National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA.
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First published April 1, 2008 - More info
It seems both like yesterday and forever ago that in spring 1969 scores of my fellow clinical associates and I, MDs from across the country who were taking clinical research fellowships at the NIH immediately following residencies in internal medicine, piled into our cars and headed north. We left Bethesda, Maryland, drove around the Beltway and up Route 95 to Atlantic City for our first experience at the “clinical meetings.” We went because we were told that we had to go by our bosses (Sheldon Wolff, in my case), since it was at the ritual of the annual spring meetings where academic medicine and clinical research showed its stuff. The same scene was repeated at virtually every academic medical center throughout the country. Young, aspiring physician-scientists came to see, hear, and learn from the masters, the very individuals whose papers they had read and quoted on rounds during their house staff training. None of us from the NIH group had been in the laboratory long enough to have accumulated enough data to present; most were still in the clinical year of a three-year fellowship and had not even entered the laboratory. Nonetheless, this trip marked the beginning of an extraordinary journey in which the American Society for Clinical Investigation and its annual spring meetings, usually held jointly with the Association of American Physicians (AAP) and the American Federation for Clinical Research (AFCR), became the backdrop to our initiation and ultimate maturation in academic medicine. There are so many aspects of the uniqueness and importance of the ASCI and its annual meeting that come to mind; I would like to briefly recall some of them.
It became clear to me as I progressed over the years through my fellowship, and as I began assuming independence as a basic and clinical investigator, that the ASCI represented the gold standard of excellence in medical research. There was no question that you submitted and hopefully presented your very best work to the assembled ASCI members at the annual meetings; if you were lucky, you might even get to present at a plenary session. One of the most exciting moments in my early career was presenting a paper in 1973 at the AFCR plenary session on my year-long work describing “The effect of in vivo hydrocortisone on in vitro lymphocyte function in humans” (1). The audience was filled with a significant portion of the ASCI and AAP membership, people who had been my idols and role models throughout medical school and house staff training. Despite more than three decades of presenting lectures at venues throughout the world, I still get a thrill reflecting on that spring morning in Atlantic City when I showed my stuff for the first time to my academic heroes. When the intimidating Henry Kunkel of Rockefeller University came to the microphone and asked a question (that I answered correctly, so he later told me), I was on top of the world. I believe strongly that we need standards of excellence in all walks of life, and the conduct of biomedical research is no exception. In many ways, the ASCI provides this standard for our field. Society membership symbolizes deserved recognition and inclusion in the ranks of those whose accomplishments we respect and whose performance we emulate.
That all the giants of academic medicine were members of the ASCI only contributed to its storied and distinguished history. In addition, it was a given that the best clinical research would be presented for the first time at the Society’s annual meetings. Almost as exciting as presenting a paper was the thrill we felt sitting in the audience and witnessing for the first time the presentation by ASCI members or soon-to-be members of what would surely become classics of biomedical research. This led to a feeling that you were participating in the evolution of your profession. As an audience participant, you could take a vicarious thrill in what was happening all around you. As an example of this phenomenon, I have retrieved from the ASCI archives the program from the very first ASCI meeting that I attended on May 3–6, 1969, in Atlantic City (Figure 1). In that program from more than 38 years ago, not even taking into account the presentations that were made during the AAP and AFCR components of the same meeting, one gets a feeling for the significance and impact of the material that was presented that weekend (Table 1). Indeed, a part of medical history was being written. Perusal of the programs of subsequent years yielded a similarly impressive array of medical breakthroughs that were first presented in public at the ASCI annual meetings.
First page of the official program for the annual meeting of the ASCI held in Atlantic City on May 3–6, 1969.
Selected presentations at the ASCI meeting in Atlantic City on May 3–6, 1969, and their ultimate implications
Yet at these same ASCI meetings four years later, I was exposed (without realizing it at the time) to the darker side of biomedical research as I listened intently on April 30, 1973, in the Pennsylvania Room of Haddon Hall to what was felt at the time to be one of the most important medical breakthroughs in decades. William Summerlin presented the paper “Successful tissue and organ allotransplantation without immunosuppression.” At the end of the presentation, the entire audience rose for a standing ovation. The barriers to transplantation had been removed, so we thought. Unfortunately, it was my first exposure to flagrant fraud in science, as it would later be revealed that Summerlin’s data had been completely fabricated (2).
