Michael E. DeBakey VA Medical Center - Houston, Texas
A Brief History of the Houston Veterans Hospital and Its Research Program
By Homer S. Black, Ph.D. and Glenn R. Cunningham, M.D.
On September 4, 1946, the U.S. Navy opened its newly constructed hospital on 118 acres of land adjacent to the fledgling Texas Medical Center in Houston, Texas. At that time, the hospital, completed at a cost of $12 million and consisting of 39 buildings and a patient capacity of 943 beds, was one of the largest and most modern hospitals in the South (Figure 1). Two years earlier, President Franklin D. Roosevelt had issued a memorandum expressing the intention that the Navy hospital in Houston, as well as other specified military hospitals, would be transferred to the Veterans Administration at the end of WWII. Of course, the Navy hospital was not completed until after the war, and the Navy was reluctant to complete construction only to immediately turn its hospital over to another agency. Consummation of this transfer required an executive order from President Harry Truman. The transfer took place at 10:30 A.M. on April 15, 1949. Thus, the Houston VA Hospital was born, although it had been a somewhat difficult birth.
Figure 1. Architect's Sketch of completed US.
Navy Hospital (ca. 1943)
Among the complications was the fact that during the uncertain three-year period from its completion until its actual transfer to the VA, $25 million had been appropriated by Congress for construction of a 1,000 bed VA neuropsychiatric hospital in Houston. Two hundred and nine acres of land had been purchased; the government took the land by condemnation and paid $600,000 for this purpose. The land, south and to the rear (across Old Spanish Trail) of the Navy hospital, had been obtained from the Herman Trust.
The events leading to the Executive order directing the transfer of the Navy Hospital to the VA arose from The Task Force Report on Federal Medical Services prepared for the Commission on Organization of the Executive Branch of the Government.1 This Commission, chaired by Herbert Hoover, was also known as the Hoover Commission. Published in January 1949, the report spotlighted, as evidence of waste in government, the situation of the U.S. Navy Hospital and the proposed VA Hospital in Houston. With no major naval installations in the area and active duty Navy personnel occupying only 10% of the hospital’s total capacity, the U.S. Navy planned to make the hospital into a neuropsychiatry center—even though $25 million had been appropriated for a VA neuropsychiatric hospital right across the street! Furthermore, at that time, the Navy’s 26 general hospitals, with a total capacity of about 28,000 beds, had an occupancy rate of only 46% with only about 900 neuropsychiatric patients. In response to this report, President Truman’s Executive order to transfer the Navy Hospital to the VA also halted construction of the proposed VA neuropsychiatric hospital, but only after about $1 million had already been spent in the purchase of land and planning. Charges of misappropriation of government monies resulted. Further public relation nightmares occurred when the Herman Trust offered to repurchase what remained of the 209 acres; the VA had provided the U.S. Army with twelve acres for construction of a reserve armory. As the land was not used, it was declared to be “surplus,” and the GSA directed the Trust to pay fair market price ($1,060,000) for it. To the public, it appeared that the VA would profit by about $400,000 at the expense of a charitable trust that had sold the VA the land (after it had been condemned) in the first place.
These problems were left to be ameliorated by Lee D. Cady, M.D., from the Dallas district of the Veterans Administration, who was appointed the first Manager (Director) of the VA hospital, with authorized utilization of 500 beds of the 943 bed constructed capacity. After five months of operation, the hospital had reached its authorized capacity, and in October 1949, authorization was granted to increase capacity to 973 beds (Figure 2). By the end of the first year of operation, the hospital had admitted 6,000 patients. The following February, the hospital was authorized to full capacity of 1,000 beds, although funds were appropriated to operate only 700 beds. Some things never change, some things do! Only a couple of years later, the Hospital Manager announced that the cigarette allotment per patient could be doubled or tripled owing to the efforts of the American Red Cross, which had donated a half-million cigarettes. If laid end-on-end, it was estimated that these would have extended from the Rice Hotel in downtown Houston to the center of Richmond, Texas, a distance of about 30 miles.
Figure 2. Entrance to Houston VAH (ca. 1949)
In 1945, the year prior to completion of the Navy hospital in Houston, General Omar Bradley, who had been recalled to serve as VA Administrator and reorganize the agency, had recruited Paul Hawley, M.D., Chief Surgeon for the European Theater, to direct VA Medicine. Dr. Hawley was a member of the Committee on Federal Medical Services (a committee of the Hoover Commission), as was Dr. Michael DeBakey who also served as full time assistant to the chairman of the Task Force. The following recommendations for reorganization were made: (1) establish a separate Department of Medicine; (2) create Resident and Teaching fellowships in VA Hospitals; (3) affiliate with leading Medical Schools where possible; and (4) establish Dean’s Committees to collaborate on Residency training programs with specific responsibility of establishing professional standards for the latter. At the time of these recommendations, the VA had 5,600 beds throughout the system that were idle for lack of personnel to staff hospitals and, given the construction program already underway, the Task Force on Federal Medical Services projected that staff shortages would be increased by a third or more.1 Thus, these re-organizational recommendations were made, in part, to address the pressing problem of anticipated staff shortages.
