1. Short History of the U.S. National Institutes of Health Victoria A. Harden, Ph.D. Historian, NIH

2. U.S. Federal Government and Medical Research No support at all before late 19th century Medical system based on “humoral” theory U.S. Constitution made no mention of health or medicine

3. Marine Hospital Service Established in 1798 under the commerce clause of the Constitution Series of hospitals for merchant seamen Placed in Treasury Department to collect 20 cents per month from each sailor Marine Hospital, New Orleans, Louisiana

4. Political Philosophy Americans were suspicious of government funding because they believed: If government funds research, government can control what research gets done. People who accept funds from the government are not self-reliant.

5. Discovery of Anesthesia Only major U.S. contribution to medicine before the U.S. Civil War Wholly in the private sector “The First Operation with Ether” by Robert Hinckley

6. Intellectual Revolution, 1870s-1890s The Germ Theory Louis Pasteur Robert Koch

7. The Power of the Germ Theory

8. National Board of Health First grants for medical research to university scientists Bitter political disagreements 1878-1883/93

9. Laboratory of Hygiene Marine Hospital Service Marine Hospital, Staten Island, NY Joseph J. Kinyoun, M.D.

10. Kinyoun’s laboratory Kinyoun’s microscope & first publication

11. Growth of laboratory 1891--moved to Washington, DC 1894--production of diphtheria antitoxin begun rabies vaccine, smallpox vaccine made available Diphtheria antitoxin made by Hygienic Laboratory, 1895

12. 1902 Biologics Control Act 1901: 13 children in St. Louis died from contaminated diphtheria antitoxin 1902: Congress acted Hygienic Laboratory given regulatory responsibility Mulford rabies vaccine outfit

13. 1901 NIH’s organic legislation Buried in a supplemental appropriations act Authorized $35,000 to build one building Authority to investigate “infectious and contagious diseases” 25 th & E Sts, NW, Washington, DC, 1904-1939/41 home of NIH

14. 1902 Research Program Begins New Name: Public Health and Marine Hospital Service Hygienic Laboratory organized into 4 divisions Pathology and Bacteriology (original work) Zoology Chemistry Pharmacology Ph.D.s hired to head new divisions

15. 1912 Non-infectious disease research New Name: Public Health Service Hygienic Laboratory authorized to investigate noncontagious diseases and the pollution of waterways

16. Pellagra: niacin deficiency Who got pellagra? Dr. Joseph Goldberger

17. Hookworm: parasitic helminth Who got hookworm? Dr. Charles Wardell Stiles

18. 1916 First professional woman hired Dr. Ida Bengtson, Bacteriologist Worked in Biologics Control

19. Ransdell Act, 1930 Hygienic Laboratory renamed National Institute of Health Charles H. Herty, Ph.D. (Georgia and N.C.) Senator Joseph Ransdell (Louisiana)

20. 1930s Change in Political Philosophy Government “control” can be used to rectify injustices Government “control” can provide oversight of ethics of research Scientists can remain self-reliant if they decide which projects to undertake

21. NCI created, NIH moved to Bethesda 1937--National Cancer Act foreshadowed categorical structure authorized to give grants and fellowships 1939-41--move from DC to Bethesda NIH’s Bethesda campus under construction, ca. 1939

22. 1938-41 70 Acres for Science Some opposition to construction from Bethesda Chamber of Commerce and Montgomery County Commission October 31, 1940: FDR dedicated campus

23. Steps Toward War Sept. 1, 1939 June 1940 Sept. 1940 Germany invaded Poland Battle of Britain U.S. National Defense Council established Japan signed mutual assistance pact with Germany and Italy: global war Congress enacted first peacetime draft in US history

24. Health of Recruits 43 percent unfit for military service 28 percent not fit for any military service 15 percent fit for limited service only NIH Division of Public Health Methods worked with the Selective Service

25. Research for the home front: Workers protected Dangers of specific munitions Diagnostic tests for toxic materials Working conditions of >300,000 defense workers improved

26. Research for the battlefield Exotic diseases Malaria Yellow fever Epidemic typhus Tsutsugamushi (scrub typhus) schistosomiasis Battlefield trauma Shock Burns Blood & blood products High altitude physiology

27. Architects of today’s NIH Surgeon General Thomas Parran NIH Director Rolla E. Dyer World War II leaders

28. 1944 PHS Act Authorized NIH grants program Authorized clinical research Mandated materials prepared for public

29. Rapid growth, 1945-2001 1945: NIH and NCI 1949: 6 institutes 1969: 15 institutes, centers & divisions 1999: 25 institutes & centers 2001: 27 institutes & centers

30. NIH Clinical Center NIH Clinical Center, 1953 “Pool of Bethesda”

31. Lorraine cross design philosophy Goal: transfer new biomedical knowledge as rapidly as possible from the laboratory to the patient’s bedside

32. Hippocratic Oath: First, do no harm Nazi medical experiments –Nuremberg Code (1946): Informed consent must be obtained Clinical Center review of protocols, 1953 Tuskegee syphilis study (begun 1932, recognized as public scandal 1972) –Protection for Human Subjects Act (1974): – Institutional Review Boards established –NIH Office of Protection from Research Risks established Office of Human Research Protections, DHHS established June 2000 Protection for Human Subjects

33. Major lines of research, 1945-2003: Human Genetics http://history.nih.gov/exhibits/genetics/

34. Major lines of research, 1945-2003: Basic Research http://history.nih.gov/exhibits/bowman/

35. Major lines of research, 1945-2003: Chronic Diseases http://history.nih.gov/exhibits/opiates/

36. Major lines of research, 1945-2003: Transitional Research http://history.nih.gov/exhibits/thinblueline/

37. Major lines of research, 1945-2003: infectious diseases http://aidshistory.nih.gov/home.html

38. Training junior scientists http://history.nih.gov/exhibits/stadtman

39. NIH worldview: absorbing but dangerous. How do we deal with the brave new world? NIH poster, with apologies to Steinberg