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Dr. Ralph E. Knutti
Second Interview
Date: July 27, 1972
Interviewer: Dr. Wyndham D. Miles
Q: &nb= sp; = Dr. Knutti, would you like to take on from where you left off last t= ime?
Dr. Knutti: = I believe we left off in Southern California after I had been successful i= n getting two small research grants from NIH. I won't go into the det= ails of those, except to say that they were extremely helpful in getting te= chnical assistance and getting some materials and equipment that was needed= to pursue the two problems.
One of the two problems had to do with renal damage caused by sulfa drug= s and the effect of high-protein and low-protein diets in protecting agains= t the damage to kidneys. In effect, rather large doses of the sulfa d= rugs were given to rats, and it was possible to protect a very significant = percentage of the rats from renal injury by giving them high-protein diet, = whereas if they were on a low-protein diet or protein-free diet, the mortal= ity rate was 100%.
The other problem had to do with some work that had been started in Roch= ester relative to what we called the transfer of blood colloids. Animals th= at had been given gum acacia again showed marked changes in their circulati= ng plasma proteins, and circulating acacia by changes in the diets. There w= as a reciprocal relationship. That is, when an animal was put on a low-prot= ein diet, the plasma proteins in the blood would diminish, and plasma prote= in would increase. This protein was drawn from sores chiefly in the liver. = The rats, in this instance, having been given large doses of acacia, which = was stored in their livers. At that time they were receiving none of = the gum. This was ended up published in the Journal of Experiment= al Medicine in 1950 and '51, I believe. I wasn't quite certain o= f or perhaps paid no attention to NIH policies at that time. I didn't= give NIH credit for some of the work in the papers, although the bulk of t= he work that was published then was indeed done at Rochester. This wa= s a wind-up.
About that time, I also became further aware of the NIH in that I had a = very outstanding young man working in my department at Children's Hospital.= His name was Phillip Sturgeon. He's now Research Director of t= he Western Region for the Red Cross. He's on our present Hematology S= tudy Section of NIH and has had a very excellent career. I guess he w= as my first resident in pathology when I went to the Children's, and he had= to go in the Army, so he only spent a month or six weeks during one summer= . When he came back, he wanted to finish pediatric training, but he d= id want some training in pediatric pathology, so he alternated and ultimate= ly wound up full-time in the pathology department in charge of hematology r= esearch and also the routine hematological laboratories of the hospital.
This was at a time when the RH factor was becoming very popular, and he = adopted techniques for RH-ing parents and children. He also, I think,= was the first person to describe an antibody occurring in infants who had = a type of hemolytic anemia. This was published in Science so= mewhere in the late 1940s. At any rate, he showed great promise, and = I had no real money to pay him. He was working, actually, on a techni= cian's slot in our personnel set-up, and it became evident that he was goin= g to either have to either get more money from the hospital and/or the medi= cal school, or go into the practice of pediatrics, for which he was qualifi= ed. I realized, after having received grants from NIH myself, that it= might be possible to write his salary or a portion of his salary on a rese= arch grant, so I encouraged him to write out a research grant application o= n a problem which he wanted to work, and submit it to the NIH.
This started an interesting chain of events and indicates how easy it is= for people in the field who are not intimately connected with NIH policies= can be misled by the approach of NIH staff in their extramural activities.= After this application was submitted, it went to the Hematology Stud= y Section. At that time, Leonard Karel was the executive secretary of= the Hematology Study Section, and one day Sturgeon got a call from Bethesd= a, which was, of course, most unusual for us on the West Coast to get calls= from the East about our work or our interests. He was asked some que= stions about his proposal. In the ensuing discussion, Dr. Sturgeon go= t the idea that everything was fine, that he was going to receive the grant= , even though it hadn't yet been acted upon by the Study Section. Thi= s, of course, is one of the delusions that people in the medical schools us= ed to have, and I dare say still have. Even when someone who is admin= istering a program here talks to them about their problem, they got the ide= a that this fellow was back of them and he could make the decision as to wh= ether or not they were going to get the grant, which, of course, is not the= case.
A short time thereafter, they changed executive secretaries in the Hemat= ology Study Section, and Frank Yeager, who is now our associate director fo= r extramural programs in the Heart Institute, took over the situation. = ; As I remember it, Sturgeon got a call from Dr. Yeager, and he gained the = impression from this telephone conversation that the grant was in the bag, = so he gave up the idea of accepting an offer from a Hollywood pediatrician,= to go into practice with him, and decided to stay at the Children's Hospit= al, where he would receive a salary from the research grant.
