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National Institutes of Health—100 Years
AMERICAN JOURNAL FRANK
W.
NEWELL,
OF O P H T H A L M O L O G Y ® Publisher and Editor-in-Chief
Tribune Tower, Suite 1415, 435 North Michigan Ave., Chicago, Illinois 60611
EDITORIAL BOARD Thomas M. Aaberg, Milwaukee Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Jules Baum, Boston William M. Bourne, Rochester Ronald M. Burde, St. Louis Fred Ederer, Bethesda Frederick T. Fraunfelder, Portland Eugene Helveston, Indianapolis Frederick A. Jakobiec, New York Michael A. Kass, St. Louis Herbert E. Kaufman, New Orleans Kenneth R. Kenyon, Boston
Steven G. Kramer, San Francisco Irving H. Leopold, Irvine Robert Machemer, Durham A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Nancy M. Newman, San Francisco Don H. Nicholson, Miami Edward W. D. Norton, Miami Arnall Patz, Baltimore Deborah Pavan-Langston, Boston Thomas H. Pettit, Los Angeles Allen M. Putterman, Chicago
Dennis Robertson, Rochester Merlyn M. Rodrigues, Bethesda Stephen J. Ryan, Los Angeles Jerry A. Shields, Philadelphia M. Bruce Shields, Durham David Shoch, Chicago Ronald E. Smith, Los Angeles Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles H. Stanley Thompson, Iowa City E. Michael Van Buskirk, Portland Gunter K. von Noorden, Houston George O. Waring, Atlanta
Published monthly by the OPHTHALMIC PUBLISHING COMPANY Tribune Tower, Suite 1415, 435 North Michigan Avenue, Chicago, Illinois 60611 Directors Edward W. D. Norton Bruce E. Spivey Bradley R. Straatsma
A. Edward Maumenee, President David Shoch, Vice President Frank W. Newell, Secretary and Treasurer
EDITORIAL National Institutes of Health—100 Years Frank W. Newell In 1887, the Marine Hospital Service estab lished a one-room Laboratory of Hygiene in the attic of the Marine Hospital, Long Island, New York, to study yellow fever, cholera, and tuber culosis. There was one researcher, Dr. Joseph J. Kinyoun, and an annual budget of $300. From this modest beginning the National Institutes of Health developed, which this year celebrate a century of service. In 1891 this research laboratory, renamed the Hygienic Laboratory, moved to a Capitol Hill building in Washington, D.C. In 1902 Congress authorized the Surgeon General of the Marine Hospital Service to promulgate regulations that would assure the potency and purity of various biologies. These responsibilities were assigned to this laboratory until 1972 when they were transferred to the Food and Drug Administra
tion. In 1902 the Marine Hospital Service was renamed Marine Hospital and Public Health Service; the name was subsequently shortened to the Public Health Service in 1912. In 1930 Congress approved the change of the name of the Hygienic Laboratory to the Nation al Institute of Health. In 1938 construction began on three buildings in Bethesda, Mary land, on land contributed by Mr. and Mrs. Luke Wilson. Building 1, a red structure with white pillars that now serves as the offices of the director of the National Institutes of Health, was dedicated in 1940 by President Roosevelt. Today the National Institutes of Health occupy a campus of 306 acres with satellite centers in Research Triangle Park, North Carolina, Hamilton, Montana, and Sabana Seca, Puerto Rico. They have a staff of
706
Vol. 103, No. 5
14,799. They employ 3,183 physicians and sci entists and spend more than 6 billion dollars annually. War research on the atomic bomb, radar, the mass production of penicillin, and the develop ment of jet aircraft significantly affected medi cal research. Government leaders and scientists assumed that if enough effort was expended, if large enough laboratories were constructed, and if adequate funds were provided, almost any biologic or medical problem could be solved. When the war ended, some 250 healthrelated wartime research programs in progress at university medical schools and independent laboratories were transferred to the National Institutes of Health from the Office of Scientific Research and Development. This transfer added large extramural biomedical research programs to the ongoing research programs within the National Institutes of Health. Thus began the growth of the present Na tional Institutes of Health. A National Institute of Mental Health was authorized in 1946. The National Heart Institute and Dental Research Institute were authorized in 1948. The Institute of Neurologic Diseases and Blindness (now the Institute of Neurologic Diseases, Communica tive Disorders and Stroke), together with the Institute of Arthritis and Metabolic Diseases, were authorized in 1950. Construction began on the 500-bed Clinical Center on the campus in Bethesda and the first patient was admitted on July 6, 1953. The authorization of the National Institute of Neurologic Diseases and Blindness reflected a combination of public awareness, health agency support, and congressional approval. A large group of voluntary health agencies con cerned with neurologic disorders provided the initial impetus to form a National Institute of Neurology. Late in the drive by these various citizen groups to convince Congress of the need for and the rewards of an institute con cerned with neurologic disorders Mildred Weisenfeld and Silas Adelsheim, the founders of the National Council to Combat Blindness (Fight for Sight!), urged Congress to form a National Institute of Visual Disorders. The tes timony of blind individuals, pleading not for themselves, but for research into blinding dis ease was persuasive. To the dismay of those supporting neurologic research the two pro posed institutes were consolidated into the Na tional Institute of Neurologic Diseases and Blindness.
