Q: So, in a sense, during your tenure as president in ASH there seems to have been a shift away from some of the earlier concerns in ASH. You start to have a ________ put on specialty boards.

Conley: I had a very placid year, when one of the big things that we had decided to develop, and were in fact developing, was our relationship with Grupenhoff, in Washington, the person who advised us and served as a lobbyist for us. Grupenhoff knew the congressmen and the senators and was very effective in introducing representatives of our Society to these people so they could explain what our concerns were. There was no question that that was an entry that we simply didn't have and that other groups did have. So I think it was thought by our Society that that was a very profitable investment.

And we were just taking over Blood at that point, and that worked out very well. The conflicts with the oncologists and clinical pathologists seemed to be, not resolved, but of less concern. We took in the oncologists. Many oncologists are members of the Society, as are clinical pathologists. So I don't hear that feud raging anymore. I think it's a foregone conclusion that things are the way they are; that there's no possibility of changing them.

Q: By way of summation I wonder if we could return to one of the questions we asked early on. And if you could, by briefly eluding to the role that the journal Blood played, the text Clinical Hematology other texts, professional societies. If you could, perhaps, talk about the definition of hematology as a discipline. How you would compare the definition of hematology when you first began, back in 1947, until 1980 or so. Compare those two, the transition from one state to another.

Conley: Well, I think a clinical hematologist, who is not an oncologist, nowadays, is either a pediatrician or an internist, who is delighted to see patients with various kinds of anemia or with those hematologic neoplasm that they are privileged to treat. What else do they do? Deal with hemorrhagic disorders and that sort of thing. Often they work in a group practice with physicians specializing in other areas.

Q: The nature of research itself?

Conley: Now an academic hematologist is something else again. An academic hematologist must be an investigator or at least lead a unit in which there are scientists doing basic research. I don't think he's going to get any support for his work if he doesn't do that.

Q: Would you see a transition having taken place, going from academic hematology being based around morphology, to one that's closer to, maybe, molecular biology?

Conley: Morphology is important--of course, a clinical hematologist must know morphology, in the sense that he knows how to look at a blood smear and a bone marrow preparation and know something about special stains, and certain techniques, sure. Any clinical hematologist would have to know about those things. He doesn't have to know how to run a blood bank and, unless he's further specialized in oncology, he probably is not going to be treating lung cancer and that sort of thing. Hematologists did do that originally, when there were no oncologists, but that's all changed. So a clinical hematologist is what I've just said. Now an academic hematologist, is almost necessarily either a group leader, in which he, by way of being a leader, is in touch with people who are doing various research projects. But the man who is doing the work is almost necessarily a specialist, in a very narrow field.

Q: Such as coagulation, such as--?

Conley: Molecular biology, he's doing DNA technology or protein synthesis or something like that. And it's very unlikely that a person who is going to get big grants from the NIH to do that personally is the doctor that you want to see if you have an undiagnosed anemia. Clinical medicine is just as complicated as research. And the idea that you can work in a clinic one day a week, and be a super doctor is just as fallacious as the notion that you can work in the laboratory one day a week and be a superb researcher. One is as difficult as the other.

Q: And what you have called for, in your own practices, through your own practices, seems to have been, to be able to apply the methods and techniques of basic research to clinical problems.

Conley: Well I started out in the primitive era where a hematologist was supposed to be an internist and I was supposed to know medicine across the board. I started out in 1947, making teaching rounds on the general medical science. We had no specialty units here. So I saw everything that came along, whether it was cardiac disease or nephritis. And I was supposed to know something about all. That went on for a number of years, but no one believes that it's possible anymore. This week, in this quarter, I am making rounds with medical students. But no one really thinks that I'm going to be an expert on all the patients I see. What you teach them, of course, is how to take a decent medical history and approach to diagnosis, but you're not expected to know the details, the ins and outs of complex subspecialty diseases. So, we no longer have the professor who knows everything, who at the same time is doing with his own hands, first class research.

[Tape Interruption]

Conley: No chairman of a department of medicine expects to recruit the three-legged stool type person anymore. What Jack Stobo, our relatively new chairman, has designed for a department is that each division head will be primarily a researcher who's going to spend most of his time in the laboratory. And he's going to have colleagues and associates who're primarily clinicians, but who're going to be interested in what's going on in the laboratory and who will bring clinical problems to the bench-- they'll be sufficiently aware of what's going on to know what the questions are. If you have a pure scientist who's never seen a patient, then he doesn't know what the questions are. So you need someone who can tell the investigators what to look for.

During my tenure--in my thirty-three years, can you imagine that?--as head of the Hematology Division here, I never had a fellow who was not an MD. But now my successor has PhD fellows, and that's the way to go, of course. You've got to have those people if you're going to do the kind of sophisticated research which you have to do these days. After all, clinical investigators are now competing with full-time PhD types for research funds. When I was a member of the Hematology Study Section, virtually all the grantees were physicians, and now a majority of them are PhDs. So that reflects an extraordinary change in the pattern of research activity--its complexity and its nature.

Q: Thank you.

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