Alfredo Lanari, a clinical research style

12 Pages·2013·0.65 MB·English

by  Romero L

ARTICLE / ARTÍCULo 69
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Alfredo Lanari, a clinical research style CT
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Alfredo Lanari, un estilo de investigación clínica os A
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Romero, Lucía1 ril, 2
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1Undergraduate degree in ABSTRACT The institutionalization of clinical research in Argentina reached its point
Sociology. PhD in Social of greatest maturity with the creation, in 1957, of the Institute of Medical Investigations
Sciences. Professor of
(Instituto de Investigaciones Médicas) of the Faculty of Medicine of the Universidad de
Sociology, Universidad
de Buenos Aires (UBA) Buenos Aires, and the drive of the man who was its director for almost 20 years, Alfredo
and Universidad Nacional Lanari. In this paper I analyze the ways in which he generated a style of clinical research
de Quilmes (UNQ).
and a referential position in the local medical fi eld that allowed him to carry out said
Postdoctoral fellow, Consejo
Nacional de Investigaciones institutional realization. This achievement was the result of a personal enterprise and at
Científi cas y Técnicas  the same time part of a larger context of transformations within the medical discipline
(CONICET,), Argentina. 
worldwide and at the Universidad de Buenos Aires. This study was carried out combi-
[email protected]
ning oral and documentary sources, such as interviews with physicians at the Institute of
Medical Investigations, members of the journal Medicina and of the Argentine Society of
Clinical Investigation (Sociedad Argentina de Investigación Clínica), as well as academic
fi les and scientifi c articles.
KEY WORDS History, 20th Century; Clinical Medicine; Biomedical Research; Argentina.
RESUMEN La institucionalización de la investigación clínica en la Argentina adquirió
su máxima madurez a partir de la creación, en 1957, del Instituto de Investigaciones
Médicas de la Facultad de Medicina de la Universidad de Buenos Aires, y del impulso
de quien fuera su director durante casi 20 años, Alfredo Lanari. En este trabajo analizo las
modalidades mediante las cuales esta fi gura construyó un estilo de investigación clínica
y una posición de referente en la medicina local que le permitieron llevar adelante
dicha realización institucional. Esta construcción fue fruto de una empresa personal
pero al mismo tiempo abrevó en un contexto más amplio de transformaciones en la
medicina mundial y en la Universidad de Buenos Aires. Esta investigación se llevó a
cabo combinando el uso de fuentes orales (entrevistas a miembros del Instituto de
Investigaciones Médicas, integrantes de la revista Medicina y de la Sociedad Argentina
de Investigación Clínica) y documentales (legajos académicos y artículos científi cos).
PALABRAS CLAVE Historia del Siglo XX; Medicina Clínica; Investigación Clínica;
Argentina.
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70 RoMERo L.
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uar rying out these activities. The years from 1955-1968
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9- Alfredo Lanari’s name undoubtedly holds expansion and the financing capacity of the National
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1): a significant place in the scientific and medical Institute of Health (NIH). In turn, in 1964, when the
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es, history of Argentina during the second half of Institut National d’Hygiène of France became the In-
Air the 20th century. His professional activity, char- stitut National de la Santé et la Recherche Médicale
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en acterized by an eagerness for innovation, was (INSERM), the activities of hospital-based medical
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A, B reflected in the different scientific enterprises research, practice and education were newly inter-
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TI that Lanari carried out with the aim of renovating twined, serving as the basis from which to begin
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LE various aspects of local and regional medicine. to redefine the professional profile of the clinical
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C His vision influenced the transformation of researcher as well as the relationship between the
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LU three fundamental fronts: medical education, laboratory sciences and clinical medical practice (2).
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S health care practice, and research. Thus, along In the area of medical education during the
with other figures in the field, he was a force 1950s a series of innovations began to take place,
behind the efforts to reform undergraduate edu- as the result of a long process occurring both re-
cation (in the hospital teaching unit, providing gionally and internationally and with strong reper-
a three-year clinical education cycle within the cussions locally, in which the prevailing medical
hospital), as well as graduate education (medical education programs were the object of revision
residency programs), which were introduced and and discussion. A number of proposals for medical
carried out by the mid-1960s at the Faculty of Med- education reform were developed in such spaces
icine of the Universidad de Buenos Aires (UBA). as regional and international Medical Education
Lanari was who initiated, within the local medical Conferences (3,4). Many of these reforms worked
field, the discussion regarding the necessity of to consolidate the “flexnerization” of medicine.
