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THE OPEN MIND
June 29, 1958
“Medical Research and the Affluent Society”
Moderator: Richard D. Heffner
Guests: Senator Richard Neuberger, Dr. Nathan S. Kline, Gilbert Cant
Announcer: The Open Mind, free to examine, to question, to disagree. Our subject today, “Medical Research and the Affluent Society.” Your Host on The Open Mind is Richard D. Heffner, historian, teacher, and author of a documentary history of the United States.
Mr. Heffner: Before we begin today’s program, I’d like to take just a moment to announce something we’re all honored with here on The Open Mind. It is the awarding of a Robert E. Sherwood Award to The Open Mind and WRCA-TV. This was an award for doing programs in the field of freedom and justice and I think I can speak for all of us here at WRCA-TV when I say how happy and delighted and honored we are to receive this signal recognition. We’ve done a number of programs in this area over the past year, and I suspect we’ll be doing a good many more in the year to come. In a very real sense, I think that our program today is inter-related with these themes – it is concerned with freedom to live a long, healthy and a good life, and concerned with justice in terms of what we do to ourselves, how we treat ourselves medically, physically and mentally.
A couple of weeks ago on the last Open Mind Program, we did a program on John Kenneth Galbraith’s new book, “The Affluent Society” and the affluent society again is a theme of ours today. We want to talk about medical research, how we treat ourselves, what we seek to find in a society that is concerned with luxury, how we seek longevity. We were stimulated in large part to this topic by a magnificent pamphlet that has been put out by the National Health Education Committee. It’s called “Do We Spend Enough Dollars to Defend our Lives through Medical Research?” I think quite clearly, that the answer is no, but this booklet details the answer tells about the millions and hundreds of millions and billions that we spend in other directions, but how very little we spend on medical research in our society.
I think now I’d like to introduce my guests who are going to join me in the discussion of “The Affluent Society and Medical Research.” My first guest is Senator Richard Neuberger. Senator Neuberger is a Democrat from the State of Oregon. My second guest is Dr. Nathan s. Kline, Director of Research at Rockland State Hospital here in New York. My third guest is Mr. Gilbert Cant who is the Medicine Editor of Time Magazine.
Gentlemen, I think that it may not be quite fair – I’ve been tooting off about winning the Sherwood Award – I think it may not be fair, Senator Neuberger, to quote a man’s wife, not necessarily against him, in a program but – I noticed in an article that you wrote, you – and incidentally, the title was “Crash Program for Health” that at the very end you said, “I still recall what my wife, Maureen, said to me when she was fighting for a paltry $80,000 in the Oregon Legislature to spend in behalf of retarded little children. Then you quote her.
She said, “The beasts in the field of my mother’s farm will do anything for their young. Can we look the next generation of human beings in the face if we have not done everything possible for them in this vital area of sound bodies and medical care?” I guess this is the question that I would begin with, because in a very real sense it’s a puzzling one – You represent the people – you’re selected by them, how do you explain their reluctance to care for their young as the creatures in the barnyard do?
Senator Neuberger: Well, Mr. Heffner, I don’t think the people have any reluctance. I think it’s up to people in positions of political leadership such as myself, the foundation you’ve just mentioned, people like Dr. Kline in medicine, people like you and Mr. Cant in the field of public opinion to give the people leadership.
I think they will respond. In my opinion, the field of medical research is the greatest frontier today. I come from Oregon, a frontier state. I’ve read how in covered wagon days epidemics of diphtheria, scarlet fever, small pox, meant death hopeless death to hundreds of people including many little children, and we clucked with pity and sympathy over that. I wonder if 50 years from now people won’t mutter with sympathy and pity over the helplessness of cancer in our own period today.
So I believe the people will respond to the need for support of medical research if those of us on this program and others like us give the people the leadership and the information they need.
Mr. Heffner: You think it’s just a matter of stimulating what basically is a public willingness to spend this kind of money?
Senator Neuberger: I do not think there is any public reluctance to support medical research if they have the facts, the information, the leadership that’s my opinion.
Mr. Heffner: Well we haven’t done it up to now and as a matter of fact, I was going to ask Dr. Kline not as a research scientist, as Director of Research at Rockland State, but rather as a psychiatrist, what – well, let me not be cute about it because I’m deadly serious – why., psychiatrically speaking, haven’t we done this? Do you think it’s just a matter of public information?
