284 MCKHANN
On the other hand, at the same time, there were a lot of people in the
field of theories of cognition who did not know very much about the
brain at all. These fields were brought together, not by clinicians, but by
people like Mortimer Mishkin, who could look at systems in primate
brains and say, “These are how some systems work.” The challenge to us
as clinicians was, how do we get from that kind of primate physiology
to human physiology? What has done it has been the advent of imaging:
lesion location, functional imaging, and, it is to be hoped, functional
correlations that are going to be closer to online images than are cur
rent imaging techniques.
There were no cellular therapies when we were in the NINDS
intramural research program in the 1950s. If a person had gone to an
NIH study section in the 1950s and said, “I think we would like to trans
plant some cells into the brain,” not only would the application have
been rejected, but the person would have been locked up as well. Cellular
therapy began in the 1970s in a small way but no one paid too much
attention to it. Now, of course, Richard Sidman and others are right on
top of stem cells, using genetic vectors as cellular therapies, and so on.
I want to move to the present. The 1950s were a golden era. We have
learnt about this from a number of people. The NIH was a great place
for a young investigator to be, whether in psychiatry, neurology or
neurosurgery. What about now in 2000? Having spent a year working
with Landis and others on aspects of clinical research, I would argue
that the NINDS and the NIMH intramural research programs are still
very special places. They allow people to do research that would be very
difficult to do in the medical school environment. First of all, at the
NIH there is a unique inpatient facility, the Clinical Center, which
makes it possible for a researcher to bring in people–at very little expense
to families–and keep them for much longer than can be done in any
other hospital environment that I am aware of. Second, there are excel
lent imaging facilities at the NIH that are absolutely crucial to asking
a lot of the questions a researcher would like to ask. Finally, specific
cohorts of patients can be attracted and studied over long periods of
time, another thing that is very difficult to do in the current medical
school environment.