Q: Would this have been similar at other study sites, in other fields?
Conley: When I joined the Hematology Study Section, the total number of study sections was very small. Maybe half a dozen, I don't know. But nothing like now. It was a very small organization, you see.
Q: And it wasn't required to try to map out where funds should go? It was done much more—
Conley: That was the responsibility of the councils. There were two review groups. The study sections who were the experts, the scientists. The councils included all kinds of people, politically oriented or not. These are political appointees basically. Some of them are physicians or scientists. But a number are not. And they are people who are supposed to have the broad view about funding needs, what kinds of research to support. So it's the councils who would determine where the cut off point would be.
Q: And who have been on the councils in this early stage?
Conley: If you're asking for names, I certainly can't. The Study Section members never met the council members. The study sections would meet, make their decisions and then this would all be passed on to the council that would meet separately. They did not do intimate reviews of the grant applications, nor were they really prepared to do that. But they looked at the big scene. Do we need more research in coronary artery disease, or this that and the other thing? And coagulation research was generally considered to be important because it was related to thrombosis, and anticoagulant therapy was coming aboard. So that was an important discipline. And this was why I was asked to join, because I had done research in coagulation sufficient to attract some notice.
[Tape Interruption]
Q: In World War II there was very little research.
Conley: Right, and then it exploded. Exploded. And this was responsible for the explosion of the medical schools. The number of full-time people in this department of medicine at the end of World War II, could be counted on the fingers of one hand, I'm sure. And now there are so many hundreds that I don't know them all. It is like this in every medical school. The NIH is largely responsible for that. Now there are other sources of funding, the Howard Hughes Institute, the Johnson Foundation,-- but those are latecomers. We were supported by other organizations. Our vitamin B-12 research was funded in part by the National Vitamin Foundation, for example. We had support from the Atomic Energy Commission for some of our platelet research.
Q: This would have fit in with Dudley Jackson's work?
Conley: Yes, yes. In those days, you didn't have to do what you said you were going to do. Our early sickle cell research, which was important, was supported by our coagulation grant. But the NIH was delighted because it was productive research. Now they've gotten more restrictive. I think you're supposed to do what you said you were going to do.[laughing] But at any rate, it was a pretty free and easy life in those days. My division was largely supported by research funds. We would not have had a division were it not for those funds.
Q: Was there any input from pharmaceutical houses?
Conley: The National Vitamin Foundation was supported by pharmaceutical houses, by multiple pharmaceutical houses.
Q: Do you remember some of the leading ones that?
Conley: I don't even know. It was a foundation.
Q: You didn't directly deal with the pharmaceutical companies?
Conley: No, but we had a lot of help from pharmaceutical houses. In our vitamin B-12 research, the vitamin B-12 was all provided free. The radioactively labeled B-12 was given to us. The Squibb- Merck people were very helpful to us. But we did not receive funding from pharmaceutical houses.
Q: Was there funding in the post World War II period from the OSRD for example?
Conley: Yes, I was going to mention that next. Apart from my connection with the NIH, I was very importantly connected with the Division of Medical Sciences of the National Research Council. The National Research Council was charged with the responsibility for dispensing research funds from the military to non-military organizations. The Army supported a lot of coagulation research. And I was a member of the Panel on Blood Coagulation. This panel, was made up of the traditional coagulationists--Seegers, Brinkhaus, Quick--and this is where I had intimate associations with those people. We would meet and argue and pass judgment on funding for research in those fields via the military services. That continued for a number of years.
There was a Committee on Blood and a Panel on Blood Coagulation. I ended up as chairman of the Panel on Blood Coagulation, and was also a member of the Committee on Blood, which had broader interests. We sponsored a number of symposia. Very important, for example, were conferences on platelets, which made it possible to bring experts together from around the world.
Q: Would these be mostly people involved in basic research, or were there also representatives from, let's say, industry, from government, from military.
Conley: Well, anybody could be invited, but these were mostly academic investigators, mostly from medical schools. But there was no barrier to having anybody. The military services themselves had research activities. The Walter Reed Institute for Research and the National Naval Medical Center had research programs. That's where Gene Cronkite was. George Brecher was at the NIH. These government institutions were themselves involved in hematologic research and their representatives participated in meetings both at the NIH and at the National Research Council. As funding was largely taken over by the NTH, the importance of the National Research Council in these activities dropped off.
Q: If we could talk about other institutional supports to the new discipline of hematology. I was wondering if you could talk about the journal Blood, itself what role you saw that playing from the '40s onward?
Conley: I think the journal Blood was certainly very important in bringing hematology and hematologists together. Blood, as you know, was initiated by Henry Stratton, who was a publisher, who for some reason was interested in hematology, perhaps because of his friendship with Bill Dameshek who became the first editor of Blood.
[END OF SIDE ONE, TAPE TWO; BEGINNING OF SIDE TWO, TAPE TWO]
Conley: Have others that you've talked to, talked about Dameshek and his important role in hematology?
