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 1. Origins 3 2. The VA Research Program Before 1946 25 Part II, Beginnings of the modern program, 1946-1953 87 3. Postwar Progress: Modern VA research begins 89 4. Research Cooperation between NAS and VA 123 5. The Tuberculosis Treatment Trials 143 6. The Atomic Medicine Program and the Birth of Nuclear Medicine 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.