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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE
NATIONAL INSTITUTES OF HEALTH
BETHESDA, MARYLAND 20205

   

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Dr. Joshua Lederberg
President, The Rockefeller University
New York, N.Y. 10021

Dear Josh:

In your letter of April 16, you asked what, since 1950, "have been the
most significant innovations in health and medical practice, judged by
their actual impact on health outcomes for significant numbers of U. S.
citizens?" You list five items and I would agree with their inclusion
on such a list, j.e.:

- Management of hypertension

- Management of fluid volume, electrolytes and
pH in acute illness

- Vaccines

- Oral contraceptives

- Psychotropic medications

1 would also include:

Antibiotics

Improved blood banking

Renal dialysis and transplants
Radioimmunoassays

Open-heart surgery

You ask about secondary references. I am aware of the following publications
which contain a similar list:

- Comroe and Dripps, Science 192, 105, 1976 (copy enclosed, attachment A)
considered "clinical advances since the early 1940's that have been
directly responsible for diagnosing, preventing, or curing cardio-
vascular or pulmonary disease, stopping its progression, decreasing
suffering, or prolonging useful life." Their list is given in
Table I of the paper. Further elucidation is found in, "The Top
Ten Clinical Advances in Cardiovascular-Pulmonary Medicine and
Surgery 1945-1975" by Comroe and Dripps, DHEW Publication No.
NIH-78-1521, and in “Retrospectroscope-Insights Into Medical
Discovery" by Comroe, Van Gehr Press, 1978.
Page 2 - Dr. Joshua Lederberg

- The President's Biomedical Research Panel, in their report
of April 30, 1976, included in Appendix B an "Analysis of
Selected Biomedical Research Programs." The Panel selected
18 biomedical advances "to serve as models to characterize
the path of biomedical research." The 18 advances are listed
in attachment B. A follow up to this study examining 25
advances is found in a report, "Further Analyses of the
Characteristics of Research Resulting in Clinical Advances
From Inception to Clinical Usage" prepared by R: I. Leininger
and G. W. Levy of Battelle for NIH on February 28, 1977,
under Contract No. NO1-QD-6-2125. The 25 items are found
in attachment C.

- "Medical items listed as innovations by selected NIH professionals"
appears in a chapter by L. M. Bernstein et al., which I include
as attachment D.
I hope this information is of use to you.

Sincerely yours,

Ve

Donald S. Fredrickson, M.D.
Director

Enclosures