National Institute of Health - History

National Institute of Health - History


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National Institute of Health - part of the Public Health Service of the Department of Health and Human Services. The NIH operates research institutes; such as the National Cancer Institute, the National Institute of Allergy and Infectious Disease, and the National Institute of Environmental Health Services. In addition, it helps fund other medical research projects.

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National Institutes of Health

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National Institutes of Health (NIH), agency of the United States government that conducts and supports biomedical research into the causes, cure, and prevention of disease. The NIH is an agency of the Public Health Service of the U.S. Department of Health and Human Services. It is the largest single supporter of biomedical research in the country and also provides training for health researchers and disseminates medical information.

The NIH comprises 25 specialized institutes that conduct or support research in various fields of health and disease, including the National Cancer Institute, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, National Institute of Dental and Craniofacial Research, National Institute of Environmental Health Sciences, National Institute of General Medical Sciences, National Institute of Neurological Disorders and Stroke, National Eye Institute, National Institute on Aging, and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

In addition to its various institutes, the NIH maintains the National Library of Medicine, which is the foremost source of medical information in the United States. The NIH also maintains several general research centres and the Division of Computer Research and Technology, which uses computer technologies to support health research programs nationwide.

Most of the research funded by the NIH is conducted in medical schools, universities, and other nonfederal institutions. The primary form of funding is the research grant.


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National Institute of Health - History

Each February the President submits his Budget to Congress. The most recent request is posted under Budget Request. You may also view requests from the recent past in our Historical Budget Requests section.

NIH expenditures are reported according to the "mechanism" of support. Description of these mechanisms (e.g. grant, R&D contract, intramural, etc.), a brief overview of NIH, and tables detailing expenditures from Fiscal Year 1983 to the present, can be found here: Spending History by Institute/Center, Mechanism, etc. (1983 to present).

NIH received its first appropriation in 1938, for the National Cancer Institute. We now receive 26 separate appropriations for our NIH components. You may view the entire history of NIH appropriations: Appropriations History by Institute/Center (1938 to present).

To support the NIH mission to uncover new knowledge and transform health care with responsive, accurate, and timely budget and performance management information.


OFFICE-BASED TELEMEDICINE

Telemedicine has also been used for decades in clinical settings. In 1906, the inventor of the electrocardiogram published a paper on the telecardiogram. Since the 1920s, the radio has been used to give medical advice to clinics on ships. Alaska has been a model for the development and use of telemedicine for decades. For example, community health aides in small villages can perform otoscopy and audiometry, and the information can be sent to specialists in Anchorage or Fairbanks to make the determination of whether a patient needs to travel to the specialist for more definitive treatment. Today, we think of office-based telemedicine as flat-screen, high-definition units with peripheral devices that can aid in physical examination of the patient. There are a lot of these units out there, all of which do not talk to each other, and some of which use proprietary communications methods. If telemedicine is to become as ubiquitous as the telephone, communications standards will be needed.

Store and forward (Sɯ), or asynchronous, technologies have been a great advance. For example, in ophthalmology and optometry, non-mydriatic cameras can be used to perform retinal screenings in diabetics without needing to dilate the eyes this has increased screening rates. Teledentistry has been used to by dental hygienists and dentists to improve access to oral health care. Dermatology and psychology are two of the biggest areas for telemedicine. Since the 1990s, studies have shown high rates of agreement between diagnoses made in person and diagnoses made via teledermatology. Other studies of teledermatology show high satisfaction rates and no delay to definitive care. However, barriers to its adoption by dermatologists have a lot to do with reimbursement. Similarly, studies show good agreement between diagnosis and treatment plans with in-person mental health care and those developed using telehealth technologies these studies also show high satisfaction rates, even among parents of children with psychiatric illness. Telemedicine equipment will continue to evolve. For example, there is already an otoscope that connects to an iPhone. Also, there will be more integration of telemedicine and decision support systems into electronic health records.

