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Q: The meetings themselves were divided between scientific sessions and organizational sessions. How were the scientific sessions, themselves, decided upon? I believe the first sessions dealt mainly with bone marrow transplants and various items dealing with bone marrow problems.
Ross: The business of the organization was conducted at a business meeting which usually was held for an hour or hour and a half, in the middle of the meeting. The scientific sessions were based upon the selection of the program from submitted abstracts. When I was the president, I did this job. I created a committee with representatives from over the world. I had a representative from Greece, another from England, another from Japan and others from other countries, as well as the USA. Every abstract submitted I had photocopied and sent copies to committee members with a check-off ballot indicating their evaluations and recommendations for inclusion in the program. These were used to select the program. It was very interesting. There usually was a concurrence of opinion as to what ought to be included and what ought not to he included. The items which were not included for oral presentation were noted as "Read by Title," and the abstracts were published together with abstracts of the papers that were orally presented. This was a good idea. It gave everybody a chance to indicate what he was working on.
Q: Were there problems that still came up between those who had previously been against the organization of the American Society of Hematology? Or, had that more or less been done away with?
Ross: I don't think Bill Castle--I may be wrong about this--you can ask him. I don't want to speak for Bill Castle. He's quite able to speak for himself! I think he was not very enthusiastic about it the society in the early years. Whether he is now or not, I don't know. Initially, Max Wintrobe was not very enthusiastic about the society. In the hierarchy of the society, I always felt quite badly that Max wasn't a participant. Max was encouraged to become a participant. It was suggested that he apply for membership which I think offended him. He said, "God damn it. They can ask me to be a member. I don't have to apply." However, he finally filed an application. Of course, he was made a member and he became president of the society and that breach was healed. I think most of the opposition to this organization has vanished.
As I commented before, the segmentation of internal medicine into various specialties is occurring. I think it's essential. I think it's handwriting on the wall. That's the way knowledge is perpetuated and developed. I don't think anybody really resents the existence of the Society of Hematology anymore. It's a good organization. It holds fine meetings. It brings together people to exchange ideas. It promotes new ideas and that's highly desirable.
Q: It's been mentioned by a number of people that an area of contention came up between self conscious hematologists and people who became to define themselves as oncologists in the development of the new field of oncology. Could you perhaps comment on this?
Ross: Yes. Hematologists, I think in large measure, tried to adhere to the study of the hematopoietic and lymphopoietic systems in the body. They were really quite successful in blazing the way for chemotherapy of illnesses of these tissues and systems. Most of them weren't very enthusiastic about getting involved in what were called solid tumors, such a carcinoma of the breast, colon, liver, brain, and so forth. They pretty much stayed clear of this, which in retrospect was a mistake.
I remember when I was chief of the division of hematology here at UCLA, instead of going out and recruiting people who could be considered as general oncologists, I pretty much hued to concept that the division of hematology should be pure hematologists. That was a mistake. Consequently, the medical school brought in people who called themselves oncologists, who initially had been hematologists but had branched out into these other areas.
Then there were very effective proponents of a specialty of oncology itself, who were not and had never been hematologists. This was contributed to initially primarily by a Dr. Byrl James Kennedy, professor of medicine, at the University of Minnesota. But he was a very effective advocate of oncologic medicine and he was able to persuade the American Board of Internal Medicine to establish a subspecialty of oncology with training programs, certification examinations, and issuance of diplomas. This was initially opposed rather halfheartedly by the hematologists but later they oppose it much more vigorously. It's too bad that both subspecialties couldn't have all been combined into one, because today many physicians who have become certified in oncology take another year also to become certified in hematology and vice versa. I think that's probably the way it should be, because the oncologist uses agents which were developed and initially were most effective in hematology and the adverse effects of these agents given to patients with solid tumors usually relate to the hematopoietic system. So you have to know a great deal about the hematologic system to be very effective as a chemotherapist of "solid" tumors.
Q: I believe another area of contention that came up within ASH was between those who wanted to introduce accreditation standards for hematologists and those who opposed turning the society into an accrediting body.
