[This tape was duplicated from a BCSP Video Master by Colorlab for the National Library of Medicine January 2006, NLM Call number HF 5261] [Leaders in American Medicine] [Produced by The National Library of Medicine in collaboration with Alpha Omega Alpha] [James A. Shannon M.D. [Interviewed by Thomas Kennedy M.D. Recorded January 1984]] Dr. Sherman Mellinkov: I'm Doctor Sherman Mellinkov and it is my privilege, as president of Alpha Omega Alpha Honor Medical Society, to introduce the filmed interview that follows. This interview, one of a series entitled "Leaders in American Medicine," was made possible by an endowment left to Alpha Omega Alpha by the late Professor David Segal and his widow, Dr. Beatrice Segal, both distinguished physicians and members of the faculty of Columbia University College of Physicians and Surgeons. The "Leaders in American Medicine" video tapes represent an effort to preserve something of the character and spirit of outstanding physicians and medical scientists before they are gone from us, as elicited by the one of the individual's own students or colleagues. Thomas Kennedy: Jim, any discussion, interview with you on the subject of leadership in American medicine really has to have, as its focal point, your thirteen years as director of the National Institutes of Health, but I was very interested in your earlier remarks, that so many of your earlier experiences seemed to have equipped you so well for the problems that you faced as the Director of NIH. Could you give a quick review of that, to kind of put the perspective on the major topic? James Shannon: Yes, I think that'd be relatively easy to do. I was born close to the turn of the century, at the beginnings of New York City as a municipality. I was brought up in a rural enviornment, although contained within the city of New York. I went to local grammar school and high school, a high school in Brooklyn, actually, and then college as a young person in age, just past the fifteenth birthday. I went to Holy Cross, took a Bachelor of Arts degree and majored in philosophy. I was probably a better athlete than a student. I then went to medical school at New York University beginning in 1925. In medical school, from 1925 to 1929, interned in Bellevue. There was no system of residencies at the time, so I had a two-year internship at Bellevue, ending as House Physician of the Third Medical Division and then went for a tour of nine years at the Department of Physiology at New York University. This would bring me to 1940, when I initiated the new laboratories at the Goldwater Memorial Hospital that is the Third New York University Medical Division. This hospital was the first chronic disease hospital built purposefully for that purpose, for the investigation and management of chronic illness, and I stayed there through 1946. But, with the opening of hostilities with the Japanese, converted my programs from physiologically-oriented inquiry into medicine, to the very practicalities of the needs of the armed forces, which was some way to contain the malaria problem of our armed forces, which we were able to do successfully. Immediately after the World War Two, although I had accepted a professorship at my former college in New York University, I elected rather, because of the resources, to join an industrial group for a short period of time. I was director of the Squibb Institute for Medical Research for a three-year period, during which time I was on the Board of Directors of the Squibb Enterprises, a member of their Industrial Management Committee, and was fortunate in having the opportunity of introducing modern developmental laboratories in support of their industrial operation. This brought me to 1949 when, at the age of 45, I was invited to join the staff of NIH as Director of the Intramural Operation and as Associate Director of the National Heart Institute, which had newly been created by the Congress in 1949. I stayed in that enterprise for three years and developed patterns of employment and patterns of program development that were novel to NIH, and, probably on the basis of that successful experience, moved to an associate directorship of NIH for a three-year period, and then to Director of NIH in 1955 at age 51, that would be. I was Director of NIH for some thirteen years, retiring, as was conventional, on my sixty-fourth birthday, as a career officer of the Public Health Service. And then, with a short stay as a Scholar in Residence at the National Academy of Science, I moved up to Rockefeller University as Professor of Biomedical Sciences, where I stayed for some six or seven years, retiring in 1975 primarily, again, because that was another retirement period of a professor at Rockefeller. I elected to return to the Bethesda area, rather than stay in New York because it was a more pleasant place to live, but eventually moved to Portland, where I've been for the last five or six years. Now, in my post-NIH period, one of the dominant influences of my activities has been a series of consultancies to voluntary agencies and industry. First at Merck and later with the Reynolds Corporation, which has been important that it's maintained contact with biomedical sciences, despite the progressive aging. The aging process, if you will. [Laughter] So, I think, in retrospect, I was fortunate to come to NIH at the time that it was ready for explosive growth, but I think anything I contributed to