Tobacco Documents Online

N}tmf1g 'I i1fi~~ gr CScle hce ~ yo.l 421 1qto Lewis TlltOM0.i arfid 4eylel pr'eOOllr House Holds Health Hearings The first foray into health science re- search by House Health and Enviran- ment subcommittee chairman Henry Waxman (D-Calif.) got off to an in- auspicious stan. Scheduled for 14 ho- vember, the day-long hearings Waxman had planned ran into a conflict with Pres• ident Caner's doome3 efforts to rush his administration's hospital cost contain- ment bill through the House. Since Wax- man and most of the active sub- committee members have spent most of this legislative session on the cost con- tainment measure, they were distracted from the health research hearings and appeared for only moments at a tinde. spending most of the day trying to shep• herd thetr bill through the House Rules Committec. But the staff had assembled an impressive collection of witnesses from as far away as California to discuss priorities in biomedical reserrch. and so. without anyone really at the helm, the show went on. When Wrxman reads the heanng rec- ord. he is hkely to be no more certain than before of just where the "scientific communuy" thinks research should be headed in the next dccade. Biologist Lewis Thomas. president of the Sloan- Kettering Cancer Center. made an elo- quent plea for basic research: phy,ician Lester Bre+luw, dean of the University of Calriurnia tLos Angeles) School of Public Health, made as eloquent a plea for epidemwlogic research. From the orientation of the wnness list and the tenor of Waxman's prepared opening re• marks, it louk% a+ though epidemiolugic research has the edge. at least in the sub. commince', estimation. In a prepared statement, read in his absence by Rep. Mickey Leland (D- Tex.), Wax,man urged mobilization of federal funds into "ntw and promising areas such as tpidemiolcigy, environ- mental scihnces. health services re- search, biostatistics. and the behavioral and social sciences. These disciplines have a strorig potential to yield informa- tion that can be directly employed to promote hCalth and prevent disease. However. this does not mean that sup- pon for new or previously neglected arens of the health sciences should erode existing support for much-needed basic biomedical research. Indeed, the two must complement one another." For a real working partnership be- tween basic and applied research, said Lewis Thor6tas, basic researchers must be given frhe rein to pursue promising leads. even if they corne back empty- handed. lust as important, applied re- 1tep. Henry 1Naxman 12 searchers must be permitted to hold off on theu studies until the saentifi: cli- mate has progressed to a point at which they are likely to do some good. "You cannot just call up allied research" for the sake of political expediency. Thomas said. "You really have to know what you are doing, and there has to be a fair de- gree of cenainty at the outset that all the facts at hand are hard and relevant." Busic researeh. in contrast to applied research. is characterized by a high de- gree of uncertainty: "The more inter- esting and meaningful the o,uesnon, the higher is likely to be the uncertamty." But the flexibility inherent in a basic re- search protocol does not mean the inves- tigator is permitted to meander. Thomas emphasized. "It is a misconception too widely held that basic research is some- how an aimless, purposeless, untar- getted endeavor. and the only facts learned are those run into by blind accident." The impression of the accidental na- ture of science may have been deltber- ately created by scientists themselves. who are fond of reciting tales of "seren- dipity-' when they arpear before Con- gress toask to be left alone "I wish WaI- pole had never produced the word serendipity." Thomas said. Basic re- search may be "exploration into un- known temtory." but it is "planned" exploration uhah is "rcptanned us n goes along." Accident plays only a very minor rore in the course of scientific dt% covery. "Accidental observations are in• deed made in science. obviously, and sometimes these turn out to be of prime importance in solving a problem. but these are often. in retrospect. nnrsrr•f P rJ observations made in the course of testing a hypolhe,ts." t'antim,rd nn pucr 63 BioS. ience Vol. 30 No. I t

House Healt h Hearings fnntinnrrl jrorn poer 12 Thomas blamed the current era of cau- tion and apprehension in scientific re- search i art on the rising expectations of the American pubhc. at ts not generally realized is that most of today's promising medical advances-the treat- ment of hypenension, for example. or of Hodgkins disease. or the interferons. or cardiac surgery. or the newly discovered regulatory hormones in the brain-are the results of fundamental research begun 20 or 30 years ago by investi- gators wl~o had something quite diff- erent in their minds at the time. We are drawing capital from a bank of un- differentiated information stored long ago, and that bank is in constant need of ~ replenishment." 