Chapter 9: The Liberal Years

a. I was surprised to learn about the funding of the polio vaccine by the American people through donations. I did not know that the Salk vaccine was a "folk victory," rather, I just assumed that it had been funded by government research. I was also surprised to learn that nearly half of medical care still took place in patient's homes in 1935.

b. I agree with Starr's position that the national investment expanded and strengthened medical research and hospitals. The NIH budget increased from 81 million dollars to 400, which strengthened and increased medical research. This also helped the NIH to expand to several different institutions, becoming the National Institutes of Health. The income of medical schools also tripled, which led to their expansions into research and patient care.

c. I think that Starr's statement that when opportunities within a profession change, so do the profession is a little misleading. I believe that a profession is always changing. As we have seen throughout the book, the medical profession has been influenced by a number of factors, including political, industrial, geographical, and economical. The opportunities within a profession certainly effect the profession, but no more than many other influences.

d. One thing that I have experienced with Starr mentions is the "categorical approach" to funding of the NIH. The NIH currently has many institutions. Each institution has certain interests. For example, the National Heart, Lung, and Blood Institute is interested in heart and vascular diseases, lung diseases, and blood diseases. In order to apply for a research grant, it is a wise idea to figure out which diseases the institute you are applying to is interested in, as they preferentially apply funding to research for some diseases over others. Starr mentions that "the way to open wide the public's purse was to call attention to one disease at a time." This strategy works for the NIH when seeking government funding, as well as for those researchers hoping to be funded by the NIH.

e. Starr discusses the relationship between medical research and government funding of the NIH. The early part of this century was a time of great increases in medical research. Funding of the NIH more than quadrupled, as did the agencies within the NIH. With the recent 1.6 billion dollar funding cut to the NIH, it will be interesting to see what effect this has on research and the economy.