Item a: I think that the degree and structure of governmental research activity in the field of aging is adequate. The suggestion of establishing a special department to review, index, and abstract all the scientific literature since 1910 which contains specific gerontological observations is listed in my additional statements. The review would include publications whose titles do not suggest that the papers contain gerontological observations.

Item b: There are, according to my experience, usually no great difficulties in the application of specific research findings to the improvement of the physical status of the aged.

Item c: I do not particularly recommend the recent emphasis on the so-called integrated interdisciplinary approach to the problems of aging because, as mentioned under item b, advances made in biochemistry and biology usually are quickly applied in internal medicine and pharmacology. Within the American Gerontological Society a 14-year attempt to integrate the different sections of the society has, in my opinion, required much expenditure of time and energy and has not resulted in any valuable accomplishments, but has encouraged generalities and unproductive council sessions.-John E. Kirk.

I have hesitated replying to your letter of August 12, since I do not consider myself an authority or expert in the aging field. During the period 1957-59, I held an NIMH grant to pursue research on social aspects of aging, and more recently, I have been collaborating with Dr. Michael A. Wallach of MIT on some aging research. The latter activity has been carried out on a strictly part-time basis.

At the present time, as my institutional affiliation indicates, I am primarily engaged on other research problems. For these reasons, I do not feel qualified to specify the amount of money that the Government should invest in aging research, nor the manner in which such funds should be distributed over the biological and social areas. I simply do not know what the present expenditure levels are.

As far as encouragement of researchers in the field is concerned, I do feel that more can be done. Such encouragement should not, however, be bought at the price of quality. Too much of past aging research suffers in this regard.-Nathan Kogan,

Al

I have been conducting medical research for the past 11 years in Milwaukee and now am professor of clinical research at Marquette University School of Medicine. We have had one National Institutes of Health grant classified under "Research in aging: Cardiopulmonary function in normal elderly males." The purpose of our study was to set up normal values for certain measurements of heart and lung function which are used routinely in the diagnosis and management of patients with heart and lung diseases. The problem with these function tests was the fact that normal standards had been established primarily for younger individuals but many of the people with disease were in the older groups. though our study involved heart and lung disease, we later discovered that it was classified also as "Research in aging." Since that time I have noticed more and more interest on the part of Congress and other agencies to support problems of aging. I have also been involved administratively in other studies which perhaps might be considered "Problems of aging." One such study involves a sociopsychological assessment of the activity program for the members of the Wood Veterans' Administration domiciliary unit particularly in relation to the most seriously disabled men, Another study sponsored in part by the American Cancer Society is designed to compare the efficacy of cytological studies of the sputum with chest X-rays for detection of early lung cancer.

I shall in the succeeding paragraphs answer to the best of my ability the specific questions you put forth in your letter of August 12.

I wonder whether the concept of "research in aging" is a product of the lay mind rather than the trained-research mind. I recognize that from a political and social point of view, the problems of our aging population are great ones and that research in this area should be encouraged. However, I am not convinced that research in aging is a logical category as is cardiovascular research, cancer research, etc. As I see it, there are several types of research which might be classified in the category of research in aging:

1. Basic physiology, chemistry, and biophysics involving research at the cellular level.

2. Either cellular, tissue or organ research pertaining to growth. This could include tumor growth, and thereby would overlap cancer research.

3. Clinical research involving processes which primarily affect older people. Most of such research would probably overlap heart research, cancer research, research in arthritis, pulmonary research, etc. All of these could be considered as part of "research in aging," but from a scientific viewpoint would seem much better classified under the systems involved such as heart disease, pulmonary disease, joint disease, etc.