NIH was largely the fruits, or the collection of an extraordinarily rich background which had, as its characteristic, more serendipity than intense personal planning. But very few things I did in that background did not find practical utility in the management of the NIH enterprises. Dr. Kennedy: It's interesting to me, that is, as you're thinking about leaving industry, you look at Brookhaven, which is a joint federal-university enterprise, and you look at NIH, you must also have been looking at opportunities in academic institutions. What tilted you in which direction and why? Dr. Shannon: I did have opportunities to leave industry either for a job in medicine, usually it would be a research professorship in medicine or one in pharmacology, for example. And in the period before and after I went into industry, I had job offers from such places as University of North Carolina, University of California - San Francisco, University of Illinois - Chicago, places of that general sort that had the conventional resources available, but were not attractive because I did not think they had the monetary resources to mount a sustained program of scope, which I felt the biomedical sciences were ready for, at the time. So, when I went down to Bethesda, they laid out the program and they said, as an initial commitment, they had assigned five million dollars for the beginning of the intramural program of the Heart Institute. They said they would like me to come down there and develop that program, which, at the time, had one employee, and that was the Director of the Heart Institute, Cassius Van Slyke. And when I arrived down there and said "yes" to that, there was one quasi-scientist employed in a sort of incidental basis. I was offered to replace Harry Eagle as Director of the Scientific Enterprises of the Cancer Institute or I was offered to come down to NIH and develop a program of my own that I felt was badly needed for the biomedical sciences that could be supported within the very broad mission of the NIH at that period of time. Well I was sensible enough to realize that I did not want to put them in a position for that to peel off resources from this side of the other institute to satisfy my needs. I did not want to replace Harry Eagle and inherit all the mistakes they had made in the Cancer Institute as well as the wise choices they had made. And I had been given five million dollars and said, "What do you want to do in the field of cardiovascular research, you yourself, as director of this enterprise?" That, to me, seemed to be quite a challenge as compared to returning to academic life with limited resources and a heavy teaching load. There was no comparison. Dr. Kennedy: Jim, the NIH wasn't the world's most distinguished institution, the intramural program, at that stage, was not the world's most distinguished, and there was very little of an extramural program. Did you have trouble recruiting people? I know there were some people, like myself, who were anxious to come, but...the junior physicians. Dr. Shannon: No, no. Go back to what I said earlier, how I was invited down by Topping and by Dyer. I became acquainted with Dyer very early on, as the director of NIH, which he was by the end of the war, but more importantly, he was a member of the Committee on Medical Research, which was [?] committee for the management of American science for the military during World War Two. So he knew me from way back when he and Topping made their initial moves in New Orleans to recruit me. They both knew that the wartime enterprises had been outstandingly successful, despite the complexity and breadth of the program. They felt that the Goldwater enterprises, which sprung up and were developed in a very short period of time, was precisely the thing they wanted done at the new NIH, the post-war NIH. They thought I could do it and they were willing to make a very broad commitment, but I felt that the more natural thing was to take what, superficially, was a bad prospect, namely a categorical institute operating within a government bureacracy, in an area where the objections were explicitly spelled out, and that is the ultimate management of the cardiovascular system. I thought that, if NIH would accept the approach that the problem with the cardiovascular system, again, were problems of the understanding of biological systems, which involved the quantitative definition of the interrelationship of these very complex biological mechanisms as the first approach to understand the nature of disease, much less its later management, that that's something I'd like to try my hand at. And, given a commitment of five million dollars, not a dollar of which was committed in any program. I had the opportunity to start from scratch. I didn't start from scratch to develop a cardiovascular program, I started from scratch to develop the management background that would support a very broad biomedical enterprise that had its base in the biological sciences, on a very fundamental level, and its transmission on the semi-applied level, physiological, pharmacological...