A very short time thereafter, he got the letter that many people have re= ceived, saying that unfortunately, although his grant had been recommended = for approval by the National Advisory Council, that funds were not availabl= e to pay the grant. When he showed me this letter, I'm afraid I hit t= he ceiling, because I thought this was a real devious way of giving someone= the brush-off, and if they weren't going to give him the grant, why didn't= they tell him that they were not going to give him the grant instead of ap= proaching it in a left-handed manner? This, of course, is not the case. Thi= s is a true statement, as all of us who have been here over the years know,= that the councils can recommend grants for payment, but if we don't have t= he funds to pay them, we can't pay them, even though they may be high prior= ity pieces of research. It depends entirely on available funds.
At any rate, I got steamed up about this, and so I wrote my old friend F= loyd Daft, he being the only person I knew at NIH, a letter in longhand, in= which I told him that I didn't like that method of operation; if they were= n't going to give Sturgeon a grant, why didn't they just say that they were= n't going to give him a grant instead of trying to lead him on? As far as I= was concerned, the NIH could take their money and they knew what they coul= d do with it. I didn't expect the letter to go any further, but I got= a letter back from Dr. Daft, attempting to explain the situation. I = guess I probably thought he wasn't being quite honest about it.
At any rate, I had occasion to come East very shortly thereafter, and I = stopped off at the NIH. They really rolled out the red rug here. = ; Dr. Daft had circulated this letter to various individuals. At that= time, Ken Endicott had just taken on the scientific directorate of the Div= ision of Research Grants, and so Floyd introduced me to Ken, and Ken spent = about two hours going over with me in detail the way study sections act and= councils act and the budgetary situation, and did such a good job at this,= that I was convinced that this was a straightforward procedure, it was not= devious, and it was the only way they could handle things under the circum= stances. I was very greatly impressed by getting this information abo= ut NIH, and even at that time, I suggested to Dr. Daft that I might be inte= rested some day in coming to the NIH. I was thinking then in terms of= carrying on research and not of administration. At that time, also, = the clinical center was just being started in terms of the construction, an= d I saw plans for this, and thought this would be a nice place to have a la= b.
So I went back to California. I don't remember the timing on this.= You'd have to look at old papers. But not very long thereafter= , several months perhaps, I got a letter from Dr. Daft, indicating that a n= ew institute had been formed. Yes, I remember when it was. It was in = the fall of 1950, because the omnibus bill was passed by Congress, I believ= e, in September or October 1950, and this included the Arthritis Institute = and NIAID, which was then the microbiology institute, neurology institute, = and perhaps one other. At any rate, Floyd indicated that this new ins= titute was being formed, that they needed administrative staff and particul= arly they needed someone to head up the extramural programs. In this = letter, he briefs out what an extramural program job would be like. T= his referred me back to my discussion with Endicott, who had done such a go= od job of explaining the whole operation.
Although I wasn't interested at that time, it sowed the seed, and the mo= re I got thinking about it as time went on, the more I thought I might poss= ibly be interested in doing something like this. I was getting mixed = up more and more into administration at the Children's. I'd taken on = the job of Chairman of the Research Committee. More funds were being = made available for research there. There was construction of a new wi= ng being contemplated, the laboratories were being renovated again, and I f= ound that I was spending practically no time at the university and a good s= hare of my time at the Children's, immersed in committee work of one kind o= r another.
So the time came when I wrote back to Floyd and asked him more details a= bout this. By that time, they had appointed a director of the new ins= titute, and that was Dr. Russell Wilder, who had retired from the Mayo Clin= ic as head of their Department of Internal Medicine. Dr. Wilder was 6= 5. He was distinguished for his interest in metabolism and nutrition and al= so his career as a successful practitioner of internal medicine, head of th= at department at the Mayo.
So I came to Bethesda and discussed this with Dr. Wilder and Dr. Daft, w= ent home and discussed it with the family, decided I would make the break.&= nbsp; This was a little unusual for someone to leave California after nine = years. The common saying is that when you go to California, after you= 've been there for a year or two, you're stuck and never come back East.&nb= sp; I thought that I could probably be more productive, and there was more = opportunity here in a new operation that was just starting, with no particu= lar tradition in terms, at least, of extramural grant support than there wa= s staying at home taking care of the store in Los Angeles.
