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From public health to biomedical research, from INH to Inserm (1941- 1964)

Excerp from P. Griset, J.-F. PIcard 'At the Heart of Life. 50 Years of Inserm', Paris, Cherche-Midi, 2014


Inserm was founded in 1964 from the merger of the National Institute of Health (INH), created during the Second World War to advocate public health measures during the Occupation, and the Claude-Bernard Association (ACB), founded in the aftermath of the war by a new generation of clinicians anxious to set up their laboratories in their hospital departments. More generally, Inserm was among the major achievements of the 'Trente Glorieuses', the three post-war decades which saw the reconstruction and modernization of the country, symbolized by three significant events in the field of health: the therapeutic revolution, with the distribution of antibiotics that overcame major social diseases, particularly tuberculosis; the creation of social welfare, which corresponded with the social program of the Resistance and with General de Gaulle's commitment to provide all of the population with the benefits of the advances in medicine; and finally the reform of the university hospitals conducted by Pr. Robert Debré to align medical teaching in public hospitals around the famous triad of care - teaching - research initiated in North America half a century earlier by the Rockefeller Foundation.

1941 - Foundation of the Institut National d'Hygiène (INH) with help from the Rockefeller Foundation

In the aftermath of the armistice and the collapse of the Republican government, Marshal Pétain announced a "national revolution" intended to settle the outcome of defeat by Germany and to prepare for the country's recovery. In the first Vichy government, the Under Secretariat of State for Health, headed by Dr. Serge Huard, launched a series of reforms of the French health system, some of which produced lasting results; a law of October 7, 1940 created the National Medical Association (Ordre national de médecine), while the one of September 11, 1941 established the framework for modernizing the pharmaceutical industry; and that of December 21 introduced the 'hospital charter' intended to provide access to hospitals for all the population with the adoption of a full-time hospital system. Finally, the concern of providing the Secretariat of Health with the intervention resources required to meet the public health issues raised by the Occupation and its succession of hardships led to the law of November 30, 1941, creating the National Institute of Health (INH). This was not the only effect of a difficult situation. In fact, it also met the requirement to address the endemic weaknesses of the French public health system observed since the beginning of the 20th century, which had caused the Rockefeller Foundation to intervene in 1917 with the introduction of an Anti-Tuberculosis Commission, which some years later was turned into the National Office of Social Health, but was abolished in 1934 against a financial background marked by the economic difficulties of the great depression.

In 1940, again in difficult circumstances for France, the Rockefeller Foundation wanted to revive the modernization of the national health framework by advocating the foundation of a new institution and contacted Pr. Robert Debré, Head of the Pediatric Department at the Enfants malades Hospital in Paris and an advocate of a pro-natalist policy, about this. The defeat suddenly stopped this initiative. However, after a brief retreat, a small team of nutritionists from the Rockefeller International Health Division returned to set up in occupied Paris. Their leader, Dr. George K. Strode, decided to open the Health Research Institute in Marseilles to meet the needs of a population including many refugees who had withdrawn to an area where food supplies proved to be highly insecure. This institute was headed by a Rockefeller fellow, Pr. André Chevallier. He held the chair of biophysics at the Faculty of Medicine and Pharmacy at Marseilles, and was an internationally recognized specialist in vitamins. In August 1940, he presented a report on vitamin A to the Committee of National Defense Experts, set up by the Vichy regime, where he mixed with Dr. Eugène Aujaleu the future first director of Inserm. He pointed out that the human body can neither synthesize it nor replace it, and of all the vitamins it is the rarest, since it is extracted from the liver of certain fish. Yet, this vitamin deficiency was likely to cause permanent lesions in children and Chevallier was responsible for organizing the collection of fish livers and their processing by the Byla de Gentilly institutions according to a process that he had developed.