The concept of Dean’s Committee hospitals arose in part from experiences in WWII in which Auxiliary Surgery Units (ASUs) were assigned to forward combat areas to provide definitive surgical care quickly to the seriously wounded.2 These major units were named after major medical centers in the states (e.g., Massachusetts General, University of Pennsylvania, Tulane, etc.), drawing upon the highly qualified surgical and medical personnel from those respective centers.3 This concept of concentrating qualified and experienced surgical and medical personnel into ASUs evolved into the mobile MASH units. The concept, as it related to Dean’s Committee-Veteran’s Hospital affiliations, envisioned the utilization of highly qualified physicians from the medical schools that would provide the highest quality patient care to the veterans. The medical schools benefited from the VA-funded resident training programs and the training and educational potential provided by the Veteran’s hospitals. Indeed, the first surgical residency program in Houston was established upon affiliation of Baylor University College of Medicine with the Houston VA Hospital.4
Importantly, it was under Dr. Hawley’s direction that the VA’s hospital-based research program was begun! Two organizational changes were instigated to vitalize the research program. First, a Research and Education Service was established under the direction of the Chief Medical Director in Central Office. This Service was composed of three Divisions, divisions for Research, Radioisotopes, and Education. Throughout the nation, where possible, hospitals were placed under the supervision of a Dean’s Committee from an affiliated Medical School. The hospital was to provide residencies for certain specialties, and department heads of the medical school were to serve as consultants and attendants at the hospital. As noted, the goal was to achieve the best available standard of medical care in the “Affiliated University Hospital.” Second, the objective was to create an environment where fundamental theories of medicine could be studied by physicians in training and the intricacies of disease could be explored by those of scientific or specialized medical training. Such an atmosphere, it was believed, would stimulate medical thinking, best foster advancements in medicine and, importantly, attract outstanding staff to the hospitals.
Paul B. Magnuson, M.D., was appointed Chief Medical Director of the VA in 1948. After the official transfer of the Navy hospital in Houston to the VA, he had enlisted Dr. DeBakey’s help in providing adequate professional personnel to operate the hospital, as the VA was woefully understaffed. Thus, the Baylor University College of Medicine Dean’s Committee was established in January 1949. Serving on it were W. H. Moursund, M.D., Dean of the Medical School; Warren T. Brown, M.D., Chairman of the Committee; James A. Green, M.D.; and Michael E. DeBakey, M.D. Dr. DeBakey had been an architect of the Dean’s Committee concept. His appointment to the Dean’s Committee created a unique opportunity—in essence, a virtual learning laboratory, to observe the operation of this affiliation and identify changes that would help achieve the lofty goals to which the Research and Education Service aspired.
The framework for a clinical research program had actually begun toward the end of WWII. It had become apparent that a vast amount of medical data on a wide array of medical problems had been accumulated during the war. Dr. DeBakey had submitted to his commanding officer, Norman Kirk, the Surgeon General of the Army, a memorandum emphasizing the potential clinical value of the data accrued in the medical records maintained by the armed services.5 Dr. DeBakey had proposed “a follow-up system to determine the natural and post-treatment history of such diseases and conditions as might be selected for the study.” The project would be a joint undertaking of the Army and VA, with the National Research Council performing a general supervisory function. Within two months of the original proposal, a Committee on Veteran Medical Problems was appointed under the chairmanship of Edward D. Churchill, M.D. and, within only three months, the program had become operational under the aegis of the National Research Council. The first efforts undertaken by the Medical Follow-Up Agency in 1947 included studies of psychoneurosis, peripheral nerve injuries, vascular injuries and infectious hepatitis; see Chapter 4, Volume 1.
Six months after the transfer of the Navy hospital to the VA, Belta Halpert, M.D., was appointed Chief of Laboratory Services. He recognized the opportunities and importance of research in improving laboratory services and patient care and, in 1950, recruited Charles L. Spur, M.D., to be Chief of the VA Research Laboratory in Houston. Drs. Halpert and Spur shared special interests in neoplastic disease. Thus, the major research thrust in this first laboratory was in the areas of cancer, metabolism, and endocrinology.
Figure 3. Arrow points to site of proposed Research Building
About this time, the establishment of a complete research facility in the field of radioisotopes was proposed. A separate two-story building (formerly a WAVE barrack) was to be converted to house the laboratory (Figure 3). In May 1950, these plans were touted in a Houston Chronicle headline that read “Houston V.A. Hospital to get Atomic Lab.” The article then explained (no doubt to allay alarm that many people would feel when anything atomic was mentioned in that era) that Houston was to have one of the finest and most modernly equipped laboratories for medical research in radioisotopes in the country. The laboratory was to carry out research on all known scientific applications of radioisotopes to medicine and apply the results to treating the sick, with the main function focusing upon radioisotope applications in the cure of cancer.
Figure 4. Bldg. 203, the General Medical and Radioisotope
Research Laboratories (ca. 1952)
By 1951, a laboratory for radioisotope research was in operation. The hospital established adioisotope bank, one of the first in the country, to facilitate clinical tests and serve as a repository of radioisotopes from which other hospitals could draw. It was not until 1952, however, that the radioisotope research laboratory (the touted “Atomic lab”) reached its full potential. In July 1952, the conversion of the former two-story/basement Navy barracks to research laboratories was completed (Figure 4). At its dedication, it was noted that although not the first laboratory in the VA Department of Medicine and Surgery, it was one of the VA’s pioneer research laboratories. This was not surprising as, only five years before, there had been no authorization to establish research laboratories in the VA and very few hospitals had established one since.6 Research activities of the Research Division at Houston were organized under an Executive Secretary (later the ACOS for R&D) and a Research Committee (R&E Committee) as a sub-committee of the Dean’s Committee. Despite all the committees, this arrangement functioned effectively!
