lives. These advances were a direct result of research; clinical observations during the hundreds of years before had not supplied the answer. Subsequently, a multi-hospital study identified that the minor tranquilizers (benzodiazepines) as the best drugs for treatment of withdrawal; whereas, the major tranquilizers, commonly used in the treatment of psychoses, actually made things worse. Similarily, people died, not from the direct effects of alcohol, but from the low blood sugar, as a consequence of excessive consumption. From research findings it was understood that alcohol can lower blood glucose in malnourished individuals, but raise it in well-fed individuals. Research has also provided the understanding that a very destructive syndrome associated with alcoholism, Wernicke's disease, which eventually causes permanent brain damage, was primarily a vitamin deficiency. The routine administration of Vitamin B1 has greatly reduced if not eliminated this problem. The discovery from animal and human experimentation, that alcohol damages the liver, even in well-nourished individuals, is changing the thinking of a generation of physicians. The inappropriate use of fluid replacement in alcoholics is now thought to cause severe or fatal brain damage (central pontine myelinolysis). The correctness of this idea was shown by reproducing the condition in animals. More recently the discovery of a genetic component in familial risk for human alcoholism, and the development of animal models for many actions of alcohol has pushed the field into the mainstream of biological research. The establishment of NIAAA has spurred an increase in alcohol research, and certainly the Federal effort has increased from essentially nothing only a few years ago, to a first-rate productive and visable research effort both in the intramural and extramural programs. However, the effort in proportion to the problem is badly out of balance. In 1980, the first Institute of Medicine Report on alcohol research clearly documented, that based upon dollars per $1,000 of cost to the Nation, research dollars per death, or dollars per chronic case, alcohol research ranks far behind research on cancer or heart disease. For example, in 1978, the amount spent on research was $209 per case for cancer, but only $1 per case for alcoholism. The Institute of Medicine concluded at that time that "alcohol research is not funded at a level commensurate with the economic cost it imposes on society or at a level comparable to research funding for other major disorders". Again, in 1982 and in 1984, this view was reiterated by this prestigious group. Their recommendation for NIAAA is a research budget of $100 million in constant 1983 dollars. Thus, the request by the Administration of only $52.8 million for alcohol research is woefully inadequate. Even the amount of $68 million would not meet the goal, but would allow NIAAA to meet its present committments and provide at least some growth. As it stands in FY 1985, it has been necessary for NIAAA to cut the currently funded RO1 and Center grants. In our Alcohol Research Center, this 10% cut has severely restricted a number of important projects. For example, we have a project to assess the genetic influence on the reaction of individuals to alcohol. This is an important study with regard to the basis of the genetic component in human alcoholism and, as a spin-off, it carries far-reaching consequences for solutions to drunk-driving problems. However, we have never been able to fully fund that project, and this year, we have again been unable to proceed at the maximal pace possible. The Alcohol Research Centers have been funded at the fully authorized level only once during the eight years that we have had our Center at the University of Colorado. In research institutions where a critical mass of high quality investigators are present, I believe that the Centers provide more research per dollar amount spent than can be achieved by any other mechanism. Funding cuts, directed at all NIAAA RO1 and Center grants this year, seriously disrupt angoing projects and inhibit the flow of new scientists into the system. These cuts are penny-wise but pound-foolish. I fully realize that the necessity of reducing the Federal budget deficit is upper-most in our minds as American citizens. However, even a small dent in the over $100 billion per year cost of alcoholism to our government and Nation would repay, many times over, the proportionately small amount of cost for alcohol research in the budget needed to accomplish this change. THE Research Society on Alcoholism recently met with the International Society for Biomedical Research on Alcoholism. At this meeting there were over 340 submitted papers and symposia ranging from "Recent Advances in Psycho-Social Research" to "Molecular Genetics." Participants came from 25 different countries. The title of this editorial resulted from the diversity, number, and quality of presentations at the meeting. There was an excitement and enthusiasm that, for many years, was shared by only a small group of researchers. Gratifying as the response to the meeting was, we have a long way to go. Such a research effort must be supported by research funds from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), by increased support from private groups as well as by government agencies in foreign countries. It is like trying to build a fire in pouring rain. Preparation requires very careful gathering of a critical mass of the right raw materials, dry shavings, tinder, etc. The striking of the match might be analogous to the establishment of NIAAA several years ago when the first few tentative flickerings and smolderings became apparent. More than once an errant drop of rain in the form of a short-sighted congressional appropriation or administrative indifference has threatened to put it out, but now I believe that we are at the stage of an honest-to-goodness flame. The flame is still very vulnerable and in need of more fuel in the form of excellence in research and much huffing and puffing by From the Department of Pharmacology. University of Colorado Health Science Center, Denver, CO. Presented at the annual meeting of the Research Society on Alcoholism in response to the presentation of the Society's Fifth Award for Scientific Excellence to Richard A. Deitrich in June 1984. Reprint requests: Richard A. Deitrich, PhD, Dept. of Pharmacology University of Colorado Health Sciences Center, 4200 East 9th Ave.. Denver, CO 80262. Copyright © 1984 by The American Medical Society on Alcoholism and The Research Society on Alcoholism. government and private funding agencies, but it is a flame nonetheless. In such a situation, when the dividing line between a fire and a black smoldering mess is very thin, one often wishes that they had remembered to bring the charcoal starter. The use of such a volatile fluid does wonders and the process becomes autocatalytic. The heat of the fire dries the new wood which then catches fire and joins in. What we are now looking for is that catalyst, the fuel that will make the flickering research that we now have, a real bonfire of significant proportions in the research world. In this meeing, I saw the fuel in the form of excellent scientists ready to explode into such a warming and rewarding fire of research advances that will ultimately "dry out" the alcoholics and alcohol abusers and let their lives burn more brightly, rather than letting them remain wet and continue to stand in the rain and prematurely rot away. Obviously, all researchers have a vested interest in this process, the efforts of all of us as well as those in the funding agencies are necessary to achieve these goals. However, there are many buckets of water that can be spilled on our fire. We are constantly plagued by poor or sloppy research, premature announcements of startling results, and promises that we cannot keep. One thing that we can do to counteract these problems is to resolve differences in research findings between our laboratories. It must be very confusing to the public to see divergent statements from scientists. I do not believe that it is acceptable to righteously insist on the correctness of our own findings in the face of contradictory evidence from other reputable scientists. Every researcher knows that when the results fit the hypothesis, the results are published; but if the results do not fit the hypothesis then the experiment is repeated again and again until either we have to change the hypothesis or find the artifact in the first experiments. I am suggesting that results from another laboratory that do not agree with our own should receive no less consideration than if we had obtained those results ourselves. Much more dangerous is the problem in science that has received much public notoriety recently: the reporting of out-and-out fraudulent research results. Scientists in research involving a chronic, eventually fatal, human disease have a special obligation to guard against such tactics. Theoretical physicists who fake data or make premature and incorrect announcements will certainly harm their career, but they will have made no promises to the afflicted of a miracle cure. This problem of fraudulent research data or even the accusation of such tactics destroys public confidence. All researchers are vulnerable. Example after example can be DEITRICH found of a trusted research associate gone wrong even among the most respected laboratories. While we can insist that it is a rare occurrence, the notoriety that the fraud attracts does not leave that impression in the mind of the public; and in the final analysis, it is the public that we must convince. Increased funding gained by excellent research, by lobbying Congress, and by appeals to private donors can disappear in an instant when a big "splash" is made over some incident involving false or fraudulent claims. The alcohol research effort is clearly deserving of, and is achieving, stature and respectability in the research world, but the hold is tenuous and requires the best effort of all involved. |