full-time positions for practitioners, professors and This process, which started in the 1910s, consisted
researchers, and he put great effort into bringing of a shift from an anatomopathological paradigm to
clinical and experimental traditions together. a paradigm centered on the basic sciences (physi-
These changes were materialized paradig- ology) and laboratory sciences, as part of a series
matically in the Institute of Medical Investigations of reforms that took place in the field of medical
(IIM, from the Spanish Instituto de Investigaciones education at US universities after the publication
Médicas) of the Faculty of Medicine of the UBA, of what was called the “Flexner Report” (5). This
of which Lanari was director from its creation in report was the result of a study on medical edu-
1957 until 1976. cation at universities in North America, appointed
Without minimizing Lanari’s active role to Abraham Flexner by the Carnegie Foundation.
in the local field of clinical medicine and in the Flexner’s report emphasized the priority of ex-
creation of the IIM, it is absolutely necessary to perimental work, cultivated within the Germanic
acknowledge the impact that the contemporary university model, highlighting the scientific foun-
climate of innovative ideas and actions had on dations of medicine. This was precisely the core
him, a climate found within both in the cosmo- of Flexner’s innovation: considering medicine to
politan arena of the discipline in the years after the be sustained by the basic sciences and, thus, un-
Second World War and in the political and aca- derscoring the importance of these sciences in the
demic environment of renovation and scientific training of physicians, thereby giving content to
professionalization that the Argentine university the notion of “scientific medicine” (6). These ele-
underwent after the overthrow of the Peronist gov- ments appear within the idea and practice of the
ernment in 1955 (1). full-time physician adopted by Lanari, as well as in
In the context of the medical discipline post- his comprehensive medical practice of research,
World War II in the U. S. and France – the two most care, and teaching, which combined experimental
important countries serving as centers of international research with clinical care.
reference for medical research, organization and At the local level a series of ideas and ac-
funding – major transformations took place within tions were also being carried out by individuals
Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334 | E-ISSN 1851-8265| ISSN-L 1669-2381
ALFREDo LANARI, A CLINICAL RESEARCH STyLE 71
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involved in movements for change and university graduate courses, and lines of research were estab- L
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renovation, with reverberations in the Faculty of lished at the IIM, producing over three generations TIV
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Medicine of the UBA, which influenced and nour- of disciples. This combination of organizational , B
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ished the orientation that Lanari’s participation and institutional approaches, academic figures e
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took in the local clinical medical field. and research practices gave way to a tradition of s A
The Universidad de Buenos Aires underwent, clinical research that was developed and institu- ires, 8
starting in 1955, a renovation process whose main tionalized within the social space delimited by the (1
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characteristic was the beginning of the profes- IIM. Even when taking into account this process of 9
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sionalization of research and teaching activities, institution-building – in which not only Lanari but , Ja
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that is, the creation and expansion of full-time also others of his contemporaries participated – his u
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positions at the university (1). This process gained “figure” must be highlighted as playing a central ry - A
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as during Rolando García’s term as dean of the and evolution of the clinical research field. 2
Faculty of Exact and Natural Sciences (a) (9).
A group made up of professors close to Ber-
nardo Houssay organized as a force for modern- ABOUT THE STUDY
ization at the Faculty of Medicine (b). The points
of greatest convergence within the core contents
of the modernization process dawning at the This work is part of my doctoral thesis (9) (c),
UBA and particularly at the Faculty of Exact and focused on the characterization and analysis of La-
Natural Sciences, the perspectives sustained, and nari’s social and professional intervention in the
the changes promoted by the group of modern- local field as well as the itinerary of his academic
izing professors of Medicine (and by Lanari in par- training. In this way, this work aims to show how
ticular), were focused on the actions and projects his singularity was based on his ability to create
to reform medical education and the implemen- his own research style (10), combining elements
tation and expansion of a full-time modality for of the “laboratory style” of experimental medicine
teaching and research. These views were reflected with the “practitioner style” of general medicine
in the 1st Argentine Medical Education Conference and the “clinical research style” he learned from
(1° Congreso Argentino de Educación Médica) teachers both in Argentina and abroad. With
held in November 1957 (9) and organized by the these elements he was able to bring together and
Argentine Medical Association (AMA, from the resignify the work practices and institutional cul-
Spanish Asociación Médica Argentina). tures of both experimental and clinical environ-
The ideas and actions of reform regarding ments, oriented towards the local clinical medical
medical education, healthcare organization and field. This style allowed him to build a reputation
the profile of health professionals, promoted re- and gain professional insertion in the field locally,
gionally and internationally, were shared by the differentiating himself from mere experimental
modernizers at the UBA, by Houssay’s group at researchers and practicing physicians so as to
the Faculty of Medicine and by the members under rapidly institutionalize clinical medical research
the Third Chair of Clinical Medicine. These groups with the foundation of the IIM in 1957.
