Q: What kind of issues?
Wallerstein: Well, for one thing we had to select the papers for the program and there were some policy issues dealing with government and so on. I don't remember some of the details.
Q: Did you do any lobbying?
Wallerstein: Lobbying, I did a fair amount of going to Washington. It's very difficult for somebody who lives on the West Coast. It was sort of a handicap. They would have been better off with somebody who lives in the East, but I was willing to travel.
Q: You mentioned a couple of times the significance of your being a practitioner and I was wondering if you could talk about that. What is the practitioner's perspective on ASH?
Wallerstein: Well, the risk in the national society is always that the only voice that's heard is somebody who's full-time university. For one thing they have a much higher profile, much more visible, much more electable.
END OF SIDE ONE, TAPE TWO; BEGINNING OF SIDE TWO, TAPE TWO:
Wallerstein: Full-time people at universities have a much higher profile. They know each other from appearing in print and in person throughout the United States. They have a much higher profile than practitioners, who don't do this sort of thing ordinarily, so that practitioners are hard to elect.
But that's perhaps not the important thing. The important thing is that the university people may make some decisions that affect training, practice, diagnosis, therapy, testing, that are, in the view of practitioners, impractical, out of step, irrelevant, threatening, or something like that. So while I sort of wouldn't want to have people in practice set the standards, they do have to do a bit of reality testing in some of the edicts that come from academic medicine.
Something else about practitioners. It is more difficult for somebody in practice to participate in national organizations. It's the time element. If you're not home, you still pay the overhead, but you don't make any money, whereas if you're on salary, it doesn't matter all that much. So academicians can always out-meeting the practitioner. But again that's a minor point. The main importance is that the practitioner can say to those who are in academic medicine, I hear what you're saying, but if you translate this into practice, you may run into these difficulties.
Q: Can you give me an example?
Wallerstein: Well, if you ask for too many tests to be done prior to beginning therapy as a standard, you might point out that these things are not acceptable to patients. They're very expensive. They're delaying. I must say these differences are disappearing for two reasons. One is that most people in academic medicine have to do private practice and learn some of the realities. And those of us in practice must follow protocols as I said earlier, that over the years have limited the dangers and expenses and have been very effective medicine. So the differences are becoming somewhat less profound. But twenty years ago--fifteen years ago--when I was so heavily involved, this made a difference. And also what you teach, what needs more emphasis.
Q: From a practitioner's perspective, what should the emphasis be?
Wallerstein: Well, I'm not sure this will resolve it. There's still much of a discrepancy right now. I think when it comes to management of leukemia, it's the same for everybody really. Trainees certainly have to be able to take care of patients. They can't spend all their time on basic research and dealing with hemoglobinopathies and things they never see in practice. So while I don't wish for one second to belittle the importance of understanding medicine fundamentally, one needs practical tools, but I think those problems have disappeared. As I said, most people in academic medicine have to take care of patients. They see what is needed and what isn't needed quite as much. But things have changed.
And there were some practice issues, governmental regulations that had been harmful to people in practice in the late seventies. May not have affected people in academic medicine all that much. We had to make sure that the society nevertheless dealt with those issues of regulations. Laboratory supervision, something of that nature.
Q: Do you remember the particularities of those regulations?
Wallerstein: It had something to do with supervision under the CLIA Bill, of private office laboratories. I don't really remember the details right now. It's coming up again right now. But setting standards that are fairly impossible for small offices to meet, and also not really all that necessary. Those are some of the examples I can think of.
Q: Can you think of any other--before I get to that, has there been a significant change in the nature of the membership of ASH?
Wallerstein: I don't think so. Those figures are available. I don't think so. I think quite a few people in practice, but as I say, the practitioners have become more disciplined on the one hand, having to follow protocols, and the academicians have become more involved in medicine. So the differences have been diluted somewhat. I don't--I also played with the format of the annual meeting. They had for years--they had a Henry Stratton lecture. Henry Stratton was one of the benefactors to the Society when it was quite small, and as a reward for the benefits that we derived from him, which were--something, he gave something for the lecture, not really all that much--he was given a prominent place at the annual meeting and he gave a little talk. And it always bothered the hell out of me, because it seemed to be out of proportion to his tangible contribution. So I engineered having them stopped and we were successful. They gave him an honorary something or other and blocked his way to the microphone. It was one of those carefully engineered things, but never again did he get up to the podium after that. It was a minor triumph.
But my skill as a president was considered sort of administrative, managerial, rather than being pioneering or innovative. But the Society--some of the things that we were doing needed a little straightening out. I think I helped to streamline some of the procedures.
Q: At the time of your presidency, was the journal Blood published by ASH?
