replace the old ones. This process had to take place with full regard for both scientific rigor and the usual vagaries of the budget process. In fiscal year 1950, for example, the Bureau of the Budget reduced the VA's budget for research contracts from the requested $2.9 million to $1.8 million. Another problem that the committee faced concerned reporting the results of the first studies. Beebe hoped that there would be "careful analysis" of the statistical data, not simply a reporting of results. For projects that were spread among several medical centers, care would have to be taken to ensure that the publication of results was coordinated across centers. The committee hoped it would have the chance to examine each manuscript "for statistical review" before publication.37

Among the projects that the Committee on Veterans Medical Problems considered during this period was one devoted to capturing the long-term outcomes of people who had sustained trench foot, immersion foot, or frostbite in World War II. To facilitate this project, Beebe obtained rosters from the Veterans Administration and the Army. Five centers would examine about 100 patients from the 115 patients' files that they would be given. The sampling plan allowed each center to see a disproportionate number of severe cases. Although the study would not yield exact information on the effect of individual forms of treatment, "residuals of cold injury" would be obtained and related to the severity of the original injury. To minimize variance in the clinical examinations, doctors in New Orleans examined ten cases in advance of the study and obtained satisfactory agreement on their observations. DeBakey, still an active member of the CVMP, observed that although expensive, the study would provide "much needed information on the natural history of this condition." The committee recommended that $67,187 be given to the principal investigators for this study. 38

Dr. F.A. Simeone, an investigator in the cold injury study, had already participated in a study of veterans who had incurred arterial wounds. In this latter study, he continued work that he had done during the war. For example, he had treated one patient by means of "non-suture anastomosis," reencountered the patient during the follow-up study, and found the patient to be symptom-free. The project also enabled him to follow up other patients who had received similar treatment to determine how many of them complained of intermittent claudication (irregular gait) or pain in walking. His preliminary observation was that sympathectomy, defined as the transection, resection, or other interruption of some portion of the sympathetic nervous pathways, decreased the incidence of claudication. Although the technical terms made the discussion difficult for non-doctors to follow, the process demonstrated that the agency's initial work followed directly from clinical interests that doctors had developed during the war.39

Impact of the Korean War

Beginning in 1950, the Korean War changed the tone of the follow-up program. What had been a leisurely excursion into the medical records from the



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