[?] and its eventual expression in the clinical sciences, and thought that the time was right for such an enterprise to take place. Remember, now, we're talking about 1946, and I said earlier, that the Goldwater Memorial Laboratories were the first research laboratories attached to a hospital, the entire purpose of which was the care, management, and development of a means of managing chronic illness. And the Heart Institute was the first commitment of the federal establishment to this broad approach because this now involved, not only in the laboratory work, which was the commitment with the early starting of the Cancer Institute in 1936, but now a very broad enterprise was an important clinical element. And, if you recall, I left the university because I had such a strong feeling that I could not do the work I wanted to, and they sent me every scientist in the government who had twenty years experience and a long list of publications and, generally, who was over 50 and 55 years old, and I used to send them back in piles that high, saying, "There is no suitable candidate for this. Let me find my own people in the academic enviornment." I went to Dyer and I said, "You've asked me out here saying that you want me to explain my capabilities in the development of this field of medicine, but now you ask me to operate within rules that defeat me before I even start." And he said, "What's the problem?" I said, "I can't hire the people I want to. Who are the only type people who are useful for my approaches. Solutions to problems in medicine." And he said, "Who's stopping you?" And I said, "Civil Service's regulations." He said, "Well let's talk to the commission." From there on, now the important thing is, that decision totally changed the recruitment problems of every new institute that was formed at NIH. It permitted me to go out and recruit commissions for the opening of the Clinical Center, such as never would have been recruitable by any other device. So it set the pattern of recruitment that permitted NIH to recruit the type of commissions that opened the Clinical Center, some two or three years later that really set that up as one of the best training grounds for young commissions that had ever been developed in this nation. So that was a fantastic opportunity that I was given, but I had to fight for it. [Dr. Kennedy]: It worked out. The intramural program of the Heart Institute was a very strong program when you enacted it. I guess you also recruited, along with Chris Anfinsen, and Bob Berliner, and Steve Brodie, and... Dr. Shannon: I say, Chris Anfinsen is an interesting case in point, and one of the young people of Brodie's group. The two of them now have Nobel Prizes. Dr. Kennedy: Yeah, Julius Axelrod, Sid Udenfriend... Dr. Shannon: A fantastic group of people. Dr. Kennedy: Yeah, yeah. You also recruited the first bunch of clinical associates at the NIH. Dr. Shannon: Of which have been the two last directors of NIH. Dr. Kennedy: Yeah, Don Frederickson was in that group and Jim Wyngaarden. Dr. Shannon: That were some very good friends of mine who I'd known over the years, who knew my background, knew our experience at Goldwater, and who knew the people who I'd recruited already for NIH, and understood what I was talking about when I said what I wanted to do. And I went to each of these institutions and I interviewed the people they selected, now this basically set the pattern. There wasn't a single person that I offered a job to, in that group of residents that didn't accept it. Dr. Kennedy: Yeah, I guess the Public Health Service at NIH had had no clinical unit at all, until that time, and that it was a, kind of a spotty operation. There were some very good people, you remember just below us were Arthur Kornberg and Bernie Horecker and Walt Merrill had done some beautiful work. And [?] there were a lot of good isolated islands of excellence. Dr. Shannon: But no medical extension. Dr. Kennedy: Right. Dr. Shannon: I was recruited this time by Henry Sebrell. I remember one thing he told me. He said, "Jim, one thing I can assure you is that I know you're worried about budget." He said, "I'll handle all the budget. You won't have to touch things." He said, "All I want is develop NIH along a conceptual line, to give us the type of clinical enterprise that NIH will be proud of, that will have a profound impact on its comparable counterpart within the university environment." He said, "I think it can be done, but I have nobody else who can do it." So I didn't think all those thoughts, basically, really, until I became... it was after I became Director of NIH. When I joined Doctor Sebrell's staff, it was with the objective in mind of providing a clinical resource that had excellence equivalent to none other in the country. And this was my purpose. And I think we did it. Dr. Kennedy: This was associated with the opening of the Clinical Center, for patients? Dr. Shannon: Yep. This is why I feel so strongly that, when NIH had the opportunity of 500 research beds, this had to be the best in the nation, otherwise they were selling the area down the river. And I thought that these were pretty blue chips to work with. I say work with, rather than play with, which is the conventional way of playing. Dr. Kennedy: I take it your industrial experience also served you well when you got saddled with the polio vaccine problem. Dr. Shannon: Well, that's an interesting thing because this is a problem that came out of the blue, and, see, in the spring of '55, the National Foundation for Poliomyelitis Research, which was the full name, NIFP, supported most, if not all, of the research in poliomyelitis, had directed its effort to the positive development of a vaccine. And I'll pause here, as I've pointed out elsewhere that the