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The Stroke Council and the Young Investigator Award

  • Louis R. Caplan
    Correspondence
    Address reprint requests to Dr. L. R. Caplan, Department of Neurology, New England Medical Center, 750 Washington Street, Boston, MA 02111
    Affiliations
    Chairman, Stroke Council of the American Heart Association, Boston, Massachusetts
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      The Stroke Council of the American Heart Association (AHA) recently announced the creation of the Robert G. Siekert Young Investigator Award. This award for meritorious stroke research will be inaugurated at the 14th International Joint Conference on Stroke and the Cerebral Circulation, to be held in San Antonio in February 1989. The recipient will be chosen on the basis of material submitted for presentation at that meeting. This award, named for one of the important leaders and a former chairman of the Stroke Council and the first program chairman of the International Stroke Conference, represents a landmark in the history of stroke research, a coming of age. This is a timely opportunity to review the history of the Stroke Council and its two most important activities—publication of the journal Stroke and the annual International Stroke Conference—and to emphasize the important contributions of Dr. Robert Siekert to each. Well known to readers of the Mayo Clinic Proceedings, Dr. Siekert is also a former editor and frequent contributor to the pages of this journal.
      Heart disease, cancer, and stroke are now, and have long been, the three most important causes of death and disability in the United States and in almost all other developed countries in the world. Yet, for reasons that are difficult to explain, the battle against stroke by society and the medical community has lagged far behind the efforts to combat heart disease and cancer. By any measure—dollars, volunteers, organizations, physicians, research, clinical facilities, literature—a disproportionately small number will be registered in the stroke column. Studies supported by the AHA and its affiliates have clearly shown that the public knows much less about stroke and cerebrovascular disease than about heart disease and cancer,

      American Heart Association, San Francisco Chapter: San Francisco Public Awareness Survey, Study 62202, Opinion Research Corporation, 1984

      American Heart Association: Stroke Awareness Study, SRI Research Center, 1985

      and, unfortunately, the same statement applies to patients with stroke, to their families, and to physicians in general. Society's meager effort against stroke is especially ironic and tragic when compared with recent advances in neurology, neurosurgery, and neuroscience. In no other field of medicine has knowledge progressed so far so quickly. Technologic advances in our ability to image the human brain during life, to study its functions and metabolism, and to image and measure its blood supply have been dramatic. We need to push rigorously forward in the battle against stroke. The Siekert Award is a step in that direction.

      The Stroke Council.