provided programmatic support and carried out This study was carried out during the period
concrete actions that framed the process of institu- of 2007-2010 combining oral and documentary
tional construction of the IIM. sources. Using in-depth interviews with the
Therefore, with this triple focus – provided members of the IIM (Lanari’s contemporaries and
by the shared orientation of the changes promoted disciples from the first, second and third genera-
after World War II in medical education and or- tions), colleagues of the journal Medicina and
ganization, of the ideas of reform and scientific of the Argentine Society of Clinical Research
professionalization fostered by Risieri Frondizi’s (Sociedad Argentina de Investigación Clínica), it
rectorate, and of Lanari’s course of studies – a was possible to uncover individual and collective
variety of healthcare services, undergraduate and discourses according to shared professional
Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334 | E-ISSN 1851-8265| ISSN-L 1669-2381
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uar specialty, association experience, and gener- strations and assignments always tuned out
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9- sources and materials such as the academic files
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1): of researchers (11-13) and scientific and opinion The condition set by Houssay to be thesis
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es, articles written by researchers, mainly published director, as well as his general way of working,
Air in Medicina (13) but also in other local scientific required that theses fall within the lines of interest
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en outlets of the time, such as Ciencia Nueva (14) and activity of the Physiology Institute (Instituto
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A, and Prensa Médica (15). de Fisiología). This was part of the organizational
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C EXPERIMENTAL AND CLINICAL gested to Lanari, which connected with Lanari’s
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LU TRAINING: LOCAL INSTITUTIONS AND own interests, was on the chemical transmission
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S FIGURES of nerve impulses. As with the majority of theses
carried out at the Institute, not only did Houssay
advise the election of the topic, but, especially at
Alfredo Lanari, also known among his friends the beginning, he himself performed the experi-
as “Pipo,” was born on February 9, 1910 in the ments (14).
city of Mar del Plata, to a middle-class family with Houssay is known to have had a particular
a previous generation of professionals on his fa- “laboratory style” (17) characterized by little use of
ther’s side (d). technology, intense work dynamics, the creation
During his undergraduate studies (1928- of experimental systems, a holistic approach to
1934) he participated in different academic envi- physiology, and the deliberate choice to perform
ronments in which he early on performed teaching research in areas of endocrinology with little in-
and research activities, showing interest in the ternational competition. Many if not all of these
development of both experimental medicine and elements had a major influence in Lanari’s subse-
clinical practice. quent scientific itinerary in terms of the training in
Bernardo Houssay was among the principal physiology he received, the specific skills and style
forerunners and figureheads of experimental med- he was transmitted, and the relational, personal
icine, giving rise to physiology and advocating in and moral values he was taught, as well as in terms
particular endocrine research locally (16). Lanari of the importance that was given to creating gen-
was teaching assistant in Physiology, of which erations of disciples for the amplified reproduction
Houssay had been chair since 1929. It was in that of the group and the scientific institution (18).
context that Lanari chose to carry out his doctoral The culture of clinical care particular to “health
thesis with Houssay: practitioners” (19) was acquired by Lanari through
the figure of Mariano Castex. As the first chair of
I met Bernardo Houssay while in my second Clinical Medicine in the university from the period
year of studies at the Faculty of Medicine. of 1918-1947, Castex worked at the Carlos G.
I had been selected to take part in a special Durand Acute General Hospital (Hospital General
commission to receive more intense lessons de Agudos Carlos G. Durand) and at the Clinical
in physiology. To students with a family con- Hospital (Hospital de Clínicas) where he not only
nection in medicine, Houssay was a very practiced medicine, but was also in charge of pro-
well-known name. He had a wise air about viding extracurricular courses in clinical medicine.
him, the air of someone entirely devoted to re- Although he did some theoretical research and
search and teaching. Everything connected to he carried out some experimental studies, princi-
Houssay was serious […] What was it that most pally he developed a clinical healthcare practice
impacted us in our first impression of Houssay? covering a wide and diverse range of topics, such
That he was always in his Institute, either at his as the study of inherited syphilis, intestinal para-
desk or in the laboratories, teaching and doing sitosis, septic foci, and allergies, publishing works
research. He had rare manual and surgical of local and international impact (12).