Dr. Kline: Well, in part, but, I think there’s also a tradition which we inherit in our culture that suffering is somehow the retribution for sin, since a good deal of culture is built on repression and guilt – not necessarily bad things. If they’re used constructively, but we still inherit the tradition that if someone suffers somehow or other they are paying for some fancied or real guilt that they have. The history of medicine shows it. This is certainly true when anesthesia was first introduced just about a hundred years ago. There was much objection to this on the grounds that woman was born to suffer, particularly during childbirth. So, this was raised as an objection to a medical advance, so that I think in part when we relieve ourselves of discomfort, we almost feel guilty of that enjoyment – of good health.
Mr. Heffner: Then I’d ask you, Mr. Cant – you’re the lay person here – to comment on this.
Mr. Cant: I think it’s a historical thing here, and I’m not an historian in the same sense that you are…
Mr. Heffner: You mean an historical block?
Mr. Cant: I’m more concerned with current affairs but we have to remember that the first really conscious care of other creatures, I think, began with the domestication of cattle some 10, or 12, or 15,000 years ago, I don’t know how many it was. And those are creatures that you can observe and you can see what your different procedures do, what effects they have. The medical treatment of fellow human beings has been a hit or miss thing, mostly hit and miss right up until the last hundred years or so. It wouldn’t have done any good for 200 years after Harvey discovered the circulation of the blood in – what was it – 1666 roughly, for somebody to give 100 million pounds a year as it would have in these days, even in this side of the ocean for research, because nobody would have known what to do with it.
The only thing that was found – and found by accident a little over 100 years later was digitalis, and that was from an old wife’s remedy. The same thing is true about microbes that cause infections-diseases. For 150 after Levvenhoeck discovered the mocrobes nobody knew anything about what they had to do with diseases until Pasteur worked on it. Now I think what we have is a historical lag
as well as historical block that now at last we have this knowledge and we haven’t quite convinced all of ourselves of it, we haven’t quite got cranked up to go.
Dr. Kline: I might add that in a book called “Aubrey’s Brief Lives” which was somewhat equivalent of Pepys’ Diary, Aubrey who knew Harvey, has a very interesting comment quoting Harvey that when his book on the circulation of the blood came out, I quote this verbatim because it was impressive, “Practice did fall off mightily and the vulgar thought him crackbrained.” So that I think your point is well taken.
Mr. Heffner: You think this refers to our investigators today too?
Dr. Kline: I’m just commenting.
Senator Neuberger: You know, Mr. Heffner, I again want to emphasize why I’m optimistic about the support of medical research. The group, such as the one you mentioned, the National Health Education Committee, leading doctors, people in public opinion, push on this. Let me just cite what I mean. When I first came to the United States Senate in 1955, the National Cancer Institute which is part of our national institutes of health where most of the government support of medical research goes and where the grants are made, the National Cancer Institute had only $21 million annually. The United States Senate last week authorized $81 million for the National Cancer Institute. Few fields of government appropriations have gone up so much proportionately.
Now during the next week, the Senate Appropriation of $81 million must be considered with the much lesser House appropriation of $57 million and adjusted in conference. If the viewers and listeners of this program want to really do something specific, they should write to their senators and their congressmen to support the Senate appropriation of $81 million for the National Cancer Institute and the same proportionately larger funds for the National Heart Institute, the National Health Institute, the National Dental Institute and so forth. But just look. In the three years since I came to the Senate, the fund for the National Cancer Institute has gone up by Senate authorization at least four times yearly. I think that’s encouraging. I know my constituents in Oregon support it and I’ll wager that the people in New York support it and in Ohio and in all the other states.
Mr. Cant: Mr. Heffner, somebody has to be the devil’s advocate here. Let me be it if I may. Let me nominate myself. I would like to know – perhaps from Dr. Kline – how nearly can you equate simply increased appropriations for these things with increased results – better results meaning very useful discoveries in actual terms of health and treatment.
Dr. Kline: I would say that at the present time, that certainly there is a quite direct correlation. If we ever reach a society in which researches can absorb all the money that’s given to them, then it will run into a law of diminishing returns.