I, of course, wasn't aware of the various personnel policies at the gove= rnment or in the NIH. Dr. Wilder and Dr. Daft recommended that I come= into the commissioned corps, the Public Health Service, and explained some= differences between the setup in the commissioned corps and civil service.= At that time, the commissioned corps seemed to be the more attractiv= e route to follow. Among other things, the retirement was non-contrib= utory, as there were the privileges=E2=80=94at least they looked big then= =E2=80=94in terms of actually implementing them, the purchasing of grocerie= s at commissaries and other things at PXs. They're not as glamorous a= s they seem, nor are they as helpful today as they were, I'm sure, during t= he war. This was very shortly after the war was over. Then ther= e was distinct savings that could be made. Over the years here, it ha= sn't been particularly effective in reducing one's overall expenses. Some o= f this is due to the time it takes to get to one of the good commissaries a= nd the nuisance, particularly, when one and one's wife are both working.&nb= sp; At any rate, I decided to come into the commissioned corps. Of co= urse, no commitment could be made by the Arthritis Institute until I was ac= tually appointed in the Corps. I had one hurdle that loomed pretty large fo= r a while, and that was my history of tuberculosis, because the physical st= andards are very high in the Public Health Service. When I went to th= e Los Angeles Outpatient Department of the PHS, I had quite a discussion wi= th the lady who was in charge of X-ray there. Fortunately, I had all = of the chest X-rays which I had taken at Trudeau and the ones that I had ta= ken at the Children's as a follow-up from the time I left Trudeau. Th= is, plus a letter from Dr. Karshner, who was in charge of radiology at the = best tuberculosis sanatorium in Southern California and also in charge of r= adiology at Children's Hospital, convinced the Public Health Service that m= y tuberculosis was healed and under control, so I did pass the physical exa= mination.
One other of the interesting features about making a move like this is t= hat because of the delay in getting one's appointment and the fact that one= owns real estate 2,400 miles away, one is hesitant about putting one's rea= l estate up for sale before the written word finally comes through. I took = that chance because I did trust Drs. Wilder and Daft.
Finally, about three or four weeks before I was supposed to start here, = we were able to sell the house, and about that time, I got information that= I had been commissioned, and orders to come to Bethesda and report. = I was sworn in on July 2nd, and I didn't report until later in July because= we drove back across the country.
In June, preceding before I had a commission, however, the Arthritis Ins= titute brought me back to the second meeting of the Arthritis and Metabolic= Diseases' National Advisory Council, and I was very greatly impressed by t= he way things were handled at that Council meeting. Dr. Wilder was in= England at that time, and Dr. Henry Sebrell, who was the Director of NIH, = chaired the meeting. Dr. Scheele, who was then Surgeon General, showe= d up and discussed the legislative problems of the time, very much like the= y were done many years later, although of more recent years, the Surgeon Ge= neral appears quite infrequently at Council meetings. But it used to = be the custom for the Surgeon General to attend and start to chair every Co= uncil meeting. Both Scheele and Burney did this very religiously. Ver= y rarely did they ever miss any of the Council meetings with which I was co= nnected. I might add for the record that Dr. Terry has not attended a= meeting of the Heart Council since I've been Director of the Heart Institu= te. I'm sure that much of this is due to pressure of his own job, whi= ch is much greater than the pressures that the Surgeon Generals used to be = under. At least it looks that way at this time.
We moved to Bethesda, and I started to work in the latter part of July 1= 951. At that time, the Arthritis Institute had received or was in the= process of receiving its first appropriation, and in this was one million,= three hundred and some thousand dollars for research grants=E2=80=941,340,= 000, I believe.
When I arrived here, I was a little disappointed to find out that my off= ice would not only not be in the clinical center, but also would not be nea= r the Director of the Institute, but in a ramshackle building which was kno= wn as T6, which was recently torn down to give way to Building 31 and the p= arking area. My first office was on the northwest corner and the firs= t floor of Building T6, facing the row of maple trees. It consisted o= f two rooms. A Mrs. Bernice Storrer had already been assigned to the = extramural programs as sort of a grants assistant and "girl Friday." = I had no secretary, and Mrs. Storrer performed these functions for a = while until I was able to get the first secretary.
One of the first things that happened when I came here was the delineati= on of the programs which the Arthritis and Metabolic Diseases Institute wou= ld attempt to pursue. About this time, Ernest Allen, who was Chief of= the Division of Research Grants, and Ken Endicott, who was Scientific Dire= ctor, were beginning to get together their thoughts about the formation of = a "bible of referral," which was to serve as a guideline as to which types = of scientific disciplines and studies should be assigned to the various ins= titutes, the institutes having increased in number quite recently. Th= ere were then obvious gray areas where certain projects might be assigned t= o one or another institute. I remember so distinctly that I had not b= een here more than a week or ten days, when Dr. Marshall Ellis, who was an = officer in the Division of Research Grants, whose function it was to assign= applications to study sections in institutes, came around to talk to me ab= out the assignment of two or three research grant applications to the Arthr= itis Institute. Well, I knew nothing about the guidelines or the rule= s. I couldn't be very helpful to him, but it impressed me by the fact= that we were going to have to carve out our own territory in this new inst= itute, and to set up and describe those functions which we would propose to= support.