11 The bank may run out. Thomas ~ wamed, unless we can modify the mood lof research-by-plan that now pervades I most scientific funding agencies. "The sciemists feel constrained to write out great -•4d I stacks of pages describing in detail the t work to be done in the next year or two. and they are convinced that if they do , not achieve the results anticipated in the i grant proposal they will never get anoth- er grant. The NI H study sections and re• ~ view bodies have become much more I conservudve in their evaluations than ever before in my memory. and they ! tend to make awards only for projects I that seem 'safe and sound.' ... No one li at either end-in the community of working scientists or in the bureau• i craoes governing the suppon of sci- ence-is ence-is willing to ran risks of being ~ wrong." Lester Bresluw. expressing sympathy with Thomas' remarks. nonetheless ful• lowed with a fervent defcnsc of cpr demmlugtc research. "Too frequenty it is forgotten that effective means for con- trolling diseuse and advancing health have emerged before understanding of _s ~~, :,I .~ the biologic mechumsms involved," he said. A delay in finding and promoting nonmedical measures that seem associ• ated wnh reduced incidence of disease. he said, wh0e sciemnrs try to diuover w!»• that association exists. would mean encessive morbidity and mortality in the interim. "The finding that cigarette smoking causes hing cancer and is a major factor in other currently important condi- tierns: ' Breslow said. "parallels in sever- al ways the identification [by John Snow in London in the 1850s1 of polluted water as a cause of cholera and other diseases. Just as Snow did not find the exact agent in polluted water that caused cholera. so today at the beginning of the 'second public health revolution' we c'o not know precisely what in cigarette smoke is re- sponsible for its many adverse con• sequences. Someday. presumably. we may find out. and such knowledge would be helpful. Meantime. however, just as in the situation that confronted people in Sno.v s ome, we can proceed with pd'eveatinn." The remainler of the witnesses at the dEty's hearings-with the exception of NIH Director Donald Fredrickson. who urged that his agency be protected from aat advocacy. pro•prevention role-lined up on the side of Lester Breslow and epidemiology. Albert Stunkard of the tdniversity of Pennsylvania suggested that NIH establish sa new study section on prevention. Judith Rodin of Yale went ont step further. proposing the ini- tiation ura new National Institute of Dis• ease Prevention and Health Promotion (an idea she quickl) acknowledged was just a pipe-dream). Ernst Wynder of the American Health Foundation proposed the establishment of six new regional in• terdisaplmary centers for disease pre• vention. And Henry Blackburn of the t!nivenity of Minnesuta said each NIH iristnute should be required to spend ItY'i to IS7, of its annual budget on re• search into pnmary prevention. Wynder summarized the emerging lines of demar- cation between basic biological research and epidemiologic research: "You do not need to know the mechanisms of a disease in order to prevem it." -Robin Maranlz Henig H KNU9.1"11f;5

H Y0094i 166 I House Holds Health Hearings The first foray into health science re- search by House Health and Environ- ment subcommittee chairman Henry Waxman (D-.Calif.) got off to an in- auspicious stan. Scheduled for 14 No- vember. the day-long hearings Waxman had planned ran into a conflict with Pres- ident Caner's doomed efforts to rush his administratioci s hospital cost contain- ment bill through the House. Since Wax- man and most of the active sub- committee members have spent most of this legislative session bn the cost con- tainment measure. they were distracted from the health research hearings and appeared for only moments at a time. spending moxt of the day trying to shep- herd their bill through the House Rules Committee. But the staff had assembled an impressive collection of witnesses from as far advay as California to discuss priorities in biomedical research, and so. vithout anyone really at the helm, the show went on. When Waxman reads the hearing rec- ord, he is likely to be no more certain than before of just where the "scientific community" thinks research should be headed in the next decade. Biologist Lewis Thomas, president of the Sloan- Kettenng Cancer Center, made an elo- quent plea for basic research: physician Lester Breslow, dean uf the University of California tLos Angeles) School of Public Health, made as eloquent a plea for epidemiotoga: research. From the orientation of the witbesc list and the tenor of Waxman'+ prepared opening re• marks. it look-, as though eptdemrologic research has the edge, itt least in the sub• committee's estimation. In a prepared statement. read in his absedce by Rep. Mickey Leland (D- Tex.). waxman urged mobihzatiod of federal funds inio "new and promising areas such as epidemiology. env,ron- mental sciences, health services re- search. biostaustics. and the behavioral and social sciences. These disciplines have a strong potential to yield informa- tion that can be directly employed to promote health and prevent disease. However. this does not mean that sup- port for new or previously neglected areas of the health sciences should erode existing support for much-needed basic biomedical research. Indeed. the two must complement one another." For a real working partnership be- tween basic and applied research. said Lewis Thomas. basic researchers must be given free rein to pursue promising kads~ even if they come back empty- handed. Just as important, applied te- . -# .q -T r ~., V; w 12 4 ;;,..