In June 1941, when Germany invaded the Soviet Union, the Rockefeller Foundation decided to leave France, as its situation was becoming increasingly problematic in a Europe occupied by the Germans. At the end of the year, these circumstances led Pr. Chevallier to return to Paris to head the National Institute of Health, the new organization partly financed by the Rockefeller Foundation and the achievement of this was sought by the Secretariat of State for Health. Moreover in the autumn, at the request of Dr. Serge Huard, he established the organizational framework for the future body: "The Secretariat of State for the Family and Health will not [be able to] accomplish the technical task imposed on it and therefore take the role of a major technical ministry having at its side an organization which offers all the scientific guarantees. In the current state of affairs, these guarantees can only be obtained by cooperating with the universities and major scientific institutions such as the Pasteur Institute. Wishing to escape from this collaboration, is automatically reducing the future INH to an institute of a working environment [that is to say a hospital] whose work will always be in an unequal fight with that of the universities." So, the INH was founded, moreover not without causing some complaints by the CNRS which had been founded some time previously, and was theoretically responsible for ensuring the coordination of all the French public research. The institute was headed by Pr. Chevallier, and in 1942, the premises vacated by the Pharmacy central office in Paris, were allocated to the INH. Initially, provided with a budget of 15 million Francs, and increased to more than 20 million in 1944, two-thirds of this budget was devoted to public health research that the demands of the Occupation made urgent. The institute then employed about thirty physicians with grants, of whom two-thirds were academics and one-third hospital clinicians, some of whom were engaged in therapeutic research.

Public health in France during World War II

The INH was divided into four departments, respectively responsible for nutrition issues, social diseases, health and epidemiology matters. The nutrition department was primarily concerned with feeding the young with the introduction of specific ration cards and organizing the distribution of essential food supplements and vitamins to compensate for certain nutritional deficiencies. Emphasizing the scale of the task ahead, Pr. André Chevallier stated that then France was the country in the world where there was the greatest demographic deficit. Therefore, the work of the INH was included as part of a pro-natalist policy. The social diseases department focused on tuberculosis research, alcoholism, syphilis and cancer. Led by the phthisiologist, Jean Troisier, it compared the effectiveness of climate cures with the effects of the BCG vaccination developed at the Pasteur Institute. With regard to alcohol control, Dr. Léon Dérobert observed the reduction in cirrhosis in the population due to restrictions imposed by the occupier's requisitions. With regard to cancer, Dr. Pierre Denoix, who after the war was head of the Gustave-Roussy Institute, established an initial register of 35,000 hospitalized patients' records in the Paris Public Hospital Service. Moreover, the INH monitored the implementation of the first anticancer chemotherapies (ascorbic acid). As for the general health department, it launched an inquiry into drinking water in the Loire valley departments, in order to fight against typhoid, and focused on occupational diseases such as lead poisoning of workers at the national print or cancers caused by handling benzene products.

The epidemiological surveys department quickly met with resistance from the medical profession with regard to measures that could dent the sacrosanct principle of medical confidentiality. Its manager, a young intern, Dr. Alice Lotte, could not obtain the mandatory reporting of tuberculosis cases which, according to the practitioners, would have risked damaging the reputation of their bourgeois clients. Nevertheless, the INH conducted a remarkable job of collecting data published in the Collection of Studies by the Institute whose first issue appeared in May 1944. It provided a departmental mapping of cases of typhus, diphtheria (the anti-diphtheria vaccine was made compulsory by a law of November 24, 1940), measles, scarlet fever and brucellosis. It also listed a poliomyelitis epidemic detected in the Auvergne region and several cases of plague found in Corsica. Finally, the dramatic increase in morbidity in the departments in western France, which were heavily bombed at the time of preparation for the landings, was recorded there. This activity obviously continued to grow after the war, and the INH set up the mortality and morbidity statistics department near the Vésinet hospital in the Paris suburbs.