Mr. Cant: The reason I ask this question is because some people contend there is such a scarcity of technically trained people that the appropriations can increase – profitably be increased roughly only in the same proportions that population growth or your graduating classes from the science schools.
Dr. Kline: There are two answers to these. One, that there are no places that I know of – no research institutes, and I know a fair number, that feel that they have as much money as they can use fully put into good research so that we’re not near that point at all. The second – you might look ahead to the fact that someday there may be such a situation, but the fact that positions are available, funds are available, for research, stimulates people to go into the field. One of the great difficulties in research until really only a few years ago was that a researcher was automatically considered a man who was willing to work for less money than – his clinical colleagues so that it’s only since the stimulation in part from our Russian competitors that research and science have achieved some respectability.
Mr. Conner who is the President of one of the pharmaceutical houses, Merck, Sharpe and Dohm came out with a very interesting suggestion that if we were to run a competition with the Russians, let’s have competition in the field of health or longevity.
Senator Neuberger: In support of what Dr. Kline has said, one of the funds that we have authorized in the Senate, the third year, is for the National Institutes of Health to make grants for the construction of medical research facilities – I’m particularly interested in that because the University of Oregon Medical School wants to construct a medical research building. That fund has been over subscribed five or six times every year by perfectly legitimate, authorized and screened requests from private clinics, from drug manufacturers, and particularly from medical schools so it indicates that there is need for these funds and for wider medical support and wider governmental support and I think the answer about the government doing it is this. Can you go down to the drugstore and buy your own cancer research or heart research; Of course you can’t.
The only way you can really do it properly is as a taxpayer through the U.S. Public Health Service and other skilled and talented and knowledgeable government channels to make these grants such as I pointed out. For medical research facilities, for medical schools, for medical training, for the most extensive kind of research, because in the field of cancer research, well I’m not an expert on it and Hr. Cant or Dr. Kline could correct me, it’s my understanding that while no break through has been made, we are on the frontier of something with advances in chemotherapy which do show promise of getting at the cause of this sinister disease.
Mr. Cant: I would correct that to say that we are on several frontiers simultaneously – not only the frontier of Oregon, but of Washington and points East.
Senator Neuberger: But I think it’s interesting to note that in the booklet put out by the National Health Education Committee, itself…
Mr. Heffner: You’re talking about government, Sen. Neuberger, they say that the drug industry has spent 7.3% of its total income which is many, many times the percentage that other industries spend on research…
Senator Neuberger: For which they deserve credit.
Mr. Heffner: Yes. Well now you’re saying you can’t go to the drugstore and if you want cancer research.
Senator Neuberger: I might point out one thing here, Mr. Heffner, what you can go to the drugstore for, which is to me very interesting. I’d never realized that figures that we spend in this country for other items. You can go to the corner and buy your chewing gum, of which there was $296 million worth sold in 1956. Alcoholic beverages cost something like $11 billion which to me is just staggering – compared to the sums we’re talking about here for support of…
Mr. Heffner: Yes, but you’re not talking about what government is spending. You’re talking about us and if we were smoking this minute, we’d be involved in this, too.
Senator Neuberger: Yes, but by far the bulk we spend for medical research comes from government sources. It’s my understanding that the rest of it is relatively small. For example, the American Cancer Society collects maybe $30 million and a great deal of that has to be spent for the treatment of indigent cases which otherwise would just die in agony, untreated, and the funds made available through the National Institutes of Health, it’s my understanding, are by far the bulk of the money spent on medical research in this country. Now is that right or wrong?
Mr. Cant: That is true, but it’s extremely difficult to establish just how much money actually goes for the kind of research we’re talking about. We can’t possibly set ourselves up here as certified public accountants and break down these figures, but when a drug company says it spends so many hundred thousand dollars on research, some of that is product research. It is not pure research, basic research, it isn’t all of it even this intermediate kind of research where you have a chemical that looks as though you might have something and you start trying it out on guinea pigs to see. A lot of these are problems of book-keeping. This is something, incidentally, Dr. Kline that I’ve discussed with Mr. Connor whom you mentioned.
