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3 Changing Times
Pages 22-52

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From page 22...
... R Keith Cannan, soon to become the new chairman of the Division of Medical Sciences, Gilbert Beebe encountered a "neutral, show me" attitude.
From page 23...
... Papers on such subjects as psychoneurosis, schizophrenia, viral hepatitis, fractures of the carpal scaphoid, wounds of the hand, testicular tumors, rheumatic fever, sarcoidosis, and the aftereffects of million-volt x-ray all reflected research that had been done under the auspices of the Committee on Veterans Medical Problems. As for new projects, the National Heart Institute supported Michael DeBakey and Bernard Cohen's study of Buerger's disease, which consisted of a
From page 24...
... The U.S. Public Health Service funded Seymour Jablon' s study of tuberculosis in naval recruits.
From page 25...
... Moise, who had been the NRC's chief staff officer to the Committee on Veterans Medical Problems and the only medical doctor who worked with the committee, resigned to take a position with the Veterans Administration. With his departure, the committee faced a period of reorganization, since its primary purpose, to award research contracts, no longer occupied much of its time.68 Since the Follow-up Agency received most of its funds from agencies other than the VA, it no longer made as much sense for the Committee on Veterans Medical Problems to supervise it.
From page 26...
... Gilbert Beebe completed a collaborative report on "variations in psychological tolerance to ground combat." Cohen, Jablon, and Beebe were also in the process of reviewing manuscripts on the subjects of prisoners of war and tuberculosis in the Army. Even as they undertook these activities, they also explored the possibility of starting new projects such as creating a roster of twins, which later emerged as a central activity for the agency, and studying the natural history of hypertension.72 As the core staff did more, the Committee on Veterans Medical Problems did less.
From page 27...
... As early as 1953, Beebe had identified the veteran population as a valuable resource for twin studies. Together, Bernard Cohen and Seymour Jablon explored the feasibility of creating a roster of twins.
From page 28...
... In 1957, another important development occurred when Keith Cannan asked the agency to participate in the program of the Atomic Bomb Casualty Commission (ABCC; Box 5~. Seymour Jablon became the first staff member to go to
From page 30...
... Perhaps for this reason, the agency, for the very first time, had no formal proposal before the Committee on Veterans Medical Problems when it met in December 1957.78 Reflecting at the end of 1957, Beebe noted that study findings often defied expectations. He pointed to the study of psychoneurosis that had been done by Norman Brill, using a sample of 1,500 Army and Navy veterans.
From page 31...
... When Bernard Cohen got sick, it stopped his work on monographs related to Hodgkin's disease and Buerger's disease. Michael DeBakey, Cohen's collaborator on the second study, was overwhelmed with other work and unable to attend to the Medical Follow-up Agency's projects.82 Then, once Beebe returned to Washington, Jablon left for Japan, a pattern that would be repeated in the years ahead as staff members shuttled back and forth.
From page 32...
... The fourth study emphasized the agency's statistical expertise and involved an examination of the effectiveness of direct ultraviolet irradiation during surgery in preventing postoperative wound infections. During the year, agency staff published seven articles or monographs in publications such as the Journal of Neurosurgery.86 DECLINE OF THE COMMITTEE ON VETERANS MEDICAL PROBLEMS The agency undertook all of this work without much guidance from the Committee on Veterans Medical Problems.
From page 33...
... During this period, Seymour Jablon published an essay on the characteristics of a clinical trial and was the second author of a piece on acute epidemic hemorrhagic fever. Gilbert Beebe's long report on the possible relation of lung cancer to mustard gas injury (see Box 6)
From page 34...
... 34 THE MEDICAL FOLLOW-UP AGENCY indebtedness to you over so many years and in such a diversity of problems," he wrote. Writing to William Stone, then chair of the committee, Cannan noted, "We plan to continue the program of medical follow-up studies and will need the active guidance of a group of medical investigators." He added, however, that he had not decided on the composition or the exact mission of such a group.
From page 35...
... First, the Veterans Administration had funded the Committee on Veterans Medical Problems and no similar means of support existed for a committee that would advise the Medical Follow-up Agency. As Cannan put it, the agency had to be supported on a "fluid basis," and the NRC was actively pursuing this possibility with the National Institutes of Health.
From page 36...
... At the same time, the agency received new computers for its work, a move that made its data processing easier and enabled it to work more effectively with the Veterans Administration.98 With more funds and better hardware in place, the agency and the NRC turned once again to the task of appointing an advisory committee. In construct
From page 37...
... Francis had the added benefit of already serving on the Advisory Committee for the Atomic Bomb Casualty Commission. Beebe also hoped that the NRC would appoint a small subcommittee to supervise the twin study, perhaps chaired by James Neel.99 On December 16, 1964, Cannan wrote Thomas Francis at the University of Michigan and asked him to accept the
From page 38...