At the Liberation, the Vichy legislation was challenged, but the research organizations founded during the war, such as the National Center for Telecommunications Studies (CNET) or the Overseas Scientific and Research Office (Orstom) and the INH were retained. However, a notable exception was the penalty imposed on Dr. Alexis Carrel who saw the Foundation for the Study of Human Problems, which he founded himself, transformed into the National Institute for Demographic Studies (Ined). For his part, André Chevallier was the victim of a denunciation and had to undergo the humiliation of a Purge Committee convened by the new Minister for Health, the communist François Billoux. He was accused not of having collaborated with the Germans, but with the Americans. Indeed, the Communist Party, probably motivated by electoral concerns, sought to highlight the deprivation of a working class, victim of the collaborationist policies of Vichy and starved by the occupier. Yet, due to the surveys conducted by the INH during the war, and corroborated by those of the US Army medical services, the exaggeration of these accusations was found fairly quickly. A report published in 1946 by André Chevallier and his fellow nutritionist Jean Trémolières on the dietary conditions of the French during the Occupation established how these had differed from one region to another, and even between the cities and countryside. In Marseilles, Lyon, Paris or Bordeaux, the decrease in the food ration (1,600 to 1,800 calories/day whereas the minimum level was generally set at 2,400) was accompanied by a significant increase in the mortality rates, particularly due to tuberculosis. However, the measures advocated by the INH to safeguard the dietary requirements of infants were probably not unrelated to the recovery of the birth rate from 1943. Moreover, the statistics showed a decrease in the mortality rate in predominantly rural regions, like the West, where it had dropped by 11%. That is to say that the French countryside had benefited from more favorable dietary conditions during the war than they had beforehand. It did not prevent André Chevallier, disowned by his authorities, from deciding to leave the INH to move to Strasbourg where he took a chair at the Faculty of Medicine and headed the Paul-Brousse Anti-cancer Center. As for the nutrition studies, they remained one of the main areas of research in human pathophysiology conducted at the institute, earning Jean Trémolières the foundation of the first laboratory specific to the INH, and then Inserm in 1964.

1945 - The creation of social welfare and medical and health research

The Liberation saw a new deal implemented for public health with the creation of social welfare. Furthermore, in a country faced with the challenges of developing science, the INH tried to react in the area of medical and health research by relying on both American aid and on the establishment of the national social welfare system. In April 1946, following an intervention by the President of the Republic, the socialist Vincent Auriol, the successor to Pr. Chevallier as head of the institute fell to Louis Bugnard, a Professor of Medicine, and Professor of Biophysics and Medical Physics at the University of Toulouse. With a good resistance record in the South-West where he maintained escape routes across the Pyrenees for allied airmen, and his contacts with the English-speaking scientific community, Bugnard had just been on an assignment to the United States to learn about the advances made in American medicine during the war. He decided to strengthen the focus of the organization towards research and he assigned a scientific advisory board to the INH whose president was the oncologist Gustave Roussy, the Rector of the University of Paris, reinstated in his office after his suspension by Vichy. This advisory board was responsible for reviewing the areas of research and the subsidies received by the Institute. By a decree of April 8 1947, the INH was assigned a status aligned with that of the CNRS, an arrangement intended to enable physicians to devote more time to research. In terms of funding, Louis Bugnard obtained the support of the recently created National Health Insurance Fund. Inspired by the Beveridge plan for the welfare state – behind the nationalization of British medicine within the National Health Service–, the Laroque Orders created the social welfare in October 1945.

