sions between the exacting world of the statistician and the pragmatic concerns of the clinician.47

Responding to the financial problems and the mounting concerns of the Veterans Administration, the Committee on Veterans Medical Problems decided that each follow-up project would be studied by experts on the particular subject, with the objective of assessing the report's ''value."48 Five years of effort had, according to Dr. Wintemitz, brought "relatively little harvest to date." The NRC wanted to evaluate the follow-up program through the final reports of the various studies, but "unfortunately,'' noted Winternitz, none of the major studies had been completed. Beebe said that the slow pace of the work reflected the many stages of a project. Even after the clinical examinations had been performed, agency staff still needed to perform the tabulations, conduct the statistical analysis, work with the investigator on a final manuscript, and make a final check of the statistics and tables used in the manuscript. Beebe hoped that the bulk of the statistical work on approved projects would be completed by the end of June 1953. 49 In the meantime, the majority of the committee's work shifted from the follow-up studies to advising the Veterans Administration on its intramural research program.50

Reviewing the Agency's Progress

By early 1953, the follow-up studies program was officially under "review and reassessment" by the NRC. The reasons were both internal and external. The Agency staff was overloaded with statistical work. Some of the investigators were late with their final reports. With the arrival of President Dwight D. Eisenhower and a Republican Congress, the external environment was also changing. The Veterans Administration faced a stringent review of its budget requests. President Eisenhower proposed the creation of a cabinet-level Department of Health, Education, and Welfare (HEW) that would include the Public Health Service and possibly other medical programs of the federal government, including those of the VA as well. Beebe and others feared the impact that the new HEW would have on the agency's funding relationships with the federal government.51

Although the work of the Follow-up Agency appeared to be stalled, the staff enjoyed a period of considerable creativity and productivity. Bernard Cohen continued his work on the studies in which he made use of existing medical records to illuminate larger epidemiological and policy concerns. His pilot study, begun in 1948 and designated R-1 or record study one, led to a detailed draft final report in 1951 (draft because it had to be put aside in the crush of other work) and to a summary of the methodology, which was published in the American Journal of Public Health, the first of a long series of staff publications that became the agency's hallmark. The success of this project encouraged the agency to undertake other record studies, each involving Cohen and one of his colleagues, on



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