Wallerstein: No, I think that came a little later. There were negotiations going on. I know that Paul Marks headed a committee that dealt with Grune and Stratton. He was enormously successful in getting a better contract, but I think they still owned the journal. I'm not quite sure when that--I think this came after my time. I'm quite sure it did. But during my time we managed--not through my doing, but through Paul's doing--to have a very much more favorable contract with the publisher. (Note: Blood became the official journal of ASH in 1976.)
Q: And after your presidency, did you continue to participate in the national executive committee?
Wallerstein: Well, there's a council, which is a sort of noncommittee, only half the people show up, ex-presidents plus a few ad hoc members, I felt it was pretty meaningless. I always felt, when you've served as president of an organization, you ought to get the hell out. Well, it's not difficult to delude yourself that your wise counsel is worth something. The truth is it isn't worth all that much. And also, if you're any good at all, you get involved in something else. When you're the head of the group--the president, the chairman, whatever it is--you give your all and you solve all time conflicts in favor of the organization. When you're through, you don't do this any more. Then you find that you've neglected all sorts of other work that was going on while you were the head of the previous group, and you solve subsequent time conflicts in favor of the new group. That's happened to me. Immediately after my presidency--actually some time during my presidency--I became much more heavily involved than I had been in the American Board of Internal Medicine.
I should have said--I told you when I started ASH in 1971 as the local arrangements chairman, there was one more element to that. In 1970 I'd been asked by the American Board of Internal Medicine to participate in a small group of hematologists, six of us, to create the boards in hematology. There never had been boards in hematology, and in 1970 I was asked, along with five or six other people, to form a test committee to create the first boards in hematology. That really was my first national thing. I think that to some extent may have helped me in my ascendancy, let me put it that way, in the American Society of Hematology. During those years--between '71, when I was the local arrangements chairman, till I was president--I eventually became chairman of the Hematology Section of the American Board of Internal Medicine, and in 1976 I was elected to the parent board. So I was involved in hematology in a very meaningful way. In two different ways. President in the American Society of Hematology and head of the test committee for hematology for the boards. Now then, the moment I finished the presidency of the American Society of Hematology, I went on the executive committee of the American Board of Internal Medicine, which was an enormously time-consuming task. More so actually than the presidency had been. And as you know, eventually I became its chairman in 1981, which I thought, at that time, was enormously time-consuming. It took me some fifty-plus days away from home.
Q: What was your function on the Board of Internal Medicine?
Wallerstein: As chairman of the Board of Internal Medicine? Well, initially I was chairman of hematology only, but when you become chairman of the organization, you are chairman of medicine with all its sub-specialties. You get appointments to the key committees. You become a member of the Test Committee, you write some more examination questions and determine policy of testing and other evaluation. So you deal with all those issues of training. So that was pretty time-consuming.
Q: How long were you involved?
Wallerstein: With the board altogether? Thirteen years. That isn't possible any more. I had two separate appointments. The hematology sequence and then the board sequence. Nowadays the chairman of the sub-specialties, including hematology, would sit on the parent board as a regular member and this would then count towards the maximum six years on the board.
In my case, I finished my entire hematology tenure without sitting on the board, because the chairman of the sub-committee wasn't sitting on the board yet. So I laid them end to end, as it were, but now they overlap to a considerable extent. Be that as it may, I devoted my entire energies, outside of practice, to the American Board of Internal Medicine. There wasn't any time left for the American Society of Hematology.
Q: Were there any major issues that you dealt with during your tenure at the American Board of Internal Medicine or were they many small issues?
Wallerstein: Well, one major issue was not to go forward with computer testing, and somebody had to say, "Enough, it isn't working." And I take credit for doing that, at least being very instrumental in stopping the money losing CBX project, which the board was heavily involved in. That wasn't the CBX--it was the Merritt Project. The CBX fell later. But it was a form of testing. I became chairman of the sub-committee and I finally decided it ain't working, forget it, and it stopped. This was sort of a negative thing.
A positive thing I supported, time limited certification, although it didn't come to a vote at that time.
I supported involvement of the sub-specialty society in some of the board activities, but they were largely managerial things.
Q: And then you subsequently became involved with the American College of Physicians?
Wallerstein: Yes. In 1977 I was asked to stand for Governor of the American College of Physicians. The job description--well, I said, I haven't got time for this. And the people who'd persuaded me to run for office said, it doesn't take any time, it takes a couple of trips to Philadelphia a year. That was a flat lie. But anyway, perhaps I wanted to hear that. Be that as it may, in 1977, I guess--I'm not sure about that--I had to stand for election once more, this time to become governor of northern California. And that led to four years of being governor, including being chairman of the Board of Governors, to the Council of Sub-specialty Societies as their first chairman. And there my contacts with hematology, with the American Society of Hematology, and my feeling for sub-specialties stood me in good stead, because of the effect of meaningful interchange between the professional societies, like the American Society of Hematology and the American College of Physicians, was very nice.
