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1938–1942: Assistant Visiting Physician, Third (N.Y.U.) Medical Division,
Bellevue Hospital, New York City. 1941-1942: Assistant Professor of Medicine, New York University College
of Medicine, New York City. 1941-1946: Director, Research Service, Third (N.Y.U.) Medical Division,
Goldwater Memorial Hospital, New York City. 1942–1946 : Associate Professor of Medicine, New York University College
of Medicine, New York City. 1944: Associate Visiting Neuropsychiatrist, Third Psychiatric Service
(Third Medical Division) Bellevue Hospital, New York City. 1944–1945: Acting Director, Third (N.Y.U.) Medical Division, Goldwater
Memorial Hospital, New York City. 1946–1947: Chairman, Malaria Study Section, National Institutes of Health,
Bethesda, Maryland. 1946–1949:
Director, Squibb Institute for Medical Research, New Brunswick, New
land. 1949–1952: Associate Director (In Charge of Research), National Heart
Institute, National Institutes of Health, Bethesda, Maryland. (Ap
pointed to Commissioned Corps, Public Health Service, 1949.) 1952-1955 : Associate Director (In Charge of Intramural Affairs), National
Institutes of Health, Bethesda, Maryland.
1955-: Director, National Institutes of Health, Bethesda, Maryland.
Malaria Conference, National Research Council.
Consultant to Secretary of War. 1948: Medal for Merit (Presidential). Scientific Societies:
American Physiological Society.
1951-1956: Member, Subcommittee on Malaria of the Committee on Medi
cine, National Research Council. 1952–1956 : Member, Subcommittee on Shock of the Committee on Surgery,
National Research Council. 1953–1956: Chairman, Malaria Panel, National Research Council. 1953–1954: Member, Panel on Allocation of Gamma Globulin, National Re
search Council. 1953–: Member, Division of Medicine Sciences, National Research Council. 1953–1960: Member, Executive Committee, Division of Medical Sciences, Na
tional Research Council.
1955-: Public Health Service Representative, Division of Medical Sciences,
National Research Council. 1957-1962: Member, United States National Committee for the International
Union of Physiological Sciences. 1954: Member, Board of Directors, Gorgas Memorial Institute of Tropical
and Preventive Medicine. 1976–1966: Member, Expert Advisory Panel on Malaria, World Health
Organization. 19.59–1963: Member, Advisory Committee on Medical Research, World
Health Organization. 1962–1966 : Member, Advisory Committee on Medical Research, Pan Ameri
can Health Organization. 1959-1965: Consultant, President's Science Advisory Committee. 1963-: Consultant to Advisory Committee on Research to the Agency for
International Development. 1965:
Department of Health, Education, and Welfare Alternate Represent
ative to Federal Council for Science and Technology. U.S. Delegate to the United States-Japan Cooperative Medical Science
1952; Doctor of Science, College of the Holy Cross.
Doctor of Science, Duke University.
Doctor of Science, Providence College. 1959: Doctor of Science, Loyola University, Chicago. 1960:
Doctor of Science, Catholic University.
Doctor of Science, University of West Virginia. 1962: Doctor of Humane Letters, Albert Einstein College of Medicine,
Yeshiva University. 1964:
Doctor of Medicine, Catholic University of Louvain, Belgium.
Doctor of Medicine, Karolinska Institute, Stockholm, Sweden. 1965:
Doctor of Science, University of Maryland.
1945: Harvey Lecturer. 1956: John F. Anderson Lecturer. 1958: Scientific Award for Outstanding Achievements in the Field of Renal
Physiology, Malaria Control, and National Administration of Medical Re
search, New York University.
Election to Membership in the National Academy of Sciences.
Public Health Service Distinguished Service Medal.
Abraham Flexner Award, Association of American Medical Colleges.
GENERAL STATEMENT Mr. Flood. I see you have a prepared statement. Generally you submit your statement for the record, as I recall it, and speak extemporaneously, do you not?
Dr. SHANNON. I would like to do that again, sir.
Mr. Flood. At this point in the record we will insert the doctor's prepared statement, and then he will talk extemporaneously.
(The statement follows:)
STATEMENT BY DIRECTOR, NATIONAL INSTITUTES OF HEALTH, PUBLIC HEALTH
Mr. Chairman and members of the committee, there are twelve separate appropriations in the Bill now before you which, together, provide funds for the programs of the National Institutes of Health. The Directors of the appropriate Institutes and Divisions will provide detail about the specific aims, accomplishments, and needs of the activities supported by each of these appropriations. This statement speaks to their common purposes and their common problems.
