Informed Consent and the Old-fashioned Conscience of the Physician-Investigator

INFORMED CONSENT AND THE OLD-FASHIONED CONSCIENCE OF THE PHYSICIAN-INVESTIGATOR* PAUL HELLER, M.D? When the Veterans Administration decided in 1960 to create the annual Middleton award for medical research performed at a VA hospital, it honored its chiefmedical director, who presided over the vast medical program of the VA from 1955 to 1963 with colorful originality, great energy, imaginative thinking in administration, and an almost missionary zeal in making VA hospitals academic institutions. He took on this task at the age of 65 after having been dean of the University of Wisconsin Medical School for 20 years. His longevity in thisjob and his ability of withstanding the hardship of the administrative and political responsibilities of the deanship must have been maintained not only by his great devotion and emotional attachment to the school which he helped to develop since 1912, but also by his insistence on spending each morning in nonadministrative endeavors with students and housestaff [I]. During World War II he served as the chief consultant in medicine for the U.S. Army's European Theater of Operations and afterward belonged to the group which General Bradley, General Hawley, and Dr. Magnuson assembled to advise them on their imaginative plan to bring the many VA hospitals, to be constructed, under the professional control of the neighboring medical schools and to remove all traces of "pork barrel" aspects in the construction ofnew VA hospitals, most ofthem on or near the campus ofmedical schools [2]. There was only modest medical research activity at some VA hospitals when Dr. Middleton assumed the reign as chief medical director in 1955. He recognized the function of medical research as a badge of academic excellence and under his administration the impetus to develop the VA research program began. When he came, the VA research budget was less than $5 million, but his dynamic leadership and his vision of VA hospitals as academic institu- *These remarks were delivered at the occasion of receiving the Middleton Award for Medical Research on April 20, 1976, in Washington, D.C, and slightly altered for publication . tSenior medical investigator, V.A. West Side Hospital, and professor of medicine and chief, Hematology/Oncology Section, University of Illinois Abraham Lincoln School of Medicine, Chicago, Illinois 60680. 434 I Paul Heller ¦ Informed Consent tions propelled it to 10 times that level in 1963 and laid the administrative basis and organizational pattern for continued growth. Needless to say, I am greatly honored by receiving the award that carries the name of this distinguished figure in American medicine. Dr. Middleton's long and productive career as a physician, educator, investigator , and administrator can serve as a model for demonstrating the most attractive features of the Oslerian tradition and clinical investigation which has become an epoch in medical history that is coming dangerously close to ending; and the attempts ofkeeping it alive behind the confusing and bewildering clichés that have become the points of gravity in today's concepts of medical education, such as general medicine, family medicine, and primary care, may be intellectually and culturally too feeble to become an effective humanizing counterweight to the computer, automation, and the other marvels of technologic advances . The hallmark of Dr. Middleton's bibliography, consisting of 280 items, is diversity. There are titles such as "The Influence of Respiration on Venous Pressure," "Insulin Shock and the Myocardium," "Multiple Myeloma and Diabetes Insipidus," "The Clinical Study of the Atrophic Tongue," and many others, including numerous articles on medical education and medical history, pointing to a universality of interest that today would hardly be favorably looked at by the wizards of NIH study sections or VA research committees and probably would receive their critical and disapproving comment: "unfocused." He remained an active medical educator in Wisconsin until September 1975, when he succumbed to appendicitis, youthful even in the cause of death. I saw Dr. Middleton the last time in November 1974, 2 months before his eighty-fifth birthday, at the Midwest Blood Club—probably one of several meetings of subspecialty organizations which Dr. Middleton attended as a qualified member; during the cocktail hour and dinner we lightheartedly chatted and gossiped, as far as this was consistent with...