Q: This change of heart that was represented by that first resistance to the creation of the Society, and then, it seems, a very favorable response to it--what would you attribute that to?
Tullis: Well, I saw very clearly that I was wrong, and that there really was a need. People wanted a Society, that was the first thing. Secondly, we were able in discussing in that first informal meeting with all of the people there the importance of keeping this as an inclusive, rather than exclusive, society. We got this incorporated into the bylaws--BANG! right in the very beginning, so that people wouldn't do what people often tend to do the second they form a group: they want to keep everybody else out. That would have been a disaster for hematology. We got them all to accept the fact that, first, it should be totally inclusive. Anybody that worked with blood would be, as long as he was reputable and had published some papers, would be eligible for admission to the Society. It would not be an exclusive group. Secondly, it would be a forum where they could get up and speak their piece. The result of this was rapid growth. So that by the meeting in St. Louis in 1959, which was the second meeting, we had grown to about 600 or 700. I think I had over 150 papers submitted from which to select the program. Then the next one was a thousand attendees, in Montreal. Columbus was maybe 1500, and it just grew like that. So now we have 3000 people.
Q: Was there a feeling that the field itself, or the discipline itself, was more defined, as far as--I mean, did people start to call themselves hematologists?
Tullis: Well, we still have a problem with this, because, by definition, it's going to remain a problem, because constantly, the professional hematologists--and when I use the word "professional," I'm speaking of the practitioners of hematology--exert influence. Because, for example, with third-party payment, if, let's say, I'm a practitioner in Cincinnati, Ohio, if I put in to Blue Shield or the Social Security Administration, or anybody, for reimbursement for seeing a patient with a hematologic problem, I can't be paid as a specialist unless I have fulfilled certain requirements, you see. We call it a "specialist," which means either I've passed the American Board of Hematology, which is now a subspecialty board, with its own regulators and its own exams and everything else, sponsored by the American Society of Hematology. Or, I have to be grandfathered in because of my history of having done it, or something of that nature, which means there's constant need, because of the economy of the practice of medicine in the United States, the way it's administrated, one has to have standards for certification. The moment you do that, you begin to say, "This man's a hematologist, that man's not a hematologist," when, from the standpoint of the basic science, the one that's not may know much more than the one that is.
Q: Did that come up as a conflict at all, around the question of standardization and certification of hematologists as opposed to research?
Tullis: It did, and I was one of the last hold outs against certification of hematologists. Dr. Carl Moore, who was Professor of Medicine at Washington University in St. Louis, Professor of Medicine at Barnes Hospital--he and I were the two main voices in the wilderness saying, "Beware, beware, beware, because if the American Society begins to set standards and write exams for the specialty, then it will become more and more beholden to the practice of medicine than to the other parts of hematology." But we eventually lost, just simply because of the economics of the practice of medicine in America.
Q: Did that have any influence on changes within the Society itself?
Tullis: No, but it led to feelings of hostility, and bruised pride, and so on. It was necessary to be sure that the hubris of the practitioner didn't begin to shine in front of the man who was working in an anatomy laboratory, which to me is just as important.
Q: Did it in any sense lead to a further exchange between the clinician and the research base?
Tullis: I don't think is has. No, it has neither damaged nor assisted the exchange of information at the national meetings. It has not influenced the kinds of publications that are in Blood, the manuscripts that are in Blood. No, I think it's been just our fear about the future more than anything that's actually taken place. We just want to be certain that hematology continues to sponsor breadth and to be inclusive rather than exclusive.
Q: Would you be able to comment on any broad changes as far as membership within this inclusive group? It might be as far as those who are certified clinicians, as opposed to those who do biochemistry.
Tullis: No, but they have been able to change the programs a little bit. For example, the pressure of the practicing hematologists, when they attend the American Society of Hematology, has been strong enough that there now is a section that's devoted to the practice of hematology. It's held on a different day, and draws a good audience, and instead of discussing the newest research, let's say, in the field of Protein C, one of the newly identified clotting proteins, or inhibitors of clotting--Protein C was discussed in Miami last fall at the practice meeting, so that those who were in practice and had a person who was clotting too much would know about this protein, you see, the clinical aspect of it. So there's been a more formal subdivision of the Society to answer the needs of the practicing hematologist, but not as yet to a level where it interferes with good basic science.
Q: Was there--well, first of all, when did this actual push towards certification take place?
