The American Society for Clinical Investigation, 1952–1975: a personal perspective

Abstract

In this perspective, I trace my experiences with the ASCI, beginning in 1952, when as a medical student I attended my first meeting, until 1975, when I completed my term as president of the Society. I focus attention on the sociological aspects of the Atlantic City meetings and the critically important role these meetings played in the evolution of academic medicine during the third quarter of the 20th century.

The period encompassed by this article begins in 1952 with the first meeting of the American Society for Clinical Investigation that I attended and ends with the 1975 meeting, when I completed my year as president and graduated to emeritus membership. In 1952 Harry Truman was the president of the United States and the Korean War was in full swing. Research was rarely carried out by medical students at the time, but I was fortunate to have been given the opportunity to spend an extended research elective in the hemodynamic research laboratory of Ludwig Eichna at New York University and Bellevue Hospital. We studied the hemodynamics of heart failure, a subject that I have worked on intermittently since then and continue to investigate at present. Eichna was the secretary of the ASCI and therefore was quite involved in Society matters. He talked to me about them at some length, giving me a bird’s-eye view, and arranged for me to accompany him to the annual meeting in Atlantic City, New Jersey, then a quiet seaside resort.

In 1952, and for years thereafter, the three clinical research societies, the Tri-Societies, met on consecutive days. On the first day, the American Federation for Clinical Research, now the American Federation for Medical Research (AFMR), affectionately called the Young Squirts, under 41 years of age, met. On the second day it was the turn of the ASCI, the Young Turks, under 46 years of age; and on the last day, it was the Association of American Physicians (AAP), the venerable Old Turks, no age limit.

The 1952 meetings were a transforming event in my professional life. I was mesmerized by the many (perhaps 300) attendees, virtually the nation’s entire academic medicine establishment. They came from all over the country, but predominantly from departments of medicine on the East Coast, then the sites of most of the “action” in clinical research. Active and emeritus members of the ASCI sat in a special roped-off section of the auditorium in the Chalfonte-Haddon Hall hotel and were the only persons permitted to ask questions after presentations. These were usually long soliloquies, followed by a query that often seemed like an afterthought.

Aside from two papers in cardiology, I had only a vague understanding of the presentations. However, on reflecting on the meeting later, I was struck by the fact that the goal of the research presented was to answer specific questions and to define pathophysiological mechanisms of disease, much as occurred in Eichna’s laboratory. However, I had become accustomed from my classes, textbooks, and the limited medical literature of the day that I perused to observations of patients, diseases, or phenomena. The ASCI clearly was in the vanguard of this paradigm shift to hypothesis-driven research that brought biomedical research into the mainstream of science. I believe that this was one of the most important contributions of the Society during this era. My early exposure to this approach to research, which we now take for granted, profoundly influenced my subsequent research efforts.

With the exception of my internship year, I attended all of the subsequent meetings of the Society in Atlantic City on my peripatetic academic path. By the mid-1950s I had become cognizant of and fascinated by some of the sociological aspects of the meeting. The Boardwalk, recently widened and refinished, was an academic meat market. This was the place where young physicians with academic aspirations were introduced to senior faculty from other (and often their own) institutions. Sitting on the railing of the Boardwalk, it was interesting to people-watch. Virtually all who strolled by, regardless of age, were white males, usually with closely cropped hair and wearing a standard uniform: white shirt with button-down collar, striped tie (black and dark green were the favorites), charcoal gray slacks, herringbone jacket often with leather elbow patches, and well-shined black shoes. Almost all (me included!) were pipe smokers. The princes of academic medicine — chairmen of important departments — strutted about, surrounded by their retinues.

In the evening the bars in Chalfonte-Haddon Hall were overflowing; the most popular drink for faculty was the Manhattan, and pitchers of beer flowed for trainees. Walking along the corridors of these hotels, sometimes one could catch a glimpse of a frightened young man emerging from a pipe smoke–filled room after a screening interview with one or two barons. If this encounter was successful, it could lead to a meeting on the following day with a prince, often semipublic in a hotel restaurant.