On the public policy front, I got my first taste of the tensions arising from dependence of the academic biomedical research community on government funding as I listened to outgoing ASCI president Arnold S. (Bud) Relman’s presidential address to the Society entitled “Academic medicine and the public” (3). In his discussion of medical education, Relman said: “This problem has now been compounded by the recent tightening of NIH funds. Everyone knew that the logarithmic rate of growth in appropriations, which occurred during the decade 1955–1965, could not be sustained, but 3 years ago when increasing military expenditures forced Congress suddenly to apply the brakes, a shock was generated which has continued to shake the foundations of the academic medical establishment ever since.” Indeed, what is past is prologue. The resemblance to the situation that we are facing today is unmistakable (4).
It is easy to reminisce about Atlantic City, but this would have little meaning to members who had never attended an ASCI meeting there. There is a spirit that was established in Atlantic City over the decades during which the meetings were held there that still prevails regardless of the physical location of the meetings. The gatherings in the lobby of Haddon Hall, the stately hotel where the major scientific sessions were held (Figure 2); the steamed crabs at Captain Starn’s, the legendary restaurant located nearby on the Boardwalk, where there was never an empty seat; the martinis at Zaberer’s, the watering hole a few miles outside of Atlantic City; and the walks along the Boardwalk in the early morning and at sunset — all of these provided a milieu of warmth, affection for one’s peers and idols, and a feeling of wanting to belong and of gradually coming to belong. My day was made if walking on the Boardwalk or eating in a restaurant I would run into Eugene Braunwald, Kurt Isselbacher, Donald Seldin, Lloyd (Holly) Smith, or James Wyngaarden, among others, and they would stop for a brief moment and congratulate me on a paper I had presented that day. It is part of the fuel that drives us, to be accepted by the people you greatly admire. It was this experience that convinced me in subsequent years and up to this day to greet, shake hands with, and spend a minute or two speaking with the young aspiring physician-scientists who I run into at the spring meetings, be they in Washington, DC, Baltimore, the West Coast, or, as has been the case for the past several years, Chicago.
Haddon Hall — the historic Atlantic City, New Jersey, hotel that served as the official meeting place for the ASCI annual meetings.
There are few thrills in the life of a young physician-scientist more exciting than election to membership in the ASCI. I had attended several successive ASCI meetings following my introduction to the ritual in 1969. I had published a few articles in The Journal of Clinical Investigation. I was still a little starstruck, but now I wanted not only to be accepted by the people who I admired, but to actually be one of them. In the early spring of 1976, after toiling for four years as a young independent investigator, I was elected to membership in the ASCI. I was ecstatic. Yet in an interesting twist, membership in the Society, as opposed to being an end in itself, actually became for me an incentive to perform at an even higher level in order to live up to the tradition established by the many distinguished members who had preceded me. In speaking with several of my peers, they expressed similar reactions to their ASCI elections. We were elected into the club on the basis of merit. Now that we were part of the club, we needed to continue to perform like we belonged there. Although membership in the ASCI is often a requirement for further academic advancement including promotions and resources, I maintain that the internal bar that it sets for us is as important as anything else.
I believe that the future of the ASCI will be healthy and enduring. The fundamental principles upon which clinical research is based are inherent to the principles of the ASCI: excellence in science, creativity, integrity, and service to the public through clinical research to improve the health of the nation and the world. The future of clinical research can only remain healthy if we continue to train outstanding young men and women who will push the envelope of science and continue to explore the unknown. These individuals will benefit from associating with a tradition of excellence and productivity. I am certain that the ASCI will continue to provide this milieu for them and will serve as an important goal for those young people who aspire to emulate their idols and mentors just as I did when I took that first drive from Bethesda to Atlantic City in the spring of 1969.
Conflict of interest: The author has declared that no conflict of interest exists.
Reference information: J. Clin. Invest.118:1214–1217 (2008). doi:10.1172/JCI34724.