Ross: Yes. I mentioned this briefly when I commented about the somewhat vigorous disagreement between the Board of Internal Medicine and the Society of Hematology. There were people in the Society of Hematology who did not really understand the mechanism of American specialty medicine. As I commented, the only real certification which has meaning in this country is one which is given by an accredited certifying board under the American Board of Medical Specialists. The hematologists didn't really understand about that. They thought they could do it themselves when, as a matter of fact, in the developing political milieu of the United States, it could not be done. The organizations who have attempted to establish independent certifying bodies in the main have fallen flat on their faces. Their certification is not recognized by the government, not recognized by the rest of organized medicine, and not infrequently is fraudulent--not that the ASH would have been fraudulent but many of these unaccredited boards are. There was a foregone conclusion that these people in the ASH were of good intent but were uninformed. They just couldn't do that. There was a good deal of hard feeling at one point but I hope that now that's all gone by! After all, the Society of Hematology is really not an accrediting body. They are not in a position to prescribe what has to be done, whereas the Board of Internal Medicine and the Board of Pediatrics are so qualified, and so recognized by organized medicine, the government, and the public. I don't know whether this still is a source of irritation among some of my brethren in the Society of Hematology or not. I hope not, but I don't really know.
Q: Dr. Ross, could you comment a bit about your personal involvement in the various stages of ASH? You served on the executive committee from 1957-1962.
Ross: If you say so, those are the dates. I was, I think, a member of the executive committee from the time of its institution and then I became president of the society in 1961. Then, subsequently, I was a chairman of the bylaws committee. We had quite a large rumble about that because the incumbent president didn't think there was any necessity for change in the bylaws, whereas the people on the bylaws committee and the society as a whole felt that there should be. This gentleman who was the president objected to one of the provisions in the bylaws that would have established a council of past presidents that had no authority but would have maintained the good will and the active participation of the past presidents who were in a position to be a considerable support and help to the organization. It was thought they might be helpful in such things as, for example, recommending where the meetings might be held in the future, establishment funding of lectureships; kinds of things like that, that then would be acted upon by the executive committee and the society as a whole. The president at that time was George Brecher. He didn't like that idea, so he was able to talk the membership of the society into voting that down, but all the rest of the bylaws revisions were voted into effect by the society as a whole.
Q: Dr. Ross, could you add a few more words on the journal Blood, and the development of ASH?
Ross: From the time of the inception of the journal Blood and the time of the creation of the Society of Hematology, it had been I believed by many people that this journal would become the official organ of the society. Well, that wasn't possible so long as Bill Dameshek and Henry Stratton owned the journal and were unwilling to transfer title to the ASH. It was repeatedly presented at the Editorial Board meetings, "Why can't we call this the official journal of the Society of Nuclear Medicine?'' As long as Dameshek was alive and Henry Stratton was around, this never came into being. When Henry, in essence, retired from Grume & Stratton he sold this journal, to Harper & Row who undertook its publication. Harper and Row were much more persuasive. They got the Society of Hematology to, in essence, put its imprimatur on the journal, which Harper and Row owned and published and controlled. The society, I think, had authority in terms of appointing the editor and the editorial board and it worked out all right. It is now the official organ of the American Society of Hematology, which is the way I think it should be and nobody's hurt too badly from this. It's too bad that the society can't cash in on some of the revenue from the journal, but that was not to be since it was initially privately held and Henry sold it to Harper & Row rather than giving it to the society, which was certainly his prerogative.
Q: Did the nature of the journal Blood change once it merged with ASH?
Ross: Yes, its nature has change. It initially was almost entirely a clinical article publication. As time has gone on, it very largely has become a publication of more or less fundamental articles dealing with laboratory research in the field of hematology with a decreased emphasis on the clinical aspect, although the clinical aspect certainly is very important. I don't know what the present circulation is because it went from a six issues per year up to twelve issues per year. The last time I was aware it was very successful in terms of distribution, circulation, and probably revenue.