The facility, identified as Building 203, provided the General Medical Research Laboratory with 8,000 sq. ft. of floor space; Dr. Spur remained its Chief. The Medical Research Laboratory consisted of eight unitized, functional laboratories, a constant temperature instrument room, two culture transfer rooms with 650°F hot air exhaust sterilizer transfer hoods, a media and culture preparation room, a sterilization room, and a refrigerated cold room. Among the laboratories it housed were laboratories for Biophysics, Steroids, Physiological Chemistry, Physiology, Physical and Analytical Research, Radiochemistry, and Histology. There was also an Animal Operating Room with adequate facilities for aseptic surgery and what was at that time modern sanitary animal quarters. The range of research included: manometric measurements of cellular respiration of tissues exposed to various types of ionizing radiation; synthesis of radioisotope-labeled chemicals employed in the intermediary metabolism of carbohydrates and fats; studies in endocrine disorders and neoplastic disease; testing of synthetic chemotherapeutic agents for toxicity and cellular growth inhibition; analysis of various body salts for metabolic and renal evaluation; and microscopic studies of tissues from tumor-bearing research animals. Many of these studies relied heavily on manometric measurements using the Warburg apparatus, although the various laboratories were equipped with spectrometers, flame photometer, polarograph, cardiac defibrillator, and electrocardiograph. It was in Bldg. 203 that Dr. DeBakey, the VA’s first Chief of Surgery, conducted some of his early vascular surgery studies, e.g., ones involving vascular grafts, cardiac pump devices, and the heart-lung machine. Dr. DeBakey had purchased a yard of Dacron from a local merchant —he had first sought to purchase nylon, but it was unavailable. Using his wife’s sewing machine, he fabricated the first cylindrical Dacron Grafts. The first surgery employing the Dacron Graft was performed on September 2, 1954, at the Houston VA. It was successful, and the patient survived another 13 years. Cardiovascular surgery continued to be the major research thrust of Houston’s Surgery Service. Dr. DeBakey recruited George Jordan, M.D., from the Mayo Clinic to succeed him as Chief of Surgery. Thus, began a long succession of distinguished surgeons, including Drs. Samuel Law (1959-1963), Paul Jordan (1964-1983), Arthur Beall (1983-1989) and James W. Jones (1989-1998). Dr. Paul Jordan also served as acting Chief of Staff for a time. His major research interests included surgical treatment of gastric ulcers and digestive diseases. Since 1999, the Chief of Surgery has been David Burger, M.D., who has major interests in colon tumorigenesis and tumor progression.
The Radioisotope Unit (the “Atomic Lab”) had been authorized in December 1949, upon the recommendation of the Dean’s Committee and approved in January 1950 by the Chief Medical Director, Department of Medicine and Surgery in Washington, D.C. It occupied 7,000 sq. ft. of floor space in Bldg. 203, and Herbert C. Allen, Jr., M.D., was Director of the Unit. Dr. Allen had been Assistant Chief of Radioisotopes in VACO and had set-up the first eight radioisotope laboratories in the VA. He remained at the Houston VA for ten years before moving to the Methodist Hospital in the Texas Medical Center.
The Radioisotope unit that he directed included a Radio-Biochemistry Lab; Organic Chemistry Lab; radioisotope preparation room; and a room for counting radioactive samples. The laboratories were equipped with Geiger-Muller counters, gas-flow counter, well counter and scintillation counter with associated scalers. There were also an Electronics Shop, Glassblowing Room, and sheet metal and instrument machine shop. The Machine shop was later staffed by Al Larkin, a First Class Machinist, who could be relied on to listen to vague ideas and then fabricate a workable device that addressed the need. The building also contained a Conference Room, Library, and Administrative Offices.
The intensive research activities of the unit focused on the use of radioactive iodine as a diagnostic and therapeutic aid in the treatment of thyroid disease; a comprehensive study of the derangements in intermediary metabolism in such diseases as diabetes and arteriosclerosis using radioactive carbon as a tracer; and the use of radioactive sulfur in the diagnosis and treatment of cartilaginous sarcomas. Dr. Allen was actively involved in the correlation of radioautographs of patients’ thyroids with their pathologies, an effort to define the type of nodule and relate it to the scan findings. He was also involved in developing a probe for the diagnosis of brain tumors using I131- labeled albumin.
The renovation of Bldg. 203 into modern, well-equipped research laboratories represented the launching of a dedicated and serious research effort at the Houston VA. The same year that the Research Building was dedicated (1952), also saw the hospital’s opening of the All Faiths Chapel. Perhaps this was mere coincidence or a compelling fulfillment of what Albert Einstein expressed in his memoirs, “Science would be lame without religion, and religion would be blind without science.” A number of other building renovations and expansions also came to fruition in 1952.