total [?] level of a vaccine for the myelitis...polio vaccine was not a role that the NFIP contributed to, except the management of the final step, and that was the making of vaccine. The techniques of tissue culture were an NIH development. The use of tissue culture in virus production came out of the Boston environment, I forget... Dr. Kennedy: Enders. Dr. Shannon: Enders and his group recieved a Nobel Prize for it. The differentiation of the polio virus into three separate strains that were distinct [?] was discovered in part at NIH, and in part a number of other people, so that any attempt at a vaccine had to provide protection against three distinct hetogenic strains, not one. In other words, a vaccine could not have been developed until Enders showed how easy it was to use the mammalian tissue to cultivate this vaccine. The vaccine could never have been produced because the hetogenicity of the biological preparation. But what the Polio Foundation did is, given this knowledge, that there are three strains that can be produced in mass development in both fluid and fixed cultures that prove out to be a persistent hetogenic effect that can produce antibodies within biological systems. They had the basis for development. How to select the strains with good hetogenic properties, how to cultivate it so toxins were developed, and how to inactivate the toxins so that a killed virus could be used. The other work was done by a variety. The cap was put on by Jonas Salk, but Jonas Salk really didn't develop the polio vaccine. Jonas put the cap on the thing, and a lot of the people in the virus field were very resentful of the way the publicity of the Foundation handled Jonas. The most resentful one was the man who later developed the... Dr. Kennedy: Oral vaccine. Albert Sabin. Dr. Shannon: Albert Sabin. Dr. Kennedy: The development and release of the vaccine proceeded with great enthusiasm and so forth. And shortly after the release, major problems. And I guess those redounded it very quickly to the NIH because the Division of Biological Standards must have been the one that signed the approval for the release, and that was part of NIH. Dr. Shannon: Yes. Dr. Kennedy: Yeah. What was that episode all about? Dr. Shannon: Well, in the first place, the possessiveness of Basil O'Connor, speaking for the National Foundation, their possession of the prestige for the development got in the way of things. The convention of the foundation said nothing would be published, everything was contained in private documents within the foundation, instead of it being handled routinely in the Division of Biological Standards, as any vaccine would. O'Connor with the prestige, the President's office behind him, imposed upon NIH the need of only two people to have all of the details of the workup, the safety status of the vaccine. One was the Director of the Laboratory of Biological Standards, the other was Henry Sebrelle. They accepted responsibility for monitoring the developmental process, so that, I think, if there'd been free publication, in retrospect, and General Lockes has the information, the problem never would have arose, but, the problem. Through the foundation the vaccination started on a very broad base in a series of weeks. In the first week, the entire Los Angeles population of children were vaccinated, as well as much of the child population of Idaho. I was working working over the weekend, which was some eight to nine days after the initial program and I got a telephone call from Los Angeles, this was eight or nine 'o'clock at night on a Friday night, I think it was from the Health Office of the City of Los Angeles, and he said they'd just had two reports of polio in children who had been vaccinated some nine days earlier, and what should he do about it. But later that night, I got another call from Los Angeles that a third person had been reported and then the next day, there were two more. So, when you get five cases within a span of two days, it's obivous this is not a natural occurrence, even though...it was potentially an epidemic here. The estimate was that the attack rate of induced polio vaccine could be fantastically high, so we talked to the Surgeon General, Saturday afternoon, and I suggested we form a working group of five or six people or larger of the outstanding people who had been concerned with the development of the vaccine, Joe Smardell, who was chairman of the vaccine committee for poliomyelitis. Dave Bodine, who was one of the important virologists, the discoverer of the cell propogation of the virus we mentioned... Dr. Kennedy: Enders. Dr. Shannon: Enders, Sabin, no Sabin was not involved, and Salk. By Monday, we had had a few more cases. I forget the total number of those initial days, it was something like thirteen or fourteen cases. Don Rivers, who was in charge of virology for the National Foundation, the former Director of the Rockefeller Institute and Basil O'Connor came down to speak with Sheily and myself, and, by that time, Sebrell had returned and he sat in with us. I had many sleepless nights in the Monday, Tuesday, and Wednesday, but I had been involved, very peripherally, in the safety tests a month or two before that had put off use of the vaccine for a month, when I pointed out that, on the basis of very fragmentary information, that, to my mind, the safety tests were inadequate and they should be repeated before the vaccine was turned loose. But