Editorial
707
The many organizations concerned with the welfare, education, rehabilitation, and services for the blind did not support the new Institute by informing Congress of the rewards of eye research. Indeed, some groups appeared main ly concerned that funds for eye research might divert funds from those available for service programs. The failure of eye groups to support publicly the Institute resulted in a minute allo cation of funds for eye research and training. The funds designated for eye research by the National Institute of Neurologic Diseases and Blindness remained at about 15% of the total appropriation. In 1965 the research funds allo cated to Communicative Disorders, largely otology, exceeded those available to ophthal mology. In 1960, Research to Prevent Blindness, Inc., was founded by Jules Stein and Robert McCormick. An initial task was to provide information to the congressional appropria tions committees concerning the need for ex panded research in ophthalmology. In 1965 Thomas Duane recommended to Congress that a definite percentage of the appropriation of the National Institute of Neurologic Diseases and Blindness be specifically designated for eye research and training. He stated, "I think you should know of the feeling that exists among an overwhelming number of leading investigators in eye research that the time has come to seek the establishment of a separate institute solely concerned with the problems of vision." At this time, too, the Association of University Profes sors of Ophthalmology was formed, which strongly supported an independent eye insti tute. In 1965 the Association and Research to Prevent Blindness consolidated the effort to seek an independent eye institute. Exceptionally helpful at this time was Repre sentative John R. Young of Texas, who had had cataract surgery performed by A. Edward Maumenee. Young was instrumental in arrang ing meetings with Dr. James A. Shannon, Di rector of the National Institutes of Health, who was strongly opposed to what he termed "dis ease of the month institutes." But he also stated in an informal meeting with Maumenee, Newell, and members of Congress, including Representative Young, that if Congress author ized an eye institute, it would be the best eye research institute in the world. On Nov. 1, 1967, the House Interstate and Foreign Commerce Committee met to consider House of Representatives Bill 12843 and related
708
AMERICAN JOURNAL OF OPHTHALMOLOGY
bills to establish a National Eye Institute. The testimony was led off by Ralph W. Ryan, then chairman of the Department of Ophthalmology at the University of West Virginia Medical School. He was followed by A. Edward Maumenee, Thomas D. Duane, Michael J. Hogan, Frank W. Newell, Herbert E. Kaufman, David G. Cogan, Bradley R. Straatsma, and Jules Stein. Their testimony (American Journal of Ophthalmology 64:1218, 1967) reflects well the state of ophthalmology that year as well as the dreams and hopes for a National Eye Insti tute. Jules Stein concluded the testimony of professionals concerning the National Eye In stitute. After the testimony of Jules Stein, John F. Nagle, blind and representing the National Federation of the Blind, was a surprise witness. He strongly supported the establishment of a National Eye Institute and the Committee re ported the bill favorably. All seemed lost in 1968 because nothing appeared to happen, but on the last day of the congressional session, both the House of Representatives and the Senate approved the bill by a voice vote and President Johnson signed the measure. This was only the beginning. An appropria tion had to be provided for the Eye Institute; a director, staff, and space had to be found. Fortunately for ophthalmic research, Carl Kupfer, then professor and chairman of the Depart ment of Ophthalmology at the University of Washington in Seattle, accepted the position of director. He started in 1970 with virtually noth ing: no staff, no facilities, no funds. He had a minute crowded office and depended upon the largess of other institutes for support. His de velopment of the research and training pro gram and the intramural program of the Na tional Eye Institute has been an outstanding model of managerial expertise. The Institute has been effectively served by the National Advisory Council, which has developed con crete and attainable goals. The National Institutes of Health have grown immensely. They now include the following
