years, the Bureau gradually brought order out of 

 chaos. 



Brigadier General Frank Mines, who took over 

 the Bureau in 1923, appointed medical consultants 

 in 1924; one group of consultants was the Investi- 

 gation and Research Group. Following this first 

 indication of involvement in research. General 

 Hines created a research section in the Medical 

 Service of the Bureau. 



Creation - 1930 



The Veterans Bureau, the Bureau of Pensions, 

 and the national homes were merged to form the 

 Veterans Administration in 1930, with General 

 Hines as the first Administrator. The VA conduct- 

 ed research, including basic research in the field 

 of medicine and closely related sciences. The ear- 

 ly history of VA medical research is described 

 well in the Administration's own words: 



Medical research was a very modest program in 

 the VA at the end of World War 11. Such medi- 

 cal research as existed at that time was almost 

 entirely conducted by contracts with members 

 of medical schools which were aflRliated with 

 the VA. When the Congress made its first ap- 

 propriation of VA funds earmarked for medical 

 research in fiscal year 1955, the total research 

 funding was a mere $4.8 million. 



Greater promise seemed to lie in intramural 

 research programs which were augmenting the 

 medical research contract program, and in 1956 

 the contract program was entirely supplanted 

 by intramural research projects. That first year 

 in which the VA directed its medical research, 

 individual research investigators reported on 

 3,644 research projects, and made enough pro- 

 gress to have 900 reports published in profes- 

 sional and scientific journals. 



The early VA medical investigators were quick 

 to discover and to put to the test one of their 

 most valuable assets— the cooperative study. 

 In a cooperative study, investigators from any 

 number of different VA facilities may agree to 

 study a selected problem under uniform guide- 

 lines. The unique quality of VA cooperative 

 studies is that the investigators may rapidly 

 amass significant statistics by drawing upon the 

 largest patient population available to any single 

 agency in the Western World. 



One of the earliest of these cooperative studies 

 was initiated in 1946 in cooperation with the 

 Armed Forces, to study the effectiveness of the 

 chemotherapy for tuberculosis. The success of 

 this study in determining the optimum medical 

 treatment caused the management of that dis- 



ease to become so effective that the VA was 

 able to close or convert all of its tuberculosis 

 hospitals to general medical and surgical care. 

 The cooperative study scored another major 

 success in finding the most effective chemother- 

 apy for treating neuropsychiatric patients which 

 threatened to tax the VA neuropsychiatric 

 (NP) hospitals beyond their capacity after the 

 end of World War II. The success of this study 

 enabled the VA to care for the NP patients in 

 existing facilities at a time when it had been 

 thought that the number of NP hospitals would 

 have to be doubled at a cost estimate approach- 

 ing a billion dollars. 



The classic VA cooperative study on the bene- 

 fits of treating mild hypertensive patients with 

 antihypertensive medicine established the value 

 of early treatment of high blood pressure in 

 prolonging active, useful life and comfort in the 

 Nation's aging population. Earlier findings 

 showed that the risk of crippling or fatal 

 strokes is directly related to the height of a per- 

 son's blood pressure, and that proper treatment 

 now available will reduce the risk of having a 

 stroke by 75 percent. This cooperative study is 

 largely responsible for a national and probably 

 world-wide mobilization of health care re- 

 sources to find and treat effectively those per- 

 sons who are developing even mild high blood 

 pressure. -^Of" 



The VA reported that all its research was ap- 

 plied until 1957. when it reported obligations of 

 $1.2 million for basic research in the medical sci- 

 ences. ^07 The following year the Congress amend- 

 ed the VA charter to specifically include medical 

 research in the functions of the Department of 

 Medicine and Surgery. Obligations for basic re- 

 search peaked in 1969 at $6.4 million, the peak 

 perhaps somewhat connected with exotic diseases 

 of Southeast Asia.^"** Of the $6.4 million, $5.8 

 million supported research in the life sciences 

 ($3.8 million for clinical-medical, $1.6 million for 

 biological, and $0.4 million for other life sciences), 

 $450,000 in psychology, $90,000 in the physical 

 sciences, $55,000 in engineering, and $25,000 in the 

 social sciences. -^0^ The latest estimates for 1977 

 obligations for basic research are $9.3 million, 

 sharply up from last year's estimates for the same 

 year. All this basic research is reported as 

 intramural; $7.8 million goes for research in the 



'*"The VA Medical Research Program: An Abbreviated 

 History," prepared by the VA Departnieni of Medicine and 

 Surgery. 1977, as part of an official report. 



WFfJera/ Funds. Vols. ll-IV;Vol. VII. NSF.^S-M, Table 11. 



vw Federal Funds.Voh. XVIII-XX. NSF69 31 , 70- .38. 71 35. 



i'^ Federal Funds. Vol . XI X . NSF 70-38. Tables C-33 and C-39 



COMPARATIVE ANALYSIS AND HISTORICAL TRENDS 361 