Medical research in this country has been, and is, so closely interwoven with the evolution of the NIH support programs that it will be logical-and, I think, of special interest to the new members of this Committee-to outline the development of these programs.
At present, about 40 percent of our total national expenditure for medical research is provided through the NIH appropriations. NIH is by far the largest single source of support for medical research in this country. The character of the programs through which this support is provided—and, incidentally, the manner in which they are administered-plays a substantial role in determining the character and directions of our national medical research effort and, in a very real sense, the quality of life of the American people. I suspect that most Americans agree with the view expressed some years ago by Professor Will Durant, who popularized philosophy in the 1930's, that “The health of nations is more important than the wealth of nations."
The tremendous strides that have been made during the past twenty years in our understanding of biological processes and in our ability to deal effectively with many disease problems has added immeasurably to our national wealth. This is true if this progress is estimated, however imprecisely, in economic terms—such as added years of individual productivity or the reduction in time lost from work. It is overwhelmingly true if the measure is humanitarian-the suffering that has been eased or prevented, the lessening of permanent disability, the young children and young parents whose lives have been saved, or the increasing number of people who are able to enjoy a vigorous and healthy old age. It is difficult to estimate in a meaningful way the consequences to a child and his family of the avoidance of death or disability due to polio, or the restoration to normal development of the child with complex congenital heart disease, much less the consequences to the family unit of the early detection and care of uterine cancer.
There is in progress a quiet revolution in the practice of medicine as the result of research. The advent of antibiotics has sharply reduced the ravages of unpreventable infections; new techniques for cardiac and other forms of surgery have made it possible to intervene in situations which a decade or two ago were beyond surgical help; drugs for the control of hypertension have significantly reduced the death rate for heart disease among middle-aged persons; a number of viral vaccines are now in common use.
The American Medical Association recently reported that the introduction of new products has been so dynamic that 7 out of 10 now on the market were not available ten years ago.
New knowledge has greatly changed the approach to the treatment of disease and the attitude of the practicing physician to science. Fifty years ago, few physicians were concerned with scientific investigations—their main professional interest was the application of existing empirical knowledge which changed very
little from year to year. Today, while relatively few practicing physicians are themselves engaged in formal research, they are fully aware of the impact of science on their capability to diagnose and treat disease.
But I am less concerned about the progress of the past than I am about the vast problems that still remain to be solved.
Despite the great strides forward in recent years, the biomedical sciences are still in a primitive stage of development. The lack of understanding of underlying causes is still the main barrier to the solution of the major chronic illnesses. Much of biological research must continue to be descriptive and observational and its approach to the solution of problems is still, necessarily, empirical. The unifying and clarifying principles and “laws" that transformed alchemy into chemistry and natural philosophy into physics have yet to be uncovered in the life sciences. In fact, too frequently a major step forward brings into view still larger-and more forbidding-areas of unknown territory. For example, the sucress in combating bacterial infectious diseases laid bare, for all to see, the puzzling roles that seem to be played by viruses in both acute and chronic dis
The puzzling and exasperating delays that mark the progress of medical research are due to the large gaps in fundamental knowledge. The history of immunization against infectious diseases provides a typical example. The demonstration that inoculation with infective material from a calf would prevent smallpox took place in 1796 but because it came about without any real understanding of the nature of the disease or of the principle of vaccination, it remained, for nearly a century, simply a technique for preventing a specific disease. Not until Pasteur, Koch and others established the principles of bacteriology in the 1880's, was it possible, in a relatively short time, to control such diseases as diphtheria, tetanus, bubonic plague, and scarlet fever.
Even so, basic knowledge was still insufficient to cope with many other infectious diseases. The existence of "ultravisible viruses" was deduced in 1898 but many years elapsed before it became possible to isolate them or grow them in a laboratory. Polio, for example, was identified as a virus disease as early as 1909 but it took more than 40 years of scientific effort on many related problems to pare the way for a successful vaccine. Not until the 1950's were knowledge of the disease and techniques for vaccine development adequate to the task. It is, incidentally, instructive to note that the tissue culture techniques used were the result of research having no direct relation to the polio problem. They were developed partly by scientists studying the characteristics of cancer cells and partly by scientists trying to improve the production technology of the fermentation industry.
We are now in a period of rapid development of viral vaccines that is, in many ways, comparable to the progress that followed Pasteur's discoveries 80 years ago. In addition to the polio vaccines, we now have vaccines for such common Firal diseases as yellow fever, influenza and measles and for several less common respiratory diseases. In the foreseeable future, we shall have vaccine for German measles (rubella), mumps, and a number of other respiratory diseases whose causative viruses have been identified.