Office-based care has many challenges and opportunities in the future. For example, what is the best use of nontraditional providers? How do we use new telehealth models that build community clinical expertise? Can we improve interfaces, such as through high-definition or three-dimensional images? How can we use less-costly equipment such as handheld devices (e.g., smartphones)? We need to continue to develop evidence-based standards for care, and determine reimbursement models that can support telemedicine to rural and remote communities.


Intrinsic factor is a protein made in the stomach. It helps your body absorb vitamin B12. In some people, an autoimmune response causes a lack of intrinsic factor.

An autoimmune response occurs if the body’s immune system makes antibodies (proteins) that mistakenly attack and damage the body's tissues or cells.

In pernicious anemia, the body makes antibodies that attack and destroy the parietal (pa-RI-eh-tal) cells. These cells line the stomach and make intrinsic factor. Why this autoimmune response occurs isn't known.

As a result of this attack, the stomach stops making intrinsic factor. Without intrinsic factor, your body can't move vitamin B12 through the small intestine, where it's absorbed. This leads to vitamin B12 deficiency.

A lack of intrinsic factor also can occur if you've had part or all of your stomach surgically removed. This type of surgery reduces the number of parietal cells available to make intrinsic factor.

Rarely, children are born with an inherited disorder that prevents their bodies from making intrinsic factor. This disorder is called congenital pernicious anemia.


Contents

While administering the NIHSS it is important that the examiner does not coach or help with the assigned task. The examiner may demonstrate the commands to patients that are unable to comprehend verbal instructions, however the score should reflect the patient's own ability. It is acceptable for the examiner to physically help the patient get into position to begin the test, but the examiner must not provide further assistance while the patient is attempting to complete the task. For each item the examiner should score the patient's first effort, and repeated attempts should not affect the patient's score. An exception to this rule exist in the language assessment (Item 9) in which the patient's best effort should be scored. [1] Some of the items contain "Default Coma Scores", these scores are automatically assigned to patients that scored a 3 in item 1a.

1. Level of Consciousness Edit

Level of consciousness testing is divided into three sections. The first LOC items test for the patient's responsiveness. The second LOC item is based on the patient's ability to answer questions that are verbally presented by the examiner. The final LOC sub-section is based on the patient's ability to follow verbal commands to perform simple task. Although this item is broken into three parts, each sub-section is added to the final score as if it is its own item. [3]

A) LOC Responsiveness Edit

Scores for this item are assigned by a medical practitioner based on the stimuli required to arouse patient. The examiner should first assess if the patient is fully alert to his or her surroundings. If the patient is not completely alert, the examiner should attempt a verbal stimulus to arouse the patient. Failure of verbal stimuli indicates an attempt to arouse the patient via repeated physical stimuli. If none of these stimuli are successful in eliciting a response, the patient can be considered totally unresponsive. [3]

Score Test results
0 Alert Responsive
1 Not alert Verbally arousable or aroused by minor stimulation to obey, answer, or respond.
2 Not alert Only responsive to repeated or strong and painful stimuli
3 Totally unresponsive Responds only with reflexes or is areflexic

B) LOC Questions Edit

Patient is verbally asked his or her age and for the name of the current month. [3]

Score Test results
0 Correctly answers both questions
1 Correctly answers one question
2 Does not correctly answer either question

  • Default Coma Score: 2
  • The patient must answer each question 100% correct without help to get credit
  • Patients unable to speak are allowed to write the answer patients or patients in a stuporous state who are unable to understand the commands receive a score of 2
  • Patients that are unable to talk due to trauma, dysarthria, language barrier, or intubation are given a score of 1

C) LOC Commands Edit

The patient is instructed to first open and close his or her eyes and then grip and release his or her hand [3]

Score Test results
0 Correctly performs both tasks
1 Correctly performs 1 task
2 Does not correctly perform either task

  • Commands can only be repeated once.
  • The hand grip command can be replaced with any other simple one step command if the patient cannot use his or her hands.
  • A patient's attempt is regarded as successful if an attempt is made but is incomplete due to weakness
  • If the patient does not understand the command, the command can be visually demonstrated to him or her without an impact on his or her score
  • Patients with trauma, amputations, or other physical impediments can be given other simple one-step commands if these commands are not appropriate