I got together with Dr. Wilder on this. At this time, Dr. Daft had= about the same position as we now call the Director of Research in an inst= itute. I think he was called, actually, Assistant Director for Resear= ch. So my communication with Dr. Daft had nothing to do with my job. = I was working under Dr. Wilder, as was he, and it was not until later when = he became Director of the Institute that we were thrown closely together in= the total adventure. Dr. Wilder was interested in his own hobbies, n= amely, starting some intramural research in the clinical center, and he gav= e me carte blanche to proceed with outlining the scientific areas which the= new institute would support from the extramural standpoint. In doing= this, I tried to define metabolism in the very broadest sense, both from t= he standpoint of basic research and also from the standpoint of clinical in= vestigation. As a result, we were able to take on a large number of c= linical activities that had been neglected areas, not only the rheumatism f= ield, but in the general area of clinical endocrinology and metabolism. Dia= betes was one of the first diseases to which we addressed ourselves. = Then later on, we recognized the poor condition of gastroenterology researc= h in the United States, the metabolic aspects of hematology, and others whi= ch are well known in the current guidelines of the Arthritis and Metabolic = Diseases Institute.
So the current "bible of referral," which has been updated a few times s= ince those days, in essence, very closely resembles the first guidelines th= at I got together and Dr. Wilder okayed at the beginning of the Institute.&= nbsp; There was no such thing in those days of having to go through a whole= chain of command below and above the Institute director to get things star= ted. It's not quite that way anymore.
About this time in the fall of 1951, it became apparent that I was going= to have to make closer liaison with medical schools in order to be able to= have a better insight into the research potentials and their interests.&nb= sp; So I started on a series of rather protracted trips over the country to= visit not only departments of internal medicine, but some grantees who alr= eady had grants from the Institute. I learned very early a lesson, th= at in this day and age of airplane travel, that it's better to take several= shorter trips than to try to combine everything into one long trip, making= one-night stands or one-day stands at various medical schools. This = can be a very tiring procedure. In fact, I frequently came back from = one of these trips completely exhausted from not only the time difference, = but from the sheer=E2=80=94well, I'll get off that line, but it's not easy = to take one-day stands and cover everything one wants to cover in a given m= edical school and see the people that you want to see. This was, of c= ourse, because of poor scheduling, because of inexperience, and we learned = from this. At that time, too, it was possible to attend all study section m= eetings, and for a while, I suppose the first year while I was at NIH, I at= tended every study section meeting and every National Advisory Council meet= ing, including those of the other institutes except when there were conflic= ting dates. Then one would make a choice as to which study section an= d which council to attend. I finally got a secretary. This was perhap= s within a month or two after I arrived. For a period of four or five= years, I was the only professional person in the extramural programs of th= e Arthritis Institute. I'd have to look over the budget build-up to s= ee to what extent we grew in that period of time, and it was somewhere from= around a million and a half to $7 million or $8 million during that period= . It was slow growth compared to the more recent advances.
We had quite a time after the decision had been made to start a trainees= hip program in breaking this loose. Finally, however, after a year or two= =E2=80=94and again, I would have to refer to the budget sheets to check thi= s=E2=80=94we received an appropriation of $50,000 to start a traineeship pr= ogram. In the interim, I had been studying traineeship programs all a= round the existing and other institutes, and when we received our appropria= tion, I tried to sit down and write the regulations for the Arthritis and M= etabolic Diseases traineeship program to include what I thought were the go= od features of the other institutes=E2=80=99 programs and eliminate what I = thought were the undesirable features.
It's an interesting commentary to note that one person wrote out the reg= ulations and within 20 minutes after submitting them to Dr. Van Slyke, who = was then the associate=E2=80=94I may be wrong on this. It may have be= en Dave Price to whom I submitted them. But whoever was sitting as as= sociate director of NIH at that time okayed the regulations for the trainee= ship program, and that was that. There was no further clearance neces= sary. Dr. Wilder had seen them and discussed them with me, but he was= , again, still interested in his own hobbies, and I was continuing to have = carte blanche as far as he was concerned. This was one of the delight= ful experiences that I had during the ten years I worked in that institute,= that I was fortunate in that my liaison with the director was such that we= had what I would say was a beautiful, easy-going relationship, and it was = never necessary for me to try to sell Floyd Daft something or for him to tr= y to sell me something, because we understood each other so very well indee= d. We never argued or fought about any particular programs or about a= ny particular issues, and I was extremely fortunate in that he did give me,= insofar as he could go under the guidelines under which he had to operate = and which I appreciated, which I have appreciated more since I've come into= the Heart Institute, we had complete rapport.
The time came when it became perfectly apparent that we were going to ne= ed more help in professional aspects of the extramural programs of the Arth= ritis Institute. I started interviewing people. I forget how ma= ny individuals I interviewed. This was somewhere in the 1955 or '56 p= eriod. I wasn't satisfied with the people that I had talked to. In th= e meantime, there was more and more pressure being put upon me to get someb= ody, not only from the increase in my own necessary activities, but from th= e fact that now we were running a fairly good-sized program and needed more= professional help. This was recognized by the Director of NIH, who w= as Dr. Sebrell, and it was suggested that there would be no reluctance on t= he part of Building One to okay more personnel for the extramural operation= .