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ALFREDo LANARI, A CLINICAL RESEARCH STyLE 73
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After obtaining his degree in 1933, Lanari Vaccarezza worked at the Physical Therapy L
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worked as assistant physician in the Clinical Med- Institute of the Clinical Medicine Hospital (Hos- TIV
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icine Service at the Clinical Hospital, under the di- pital de Clínica Médica) and held the role of se- , B
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rection of Dr. Mariano Castex. Dr. Castex trained nior practitioner of the Model Institute of Clinical e
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him in semiology and in clinical practice and Medicine (Instituto Modelo de Clínica Médica). s A
taught him the importance of performing routine Later he began his experience at the Dr. Francisco ires, 8
hospital rounds, meticulous and systematic Javier Muñiz Hospital of Infectious Diseases (Hos- (1
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clinical observation, and professional and personal pital de Infecciosas “Dr. Francisco Javier Muñiz”), 9
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commitment to the care and treatment provided where he received scientific recognition for his re- , Ja
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to each patient. Although he continued to value search, clinical care and teaching developments u
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the skills acquired through his work with Castex, regarding tuberculosis. He became chair of Pa- ry - A
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and the Koch Ward, both located at the Muñiz 2
The fact that he and I did not think alike re- Hospital (20).
garding research methodology has to do with After finishing his undergraduate education,
the 25-year age difference between us as well Lanari started working for the Infectious Disease
as our different research fields. Present-day Service at the Muñiz Hospital under Vaccarezza’s
researchers schooled in molecular biology direction:
would say the same about me if they saw me
working with dogs. (15 p.16) (own translation) Although I started attending the Muñiz Hos-
pital before 1939 […], it’s been since that year,
Lanari worked with Castex until 1947 when with long periods where I’ve been abroad,
Castex resigned from the university, in a context that I’ve been connected to the Chair of Tu-
of political dismissals and resignations of faculty berculosis. In this chair I’ve seen what real
resulting from the tensions held with the recently organization is, what the scope of Professor
elected Peronist government (1,14). While his re- Vaccarezza’s work is. His duties range from
lationship with Castex did not continue in time nor giving classes to getting dogs sent to my exper-
outside of the work he developed between 1933 imental lab […] Attending during these fifteen
and 1947 under his chair, Lanari did keep close years the three weekly meetings, discussing
professional and personal contact with Houssay cases, suggesting treatments, inspiring original
and Vaccarezza (who will be discussed next), research, reading everything published within
even after finishing his work under their chairs. the chair. (21 p.57) (own translation)
Along with Houssay and Alfredo Bartolomé
Lanari (Senior), Raúl Francisco Vaccarezza was Unlike Castex, Vacarrezza was considered by
the third person of great impact and influence Lanari to be a promoter of clinical as well as exper-
in the orientation and characteristics of Lanari’s imental research, especially in pneumology (15).
scientific training, both at its beginnings and as
it developed. Unlike with Houssay and Castex,
Lanari maintained not only a professional con- Training with the Boston group: the
nection but also a personal, friendly and familiar clinical research style of Cannon, Luco and
relationship with Vacarezza (13). Rosenblueth
This closer tie was possible because of the re-
lationship that Vacarezza already had with Alfredo Between September 1938 and May 1939,
Bartolomé Lanari (Senior): Vaccarezza had been Lanari acted as voluntary assistant in the service
Lanari’s assistant in the Chair of Medical Physics of Professor Minot in Boston, where he met Arturo
and was one of the physicians who supported him Rosenblueth and Joaquín V. Luco. He worked with
during his time as dean, acting as Secretary of the them on discussing and comparing electric theory
Faculty from 1919-1920 (during Linari’s first term) and chemical theory in the synaptic transmission
and in 1927-1929 (during his second term). of nerve impulses, although fundamentally he
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uar in the maturation of his views on medicine and practices and ideas – to clinical medicine. After
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9- referential figures in neurophysiology: Rosen- mally his predilection for clinical pulmonary
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1): blueth was director of the Institute of Advanced physiopathology. Later on, the influences of these
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es, Studies of the Mexican Polytechnic Institute (In- figures would reach further than the choice of a
Air stituto de Estudios Avanzados del Instituto Poli- research area. The ideology and style of Cannon,
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en técnico de México), and was creator, along with Luco and Rosenblueth would be expressed in the
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A, Norbert Wiener, of cybernetics, while Luco was a institutional and intellectual project of the IIM.
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TI person of reference in that field of studies in Chile.