I didn't realize how inadequate because I didn't have all of the facts, nor were they made available to me. But the first thing I insisted upon, if I was going to have a working committee be helpful at all, there had to be total disclosure of all of the elements that went into the decision-making, of testing the vaccine, and the like. And certain things became immediately apparent. The safety tests and the utilization had been largely based on laboratory-scale work. But the vaccine that was developed for use in the field was large-scale industrial practice, applying much the same techniques. The technique was, inactivation of the formula, which resulted in a logged per-unit time fallen infectivity with time, and the first thought occurred, were the projections to relative zero from the straight line relationship that obtained, and that, that initial night or the second night, I couldn't sleep, and I became convinced that they never had considered the problems that were involved in going from small to large-scale production, going back to my Squibb experience with thousand-gallon tanks of penicillin production. [Dr. Kennedy]: Thousand gallon? [Dr. Shannon]: Thousand gallon, yeah. Thousand-gallon tanks, streptomycin and the like. And the total inability to provide safety techniques from small flask laboratory-type operation. And that one had to assume that one knew nothing. Now, the way these tanks were seeded, and how the things were added, is the proteins and the cells and whatnot were added, they were infected, and then formula was dumped in so it was provided in concentration of a given amount. And it seemed to me that the likelihood of that initial dump of the formula, of high concentrations of formula, producing protein precipitates around the live virus might make them nonavailable for the action of further formula, and that it's the type of thing you could cook until hell freezed over, you could not inactivate in this heterogeneous system. All the safety tests that had been set for the inactivation process were based on laws of mass action which were attributable to homogeneous systems. I felt that what we were dealing here, with a heterogeneous system where the degree of safety was not determined by the sensitivity of the individual tests, but rather by the volume of the material that was tested and the chance of that volume containing an active element. Now, the importance of that view was, if indeed I was right, that we were dealing with a type of particulate matter that was removed from the system and could not be inactivated by whatever length of time those things could be. Then one had a simple physical solution. If one put that next to an asbestos filter, it would remove particulate matter, and only the homogeneous, inactivated materials would come through, and the prediction was that if they introduced two filtration steps, they would have all the safety that was needed. But to be sure that that was the case, they had to test large volumes in proportion to the total batch. So, you could say the chances of a live particle existing within a liter of the material was lessened, perhaps one in a thousand, something like that. Well, I was really castigated by the foundation because, one, it had meant that the pharmaceutical people had to redo their safety tests, two, it had to test the thesis and it would take two weeks to do it, but they had infectious material and they couldn't clean it up with filtration and put in [?] and have an answer in ten days, then my thesis was wrong. If, on another hand, they could take an infectious material that was not inactivatable, that had been cooked for long periods of time and still active, and totally removed the infectivity without removing the antigen, then my problem was solved. And what we did then was run it through, and within two weeks, we could take highly infectious finished vaccine and completely clean it up with single filtrations. On the basis of that, we rescheduled the inactivation process into posing two filtration steps, one at the immediate period of inactivation, and the other at the terminal period of inactivation. We expanded the test material and felt we had an adequate system of safety. But this required a rehearing of the entire industrial process. And it meant that the vaccine that was available was not usable. That only new vaccine made by these newer guidelines was utilizable. And this meant that the pharmaceutical industry had to go out of the business of distributing vaccine for at least a two week period to do it. So I suggested to Len Sheally that the only way to do that was to call and answer the corporations to Bethesda and we invite them down the next day, the responsible manager of the corporation, either the President, the Chairman of the Board, depending upon how they do it, together with his Chief Scientist. The five ones that... Dr. Kennedy: Five companies in the business. Dr. Shannon: ... that came down, we talked to them as a group for about a half of an hour, laying out the problem, and then we talked to each group separately. We had five sessions that went from about ten o'clock in the morning to about two o'clock the next morning. When we walked away, the vaccines were withdrawn and they agreed to redo the process. Now, the fortunate thing is that it worked and we went back to human inoculation with the sense of security that we should have had initially, but we did not