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C HARVARD MEDICAL SCHOOL DEPARTMENT OF MEDICINE DIVISION OF REfPIRATORY'DIfEAlE! GARY L. NUBER, M.D.,.CNICF l BETH ISRAEL HOSPITAL Mailing Address: ETN ISRAEL HOSPITAL •330 lROO%LINE AVENUE BOfTON, MASSACNUlETTS 02215 l617) 73d-2]91 December 2~5,~ 19~7~8~ Lee E. Stanfor& Shook, Hardy & Bacon Mercantile Bank Tower 1101 Walnut Kansas City, Missouri 4106 Dear Lee, I have reviewed the letter that was sent to you by Dean Meadow outlining his proposed solutions for providing a future, including the proviision of adequate faciliities, for the Tobacco and Health Research Program at Harvard University. I am in general accord!with his presentation, inipart because there are no other alternatives. I am sorry that it has taken so longito develop this proposal, both from the standpoint iin the delay in communicating suggested solutions to our grantors andifromithe standpoint of the tolili it has taken on all of us, including'the industry grantors, over the past year. As DeaniMeadow'has indicated', however, the solutions proposed are addressed to matters beyond "bricks andimortar,` Those solutions have taken time to develop, and have been done in such a way as to provide a productive and secure setting for our program for at least five years There are a'number of specific comments I would like to make in regard'to this proposal. If there is a bias to my comments, it is because I want the program to continue, preferably at Harvard, or elsewhere if needibe. My reasons are straight forward, and are essentially as summarized by the Harvard ad hoc Advisory Committee. The program is productive of good research in an area important to better understanding smoking and health. It is unique in its comprehensive potential and it is undertaking successfully a difficult research task where there is otherwise a near total void in this country, as well as elisewhere. I believe it is important to have a program of this nature that is not sponsored primarily by the government, as it is my experience and conviction that, as I have communicated'to the Federal' advisory councils, NIH-funded programs are biased in their content and produce results that often are not objective initheir outcome. This program provides an alternative. We have several excellent examples of new research, data generated from the Harvard effort that are "against the grain`of government-sponsored programs and, because of their quality, will stand, I ~ believe, the test of time. Some of this research could never be undertaken 4; or sustained with NIH as the sole nutrient source, and for that reason1I .1 hope we can resolve a means to continue our endeavors. ~ U Ideally, we wouldilike to have our researchilaboratories, animal ~l) inhalation studies, an&administration physically all under one roof. This '7 is not possible at Harvard University within a reasonable period of time.

C Lee E. Stanford December 25, 1978 Page 2 C Our program is large and our space requirements exceed any existing facilities, nor can any be made available to us i~n the near future. It is indicated that I have conclude&that the best available option is to house our research in~three l'ocations: Charlesgate West, the Harvard'School of Public Health~, andithe Mount Auburn Hospital. The key words are "available opti~on." After almost a year of searching no one has been able to find any other reasonable option that even canibe considered. It is proposed by Dean Meadow that Charlesgate West be renovated to house our animals. That is no one's first choice, but it is everyone's first available option. Charlesgate West is, after all, a commercial building that is off-campus. As proposed by Ms. Koch-Weser, an experienced architect and research facilities developer, and as reviewed and assured by Dr. B'ernard Trum, the outgoing Director of Harvard's animal facilities, the plans for Charlesgate West that were sent to you will provide an acceptable, if not ideal, animal facility at reasonable cost. Dr. First and I agree with that position. A "more ideal" solution, with strict isolation of "clean" versus "dirty"'animal care utilization, could be implemented!at Charlesgate West for more money, but no one will make that recommendation. A better solution on the University campus could, be implemented if the facility were to be developed as part of Harvard's new multi-million dollar underground animal quarters, but it woul&not be available until the end of 1979 or later. Thus, I would accept the propose& Charlesgate West plan, with the primary advantage of its being close to the Harvard School of Public Health and Dr. First, where there is no need for additional facili~ties improvement. I am extremely plieased with the sel'ection of the Mount Auburn Hospital, as it is a site:about which I have communicated to you and Bill Shinn.in a favorable perspective long before our current difficulties developed. As indicated at the time, the Mount Auburn Hospital was explored as a possible location for the program,when Harvard had to leave the Boston City Hospital,, and would have been my first choice if they could have accommodated us at the time. They could not then, and can do so:now only because the structure (the Clark Building) which contained their School of Nursing, which has since closed, is available to us wilth adequate space to house our research, laboratories and administration in contiguous quarters. The facility needs a renovation:commitment, however, to convert it into research space. The fact that inilocating our program at that site we will be developing, in a sense, a named Harvardiresearch institution, the William B. Castle Laboratory, has, for both the industry and for me, a special sense of historical perspective. It is the part of Dean Meadow's proposal that I can endorse with the greatest enthusiasm. 03748589 Mr. Meadow has requested that the industry help provide funding for the renovation of faciilities at the Mount Auburn Hbspital beyond those needed for the program, with the assurance that the Hospital will pay the industry grant back that amount over the five-year period under consideration. I am not an advocate of that request. I fact, I amiopposed to it for several different reasons. Mr. Meadow has indicated to me that it is "his

