MCKHANN 285However, I do have some suggestions for change. Anyone who has
run a neurology department is aware of the fact that you cannot do
everything. You have to focus and identify what the strengths of your
department are going to be. I believe that the NIH has to do the same
thing. When I was here in the 1950s, the NIH was unique. The NINDB
was a spin off, in a sense, of the Montreal Neurological Institute. Thus,
it very much focused on epilepsy, and there were not many other epilepsy-
oriented programs then. But, over time, epilepsy programs sprang up all
over the country, so one could now argue whether the NIH has a unique
role to play in epilepsy or not. If it does, one ought to rethink how it
would be different from the programs for which it was essentially a model.
The problem of maintaining flexibility with scientific staff is not
unique to the NIH. Every medical school faces this problem–aging
faculty, tenure problems–yet still wants this atmosphere of bright young
people. Forty years ago, we were all in our late twenties or early thirties.
That was what made this a really great place. It is very important that that
group of young people be established and maintained. It is hard to do.
Many people who came to the NIH in the 1950s did not know what
the NIH was. They did not know much about research, and they did not
know much about what their laboratories were doing. I would argue
that, sadly, to some extent, this is still a problem and that one of the
NIH’s challenges is to get out and tell the young people what a great
opportunity it can offer.
My last comment has to do with a problem of insularity. This, again,
is in no way unique to the NIH, but I think it is very important that, as
the NIH develops, ways are found to work outside the NIH with other
institutions. This is not easy because of all of the problems with the
data, the relationship with who is on the study section and who is not,
but these can be solved.
I would like to conclude by noting that I am one of many people,
both in neurology and psychiatry, who essentially owes his career to
the NIH. I, like Sid Gilman, have had grant funds from the NIH ever
since I was here in the 1950s. As a child, an adolescent–I will not say
an old man–a maturing man in the field of neurology, all stages in my
career have been supported by the NIH, so I owe the institution an
enormous debt.