4. The psycho-social aspects of the care and happiness of our older citizens. Here is a problem about which I am not too optimistic. The difficulty here is assessment and evaluation of the results of such research. Often the benefits derived seem to be in part related to the enthusiasm and the newness of a new activity program and the interest shown by the dedicated personnel rather than the activity program itself. I find a great deal of philosophic discussion of the problems of the aged and a great deal of apology and a great deal of explanation for why we must carefully consider studies for the aged, but unfortunately the scientific value of most of the studies is highly questionable because the methods for evaluation are so difficult to set up, for the people involved in these efforts must be strongly committed to such programs before they would get into this field. It would be most difficult, therefore, for an investigator who believed that that type of program for an elderly group would be highly effective and then would test this out over a 2- or 3-year period to come to the conclusion that all of his efforts really did not show appreciable benefit in the elderly people with whom he was working. In the study which has been in progress in the Wood VA Hospital, it is my impression that with the transition from newness to a routine effort such activity programs lose their effectiveness. I am afraid that the difficulty in evaluating such studies may invalidate much of the work in this field. Unfortunately many psychologists and sociologists who are working in this area do not have adequate background in scientific methods and are not completely objective in their evaluations.-Ross C. Kory.

In answer to your letter of August 12, 1960, I would like first to be sure that we agree on a definition of what research in aging is. Is the eventual goal that of prolonging life or should the emphasis be placed on making life of old people more useful and/or pleasant? That these two aims are not necessarily identical is shown by an example which I witnessed in Montreal. A friend of mine who is a competent general practitioner gives tranquilizers to all his old patients. He feels that he makes them happy, but I gather that the families of some of these patients do not like this policy as they feel that the doctor makes them passive or as one of them told me, he transforms them into vegetables.

I for one am inclined to feel that research on aging should not so much aim at prolonging life as at making the life of old people more effective. Thus, I would be inclined to have at least a number of research projects oriented toward such a goal.

Unfortunately, when I tried to answer the questions in your letter, I find that most of these questions do not deal with what I feel is this important aspect of research orientation. Nevertheless, here are a few answers to the best of my ability.

Continuous research in medical, biological, and social fields should be done in order to complete this sketchy program.

If some of the economical and psychological factors in aging are better understood today, conversely we are still completely unaware of what aging is and we do not yet understand the fundamental biological problems related to this process. Much more research should be encouraged to study these problems.-C. P. Leblond.

Regarding your letter of September 28 concerning research in the field of aging we are just now closing our study of effect of parabiosis upon aging. This research will continue for another year.

We are opening a large experiment on effect of feeding irradiated beef to beagles for a 3-year period. We have also found that the effect of exercise and sex differerence is very important and it makes the female rat live longer and exercise more in their lifetime.

We have found no relation between the amount of fluoride consumed in relation to teeth decay.-C. M. McCay.

It seems probable that your recent letter came to me because, quite apart from my personal interest as a physician in the problems of the elderly, we have been studying as physiologists certain changes in the nervous system which seem to be associated with aging. It must be emphasized that I can speak only from those standpoints and have no expert information bearing on many of the questions you raise. What I have to say, therefore, will probably be of limited value to you and I would prefer that my name be not used. May I emphasize however my sympathy, as an academic physician, with the highly pertinent article by Mr. Russell in the current Harper's magazine bearing on this broad subject. In that article it was pointed out that the crying needs in modern medical research are for inquisitive well-trained basic investigators, and for unfettered support in their development and work. The dangers of project research, and that aimed toward specific practical goals are well stated.

In short, it seems evident to the writer that increasingly large Federal expenditures will be necessary for productive medical research of all kinds, and inevitably the total budget of the NIH must continue to rise. Increasing support of the teaching, as well as research activities of men and of our universities must come from such a source. But just because one is interested in some biological problem associated with aging, is no reason why that support should come from a special Gerontological Institute. Nor is there much to suggest that major advances in our knowledge of aging are apt to emerge from an emphasis laid by such an institute. Cardiovascular, neurological and other problems exist throughout the life span and are not limited to any age group. Were one forced to consider some special field for emphasis, one might expect (on past performance) that embryology or child development would be more fruitful. Hopefully, however, such special artificial emphasis will not come about.