C Lee E. Stanford December 25, 1978 Page 3 job" to ask the industry for this consideration ""on behalf" of the Mount Auburn Hospital. The Director of the Mount Auburn Hospital, Mr. Walter Allen, has indicated that the Hospital will support our program and its location in Cambridge independent of this consideration:. The direct cost budget estimates that have been prepared by our staff are essentially the same as those that were developed with your help now almost eight months ago. There has been in inflation factor, from April to the first of December of this year, however, of approximately $50,0001in the cost of equipment neede&. Various suppliers of the equipment in question have indicated that there will be an additional $'50,000 inflation factor over the next four-to-six months. In like manner, as indicated by Ms. Koch-Weser, projected renovation costs will continue:to increase by a factor of approximately 1o per month,. Where there is now a deficit of approximately $66,500 in projected net renovation and equipment costs, there was a positive balance:in the initial projections we made several months ago. Regarding the matter of my appointment at Harvard Medical School, I am in general agreement an&, under the circumstances, pleased with the decisions that have been reached. It was pointed out, by Dr. Kass, to several of the industry grantors in 1972 that continuatilon:of my appointment (or any one else as the Program Director in the academic ladder in which I am now located)~ would require provision of a $1 milllion endowment to~the University. That is not something I recommended then, or now, as there are other alter- natives for appointments at Harvard. In developing solutions for our program within the fiscal guidelines of a five-year extension at the current rate of support, Dean Mead'ow could not identify a plan both to develop facilities and to maintain the researchl program at an acceptable level, with overhead. He, in essence, compromised significantly his position by foregoing overhead on the program in lieu of the industry providing renovation funds, although he does reserve the right (as I amisure he is required to do) to raise the matter for dYscussion, later. I think that is fair, and expends most effectively the proposed monies for research,, as I am sure the industry grantors would prefer. He identified in his proposali what the usual Harvard overhead would'be for a: research program housed in the propose&locations. Harvard does indeed colilect that amount of overhead from all of our other grantors, as well! ass from grants to other investigators. When overhead~is provided, the University usually (but not always) bears the cost of providing facilities. There has always been an objection by some of the tobacco industry grantors to providing Harvardlits usual overhead, for one reason or another. That 0 would be a most valid objection, if the funds were provided for general CJ research support or institutional program development. The industry support *41 to our program, however, is for a very specific research charge, and the ~ program does have a real overhead. In an attempt to find a solution within UiV the guidelines provided by the industry, Dean Meadow has made, in my judge- ~ ment, an equitable and fair trade on this matter.

/ Lee E. Stanford! December 25, 1978 Page 4 I believe the proposed solution wouldiprovide us a productive and~ secure home for the next five years. I would like to have that much time, whichiwe have not had in the past, to do our research and to bring this program to its real potentiall. I offer no excuses for the past, for under the circumstances of events not controllable by us I think we have done a good job. The Harvard Advisory committee thought so, too. We all know that what we can achieve wiLl be better, if we ever have adequate facilities and a secure setting for a reasonably sustained period. Dean Meadow's proposal would achieve bothiobjiectives. It is not perfect or ideal, but it will, work. For the first time since we had to leave the Channing Laboratory, we have, in Dean Meadow, someone who is an advocate of our program and our research efforts, andlwho ils in a position to help us effectively. That is worth a llot. I hope these comments are helpful. Please let me know what else I can do to be of assistance. Sincerely, Gary L. Huber, M.D, Chief Respiratory Diseases Unit GLH :mtc