From the beginning, a duality of purpose attended the committee's work. On the one hand, the committee was to advise the Veterans Administration on its medical programs. This advice involved matters related to clinical medical practice, such as whether radioactive isotopes should be used in VA hospitals. The VA also expected advice related to its research program. According to Paul Hawley, the VA was not equipped to undertake major clinical or biological studies. Instead of doing the work itself, it sought to fund extramural work that would be done in places with better facilities and superior personnel. Nor did VA officials feel competent to evaluate research proposals. The expectation was that the committee, along with other advisory committees of the NRC, such as those pertaining to medicine and neuropsychiatry, would handle this task.

The committee was also to serve as a focal point for follow-up studies that were not directly related to the VA's medical care. Hawley justified this by noting that the VA's greatest research contribution "would be the follow-up of disease conditions throughout a life-time or even throughout several generations." Dr. Francis Braceland also stressed that the committee should not allow its broad mission to cause it to lose sight of follow-up studies "as its major method of attack." The committee passed a motion that ''in allocating support for research problems, emphasis be given to projects of major importance for long-term study."

Follow-up Studies

One study received consideration and approval at the committee's first meeting. The idea involved the study of soldiers from different geographic regions who had developed rheumatic fever during military service. A greater incidence of rheumatic fever among those in military service would suggest the importance of environment, rather than heredity. Control groups were formed by using adjacent serial numbers to choose from men with non-rheumatic fever hospital diagnoses in the same year or men who took out National Service Life Insurance, depending on the needs of the particular study. Affected soldiers were also to be compared with family members who had remained at home.

This study indicated just how useful the data gathered by the military could be in understanding the course of disease.17 It also showed that follow-up could take many different forms. Michael DeBakey had tended to emphasize clinical follow-up: the reexamination of a patient to observe the course of a disease or the long-run efficacy of a particular treatment. Beebe, among others, had an interest in what he called "mass statistical studies," done entirely from records and not requiring a doctor to observe a patient. The most obvious sort of mass statistical study involved determining the death rates over time from individual diseases, injuries, or psychiatric conditions that had arisen during the war. Death records were widely available because an estimated 98 percent of all World War II veterans had taken out the National Service Life Insurance policies offered them during their service.18



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