Tullis: Well, it began very early, just as we'd predicted it would, and we stamped out the fire every other year, Dr. Moore and I, up to the 1960s. Finally, by the middle 1960s, it was evident that if we did not do it, if we, as a society, didn't assume the responsibility for overseeing subspecialty boards, that somebody else was going to do it--probably the pathologists, because the pathologists already had their boards for certification in atomic pathology, in clinical pathology, which included a division of hematology, which was just diagnostic hematology in hospital laboratories.
Q: Are there other societies that have had similar fates as that of hematology?
Tullis: I can't answer that. I don't know.
Q: I was just wondering if this was—
Tullis: I don't think so.
Q: --quite late in the game to form a professional society, as far as the dates go.
Tullis: Yes, it is, but I think this, again, goes back to one of the questions you asked me early yesterday, and that had to do with why were so many persons who were professors of medicine and chairmen of departments, hematologists.
Q: In the first meeting of the ASH, scientific meetings dealt with bone marrow transplant?
Tullis: You must have looked it up!
Q: I looked it up, actually.
Tullis: Let's see, I had Wayne Rundles speak, and Ivan Brown speak--yes, we did have a session on bone marrow transplantation. I'd forgotten that--
Q: And then there was another session on Paricks'--I might pronounce this wrong--
Tullis: Paroxysmal nocturnal hemoglobinuria.
Q: [says same, in unison]. Right.
Tullis: That's right. Because Crosby was working on that here in Boston, and so he was logical to do it.
Q: Is that what determined the scientific content in the early days of ASH?
Tullis: No, that's the organizational meeting you're speaking about--
Q: Right.
Tullis: --and I just got on the phone and called some of my friends, like Wayne Rundles at Duke, and so on, and I said, "You know, we're going to have this organizational meeting. Will you come?" He said, "Sure." I said, "Well, would you give a paper on so and so?" The same way, Crosby was right here working with Dameshek, and so that made it easy, you see, and natural. Now, when the next meeting, which was the first actual meeting of the American Society of Hematology, took place in Atlantic City--again, I put a notice in Blood that it was going to take place in one year, to send abstracts in for review, manuscripts to look at. Then we picked a program from that, and that was the first meeting. Then, again, I was still president for the second meeting, before Dr. Moore took over, and for that meeting I'm sure I must have had three or four hundred abstracts submitted.
Q: For the second, I had topics such as "Hemoglobin electrophoresis?"
Tullis: Yes, that's right.
Q: "Leukemia and thalassemia."
Tullis: Yes. Because from then on, you see, there was a format for it, and papers would be submitted, and the president would pick out referees in different specialties to judge the quality of the papers and decide what would be a good program. There's always been more to have than there's room to have, so there's no question about having good quality.
Q: In 1957, I believe, a Presidential Symposium was suggested for the ASH meetings? Is that right?
Tullis: I had forgotten that. Well.
Q: Did this play a particular role, as far as the--
Tullis: No, no. Just to sense what was going on that was of value, and something new would have that. Then we'd begin, not long after that, to have papers that were memorializing individuals. You know, "The Dameshek Paper," "The Dameshek Prize," and "The Stratton Prize," and so on.
Q: And have those prizes and these very symposia played a role in developing cutting-edge research, as far as--
Tullis: Not really. They haven't played a role in developing it. They've played a role in disseminating the knowledge of it. Yes. And they're usually very good.
Q: Perhaps you could talk a bit about the actual development of a constitution for ASH. I was under the impression that it took a bit of doing to actually come up with the principles for ASH. This is mostly from a reading of the--
Tullis: At the organizational meeting, we got the sense that the people there understood what we were saying and recommending and wanted that, which was a loosely structured society, minimal overhead, minimal administration, maximal inclusion of people from different branches of science, and to do it in a way that would lead to the development of the field. That was not too hard to get into a constitution. We only had, as I recall, about three or four constitutional meetings under Dr. Davidson and myself, Scott Swisher--and you may have the list there of who were the original members. I had a man from Montreal whose name slips me, a very good hematologist, now deceased, who was on the committee to represent Canadian interests. Who else? Hale Ham, I think, was on it when they--yes.
Q: I would think that--
Tullis: Yes. I know he was. Hale Ham was on it. Because, again, he was here in Boston; it made it easy for us to meet.
Q: The people who participated in the development of the constitution: would you say that, in any way, they further influenced the self conscious definition of hematology as a field? Would the constitution play that role, or was it more a formality?