At the same time, within the Resistance medical committee, of which he was one of the leaders, Pr. Robert Debré had prepared a plan to 'organize the medical profession and reform the teaching of medicine,' in which - though he admitted the need to modernize the health system - he wanted to protect French medicine from a double danger: on the one hand, to safeguard private practice from the vague tendencies of nationalization that could be foreseen with the introduction of a national social welfare system, and on the other hand, to ensure that the merger of the hospital and the university, which was necessary to adapt medical teaching to the requirements of modern medicine, did not occur at the expense of the clinic. He was named as President of the INH, from which he said he expected a more assertive attitude in terms of disease prevention, particularly to control tuberculosis. Debré foresaw all the benefits that the introduction of social welfare could bring to medicine, by financially supporting research with, for example, the opening of the National Blood Transfusion Center (CNTS) founded in 1947 at the Saint-Antoine hospital, where systematic screening of mother-child Rhesus incompatibility was practiced and where Marcel Bessis performed the first exchange transfusions to prevent the pathological consequences of the disease in infants. An advisory committee of health studies relating to social welfare was set up to focus research on topics such as infant mortality, the efficacy of the BCG and streptomycin resistance, the formation of dental caries, rheumatology, etc. However, despite these measures, the INH was adversely affected for a long time by its limited budgetary resources. Its budget in 1947 did not exceed about fifty million old francs, compared to the billion francs available to the CNRS or the CEA at the time. In 1953, Louis Bugnard made a telling comparison before the Economic and Social Board: he said where 1 franc was spent on medical research in France, 90 were spent in Great Britain and 1,000 in the United States.

US grants for French Physicians

Despite its limited resources, the INH managed to introduce a system of grants to send French physicians to complete their training in the United States. After his appointment, Louis Bugnard made contact with the Rockefeller Foundation, and with the help of the cardiologist André Cournand (Nobel prize winner for medicine in 1956), he created a support fund for French medical research in the United States. Through these contacts, the INH could provide French physicians with diphtheria, tetanus, whooping cough and polio vaccines (DTP-Polio), electroencephalography equipment and centrifuges, or the first cortisone specimens manufactured by the pharmaceutical company Merck. This system also facilitated mobility. It enabled Jean Dausset to discover the latest advances in immunohematology at the Boston Children's Hospital, Alexandre Minkowski to learn about obstetrics at the Michael Reese Hospital in Chicago, the neurologist Jean Scherrer to be received at the National Physiological Institute at the University of Illinois, or the oncologist Maurice Tubiana to learn about radiation medicine at Columbia University and at the Radiation Laboratory at Berkeley. Indeed, this type of visit enabled French physicians, who had benefited from it, to discover biomedicine growing in America: "Over there," Tubiana later wrote, "astounded, we discovered a new medicine. Some perceptive minds, like Debré or Bugnard, had understood that it was necessary to encourage young physicians to develop in the United States. In 1947, I was fortunate to be one of them, and I still have a dazzling memory of those fourteen months where modern medicine was revealed to me. Its first feature was rigorous reasoning. I had to learn to justify any diagnosis and treatment. Full of the prestige of my residency in the Paris hospital service, I was at first surprised at having to defend each one of my reasons tooth and nail, however this concern for thoroughness was a revelation to me." These processes filled us with enthusiasm, but led to different conclusions as to the best way to introduce them in France. Nevertheless, Tubiana marveled at the "symbiosis which existed in the United States between biology and medicine, between technology and the clinic," and wanted to apply a system in France where "no partition would separate the researcher from the practitioner, the basic researcher from the clinician."