And then to the Board of Regents. That tenure in the college moved me away a little bit from hematology. There were so many other issues to deal with that I had to sacrifice some of my hematology expertise.
Q: Just in terms of time, or were there issues involved?
Wallerstein: The time demand. In order to stay on top of your specialty, you have to give it your all, and I couldn't do that. If you haven't done this for a few years, you lose enough footage to--then when I got into the presidential chairs, as it were, I even had to give up my activities at the San Francisco General Hospital. I told you yesterday what it was. I had such a good time with microscopy, morphology, the residents sort of flocked to our sessions and I enjoyed that. I had to give that up. There simply wasn't enough time. My year as president of ACP I was gone two hundred days and traveled two hundred thousand miles. That certainly interferes with anything else, in that it sort of cost me in a way, my involvement with hematology. I have regrets about it, but you have to make some deliberate choices and I did make this deliberate choice. You don't get asked to be president of the American College of Physicians with sixty thousand members very often. And I enjoyed that. But it took me out of the active participation. Not just in running the Society, but being familiar with the issues, and, to some extent, actually with the expertise in hematology, and I haven't quite recovered that.
And when the college year was over, all of a sudden I found myself with these two hundred extra days on my hands. The immediate past presidency wasn't nearly as involving. I had to decide what I was going to do next. The obvious option was to assume all my previous activities, teaching and practice. While I was still trying to decide what to do, the president of this hospital came to me and said, "You don't want to go back to what you did before. We need your help here in the hospital with the merger of Presbyterian Hospital and Children's Hospital. Would you help us with administration?" And I thought about this for a while and I said to myself, that's something I haven't done yet. I'd done research and then teaching and then practice, then had national involvements. Here's an opportunity to do something non-practice at the local level, which I had ignored for almost twenty years, and deal with health care delivery. Not in a global fashion, but in a city in a specific hospital, requiring some management ability and knowledge that I hadn't acquired previously.
So I felt this to be a new challenge and to some extent it gave me some pangs of conscience, because I moved away from my previous colleagues and involvements. And I feel it very acutely right now. My good friend, Y. W. Kan, is the president right now. He invited me to a black tie dinner in Boston, and there's a dinner in his honor, a presidential reception to which I'm invited, and I can't go to Boston. I just can't. We have the merger here, the oncology center. We have so many issues here right now in regard to some other things, that I simply cannot go this year. And I feel that this is a major non-event in my life, that I cannot go to the annual meeting of the American Society of Hematology, where my very close friend and colleague is presiding. And all sorts of people called me, trying to get together in Boston, and I had to say sheepishly, :I'm not going." I feel I've lost something here. But time moves on. You can only do one thing. If you want to do it well, you'd better be there.
Q: Would you say the same thing about microscopy, morphology, those parts of research?
Wallerstein: Well, I still enjoy--I've given up seeing new patients unless they're hematology, and in hematology I still get a fair number of very interesting problems, and I must say I still enjoy using the microscope, which gives me a quick answer to complicated questions a good part of the time. But I have almost no one to share this joy with. My son is gone. And he wasn't all that interested in morphology anyway. And my young associate, he's sort of interested, but not very. So it's almost like a lost art. It's like quilt-making, I suppose.
Anyway, for my personal enjoyment I'm still very--I love to look at slides of my own patients. New problems. Some years ago a grateful patient of mine gave me a wonderful Leitz microscope with a photography setup. In a good year I take fifty rolls a year of film. I still have exactly the same equipment. I don't think I've taken a roll of film for the last six months. As much as I enjoy it, I don't enjoy it as much as I did before, mostly because the competing other things need my attention, have my attention. A long ways from hematology. Some of the skills I developed in dealing with issues stand me in good stead here in administration, although there's some new things I have to learn. The discipline is the same. I'm trying to learn as much about a problem as I possibly can. Then make a decision and act on it. I do that. Especially if they're hematology problems. But these are a different set of problems.
So I perhaps have moved further away from ASH than any of the people you will interview, but I tried to warn you about his ahead of time, but you said, well, it's just as well, because you get some variety. So that's your problem, not mine. I'm happy doing what I'm doing and I still enjoy what hematology that I do. But if I had to choose right now between getting up and resuming any of my other activities, even at a most favorable level, surrounded by students and residents, I wouldn't want to go back. I feel I've done this, and I do like switching careers. I think switching careers is rejuvenating. Learning new skills is kind of fun. And while I've always admired those of my friends who devoted their whole lives to sitting at microscopes and talking to students, it isn't very interesting to me any more. I think students and residents in general need somewhat younger teachers than I am now. And I felt this the last two years, while they're nicer and nicer and more and more deferential to me, it was not as productive a relationship, and I felt that I was getting just a little bit too old to be taken all that seriously.
Back to Dr. Wallerstein's Profile
|
