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Gardner McMillan

Year: June 30th, 2002
Location: Bethesda, Maryland
Interviewed by: Blackburn, Henry

Abstract

Gardner McMillan, Canadian pathologist, tells how he was called to consult on research programs for atherosclerosis by Bob Grant in the early days of the National Heart Institute, and then never left. McMillan worked for years in the Division of Vascular Diseases at NHLBI on atherosclerosis and hypertension programs, including the SCORS program and the PDAY Study. He shows a keen sense of history and actually attempted an historical analysis of research with the object of tracing the course of ideas from the past into the future. Didn’t work.

From his long and useful service overseeing atherosclerosis research programs at the institute, we speak of the battle for balance of support for research disciplines, the appeal of prevention researches to Congress in testimony, the recurrent theme of light versus heavy-handed administration of research from Bethesda, and the personalities of NIH figures, through all of which McMillan remains the “fair and balanced” Scots gentleman we knew over the years of his influence and responsibility at the Institute. (Henry Blackburn)

Quotes

I think one of the interesting things historically is that many of the ideas that we are now manipulating experimentally rest on theories that are in fact very old.

[ed. That’s a wonderful beginning. “There’s nothing new under the sun.”]

Sort of…The detail is new… But the idea is often very old. And the best place I know to get some of that history is in the Cowdry’s book: Arteriosclerosis. Long has a chapter there that brings out those historical features. (1)

So Much for the History of ideas

I came on board as sort of a special assistant to the Director, principally to look at what was going on in arteriosclerosis. He had reviewed the total Institute portfolio and came to the conclusion that it didn’t have nearly enough myocardial infarction work. That had nothing to do with me, but having decided that, he decided to get the rest of the portfolio looked over and checked for balance and so on. So I came essentially on a one-year contract to look over the content of atherosclerosis initiatives at the institute.

I was attracted to the idea that if you could look back on the history of some subject, you could usually trace pretty clearly the path of progression of ideas. And I thought if you could do that retrospectively, maybe you could also do it prospectively. And if you were going to do it prospectively you’d need a huge base of data. Anyway, I thought I might be able to get a clue, at least, of where our field might go.

So anyway, I read over a huge mass of proposed research, which actually meant looking at grants and grant progress. What I found was what people proposed to do isn’t necessarily very close to what they actually did… it came unglued at the point where they said, “This is what we want to do and this is how important it is and so on.” And two or three years later, “This is what we’re actually doing.” But it ruined my idea of prediction. You couldn’t really grasp a prospective. So anyway, I amassed a lot of data on current support programs in arteriosclerosis. And I never did leave the Institute. (3)

Framingham

And it became sort of a gem in the Institute’s support programs.

[ed. Sometimes a very tarnished gem, according to Bob Berliner and others.]

Yes. There was always an argument between the basic science people and the community-oriented people. But the Framingham Project was not only important for what it did, but it was important to stimulate interest in new areas of basic science as well. Now, it’s a long way back, perhaps, from Kannel, Castelli and so forth, to interesting, basic things, some of which are quite removed. But, nevertheless, the general interest in lipids in particular was very much influenced by Framingham.

But you know, I don’t know that the basic people really believed that they owe anything to Framingham. But the fact of the matter is it would not, I think, have flown, economically or in priority within the Institute, if it wasn’t delivering new insights. (8)

Q, During your years at NIH, did you see a shift between interest in community and epidemiologic studies versus clinical research or is this something that’s always been there?

Yes, there has been a change. It’s been partly within the Institute. But I think mostly it was influenced by the growth of interest in community epidemiology, whatever you want to call it. There have been ups and downs in the interest of Congress in these kinds of things. At one point there was a big push that the only legitimate support was for basic research, whatever that meant. Then there was an interest of the Congress in, I guess, applied medicine or whatever you want to call it, partly influenced by Framingham and similar studies. There were a bunch of them around – Keys and the one Ivan Frantz was running.

The idea that research should deliver to the public some practical product by influencing medical practice or education or whatever.

I don’t know about other institutes, but the Heart Institute had to scramble pretty hard to show that it had… responded to that Congressional interest. You tried to find programs among your grants that had something to do with public education. I think the interest from the Congress was in having a practical product that could be delivered to the public, whether it was education in other public health strategies. [The Directors] liked to go down and testify and be able to say, “We’ve got this for you.” Mostly what one was able to do were risk-factor studies of one form or another, for example. (10)

But the way it looked to me was that the Director would go down and testify about all the wonderful things the Institute was doing and how some of them were so wonderful he needed some more money. But then in the questioning periods some Congressional person would raise the practical community- delivery questions. And the Director would cope with that as best he could. These often resulted in language reported in the Congressional Record to pinpoint the question that was asked and then to suggest that the Institute ought to orient itself to look after that area, perhaps with a promise of some money. And those things were influential because the Institute Director sort of felt he had to be able to go back next year and report on that. And, of course, if there was some money to help him start something he’d do that too. (13)

The Early Days

The thing I remember most in looking back is the very rapid growth of atherosclerosis research as a field. Because up until just after WWII the field was very sparsely populated with investigators. But beginning about 1945-1950 all kinds of investigators came in. Usually they had a different mother discipline, biochemists, biophysicists, whatever they were, even pathologists for that matter. But they came in because there was grant support available and growing. Whereas you could count on the fingers of one hand the number of investigators before WWII, they became multitudinous by 1950.

People like Page who had an interest in hypertension I think found it easy to switch from hypertension; he didn’t really switch from hypertension, but added arteriosclerosis upon it as a research activity. We had people like John Gofmanwho I think began, as I recall, I may not be accurate, as a protein chemist in the blood chemistry business and brought his techniques over to look at lipoproteins. (15)

Asked about Bethesda Control

But always there have been staff members who thought that not only did they control the money but that they should guide, sometimes with a fairly heavy hand, what was being done. Now in protocols that have fairly fixed stuff to get through, that’s fine. If they [investigators], you know, wander off and don’t do what the protocol calls for they need to be brought back to the protocol.

But for a lot of studies the protocol should evolve as the research evolves. And it seemed to me, at least, that the only way you could do that was stand on tip-toes nearby and, you know, not try to push things around. What you can do is put investigators in touch with each other where you think one investigator might have something that might benefit the other. Anyway, I think there always will be staff people who feel they ought to

operate

projects. I think in population studies the protocol takes precedence. Anyway, I don’t know how they do things these days from NIH. And furthermore, I don’t propose to worry about it! (17)

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