2. Horizontal Eye Movement Edit

Assesses ability for patient to track a pen or finger from side to side only using his or her eyes. This is designed to assess motor ability to gaze towards the hemisphere opposite of injury. This item is tested because Conjugated eye deviation (CED) is present in approximately 20% of stroke cases. CED is more common in right hemispheric strokes and typically in lesions affecting the basal ganglia and temporoparietal cortex. Damage to these areas can result in decreased spatial attention and reduced control of eye movements. [4]

Score Test results
0 Normal Able to follow pen or finger to both sides
1 Partial gaze palsy gaze is abnormal in one or both eyes, but gaze is not totally paralyzed. Patient can gaze towards hemisphere of infarct, but can't go past midline
2 Total gaze paresis gaze is fixed to one side

  • If patient is unable to follow the command to track an object, the investigator can make eye contact with the patient and then move side to side. The patient's gaze palsy can then be assessed by his or her ability to maintain eye contact.
  • If patient is unable to follow any commands, assess the horizontal eye movement via the oculocephalic maneuver. This is done by manually turning the patient's head from midline to one side and assessing the eye's reflex to return to a midline position.
  • If the patient has isolated peripheral nerveparesis assign a score of 1

3. Visual field test Edit

Assess the patient's vision in each visual fields. Each eye is tested individually, by covering one eye and then the other. Each upper and lower quadrant is tested by asking the patient to indicate how many fingers the investigator is presenting in each quadrant. The investigator should instruct the patient to maintain eye contact throughout this test, and not allow the patient to realign focus towards each stimulus. With the first eye covered, place a random number of fingers in each quadrant and ask the patient how many fingers are being presented. Repeat this testing for the opposite eye. [3]

Score Test results
0 No vision loss
1 Partial hemianopia or complete quadrantanopia patient recognizes no visual stimulus in one specific quadrant
2 Complete hemianopia patient recognizes no visual stimulus in one half of the visual field
3 Bilateral Blindness, including blindness from any cause

  • If patient is non-verbal, he or she can be allowed to respond by holding up the number of fingers the investigator is presenting
  • If patient is not responsive the visual fields can be tested by visual threat (the investigator moving an object towards the eye and observing the patient's response, being careful not to trigger the corneal reflex with air movement).

4. Facial Palsy Edit

Facial palsy is partial or complete paralysis of portions of the face. Typically this paralysis is most pronounced in the lower half of one facial side. However, depending on lesion location the paralysis may be present in other facial regions. While inspecting the symmetry of each facial expression the examiner should first instruct patient to show his or her teeth (or gums). Second, the patient should be asked to squeeze his or her eyes closed as hard as possible. After reopening his or her eyes, the patient is then instructed to raise his or her eyebrows. [5]

Score Test results
0 Normal and symmetrical movement
1 Minor paralysis function is less than clearly normal, such as flattened nasolabial fold or minor asymmetry in smile
2 Partial paralysis particularly paralysis in lower face
3 Complete facial Hemiparesis, total paralysis in upper and lower portions of one face side

  • If the patient is unable to understand verbal commands, the instructions should be demonstrated to the patient.
  • Patients incapable of comprehending an commands may be tested by applying a noxious stimulus and observing for any paralysis in the resulting grimace.

5. Motor Arm Edit

With palm facing downwards, have the patient extend one arm 90 degrees out in front if the patient is sitting, and 45 degrees out in front if the patient is lying down. If necessary, help the patient get into the correct position. As soon as the patient's arm is in position the investigator should begin verbally counting down from 10 while simultaneously counting down on his or her fingers in full view of the patient. Observe to detect any downward arm drift prior to the end of the 10 seconds. Downward movement that occurs directly after the investigator places the patient's arm in position should not be considered downward drift. Repeat this test for the opposite arm. This item should be scored for the right and left arm individually, denoted as item 5a and 5b. [3]