}~ Rep. Henly Waxmen t rW. 1 searchers must be permitted to hold off on thcii studies until the screnti6c eli- mate has progressed to a point at which they are likely to do some good. "You cannot just call up allied research" for the sake of pobtical'expediency. Thomas said. "You really have to know what you are doidg. and there has to be a fair de- gree of cenainty at the outset that all the facts at hand are hard and relevant." Basic research. in contrast to applied research, is characterized by a high de- gree of uncertainty: "The more inter- esting and meaningful the question, the higher is likely to be the uncenainty." But the flexibility inherent in a basrc re. search protocol does not mean the inves- tigator is permitted to meander. Thomns emphasized. "It is a mr+conception too widely held that basic research is some- how an aimless. purposeless. untar• getted endeavor. and the only facts learned are those run into by blind accidetut." i The impression of the accidental na- : ture of science may have been deliberh ately created by scientists themselves. who ars• fond of reciting tales of "seren- : dipny" when they appear before Con- gress to ask to be left alone. "I wish Wal- pole had never produced the word serendtpity." Thomas said. Basic re- scarch may be "exploration into un- known terrirorv." but it is °planned" exploration which is "replanned as it goes along." Accident ploys onl% a very minor rok in the course of sctemifi, dis- covery. "Accidental ob.ervauons are in- deed made in science. obvrou.ly. and sometimes these turn out to be of prime importance in solving a problem, but these are otlen, in retrospecl, nin•.1M•r t. eJ observanons made in the course of testing a hypothe,is." ('unrimu-J nn pacr 63 BiuScience Vol. 30 No. I I

NKO09'17167 hcuse Health Hearings CnnrinnrJ'Jrum pnXr 12 Thomas blamed the current era of cau• tion and apprehension in scietitrfic re• ASW on 1he rising expectations search i ef the Amencan public. a"W(-i t~rs not generally re ited is t at most of' today's promising medical advanees-the treat- ment of hypertension, for txample. or of Hodgkins disease. or the interferons. or cradiac surgery. or the newly discovered regulatory hormones in tEte brain-are I the results of fundamental research begun 20 or 30 years agb by investi- gators gators who had something quite diff- Ierent in their minds at the time. We are drawing capital from a bank of un- ,ditTeremiated information stored long ago. and that bank is in constant need of replenishment." The bank may run out. Thomas ~ warned. unless we can modify the mood t of research-by-plan that now fiervades f most scientific funding agencies. "The scremias feel constrained to write out grcat ~ stacks of pages describing in detail the work to be done in the next year or two. and they are convinced that if they do j not achieve the results anticipated in the grant proposal they will neverget anoth- er grant. The NIH study sections and re- view view bodies have become much more ~ conservative in their evaluations than ever before in my memory, and they ~ tend to make awards only for projects ~ that seem 'safe and sound.' ... No one ~ at either end-in the community of working scientists or in the bureau- cracies cracies governing the support of sci- ence-is willing to run risks of being wrong." Lester Bmslow. expressing sympathy with Thomas' remarks, nonetheless fol• lowed with a fer\ent defense of epr demiologic research. "Too frequently it is forgotten that effective means for con- trolling disease and advancing health have emerged before understanding of the biologic mechanisms involved," he said. A delay in finding and prumoting nonmedical measures that seem associ• a.eo KiiL ic\,uKS ..f he said. while scienti.ts try to discover whv that association exists. would mean excessive morbidity and mortality in the interim. "The finding that cigarette smoking causes lung cancer and is a major factor in other currently important condi• tions: ' Breslow said. "parallels in sever• al ways the identification Iby John Snow in London in the 1850si of polluted water as a cause of choleia and other diseases. Just as Snow did not find the exact agent in polluted water that caused cholern- so today at the beginning of the 'second public health revohition' we do not know precisely what in cigarette smoke is re- sponsible for its many ddverse kon- sequences. Someday, presumably, we may find out. and such knowledge would be helpful. Meantime. however. just as in the situation that confronted people in Snow's time, we cr.n proceed with prevention." • The remainder of the witnesses at the day's hearings-with the exception of NIH Director Donald Fredrickson, who urged that his agency be protected from an advocacy. pro-prevention role-lined up on the side of Lester Breslow, and epidemiology. Albert Stunkard of the University of Pennsylvania suggKsted that NIH establish a new study settion on prevention. Judith Rodin of Yale went one step farther, prop-mrug the ini- tiation of .r new National Institute of Dfs- ease Prevention and Health Promotion Ian idea she quickly acknowledged was just a pipe-dreaml. Ernst Wynder of the American Health Foundation proposed the establishment of six new regional rn- terdisctplinary centers for disease, pre- vention. And `ferpry Blackburn of the University of Minnesota said each NIH institute should be required to spend 101,7 to 15 i of its annual budget on re• search into primary prevention. Wynder summarized the emerging lines of demar' cation between basic biological research and epidemiologic «search: "You do not need to know the mechanisms of a' dr;eas: ... tz rr......f .f •. -Robin htaranu Healg r