It remains true, however, that the social and economic aspects of aging are of increasing concern to the country and doubtlessly rational planning must rest on more well-considered social welfare research within this special age group. Whereas the writer knows of no current practical applicability of any specific medical gerontological research findings, undoubtedly results of biological investigation in almost any field can well have vital application to the elderly. It would seem relevant, therefore, for any subcommittee interested in the aged to add its strong support to the NIH as a whole. Even those congenitally averse to Government support, of which I am not one, have little but praise for the performance of the research grant and study sections of those Institutes. All Institutes are certainly supporting creative intramural and extramural research with real bearing on the problems of the elderly. I think the degree and structure is currently adequate. I have no immediate suggestions for any needed change when someone at present has a good idea and is prepared to carry it out, he can get financial support. Inevitably, as the number of well-trained investigators increases, this outlay will have to be progressively greater.-J. W. Magladery.

Adequacy of current governmental research activity in the field of aging. The processes of aging and the distinctions between natural aging and disease are so complex, and we know so little about the best methods of penetrating deeply into these problems, that we ought not to hope for rapid and spectacular advances, even if all the governmental appropriations for health research were devoted to aging for several decades.

The foregoing statement is not an argument against continuing the effort to penetrate more deeply into the problems of aging; but I am impressed by the vast numbers of persons who suffer from physical and psychological disorders that are not specially associated with aging. Looking at what has been achieved during the past 50 years by research in medicine and related sciences, I believe that much more can be expected from efforts in these other areas than from allout efforts to attack aging as if it were a disease to be prevented or cured.

There appears, therefore, to be no reason for drastic changes in the present degree or structure of governmental research activity in the field of aging. I would be inclined to postpone any change of emphasis or method until research developments themselves gave promise of new leads. I say this all the more confidently because I have been impressed by the attitude of the scientists and other staff members of the National Institutes of Health-their up-to-date knowledge of what is happening in medical research, their flexibility and their desire to make the programs, intramural and extramural, effective in relation to new conditions.

The practical applicability of specific research findings: As is well known, many of the most valuable contributions to human health have emerged from the efforts of research workers who did not set out with any practical objective in mind; and that is a strong reason for applauding the recently increased support, by the National Institutes of Health, of research and training in the basic medical sciences.

As regards direct alleviation of physical disabilities of the aged, it is my impression that considerable advances are being made by investigations of drugs, development of surgical techniques, and methods of physical rehabilitation. I believe, however, that practical psychology has more to offer to the aged than any other skill; and in this area I believe that formal research is not nearly so important as the accumulation of experience and the development of understanding by intelligent and sympathetic social workers, nurses and physicians. I recall, for example, an application for a grant in aid of research on persons in homes for the aged—an inquiry that would have produced masses of questionnaire data for punchcards and perhaps an electronic computer. While reviewing the application I visited one of the homes and saw listless men and women in drab surroundings. My reaction-that questionnaires and punch cards were not the solution was confirmed by the social worker who accompanied me, and who described how, in other places, the residents of such homes had been transformed by the efforts of nurses and social workers who had sympathy, commonsense, and a proper training.

Changes in the directions now being taken in gerontological and geriatric research and in the types of financial investment. I think that most of the worthwhile research in the past has sprung from the minds of individual investigators; and I would be be sorry to see a committee-even a committee of experts-telling people what they should do in research.

In this connection I believe that it is important to clarify the distinction between research, in the strict sense, and the development of improved services. Many research grant applications in the field of chronic diseases and in the problems of aging are really requests for help in the development of services. However sympathetic a research-grant reviewing committee may feel toward the aims of the applicants, it cannot legitimately approve the application as a research project.

A serious and well-organized effort to improve services of any kind, for example, to the aged in a certain community, entails invention of methods, often requires ingenuity, and produces experience that can be valuable to other workers elsewhere. That, I think, is justification for support of such efforts by other than local funds; and if the projects that appear in research-grant applications were sorted into those that were strictly research projects and those that were development or demonstration projects, there might be found some justification for reallocation of governmental funds as between those categories.

The word "research" is so loosely used nowadays that there is little wonder that people label their projects inappropriately and send applications to the wrong agencies. I wonder whether some more guidance could not be given before the applications are written.-Donald Mainland.