Score Test results
0 No arm drift the arm remains in the initial position for the full 10 seconds
1 Drift the arm drifts to an intermediate position prior to the end of the full 10 seconds, but not at any point relies on a support
2 Limited effort against gravity the arm is able to obtain the starting position, but drifts down from the initial position to a physical support prior to the end of the 10 seconds
3 No effort against gravity the arm falls immediately after being helped to the initial position, however the patient is able to move the arm in some form (e.g. shoulder shrug)
4 No movement patient has no ability to enact voluntary movement in this arm

  • Default Coma Score: 8
  • Test the non paralyzed arm first if applicable
  • Score should be recorded for each arm separately, resulting in a maximum potential score of 8.
  • Motor Arm assessment should be skipped in the case of an amputee, however a note should be made in the scoring of the amputation.
  • If patient is unable to understand commands, the investigator should deliver the instructions via demonstration

6. Motor Leg Edit

With the patient in the supine position, one leg is placed 30 degrees above horizontal. As soon as the patient's leg is in position the investigator should begin verbally counting down from 5 while simultaneously counting down on his or her fingers in full view of the patient. Observe any downward leg drift prior to the end of the 5 seconds. Downward movement that occurs directly after the investigator places the patient's leg in position should not be considered downward drift. Repeat this test for the opposite leg. Scores for this section should be recorded separately as 6a and 6b for the left and right legs respectively. [3]

Score Test results
0 No leg drift the leg remains in the initial position for the full 5 seconds
1 Drift the leg drifts to an intermediate position prior to the end of the full 5 seconds, but at no point touches the bed for support
2 Limited effort against gravity the leg is able to obtain the starting position, but drifts down from the initial position to physical support prior to the end of the 5 seconds
3 No effort against gravity the leg falls immediately after being helped to the initial position, however, the patient is able to move the leg in some form (e.g. hip flex)
4 No movement patient has no ability to enact voluntary movement in this leg

  • Default Coma Score: 8
  • This is performed for each leg, indicating a maximum possible score of 8
  • Test the non paralyzed leg first if applicable
  • Motor leg assessment should be skipped in the case of an amputee, however a note should be made in the score records
  • If patient is unable to understand commands, the investigator should deliver the instructions via demonstration

7. Limb Ataxia Edit

This test for the presence of a unilateral cerebellar lesion, and distinguishes a difference between general weakness and incoordination. The patient should be instructed to first touch his or her finger to the examiner's finger then move that finger back to his or her nose, repeat this movement 3-4 times for each hand. Next the patient should be instructed to move his or her heel up and down the shin of his or her opposite leg. This test should be repeated for the other leg as well. [3]

Score Test results
0 Normal coordination smooth and accurate movement
1 Ataxia present in 1 limb rigid and inaccurate movement in one limb
2 Ataxia present in 2 or more limbs: rigid and inaccurate movement in both limbs on one side

  • If significant weakness is present, score 0
  • If patient is unable to understand commands or move limbs, score is 0
  • Patient's eyes should remain open throughout this section
  • If applicable, test the un-paretic side first

8. Sensory Edit

Sensory testing is performed via pinpricks in the proximal portion of all four limbs. While applying pinpricks, the investigator should ask whether or not the patient feels the pricks, and if he or she feels the pricks differently on one side when compared to the other side. [3]

Score Test results
0 No evidence of sensory loss
1 Mild-to-Moderate sensory loss patient feels the pinprick, however he or she feels as if it is duller on one side
2 Severe to total sensory loss on one side patient is not aware he or she is being touched in all unilateral extremities

  • Default Coma Score: 2
  • The investigator should insure that the sensory loss being detected is a result of the stroke, and should therefore test multiple spots on the body.
  • For patients unable to understand the instructions, the pinprick can be replaced by a noxious stimulus and the grimace can be judged to determine sensory score.