We can’t get absolutely sharp answers. It so happens that in my job they love to be able to say $1,863,000,000 right down to the fraction of a cent they spent in a year on so and so. We can’t do it. The general answer I think, is that roughly 2/3 of all money used for medical research of the kind we’re all talking about, does come from the federal government. Incidentally, of course, when I posed as devil’s advocate here, I was never suggesting for one moment that Dr. Kline’s Rockland Hospital had enough money or that it could ever possibly have too much. We know it can’t. But I think we come back to this historical thing – until recently it didn’t seem as though it did any good. Now only in the last, roughly 20 years, since the sulphur drugs came across from Germany is it clear that in one area after another can we do good – the same pamphlet from this committee that you mentioned – the things that we have done in the last 20 years – it is now clear that if we lay out this money, we can do a lot of good with it.
And especially if we lay it out on a long range program, and that’s something I’d like to ask Dr. Kline about – the advantage of the long range program.
Dr. Kline: This is a tremendous problem in the field of research because most support, except in a fortunate situation such as ours where the state of New York has underwritten such a program is on a yearly basis and this makes for a good deal of insecurity. A man takes a job and has no guarantee that it will last more than a year.
Mr. Heffner: I think this is a point that Sen. Neuberger was making before.
Senator Neuberger: I think we have to have the same sense of urgency about the war, if you want to call it that, against cancer and heart disease and these other maladies that plague the human race, that we have about our military appropriations. For example, when the Appropriations Committee is having hearings, time and again high officers in the Air Force, the Army and the Navy say: gentlemen, unless you provide this fund, I cannot accept responsibility for the security of the United States and it seems to me you have to have the same urgency on the part of the doctors that come before us and the other technically qualified people in behalf of funds for the N.I.H, And just say: gentlemen, it seems to me that we should explore every single possible avenue no matter how remote, no matter how far-fetched that might lead to a breakthrough in the field of cancer and heart disease, etc., and only the government has the kind of funds for that and it seems to me that the American people, if I assess public opinion correctly, want to spend their tax money for that purpose – lots of grumbling about taxes but never about that spent on the National Institutes for Health.
Mr. Heffner: Yes, you make that point, Sen. Neuberger, but you also said before that the appropriations for the National Institutes have increased just about double more than that.
Senator Neuberger: More than that. More than double, four times if the Senate fund sticks during the next few weeks – four times for the National Cancer Institute in the three years I’ve been a Senator.
Mr. Heffner: If everybody listening writes in, they’ll make the Senate appropriation which is larger, prevail.
Senator Neuberger: Correct.
Mr. Heffner: But what about this question? You say in an article that I’ve read recently, that your neighbor in Washington is Dr. Sheeley, who is Surgeon General…
Senator Neuberger: Until recently. When he retired.
Mr. Heffner: All right, you put the question to him to combat cancer, how much money could you spend, could you take, could you use constructively and his answer was half a billion dollars a year. Now you’re talking about half a billion dollars on the one hand and now you’re talking about $80 million lf the Senate prevails tomorrow, the next day…
Senator Neuberger: But we are making progress toward that goal and I want to say that Dr. Sheely thought of that in the terms that Mr. Cant expressed as a continuing appropriation to be used as fast as there were the medical researchers, the medical schools, the private clinics and the private laboratories to use it. And we are advancing toward that goal all the time and I think relatively soon we will make available every dollar that can be spent because I think public opinion wants this type of appropriation.
Mr. Heffner: But you see, I think one of the troubles is, and maybe Mr. Cant would comment on it, is that with something as dramatic as the Salk vaccine, I think a good many of us felt that here was an instance where some one thing happened and I don’t think we feel about it in the way that you describe. You talk – you gentlemen all talk about putting money into research in many many different ways. Fundamental research or a fundamental program that leads to medical schools and to making research a more and more attractive field, but I think that for many of us, we felt that the Salk vaccine just happened – like that – and that here there was a need for a certain amount of money for research and when the research was finished, it was finished, and I think maybe you1 ve got to do more of a job of education.