In 1955, bids were opened for a six-story addition to the neuropsychiatric building that would raise total hospital capacity to 1,350. Also included was a therapeutic activities building with gymnasium/auditorium, bowling alleys and exercise and music rooms. Later, in 1958, the sports therapy program was extended to include a nine-hole pitch and putt golf course, a project enthusiastically promoted by Alex D. Pokorny, M.D., Head of the Psychiatric and Neurology Service, who also happened to be a golfer. By 1958, the Houston VA Hospital had become the sixth largest of the 150 VA hospitals in operation. Leadership of the Research Program underwent several rapid changes. In 1960, Joe Meyer, M.D., who had served as Chief, Medical Research since 1959, was appointed Chief of the Research Laboratories Division in Central Office. This would not be the last time that Houston VA Research Administrators would fill important Central Office positions. Subsequently, Hollis G. Boren, M.D., served as ACOS/ R&D for one year before being appointed Chief of Medical Services and Chief of the VA Pulmonary Diseases Research Program Committee. Dr. Boren served as ACMD/R&D in VA Central Office during the 1980s.
Despite these abrupt changes in leadership, the research program continued to grow. In 1961, $500,000 was allocated to expand a hospital floor to house additional research laboratories. These included radioisotopes, psychiatry, cardiovascular and cancer studies, all grouped under the broader term of general medical research. That year Dr. Alex Pokorny reported on a completed national cooperative study, “Project 5”, on the influence of psychic energizing drugs on recovery from neurotic or psychotic depressions. The following year, Anand P. S. Dhariwal, Ph.D., was recruited to the VA to study gastrointestinal hormones, pancreozymin and gastrin in an effort to find alternatives to allergy therapy. His Baylor consultant was Andrew V. Schally, M.D., who was later awarded the Nobel Prize. That same year was notable for another event: after 100,000 admissions, a baby was born at the hospital. A veteran, losing the rush to get his wife to hospital, turned into the VA Hospital and the child was delivered in the emergency room.
Other milestones occurred in 1962. After a series of Central Office inspections in response to accusations of uncleanliness of the hospital, the hospital and its Director were exonerated. The Director received overwhelming support from a number of veterans groups and the community. Nevertheless, after 14 years of outstanding leadership in which the hospital made tremendous strides, Dr. Lee Cady, the hospital’s first Manager, was to be transferred to the St. Louis VA Hospital. He opted for retirement instead. His replacement was John W. Claiborne, M.D., who had been Director of the St. Louis VAH for the previous nine years. At that time, the hospital Director’s salary was reported to be $19,000! For comparison, the average salary for a Full Professor at American Universities and Colleges was $5, 600 per nine month academic year.
Throughout the 1960s the research program continued to make formidable contributions to scientific knowledge with the inevitable improvement in patient care. Under the direction of Virginia E. Davis, Ph.D., and Harold Brown, M.D., who had come from the Salt Lake City VAH to become Chief of Staff in 1961, studies from the Metabolic Research Lab found that alcohol caused major changes in the breakdown of two nervous system hormones, seratonin and norepinephrine. Follow-up studies, with the collaboration of J. L. Cashaw, Ph.D., also found that ethanol interfered with normal disposal of dopamine and enhanced its conversion into tetrahydropapaveroline (THP). THP is converted to morphine by the poppy plant, and it can be converted to other narcotic alkaloids as well. These Houston VAH studies were the first to explain the biochemical similarities of methadone and alcohol addiction, and Dr. Davis was the first at the Houston VAH to be honored with the Research Career Scientist Award.
Ira L. Shannon, D.M.D., came to the VA in 1967 from the USAF School of Aerospace Medicine at Brooks AFB to direct the Oral Physiology Research Laboratory. His close association with NASA sparked a joint effort to develop ingestible toothpaste that could be used in space flight. The product was first used on the Apollo flights. This discovery also filled a therapeutic need for total-care patients in the VA system. In addition, under Dr. Shannon’s supervision, a stannous fluoride gel to retard tooth decay and an artificial saliva were developed. These products continued to be compounded under the direction of Leigh Wyborny, Ph.D., Director of Preventive Dentistry Support Center, and distributed to VA hospitals throughout the country.
In 1956, John M. Knox, M.D., the first Baylor College of Medicine Dermatology Consultant, initiated two branches of research at the VA, in Photobiology and Syphilology. The Photobiology Laboratory was directed for 35 years by Homer S. Black, Ph.D., a Senior Research Career Scientist. The work, directed by Dr. Black, involving the influence of dietary antioxidants and fats on UV-induced skin cancer, first received international recognition in the 1970s when it was shown that dietary antioxidants inhibited UV-carcinogenesis. Studies from the Photobiology laboratory also demonstrated that low-fat diets reduced the incidence of UV-induced skin cancer. Dr. Black successfully bridged basic science and clinical medicine when he led the first clinical trial in which it was demonstrated that a low-fat dietary intervention reduced the occurrence of subsequent skin cancers in skin cancer patients.