Finally, a young man who at that time was doing some research in the mic= robiology institute got the word, and I think he got the word through Ed Ra= ll, who is now Deputy Associate Director for Extramural in the Arthritis In= stitute. Ed Rall at that time was the Executive Secretary of the Microbiolo= gy Study Section. Ed alerted me there was this young man who was work= ing with Bob Coatney in the malaria project, who was a pharmacologist who g= raduated from Yale. The time came when John Sherman came down to see me abo= ut the possibilities of coming to work in the Arthritis Institute's extramu= ral programs. I was duly impressed by the way Dr. Sherman handled him= self. I was further impressed by the depth with which he went into th= e whole situation and its possibilities, and I was even more impressed by h= is past record, not only his military record, but his record in New Haven a= nd at the NIH. So the happy day came when he signed on as an assistan= t in the extramural program, and his career since that time is well known.&= nbsp; You will, I'm sure, if you haven't already done so, have this on the = record from Dr. Sherman himself. That was the start of an escalation = of the staffing of the extramural programs which continued, and I assume is= now continuing up to the time I left the Arthritis Institute.
To go back for a moment in terms of programs that were developed in sequ= ence, the research grants program was the first, as I've indicated. T= he traineeship program was the second, and then the training grants program= came along a year or two after the traineeship programs were instituted. I= was called to Dr. Sebrell's office one day to discuss the extramural progr= ams with him. Dr. Sebrell took an active interest in everything that = was going on at the NIH. At that time it was small enough, 1 guess, f= or him to do this. On the other hand, he did not intrude in the operation, = but he would pass on suggestions from time to time. On this particula= r occasion, he suggested that it might be interesting to look into the reha= bilitation field. I remember so well he said, "There's gold in them t= har hills." Just about that time, Howard Rusk had given a talk at the Surge= on General's staff meeting which I attended, and I was greatly impressed by= Dr. Rusk's arithmetical approach to the rehabilitation problem. Also= in those days, I think almost everybody who wanted to attend could attend = the Surgeon General's staff meetings which were held, I believe, every two = weeks. At the present time, I don't know the guidelines, but I think = that Dr. Sessoms is the only person that attends the Surgeon General staff = meetings at NIH. There was a time later when it was limited to institute di= rectors, but because of the great increase in staff of the Public Health Se= rvice as a whole, I believe that it's limited to just the one representativ= e from the NIH. If it's not limited, only one person goes, usually.= p>
After hearing Howard Rusk and talking with Dr. Sebrell, I took a trip up= to New York and spent a morning with Dr. Rusk. He was very enthusias= tic about the possibility of the Arthritis Institute getting interested in = the field of rehabilitation. It was possible for us to do this at tha= t time because the internal NIH guidelines had not yet been set down that o= ur training programs were to be strictly oriented toward training for resea= rch. In the Omnibus Act and also in the Hart Act, it very specificall= y spelled out that traineeships are "for the training of young physicians i= n the diagnosis, care, and prevention of patients with arthritis and other = metabolic diseases or of heart disease and so forth," which gives one a bro= ad approach to the total categorical disease problem. Later on, a loc= al ruling precluded activities in these areas, with the exception of the Me= ntal Health Institute and certain activities of the Neurology Institute.&nb= sp; So sooner or later, the other institutes got out of the clinical traini= ng business. It's interesting to note that as of this moment, it look= s as though our supplementary appropriation for fiscal year 1966 will come = through with $3 million for the National Heart Institute for clinical train= ing. So this is picking up something that the Heart Institute has sup= ported years ago, along with other institutes.
To go back to Howard Rusk, it seemed to be reasonable to support certain= trainees in the field of rehabilitation if they were engaged in or spent a= t least a fraction of their time in rehabilitating arthritics. So I b= elieve all of the first group of trainees that were awarded with the $50,00= 0 that we had then in the first year of our traineeship program were in the= field of rehabilitation. We also explored the possibility of trainin= g ancillary personnel for rehabilitation centers.
I will tell this story as I saw it, and I am not sure of the facts, so i= t's pieced together with hearsay, discussions I had with various contempora= ries and other people, and the facts will have to be brought out by a more = accurate evaluation of the story. But it is how the Arthritis Institu= te got out of the rehabilitation business. At that time, Fred Stone w= as my counterpart in the Neurology Institute. Obviously and for good = reason, neurology was interested in rehabilitation. Also at that time= , Dr. Van Slyke was Director of the Heart Institute. The legend goes = that the Heart Institute had something like $300,000 that they were going t= o have left over that year and were exploring ways and means of "spending i= t wisely." At any rate, there had been some ground work laid for this, and = one afternoon I was invited to a meeting at Dr. Van Slyke=E2=80=99s home, w= hich is in the building here on the reservation that Dr. Mider now occupies= . At this meeting were Dr. Rusk, Dr. Van Slyke, Dr. Pierce Bailey, wh= o was Director of the Neurology Institute, I think Dr. Fred Stone was there= , and Dr. Sebrell. The plans were laid at that meeting, and this I kn= ow about, but I don't know the details that took place before the meeting, = to turn over the $300,000 that the Heart Institute had to the Neurology Ins= titute to start a comprehensive traineeship program in the field of rehabil= itation, with special training stipends which were above the training stipe= nd level which was then available to the other institutes.
