The Medical Follow-up Agency The First Fifty Years, 1946-1996 (1999) / Chapter Skim
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2 The Early Committee Years
2 The Early Committee Years
Pages 8-21
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From page 8... ...
Gilbert Beebe and John Ransmeir, M.D., became, in effect, the first Medical Follow-up Agency staff. Beebe handled matters related to statistics; Ransmeir supplied medical advice.
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From page 9... ...
A greater incidence of rheumatic fever among those in military service would suggest the importance of environment, rather than heredity. Control groups were formed by using adjacent serial numbers to choose from men with non-rheumatic fever hospital diagnoses in the same year or men who took out National Service Life Insurance, depending on the needs of the particular study.
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From page 10... ...
The contemplated study would involve the medical records of up to 9,000 people. These records would have to be culled from the 18 million Army records housed in a federal records center in St.
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From page 11... ...
Placing heavy emphasis on medical follow-up, he thought that the committee should concern itself primarily with the "salvage of medical information from our experience in the war and overall guidance and advice in the medical research program." Committee member Francis Braceland admitted that this aspect of the committee's work had developed slowly and should be "more actively pursued." DeBakey agreed but noted that funding was problematic. Because VA rules allowed contracts to be let for only a year at a time, an investigator had no assurance of continuing support.
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From page 12... ...
Its work included the statistical evaluation of all projects submitted by the committee, doing detailed statistical planning on clinical follow-up and mass statistical studies, assisting investigators in devising and testing record forms and schedules, drawing samples for studies, and providing investigators with data from service medical and personnel records. In little more than a year, the staff had done statistical planning for 16 follow-up studies.
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From page 13... ...
One could, for example, compare survival rates for different diseases over time.33 For this reason, the committee endorsed a program of mass statistical studies, hoping that certain diseases could be followed routinely for mortality, morbidity, and rates of hospitalization.34 By the end of the 1940s, the Committee on Veterans Medical Problems and the Follow-up Agency had acquired a new degree of sophistication. The committee rarely accepted an application for a study unless its staff had explored the study's administrative and statistical feasibility.
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From page 14... ...
Despite these financial issues, the work of the Committee on Veterans Medical Problems had already generated 59 published papers related to the various studies.36 As the first round of studies neared completion attention turned toward the next steps. Neither Gilbert Beebe nor any of his staff had envisioned such a large program.
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From page 15... ...
The committee hoped it would have the chance to examine each manuscript "for statistical review" before publication.37 Among the projects that the Committee on Veterans Medical Problems considered during this period was one devoted to capturing the long-term outcomes of people who had sustained trench foot, immersion foot, or frostbite in World War II. To facilitate this project, Beebe obtained rosters from the Veterans Administration and the Army.
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From page 16... ...
As DeBakey noted, the finding that there were no long-term consequences of infectious hepatitis once a patient recovered from the disease would affect the determination of disability pensions for both wars. DeBakey admitted that the work was "costly and time-consuming" but noted that "the preliminary reports of some of the studies already provide knowledge that should permit great savings in the operational activities of the Veterans Administration."43 The review of follow-up activities that took place at the beginning of the Korean War enabled the Committee on Veterans Medical Problems and the Follow-up Agency to gain a comprehensive view of the work being undertaken.
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From page 17... ...
A large study of 2,700 men with peripheral nerve injuries (see summary of study in Box 1) , conducted at five university hospitals, reinforced the necessity for specialized necrologic treatment of such injuries, including early diagnosis, prompt evacuation, and the use of special neurophysiological techniques as an adjunct to surgery.
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From page 18... ...
Between 1952 and 1955, the agency faced a painful transition from total dependence on the Veterans Administration to more diverse sources of financial support. This period coincided with expansion of the VA' s own intramural activities, which decreased its reliance on external contracts, and with the arrival of the first Republican administration in Washington since 1932.
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From page 19... ...
Bernard Cohen continued his work on the studies in which he made use of existing medical records to illuminate larger epidemiological and policy concerns. His pilot study, begun in 1948 and designated R-1 or record study one, led to a detailed draft final report in 1951 (draft because it had to be put aside in the crush of other work)
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From page 20... ...
, designated R-4, which was to focus a great deal of attention on the agency, involved examining an environmental situation rather than a disease entity, for which the record approach was better suited than the clinical approach. The study itself focused on the mortality expe
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From page 21... ...
Excited by this finding, the staff believed that record follow-up projects deserved a more important place in the committee program than they had received. As Bernard Cohen put it, "the medical records of the armed forces and the Veterans Administration provide unparalleled materials and opportunities for follow-up studies."52 Donald Mainland, a professor of medical statistics at New York University, produced a more sober evaluation of the Follow-up Agency in a report for the NRC that appeared in March 1953.
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