Q: Did the change in the nature of Blood take place with the development of new techniques that could be applied in hematology, or did it take place with the change of personnel who were interested in hematology as a discipline, or for some other reason?
Ross: I think the change in the field has primarily been a reflection of the change in interest of people who were in the field. The approach to the genetic, biochemical, biophysical, and other aspects of hematology came about after the clinicians had established the organization and the journal. This is quite natural. Initially, in medicine, the clinicians are the people who introduce things and then subsequently the more scientifically inclined brethren come along and explain what things are and try to make advances. This has happened in the society and in the journal. If you look at the programs of the meetings now in comparison with those held twenty years ago, it's obvious that this change has occurred and the emphasis on the clinical aspects of hematology has diminished and emphasis on fundamental research has increased. That's quite appropriate and very valuable.
Q: Dr. Ross, I'd like to now talk about your association with the development of nuclear medicine, both in terms of the development of the Society of Nuclear Medicine as well as in the capacity you served at various missions and projects abroad.
Ross: All right. As I've already told you, my initial research involved the use of certain tracer radioisotopes in studying the kinetics of blood formation and destruction as well as the use of radioisotopes for therapy. Initially these were research tools but as time passed it became apparent that they could be adapted and used very advantageously in the diagnosis and therapy of human disease. My involvement in this was, as I think I detailed, not only related to hematology but also to certain aspects of cardiovascular physiology [?], and in endocrinology, specifically related to the thyroid gland. Again, at the very beginning, there was no recognized specialty field of nuclear medicine. These isotopes were used as research tools and they were not considered as anything particularly useful from a practical clinical aspect. As time went by and radioisotopes began to be used more widely in the practice of medicine, it became apparent that such use was becoming a clinical discipline and a clinical specialty. As a consequence a group of physicians in the northwestern part of the United States organized a society of nuclear medicine which initially was comprised primarily of physicians in Washington and Oregon, and a few from California. This served, again, as a focus for the development of the field and it rapidly expanded to include representatives from the entire United States. These were organized in chapters on the basis of state of location. This proved very effective and led to a marked expansion in the clinical application of radioisotopic tracers and their therapeutic uses.
At one time nuclear medicine--I believe this was in the 1960s--was the most rapidly developing specialty field in the whole area of medicine. Radioisotopes soon were in use in almost every hospital in the country and clinical uses soon were being taught by preceptorship in many teaching hospitals. Frequently this was done under the aegis of the radiology departments, although radiologists had not played much role in the research development of these materials nor in the applications of these materials to clinical medicine.
As time went by, it became apparent that in order for this use of radioisotopes in clinical medicine to prosper as a specialty there had to be some mechanism of training or any recognizing physicians who wanted to go into the field. As a consequence of this, it was thought desirable to establish a certifying board in nuclear medicine, which in this country is the only way in which an area of clinical practice can really get recognition as a clinical specialty. Up until the time that the American Board of Nuclear Medicine was created in 1971, the recognized specialties which used isotopes most were internal medicine, pathology, and radiology. Radiologists radioactive isotopes as a modality in imaging and this was pretty much the extent of their interest. The pathologists used them for in vitro testing. The internists used it as a modality for investigating physiological and pathological processes and for treating patients. The only reason that the Board of Nuclear Medicine ever got to be was because the pathologists and the radiologists were fighting about who was going to control the field. Every time one of them would move forward the other would block him. The internists were passive since they hadn't yet been convinced that this was really a clinical rather than a research discipline. However, we were successful in interesting all three of these groups in becoming sponsors of the Board of Nuclear Medicine. The Board was established as the first so-called conjoint board with these three other boards as our sponsors. This sounded fine, but in practicality it was terrible because the radiologists wanted to gobble us up, the pathologists wanted to gobble us up, and the internists didn't want anybody to gobble us up, so we had lots of troubles. But we prospered and established training programs--some ninety of them. The field of nuclear medicine became a recognized specialty as a consequence of the establishment of this board. We've certified thirty-five hundred candidates, and we give examinations each year to about one hundred and fifteen people. We certify about seventy percent of them and fail the rest, which is about par with the other twenty-two recognized specialty boards. The field has prospered!!
