A new era in medical research and practice

The American

Journal JULY,

VOL. IX

of Medicine

1950

Editorial A New Era in Medical

Research

historians of the future will probably mark the year 1949 as the beginning of a new era in medical research and practice, citing as the precipitating document the report of Hench, Kendall, Slocumb and Polley’ on the effects of cortisone in the treatment of rheumatoid arthritis. The full significance of this event will not be apparent for many years to come, nor can we as yet evaluate the results definitively in terms of known principles. Nevertheless, we can already speculate on the broad effects in basic and clinical research. The so-called degenerative diseases today account for the major share of mortality and morbidity in industrially developed areas of the world. Obscure in origin and resistant to treatment, these diseases have challenged the best thought in research and medicine for several generations. Although there has been individual speculation as to inter-relationships, there had not been until this year convincing evidence to provide medical scientists with a clue to a common factor in the etiology of such diverse conditions as rheumatoid arthritis, glomerular nephritis status asthmaticus, and lymphatic leukemia. Recent studies have given the medical world evidence that the adrenal steroid, produces positive therapeutic cortisone, effects in diseases not previously known to be associated with hormonal imbalance.

and Practice

The direct result has been to provide a promising therapeutic approach through adrenocortical research. By the close of 1949 scientists in various parts of the United States had begun clinical testing of cortisone and pituitary adrenocorticotropic hormone in no less than fifty disease entities. As might have been expected the results in many cases were negative; in others, inconclusive, and in a few, dramatically encouraging. Studies also had been launched to determine the physiologic properties of both cortisone and ACTH. Work had begun on the formidable problems of producing the hormone in sufficient quantities, first to supply it for expanded scientific study of its clinical usefulness and eventually to satisfy the demands of physicians and their arthritic patients. As these technical problems are solved, other difficulties in the field of health economics undoubtedly will arise. The cost and distribution of cortisone and ACTH will present problems. These, too, must be solved if adequate research is to be done and if the substances are ultimately to be used widely for the benefit of mankind. The contribution of Hench, Kendall and their co-workers will, in fact, have its most powerful effects in fundamental research. Their work presents the medical scientists with a clue to systematic study of the relation of hormones to chronic disease. As scientists of the past epoch sought to find specific causes through bacteriology, so in the new era investigators may seek for a

DICAL

1 Pm. Staf Meet., Mayo Clin., 24: 181, 1949. I

2

Editorial

metabolic factor as a common denominator underlying many baffling diseases. Endocrinology, physiology and biochemistry probably will take the dominant position which bacteriology and its related disciplines have held in medical research for three-quarters of a century. The synthesis of newly discovered substances also is a possibility which promises a new era in chemotherapy, following its recent triumphs in the protozoa1 and bacterial diseases. Certainly, the isolation and synthesis of cortisone and the demonstration of its therapeutic effects point the way to a great expansion of research upon the steroid hormones. Intensive study of steroid metabolism may uncover basic mechanisms that account for the difference between health and disease. A common factor in the metfor example, may be abolic process, responsible for maintaining normal functions in various organs not previously believed to be related, or some one series of chemical reactions may be found to be essential for maintaining many substances normally present in the body. Much fundamental study must be done before such conclusions can be reached. In any event, the achievements of hormonal research in 1949 open many new fields for intensive investigation. Study of the patterns of urinary steroid excretion and isolation of new substances secreted by the endocrine glands are only two lines of investigation suggested by recent developments. New methods of testing for biochemical deficiencies also are needed. Be-

cause the new leads are promising, more scientists will be attracted to the basic study of disease and to the search for a common cause, as contrasted with the former emphasis upon specific etiology and localized diseases. Research and scientific medicine have been moving slowly toward a new theoretic and clinical synthesis. With the advance of biochemistry and biophysics there have been vast improvements in the methods, measurements and instruments available to the medical investigator. Without these tools the closer integration of the disciplines, which brought about the accomplishments of 1949, could not have been achieved. In the meantime, however, scientists in general and the public have placed major emphasis upon the search for specific causes or cures of specific diseases. Until now it has been difficult to convince the supporters of medical research that basic study could yield far-reaching results, not only in a single disease such as rheumatoid arthritis, but in a variety of conditions which affect a large proportion of the world’s population. One of the most significant results of the introduction of cortisone assuredly will be increased support of basic research, as the indispensable foundation for progress in both the physical and mental diseases of mankind. LEONARD

A. SCHEELE, M.D.,

Surgeon General United States Public Health Service, Federal Security Ageny

AMERICAN

JOURNAL

OF

MEDICINE