Researchers in Syphilology sought a vaccine as a preventative to syphilis. As the scope of this research expanded, the Syphilology Lab became affiliated with the Houston VA’s Infectious Disease section of Medicine headed by Daniel Musher, M.D., who had joined the VA in 1976. Drs. Knox and Musher recruited Robert Baughn, Ph.D., who later received the Research Career Scientist Award, and it was Dr. Baughn who identified and characterized components of circulating immune complexes associated with secondary syphilis. Dr. Musher was, and remains, involved in the characterization and epidemiology of Pneumococcal pneumonia. Edward Young, M.D., an authority on Brucellosis, who also joined the VA around 1976, assumed the duties of Hospital Chief of Staff in 1983 and remained in that position until 1997 when he returned to clinical duties in the hospital’s Infectious Disease Section. He is also a member of the World Health Organization (WHO) Expert Panel on Brucellosis.
By 1968, the VAH in Houston was sponsoring 44 individual research units that were conducting a total of 109 research programs. Ismet Karacan, M.D., arrived from the VA Hospital in Gainesville, Florida, to become ACOS/R&D in 1972. Dr. Karacan, a recognized international authority on sleep disorders, was also the Director of the Sleep Laboratory. Among the programs he initiated at Houston were frequent “Town Hall” meetings to help investigators keep abreast of current activities in the research program as well as to address significant problems. Dr. Karacan, who was of Turkish decent, held yearly budget interviews with each investigator and, in a residual accent, frequently informed investigators that their budgets “had been cut by about a turd.” In fact, after a few years, most investigators’ programs had been thoroughly purged of any waste. When Dr. Karacan moved from Florida, he brought with him John I. Thornby, Ph.D., a biostatistician, who made, and continues to make, significant contributions to the strength of the research program. An exceptionally capable administrative officer (AO), George McAdams, was recruited shortly after Dr. Karacan arrived in Houston. Despite budget constraints, the research program flourished under their combined leadership.
When Mr. McAdams was recruited as AO, he replaced Mr. Norman Brown. Mr. Brown had, in turn, replaced Mr. Jose Coronado, the first Research AO in Houston. Both had been assigned to Hospital Director training programs. Mr. Coronado, who had begun as an administrative assistant in Bldg. 203, became the first Director of the San Antonio VA Hospital and Mr. Brown later held a number of Director’s positions.
In 1973, a contract was awarded for the architectural and engineering design of a 70,000 sq. ft., $4.5 million research and education building, to be built adjacent to the hospital, to support staff in extensive research and continuing education programs.
John Claiborne, M.D., the Hospital Director, retired in 1975 after serving 12 years as Director of what had by then become the 5th-largest (1330 beds) VA Hospital in the country. When Mr. John J. Cox succeeded him, the director’s salary had risen to $36,000. Mr. John Sheehan became Hospital Director in 1977. He was known within the VA as something of a trouble-shooter and he assumed the reins during a period in which the hospital was undergoing critical change.
In 1978, VA Hospitals were given the designation “Medical Center” to reflect the broad range of health care provided to veterans. On September 29, 1978, dedication ceremonies were held to signal completion of the “new” Research and Education Building in which 35,000 sq. ft. were allocated for research (Figure 5). The new research building was designated Bldg. 211 in the hospital’s building nomenclature scheme, later changed to Bldg. 109 upon completion of the new replacement hospital. The building housed laboratories in research areas such as dental hygiene, alcoholism, Hodgkin’s disease, venereal disease, and cardiology. The intention was to concentrate all research laboratories in this building and, in particular, provide space for labs operating near the hospital’s patient-care areas. Of course, there was not adequate floor space for all active laboratories and some remained in Bldg. 203.
Figure 5. The “New” Research and Education Building
( Dedicated in 1978)
A number of research programs were active during the 1970s and 1980s. Some were ongoing for several years. The Renal Disease Lab, directed by Edward J. Weinman, M.D., was involved in studies of renal metabolism, particularly the employment of micropuncture techniques to investigate the kidney’s handling of urate. Dr. Weinman was followed by Drs. Donald Wesson, M.D., Horacio Adrogue, M.D., and George Dolson, M.D. The Radiobiology Lab., directed by Naresh Prasad, Ph.D., investigated the relationship of aryl hydrocarbon hydroxylase to bronchogenic carcinoma. In closely related experiments, Nelda Wray, M.D., in her exploration of biochemical parameters in human lung cancer diagnosis, was attempting to develop an easy diagnostic test to detect human lung cancer in its early stages. Clifford S. Sato, Ph.D., and Ference Gyorkey, M.D., were involved in studies of carcinoma of the prostate and the relationship of glycosamines and zinc. Dr. Gyorkey was Chief of Laboratory Services.