      The current Stroke Council had its origin in an ad hoc committee appointed by the AHA called the “Coordinating Committee for a Nationwide Stroke Program,” which first met in March 1964 under the chairmanship of Dr. Irving Wright, a cardiologist and a professor of medicine at Cornell. This committee was initiated to identify interest and expertise in the field of stroke and to sponsor this activity securely within the bosom of the AHA. In January 1967, rules and regulations were established, and the committee became the Council on Cerebrovascular Disease. Dr. Clark Millikan, then at the Mayo Clinic, was the chairman, and the committee included several key persons still active today in the field of stroke—Drs. William Hass, Albert Heyman, Fletcher McDowell, John S. Meyer, and James Toole. Dr. Siekert became a member of this council in 1968. In 1972, the name was simplified to its current form, the Stroke Council of the AHA.
      In the 1960s, the only other organized stroke activity was another ad hoc committee, which had been appointed by two component institutes of the National Institutes of Health (NIH)—the National Institute of Neurological Diseases and Blindness and the National Heart Institute (later to become the National Heart, Lung, and Blood Institute [NHLBI] and the National Institute of Neurological and Communicative Diseases and Stroke [NINCDS]). This committee was called “The Joint Council Subcommittee on Cerebrovascular Disease.” This organization functioned from 1961 to 1972 as the NIH focal point for stroke planning; sponsored the Princeton Conferences on Cerebrovascular Diseases, which have been held every 2 years since 1954 under the joint sponsorships of the NIH, the AHA, and the American Neurological Association; and initiated the Cerebrovascular Disease Survey Reports, which have been published by NINCDS at 5-year intervals.
      The Stroke Council is one of 14 scientific councils of the AHA. It is governed by an Executive Council composed of about 24 members who traditionally were carefully chosen to include a mix of specialists active against stroke—neurologists, neurosurgeons, vascular surgeons, and internists—and of clinicians and basic researchers. The editor of the journal Stroke and representatives from NINCDS and NHLBI attend meetings as liaison members of the council. The following are the major functions of the council: to publish position papers and up-to-date scientific stroke materials; to advise the AHA and the press on stroke-related matters; to interrelate with the AHA journals Stroke and Current Concepts of Cerebrovascular Disease, a “minijournal” distributed by AHA affiliates; to conduct scientific sessions at the annual AHA meeting and the annual International Stroke Conference; to appoint representatives to AHA research committees who will ensure that research awards and funds are fairly allocated to the field of stroke and will help in the selection of awardees; to sponsor and select student scholars in cerebrovascular disease; and to participate fully in all activities of the AHA, including its annual workshop for science writers. Student scholarships have been awarded annually since 1980; their intent is to stimulate medical students to pursue careers in stroke research. Stipends, which have ranged from $1,000 to $1,500, are given annually to 10 medical students for 3-month clerkships under the supervision of faculty preceptors chosen by a committee of the Stroke Council from competitive proposals. The census of members and fellows of the Stroke Council has grown dramatically since 1973, and it is now the fourth largest council in the AHA with a membership of 1,140.
      The AHA has presented Established Investigator and Career Scientist awards to stroke researchers, averaging two to four total awards each year. During the early 1980s, stroke research applicants for the Established Investigator awards represented 3.3% of the total applicant pool and 5.7% of the awardees. The Executive Council delegates to the AHA Research Committee have been Drs. James Halsey, Jr., O. M. “Mac” Reinmuth, A. G. “Jerry” Waltz, and Myron Ginsberg.
      Dr. Siekert was a member of the Executive Council of the Stroke Council from 1968 through 1980; he served as vice-chairman of the Executive Council from 1973 to 1974 and as chairman from 1975 to 1976. In addition, he served on the Nominating Committee of the council in 1978. Even after leaving the Executive Council, he maintained a position on its Credentials Committee from 1981 through 1986. In 1974, Siekert suggested that the Stroke Council sponsor a large independent stroke conference, and the Executive Council agreed. Siekert was the program chairman and architect of the first Stroke Conference in 1976. For his activities on the Stroke Council and in the AHA, Siekert was awarded the Distinguished Achievement Award in 1984.
      The chairmen of the Stroke Council since 1973 have been Drs. Fletcher McDowell, Robert Siekert, A. B. “Abe” Baker, William Hass, “Mac” Reinmuth, Edward S. Cooper, Mark Dyken, and Louis Caplan. In addition to Siekert, other members of the Stroke Council have been awarded the highest honors given by the AHA. Dr. Clark Millikan has received the Golden Heart, Award of Merit, and Distinguished Achievement Award. The Golden Heart was awarded to Dr. William Hass in 1987. Drs. Fletcher McDowell and Edward Cooper also have achieved the Award of Merit, and Dr. Mark Dyken received the Distinguished Achievement Award in 1987.

      The International Stroke Conference.

