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Luminaries of CC Past and Present Launch 17th Research Festival
By Rich McManusPhotos by Bill Branson
On the Front Page...
One couldn't have blamed the Clinical Center for bursting a bit at the seams with pride on Oct. 14 as more than a dozen of NIH's most esteemed clinical investigators launched Research Festival week with stories some highly technical, others highly personal of how NIH's hospital, now celebrating its 50th year, figured in research triumphs ranging from the cure of certain cancers, to radical lowering of the incidence of coronary heart disease, to new life-extending therapies for HIV infection.
Speaker after speaker at the CC 50th anniversary scientific symposium on the past, present and future of clinical research gestured ceiling-ward in Masur Auditorium to indicate on what floor within the hospital this or that patient-dependent breakthrough occurred.A good mix of younger intramural scientists visited throughout a day-long, 15-speaker event that seemed meant, quite literally, to inspire a new generation to risk their careers for bold ideas in which they believe. Former NCI director (1980-1988) Dr. Vincent DeVita lingered for some time on the career of former colleague Dr. Min Chiu Li, who despite having discovered a cure for choriocarcinoma and other major research advances, was "invited to leave" both NIH and another major medical center for the sin of being too far ahead of his time. DeVita seemed to suggest that such courage, married to such talent, is a rare thing these days, and ought to be cultivated.
Fondly remembering his days as a member of what he dubbed "the Society of Jabbering Idiots a body that I've been unable to duplicate at any other institution I've served," DeVita said that Friday conferences at NCI in the 1970s and 1980s were an intellectual hothouse. There, such innovations as drug therapy for leukemia, Hodgkin's disease and diffuse large B cell lymphoma, as well as platelet transfusion as an adjunct to cancer chemotherapy "which is now a $100 million a year industry" had their genesis, despite having been actively opposed at the outset. Set against a biographical backdrop of personal heroes who bucked odds to advance cancer research, DeVita, now a professor of medicine at Yale, plotted a continuously rising curve of relative survival rates from cancer, from 41 percent in 1980, to 52 percent in 1990, to 62 percent today. He concluded his talk with a widely shared sentiment: "It's good to be home."
NIH director Dr. Elias Zerhouni had opened the symposium with a brief overview of the Roadmap initiative, explaining that "the landscape of disease is completely different in 2003 than it was in 1953, when the Clinical Center opened." Whereas acute-care medicine was the focus of the CC's early days, it is now chronic ailments that claim most research attention. He called the 2003 Nobel Prizes, wherein physicists won the medicine award and physicians won the chemistry award, evidence that "science is converging as we get to the root of biological systems and their function."
Zerhouni expects big things of the Clinical Center in particular, putting it at the heart of a Roadmap effort to revitalize the clinical research effort nationwide. "The Clinical Center is to play a core role in the entire system of clinical research," he said, describing the hospital as a place where clinicians can conduct "bold trials without worrying about economic consequences." He expects the CC "to redefine the leadership and training role in clinical research...I expect the leadership from this institution to go on to populate other medical centers in the United States."
Dr. Thomas Waldmann, chief of NCI's Metabolism Branch, said that his "intimate association with the Clinical Center, with its proximity between the laboratory and bedside" has been the "pivotal factor in my career." He outlined a "revolution in clinical immunology" that has taken place in the last five decades. When he arrived at NIH in 1956, he said, science had only a primitive understanding of lymphocytes. The cells from only a single patient, he reported, eventually led to breakthroughs in several lines of research, including HTLV-1, IL-15, and a substance known as anti-TAC. "That is the advantage of having a Clinical Center patient population," he declared.
Braunwald marveled that, at NIH, studies done in dogs could be translated to human patients simply by walking across a hall. He reminded the audience that it wasn't until 1961, in a paper based on research from the then-fledgling Framingham Heart Study, that the now-common litany of coronary risk factors was established: high blood pressure, high cholesterol and cigarette smoking. The curve of age-adjusted death rates from coronary heart disease peaks in 1963 just as the Framingham results are being digested and the surgeon general first warns about smoking then plummets 65 percent in the years since then, Braunwald showed. "It's one of the real success stories of the 20th century."
Braunwald offered cultural observations as well. "It's hard to describe what the atmosphere was like here in the 1950s," he said. "We hadn't yet lost our innocence as a country...Medicine was revered, the federal government was admired. This was 15 years before Vietnam, and 18 years before Watergate, back when this extraordinary enterprise was being built."
NIH then was "populated with extremely ambitious young people, who were competing for positions. There would be 250 qualified applications for each position," he recalled. "Resources were abundant, there were acres of space...There was a camaraderie, an enthusiasm and an openness that was unique. Virtually all of the senior investigators and branch chiefs were under age 40. We knew we were doing something new and different and that it was a privileged time to be here.
"Clinical research didn't really exist yet," he continued. "It was just a hobby for physicians. There was no such thing as full-time or part-time clinical research. The term 'translational research' had not yet been invented...The opportunities for collaboration were such that the whole was far greater than the sum of its parts there was virtually no limit on what we felt we could achieve."
Then came diaspora. Braunwald left in 1968. But he isn't preoccupied with NIH's past, however golden. "From the new Roadmap that Dr. Zerhouni has just introduced, it looks like the best is yet to come," he predicted.
While the CC claimed center stage on Research Festival's opening day, the 17th annual event rolled smoothly through the rest of the week, including an array of mini-symposia, poster sessions and informal gatherings such as a major luncheon on Oct. 15 at which hundreds of NIH'ers enjoyed a free meal under a wind-whipped tent as the band Streetlife entertained from a corner.
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