Basically, I don't feel that I am in a position at the moment to contribute greatly to this problem. My greatest concern of late regarding the USPHS-supported programs has been the deleterious effect which these have had upon medical education, simply because there has been no parallel program which will support the teacher. In fact, it has been my observation that many potentially good teachers have been enticed away from teaching into pure research because the funds for support of the latter activity were plentiful and often prestige and rank became dependent upon the ability to attract these funds. Under such circumstances, teaching obligations might have been considered detterent to progress. This statement does not mean to imply that the program, as far as it goes, is not an extremely valuable one, which has been of tremendous impetus in the development of medical research in the postwar years. My current concern is for the lack of a parallel program which would support medical education directly.

Regarding the advisability of an Institute in the National Institutes of Health designated specifically for the study of aging, I have mixed feelings. It is evident that the various disciplines encountered in such studies cross all presently existing Institute boundaries and for this reason it may be difficult to correlate in a centralized administrative fashion. On the other hand, there is great need for the presence of a body strongly motivated to encourage research in this field. If the

latter can be done without creating a special Institute, I would be in favor of that action.-George Margolis.

Since leaving Emory University, I have been engaged in further specialty training in psychiatry and am now assistant professor of psychiatry at Georgetown University and director of research in psychiatry at District of Columbia General Hospital. My activities have not allowed me time or opportunity to keep abreast of the structure and function of our aging research programs, as I had while engaged in basic medical science research. However, I would be happy to share with you and the committee some of my ideas as to areas of research need re aged and aging as I now view them from a more multidisciplinary standpoint. While the general problems confronting the aged group are profound on each level, i.e., social, biological and emotional, I do not believe that the basic questions are radically different from those which might be profitably answered for similar problems arising in less aged individuals or groups.

The answers to the etiology of degenerative disease, which takes its toll of disability or death at an advanced age, do not lend themselves to explanation any better when approached at age 60 than at age 35. Therefore, we create error in the mind of the public and emerging investigators when we confuse the issues of the aged and the process and problems of aging.

I would therefore suggest that greater stress be laid upon the investigation of the means to combat and correct "social illness" and emotional illness in the already aged group while expanding the means to better treat or hopefully eradicate their physical disease processes through increased and intensified research into the dynamic processes of growth and maturation at each of the levels of activity, i.e., social, biological, and emotional, at all age levels.-Paul B. Maves.

I would only like to express my strong belief in the desirability of more coordinated research in the field of aging. It seems to me that more meaningful results would be obtained in this field if some central agency planned research and approached universities or persons interested in a given area, and solicited them to carry out certain phases of a larger research project. Some kind of Manhattan project in the field of aging would bring better and faster results.-Henryk Misiak.

Your question (B) as to the practical application of research findings: The scientist, in carving out a piece of new knowledge, must be free to fractionate it, validate it, and report it to his peers for criticism according to established methods and procedures in his discipline. His concern is with truth rather than application. Having arrived at and reported a conclusion, the scientist considers his duty ended, and he goes on to his next task. And so our scientific literature is filled with isolated, unrelated gems of truth, often signed by young men in training, often acting as "principal investigators." It frequently happens that they are in such a stage of development or so totally immersed in the technical aspects of their work that they cannot convey their general design or intention to their fellow workers, and even less to the general public. Does this mean that the application of new research to "the improvement of the physical and social status of the aged" must be left to the chance imagination of readers? I suggest that the professor or the department head who set and guided the work for the scientist has the obligation and the challenge-to fit these new bits of truth into an understandable mosaic, to show the philosophy back of them and the general goals toward which they are pointing. Some of this is done at present by annual critical reviews in many areas of science. We would have greater stimulation, and probably more practical application, if research groups would also regularly report on their progress and intentions.-Robert T. Monroe.

May I, in closing, make an urgent plea for more attention to the problems of aging in the skin? This organ system is, in many ways, one of the most notorious to suffer the ravages of the years. I am personally interested in launching a program of study on human skin.-William Montagna.