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C ences: Rosenblueth was “a friend, geographically THE DEVELOPMENT OF A NEW
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LU distant but with whom I nonetheless kept in touch RESEARCH STYLE
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S until his death in 1970.” Luco was “an inseparable
friend in Boston, whose decision to take on full-
time work in Chile had an influence on me; it took In 1939, back in Buenos Aires and with no
me away from the classic scheme of the part-time opportunities to do full-time clinical research be-
clinical physician to foster in me the rigor of the cause there were no such positions for a clinical
full-time professor and researcher with exclusive physician at the Faculty of Medicine, Lanari di-
dedication to the institution” (23 p.36-37). vided his time between clinical and experimental
When Lanari met both in Boston, Walter medicine: in the morning, part time, with Mariano
Cannon was the figure behind them. He was one Castex, acting as adjunct professor in the Chair
of the most prominent scientific personalities in of Clinical Medicine and in the afternoon, at the
the field of international medicine. From the time Physiology Institute.
he served in the First World War until his death at Although he never stopped frequenting the
the end of the Second World War, Cannon was a Institute and exchanging ideas with Houssay,
pioneer in the field of physiology, acting as chair Lanari soon resigned this ad honorem position
of Physiology at Harvard Medical School during and started working at the Muñiz Hospital, where
1920-1940 (22). the Chair of Pathology and Clinical Treatment of
Lanari also completed an advanced course Tuberculosis was held by Vaccarezza, who of-
from 1938 to 1939 in which he worked with fered Lanari a paid position. Although it was not
Cannon. This relationship as well as those with a full-time position, it was enough to live on; he
Luco and Rosenblueth were the experiences of was appointed Interim Chief of Physiopathological
greatest importance to Lanari, as they helped so- Research under the chair. It was then he started
lidify his particular belief in breaking the duality developing lines of work on topics of respiratory
between clinical and experimental (laboratory) physiology. These topics were added to his first
medicine, and they strengthened his inclination lines of research in the field of neurophysiology
for research. Cannon was a great proponent of this and neuromuscular disorders (with myasthenia
conjunction and particularly of physiology and its gravis receiving most of his attention), topics
application within clinical medicine (24): which he never abandoned, although they were
sometimes interrupted or discontinued at different
I worked with Cannon and Rosenblueth for no stages of his career (14).
more than eight or nine months, we published In addition to these positions, he also worked
some works, and then I know exactly what I as physician at the General Directorate of Taxes
wanted to do. I came back to Buenos Aires (Dirección General Impositiva). Although this
with the idea that I would work full-time in meant an important workload, it was a necessary
clinical research. (14 p.26) (own translation) addition in order to round out his salary in a way
that would allow him to live comfortably; doing so
Indeed, Cannon strengthened the vocation for was difficult with only his part-time work as pro-
physiology that Lanari had received from Houssay fessor in the university and in the hospital.
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ALFREDo LANARI, A CLINICAL RESEARCH STyLE 75
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Not long after his return to Buenos Aires, to “highlight new advances in any of the medical L
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in october of 1939, he founded the journal Me- fields”; and the third section was dedicated to TIV
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dicina with a group of physicians that, although critical reviews of books of both national and in- , B
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they had been trained by Houssay, did not limit ternational origin. A fourth section was made up of e
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the orientation of their research to the experi- editorials (25 p.1). s A
mental field (physiology) but rather were inter- In october 1943, in the context of suspen- ires, 8
ested in its clinical application as well. Lanari sions of faculty initiated by the de facto gov- (1
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was member of the journal’s Editorial Committee ernment established in the country, Lanari resigned 9
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until his death in 1985. The publication and dis- his positions in the chairs held by Castex and Vac- , Ja
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semination of this type of work in clinical re- carezza. His distance from the university was rela- u
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search required a particular outlet, and with that tively short-lived, given that after two years’ time, ry - A
purpose Medicina was founded: iunn iMvearys it1y9. 4A5t, tLhaant artiim wea sh ere iwnacso rappopraotiendte idn toC hthieef pril, 20
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I would say that the Houssay’s core group is of the Experimental Laboratory of the Chair of Pa- 2
Braun Menéndez, Foglia, Lanari. These in- thology and Clinical Practice of Tuberculosis, and
dividuals basically dedicated themselves to began offering his first course on “Complementary
the direct study of the human being. They  Teaching of Clinical Medicine” in Castex’s service.
are the same people who, at a certain point, Moreover, that same year in September, he was
when they started finishing their studies and  appointed honorary adjunct physician in the Fifth
wanted to release their results, found that, Ward of the Clinical Hospital (24).
in Argentina, there was no scientific society  In the 10-year period following Lanari’s des-
appropriate for publishing their work […] ignation as tenured professor and full-time inves-
Therefore, years later when we appeared, we  tigator in the Third Chair of Clinical Medicine
were “their hands” (they were the minds; we and his directorship of the IIM in the Tornú Hos-
can say we were the hands), and in 1960, the pital, Lanari continued developing and improving
Argentine Society of Clinical Investigation training activities both locally and internationally.
emerged. But long before that, that same Starting in 1947, he offered classes in Physio-
group had gathered to publish the journal pathology of Respiration in the advanced training
Medicina. It was 1939 and they all belonged course for phthisiologists under Vaccarezza and
to Houssay’s group. (e) continued as Chief of the Experimental Laboratory
under Vaccarezza’s chair, in addition to offering
The journal was born out of the inspiration his collaboration as auxiliary in the Antitubercular
of Lanari and others, none of whom were older Drug Dispensary. He was appointed adjunct pro-
than 30 or 35. They thus belonged to the new gen- fessor in the First Chair of Clinical Medicine in
eration of physicians trained in the years after the June 1950 as a result of a public selection process.