May, 1987
institutes: Cancer; Eye; Heart, Lung and Blood; Aging; Allergy and Infectious Disease; Arthri tis, Muscle, Skeletal and Skin Diseases; Child Health and Human Development; Dental Re search; Diabetes, Digestive and Kidney Diseas es; Environmental Health Sciences; General Medical Sciences; and Neurological and Com municative Disorders and Stroke. Additional ly, the Institutes include the National Library of Medicine; the Division of Research Re sources; the National Center for Nursing Re search; the John E. Fogarty International Cen ter; the Warren Grant Magnuson Clinical Center; Division of Research Grants; Division of Computer Research and Technology; and the Division of Research Services. The brief period since the National Eye Insti tute was founded has seen unprecedented advances in ophthalmology: vitrectomy, intra ocular lenses, laser photocoagulation, new medications for glaucoma and ocular inflamma tion, contact lenses, and clinical trials—a proud record. The researchers and staff of the Nation al Institutes of Health deserve our fullest sup port and commendation. Because they work either as civil servants or commissioned offi cers in the Public Health Service, their compen sation is strictly regulated. The scientists can devote themselves fully to research and from their ranks have come many of the outstanding scientists in the world. The future is even more promising— conquest of ocular complications of diabetes, understanding the immunology of uveitis, im proved management of retinal disorders, cata racts, glaucoma, and ocular tumors. A particular strength of the National Eye Institute, and other Institutes, has been their public demonstration of the effectiveness of basic research in combating disease. The inter action between the leadership of the Institute, their intramural research programs, and the scientific community at large has focused atten tion and expertise on a variety of disorders and has provided exceptionally rich rewards.
W.
NEWELL,
OF O P H T H A L M O L O G Y ® Publisher and Editor-in-Chief
Tribune Tower, Suite 1415, 435 North Michigan Ave., Chicago, Illinois 60611
EDITORIAL BOARD Thomas M. Aaberg, Milwaukee Mathea R. Allansmith, Boston Douglas R. Anderson, Miami Jules Baum, Boston William M. Bourne, Rochester Ronald M. Burde, St. Louis Fred Ederer, Bethesda Frederick T. Fraunfelder, Portland Eugene Helveston, Indianapolis Frederick A. Jakobiec, New York Michael A. Kass, St. Louis Herbert E. Kaufman, New Orleans Kenneth R. Kenyon, Boston
Steven G. Kramer, San Francisco Irving H. Leopold, Irvine Robert Machemer, Durham A. Edward Maumenee, Baltimore Irene H. Maumenee, Baltimore Nancy M. Newman, San Francisco Don H. Nicholson, Miami Edward W. D. Norton, Miami Arnall Patz, Baltimore Deborah Pavan-Langston, Boston Thomas H. Pettit, Los Angeles Allen M. Putterman, Chicago
Dennis Robertson, Rochester Merlyn M. Rodrigues, Bethesda Stephen J. Ryan, Los Angeles Jerry A. Shields, Philadelphia M. Bruce Shields, Durham David Shoch, Chicago Ronald E. Smith, Los Angeles Bruce E. Spivey, San Francisco Bradley R. Straatsma, Los Angeles H. Stanley Thompson, Iowa City E. Michael Van Buskirk, Portland Gunter K. von Noorden, Houston George O. Waring, Atlanta
Published monthly by the OPHTHALMIC PUBLISHING COMPANY Tribune Tower, Suite 1415, 435 North Michigan Avenue, Chicago, Illinois 60611 Directors Edward W. D. Norton Bruce E. Spivey Bradley R. Straatsma
A. Edward Maumenee, President David Shoch, Vice President Frank W. Newell, Secretary and Treasurer