have. But I attribute the difficulties to the secretiveness of the foundation and I think the Public Health Service was at fault because they should not have handled the foundation any easier or less rigidly than they handled any pharmaceutical division. They should not have been given preferred treatment. Also, we were in part at fault, the industry was at fault, they took a laboratory procedure, applied... Dr. Kennedy: Scaled it up too fast? Dr. Shannon: They themselves should have known that there was a flaw in the whole developmental process because they missed an essential step. So there was no need for this ever to have happened. So the NIH was painted in the box, it made very bad decisions, industry was painted in the box, and it was the forceful personality of O'Connor, with the political support he had, twas able to override some of the essential details of federal management of an important biological problem. Well, that's the history of NIH. In that critical period of '55 to '65, which is when most of the new programs were established, we established an adequate training program that dealt primarily with the needs of basic, applied, and physician-oriented scientists or physicians at both basic and applied levels. Dr. Kennedy: You converted the training program from a clinical program to a scientific program? Dr. Shannon: Yes, but we provided a new type of clinical enterprise that produced scientists capable of, not really taking care of patients, but investigating, from a fundamental standpoint, the mechanics of disease and we saw, for the first time entering, in all logical ways across the country, fundamentally-oriented scientists who were taking advantage of the natural experiments produced by disease for study. Dr. Kennedy: My general impression is that, in the 1930s, before the war at any rate, most of the research in this country was being done in the private eastern universities. By the time you were getting ready for retirement, it had spread quite widely. There was a very expanded research base throughout the nation. How do you see the future? Where is it going? Dr. Shannon: Well, first, before the future, I'd like to comment on the thirties. Science could have died in this country, in the thirties. The Depression was severe, but the federal establishment one, at least the biomedical sciences, maintained a superb research enterprise in the young development of NIH and in the establishment in 1936 of the beginnings of the Cancer Institute. And indeed, WPA supported a number of our scientists... Dr. Kennedy: I didn't know that. This is not generally known, during a time when they would have died, their science would have disappeared had it not have been for this...[?] in supporting artists and writers and the like, they also supported scientists. This is not a well-known thing. But, looking out at the future from the broad base we have now, I think that the bureaucratic structure, both in our universities and in our federal establishments, is getting too complex. It's trying to monitor the research effort in too discrete, and over too short time for researchers to make their judgements. I think that the enterprise is healthy now, and now is the time to modify our attitude towards science, provide a vote of confidence to much of the federally-supported, university-based science, federally-based science. Give them a vote of confidence, so they really can look forward again to the type of long-term planning we were able to do in the 1960s which no longer is possible today. And science will suffer insofar as that potential is removed as it is being very rapidly removed today. Dr. Kennedy: Do you see, in your travels around the country, problems with the institutions where science is going on? Is this something that needs more attention? Dr. Shannon: Well, NIH has a lesser capability of providing what was provided in the sixties, their grant terms are shorter, their new procedures are much more complex and more time consuming, renewals coming up repetitively. They've more or less retreated from a creative element as a realistic procedure. Their creative element awards now are inadequate as to sum and inadequate as to time, they're not satisfying, the purpose for which they were established and used during the sixties and early seventies. I think that the time is ripe for renewal of a basic inquiry today, "Where is science in this country going, what has the NIH done that has been good, what is in jeapordy now, looking towards the future, and what modifications of trends should be established at this point in time." And I don't think that the study that has been commissioned within the National Academy of Science, the National Institute of Medicine, is set up to do that in a thorough way, although, they may participate in it. I think this is something that has to be done by the private sector in conjunction with the public sector. And I think this can probably best be done within a foundation framework rather than within pre-existing, formalized scientific structures, and I think this would be... Dr. Kennedy: You think the time is ripe for this kind of... Dr. Shannon: The time is ripe now for "look at what we have and where we're going." Comparable to what we did in the late fifties, and using both... Dr. Kennedy: A combination of Bang Jones and Waldridge. Dr. Shannon: Together with very congenial, very supportive secretaries and a very supportive Congress.