I emphasize that my involvement in nuclear medicine began as a consequence of using isotopes as tracers in the field of research hematology. That was true of most of the original people in the field. Now the people who go into the field go into it with the specific intent of becoming practitioners of nuclear medicine. Interestingly, most of these people work in large, major medical centers or major hospitals, although some practice in communities of smaller size, and in smaller hospitals.
Last year we were successful in getting "sprung" clear of the controlling influence of some of our sponsors and we are now an independent primary board and can determine our own destiny without being blocked by these other boards!!
Q: In 1953, President Eisenhower gave a speech in the United Nations where he said that atoms and atomic energy could be used for peaceful purposes. By 1955, you were participating in the first international conference on the peaceful uses of atomic energy. This was in Geneva, Switzerland. I wonder if you could comment on that?
Ross: That was a wonderful meeting. There were representatives from all over the world, including the Soviet Union, which was presenting recognizably spurious information and data. It provided an opportunity for interchange of opinions, ideas, and comments, and the establishment of friendships. I was very fortunate in being designated to represent the United States at this conference. Not only did I enjoy the scientific aspects but I also enjoyed the food, the booze and the opportunity to travel around Europe. That was the first time I'd ever been to Europe. This was, I think, the only general, international conference on nuclear and atomic energy, that's been held.
As a consequence of Mr. Eisenhower's comments and beliefs, there were certain scientific missions established to Latin America. They were called Atoms for Peace. There was one that went to the east coast of South America and one to the west coast. I went to the west coast with the mission that went there. I think it's fair to say that the intent of this was to try to interest the Latin American people in the United States as a source of information and possible nuclear power development, but the medical aspects of it were important, too. This was quite successful because the whole of Latin and South America now turns to the United States for its reliance on things relating to nuclear activities rather than the Soviet Union. Had these missions not been held, it might well have been the other way around.
Q: This was in 1956?
Ross: I believe that was the year. I can't be absolutely certain. I don't remember the dates so clearly, but I think it was in 1956, the year or two after the conference in Geneva, Switzerland. It was quite successful. We visited the capitols of each of these countries. We were under the auspices of the ambassador in each country. We had entree into the highest levels of the local government. They were fascinated and intrigued primarily from the standpoint of power development but also, possibly, from the stand- point of military exploitation. The medical aspects came along in third place, but we played a fairly significant role.
In these missions, we were able to interest very good physicians who came to the United States for education and training in the clinical applications of nuclear medicine. Latin Americans also came to the USA to learn nuclear engineering, and power development. What the military aspects of the interchange were, I don't know. But it was really a very successful enterprise and there were many young men who came here. Interestingly, many of them after going back to their country ultimately returned to the United States, which is somewhat unfortunate, but they had much better opportunities here than they would have had in their own country. But this was a very exciting and a very worthwhile scientific and political mission activity on the part of the United States.
Q: During the international conference in Geneva, and later during the mission to Latin America, were the issues of monopoly over atomic energy raised as points of contention?
Ross: There wasn't any question that there was some suspicion on the part of the local people. I remember a cartoon once that appeared in, a paper in Santiago, Chile, which showed Uncle Sam standing there saying, "Atoms for Peace," holding big bombs behind his back. That wasn't very good publicity. But I think our mission, which included many very personable people who were able to speak to some extent in Spanish and in Portuguese, was able to allay the fears of many of the Latin Americans, and maybe turned away the wrath that might have otherwise have occurred.
It was very evident that there was competition between the United States and the Soviet Union to enlist the cooperation of these Latin American and South American people in the use of nuclear energy.
Q: Did this competition come up in the international conference in Geneva, too? Since the United States and the Soviet Union were both there?
Ross: There was very keen competition in the presentation of papers and I would say that it was a competitive presentation all the way down the line between these two people, from medicine to power generation, et cetera, et cetera. That's all right. That's the way we live.