EDITORIAL National Institutes of Health—100 Years Frank W. Newell In 1887, the Marine Hospital Service estab lished a one-room Laboratory of Hygiene in the attic of the Marine Hospital, Long Island, New York, to study yellow fever, cholera, and tuber culosis. There was one researcher, Dr. Joseph J. Kinyoun, and an annual budget of $300. From this modest beginning the National Institutes of Health developed, which this year celebrate a century of service. In 1891 this research laboratory, renamed the Hygienic Laboratory, moved to a Capitol Hill building in Washington, D.C. In 1902 Congress authorized the Surgeon General of the Marine Hospital Service to promulgate regulations that would assure the potency and purity of various biologies. These responsibilities were assigned to this laboratory until 1972 when they were transferred to the Food and Drug Administra
tion. In 1902 the Marine Hospital Service was renamed Marine Hospital and Public Health Service; the name was subsequently shortened to the Public Health Service in 1912. In 1930 Congress approved the change of the name of the Hygienic Laboratory to the Nation al Institute of Health. In 1938 construction began on three buildings in Bethesda, Mary land, on land contributed by Mr. and Mrs. Luke Wilson. Building 1, a red structure with white pillars that now serves as the offices of the director of the National Institutes of Health, was dedicated in 1940 by President Roosevelt. Today the National Institutes of Health occupy a campus of 306 acres with satellite centers in Research Triangle Park, North Carolina, Hamilton, Montana, and Sabana Seca, Puerto Rico. They have a staff of
706
Vol. 103, No. 5
14,799. They employ 3,183 physicians and sci entists and spend more than 6 billion dollars annually. War research on the atomic bomb, radar, the mass production of penicillin, and the develop ment of jet aircraft significantly affected medi cal research. Government leaders and scientists assumed that if enough effort was expended, if large enough laboratories were constructed, and if adequate funds were provided, almost any biologic or medical problem could be solved. When the war ended, some 250 healthrelated wartime research programs in progress at university medical schools and independent laboratories were transferred to the National Institutes of Health from the Office of Scientific Research and Development. This transfer added large extramural biomedical research programs to the ongoing research programs within the National Institutes of Health. Thus began the growth of the present Na tional Institutes of Health. A National Institute of Mental Health was authorized in 1946. The National Heart Institute and Dental Research Institute were authorized in 1948. The Institute of Neurologic Diseases and Blindness (now the Institute of Neurologic Diseases, Communica tive Disorders and Stroke), together with the Institute of Arthritis and Metabolic Diseases, were authorized in 1950. Construction began on the 500-bed Clinical Center on the campus in Bethesda and the first patient was admitted on July 6, 1953. The authorization of the National Institute of Neurologic Diseases and Blindness reflected a combination of public awareness, health agency support, and congressional approval. A large group of voluntary health agencies con cerned with neurologic disorders provided the initial impetus to form a National Institute of Neurology. Late in the drive by these various citizen groups to convince Congress of the need for and the rewards of an institute con cerned with neurologic disorders Mildred Weisenfeld and Silas Adelsheim, the founders of the National Council to Combat Blindness (Fight for Sight!), urged Congress to form a National Institute of Visual Disorders. The tes timony of blind individuals, pleading not for themselves, but for research into blinding dis ease was persuasive. To the dismay of those supporting neurologic research the two pro posed institutes were consolidated into the Na tional Institute of Neurologic Diseases and Blindness.
