career goals have been irrevocably determined to an area of investigation for a sufficient period, and at an adequate intensity, to make the experience worthwhile in itself, and to attract able young minds to the field. While I agree that the relatively low proportion of research grants awarded to clinical neuroscientists is a matter of concern, it would be inappropriate to consider making awards on grounds other than scientific merit. I believe that only by training a cadre of highly competent clinical scientists can we correct the present situation and maintain our commitment to scientific excellence.
Neurological Clinical Research
the Senate and House committees. (The current “torchbearer” is David Daly, MD, who has continued to carry out this thankless but essential assignment with effect and quiet dignity.) That the “old days” are gone and that the attitude of the nation toward the health profession has changed drastically can’t be denied. The lead article in the January 7, 1978, issue of Suturduy Review, entitled “The Great Health Care Rip-off,” is eloquent testimony to this unfortunate development. It is long overdue that both neurological societies, all the lay societies (“Gentle Legions”), the medical schools, as well as neurologists in individual or group practice combine their efforts in the field of neurological research. It may not be too late, but “time’s a wastin’.”
Stephen Stolzberg, M D As a full-time clinician, I found the editorial on clinical investigation very interesting since it seems to explain the fact that most volumes or courses entitled “Recent Advances and/or Progress in Clinical Neurology” have very little progress to report. On the other hand, I doubt there is any urban area in the United States that has a shortage of well-trained clinical neurologists, yet training programs are graduating clinical neurologists at the same rate they were ten years ago. I think it is time the academic neurology departments redirected their energies into clinical research and away from continued training of clinicians. Author’s address: Portland Neurological Associates, PC, 2800 N Vancouver, Portland, OR 97227.
The Public’s View Charles A. Kane, MD Though this is not commonly appreciated, it was not the medical profession, academic or practicing neurologists, or the medical schools who were responsible for the origin and continued funding of the National Institutes of Health or the original National Institute for Neurological Diseases and Blindness (NINDB). Rather, it was an aroused public, spurred by such individuals as Mary Lasker, a few farsighted neurologists, for example, A. B. Baker, MD, and especially genuine “friends of MedicineINeurology“ in the Congress, such as Senator Lister H ill and Representative John Fogarty (both deceased) who struggled valiantly against immense inertia to foster the “birthing” and nurture of the institutes. From this modest beginning the National Citizens Committee for the Neurological Sciences arose, coordinating the diverse, often conflicting interests of the many lay societies with the budgetary needs of NINDB as seen by its director and staff. Early in this process, the contributions of the American Academy of Neurologyinitially standing virtually alone for the neurosciences-can be pointed to with pride. Among other things, “principal (civilian) witnesses” appeared regularly before the Congress, interpreting the needs of the neurosciences to both From the Division of Neurology, Kaiser-Permanenre Medical Center, Hayward, CA 94545.
Public Support Frank M. Yatsu, MD I applaud Dr Plum’s much-needed comments on the crisis facing neurological clinical investigation. As a member and now Chairman of the Neurological Program Project Committee, I have sadly wimessed the erosion of clinical investigation by the process he outlines. Lost support for the “innovative tinkerer or gifted dilettante,” implying an untutored genius, is indeed regrettable, but the foundation of quality clinical research must rest upon a bedrock of rigorous science. To this end, support for postdoctoral training must receive high priority to ensure the steady and enlightened flow of creative investigators. Thus, increased funding for highly publicized competitive TIAs and RCDAs available in larger numbers is a necessary long-term commitment of the NINCDS. N o question that in the final analysis the direction and allocation of funding become a public mandate, an expression of our legislative process. The political reality is that the pivotal role in the decision-making process is played by congressional committees, all of which respond to pressure groups, special interests, and lobbyists. Though still fragmented in its thrust, neurology has grown up to this reality and now needs leadership to provide the push (and maybe shove). From the Department of Neurology, University of Oregon Health Sciences Center, Portland, OR 97201.
Arachnoid Cyst with Choroid Plexus Ellsworth C. Alvord, Jr, MD, and Cheng-Mei Shaw, MD The case report by Rosich-Pla et al on a congenital “arachnoid cyst” (Ann Neurol 2:443-446, 1977) presents the intriguing problem of how choroid plexus could be present in a cyst composed only of leptomeninges. From the Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195.