Tullis: We were very conscious of wanting to fulfill these principles, and try to--well, even though we didn't put it in the constitution, we carefully advised the officers that the society, once it was formally formed, should not meet in tandem with the American College of Physicians, for example, which is where we'd had the first two meetings, because we felt that would influence the nature of the program to a clinical program, which we didn't want. So we would meet independently, and that's why I had to find a date in the year that there wasn't a competing meeting. And that turned out to be the first week in December. We set the constitutional guidelines up for that, an annual meeting, and all that. [Interview interruption]
Q: Dr. Tullis, I would like it if you could comment on the relationship that developed between the journal Blood and ASH itself.
Tullis: The relationship was very informal in the beginning, but after two or three years--this is about the Society--the Advisory Board, which consisted of the retired presidents plus some elected ones, requested that the editor of Blood meet annually with the Advisory Board to be certain that there was a commonality of desires and interests in the field. There was no attempt of one to influence the other. But this relationship began to grow and strengthen. There was some resistance in the Society to letting Blood become an official journal of the American Society of Hematology. This was due, I think, primarily to personal feelings on the part of some hematologists from strictly non-practice type of backgrounds--and I'd rather not get into the names of the individuals--who, for reasons of their own, were not supporters of Dr. Stratton. They felt that he was not scientifically trained, and that his medical degree was an honorary degree, which it was, and that he didn't have the qualifications to be a member of the Society, and therefore his journal and his influence should not be in official control of the American Society of Hematology for fear the financial aspects of Blood would influence the Society. So they resisted this for a long (period of time, but, little by little, it became apparent that, for continuity of quality after Dameshek left, and to be sure that the editor would be an appropriate person, and be sure that there was something other than a single individual, like a publisher, making a decision that could influence hematology, it became more and more evident to the officers--
Q: What years would this be?
Tullis: I can't specifically say the years. Just to give you a rough frame of reference, I'd have to go back and look at my notes, but it was about ten years or twelve years ago, the obvious move, officially, was going to take place. But it began to build within two or three years after the Society started. I think it's been to the best advantage of Blood, and vice versa.
There was also some worry within the Society, the American Society, that it could be economically a very difficult thing to do, because the publication of a journal is a very expensive business, in this day and age. But with the increase in dues, and with the increase in the circulation of Blood, so that it became apparent that it was as journal that was being read internationally and not just nationally, I think that the wise thing to do was what took place, which is to make it the official journal.
Q: Did the nature of the journal itself change with this relationship?
Tullis: Not appreciably. I don't think so. It had changed somewhat with the new editors, but--when Dr. Marks, Paul Marks, became editor--not a lot.
Q: Was that more just due to the personal taste of the editor?
Tullis: Yes. Because, you see, again, an editor-in-chief in a scientific journal cannot have competence in all of the fields--the subspecialty fields of hematology now are many different fields in themselves--so that he has to call on an Advisory Committee to do this. When one has an Advisory Committee, it's going to be used, so that the editor would use associate editors and Advisory Committees that would smooth out any bumps in the road that might relate to him as an individual.
Q: Were there any other people besides Dr.Dameshek that you would like to talk about in terms of playing influential roles in ASH? As far as, as an organizing center for hematologists.
Tullis: I think the influence of individuals can be felt in the early stages of societies much more than in the later stages, because institutions, whatever they are, become so strong in themselves that single individuals can't have very much impact, and I don't see any significant impact in the last decade. Now, that may be just that I'm not as much personally involved and don't see some of the decisions. I think that there have been some strategic errors within the Society, but they're not due to any one individual. To me, one of the errors was to lose oncology as it grew from hematology. Oncologists, originally, were one hundred percent just hematologists, because one of the major side effects of any chemotherapeutic drug is bone marrow depression, whether these are deficient platelets or deficient white cells, or red cells, and all of the consequences thereof. So that, in the beginning, those of us that were in hematology and treated leukemias and everything were the ones that then took over the treatment of solid tissue tumors [?]. But right away, this put a huge number of new concepts, ideas, new chemical knowledge and so on, new pharmaceutical knowledge of particular nucleic acids' synthesis and management, that was important to hematology, but somehow or other, we lost it. And the new societies that came out of oncology were formed independent of hematology. Now, there are those who say that was good, because if oncology were still part of the American Society of Hematology, it would dominate the meeting. Admittedly, we still have some oncology at the American Society of Hematology meetings, and some oncology published in Blood, but I think that there will reach a day, in the not-distant future, when oncology will have reached its apogee and will begin to come back closer to hematology, because it won't have enough new things to support it as a subspecialty. It would be too bad if it couldn't be brought back under the umbrella of the American Society of Hematology.
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