For many years. John S. Meyer, M.D., who directed the Stroke Research Lab., focused on the precise measurements of cerebral blood flow in patients who suffered stroke or were at risk for one. David Graham, M.D., Director of the Gastrointestinal Research Lab was involved in studies evaluating various drugs in the treatment of gastric ulcers, NSAID treatment of gastritis, and the etiology of H. pylori in gastric ulcer development. In this regard, Robert Genta, M.D., who succeeded Dr. Gyorkey as Chief of Laboratory Services, collaborated with Dr. Graham in developing the “Genta Stain” for the detection of H. pylori. Doyle Evans, Ph.D., a Research Career Scientist, conducted independent studies integral to research efforts in the gastroenterology section, particularly with respect to microbial etiology of gastric disease. In 1989, Dr. Graham recruited Boris Yoffe, M.D., who developed a program on hepatitis and, in collaboration with NASA, liver tissue engineering. Dr. Graham was recipient of a Berry Award for outstanding research in the Federal Government. During this period, Robert J. Luchi, M.D., was co-chairman of a cooperative study on unstable angina in which the effects of medical versus surgical treatment were compared. Dr. Luchi, who came to the Houston VA in 1969, served as Chief of Medicine and ACOS for Extended Care and Aging and was the Founding Director of the Huffington Center on Aging. William E. Fann, M.D., Psychotropic research, investigated several psychotropic drugs and their interactions and side effects on a variety of mental health problems. Glenn R. Cunningham, M.D., Reproductive Endocrinology Lab examined factors affecting spermatogenesis and motility of sperm in patients with low sperm motility and infertility and is currently examining animal models for prostate cancer and androgen replacement related to treatment of benign prostate hypertrophy (BPH). John Comstock, M.D., who joined the VA in 1972, was involved in efforts to isolate the insulin gene and examined transcription factors involved in its activation/inactivation. He served as ACOS for Ambulatory Care before leaving the VA in 1998. Robert Gagel, M.D., joined the Endocrinology Laboratory about 1980 and was involved in studies of medullary carcinoma of the thyroid and metabolic bone disease. In 1991, he left the VA to become Chief of Endocrinology at M.D. Anderson Hospital in Houston. Roger D. Rossen, M.D., Immunology Research Lab, directed several projects of relevance to problems in clinical immunology, e.g., the incidence and clinical significance of circulating immune complexes in sera of patients with chronic glomerulonephritis and various forms of cancer. Frank Orson, M.D., recruited in 1984, is director of the Immunophysiology Lab, where he initiated studies on the immunology of aging. Currently, he is investigating molecular immune responses, particularly those occurring in pulmonary and gut tissues, with a goal of developing HIV and allergy vaccines. David Baskin, M.D., a neurosurgeon, also joined the VA in 1984. He continued his pioneering work relating to drugs that reverse paralysis in stroke patients and is currently working on a system to selectively deliver compounds to compromised tissue, thereby improving both the assessment and treatment of central nervous system disease. These physicians are but a few of the investigators making valuable contributions to the research program during the 1970s and 1980s era.
Plans to modernize the hospital were begun in 1979. What started with 39 buildings constituting the most modern hospital in the South in 1949 had grown to more than 60 buildings— and was described as the worst designed and most outmoded hospital in the VA system! Rather than attempt modernization, a decision was made to build a replacement facility.
The Houston VA Medical Center became the 33rd institutional member of the Texas Medical Center (TMC) in 1985, making the TMC the largest medical complex in the world! Construction of the replacement acute-care hospital began in April 1986. The facility, intended to provide approximately 1.6 million-sq. ft. with 1,039-bed capacity, had a $191 million price tag and was to be the largest hospital within the VA system. The hospital, to be built behind the existing hospital on what had been the golf course, was designed to serve some 48,000 veterans in 26 Texas counties.
Roger Rosen, M.D., in collaboration with investigators from Baylor College of Medicine, successfully established the Research Center for AIDS and HIV Associated Diseases in 1987. The auditorium of Bldg. 211 (now 109) was renovated to house the P2+ facility. Holly Birdsall, M.D., had been recruited by Dr. Rosen—in more ways than one, as they were a husband and wife team—and she made significant contributions from her studies of how HIV is delivered to the brain and creates sanctuary there for itself. Joann Trial, Ph.D., recruited by Dr. Rosen in 1989, developed a Flow Cytometry Lab in the Center that continues to serve as an important resource for the Research Service.
When George McAdams, AO, transferred to the VAH in San Francisco, Fran Konicki, who had been AO at VAH, New Orleans, assumed those duties in Houston. She proved to be extremely able, for she, with assistance from the Chairman of the R&D Committee at that time (Dr. H.S. Black), managed to keep the research program afloat when health reasons forced Dr. Karacan to step down as ACOS in 1987. Both were instrumental in persuading Glenn Cunningham, M.D., to consider the vacancy. In 1989, he became ACOS, R&D, a position he held for 14 years. After Dr. Karacan resigned from the VA, his co-investigator, Max Hirskowitz, Ph.D., took over as director of the Sleep Laboratory.
Drs. Nelda Wray and Carol Ashton, M.D., successfully created the Center for Quality of Care and Utilization Studies in 1990. The Center is currently one of eleven Health Services Research and Development (HSR&D) Field Programs within the VA that are expected to serve as a resource for the local VA, Regional, and Central Offices in the pursuit of excellence in patient care. Generally, the Houston Center’s areas of interest have been basic quality assessment, measuring and monitoring the technical competence of the VA health care delivery system and examination of the determinants of utilization of services. The Center, which occupied temporary quarters during the early years, is now housed in newly remodeled permanent facilities across the street from the hospital in what was once a Nabisco™ bakery. From its beginnings with only three health services researchers, the Center has, after ten years of operation, grown to more than 80 faculty and staff employees and to boasting an operating budget in excess of $6 million.7 Examples of current investigations include examination of racial disparities occurring in quality of care with respect to cardiac procedures, and treatment and long-term clinical, virologic, and immunologic outcomes in HIV-infected individuals, studies led by Drs. Laura Petersen, M.D., and Maria Rodriguez-Barradas, M.D., respectfully. The center is now an established VA HSR&D Center of Excellence with a national reputation for outstanding health services research. In January 2003, Dr. Nelda Wray was appointed VA Chief of Research and Development in Central Office where her “imprinting” on the VA medical research enterprise was immediately felt 8, 9. The Houston VA HSR&D Center continued under the direction of its co-founder, Dr. Carol Ashton.
