal support.

Anne Knight, Barbara Klein and Robert Putnam, editors, have improved the quality of the text in many ways, and Dorothy Shoemaker has provided important bibliographic assistance. Many colleagues were kind enough to review individual chapters. Joel Braslow, M.D., Ph.D., made important contributions to the chapter describing VA psychopharmacology trials. I owe particular thanks to the late Clark Sawin, M.D., for a careful and helpful review of the entire manuscript. Of course, the responsibility for the final product rests with me.

Marguerite T. Hays, M.D. Palo Alto, CA

iii

Introduction

Tracing the path of progress in VA medical research does not involve drawing a straight line. It requires, rather, sketching a jagged streak forward--the many high points marked by significant findings and the development of medical advances, the few downticks indicating an occasional disappointment--the trend always upward toward promise and hope for improved health care and a better quality of life.

The focus of this history is the innovation produced in this remarkable program; a few examples of what VA research has accomplished include the:

First decisive trials of effective treatments for tuberculosis; Demonstration of the lifesaving value of treating hypertension; Development of the concept of CT scanning; Discovery and development of radioimmunoassay, facilitating measurements of previously

impossible precision; Cooperative studies proving the efficacy of psychoactive drugs in stabilizing psychiatric

disorders; Demonstration of the relationship between smoking and lung cancer, leading to initial

warnings in the Report of the Surgeon General; and Development of a practical, implantable cardiac pacemaker.

Although this research program produced more than enough accomplishments to completely occupy its text, this history also attempts to depict the pioneers who carved that path of progress. In large measure, the history of VA medical research is their story.

In several instances, personal comments are included from the men and women--investigators, managers and administrators--who brought VA research alive. Some of their accounts are truly fascinating, sounding more like adventure stories than what might appear in scientific journals. For example, Ludwig Gross, M.D., a war refugee who escaped Poland just ahead of the Nazis, came to America and became a U.S. Army doctor. Even while in the Army, he carried out research, keeping his special mice in cages in the trunk of his car. In 1944, the Army assigned him to the clinical staff of the Bronx (NY) VA Hospital, and he remained there for a long productive career. At first, he did his research in an old bathroom after hours, breeding his own mice for his experiments. His work led to the proof of the viral cause of mammalian leukemia.

And, when Dr. William Oldendorf was working as a VA neurologist at the Los Angeles VA Hospital, he was looking for a way to avoid suffering by his patients who needed brain imaging, rather than doing painful pneumoencephalography. He reasoned that composite pictures of the brain area from x-ray images taken at many angles would serve the purpose. Using simple equipment--including an old model-railroad track--he personally built the prototype for CT scanning--which has since benefited millions of patients worldwide.

Some few of these researchers achieved a degree of celebrity, gaining eminence in their field, and perhaps even becoming perceived in the general medical community as having extraordinary genius

iv

and exceptional vision. There are many more stories of researchers whose careers reflect little of celebrity, but much of imagination, competence, and intense excitement about their work. The personal stories reveal another important characteristic of these investigators: the patience with which they approached the mundane tasks along the way to achieving results. Records clearly indicate that "payoffs" in scientific knowledge often emerged only after extensive, long-term follow-through study. The keys to success were determination to proceed, to persist, to prevail. As one VA research leader said, "there were more `wear-throughs' than breakthroughs." A word about the scope of this book is in order: the recording of history is a never-ending process, but preparation for publication must have an organized, terminal point. In covering the more distant history of VA medical research--extending back to the era of the Veterans' Bureau in the late 1920s--through the year 1980, it was the intention of this work to record and, in some sense, safeguard that period of history most at risk of being lost to posterity. Unlike this text, VA research did not conclude in 1980. Together with Health Services Research and Development, and Rehabilitation Research and Development, the VA Medical Research Service continues to evolve and to engage in vitally important studies. Investigation of primary clinical issues continued, and new special studies were launched in areas of special interest to the veteran patient, such as post-traumatic stress disorder, "Gulf War Syndrome," prostate cancer and AIDS. Between records developed since 1980, the personal knowledge of the current VA staff, and the recollections of those who have departed in recent years, the story of this continued history exists in rich detail. It can only be hoped that this next chapter of the story of VA research will be recorded and told. That, however, is a matter for future exploration. For now, the story of the beginnings of VA medical research, and its truly remarkable accomplishments over the span of its first half-century, should be adventure enough.

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