9. Language Edit

This item measures the patient's language skills. After completing items 1-8 it is likely the investigator has gained an approximation of the patient's language skills however it is important to confirm this measurement at this time. The stroke scale includes a picture of a scenario, a list of simple sentences, a figure of assorted random objects, and a list of words. The patient should be asked to explain the scenario depicted in the first figure. Next, he or she should read the list of sentences and name each of the objects depicted in the next figure. The scoring for this item should be based on both the results from the test performed in this item in addition to the language skills demonstrated up to this point in the stroke scale. [3]

Score Test results
0 Normal no obvious speech deficit
1 Mild-to-moderate aphasia detectable loss in fluency, however, the examiner should still be able to extract information from patient's speech
2 Severe aphasia all speech is fragmented, and examiner is unable to extract the figure's content from the patients speech.
3 Unable to speak or understand speech

  • Default Coma Score: 3
  • Patients with visual loss should be asked to identify objects placed in his or her hands
  • This is an exception to recording only the patients first attempt. In this item, the patients best language skills should be recorded

10. Speech Edit

Dysarthria is the lack of motor skills required to produce understandable speech. Dysarthria is strictly a motor problem, and is not related to the patient's ability to comprehend speech. Strokes that cause dysarthria typically affect areas such as the anterior opercular, medial prefrontal and premotor, and anterior cingulate regions. These brain regions are vital in coordinating motor control of the tongue, throat, lips, and lungs. [6] To perform this item the patient is asked to read from the list of words provided with the stroke scale while the examiner observes the patient's articulation and clarity of speech. [3]

Score Test results
0 Normal clear and smooth speech
1 Mild-to-moderate dysarthria some slurring of speech, however the patient can be understood
2 Severe dysarthria speech is so slurred that he or she cannot be understood, or patients that cannot produce any speech

  • Default Coma Score:2
  • An intubated patient should not be rated on this item, instead make note of the situation in the scoring documents.

11. Extinction and Inattention Edit

Sufficient information regarding this item may have been obtained by the examiner in items 1-10 to properly score the patient. However, if any ambiguity exist the examiner should test this item via a technique referred to as "double simultaneous stimulation". This is performed by having the patient close his or her eyes and asking him or her to identify the side on which they are being touched by the examiner. During this time the examiner is alternating between touching the patient on the right and left side. Next, the examiner touches the patient on both sides at the same time. This should be repeated on the patients face, arms, and legs. To test extinction in vision, the examiner should hold up one finger in front of each of the patient's eyes and ask the patient to determine which finger is wiggling or if both are wiggling. The examiner should then alternate between wiggling each finger and wiggling both fingers at the same time. [3]

Score Test results
0 Normal patient correctly answers all questions
1 Inattention on one side in one modality visual, tactile, auditory, or spatial
2 Hemi-inattention does not recognize stimuli in more than one modality on the same side.

  • Default Coma Score: 2
  • Patient with severe vision loss that correctly identifies all other stimulations scores a 0

The NIHSS was designed to be a standardized and repeatable assessment of stroke patients utilized by large multi-center clinical trials. [7] Clinical researchers have widely accepted this scale due to its high scoring consistency, which has been demonstrated in inter-examiner and in test-retest scenarios. [8] Clinical research use of the NIHSS typically involves obtaining a baseline NIHSS score as soon as possible after onset of stroke symptoms [9] [10] The NIHSS is then repeated at regular intervals or after significant changes in patient condition. This history of scores can then be utilized to monitor the effectiveness of treatment methods and quantify a patient’s improvement or decline. [11] [12] The NIHSS has also been used in a prospective observational study, to predict 3 month outcomes of patients with undernutrition during hospital stays directly after a stroke. [13]