In other fields, the problems are more difficult. For the chronic diseases with which medical research is now primarily concerned-heart disease, cancer, an array of metabolic and neurological diseases, and congenital defects—the valleys of ignorance are broader than the peaks of knowledge. The exploration of the cause of these diseases or defects-which must precede the development of wholly effective treatment and preventive measures—is most formidable. In fact, many of these diseases probably have no single cause. Rather, the cause of disease and the determinants of the rate of progress in dealing with it are likely to be a combination of chemical and biological, environmental and developmental, and behavioral and sociological factors. A total understanding of these diseases will teovire research in many disciplines and in many directions.
The change in the pattern of major health problems from the acute infectious to the more complex chronic diseases and the consequent change in the research emphasis is paralleled in the evolution of NIH and its programs.
NIH had its beginnings in 1891 in a small bacteriological laboratory at the Marine Hospital on Staten Island. This was soon transferred to Washington and became the Hygienic Laboratory. For its first 20 years, it was exclusively concerned with communicable diseases which were then the major public health problem and accounted for more than half of all deaths. About the time of World War I, its activities were gradually expanded. The Hygienic Laboratory discovered the cause of pellagra, a dietary deficiency disease then common in the South, it did pioneering work in the study of shock resulting from immunizations, and it formulated the first sound theory about personal sensitivity that helped to lay the foundation for the study of allergies—which were until then unknown and unsuspected.
As the application of the new science of bacteriology progressively brought the major infectious diseases under control, the death rate for these diseases rapidly declined-from 648 per 100,000 population in 1900 to 208 in 1937. By 1950 the rate was down to 65—a tenth of what it had been half a century before. But partly as a result of this success, the other major causes of death and the so-called chronic diseases loomed larger as national health problems. The death rate for malignant neoplasms rose from 64 in 1900 to 112 in 1937, for cardiovascular and renal diseases from 345 to 455, and many people who would formerly have fallen victim to diphtheria, smallpox or typhoid fever now survived to enjoy an arthritic old age. The first significant step to extend the research activities of NIH to these fresh areas of public concern was the creation of the National Cancer Institute in 1937.
The National Cancer Act of 1937 marks a sharp turning point in the history of NIH. It set the stage for a series of actions which were completely to alter the scope, orientation and mechanisms not only of the NIH programs but of the whole national biomedical research effort. The ultimate effect of the pattern set by the Act was
To focus attention on specific diseases, or groups of diseases, and to authorize special programs to discover the cause, facilitate the diagnosis, improve the treatment, and, hopefully, devise preventive measures for these diseases;
To complement the research conducted by NIH itself with grants-in-aid to non-Federal institutions for research projects directed towards the same ends;
To give NIH responsibility not only for the conduct and support of biomedical research but for research-training through the award of fellowships; and
To dramatize these disease-oriented programs and give them greater public visibility-by grouping them in separate categorical Institutes named for
the major disease entities within their area of responsibility. The transformation did not, of course, come about all at once. The Cancer Act merely authorized a comprehensive cancer program that included research projects grants and fellowships for this purpose only. Its immediate effect was to create twin Institutes in 1937—the National Institute of Health and the National Cancer Institute on the new grounds in Bethesda. But the new grant program awarded only 9 research project grants, totaling $91,000, in 1938.
The intervention of World War II slowed the pace of development and—except for budget increases to off-set war-time inflation and to pay for special warrelated research projects undertaken by NIH—the situation remained fairly static. In 1945, the two Institutes had appropriations totaling $2.8 million of which $170,000 was for research grants. Total national expenditure on medical research, from all sources, at this time was about $70 million.
The Public Health Service Act of 1944 extended the authority to award research-project and research-training grants to the other programs of NIH and prepared the way for the post-war transfer to NIH of the medical research projects sponsored by the war-time Office of Scientific Research and Development.
The creation of the other categorical Institutes then followed in rapid order. In 1948, the National Heart Institute and the National Institute of Dental Research were created by acts of Congress which, at the same time, created NIH's present 'federal' structure and changed its collective name to the National Institutes of Health. A National Microbiological Institute was administratively established—its name subsequently changed to the National Institute of Allergy and Infectious Diseases as its scope enlarged. In 1949, the Division of Mental Hygiene became the National Institute of Mental Health. In 1950, the Congress created the National Institute of Neurological Diseases and Blindness and the National Institute of Arthritis and Metabolic Diseases.
This organizational growth was accompanied by considerable construction at the Bethesda campus, which was largely completed by 1953, and appropriate increases in the direct operating budget. There was, however, little program expansion during the period from 1950 to 1956. While this was partly due to the Korean war, it was also, necessarily, a period during which the new Institutes