Mrs. Lasker, distinguished guests, members of the Lasker Award Committee, Mr. Chairman, ladies and gentlemen:
I stand before you two and a half months after assuming the position of the director of the National Institutes of Health—a job described by President Johnson as staggering and by the Secretary of Health, Education and Welfare as one with tremendous challenges. Yet I have found during this brief time, experiences so heartening, advances so promising, and support from all segments of our society so firm that I want to report to you a most stimulating endeavor, with tremendous potential even when viewed against the background of the remarkable accomplishments of past years.
The National Institutes of Health is dedicated primarily to the conduct and support of research on the major diseases of man. This staggering task demands a big organization. The NIH program has contributed to every major health institution in the country and has benefited directly or indirectly every citizen. For almost every medical advance in this country in recent years has been supported to some degree by NIH programs. In general, the dollar support has been greatest in those areas of greatest death and disability—cardiovascular disease, cancer, arthritis and metabolic diseases, neurological diseases, allergy and infectious disease, dental diseases, and the problems of child health and human development. Support is also extended to research training, institutions, and special resources.
On April 1 of this year, two new organizations and two new responsibilities were merged with the research mission of the National Institutes of Health. The charge is to blend in a purposeful and effective way the federal government's resources in medical research, education of health professionals, and biomedical communications. The resources of the Bureau of Health Manpower and of the National Library of Medicine will be severely taxed during the next few years as they seek to meet the urgent needs in their fields.
But our object today is to focus on the contributions of research. Those of the past and the potentials of the future, owing largely to the active work or stimulus of individuals preset in this room, have created a research structure unparalleled in excellence of young investigators emerging from research training programs and participating in the formulation of broad policies and strategies. These are the men and women who must decide how to explore the unknown. And they are betting their careers, their life's work, that the research they are doing is in the right direction—that it will pay off.
In early September, Institute by Institute told me of progress along three general lines.
First—toward a better understanding of the nature of life processes. An excellent example is the work for which Dr. Khorana and, to speak with pardonable pride, our own man Dr. Nirenberg are to receive a Nobel Prize.
Secondly, there were reports of very promising leads, which will probably result in major modifications of medical practice in the 1970s.
One example is the firm documentation of major risk factors in coronary artery disease, the main cause of heart attacks. The major risk factors are smoking, hypertension, and high serum cholesterol. All three together increase the risk of heart attack by more than five times. The presence of only two factors lowers the risk from this high level to about twice the average, while the presence of only one factor drops the risk to nearly average.
We can look forward to continued improvement in treating hypertension. The use of cigarettes seems to be decreasing. And field tests of lipid-lowering agents are currently under way to determine their potential for preventing second heart attacks.
Dental scientists now predict progress on a number of fronts, such as the elimination of dental caries as a major problem in the 1970s.
There were reports of major advances in the development of artificial kidneys. A new program to control pneumococcal pneumonia through use of a vaccine was announced yesterday.
A virus infection in rabbits and a variety of tumors in mice have been controlled by inducers of interferon, as announced just last week by NIH scientists. Whether the control of these tumors is attributable to the action of interferon, a natural defense against viruses, remains to be determined.
A third line of progress concerns the endeavor of the various Institutes to make the fruits of research available to the patient without undue delay. Of several possible examples, let me select two.
It appears from the work of George Cotzias and others that administration of L-DOPA to patients with Parkinson's disease can be an effective weapon in the hands of the physician. Dramatic improvements are seen, and up to 75 percent of patients are expected to benefit from the drug. But there are serious and unpleasant side effects and problems of supply reminiscent of the early days of penicillin. To solve problems of this character without extraordinary measures would probably take years. Therefore, the National Institute of Neurological Diseases and Stroke has held meetings with an expert task force, and will carry out, within the shortest time compatible with sound scientific principles, a cooperative program for testing L-DOPA and other compounds for efficacy and safety.
The program will be supported in some 20 institutions throughout the nation. Further aims are to determine any long-term effects of these drugs, and to see that an adequate supply of pure compound is made available to the scientific community for further basic and clinical research.
Another interesting feature of the L-DOPA story is that the formulation and testing of the underlying hypothesis—that L-DOPA should benefit Parkinson's disease patients—was made possible by a vast amount of basic scientific work on nerve impulse transmission. Indeed, one of the recipients of last year's Lasker Awards, Dr. Bernard Brodie, contributed significantly to this body of knowledge through studies of the central mechanisms by which reserpine regulates blood pressure.
The second example derives from our growing ability to utilize resources rapidly—to capitalize on research findings. This is seen in progress towards the control of German measles. First there was an exploratory period following the discovery of the devastating effects of this infection when it attacks women in early pregnancy and causes congenital defects in the child. The second phase was the development of an effective vaccine. Tests of this experimental vaccine have already been made in this country and abroad with quite encouraging results. We feel fairly confident that by 1970, when the next German measles epidemic is expected, a safe and effective vaccine will be available.
Think for a moment of the implications of this advance. Everyone in this room had as a child the normal childhood diseases—mumps, measles, German measles, whooping cough—and perhaps scarlet fever, rheumatic fever, diphtheria, and poliomyelitis. In the 1970s, all of these childhood diseases should have disappeared in America.
Today the United States leads the world in medical sciences. This is not accidental, but rather a direct result of painstaking and sometimes spectacular research in laboratories and clinics across the land. This is a consequence of governmental, industrial and private support. And it strongly reflects the visionary, spirited and tireless efforts of private citizens, such as those in this room.
We have a grave responsibility to foster the present apparatus for research and education in medical science. If we continue to build well now—and we cannot afford to fail in this—we can look forward to accelerated payoffs in the decade ahead. There will be payoffs in a deeper understanding of the basic processes of life; in continued advancement in the control and cure of disease; and in new research opportunities, which are often the most exciting results of all.
First Row, left to right: Severo Ochoa, New York University School of Medicine ● John Talbott, The Journal of the American Medical Association ● Mathilde Krim, Sloan-Kettering Institute ● Michael DeBakey, Chair of the Jury, Baylor University College of Medicine ● Howard Rusk, Institute of Rehabilitation Medicine ● Irving Wright, Cornell University Medical College ● Sidney Farber, Harvard Medical School at the Children's Hospital ● Stanley Yolles, National Institutes Health
Second Row, left to right: David Karnofsky, Sloan-Kettering Institute ● Martin Cherkasky, Montefiore Hospital ● E.M. Papper, Columbia University ● Edward Dempsey, Columbia University ● Saul Krugman, New York University Medical Center ● George James, Mount Sinai School of Medicine ● Alan Miller, Department of Mental Hygiene State of New York ● Frederick Stone, National Institute of General Medical Sciences
Not pictured: H. Stanley Bennett, The University of Chicago ● Philip Lee, Assistant Secretary for Health and Scientific Affairs ● H. Houston Merritt, Columbia University ● George Palade, The Rockefeller University