Presumably, Dr. Sebrell had not heard of this before, and I think it's o= nly fair to state that he seemed like a pretty unhappy man at this meeting,= and he left before the meeting was over. The scuttlebutt has it that= this was actually so said and sealed beforehand that Dr. Sebrell really ha= d no recourse to object to this. At any rate, this is how the Arthrit= is Institute got out of the rehabilitation business, because the stipends w= ere such that according to our regulations, we could not match them. = Special regulations were written for this very special program, and we no l= onger dabbled in training in rehabilitation, although for a number of years= we did support some research in rehabilitation of arthritics, which was do= ne in Howard Rusk's department by Dr. Lowman.
One other note about Dr. Sebrell, again, the NIH was so small that the s= cientists on the campus could get together, and there used to be a weekly N= IH staff meeting which was held in Top Cottage, which was just about under = where I=E2=80=99m now sitting. Intramural scientists, both= clinical and basic, and extramural staff and administrative staff would at= tend these staff meetings, and it was the custom to introduce new staff mem= bers at the NIH at those meetings, and also to hear a scientific paper or a= progress report on the development of extramural activities. It was = a very good means of communication. It obviously outgrew itself and b= ecame too ponderous to handle in a few years, but through this method we ke= pt pretty well informed about what was going on at the NIH during that peri= od. I would suspect that this ended about 1955. I'm fairly cert= ain that it ended before Dr. Sebrell left the NIH.
T-6 was an interesting place, too, because it was possible to not only h= ouse the extramural staff of all of the institutes, but there were certain = institute directors who had their offices there. Among these were Dr.= Van Slyke, Director of the Heart Institute, and later Dr. Watt, Dr. Bob Fe= lix, who was Director of the Mental Health Institute, Dr. Pearce Bailey, wh= o was Director of the Neurology Institute. The extramural staffs of the ins= titutes, as well as the staff of the Division of Research Grants, including= all of the executive secretaries, were so small at that point that we coul= d all get together for staff meetings in the one big meeting room that was = there in T-6. I don't know how many hundred people now occupy such po= sitions that would have made them eligible to attend the staff meetings we = had in those days, but I would say that there were probably not more than 3= 0 or 40 individuals in toto who had to do with the total extramura= l programs at that time. This, again, was good and was healthy, becau= se the executive secretaries of the study sections and the grants branch ch= iefs of the institutes could get together and discuss mutual problems and m= utual interests in policy and be very helpful in formulating policy.
This type of communication was superseded by the ECEA, Executive Committ= ee for Extramural Affairs. I sat on this for many years. Admitt= ance to the ECEA was only for grants branch chiefs. This was one step= which took the grants branches of the institutes further away from the Div= ision of Research Grants, and I'm not in the position now to know how much = communication there is along these lines. The extramural activities a= re all in the Westwood Building=E2=80=94not all, but the primary extramural= activities of the categorical institutes are in the Westwood Building, alo= ng with, I think, most of the Division of Research Grants. But I'm fa= irly certain that all executive secretaries and all grants people can't get= together anymore in a meeting that could be effective, and if they had suc= h a meeting, it would have to be in the auditorium of the clinical center, = I should think. So that communication has necessarily become a proble= m because of sheer increase in the size of the activity.
However, we had very close liaison with the executive secretaries and th= ere were very few study sections, actually. There were probably not m= ore than six or seven. Again, we'd have to go back to the record to look at= this, but among some of the outstanding executive secretaries were Barney = Brunstetter, who was the Executive Secretary of the Pathology Study Section= . Dr. Endicott and myself both being pathologists, used to needle Bar= ney Brunstetter, who was not a pathologist, in his dedication to doing some= thing about stimulating research in pathology. I suppose if any one p= erson deserves the credit for the upsurge in pathological research, it was = due to Dr. Brunstetter=E2=80=99 s activities and his dedication and hard wo= rk at this. He, unfortunately, was killed in an airplane accident in = Albany, New York, in the mid-1950s. It was one of a rash of people fr= om NIH who were killed that year in airplane accidents.
Irv Fuhr, who is still an executive secretary, was among those present.&= nbsp; Don Larson was an executive secretary even before I came here and sti= ll has one of the biochemistry study sections. Marshall Ellis, who al= so assigned research grants, was Executive Secretary of the Surgery Study S= ection.