Q: If you could add something on Dameshek—
Conley: Dameshek was a remarkable man, an imperious presence: at any meeting which he attended, he always sat down next to a microphone and he rarely failed to make a comment on any hematologic paper, any subject. He was really very broadly knowledgeable. These were not unimportant comments. He traveled widely. He got to know hematologists throughout the world. He attracted to his laboratory many young foreigners who worked there. It gave him a sort of international clientele. And when he organized Blood, he made a point of accepting papers from all over. I'm not one of his critics and if you want to read what one of his critics say, you have to read Dr. Wintrobe's The Blossoming of a Science, which I think is perhaps unduly critical of Dameshek. Dameshek certainly made the most of his opportunities, and I think there was a feeling, which I certainly have no reason to support, that in receiving all of these manuscripts, he was pre-informed about things and was quick to write editorials and to get his own people involved.
Q: I've heard such comments.
Conley: I certainly have no information myself. I read this in Wintrobe's book and I've heard other people talk about it. But I think having a journal certainly did help hematology. In 1942, we had a textbook for the first time. In 1946, a journal. So that began to solidify, hematology as a clinical specialty. And most of the original papers were pretty much clinically based. So yes I think Blood has been important.
Now Blood was firmly managed by Dameshek and Stratton for many years, and actually it was about the time that I was the President of the Society when tumultuous decisions were being made. One of them was to take Blood as the official organ of the society. And that was not accomplished without some little difficulty. But in fact, it was ultimately very smoothly accomplished and I think it has worked out very well.
Q: What were the difficulties?
Conley: I think those who had it were not very anxious to let go of it.
Q: Oh, to put it under the aegis of the American Society--
Conley: The American Society of Hematology was not going to take it unless it was the official organ, that the Society would appoint the editor, would appoint the editorial board, would review the manuscripts. And you can imagine that a private journal wouldn't be too happy about that.
Q: Jumping ahead a little bit, would the ASH membership be most likely to publish within Blood or were there other journals just as likely to receive--?
Conley: When Blood first came out, as Dr. Wintrobe points out in his book, a number of hematologists did not submit their papers to the journal because of the feeling that you've heard expressed. But that was long ago. When the proposition was made that there be a society of hematology, this came from the same group from Stratton and Dameshek. At that point, Castle said I'm not going to have anything to do with it. But Hale Ham, who was one of Castle's associates, said let's join them and lick them, or words to that effect. So he got some of his friends to go to the organizational meeting and to play a significant role in how the society was organized, and in constructing the by-laws, and helping to make it the kind of society that it turned out to be.
Q: When was your first association with the American Society of Hematology?
Conley: I'm a totally non-political person, really. I had enough to do to run my own show. I am not a joiner, by nature. I don't go to a lot of meetings. I have never attended a meeting of the International Society of Hematology outside of the United States, for no good reason, except that I just haven't felt, that if I really wanted to learn something, those were not the meetings where really hot new stuff is presented. It's a wonderful opportunity, and I should have taken advantage of it, to meet people and to see various parts of the world. I can now say I should have but I didn't. I did not immediately join the American Society of Hematology, but I didn't have any sense of antipathy.
But when it turned out to be a nice solid organization, I soon joined and then quickly got involved. I was a member of the editorial board of Blood for two periods of service. I was a member of the Council of the American Society of Hematology twice, and ended up as the Vice President and on up to being President. I was obviously very actively engaged in that society not long after it had been established.
It was, at times, a very contentious society for a while. There were meetings at which there were heated debates, in which people called each other names, and in sessions preceding my presidency--not the immediate preceding ones -- it was pretty uncivilized. But then the Society grew up and it's been nothing like that. It's very high class.
Q: Could you recount some of the significant contentions that took place during the early stages?
Conley: I think that there were great arguments over the by-laws. There were great arguments over the extent to which the Society should be involved in politics, in the sense of trying to influence the Congress on issues. There was great agony about the disputes between hematologists and clinical pathologists and that sort of thing, and attempts to resolve those issues through one mechanism or another in the Society. But of course, those issues didn't get resolved. The Society did decide, as most academic societies decided, that they did have to have an input to the Congress. And our Society immediately preceding and during my presidency, employed Mr. Grupenhoff, who was a highly competent lobbyist in Washington to advise us. We didn't even know what was going on. We didn't read the Federal Register. Very important decisions were being made. For example, there was a proposal published in the Federal Register which was going to require that all laboratories that did hematologic tests had to be headed by a clinical pathologist. That would have killed the hematologists.
Q: And this was at the time when there was this contention with clinical pathology within--
Conley: Yes. And it was just by chance that somebody read this. A non-member of the Society called it to my attention. Nobody in our society was reading the Federal Register, you see. So it was clear that we needed somebody who knew what was going on at least to tell us. So that was done very effectively when Grupenhoff was employed. The society now includes clinical pathologists, oncologists-- it has an enormous membership. I think that within the Society, they meet very amicably. But there were some pretty hot times.