With American aid, medical physics became a major focus of research at the INH. As a biophysicist, Louis Bugnard, was interested in radiation medicine. In the aftermath of the war, the success of the Manhattan program, which resulted in the atomic bomb, gave rise to the introduction of new government agencies responsible for nuclear energy applications. In France, the CEA, the Franch atomic energy agency which was founded in November 1945 and headed by Frédéric Joliot-Curie, had the aim, amongst others, of making the advances in nuclear physics available to the life sciences and medical research. Bugnard was appointed in his scientific advisory board and was responsible for organizing education for users of the radioactive markers, radiophosphorus 32 and cobalt 60, supplied by the US Atomic Energy Commission, or iodine 31, a radiation source used in cancer therapy. Thus, the Rockefeller Foundation helped Bugnard to provide one of his students, Jean Coursaget (future head of the biology department at CEA), with a mass spectrometer installed at the Necker hospital for the study of the human metabolism. Bugnard also took care of the large equipment for cancer therapy. With significant participation by the CEA and a grant from the Rockefeller Foundation, Maurice Tubiana was able to install a betatron at Villejuif hospital. Finally in terms of public health, he was actively concerned with radiation protection. Within the World Health Organization (WHO), he studied the threat caused by the fallout of American and Soviet atomic experiments in the atmosphere. After the "Atoms for Peace " conference (1956), he set up the Central Department for Protection against Ionizing Radiation (SCPRI) at the Vésinet hospital, which was an organization headed by Pr. Pierre Pellerin responsible for problems related to the development of civil nuclear energy (preparation of biological metrology for radioactivity, development of dosimetry for workers in the industry, etc.).

The 1950s - The impetus of the clinic, the 'Claude-Bernard association' (ACB) and medical research

However, faced with the growth of the new life sciences at the CNRS or the Pasteur Institute, the INH remained timid in the face of the promises of cell physiology, molecular biology or genetics that seemed promising for medical research. A new generation of clinicians wished to establish research in the hospital, blaming the INH for not supporting this new "biomedicine" which they reported was growing in the United States. Marked by the events of the war - some had to leave the profession because of the Vichy racial laws, others joined the resistance or enrolled in the Free French forces -, these neo-clinicians decided to react against both the political and scientific conservatism of their medical environment. Jean Bernard, Jean Hamburger and René Fauvert, who were representative of this generation and were young bosses in the Paris public hospitals service, decided to take charge of the future of medical research. They were less interested by infectious diseases - now almost eradicated with the new antibiotics - than by "systems' diseases", in Hamburger's words, made up of cancers, nephritis, cardiovascular diseases, and allergies. At the start of the 1950s, they met as a small group, the 'Thirteen' club, which they invited their best pupils, Gabriel Richet or Georges Mathé to participate. In 1947, Hamburger created an association for medical research to overcome the shortcomings of the research budget, which was later turned into a foundation for medical research (FRM) and which has remained a major stakeholder in research to the present day by providing grants to young physicians attracted by the lab bench.

The idea of founding the Claude-Bernard Association for medical research came from the meeting of these neo-clinicians and the Director of the Paris public hospital service (AP-HP), Dr. Xavier Leclainche, a physician who wished to modernize the venerable institution. Leclainche was assisted by a modernist mandarin, Pr. Raoul Kourilsky, a pulmonologist at the Saint-Antoine hospital and the father of François and Philippe Kourilsky, respectively future directors of the CNRS and Pasteur Institute. He made an appeal to the Paris city council, the body which decided the AP-HP budget: "The root of the problem is the excessive separation between biology and medicine. That is to say, too restrictive a view of the clinic which results in the elimination of research from our hospital work. The truly groundbreaking advances made for the last ten yeas in all scientific disciplines have placed new responsibilities on physicians and it is no longer enough to borrow techniques and methods from related sciences. If you wish to accelerate the pace of scientific progress in medicine, pathophysiological research must be set up hard at work in the hospital. Claude Bernard foresaw this requirement seventy-five years before with prophetic insight."

In 1952, the association was provided with a scientific advisory board where, alongside Robert Debré and Louis Bugnard, our neo-clinicians were found. And in 1956, the ACB was able to set up its first six hospital laboratories, most of which would become the first Inserm research units. They were Jean Bernard's Research Center for Leukemias and Blood Diseases, the future Hayem Center at the Saint-Louis Hospital, and Jean Hamburger's Research Center for Kidney Failure at the Necker hospital, where the first dialysis machines were installed and the first kidney transplants were carried out, René Fauvert's Isotope Research Department at the Beaujon hospital, Bernard Halpern's Allergology Center at the Broussais hospital and Jean Scherrer's Neurology Research Center at Salpêtrière hospital. Due to the cooperation between the INH and ACB, other laboratories were founded in subsequent years, as and when the medical research budget improved (250 million old francs in 1957 according to the French documentation service). The Debré reform and the second wave of creation of major research institutes at the initiative of the new General Delegation for Scientific and Technical Research (DGRST) allowed previously dispersed efforts to converge.