      From its inception, the Stroke Council had available to it a section at the general meeting of the AHA that lasted a half or a quarter of a day. The number and quality of submitted papers were suboptimal, and many neurologists, neurosurgeons, and stroke researchers had little interest in attending a cardiology meeting. In the 1970s, a new surgical procedure, carotid endarterectomy, stimulated interest in stroke among many vascular surgeons, and the advent of the dissecting microscope made neurosurgical procedures on cerebral aneurysms and other cerebral vessels more feasible. Neurologists, neurosurgeons, vascular surgeons, and internists interested in stroke had no forum to discuss cerebrovascular problems and research. Although the Princeton Conference met every other year, it was a closed meeting attended by only a small group of selected invitees.
      During the chairmanship of McDowell, the Executive Council accepted Siekert's proposal to sponsor its own meeting separate from the annual AHA session and devoted entirely to the subject of stroke. Planning for the first meeting began in 1975, when abstracts were invited and the meeting was announced. Siekert decided that the meeting should be held in early February in midwinter in a potential vacation area in southern United States. The timing was chosen to avoid conflict with other meetings. Neurologists, neurosurgeons, vascular surgeons, and internists all should have ample opportunities to participate in the meeting, and the scientific sessions and social events of the meeting should foster discussion, camaraderie, and cooperation among these divergent groups. The program should be divided between clinical and basic research topics. The wisdom of these ideas is reflected in the fact that these themes have persisted as guidelines for all subsequent meetings.
      Siekert was the program chairman of the first meeting. He sought and obtained the cooperation of the Canadian Heart Foundation and Stroke Society (Dr. Henry Barnett), the Section on Cerebrovascular Diseases of the American Association of Neurological Surgeons (Dr. John M. Tew, Jr.), and the Society for Vascular Surgeons (Drs. Jesse Thompson and James DeWeese). Later, the American Neurological Association (Dr. James Toole) agreed to cooperate. These organizations cosponsor the meetings with the AHA Stroke Council. The first meeting took place at the North Park Inn, Dallas, the then-new home city for the AHA, on Feb. 27 and 28, 1976. The number of abstracts submitted far exceeded expectations, and the meeting was composed of platform presentations and discussion of papers chosen from the abstracts. The registration fee was $25.00. About 350 enthusiastic attendees crowded the small meeting rooms and halls, and the meeting was judged by all to be an unqualified success.
      Dr. Siekert later made these comments about the meeting. “The papers were good and some outstanding. It was lively, contained good argumentative debate, and was extraordinarily well attended throughout all sessions. There were some difficulties with the meeting room. As an example, I remember several crystal prisms fell from the chandeliers, and pieces of ceiling plaster fell on the audience. The lights for the room were awkwardly placed and had but a single control—all on or all off. The projection equipment was too small and ill-suited for the room, and the projectionist was crowded by the overflow audience. Nonetheless, the attendees took all of this in good spirits and recognized the conference for what it was supposed to be.”
      Subsequent meetings have grown in scope and size. Dr. Siekert chaired the first five conferences and was ably succeeded by Dr. J. Donald Easton and recently by Dr. Vladmir Hachinski. In the 1970s, the stroke research centers funded by NINCDS held meetings the day before the conference. In recent years, participants in many stroke research projects and trials have met before and during the annual stroke meeting. This format has brought many young investigators to the meeting. The conference has become increasingly international in flavor, with attendees coming from all faces of the globe. The winter stroke meeting in southern United States is now generally and widely acknowledged as the primary site in the world for “action” in the field of stroke. The format of the meeting has changed slightly. A symposium and a named lecture (recently called the Willis lecture) are held on Thursday afternoon. Breakfast seminars, platform sessions, and posters fill the program all day Friday and on Saturday morning. The Stroke Council has its annual meeting during luncheon on Friday, and the Executive Council meets on Saturday after the close of the meeting. The number of attendees at the conference was 515 in 1987 and 590 in 1988. Clearly, the conference has far exceeded the dreams and expectations of the AHA and those who participated in that first meeting in Dallas.

      The Journal

      Stroke.