As the Arthritis Institute developed and got more interested in clinical= investigation, I had the feeling that clinical research grant applications= were not being handled properly. At that time, they were sent to the study= section which had the greatest degree of sophistication in the basic probl= ems which were spelled out in the application. There were at least tw= o study sections which were clinically oriented. One of these was the cardi= ovascular study section, with which the Arthritis Institute had no contact.= Another was the Surgery Study Section, with which the Institute had = a little contact in some of the orthopedic surgery applications that wer su= bmitted to the NIH, and there were very few of these indeed. But the = applications along the lines of clinical investigation from departments of = internal medicine that were within the realm of interest of the Arthritis I= nstitute were sent to such study sections as metabolism and nutrition, endo= crinology, sometimes even to more highly scientifically oriented study sect= ions like physiology and pharmacology.
The percentage of approvals of these applications was, we felt, extremel= y low compared with the percentage of approvals of applications in the real= fields of interest of the members of the study sections themselves, the mo= re basic study sections. Dr. Daft and I had many discussions about th= is, and we finally approached Ernest Allen and Ken Endicott with a proposit= ion to form a new study section which would address itself to a clinical in= vestigation in those areas which were not then included in clinical investi= gation. This was agreed upon, and we set to pick members of this stud= y section. I submitted a list to the Division of Research Grants.&nbs= p; This was circulated to some of the other institutes for their additions = or deletions, but as I remember it, a great majority of the members in the = original General Medicine Study Section were names that had been submitted = from the Arthritis Institute. These were individuals who were disting= uished themselves in clinical investigation and in various areas.
The guidelines for assignment of research grants were amended to admit t= his new study section, and I believe that Dr. [Clifton] Himmelsbach was the= first executive secretary. If he was not the first, the first lasted for b= ut a short time, and Dr. Himmelsbach took over that position until he subse= quently moved to the clinical center into his present position.
It's of interest to note that we thought that we might get more sympathe= tic understanding from people who themselves were engaged in clinical inves= tigation, but after a few meetings of this study section, on an analysis an= d comparing the actions of the new study section with the old method of ope= ration, which was to distribute the grant applications to a series of other= study sections, we found no significant difference in the approval and dis= approval rates. So that from the standpoint of trying to push clinica= l investigation and perhaps get more applications approved than had been ap= proved previously, this study section was a failure.
Although from the standpoint of taking the load off some of the other st= udy sections and concentrating clinical investigation in one study section,= it was a success, and I think it's worked very well ever since. I th= ink this goes to show that the axiom that we've talked about here for a lon= g time is probably true, and that is that the more an individual knows abou= t a subject, the more critical he's inclined to be about his own subject.&n= bsp; Therefore, the less likely an application of somewhat less than high q= uality has a chance of being approved.
We did an interesting rundown along these lines one time in the General = Medicine Study Section, and it was composed of roughly three individuals in= the field of rheumatism, three individuals in the field of metabolism, thr= ee individuals in the field of endocrinology and diabetes, chiefly diabetes= , and some others. In studying individual priorities that were given = individual applications, we found that the people who knew least about the = field of arthritis, for example, were the people who would give the more li= beral priority scores to the arthritis applications, and on the other hand,= the arthritis experts on the panel would give the most critical priority r= atings which were usually lower than those people who were not experts in t= he field.
I don't know if I said that properly the first time or not, but I'll try= to clarify it. Those people who were not experts in the field of art= hritis would give a higher priority score=E2=80=94that is, a better rating= =E2=80=94to an application. The people who were experts in the field of art= hritis would give a poorer rating to the same application.
I've been talking about some of the events in the early days of the extr= amural programs. Some small items that indicate how times have change= d come to mind. I remember, for example, how difficult in the early d= ays it was to get through a requisition for an electric typewriter. I= also remember the paucity of duplicating equipment in terms of our modern = means of duplication. There was a time when there were but two or thr= ee duplicating machines at the National Institutes of Health. I think= these were in Building One, the clinical center, and they were Thermafax m= achines. I became aware of the need for duplication other than mimeog= raphing fairly early when it was necessary to have copies of applications a= nd correspondence to distribute more widely than one could do by the ordina= ry stencil, and looked into the types of equipment that were available at t= hat time, finally settled on the Eastman-Kodak Verifax. This was a real cho= re to process this equipment. I forget now all the red tape concerned= , but we finally got it.
It was interesting to note that this was the first duplicating device of= any type other than mimeograph or ditto in any of the extramural institute= setups, and it was requisitioned by Building One during the polio problem,= when it was necessary to copy letters that had signatures in blue ink, bec= ause the Thermafax would not take off blue ink. If you compare that t= o now, a somewhat primitive device and the only one of its kind then, to th= e numbers of duplicating machines that are here now, it simply points up ho= w really primitive we were at that time.