NIHSS use in tPA eligibility Edit

NIHSS has gained popularity as a clinical tool utilized in treatment planning. Minimum and maximum NIHSS scores have been set for multiple treatment options in order to assist physicians in choosing an appropriate treatment plan. [9] [10] Tissue plasminogen activator (tPA), a type of Thrombolysis is currently the only proven treatment for acute ischemic strokes. Ischemic strokes are the result of blood clots that are preventing blood flow within a cerebral blood vessel. The goal of tPA treatment is to break up the clots that are occluding the vessel, and restore cerebral blood flow. Treatment with tPA has been shown to improve patient outcome in some studies and to be harmful in others. The effectiveness and risk of tPA is strongly correlated with the delay between stroke onset and tPA delivery. Current standards recommend for tPA to be delivered within 3 hours of onset, while best results occur when treatment is delivered within 90 minutes of onset. [14] Since the NIHSS has been established as a quick and consistent quantifier of stroke severity, many physicians have looked to NIHSS scores as indicators for tPA treatment. [15] This rapid assessment of stroke severity is targeted to reduce delay of tPA treatment. Some hospitals use an NIHSS of less than 5 to exclude patients from tPA treatment, however the American Heart Association urges against NIHSS scores being used as the sole reason for declaring a patient as ineligible for tPA treatment. [16]

NIHSS structure Edit

In an effort to produce a complete neurological assessment the NIHSS was developed after extensive research and multiple iterations. The goal of the NIHSS was to accurately measure holistic neurological function by individually testing specific abilities. NIHSS total score is based on the summation of 4 factors. These factors are left and right motor function and left and right cortical function. The NIHSS assesses each of these specific functions by the stroke scale item listed in the chart below. [17]

Left cortical Right cortical Right motor Left motor
LOC questions Horizontal eye movement Right arm motor Left arm motor
LOC commands Visual fields Right leg Left leg
Language Extinction and inattention Dysarthria
Sensory

Modified National Institutes of Health Stroke Scale Edit

The Modified NIH Stroke Scale (mNIHSS) is a shortened, validated version of the mNIHSS. It has been shown to be equally, if not more, accurate than the longer, older NIHSS. It removes questions 1A, 4, and 7. This makes the mNIHSS shorter and easier to use. The mNIHSS predicts patients at high risk of hemorrhage if given tissue plasminogen activator (tPA) and which patients are likely to have good clinical outcomes. [18] The mNIHSS has also recently been shown to be taken without seeing the patient, and only using medical records. This potentially improves care while in the emergency room and the hospital, but also facilitates retrospective research. [19]

The National Institutes of Health Stroke Scale has been repeatedly validated as a tool for assessing stroke severity and as an excellent predictor for patient outcomes. [20] [21] [22] Severity of a stroke is heavily correlated with the volume of brain affected by the stroke strokes affecting larger portions of the brain tend to have more detrimental effects. [23] NIHSS scores have been found to be reliable predictors of damaged brain volume, with a smaller NIHSS score indicating a smaller lesion volume. [24]

Effect of stroke location on NIHSS prediction of stroke severity Edit

Due to the NIHSS’s focus on cortical function, patients suffering from a cortical stroke tend to have higher (worse) baseline scores. The NIHSS places 7 of the possible 42 points on abilities that require verbal skills 2 points from the LOC questions, 2 points from LOC commands, and 3 points from the Language item. The NIHSS only awards 2 points for extinction and inattention. [25] Approximately 98% of humans have verbal processing take place in the left hemisphere, indicating that the NIHSS places more value on deficits in the left hemisphere. This results in lesions receiving a higher (worse) score when occurring in the left hemisphere, compared to lesions of equal size in the right hemisphere. Due to this emphasis, the NIHSS is a better predictor of lesion volume in the strokes occurring within the left cerebral hemisphere. [16]

NIHSS as predictor of patient outcomes Edit

The NIHSS has been found to be an excellent predictor of patient outcomes. A baseline NIHSS score greater than 16 indicates a strong probability of patient death, while a baseline NIHSS score less than 6 indicates a strong probability of a good recovery. On average, an increase of 1 point in a patient’s NIHSS score decreases the likelihood of an excellent outcome by 17%. [26] However, correlation between functional recovery and NIHSS scores was weaker when the stroke was isolated to the cortex. [24]


Evolution of BPCA

The original BPCA legislation directed the HHS Secretary, acting through the NIH Director, to establish a program for pediatric drug development. The NIH Director delegated lead responsibility for the BPCA’s off-patent drug component to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

NICHD was chosen to lead NIH's BPCA efforts, in part, because of its success with the Pediatric Pharmacology Research Unit (PPRU) Network. The PPRU comprised a group of experts in pediatric pharmacology who conducted pediatric clinical trials from 1994 to 2009. Their work initiated key pediatric research, including clinical trial designs, and many label changes for drugs used in children. In addition, NICHD's strengths in sponsoring research and conducting safe and effective clinical trials in populations thought to be “fragile,” such as children and pregnant women, made the institute the natural choice to spearhead NIH's BPCA activities.