University Reform of 1918: Alberto Taquini, os- In 1949, he was relieved of his responsibilities
valdo Fustinoni, Venancio Deulofeu, Mario Brea, as physician at the General Directorate of Taxes
Alfredo Pavlovsky, among the main figures (25). after he declined to sign an official announcement
In the first lines of the first issue, Lanari high- organized by the Peronist government (14).
lighted that the platform of the journal should Thus, from 1949-1951 he only exercised private
“provide the Argentine medical family with a practice, providing health care to patients at his
journal specialized in general medicine with an office and at a clinic, the Thorax Institute (Instituto
organization grounded in the quality of its original del Tórax), with Vaccarezza and other members of
articles” (25 p.1). This mission was materialized the Muñiz Hospital group (14).
in the three sections that structured the journal: This event in 1949 was added to the massive
the first section aimed at publishing original works faculty dismissals that had taken place in 1943. In
and considerations of cases, which should be 1947, the University Act No. 13031 (Ley Univer-
“brief and productive” (in terms of generating new sitaria 13.031) came into effect, which annulled
knowledge and not giving a mere description of a the University Reform Bylaws of 1918, thereby
clinical case); the object of the second section was overriding university autonomy, the tripartite
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76 RoMERo L.
2
1
0
2
pril,
A
y - government [among faculty, students, and grad- process of university renewal and reconstruction
uar uates] and student participation. Given the accu- mentioned previously (28). In that context, a
n
a
0, J mulation of all of these conditions adverse to his public selection process was started to hire a Chair
8
9- professional development and an offer he received of Clinical Medicine in mid-1956. This event in
6
1): for a position to work and do research in the USA, particular helped him decide to return and apply
8(
es, he decided to leave the country: “I was quite fed for the position under the condition of it being
Air up with the political situation of the country and full-time.
os
en I was experiencing some difficulties in my job; I This way of working, core to the professional
u
B
A, was offered a position and I left” (14 p.27). ideals that Lanari had carried with him up to that
V
TI point, was something he had learned first from
C
LE Houssay and later from Rosenblueth, Luco and
o
C Second period abroad at the National Cannon. The peculiarity and novelty of these last
D
U Jewish Hospital, Denver three figures was to consider full-time work as part
L
A
S of the professional responsibility of the clinical
Between January and May 1951, with a schol- researcher:
arship granted by the Rockefeller Foundation,
Lanari carried out a research fellowship in the With them I realized that the only way to do
USA at the University of Colorado, Denver. He research seriously was to do it full-time. In
focused on the study of methods used in the func- theory, at least, one would want researchers
tional exploration of the respiratory system (26). to be devoted to clinical research, to see and
Later, between the end of 1951 and July 1952, he provide care to patients in their workplace,
was appointed Advisor in Cardiopulmonary Phys- and not to have concerns that lead them to
iopathology by the World Health organization private practice. Full-time work is in fact a
(WHo) in Guayaquil, Ecuador. mental state. (14 p.27) (own transation)
He returned to Argentina the following year
when he was appointed adjunct assistant professor In these reflections on the nature and the
in the Third Chair of Clinical Medicine and, one functions of the full-time researcher-physician,
month later, he was appointed ad honorem pro- his vision of the organizational and physical base
fessor of the advanced course in phthisiology in needed for such practice also stands out: it is a
the Chair of Tuberculosis. During that period, he vision of the shared ecology of clinical care and re-
dedicated time to preparing the thesis needed in search. This perspective would later be expressed
order to receive his degree as medical educator: within the organizational culture of the IIM, en-
“El problema general de injertos y transplante de compassing comprehensively the work of patient
órganos” (The general problem of grafts and organ care, research and education.
transplants), which was approved in 1954 (24).
