Between Bench and Bedside: Building Clinical Consensus at the NIH, 1977–2013

Abstract

After World War II, the National Institutes of Health (NIH) emerged as a major patron of biomedical research. In the succeeding decades, NIH administrators sought to determine how best to disseminate the findings of the research it supported and manage their relationship with clinicians in the national community. This task of bridging research and practice fell to the Office of Medical Applications of Research (OMAR), which administered the NIH Consensus Development Program (CDP) between 1978 and 2012. This article argues that the CDP represented an unusual attempt to depoliticize biomedical research and medical practice at a particularly controversial time in American medicine. Throughout the program's existence, administrators sought ways to bring new knowledge to the medical community without creating the appearance of regulating clinical practice. For an agency with a mandate to promote the production of new biomedical knowledge, the question remained open as to how far this responsibility extended from the bench to the bedside. In striking this balance, the leadership sought to refine their understanding of the role and mission of the NIH. The history of the CDP has much to tell us about postwar biomedical research, health politics, and the institutional development of the NIH.

A Debatable Top Ten Papers in Geriatric Medicine List

“…The report of the 1987 National Institutes of Health (NIH) consensus meeting on comprehensive geriatric assessment (CGA) ( 20 , 54 , 55 ) made explicit the components of this then “new technology” ( 56 ) that remains our most reliable intervention for high need patients. ( 57 ) I picked Rubenstein’s positive geriatric evaluation unit trial ( 7 ) as one of the top ten for its timely support of the utility of both CGA and the field.…”

“…This includes assessing basic and instrumental activities of daily living with standardized tools like those developed by Sidney Katz (1924-2012) (18,52) and M. Powell Lawton (1923Lawton ( -2001. (19,53) The report of the 1987 National Institutes of Health (NIH) consensus meeting on comprehensive geriatric assessment (CGA) (20,54,55) made explicit the components of this then "new technology" (56) that remains our most reliable intervention for high need patients. (57) I picked Rubenstein's positive geriatric evaluation unit trial (7) as one of the top ten for its timely support of the utility of both CGA and the field.…”

Shared Principles? German Responses to American Bioethics Since the 1970s

“…Discussing the principle of autonomy in their book, Beauchamp and Childress highlighted that this kind of respect had to be claimed since it contradicted the physician's professional standing: 'The authority assumed by medical professionals presents many of the difficulties about autonomy and consent that arise in the medical setting.' 58 What was true for the American medical profession, 59 turned out to be even more problematic within the German context due to the very understanding of what the term autonomy actually represented and to whom it referred. The BÄK's journal during the 1980s occasionally mentioned autonomy in the relation to patients' choices.…”