Try It or Trial It
“Try it or Trial it” is an apt title for a session at this 25th Princeton Stroke Conference because of the pivotal concepts this think tank has initiated in basic and clinical research designed to prevent, treat and rehabilitate stroke victims. Having attended these conferences intermittently since 1961, I suspect I am now the senior attendee. You may not be aware that Irving S. Wright, who founded this conference, was a cardiologist who introduced heparin to the United States from Sweden by studying its safety and efficacy in one of the first randomized trials for patients experiencing myocardial infarction to prevent venous thromboembolism and extension of acute myocardial infarction. In the same context it was he, along with Mrs Mary Lasker, who developed the concept for Princeton Conferences and for a change in national policy regarding research in heart disease and stroke. As Mrs Lasker recalled to me, one of her friends had recently experienced a stroke and she was told there was no treatment other than bed rest. Together they decided to change this sorry state of affairs: Mrs Lasker supplied funds and Dr Wright the impetus for inviting colleagues from many disciplines to Princeton, New Jersey in the dead of winter to develop a plan for national action. Thereafter, Mrs Lasker and her friend, Florence Mahoney, devoted their efforts to this neglected field and urged President Lyndon Johnson to change the name of the National Institute for Neurological Diseases and Blindness to include the word “stroke” so that a national effort could be initiated in this neglected field.
Here is the letter she wrote to me:
Mary McSweeney has given me your letter of some weeks ago to answer.
I have always been deeply interested in the stroke field, because both my mother and my father were stroke victims, and I felt there just wasn’t sufficient interest in the area. Irving Wright shared this feeling, and we were both anxious to get something started.
My old files are presently stored at my country home and Miss McDonough will look to them when she comes to visit me there to see if there is anything of interest for the years 1953, 1954 and 1955.
Dr. Wright told Miss McDonough that I had contributed $25,000 toward the first Conference. At that time, Dr. Wright said he felt the neurologists wouldn’t do anything as they were more interested in ‘esoteric tumors’ than in a Conference on Cerebrovascular Diseases.
It is my impression that I also gave some support to several later Conferences, although I may be wrong about this and we will have to look in the old files in the country for corroboration.
The idea for a Commission for Heart, Cancer and Stroke was something which developed because of my interest in strokes, but it was not related to the Princeton Conferences except that I saw from the Conferences that we did have a nucleus of men interested in the field of research finally.
I also was one of the people who urged that the name of the National Institute of Neurological Diseases and Blindness be changed to the National Institute of Neurological Diseases and Stroke after the separate Institute for Eye Diseases was established.
I particularly remember the interest and enthusiasm which Dr. Wright had for the Conferences and his talent in organizing them, as well as the interest of Dr. William Foley.
It seems to me that one of the things which the Princeton Conferences could do in the future would be to circulate to all neurologists the fact that the use of anti-hypertensive drugs would reduce the incidence of strokes. Also, I think that general practitioners should be encouraged to look for hypertension in their patients and treat it more energetically, particularly stressing to the patients the importance of taking the drugs.
I would be happy to see anything that you write about the history of the Conferences.
With all best wishes,
Mary Lasker (signature)
For the First Princeton Conference, they assembled 34 individuals from different disciplines who agreed that the problem needed to be addressed, and they spent 3 days in deliberation.1 These forward-thinking predecessors set the stage by identifying what was then an emerging national problem which has now become epidemic and which soon will exceed cancer and heart disease as causes for disability, particularly if one includes the emerging scourge vascular dementia.
At the time of the First Conference, I was a Fulbright Fellow at the National Hospital, Queen Square, London, when Eascott et al had just published their now famous article in The Lancet.2 After I returned I initiated case finding at the University of Pennsylvania and my first Fellow, Dr Martin Reivich, performed retrograde catheter angiography. Using this then new technique, we identified what has come to be known as the “Subclavian Steal.”
When I moved to North Carolina it was my good fortune to recruit George and Virginia Howard who put the words prospective, randomized and statistically significant into my lexicon and then Dr William McKinney added “Ultrasound” to the repertoire. After a short interval it became a substitute for angiography as a means by which to do repeated studies on the carotid and other arteries safely and atraumatically. Since then we have experienced a burgeoning of methods for prevention and for recognition of those at excess risk for stroke.
We have come an enormous way during my lifetime in stroke, and the chances are that we will continue the trend not only for secondary but primary prevention. This workshop has been and still remains the flagship meeting for assessing the state of the art, for developing new ideas for prospective studies by which to identify, prevent and rehabilitate those at excess risk for stroke. Now, we will hear the affirmative and contrary views regarding 3 new modalities of therapy.
- Received June 20, 2006.
- Accepted August 6, 2006.
Members of the Conference on Cerebral Vascular Diseases. In: Wright IS, Luckey EH, eds. Cerebral Vascular Diseases. Transactions of a Conference held under the auspices of The American Heart Association Princeton, New Jersey; January 24–26, 1954. New York, NY: Grune & Stratton; 1955: v-163.
Eastcott HHG, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemplegia. Lancet. 1954; 2: 994–996.