Another thing that became apparent very early in the development of the = extramural programs was a need for some type of substantive program analysi= s to be able to not only justify budgets, but to have an account of progres= s in research in the given area. As a matter of fact, when John Sherm= an came into the extramural programs of the Arthritis Institute, his bigges= t responsibility, as I put it to him, was to analyze in a substantive manne= r all of the research programs that were being supported by the Institute, = to start an analysis and some technique of data storage and retrieval, so t= hat we would be able to spell out precisely the development in any given sc= ientific area that we supported. Unfortunately, the press of other ma= tters during that period precluded Dr. Sherman from ever getting into this,= and up to this point, I doubt very much if any of the institutes have this= type of an analytical situation under control, although we've made many ef= forts to set up systems whereby we could keep a running analysis and a retr= ospective analysis of research advances that have been made through our sup= port.
Along this line of program analysis and substantive matter, as the progr= ams grew, it also became necessary to have more sophisticated and accurate = fiscal analyses available at the drop of a hat. At that time, my wife= was Clinical Director of the Miners Memorial Hospital Association, and I u= sed to hear her tell about the Univac setup they had for the coordination o= f the data in the ten hospitals which they ran. I became more and mor= e convinced that the only answer to both the substantive and fiscal analyse= s of programs was in a modern computer setup.
I had developed an analytical scheme for keeping tab of the programs in = the Arthritis Institute, which was composed of McBee cards, with the punch = needle system. This worked pretty well because you could get all the = data about one research grant that seemed to be necessary at that time, inc= luding fiscal and substantive information about the grantee and the institu= tion on one of these cards. But the time came when the program grew t= o the point where the cards toppled over on their own weight. You jus= t couldn't do a complete analysis because the program was so large, that it= took time and also took a lot of time to punch these things, and they beca= me quite ineffective.
So I proposed for the extramural programs of the Arthritis Institute a m= ore modern setup, namely a data storage and retrieval system on something u= sing some equipment as the Univac or IBM equipment. From the time tha= t this was first proposed until we finally got it, about three or four year= s elapsed. This developed into a running controversy between the vari= ous individuals who were concerned with overall NIH program analysis and bu= dget office, and the recognition that something like this was actually need= ed and would be important for an institute to have within itself. It = made perfectly good sense to me that any device like this in an institute s= hould be compatible with a centralized device, but the bedrock of data at t= hat time was in the intimate operations of the institute extramural area, i= ts own budget office and its own programming activities. This was the= raw data on which any centralized device would have to feed.
So there were a whole series of meetings and frustrations associated wit= h the procurement of equipment for this purpose. It was vetoed up and= down the line. In fact, for a while, Dr. Daft himself was not quite = sold on the idea. This in no way negates what I indicated earlier about our= close working relationship, but simply a hard-headed look by him at our pr= oblem and also evaluating the chances that we might have from a realistic s= tandpoint in being able to get this.
The way in which it was finally worked out was that we managed to write = a contract with a firm, the name has slipped me now, whose business it was = to give advice for business organization. So they came in and did a s= tudy not only of our problem, but of our problem as it related to the Divis= ion of Research Grants, to other institutes, and to the NIH as a whole.&nbs= p; They came up with a report not only on the reorganization of the extramu= ral program of the Institute, but also a suggestion and recommendation as t= o our data storage and retrieval mechanisms.
This culminated in a meeting in the conference room of Building One one = day, in which all of the experts in this field who were then at the NIH met= with us and representatives of this company. It was decided that we = could go ahead and purchase the equipment that was needed. This was the fir= st institute that went into its own modernized data storage and retrieval s= ystem.
When I came into the Heart Institute four years ago, even then the Heart= Institute was depending on McBee cards, and it didn't take us very long in= the Heart Institute to get set up on the IBM scheme. This has worked= very well indeed in the Heart Institute, I assume it has in the Arthritis = Institute, but we've been very fortunate here to have in charge of this Mrs= . Janet Welsh, who was trained with Documentation, Inc. With her back= ground and training in this very field, the Heart Institute slid into this = very rapidly and readily, and it's, of course, been extremely helpful.
I'm sure that this will integrate with the new computer setup that we he= ard about a few weeks ago that's being set up here at the NIH, and indeed, = I think that the NIH has come around to realizing that at the operations le= vel is the only source for raw data. This is a day-to-day operation, = it's never the same fiscally from day to day because of negotiation of sums= of money involved in research grants, where the Council sets the ceiling l= evel for the grant, but the actual amount of money that's awarded depends u= pon negotiation between the staff and the institution. This is extrem= ely important in dealing with very large grants. The Heart Institute,= for example, has at least one grant that's over $1 million a year, but it'= s very difficult to estimate from one quarter to the next as to how much mo= ney is actually going to be needed and used by the grantee. So this b= rings into play very large sums of money that are in continual fluctuation.= So that one really doesn't know where they stand until about a= month or two before the end of the fiscal year, and the only way it can be= done is through computer operation. At least that's the way it seeme= d to me, and I think that this is generally recognized now in a program tha= t's as large as the total NIH programs.
End of interview