HISTORY OF NIH

The history of NIH reflects an interweaving of the disciplines of public health, medicine, and basic biology, with a changing emphasis among these areas as health science progressed. The NIH had its origins in the Laboratory of Hygiene, which was created in 1887 to research cholera and other infectious diseases. The laboratory was an out-growth of the Marine Hospital Service created in 1798 and, in turn, became the Public Health Service in 1912. Early activities focused on infectious and communicable diseases brought to the United States on incoming ships, and on the prevention of epidemics of yellow fever and cholera. In 1914, Dr. Joseph Goldberger described his findings that pellagra was a nutritional deficiency disease, rather than an infectious disease, and could be prevented by appropriate diet. This discovery marked a shift from infectious disease investigation. Research on the importance of nutrition in disease causation was fostered by this discovery, and the essential nature of vitamins in health followed.

The modern era of NIH began in 1930 with the redesignation of the Hygienic Laboratory as the National Institute of Health. In 1935, 45 acres of land in Bethesda, Maryland, were donated for the use of the National Institute of Health. Additional gifts of land were made and the buildings and grounds on the current site and were dedicated in 1940.

The National Cancer Institute Act was passed in 1938, and the first awards for research fellowships were made the following year. Laboratories at NIH were important in improving prevention and medical care during World War II. The contributions of science to the war effort provided a compelling rationale for the remarkable investment in biomedical research that followed during the second half of the twentieth century.

The Public Health Service Act of 1944 provided the legislative authority for post – World War II research programs and made the National Cancer Institute a part of NIH. In 1948, the National Heart Institute was authorized, and the name of NIH officially became the National Institutes of Health. The research emphasis shifted to investigation of basic biology and biochemistry and the disorders of biology that lead to disease. Prevention and treatment of diseases have been based largely on understanding the fundamental alterations in biology following World War II. Support for research conducted at colleges and universities also increased with an expanding budget. Other institutes and centers have been authorized and totaled twenty-seven in 2001. A clinical center on the Bethesda campus was dedicated in 1953 as the principal on-campus or intramural resource for clinical research. This facility combines patient facilities (inpatient and outpatient) with laboratories to foster integration of research from patient to laboratory.

During the second half of the twentieth century, the breadth and complexity of biomedical research activities conducted at NIH and supported at non-NIH sites increased. From 1950 onward, research emphasis shifted to chronic diseases, which had assumed epidemic proportions in the United States and other industrialized countries. Basic levels of molecular biology and genomics were increasingly probed. This led to an important benchmark at the turn of the millennium — the publication of the human genome map. Information on the inherited susceptibility and the interplay between genetic and environmental factors will eventually provide insights that will be translated into practical research.

Studies of large populations, like the Framingham Heart Study, have also been initiated by NIH to delineate risks for disease. Similarly, large interventional trials have tested effective means of preventing and managing these risks. These investigations were an outgrowth of an improved understanding of disease causation and the need to extend these findings to patients and populations. The growth of knowledge has been exponential, and the investment in biomedical research has produced a remarkable return to the public in improved health and increased longevity. Political support for the NIH budget has been consistent and bipartisan, reflecting broad public-interest support and confidence in the benefits of health research.


The National Cancer Act of 1971

President Roosevelt's 1940 Dedication of the First NCI Building

On October 31, 1940, President Franklin D. Roosevelt delivered a speech dedicating the first six buildings of the new National Institute of Health in Bethesda, Maryland. Building 6, as noted in this video excerpt, was NCI's first official building.



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  3. Chicha

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  4. Vull

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