On October 29, 1990, the replacement hospital (described as the “flagship” of the VA system) was officially dedicated (Figure 6). At that time, the facility’s cost, originally projected at $191 million, had exceeded $250 million. By the time the hospital opened in June 1991, its catchment area had increased to more than half a million veterans, with referrals coming from all over the United States. It was the first hospital in the VA system to eliminate open wards and house patients only in private or semi-private rooms. The facility’s architecture, which featured interior courtyards, allowed all patients’ rooms daylight exposure. It also included state-of-the-art features, e.g., an automated transport system that delivered laundry, food and supplies to patient care areas on carts moving over magnetic paths and up designated elevators. The automated laundry essentially eliminated employee handling of soiled laundry, managing all tasks from sorting to the final folding. This prototype laundry for future hospitals was inspected by Queen Elizabeth II while on a visit to Houston in 1991.
Figure 6. The “New” Houston VAH (ca. 1994)
The old hospital and surrounding buildings were scheduled for demolition in 1992-1993. This included Bldg. 203, and the last remaining research laboratories (Photobiology, Radiobiology, and Dental) were transferred to Bldg. 211 (now Bldg. 109). Approximately 35,000 sq. ft. became available for Research, as space had been provided to meet Education’s (R&E) requirements in the replacement hospital.
Once the new hospital was operational and many of the “kinks” had been worked-out, John Sheehan retired as Hospital Director in 1994. He had served in that capacity within the VA system for more than three decades, including 17 years at Houston. Mr. Robert Stott assumed the post in 1995 and, after two years, left to take a managerial post with the Texas Medical Center. Mr. David Whatley assumed the directorship in 1997 and instituted major organizational-management changes in an effort to streamline operations and make delivery of health care at the hospital more efficient. In some areas, implementation proved painful, and the final report card on how successful these changes have been in meeting their goals remains to be issued. Mr. Edgar Tucker replaced Mr. Whatley in 2001.
The late 1980s and early 1990s saw the recruitment of several outstanding researchers to the Houston VAH. Timothy Thompson, Ph.D., arrived in 1988 and developed a strong research program in prostate cancer. His group is currently involved in the identification of genes related to metastasis and their application in immuno-gene therapy.
Andrew Schafer, M.D., from the Brigham and Women’s Hospital in Boston, came to the VAMC as Chief of Medicine in 1989. His research effort was to systematically understand the effects that inflammatory mediators had on heart structure and function and transfer this knowledge to clinical practice. Dr. Schafer recruited a number of investigators to this program, including Douglas Mann, M.D., who was recruited from the Charleston, S.C. VA in 1990. Dr. Mann pioneered investigations into cardiac inflammation and inflammatory mediators, such as tumor necrosis factor, and undertook examination of drugs that could divert inflammatory agents away from injured heart cells. Dr. Mann holds the Gordon Cain Chair of Internal Medicine and is Director of the Winter’s Center for Heart Failure Research at Baylor College of Medicine. Shortly after Dr. Schafer arrived in Houston, he recruited Michael Kroll, M.D. whose research involves platelet activation under conditions of elevated arterial wall stress and subsequent platelet-dependent thrombosis. Others recruited to this program include William Durante, Ph.D., and Jose Lopez, M.D. Dr. Durante studied stress-induced proteins, their role in growth control and the clinical application to vascular disease. Dr. Lopez examined mechanisms of thrombotic disorders associated with a deficiency of the von Willebrand factor-cleaving protease ADAMTS-13. Burton Dickey, M.D., joined the Houston VA in November 1990. His laboratory has worked in interorganellar vesicular transport as a basic biological field, focusing on intracellular trafficking of the beta-2-adrenergic receptor during ligand-induced desensitization, mast cell exocytosis in allergic and innate immune responses, and airway epithelial mucus secretion as a defense mechanism against infection and in airflow obstruction in asthma. Dr. Dickey is also Chairman of the Department of Pulmonary Medicine at MD Anderson Cancer Center. Roberto Adachi, M.D., joined Dr. Dickey’s laboratory as a fellow in 1996 and became an independently funded PI in 2000. He has taken the lead in the mast cell biology program. Dr. Cunningham (Endocrinology) recruited Marco Marcelli, M.D., in 1992. Dr. Marcelli studied the role of androgen receptor in mediating transition of prostate cancer to androgen independence. Daniel Epner, M.D., who began an experimental cancer therapeutics program in 1994, with emphasis on abnormal nutrient metabolism, is currently Chief of Oncology at the VA. Michael Ittmann, M.D., Ph.D. joined the Houston VAMC in 1997 after having served at the New York VAMC (Manhattan) since 1987. His main research interest is signal transduction in prostate cancer and BPH. He serves on the board of scientific directors for the Specialized Program in Research Excellence (SPORE) for prostate cancer at BCM and in 2003 was appointed Chief of Pathology and Laboratory Medicine at Houston VAH. In 1999, shortly before Dr. Shafer left to assume the Chairmanship of the Department of Medicine at the University of Pennsylvania, he recruited Hong Wang, M.D. Her studies involve the relationship of homocystein to cardiovascular biology and pathology.