Letters
563
Neurological Clinical Research
the Senate and House committees. (The current “torchbearer” is David Daly, MD, who has continued to carry out this thankless but essential assignment with effect and quiet dignity.) That the “old days” are gone and that the attitude of the nation toward the health profession has changed drastically can’t be denied. The lead article in the January 7, 1978, issue of Suturduy Review, entitled “The Great Health Care Rip-off,” is eloquent testimony to this unfortunate development. It is long overdue that both neurological societies, all the lay societies (“Gentle Legions”), the medical schools, as well as neurologists in individual or group practice combine their efforts in the field of neurological research. It may not be too late, but “time’s a wastin’.”
Stephen Stolzberg, M D As a full-time clinician, I found the editorial on clinical investigation very interesting since it seems to explain the fact that most volumes or courses entitled “Recent Advances and/or Progress in Clinical Neurology” have very little progress to report. On the other hand, I doubt there is any urban area in the United States that has a shortage of well-trained clinical neurologists, yet training programs are graduating clinical neurologists at the same rate they were ten years ago. I think it is time the academic neurology departments redirected their energies into clinical research and away from continued training of clinicians. Author’s address: Portland Neurological Associates, PC, 2800 N Vancouver, Portland, OR 97227.
The Public’s View Charles A. Kane, MD Though this is not commonly appreciated, it was not the medical profession, academic or practicing neurologists, or the medical schools who were responsible for the origin and continued funding of the National Institutes of Health or the original National Institute for Neurological Diseases and Blindness (NINDB). Rather, it was an aroused public, spurred by such individuals as Mary Lasker, a few farsighted neurologists, for example, A. B. Baker, MD, and especially genuine “friends of MedicineINeurology“ in the Congress, such as Senator Lister H ill and Representative John Fogarty (both deceased) who struggled valiantly against immense inertia to foster the “birthing” and nurture of the institutes. From this modest beginning the National Citizens Committee for the Neurological Sciences arose, coordinating the diverse, often conflicting interests of the many lay societies with the budgetary needs of NINDB as seen by its director and staff. Early in this process, the contributions of the American Academy of Neurologyinitially standing virtually alone for the neurosciences-can be pointed to with pride. Among other things, “principal (civilian) witnesses” appeared regularly before the Congress, interpreting the needs of the neurosciences to both From the Division of Neurology, Kaiser-Permanenre Medical Center, Hayward, CA 94545.
Public Support Frank M. Yatsu, MD I applaud Dr Plum’s much-needed comments on the crisis facing neurological clinical investigation. As a member and now Chairman of the Neurological Program Project Committee, I have sadly wimessed the erosion of clinical investigation by the process he outlines. Lost support for the “innovative tinkerer or gifted dilettante,” implying an untutored genius, is indeed regrettable, but the foundation of quality clinical research must rest upon a bedrock of rigorous science. To this end, support for postdoctoral training must receive high priority to ensure the steady and enlightened flow of creative investigators. Thus, increased funding for highly publicized competitive TIAs and RCDAs available in larger numbers is a necessary long-term commitment of the NINCDS. N o question that in the final analysis the direction and allocation of funding become a public mandate, an expression of our legislative process. The political reality is that the pivotal role in the decision-making process is played by congressional committees, all of which respond to pressure groups, special interests, and lobbyists. Though still fragmented in its thrust, neurology has grown up to this reality and now needs leadership to provide the push (and maybe shove). From the Department of Neurology, University of Oregon Health Sciences Center, Portland, OR 97201.
Arachnoid Cyst with Choroid Plexus Ellsworth C. Alvord, Jr, MD, and Cheng-Mei Shaw, MD The case report by Rosich-Pla et al on a congenital “arachnoid cyst” (Ann Neurol 2:443-446, 1977) presents the intriguing problem of how choroid plexus could be present in a cyst composed only of leptomeninges. From the Department of Pathology, University of Washington School of Medicine, Seattle, WA 98195.
Letters
563
