Growth—Magnitude and Consequences in Medicine

GROWTH—MAGNITUDE AND CONSEQUENCES IN MEDICINE* IRVINE H. PAGE, M.D.f On great occasions such as this Mayo Clinic Symposium on "Growth—Magnitude and Consequences," I think of Robert Benchley's remark that before starting a speech, it is a good idea to say something. What I want to say is simple and self-evident, but cannot be overemphasized . The Mayo Clinic originated group practice. Equally important , as a result ofits high ethical and scientific standards, it has nurtured this great innovation. It is hard to select among the complexities of our lives those things which may affect our growth. I must be brief, arbitrary, and provocative, not an unfamiliar stance for me. I wish I could give my thesis an authoritative flare with a semantic density which would make me quotable even if incomprehensible, like the woman who wrote a note to the milkman saying, "Don't leave milk today. Ofcourse when I say today, I mean tomorrow, because I am writing this yesterday." I shall divide the problem of"Growth—Magnitude and Consequences in Medicine" into three categories: (1) material growth, (2) cultural growth, and (3) transcendent growth. Material Growth Material growth in medicine has been prodigious, and there are no signs of a decrease. So spectacular has been the production of new drugs, vitamins, and instruments that most people have accepted them as the principal mark of progress. How has this come about? Money has been one of the important ingredients, first from private and commercial sources and later from government. Until the advent of taxpayer's money, the amounts were small, biomedical science grew slowly but surely, and few thought of concerning themselves with research as an essential profession. But government has changed all that. ?Address presented at the Mayo Symposium on Growth, Rochester, Minnesota, October 1973. fResearch Division, Cleveland Clinic Foundation, Cleveland, Ohio 44106. Perspectives in Biology and Medicine · Autumn 1974 | 123 Since research is the basis for material advances in medicine, it is worth digressing a moment to comment on research policy; some have called it the "science of science," a phrase to which as often used I do not wholly subscribe. It would be easy to espouse a single approach as being uniquely productive . But looking back three centuries—the Baconian period of systematized research—it is clear that there is no single way. At the risk of being dogmatic because of brevity, I shall give you my philosophy of research. Research prospers best in the special circumstances called a "research environment," which usually is created by the head of a laboratory. Space, equipment, ancillary personnel, and abundant money are not its prime constituents. This needs special emphasis today because many young investigators feel bereft without a surfeit of each. The quintessential element is the type of stimulating atmosphere which is both cooperative and competitive, harmonious and critical. The two qualities I cherish most in an investigator are character and the ability to use freedom responsibly. Research workers can be divided roughly into the team workers and the "loners." Both should be able to find a home. The subject of their studies had best be left to the investigator, although I believe that a group is better when a general theme is followed, such as cancer or cardiovascular disease. As you have guessed, what government calls "targeted research" has a very limited appeal to me, because it is so much more likely to succeed in the applied rather than the basic sciences; hence, my long-time opposition to the concept of the current "war on cancer." There are those who study highly limited problems in great depth and intensity and, if successful, may be rewarded with a Nobel Prize. Others cover much broader objectives and tend to discover relationships among the varied facets of nature. The results of their efforts are harder to pinpoint but are equally vital. If a suitable research environment is created, then what may we expect? My guesses are: (1) We as a nation are aware of the necessity of research; it will not wither. (2) Over the short term, its rate of growth will probably slacken. (3) The loss of some monies devoted to specific programs will...