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Biomedicine in the Twentieth Century: Practices, Policies, and Politics

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Biomedicine in the Twentieth Century: Practices, Policies, and Politics Biomedicine in the Twentieth Century: Practices, Policies, and Politics Caroline Hannaway EDITOR 2008 Amsterdam • Berlin • Oxford • Tokyo • Washington, D.C. iv ©2008, Caroline Hannaway All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without prior written permission from the publisher. ISBN 978-1-58603-832-8 Library of Congress Control Number: 2008920118 Publisher IOS Press Nieuwe Hemweg 6B 1013 BG Amsterdam The Netherlands fax: +31 20 620 3419 e-mail: [email protected] Distributor in the UK and Ireland Gazelle Books Services Ltd. White Cross Mills Hightown Lancaster LA1 4XS United Kingdom fax: +44 1524 63232 e-mail: [email protected] Distributor in the USA and Canada IOS Press, Inc. 4502 Rachael Manor Drive Fairfax, VA 22032 USA fax: +1 703 323 3668 e-mail: [email protected] LEGAL NOTICE The publisher is not responsible for the use which might be made of the following information. PRINTED IN THE NETHERLANDS N I H I NTRAMURAL P R O GRAM 27 Disease Categories and Scientific Disciplines: Reorganizing the NIH Intramural Program, 1945-1960 Buhm Soon Park In the summer of 1986, the United States Congress designated fiscal year 1987 as the “National Institutes of Health Centennial Year” in order to observe the agency’s anniversary with appropriate ceremonies and activities. President Ronald Reagan accordingly proclaimed: “The National Institutes of Health, which began as a one-room laboratory at the Marine Hospital on Staten Island in 1887, has become the world’s foremost biomedical research center. Its investigators are at the forefront of discoveries that contribute to better health for mankind.”1 In addition to investigations conducted in the National Institutes of Health’s (NIH) own “intramural” laboratories, Reagan also noted the importance of the agency’s “extramural” program in supporting the activities of non- federal scientists in universities, medical schools, and other research institutions. Indeed, no other federal agency supported more academic research and development (R&D) than the NIH, which had grown since its beginnings into a vast research complex encompassing twelve insti- tutes and several divisions and centers with a hefty budget of $6 billion.2 The expansion of the NIH in its first hundred years is most visible in the agency’s changing organizational chart. The Hygienic Laboratory, as the one-room laboratory on Staten Island, New York, came to be called, was relocated to the nation’s capital in 1891. Subsequently, it moved to a new, separate building in 1904 and had four divisions established along the lines of scientific disciplines (the Divisions of Pathology and Bacteriology, Chemistry, Pharmacology, and Zoology)–the internal 28 PARK structure reflecting the high status of science at the turn of the century within the public health and medical research communities.3 There was no change to this four-division structure for more than three decades, but it was during this critical period that an expanded role for the federal government in medical research was much considered and debated. As Victoria A. Harden aptly shows, the 1930 renaming of the Hygienic Laboratory as the National Institute of Health was an outcome of the prolonged legislative debates over this issue.4 By the time the NIH moved from downtown Washington, D.C. to the spacious Bethesda campus in 1939, its position as the research arm of the Public Health Service (PHS) was considerably strengthened with the addition of two new units– the Divisions of Industrial Hygiene and Public Health Methods.5 A further tweaking during World War II made the NIH an organization of eight components: one institute (the National Cancer Institute, which officially became part of the NIH in 1944); two divisions (Infectious Diseases and Physiology); and five laboratories (Biologics Control, Industrial Hygiene Research, Pathology, Chemistry, and Zoology).6 The postwar years, however, witnessed the reshuffling of these components and the creation of new institutes along the lines of disease categories, such as heart disease, mental health, arthritis, and allergy. Hence, it has been the National Institutes of Health since 1948. The origins of the “disease category” structure of the NIH and the ramifications of this for the postwar development of the biomedical sciences have not been fully explored in the history of science or the history of medicine.7 In this paper I focus on the expansion of the NIH intramural program within the categorical framework, as I will be discussing the changing relationship between the NIH and the extra- mural community elsewhere. Each of the seven categorical institutes that constituted the NIH in the 1950s had a different experience in building its intramural program, depending on the existence of previous activities in that particular category within the NIH or the PHS and the level of congressional support for its growth. Unique as individual situations were, I show that there was a common goal among the categorical