... reflected "the increased evidence of potential for epidemiologic as well as other studies on the natural history of disease."~03 Charging the committee to "develop the scientific content of the program and to oversee the work of the Follow-up Agency and collaborating investigators," Cannan wrote to one committee member that he expected the committee "to be involved in a constant reassessment and reformulation of program in response to the progress of medical research generally."~04 The committee contained some carryovers from the former CVMP, including DeBakey, and included a rich mix of epidemiologists, public health professionals, and statisticians from academia and the public sector. Public health figures outnumbered clinicians.
From page 39...
... Dr. MacMahon described the committee's Seymour Jablon (seated)
From page 40...
... Other ongoing projects included studies of the epidemiology of coronary heart disease, the Hodgkin's disease project, and the study of occupational exposure to x-rays.~° THE TWIN AND PRISONER OF WAR STUDIES MATURE One of the most important ongoing projects in 1966 was the study of prisoners of war (POWs)
From page 41...
... In a 1967 letter from staff statistician M Dean Nefzger to Gilbert Beebe (in Japan on his rotation for the Atomic Bomb Casualty Commission)
From page 42...
... They co-authored a paper that announced the Twins Registry to the medical world and interested a large number of investigators.~4 Having anticipated this interest, Jablon and Neel brought the matter to CEVFUS in its March 1966 meeting. The committee agreed that the twins had to
From page 43...
... The committee considered the first three proposals to use the NASNRC Twins Registry in 1967. One, which became an ongoing study with followup into the 1980s, compared smoking patterns and other potential risk factors with the incidence of lung cancer and aimed to demonstrate the disparate roles that heredity and environmental factors played in these diseases.
From page 44...
... Despite these limitations, however, the MFUA twin cohort (see Box 9) became a key resource in epidemiologic and heritability studies for several decades.~7 From the beginning, CEVFUS members, especially James Neel, expressed concern that the Twin Registry would attract researchers with poorly designed studies that ran the risk of violating the confidentiality of the twins or exhausting their patience (e.g., by following up too often or overusing a regional cohort that had been used recently for another study)
From page 46...
... In part, this attack reflected changing circumstances: Keith Cannan, who had been so instrumental in obtaining funding from the National Institutes of Health, no longer headed the agency's parent Division of Medical Sciences, and NIH staffers with short institutional memories no longer remembered just why they were funding the MFUA. Moreover, NIH faced its own internal budgetary problems.
From page 47...
... Following protests, including those of CEVFUS Chairman MacMahon that withdrawal of support would have "tragic" consequences for "the most important single epidemiologic research program in the United States at the present time," NIH agreed to re-fund the agency's programs (including the Twin Registry) , but at a lower level than requested.
From page 48...
... Agency staff presented a paper on regional differences in mortality from cerebrovascular diseases at a conference on stroke epidemiology and began planning for a third test of the completeness of VA information on the mortality of the general population of war veterans. Planning efforts started on a study of behavior patterns in coronary heart disease; an examination of bleeding as a potential
From page 49...
... Later, MFUA staff became convinced that these alerts were never distributed by the surgeons general to field officers. However, a series of meetings resulted between MFUA staff and armed forces and VA medical personnel to discuss follow-up studies coming from the war in Vietnam.~29 The group agreed to consider the need for follow-up studies on battle casualties from the Vietnam War as a test case for a more organized effort to identify priority problems and potential investigators.
From page 50...
... It approved new uses of the Twin Registry in 1971, including studies of risk factors in coronary heart disease, hereditary and environmental factors in dermatological conditions, and familial factors in early mortality. In addition, CEVFUS approved studies of amyotrophic lateral sclerosis and Hodgkin's disease.
From page 51...
... Beebe reminded Dunham of the history of the earlier Committee on Veterans Medical Problems, phased out by Dunham's predecessor when its "broader" mandate proved impossible for its role as advisory body for the MFUA. Lee, he clearly implied, wanted to return to the earlier VA-NRC relationship, but Beebe cautioned against changing "the mission of the present Committee without a pretty good discussion of the reasons therefor," and without verification that it would be in the best interests of the Medical Follow-up Agency's program as well as those of the VA.
From page 52...
... CEVFUS members expressed their unwillingness to take an "aggressive" stand in the development of the program, preferring instead to "encourage the kinds of studies that seem best suited to the opportunity presented by the military-veteran experience." So far removed was the committee from day-to-day operational thinking that its members declined to consider funding prospects for future proposals, on the somewhat dubious grounds that "worthwhile proposals would always find support." The committee effectively ceded to MFUA staff the basic program-setting responsibility that Dunham clearly had hoped the CEVFUS would seize. For his part, Lee's plan to return to the old MFUA-VA relationship was also denied.


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