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STANFORD UNIVERSITY MEDICAL CENTER
\ STANFORD, CALIFORNIA 94505

 

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July 11, 1975

STANEORD UNIVERSITY SCHOOL OF MEDICINE
Department of Genetics
f415) 497-5032 —

Dr. William Baker

Biotechnology Resources Branch
Division of Research Resources
National Institutes of Health

Bethesda, Maryland 20014

Dear Bill,

Our mutual colleagues here have called my attention to the white
paper which you had put on the AIMADV directory and on which I will give
you some comments shortly.

By coincidence I have had somewhat similar preoccupations recently
and in fact had sent you a message, of which I enclose a copy here now.
I should stress to you that all of this was written without knowledge of
your own draft.

I am still trying to think through the basic strategies of responding
to this mission for WHO. Of course, it has a very important difference from
the challenges for this country, namely that the immediate problem is to
bring the rest of the world up to a standard that even nearly approximates
that which has already been achieved here.

I understand that you may be visiting here within the next few weeks
and I would certainly enjoy having a chance to talk over the draft with you
in some more detail at that time.

That would be a be-ter occasion to discuss the details of your white
paper, but I might mention just a few comments now,

Of course, it is true that environmental engineering based on rather
crude knowledge of infectious process has accounted for the larger part
of the control of contagious disease in developed countries. Where it was
possible to develop an effective vaccine, as in the case of smallpox, we have
substantial hope of actual eradication even on a world-wide basis, But even
here we should comment that imperfect knowledge of the vaccine almost
frustrated the effort-since it was only when stable vaccine preparations
that could be assayed fer their effectiveness became available that really
effective control on any global basis actually became possible. A great deal
of previous effort was wasted owing to the inefficacy of the vaccine in a
tropical environment. Probably similar things might be said about the last
ditch eradication of, for example, typhoid fever - the efficacy of vaccination
programs on the basis of present knowledge there being probably almost entirely
mythicalf

over
LY. J. P, KENNEDY, JR. LARORATORIES FOR MOLECULAR MEDICINE, DEDICATED TO RESEARCH IN MENTAL RETARDATION

MOLECULAR BLOLOGY HEREDITY NEUROLIOLOGY DEVELOPMENTAL MEDICINE
 

Dr. William Baker -2- 7/41/75

The infectious diseases that still remain a serious problem in many
parts of the world, like veneral disease, tuberculosis and above all malaria
and the parasites, probably can not be efficaciously controlled on any
socially and economically realistic basis without additional technology!

But technology will hardly be enough if there are not the means and the
manpower to disseminate it.

If we pass by those considerations and turn to the degenerative and
neoplastic disorders, which are our major public health problem in this
country, then of course I agree that we absolutely require much more
sophisticated knowledge of the disease process,

My own perspective on the role of artificial intelligence in that
arena does not quite coincide with the presentation that you have offered
if I understand it. I guess I am not optimistic that artificial intelligence
by_itself is going to lead to a revolution in our understanding of a
particular disease, Rather, I think of it as a major supplementary tool
together with any other lines of research to enable us to make much more
rapid progress than might otherwise be possible for the solution of a
variety of very tangled and complicated problems. In this way, for example,
the DENDRAL effort is just as relevant to the understanding of disease by
the support that it can give to the comprehension of chemical structure
and then of metabolism, chemotherapy and so on, as are the programs that
are more immediately directed to the modelling of disease processes.

I do agree with your remarks just before the heading "Opportunities
for Technology" about some of the system impediments to the actual solution
of disease problems. But I think you should clarify that this is not so much
the lack of incentive and motivation within the academic sphere as it is the
extreme complexity of dealing with the political and social environment which
constitutes the setting of disease control. Academic people are simply not
going to be g’ven the power to implement the kinds of changes that will
accomplish th: goals that we all agree upon. So in that framework it is indeed
true that there is not much encouragement or motivation to attempt an
impossible ta:k from that particular platform. However, I agree that more
could be done than is at the present time to bridge the gap between academic
research and practical applications. But for a very good example of how not
to do it, look at the cancer crusade with its implication of centralized
management knowing all the answers!

If it were only possible to get across the message that it is the
business of th2 political central management to define the goals and then to
get the scient [fic talent needed to effectuate those goals from the periphery,
I think we could make much more rapid progress. I do not think a few people
in Washington or even in the Bethesda are going to compete effectively with
the scientific and medical insight that is distributed around the rest of
the country in the definition of scientific solutions to the problems once
these have been carefully stated and the incentives to solve them laid out
by political decision.

 

over
 

Dr. William Baker -3- 7/11/75

Well, E really do think it will be much easier to go over this
if we do have a chance to discuss it in person. If that does not prove
to be practical, I will try to prepare a more deliberate set of comments.

To return to my original point about WHO, you can see that I am myself
engaged in a rather similar exercise in trying to formulate some strategy
for the most effective collaboration of technology and social decision in
what may be an even more complex environment. So, any help you can give
me on that score would certainly be very much appreciated. However, as I
may have indicated before, this is to be kept somewhat discrete as I am
still not exactly clear what my role will turn out to be when I return to

Geneva.

Sincerely yours,

  
  

féshua Lederberg
Professor of Genetics

JL/rr