Q: At this time were the questions of safety and the hazards of nuclear energy raised?
Ross: Not very much, no.
Q: Was Herman Muller, the American geneticist, in Switzerland? Did he talk about mutation rates at that point?
Ross: I cannot remember that. He might well have been. I have heard him lecture, but I can't remember whether it was in Switzerland or someplace else. I just don't remember that.
Q: Did he have much impact being one of the first people to develop a theory of mutations in chromosomes at this point?
Ross: He had an impact on the research that was conducted under the auspices of the Atomic Energy Commission, particularly in Oak Ridge and also in the Soviet Union. They were very interested in this subject. The initial interest was the possibility of using ionizing radiation to improve agricultural genetics. In the Soviet Union, when I visited there, there was one huge building that was dedicated to an attempt to improve strains of plants by radiating seeds. In this country, there was considerable interest in this. I don't think it bore any very great fruit eventually.
I don't believe that Dr. Muller's presentation and comments had a great deal of influence on the medical aspects of radioisotopic use, though it might have had much more than I recognized.
Q: Were there other people there who raised the medical aspects besides yourself?
Ross: You mean about the safety aspects?
Q: The safety aspects.
Ross: Not very much. It wasn't emphasized and nobody really wanted to hear about it as I recollect. Scientists don't want to hear about it now particularly either. After this Chernobyl event in the Soviet Union, UCLA medical center was flooded with queries from people who had been tourists over there in the Soviet Union at the time of the accident. They were scared half to death, out of their wits! They wanted to find out about this and that and the other. It was apparent that they had received a minuscule amount of ionizing radiation exposure. And one can attempt to allay their fear on the telephone, but ultimately you have to say, "Well, if you don't want to believe what I tell you, we'd be glad to arrange to see you in consultation for such and such a fee, and for such and such a fee have measurements made." As a rule, that turned them off. They didn't call back again. We did arrange to have half a dozen of them quantitated in the total body counter at the V.A., and, indeed, the showed minuscule amounts of half a dozen isotopes that they had' picked up while they were in Kiev.
Q: One of the other issues that's raised along with discussions of Eisenhower's Atoms for Peace Program is the commercialization of the nuclear energy industry as well as the various forays the industry makes into the medical field. Did this come up for discussion at any point?
Ross: Certainly the industrialization of nuclear energy is a very important aspect. In this country, it has been left, really, primarily to private corporations to develop fundamentally, the power industry. In other countries, of course, it has been done by the government. In France, which generates most of its electricity by nuclear power, this all belongs to the government. It is possible that in this country nuclear power generation might not be fought with such a tremendous flack by people who are worried about everything under the sun without much basis for worry if nuclear power generation had been developed by the government, but that's not the way we really do business in this country. I think the development of nuclear power generation was much better done, in terms of scientific and engineering process, by private corporations in competition. Unfortunately, the alarm reaction of many of our citizens, complemented by the Chernobyl disaster, has set back the development of nuclear power generation by at least a generation. As long as gasoline and coal are cheap, I don't think it's going to go ahead very much. But if we get in the position in which France finds itself, then we're going to have to generate electricity with nuclear energy, which with proper precautions, I think, is quite all right. There have been a great many more people in this country killed as a consequence of fossil fuel power development and generation than have ever been damaged or hurt from nuclear power generation, if you consider the number of people who have been killed in mining accidents in getting out coal, the number who are damaged, many of them irreparably, in oil drilling activities, the number who suffer as a consequence of the smoke and the smog that's released, and the fact that the burning of fossil fuels releases far more radioactive material into the environment than does a well controlled nuclear reactor. These are things that people don't think about. Unfortunately, it's not been possible to present this information to make them comprehend that this is not all that dangerous and it probably is much less dangerous than using fossil fuel. I once started a crusade on that but I got discouraged and stopped.
Q: When did you start this? How was it started?
Ross: This was in 1956, or 1958, or something like that. That was a long time ago. It was, maybe, thirty years ago, but it didn't seem to have much impact. I had other things that were much more interesting than that, so I dropped it.
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