Q: Could you, perhaps, go into a little more detail about the content of the conflict between clinical pathologists and hematologists and how it was reflected in this legislation--
Conley: When I learned of the impending regulations and threats to hematologists, I appointed an ad hoc Committee on Laboratory Standards and asked Frank Trobaugh to serve as its chairman. Frank became very aggressively involved with the appropriate federal agencies. Since that time the Society has had strong representation and has wielded a significant influence. Clinical laboratories have come under the close eye of federal regulatory bodies. The Clinical Laboratory Improvement Act was passed in 1977. Clinical Laboratories are now under the inspection of several governmental agencies. Laboratory tests must be standardized, and the qualifications of laboratory directors and medical technologists are set out. For a time proficiency testing was carried out under the supervision of the Centers for Disease Control. I have had no personal involvement with all of this, and I am unable to evaluate its effect. There is still concern about conflict of interest in the operation of certain clinical laboratories, so all of the issues are not yet settled, but the American Society of Hematology now is kept well-informed about what is going on and is actively participating in the decision-making process.
[Tape Interruption]
Conley: Another contentious area related to-the development of specialty boards. Specialty Boards were first invented many years ago. My recollection, which may be incorrect, is that the first specialty boards were in tuberculosis and then gastroenterology. After World War II, as specialties developed as hematology did, there was pressure to form other specialty boards. And hematology was a latecomer.
There were many academic hematologists who didn't think a specialty board was a good idea. I was among those most violently opposed. And the reason that I was opposed, was for the reasons that I've already expressed to you. My training program here would not meet the specifications of any specialty board, you see. We did not have an organized training program in which we guaranteed that each trainee spent two months doing this, two months doing that. I thought that as soon as we did that our very successful training program would be devastated. Maybe it's all right to train people that way who are going to go into practice. But in terms of our program, we were training hematologists to lead the academic life, and most of them have done that. And so I greatly feared what would happen if we had boards and a structured program.
Philosophically, it seemed to me that what you want is a physician who knows how to do what he does. If you're taking care of leukemia patients and you don't deal with a blood bank, it isn't terribly important that you know how to run a blood bank. So the idea that you had to be across the board knowledgeable didn't appeal to me, particularly at this time when already knowledge was so increasing that you really couldn't be fully informed in every field. I was opposed to this and so were many of my friends. I told you that Carl Moore had opposed even the formation of an organization, because it would lead to a definition of a hematologist and then to boards. So he was opposed to it.
But the American Board of Internal Medicine, seemed to have it among their objectives to have every branch of internal medicine codified and sub-specialized. There was some pressure from the Board to develop sub-specialty boards. And there was a faction within the American Society of Hematology that wanted a board for one very special reason and, it was political: the feeling was that if we had a hematology board, we could keep out the clinical pathologists. I don't suppose you'll find that written anywhere. But that was a strong feeling. But when this issue was put to vote to the membership of the American Society of Hematology, they voted weightily against supporting a specialty board.
Q: Which in essence meant they were voting still to maintain ties with clinical pathology?
Conley: Well, they didn't want a specialty board and that's all I can say. The membership voted against having a specialty board in hematology, which promptly evolved nonetheless.
Q: Who were the people behind the legislation for putting clinical pathologists at the head of any lab dealing with blood?
Conley: The clinical pathologists and their organization, the American Society of Clinical Pathology.
Q: They had there own lobby? Is that the--?
Conley: Yes, the pathologists, of course, traditionally did hematology, and as clinical pathology evolved, it evolved within departments of pathology. For example, the Department of Laboratory Medicine here is a hospital department, but academically it's assigned to the Department of Pathology.
Q: In your year-end report as President of the American Society of Hematology you mentioned a high frequency of error in clinical laboratory tests.
Conley: Yes, the CDC, had started to send out unknown specimens to laboratories all over the countryside. And then the laboratory did the tests and reported the results. The results of the tests were distressingly frequently erroneous. I suspect that that's been greatly improved. There's been a revolution, you see, in laboratory medicine because of the development of machines that do all the work. So much of what is done now is done by machines.
Q: Also in your report, your year-end report to ASH, you suggested that ASH should be more active in the problems of the blood transfusion field.
Conley: Yes, because I told you that was a time in which the least academic area of hematology was in blood banking. There were great feuds between the American National Red Cross and the American Association of Blood Banks, which was a more profit-oriented organization. The NIH has assisted in developing research in blood banks, and the current situation is much improved.
Q: This was also at the time, at least in the popular press, where there was a lot of discussion about hepatitis, contamination in blood supplies.
Conley: There was no question about that. There was a commercial blood bank here in Baltimore, in a poverty stricken area, where we were buying blood. The people who were contributing the blood were delighted to have the small amount of money they got to go out and buy heroine or what not. It was a disaster. The organization that ran this blood bank tried to set up a branch over in the commercial district, hoping that people would come in, in their lunch time and give blood. It was a failure. It didn't work. People didn't come. The NIH was getting many of its platelets from this place, I don't know how much hepatitis they spread around. But I think there are good data to show that that's not the kind of blood you want to receive.
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