Mr. Cant: Mr. Heffner, I would like to comment on that, because if that is the impression that many of our viewers have, they have terribly short memories. I happened to have worked on the very first fund raising program for what was for that year called “The President’s Birthday Ball – it was the first one staged by Basil O’Connor and his group for President Roosevelt’s birthday back in 1934, and that of course, has grown into a tremendous annual March of Dimes thing and I have forgotten – I didn’t do homework for this program – exactly how many dimes it is, but I think the last figure I used was 2,000,000,000 dimes which is $200 million have gone into research. And that began roughly 20 years ago – again you can’t get a precise date. This was money that came from the people, Senator, in the form of their dimes and half dollars.
Mr. Cant: I think this is very important. It so happens this is the Open Mind – let me express an opinion that may not be universally popular – the National Foundation for Infantile Paralysis has been criticized for overdramatizing polio – for being too aggressive in its fund raising, and perhaps for making polio which was a comparatively rare disease and comparatively rarely killed people, though it did have this dreadful paralyzing effect, appear in the mind of the public a more urgent problem than cancer or heart disease. I don’t think they should be criticized for that. Oh, perhaps in some detail, yes, but in general, that foundation showed what can be done with money and determination and with all the differences of opinion, and I’ve had some – with Mr. O’Conner himself and with other people, with all these difference of opinion, it is still true that they did absolutely basic research. They spent money for research that didn’t look as though it had anything to do with polio, and eventually it paid off and they did a tremendous undramatic screening job to find out just how many different kinds of polio virus there are. That job took years. It involved three of the biggest university laboratories where they have specialists in viruses including Dr. Salk.
When it was done, they had the money for a sort of crash program, for two reasons, and incidentally this is one of the places where I disagree, I think they crashed it one year too fast. But, they had the money from their own resources, they could get money from drug companies which were going to manufacture the vaccine and they were set to go. Now other organizations are trying to do the same thing. One little note on this. Let us never forget that the American Heart Association was the first one to introduce lifetime grants to researchers, giving them $30,000 a year for life. Out of which they can get, I should say roughly half their salary and the other half, roughly; for laboratory expenses, etc. This is a very valuable thing.
Dr. Kline: Two things on Mr. Cant’s comments. One – medical advances in one field always are represented in advance in another field. That is research done in polio contributes to research in all other areas.
The second thing is that certainly the will of the people would seem to be very strongly, as Sen. Neuberger has pointed out, to support this. He’s never criticized for supporting a bill of this type and there is more and more awareness of the importance of medical research. In my own field, I’m connected with an organization, which is specifically for research in disease rather than clinical services and although it’s just been incorporated, funds have come in without solicitation. So that I think the will of the people is overwhelmingly to do something about it…
Mr. Heffner: Despite the guilt?
Dr. Kline: Perhaps because of it.
Senator Neuberger: You know, I think Mr. Heffner, the very fact that Mr. Cant emphasized what was achieved in the field of polio dramatizes the great frontier which I began by emphasizing earlier on the program. In the last year before the Salk vaccine was developed, polio despite its terrible crippling effects, as outlined by Mr. Cant, killed only 579 people – only 579 children under the age of 14 and yet cancer last year killed nearly 4,000 children below the age of 14. And it’s still the greatest killer of children, except accidents, although we think of it as a disease of old age. And it seems to me the frontier ahead of us is so great that only the government can handle the bulk of the problem. Now I don’t mean that private contributions, that private laboratories cannot make great strides in this field but I believe that the NIH appropriations are still the core of our chance of making a breakthrough in the field of cancer and heart.
Mr. Cant: I think that is true, but I don’t think we can ignore the roughly one third which, I believe is private money or corporate money. An interesting thing came up this past week. I was in San Francisco covering the annual convention of the American Medical Association for Time Magazine and I think the most interesting scientific paper that I came across there was one by Dr. Wendell Stanley of the University of California on the possible relationships between viruses and cancer. He was not planning to have all the answers – he was presenting a theory. This is a theory which we are now pretty well equipped to do a lot of work on because what you t re talking about, most of these cancers in children, are blood cancers, leukemia, which may be connected with viruses. We have enough information now, using the experience of the polio foundation, to spend a lot of money along the lines he suggest.
Mr. Heffner: Our time is up and we had better hope that industry, government and the public all spend that money and accomplish the research that has to be accomplished. We’ll be back in two weeks on The Open Mind with the subject “Talent, Excellence and the Affluent Society.”