Later that year, he again left the country
and moved to Denver, where he worked as as- Return and reestablishment in Argentina
sistant professor of Medicine at the University of as the full-time Third Chair of Clinical
Colorado, Denver, until 1956. There, he worked Medicine
at the National Jewish Hospital, associated with
the university, serving as Chief of the Cardiopul- In october 1956, back in Argentina, he was
monary Laboratory and as Assistant Professor. appointed a full-time position as Chair of Clinical
During the years he worked in Denver, Lanari in- Medicine, becoming the first professor of Clinical
vited a number of young physicians to work with Medicine with full-time dedication at the Faculty
him. Those physicians later became part of the of Medicine of Buenos Aires (f). He immediately
IIM staff (27). asked to take leave until February 1957, so that he
His return to and reestablishment in Argentina could travel to Denver, where he had left some re-
were due to the favorable professional conditions search activities unfinished at the National Jewish
that he saw in the new scientific scenario that Hospital as well as some teaching activities at the
opened up nationally after 1955, as a result of the University of Colorado (24).
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ALFREDo LANARI, A CLINICAL RESEARCH STyLE 77
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U
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o
once back in Buenos Aires, in July 1957 the Lanari’s singularity therefore lies in how he L
E
C
IIM was opened and he was offered the position connected the practitioner style he learned from TIV
A
of director. He accepted, under the condition that Castex and the clinical research style he learned , B
u
the position be full-time, uniting this new position from Vaccarezza with Houssay’s laboratory style: e
n
o
with the chair obtained a year earlier. The per- not only did he consider health care activities to s A
manent committee in charge of analyzing mea- be inherently important, he understood them to ires, 8
sures to foster and finance scientific research at the be irreplaceable inputs for clinical research, that (1
):6
Faculty of Medicine, presided over by Houssay, is, to produce original knowledge oriented to- 9
-8
0
honored his request, stating him to be under full- wards the resolution of (or inspired by) human , Ja
n
time employment and joining the directorship health problems. This conjunction of institutional u
a
with his position as Third Chair of Clinical Med- practices and cultures had a unique expression in ry - A
imcianteio. nI no ft hthise rIoIMle, hreec rsupietianrgh ecaodlleeda gtuhees iunnitdiaelr fhoirs- Lclainnaicrai,l reensvuilrtoinngm ienn th iosf ftuhlel- tihmoesp iwtaol rka nwd itthhien utnhie- pril, 20
1
chair, members of the group that worked with him versity. This was the legacy that he received from 2
at the Muñiz Hospital and at the Clinical Hospital, his teachers Luco, Cannon and Rosenblueth and
and other researchers who had taken advanced that he resignified within the local clinical medical
courses abroad (24). field, unlike his predecessors, who had never before
The experience and the path that Lanari been awakened to this type of vocation. Thus, the
would undertake from that moment onward, as combination of experimental and clinical cultures
a trained researcher, was built on the integration and practices within a full-time dedication became
and resignification of the inheritance he received the seal and the originality of Lanari’s educational
from the local and foreign clinical and experi- itinerary.
mental traditions that he passed through during Later on, his path, his perspectives and his
his years of training. That inheritance consisted of practices coincided both with a local political
specific ways of exercising medical care, research academic context and with a disciplinary context
and education practices and the construction and conducive and favorable to their institutional ma-
support of institutional environments and organi- terialization. on the one hand, the context of the
zational models conducive to the comprehensive so-called academic modernization or Argentine
development of these activities. university renewal after 1955, which fundamen-
tally supported the professionalization of the
role of professor/researcher. on the other hand,
FINAL REMARKS the support of experimental research activities
provided by American and French financial net-
works and promoters, reinforcing what was called
If we pay attention to the evolution of the lines “scientific medicine” (2). These processes made
of research established and developed by Lanari, the creation of the IIM as well as the institution-
as well as to the different institutions in which he alization of the Lanari style possible, leading to
participated throughout his education, we can the development of a tradition of a unique type of
observe how research styles from Houssay’s ex- research, developed over the course of 20 years.
perimental perspective and how practices and vi- However, this favorable “climate of the times,”
sions regarding the health care provided to clinical as well as the creation of the IIM, are objects of
medicine patients, represented by Vacccarezza and analysis that go beyond the scope and objectives
Castex, helped to forge Lanari’s style. What he did of this work. They are mentioned for the sake of
not take from the Argentine pioneer in physiology, at least signaling the direction that Lanari’s indi-
and, in turn, did take from his teachers of clinical vidual path would take within the context of an
medicine, was the high value placed on the ac- institutional project materialized in the IIM.
tivities of care, taking the patient and the patient’s
disease as the focal point of medical interest and in
the formulation of research problems.
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78 RoMERo L.
