Letters to the Editor

LETTERS TO THE EDITOR Dear Sir: re: International Scientific Collaboration: How Will It Enter the Twenty-first Century? The papers published in Proceedings ofthe International Symposium on "The Role and Significance of International Cooperation in the Biomedical Sciences" provide a perspective of the past and present status of international scientific cooperation. However, discussion of the future is noticeably limited to comments on how to continue the practices already developed. No discussion is made ofalternative or innovative approaches to international collaboration. This omission is striking because there are some trends that work to reduce the feasibility of the older approaches. First, while we can all deplore the shortage of funding for investigators to visit and/or undertake research in a foreign laboratory, perhaps we should question how practical this is. In the United States, at least, the proportion of young professionals involved in a two-career marriage is increasing. This obviously complicates planning of a foreign fellowship , no matter how desirable it is. Furthermore, specialty and subspecialty training is now so long that many young investigators will have begun a family by the time they have gained enough knowledge in their chosen field to benefit from a foreign fellowship. Second, the past half-century has been characterized by an exponential growth in knowledge. In medicine, this has been accompanied by an increasingly heavy reliance on advanced technology. For example, in my own field, cardiology, physicians no longer need to scan through yards of electrocardiographic recordings while exercise testing a patient; they can wait for the computer to store and analyze all cardiac cycles and print out an average beat for each stage of exercise. High-speed image processors acquire, display, analyze, and store megabytes of data, providing "bread-loaf" views of the heart and its diseased myocardium. While these devices facilitate certain types of research, the usefulness of their study to the foreign fellow whose own country lacks the resources to purchase such a device is questionable. What are the alternatives? I will describe one approach [1] that has been an ongoing success over the past 4 years—not as being the only one or the best but as an example of how available technology can be used. First, let me provide some background information. Atherosclerotic heart disease is a major health problem in the Western nations, but it is a difficult and slow task to evaluate new 'Published as issue 3, part 2 of Perspect. Biol. Med. 29, 1986. Permission to reprint a letter printed in this section may be obtained only from the author. 308 Letters to the Editor therapies. The standard end point is survival—does the treatment prolong life? However, death is not a specific end point, since patients may die of unrelated causes and the death rate is low enough that thousands of patients need to be studied to provide adequate statistical power to test a hypothesis. Therefore, the measurement of the function of the left ventricle of the heart provides a satisfactory intermediate end point because it is quantitative—so fewer patients need to be studied—and it correlates with survival anyway. However, left-ventricular function is most accurately measured by performing contrast angiography, an expensive procedure which in the United States will not be reimbursed by insurance companies unless performed for patient care. Angiography can be performed in West Germany for clinical research, and my collaborator, Dr. Detlef Mathey, has very actively been studying patients in Hamburg. Left-ventricular function is most accurately analyzed using computer-assisted methods, which constitute the subject of my research in Seattle but which were not available to Dr. Mathey. One may think that the story ends here, with the union of our efforts, but it does not. Initial attempts at collaboration between our laboratories were frustrating; the postal system was slow, and telephone calls were not only expensive and inefficient for data transfer but difficult to schedule owing to the 9-hour time difference between Hamburg and Seattle. The breakthrough came in 1984, when we established a computer link via satellite, enabling daily low-cost transmissions of queries, messages, data, results, and even abstracts. In fact, whole manuscripts have been drafted in Hamburg, transmitted to Seattle for addition...