institutes at the NIH to establish a strong basic research program covering several scientific fields, even if their links to categorical missions might be neither direct nor transparent. It was each institute’s Associate Director in charge N I H I NTRAMURAL P R O GRAM 29 Figure 1. Changes in the organization of the NIH. By 1953, seven categorical institutes of the NIH were in operation: the National Cancer Institute, the National Heart Institute, the National Institute of Mental Health, the National Institute of Arthritis and Metabolic Diseases, the National Microbiological Institute (renamed in 1955 as the National Institute of Allergy and Infectious Diseases), the National Institute of Neurological Diseases and Blindness, and the National Institute of Dental Research. Source: National Institutes of Health, Data Book 1954, Office of NIH History. of research, or “Scientific Director,” who exerted a pivotal role in shaping its program. In the 1950s, the Scientific Directors emerged not only as a group that decided a variety of intramural affairs, such as hiring and pro- motion policies and the resources to share in inter-institute collaborations, but also as the chief interpreters of the relationship between categorical missions and scientific progress. Shaping the Cancer Program Not all institutes had to build their intramural programs from scratch in the post-World War II years. A good example is the National Cancer Institute (NCI), which had maintained a remarkable degree of continuity since its establishment in 1937. Carl Voegtlin, the NCI’s first director, or 30 PARK “Chief” as he was called at that time, was a pharmacologist-turned- cancer-researcher with a broad knowledge in the field. Voegtlin was in complete charge of the research activities of his intramural scientists, who were all assembled in one building after 1940, and yet he had no firm organizational pattern in mind. Instead, he preferred to see a series of multidisciplinary groups formed to tackle specific problems, with his senior scientists acting as temporary chairmen of the groups. Voegtlin placed great emphasis upon this flexible, team-oriented approach to cancer research where no predominant theories existed, but at the same time he had a subtle influence upon the direction of research by giving sugges- tions, not direct orders, backed up with the funds he could allocate. Several research lines to which Voegtlin gave high priority included the biochemical characterization of tumor tissue, carcinogenesis in tissue culture, nutritional factors in tumor origin and growth, and studies of gastric cancer. He also chaired scientific conferences, held once a month or at his request, at which new findings and research plans were discussed. Occasionally, prominent speakers were invited to give a talk at these events. In addition, Voegtlin made it a rule that the intramural staff send their papers to the Journal of the National Cancer Institute, a new publication managed by the NCI and edited by himself.8 Upon his retirement in 1943, Voegtlin was succeeded by Roscoe R. Spencer, who had built strong credentials as a microbe hunter, especially for his heroic contribution to the development of a successful vaccine against Rocky Mountain spotted fever.9 But Spencer possessed a short résumé as a cancer researcher. As one of his colleagues observed, “His interests in cancer were primarily at a philosophical level, with cancer as an example of species adaptation in a multicellular organism.”10 Devoid of towering authority in cancer research, Spencer was not an effective administrator, either. Under his editorship, for example, the institute’s journal began to atrophy from a diminishing number of contributions, partly because of the war, and partly because of Spencer’s failure to force his staff to follow the publication rules set by his predecessor. Nor did he display political acumen. Spencer’s 1946 testimony before the House Appropriations Subcommittee, which was mistakenly construed as the NCI’s hesitancy in taking up an immensely expanded budget, did not earn him much trust from the Public Health Service’s senior officers or from N I H I NTRAMURAL P R O GRAM 31 powerful cancer research advocates. The next year Spencer was replaced by Leonard A. Scheele. Scheele was a veteran PHS officer who had had experiences of serving as a quarantine officer, a state health officer, a special cancer fellow at the Memorial Hospital in New York, an officer-in-charge of the National Cancer Control Program, a chief of the Medical Division of Civilian Defense, and an assistant chief of the NCI before becoming its director in 1947. Scheele’s interests were not so much in cancer research per se as in cancer prevention and control. With his expertise more in administra- tion than in bench work, Scheele made an important contribution by formalizing the internal structure of the NCI into three branches: the research branch, with six sections of biology, biochemistry, biophysics, chemotherapy, endocrinology, and pathology at Bethesda, and a seventh section of a combined laboratory-clinic unit in San Francisco; the research grants branch; and the cancer control branch.
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