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April, FINAL NOTES National Research Councils were created in the
y - mid-1950s – in 1958 in Argentina the National
ar
nu a. The Argentine university was born and de- Council of Scientific and Technological Research
a
0, J veloped in the Napoleonic tradition, structured (CoNICET, Consejo Nacional de Investigacio-
9-8 basically and fundamentally as a place for the nes Científicas y Técnicas) was created – as
1):6 reproduction and transmission of knowledge. well as National Institutes devoted to research,
Aires, 8( Tthhee ruenfoivree,r stihtye apirmofeeds smioanianlliyst aptr ogfiralen toinugt liqnueadl ifbyy- mtecahnnagoelomgeicnat l aacntdiv iptireosm. Tohtieo nN aotifo nscaile Inntsitfiitcu tean odf
os ing degrees for the exercise of classic liberal Agricultural Technology (INTA, Instituto Nacio-
en professions, relegating the production of original nal de Tecnología Agropecuaria) was created in
u
A, B knowledge to a place of less importance (7). The 1956 and a year later the National Institute of
TIV transformations introduced into the university Industrial Technology (INTI, Instituto Nacional
EC by the process of the University Reform of 1918 de Tecnología Industrial) was formed.
L
o primarily impacted organizational aspects of the
C
D university government and its academic course of b. The Physiology Institute, created in 1919, and
LU studies, and although it meant an affirmation of its director Bernardo Houssay, were key to the
A
S the university as a research environment, it also consolidation of experimental medicine in Ar-
demonstrated contradictions and profound limita- gentina and to physiology and endocrinology
tions, preserving the professionalist pattern held worldwide (their importance was no less in the
since the university’s origins (8). From that per- field of Argentine scientific policy). By the 1940s,
spective, the historical phase of openness at the the Institute was a central part of the Faculty of
UBA from 1955-1966, considered to be a time of Medicine, with a staff of 130 instructors teaching
“university reconstruction” (1), took on particular physiology, biochemistry and biophysics to more
meaning by granting renewed importance both than 800 students. While he worked in several ar-
materially and symbolically to the production of eas of research, his major interest was in the rela-
original knowledge. This led to the creation and tionship between the pituitary gland and diabetes;
multiplication of full-time positions for researching indeed, in 1947 he obtained the Nobel Prize in
and teaching, in turn giving way to the profession- Medicine precisely for discovering the role played
alization of those activities and to the establish- by the hormones from the anterior lobe of the pi-
ment and initiation of public selection processes tuitary gland in carbohydrate metabolism (6). The
to fill and occupy these positions. In this context, “Houssay group” was formed out of this Institute.
the fundamental issue, raised by renovators such In 1958, Florencio Escardó was appointed “nor-
as Risieri Frondizi, centered on the debate of the malizing” dean of Medicine, supported in the
“social function” of the university, whose ba- Faculty’s Executive Council by Eduardo Braun
sic role was said to be that of research – and of Menéndez, Eduardo de Robertis, Alfredo Lanari,
teaching – as well as that of professional training Mario Brea, Eduardo Manzini, Armando Parodi,
and social extension. These meanings tied to the and Venancio Deulofeu.
social function of the university recovered consti-
tutive reform ideals – autonomy and extension – c. This article is based on “Conformación de la
giving them new purpose in the new context of tradición: Alfredo Lanari, la construcción de un
academic reform that had opened in 1955. Look- estilo de investigación propio” (“Forming the
ing at the issue more broadly and generally, the Tradition: Alfredo Lanari, the creation of a re-
framework of ideas and processes within which search style”) (9).
this series of actions and projects of university re-
newal were taken, aimed at granting science and d. Lanari’s primary socialization is significant con-
the university a space of renewed importance in sidering his father’s weight and position in the Ar-
society, should be considered. After World War gentine medical field during the 1920s. Alfredo
II a new phase in the relationship between sci- Bartolomé Lanari (Senior) was head of the Physical
ence and the State began. In central countries, Therapy Institute (Instituto de Fisioterapia), where
the State gave science and technology a place of he taught Medical Physics. He was appointed Dean
priority on the agenda, increasing resources and of the Faculty of Medicine in May 1919 – and again
creating new institutions devoted to research as from 1927 to 1929 – putting into effect a series of
well as specialized national and regional organi- transformations throughout his three-year term
zations such as the United Nations Educational which were very relevant to medical education:
Scientific and Cultural Organization (UNESCO) the effective implementation of “docencia libre”
and the Economic Commission for Latin America [a 1903 regulation that allowed graduated profes-
(ECLA), created to promote and regularize sci- sionals to teach open extracurricular courses to
ence and technology. This trend was followed undergraduates, with which they could also gain
in developing countries, in the climate of ideas experience favorable to them in competitive selec-
and actions known as “developmentalism,” as tion processes for paid positions], limitation of the
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