Inserm: Reorganization in 1964 and Early Research Collaboration

The decree of 18 July 1964 reorganized France’s National Institute of Hygiene as the National Institute of Health and Medical Research, known by its French acronym Inserm. The new institute inherited existing staff and research activities and remained under the public health authorities. Eugène Aujaleu, who had long led France’s central health administration, became its first director. The name retained both “health” and “medical research,” reflecting the connection between public health responsibilities and the expansion of experimental medicine.

Forces behind the reorganization included government bodies coordinating scientific research and physicians seeking closer ties between hospital care and laboratory work. Historian Jean-François Picard particularly identifies the involvement of the General Delegation for Scientific and Technical Research in this transition. Oncologist Georges Mathé helped establish specialized scientific committees.

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France already had several hospital research centers before Inserm’s establishment. Laboratories supported by the Association Claude-Bernard studied leukemia, liver and kidney disease, allergy, biochemistry and other subjects. Researchers needed access to patients, instruments, experimental methods and teams able to work continuously. Research carried out by clinicians in their spare time could not meet all these needs.

The hospital and university reform of 1958, strongly promoted by Robert Debré, brought care, teaching and research together in university hospital centers and advanced full-time medical appointments. The 1964 reorganization continued in this direction by bringing dispersed expertise into a national research organization. Its early priorities included cancer, genetics, immunology and molecular pathology. Work proceeded through hospitals and research units rather than being concentrated on a single campus.

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On 23 November 1964, Budget Secretary of State Robert Boulin explained to the Senate that the new arrangements enlarged the administrative board and established a twenty-member scientific council and specialized scientific committees. Subject experts gained a role alongside administrative management, giving different research fields channels for discussion and coordination.

The personnel reforms of the same year were also significant. Two decrees of 12 May concerned researchers and contract technical and administrative staff respectively, aligning their employment arrangements with those of corresponding staff at the French National Center for Scientific Research. Research required recruitment, technical operations, data processing and everyday administration as well as proposals from principal investigators. Research and technical posts therefore needed to grow together.

References: [2]

The government’s proposed budget for 1965 shows the scale and geographical distribution of the reorganized institute. Operating funding was to increase by 4.92 million francs, supporting 155 additional staff, including 68 researchers and 74 technical personnel. Increased funding and recruitment plans provided staff for new research units.

For facilities, proposed commitment authorizations amounted to 22.7 million francs to launch seven new research units: two in Paris, two in Créteil, two in Lyon and one in Bordeaux. These authorizations set the scope of permitted financial commitments, distinct from expenditure actually paid that year. The plans show that Inserm developed beyond the Paris area from the outset, treating specialized equipment, researchers and technical staff as parts of a single undertaking.

References: [2]

One specific contribution came from a statistical research unit in Villejuif, near Paris. In 1967, Daniel Schwartz and Joseph Lellouch jointly published a paper on therapeutic trial design, listing the unit and Inserm as their affiliations. They argued that a trial’s purpose must be clear from the start: to understand how a treatment works, or to help physicians choose a treatment under practical conditions.

The paper illustrates the distinction with a hypothetical comparison between radiotherapy alone and thirty days of medication followed by radiotherapy. Making the control group wait thirty days to equalize conditions could help isolate a drug effect, yet might not answer which practical treatment schedule should be chosen. Changing the research purpose also changes patient selection, outcome measures, costs and the handling of withdrawals. The authors turned clinical questions into statistical design problems and thanked the British Medical Research Council’s Computing Service Centre for assistance with the English text and discussions.

References: [3]

The paper illustrates one form of cooperation within Inserm: statisticians helped define the questions research should answer as well as calculate results for physicians. Biomedical development nevertheless did not eliminate public health research. Luc Berlivet’s institutional history describes the transition from a hygiene institute to a biomedical research organization as a process spanning decades, with continuing tensions over resources and standing between population health surveys and experimental research. The year 1964 marked an institutional step in that transition. Later achievements emerged from sustained cooperation among research units, hospitals, specialist committees and international colleagues.

References: [3] [4]