Editorial
707
The many organizations concerned with the welfare, education, rehabilitation, and services for the blind did not support the new Institute by informing Congress of the rewards of eye research. Indeed, some groups appeared main ly concerned that funds for eye research might divert funds from those available for service programs. The failure of eye groups to support publicly the Institute resulted in a minute allo cation of funds for eye research and training. The funds designated for eye research by the National Institute of Neurologic Diseases and Blindness remained at about 15% of the total appropriation. In 1965 the research funds allo cated to Communicative Disorders, largely otology, exceeded those available to ophthal mology. In 1960, Research to Prevent Blindness, Inc., was founded by Jules Stein and Robert McCormick. An initial task was to provide information to the congressional appropria tions committees concerning the need for ex panded research in ophthalmology. In 1965 Thomas Duane recommended to Congress that a definite percentage of the appropriation of the National Institute of Neurologic Diseases and Blindness be specifically designated for eye research and training. He stated, "I think you should know of the feeling that exists among an overwhelming number of leading investigators in eye research that the time has come to seek the establishment of a separate institute solely concerned with the problems of vision." At this time, too, the Association of University Profes sors of Ophthalmology was formed, which strongly supported an independent eye insti tute. In 1965 the Association and Research to Prevent Blindness consolidated the effort to seek an independent eye institute. Exceptionally helpful at this time was Repre sentative John R. Young of Texas, who had had cataract surgery performed by A. Edward Maumenee. Young was instrumental in arrang ing meetings with Dr. James A. Shannon, Di rector of the National Institutes of Health, who was strongly opposed to what he termed "dis ease of the month institutes." But he also stated in an informal meeting with Maumenee, Newell, and members of Congress, including Representative Young, that if Congress author ized an eye institute, it would be the best eye research institute in the world. On Nov. 1, 1967, the House Interstate and Foreign Commerce Committee met to consider House of Representatives Bill 12843 and related
708
AMERICAN JOURNAL OF OPHTHALMOLOGY
bills to establish a National Eye Institute. The testimony was led off by Ralph W. Ryan, then chairman of the Department of Ophthalmology at the University of West Virginia Medical School. He was followed by A. Edward Maumenee, Thomas D. Duane, Michael J. Hogan, Frank W. Newell, Herbert E. Kaufman, David G. Cogan, Bradley R. Straatsma, and Jules Stein. Their testimony (American Journal of Ophthalmology 64:1218, 1967) reflects well the state of ophthalmology that year as well as the dreams and hopes for a National Eye Insti tute. Jules Stein concluded the testimony of professionals concerning the National Eye In stitute. After the testimony of Jules Stein, John F. Nagle, blind and representing the National Federation of the Blind, was a surprise witness. He strongly supported the establishment of a National Eye Institute and the Committee re ported the bill favorably. All seemed lost in 1968 because nothing appeared to happen, but on the last day of the congressional session, both the House of Representatives and the Senate approved the bill by a voice vote and President Johnson signed the measure. This was only the beginning. An appropria tion had to be provided for the Eye Institute; a director, staff, and space had to be found. Fortunately for ophthalmic research, Carl Kupfer, then professor and chairman of the Depart ment of Ophthalmology at the University of Washington in Seattle, accepted the position of director. He started in 1970 with virtually noth ing: no staff, no facilities, no funds. He had a minute crowded office and depended upon the largess of other institutes for support. His de velopment of the research and training pro gram and the intramural program of the Na tional Eye Institute has been an outstanding model of managerial expertise. The Institute has been effectively served by the National Advisory Council, which has developed con crete and attainable goals. The National Institutes of Health have grown immensely. They now include the following
May, 1987
institutes: Cancer; Eye; Heart, Lung and Blood; Aging; Allergy and Infectious Disease; Arthri tis, Muscle, Skeletal and Skin Diseases; Child Health and Human Development; Dental Re search; Diabetes, Digestive and Kidney Diseas es; Environmental Health Sciences; General Medical Sciences; and Neurological and Com municative Disorders and Stroke. Additional ly, the Institutes include the National Library of Medicine; the Division of Research Re sources; the National Center for Nursing Re search; the John E. Fogarty International Cen ter; the Warren Grant Magnuson Clinical Center; Division of Research Grants; Division of Computer Research and Technology; and the Division of Research Services. The brief period since the National Eye Insti tute was founded has seen unprecedented advances in ophthalmology: vitrectomy, intra ocular lenses, laser photocoagulation, new medications for glaucoma and ocular inflamma tion, contact lenses, and clinical trials—a proud record. The researchers and staff of the Nation al Institutes of Health deserve our fullest sup port and commendation. Because they work either as civil servants or commissioned offi cers in the Public Health Service, their compen sation is strictly regulated. The scientists can devote themselves fully to research and from their ranks have come many of the outstanding scientists in the world. The future is even more promising— conquest of ocular complications of diabetes, understanding the immunology of uveitis, im proved management of retinal disorders, cata racts, glaucoma, and ocular tumors. A particular strength of the National Eye Institute, and other Institutes, has been their public demonstration of the effectiveness of basic research in combating disease. The inter action between the leadership of the Institute, their intramural research programs, and the scientific community at large has focused atten tion and expertise on a variety of disorders and has provided exceptionally rich rewards.