During the 1990s, a number of administrative changes were made in the Research Service. Fran Konicki (AO) retired after more than 40 years of government service. She had been recruited from the New Orleans VAH by Mr. Sheehan with whom she had first served as Public Affairs Officer when he was Director of the Bronx VAH. Two AOs followed for short periods of time, David Beery and Barbara Siebert-Crosland. In 2001, Joyce McDaniel, who had been the AO for the HSR&D Center, became AO for R&D.
In addition to the AIDS and HSR&D Centers, other Centers were established in Houston. In October 1997, the Center of Excellence on Healthy Aging with a Disability was founded, with Trilok Monga, M.D. and Arthur Sherwood, Ph.D., medical and scientific directors, respectfully. The mission of this Center was to conduct research advancing new care and treatment strategies that eliminate preventable secondary problems in patients with disabilities. In 1999, Diana Rintala, Ph.D., a current Research Career Scientist awardee, was recruited to the Center, where she currently investigates neuropathic pain associated with spinal cord injuries with the intention of developing new and efficacious medication strategies.
Houston VA’s newest Center was established in 2001. The Parkinson Disease Research, Education, and Clinical Center (PADRECC), under the direction of Eugene Lai, M.D., is one of six across the nation dedicated to study the disease, its cause, treatment, and clinical care.
The year 2003 saw changes in the management of the research program once again. After 14 years, and with considerably greater clinical responsibilities, Dr. Glenn Cunningham stepped down as ACOS, R&D. Under his leadership, the Research Service had experienced impressive growth. Previously, the research program had been constrained by unfavorable fiscal policies with Baylor College of Medicine. This was recognized early-on by Dr. Cunningham, who attempted to gain the requisite flexibility to grow the program through establishing a VA Research Foundation. Many other stations had created foundations, but Baylor’s comfort with the status quo doomed this initiative. Nevertheless, though efforts to establish a Foundation proved unsuccessful, broaching the subject won Dr. Cunningham more favorable terms on indirect costs returned to the VA from VA researchers’ industry and NIH grants. This in itself provided the program with greater flexibility than it had previously enjoyed. During Dr. Cunningham’s 14-year tenure research funds increased by 400 %, research space increased from approximately 70,000-sq. ft. to over 89,000-sq. ft.; space in Bldg. 110 (formerly a Nurses’ Resident Hall), previously designated as administrative offices, was renovated to provide modern laboratories; and another 25,000 sq. ft. was leased from the Texas Medical Center to house the HSR&D Center of Excellence. A compliance nurse and computer technician were added to the administrative staff. The nurse was responsible for training clinical researchers and supervising clinical research protocols, while the computer technician provides support to both basic and clinical researchers. Dr. Holly Birdsall, who took the reins of leadership as ACOS R&D when Dr. Cunningham stepped down, brings considerable management skills to the post. It is anticipated that the previous era of growth and strength of the research program will continue.
Finally, while it has not been possible to mention all investigators who have made important contributions to the VAMC research effort, this brief history highlights the breadth and significance of the research enterprise in Houston. This enterprise, however, has thrived only with the help of the hundreds of post-doctoral fellows, research technicians, administrative staff, and other support personnel whose efforts have been essential for its success.
Acknowledgements: The authors would like to thank all those who provided important information for preparation of this booklet, with particular gratitude to Ms. Brenda Wade, a “treasure trove” of historical documents and information. Our special thanks are extended to Dr. Michael DeBakey who generously provided not only first-hand knowledge of the early organization and operations of the Medical School-Veterans Hospital affiliation, but also references and helpful discussion and recommendations for the manuscript.
Addendum: President George W. Bush signed Public Law 108-170 on December 6, 2003 officially changing the name of the Houston facility to the Michael E. DeBakey VA Medical Center, in recognition of Dr. DeBakey's long and tireless efforts on behalf of our Nation's veterans.
1. Task Force Report on Federal Medical Services [Appendix 0]. Prepared for The Commission on Organization of the Executive Branch of the Government, January, 1949.
2. DeBakey ME. History, the torch that illuminates: Lessons from military medicine. Military Medicine 161: 711-716, 1996.
3. DeBakey ME. Personal communication (Supplement Number 3), 2003.
4. Montrey JS. DeBakey and the VA: A 50-year history. Veterans Health System Journal, December, 1999.
5. Berkowitz ED and Santangelo MJ. The Medical Follow-up Agency. The first fifty years, 1946-1996. National Academy Press, Washington, D.C., 1999.
6. The Voice 2, Houston, 1952.
7. Research Monitor 9, Houston, 2001.
8. Canceling grants, VA research chief shakes the system. Science 300: 574-575, 2003.
9. VA shaken by plan to cut grants, cultivate the “stars.” Science 301: 24-25, 2003.