      Stroke was first published by the AHA in 1970 under the editorship of Dr. Clark Millikan. The journal was published every other month until 1988, when it became a monthly publication. The editorial board has always tried to balance the contents of the journal among editorials and clinical, research, and epidemiologic articles. An important and unique feature of Stroke since its outset has been a section called “Abstracts From the Literature.” Dr. Siekert has been responsible for this section since 1972. He and his Mayo Clinic colleagues referenced and abstracted key articles from the American and world literature on research and clinical aspects of cerebrovascular disease. Organized by topics and indexed in the journal, this abstracts section, funded by NINCDS, included all pertinent articles except those published in Stroke. Since 1976, Stroke has also published abstracts of presentations at the international stroke meeting.
      Millikan was succeeded as editor by Drs. Fletcher McDowell and Henry Barnett. Dr. “Mac” Reinmuth is the current editor. In 1982, responding to plans for publication of a competing international stroke journal, Dr. Barnett expanded the editorial board to include more international representation. The original editorial board in 1970 had 22 members, including 1 member from Canada and the others from the United States. The current editorial board has 64 members, including 51 from the United States, 4 from Canada, and 9 from Europe and Asia. Dr. Siekert has been a member of the editorial board since 1977. Subscriptions have steadily increased, and the journal had approximately 6,000 subscribers in 1988.

      Other Organizations That Contribute to Stroke Activity.

      The NINCDS has had a continuing interest in research related to stroke. Under the guidance of Drs. Murray Goldstein and Michael Walker, the institute has funded investigators who perform basic and clinical studies and clinical trials, and it has supported new investigators and promoted research training and career development opportunities and awards for clinicians and basic scientists entering the stroke research field. NINCDS has also generously awarded contracts to stroke research centers throughout the United States. Unfortunately, the number of stroke-related grant applications received by NINCDS continues to be small. For example, in 1985, only 94 applications (of 2,215 total) submitted to the NINCDS pertained to basic, applied, or clinical research on stroke. Of these, about 84% were approved on scientific merit, and about a third of the approved grants were funded. Approval and funding rates were similar to those for all NINCDS applications. NINCDS has continued to support the Princeton Conferences on Cerebrovascular Diseases and to publish Cerebrovascular Disease Survey Reports at 5-year intervals. There is no standing NIH stroke committee, but both NINCDS and NHLBI maintain active liaisons with the AHA Stroke Council and have been vigorous supporters of the council.
      The NHLBI has supported intramural and extramural research in cerebrovascular disease since its establishment in 1948. NHLBI advisory committees consider initiatives targeted on diseases of the vessels of the head and neck that may relate to stroke. Risk factors and prevention strategies for stroke are addressed in the institute's epidemiologic and clinical trial activities; investigation of the biologic mechanisms responsible for vascular diseases of the head and neck (cerebrovascular disease leading to stroke) as well as the heart and other organs is a research priority. In the fiscal year 1987, such cerebrovascular disease research was supported with approximately 8.4 million dollars.
      The National Stroke Association, founded in 1984, has its headquarters in Denver, Colorado. This organization, which merged with the Dwight D. Eisenhower Institute for Stroke Research in 1985, supports many stroke clubs and emphasizes public and patient education in the field of stroke but has not yet become extensively involved in stroke research.
      Only a quarter of a century old, the Stroke Council of the AHA has come a long way. Nevertheless, a great deal more must be done if stroke is to attain its rightful proportion of research and clinical funding and activities. The burden of stroke patients in numbers and dollars far outweighs that of sufferers from Alzheimer's disease, acquired immunodeficiency syndrome (AIDS), motor neuron disease, and muscular dystrophy, yet these other diseases consistently out-compete stroke for research funds and attention. We salute Dr. Robert Siekert and the Stroke Council for their activities in years past. We hope that their example will stimulate future physicians and scientists to join the difficult but rewarding battle against stroke.

      Acknowledgment.

      I thank Drs. William Hass, Robert Siekert, Murray Goldstein, Thomas L. Robertson, Jr., Mark Dyken, O. M. “Mac” Reinmuth, and Edward Cooper for sharing information from the past and for reviewing this editorial.

      REFERENCES

      1. American Heart Association, San Francisco Chapter: San Francisco Public Awareness Survey, Study 62202, Opinion Research Corporation, 1984

      2. American Heart Association: Stroke Awareness Study, SRI Research Center, 1985