1958 - The university hospital reform and the foundation of the DGRST: a new deal for medical research

Among the first achievements to the credited to the Fifth Republic, the university hospital reform drafted by Robert Debré at the Liberation was a major event. In 1956, he led an inter-ministerial committee convened at the instigation of a group of radical Mendésist physicians led by the immunohematologist, Jean Dausset, in order to bring the hospitals and universities closer together. In fact, these measures to combine the triple function of care, teaching and research in one place, were directly inspired by the ones introduced by the Rockefeller Foundation in North America fifty years earlier. In France, despite this precedent, they still encountered reluctance from the medical and university profession. Therefore, the Debré reform was only adopted at the end of a long debate, ratified by an executive order (i.e. not voted by the parliament) in December 1958 when there was a change of Republic, reminiscent of the Laroque order for the adoption of social welfare by De Gaulle 'Gouvernement provisoire' in 1945, and because, due to a fortunate coincidence of circumstances, the Prime Minister, Michel Debré, happened to be the son of the sponsor of the reform. The 1958 order provided for the foundation of university hospital centers (CHU) and established a body of university professors, who were full-time clinical practitioners (PU-PH). The fact remained that medical research, which Jean Dausset had vigorously campaigned for during the preliminary debates, hardly benefited - with the exception of the introduction of a third university cycle which required a thesis - for a lack of having provided the necessary financial resources.

It was only partly postponed. In fact, the new republic operated a major shift in the organization of French research by launching a proactive scientific policy, included in the concerns about national independence dear to General de Gaulle and in the "overriding obligation" raised by the Planning Commission, anxious to bring research closer to the expanding economy. In 1959, the General Delegation for Scientific and Technical Research (DGRST) was set up, supported by a committee of experts which included one physician, Pr. Jean Bernard, and one radiobiologist from the Pasteur Institute, Raymond Latarjet. Its budget fell within the priorities of the 5th Plan. In these proceedings, the physicist Pierre Auger (one of the founders of the CEA in 1945) recommended giving priority to the life sciences, and he referred to the case of molecular biology - and its applications - "which," he said "include the various aspects for research on the composition and the role of biological macromolecules, DNA, proteins, enzymes, their functions in reproduction and metabolism, and their combinations in the internal organization of the cells. Indeed, there is a very productive combination between the fields of biochemistry, biophysics and cell physiology surrounding the concept of the macromolecule, [which may be of interest] to genetics, radiobiology and cellular differentiation. Aging and cancer are also closely related to this field [which] represents one of the major trends, and one of the most active and full of promise for the future of biology." After identifying the areas where French research lagged, the DGRST launched an incentive plan of concerted actions, and a system of scientific programming inspired by American research which represented real innovation in France in the 1960s. Priority was given to the life sciences and medical research: out of the nine initial actions launched in 1960, five related to these areas. The "molecular biology" action, whose management was entrusted to the Pasteur Institute director and Nobel prize winner Jacques Monod and which the oncologist Georges Mathé participated in. It was subsequently provided with a budget of 27 millions francs (out of an allocation of 140 millions francs). The "cancer and leukemia" action was directed by Pr. Jean Bernard (19 million francs), and the others were dedicated to brain functions and diseases, applications of genetics (for agronomy), and nutrition.

