The loyal opposition

Abstract

S INCE 1948 I ha\re watched the power of government grow in its relation to the conduct of research and medical practice. This has been and is an exciting experience. But as some say, fortunately we don’t get all the government we pay for. In retrospect, most of it has been for the good, but the bad has yet to be filtered out. The “good guys” are the good bureaucrats, while I am among the bad guys, a skeptic. We need far more good guys than skeptics, but without the latter there would be chaos because tllost good guys are activists-better to do something bad than to do nothing at all! When uncertain of what to do they exhibit Brownian Inovelnent, jostling this way and that on dead center, all the while seeming to be doing something. During such phases they are often inclined to pass legislation of the “thrusting, innovati\re, targeting” kind ! Skeptics are unpopular, as well they should be; there must be a streak of meanness in them and envy for goodies they have cut themselves out of. The Rose Garden, intellectual diplolIlatic immunity and membership in jet-set Acadelne is not for them. But without the atmosphere they create, good science or medicinc is dead. Without a loyal opposition-and this is the way I prefer to think of skepticsactivists run without brakes, the horn of publicity on full blast. Thrre is a strong wind blowing for governmental direction of clinical research to “identify” and foster those areas most likely to bring fruitful results. Among the many possibilities in cardiovascular disease, the artificial organ area was selected. At a time when there is much worry over excess numbers of people and the resliltant threat of famine, why this sudden concern for prolonging life, if such is possible, by artificial organs? While millions are lacking enough food for subsistence, we exhibit a touchinq concern for the few who are fatally handicapped. As an experiment I favor it; as a social phenornenon, I sharply question it ! Being a partly artificial man has little appeal for me. But to show you how unconsciously up-to-date even Boston can be, I recently saw a sign in the window of a music shop on Tremont Street advertising, “used organs for rent.” To my great surprise, I read in the New York Times that some of the “active role in guiding research” seems to have blown over onto the American Cancer Society. Its board of directors adopted a resolution calling for the society, “to map out and encourage research in areas that promise direct and immediate help to patients.” Only I could quarrel with these sentiments. To a limited point I must agree, but for the long pull the concept will do more damage than good. If Einstein, Hahn and hlitner had been concerned with bringing the fruits of the laboratory to the annual “breakthrough dinner,” we would be without both atomic energy and the more ordinary variety in the next hundred or so years, except for that which produces babies. To me the main problem of the public health aspect of cardiology is prevention of rhellmatic fever, hypertension and arteriosclerosis. These diseases are responsible for the vast majority of cardiovascular deaths, and yet they receive short shrift in comparison with the more glalnorous aspects called bioengineering. This subject is one of the strange paradoxes of Inedicine. LVe seem to know the price of so much and the value of so little. This is my complaint, but what to do about it? Here are some samples of my bill of particulars. 1. Research excellence is usually achzeved by buzlding an environment conducive to creativity. Creativity is a delicate flower, but it is worth the most perceptive cultivation. There are two ways to recognize it: by the results achieved and by its feel. Both are necessary criteria. hiost uni\,ersities create such an environment by guess