The DGRST also examined the operation of the scientific organizations which were not satisfactory and this seemed to be the case for the INH, which had not managed to adapt to the new requirements of medical research. In 1959, an administrative reform commission criticized the institute with regard to the management of its staff, particularly its inability to address the issue of the overlapping of functions between physicians and researchers. In fact, the commission recommended breaking up the INH, assigning its non-clinical activities to the CNRS and incorporating the epidemiological surveys with the relevant department in the Ministry of Health. These proposals seemed unacceptable to the ministry which could not ignore medical research in the general sense. Similarly, the clinicians did not intend relinquishing their laboratories recently established in the hospitals by the Claude-Bernard Association and the INH. As for Bugnard, who was additionally marked by his political friendships inherited from the defunct Fourth Republic, he seemed to be out of favor with the new authorities. The Minister of Health, the Gaullist Raymond Marcellin, wanted to replace him with Eugène Aujaleu, the irremovable General Director of Health, a post which he had been appointed to twenty years earlier at the Liberation, and where he now was at the end of his career, after having actively support the university-hospital reform. As for the councilor to the Minister, the oncologist Georges Mathé, who had the sympathetic ear of General de Gaulle, he recommended taking advantage of the circumstances to turn the INH into a "real" scientific institute, that is to say, an organization able to bring medical research closer to the developments of molecular biology.

1964 - When the INH became Inserm

Thus, a decree of July 18, 1964 turned the INH into the National Institute for Health and Medical Research (Inserm). Georges Mathé monitored the arrangement of the new organization closely. He informed his board that the new institute would have to take into account the concerted actions of the DGRST and that to do this, it would be provided with an equipment budget of 100 million francs. The scientific advisory board was reorganized to oversee thirteen specialized scientific committees, whose arrangement reflected the priority now given to biological research, while matters of epidemiology and public health were transferred at the bottom of the list. Therefore, the decisive turning point of medical research started, attracted by the promises of molecular medicine. 

Backed by the financial contribution recorded in the Fifth Plan, the institute saw its budget, which amounted to 28 million new francs in 1962, grow quickly to triple and reach 72 million francs in 1966. At the same time, the numbers at Inserm doubled, from 750 to 1,400 members of staff. Due to the agreements that Aujaleu managed to make with the hospital administration, Inserm could begin the construction of about sixty research units, including, the laboratories of the hematologist Marcel Bessis and the endocrinologist Étienne-Émile Baulieu (the father of the second day pill) at Kremlin-Bicêtre, the gastroenterologist Serge Bonfils at the Bichat hospital, the neurophysiologist Paul Dell at Sainte-Anne, the nephrologist Gabriel Richet at Tenon hospital, André Soulairac's for clinical psychophysiology and psychobiology, Jean-Pierre Soulié's for cardiac surgery, and in the provinces - as required by the decentralization policy -, laboratories at Lyon for Jules Traeger (renal metabolic disease) and Michel Jouvet (experimental and clinical neurophysiology), at Marseilles for Serge Lissitzky (endocrinology) and for Henri Sarles (digestive diseases), or for Henri Gastaut (neurophysiology), who had the first laboratory supported by Inserm and the CNRS at Marseilles, and for the biophysicist, Constant Burg at Nancy, who was soon asked to lead the new institute, or at Toulouse, for Louis Douste-Blazy (cancer and biochemistry), etc.

Obviously, the integration of Inserm in the French scientific landscape, did not fail to cause a stir in other research organizations, whether it was the Pasteur Institute, which failed to get the Nobel prize-winner André Lwoff appointed as chairman of the scientific advisory board of Inserm, or at CNRS, where the biologists did not hide the low regard they had for the "alleged" scientific skills of doctors. "Biology has always done more for medicine than medicine itself, in return for which the CNRS does not have to help the medical double game," said Pierre Chambon, professor at the Collège de France and founder of the future Genetics and Molecular and Cell Biology Institute (IGBMC) at Strasbourg. Thus, the new organization was already faced with serious challenges at its beginning stages...

                                 ...The end of the story in 'At the Heart of Life. 50 Years of Inserm', Cherche-Midi, 2014