In the 1950s, there were no organized research training programs; research was learned entirely in an apprentice mode. In some instances, aspiring clinical investigators spent a year or two in a preclinical science department. Before the NIH budget had begun its upward trajectory, it was a buyer’s market for academic departments, with a growing number of young physicians interested in biomedical research but relatively few positions. However, a successful presentation at an ASCI meeting coupled with an article or two in The Journal of Clinical Investigation were the tickets to academic success. Election to the ASCI was considered to be a stamp of excellence and often led to an associate professorship in a top medical school. Election to the AAP meant that you were full professor material.

With the passage of time, my role at these meetings changed from that of an awed spectator to a participant. I was elected to the Society in 1963 and served on the editorial committee of the JCI from 1964 to 1971. A great honor came to me in 1974–1975 when I served as president of the Society. I learned a great deal from these ASCI-associated activities, including how to assess research, evaluate candidates, and think about the larger issues facing academic medicine, some of which I discussed in my address to the Society (1).

For decades the academic year was synchronized to the annual meeting of the Society. Not only was this the high point of the year scientifically, but it also provided the venue for many important satellite meetings. The annual meeting of the Association of Chairs of Medicine was held in conjunction with the ASCI’s, and this assured that virtually all chairs attended the Society’s meetings. I gained much from the meetings of this association, which I began to attend in 1968 as a rather junior chairman. Equally important to me were the annual meetings of the editors of Harrison’s Principles of Internal Medicine, also held in conjunction with the ASCI meeting.

As the years went by, the character of the Society’s meetings changed as well. The meetings grew rapidly in size, as clinical research in the United States was fueled by the progressive growth of the NIH budget. The meetings outgrew Haddon Hall’s auditorium and moved to the famous Atlantic City Steel Pier. When I became an emeritus member in 1975, the country had changed remarkably since my first meeting in 1952. Gerald Ford was now president of the US. The country had been deeply traumatized by the assassinations of John and Robert Kennedy and of Martin Luther King, as well as by Watergate. The Vietnam War was drawing to its tragic conclusion, and the cold war was at its height. The ASCI meeting had now become a bit more representative of the country, with important scientific contributions no longer confined to the Boston-Washington corridor. The appearance of the participants had also changed. Long hair was the rule, and facial hair was quite common. Small but growing numbers of women and minorities were in attendance. Dress had become casual. What I considered to be the most exciting scientific presentation of the meeting over which I presided was delivered by an immunologist without tie or jacket who sported a huge mustache and pony tail: he was from San Francisco, of course. Departments were now competing avidly for well-trained and promising faculty members to populate their rapidly growing NIH-sponsored research programs. Clinical research had become a seller’s market.

In the 1970s, gambling casinos had sprung up in Atlantic City and thereby first disturbed and then ruined the ambience of this academic meeting. The ASCI Council began to think about the unthinkable — leaving Atlantic City! I resisted this idea because I knew that something magical would forever disappear from our professional lives — the annual pilgrimage of clinical investigators to this out-of-the-way place. However, I fought a losing battle. The ASCI moved, probably appropriately, given what was happening to Atlantic City, but unfortunately I was correct — something magical had indeed disappeared and has never returned.

The meetings moved in 1977 to Washington, DC, and then to other cities, ultimately settling in Chicago, in order to make travel easier for investigators and trainees from the entire country, as the center of gravity of clinical research moved westward. With the flowering of the medical subspecialties, afternoon and evening sessions were added. However the Tri-Societies could not compete successfully with the meetings of the subspecialty societies. The Society’s meetings, held with the AAP, became a series of brilliant “State of the Art” lectures that cut through several disciplines and were delivered by the most creative and accomplished investigators in the country. This format, which continues to the present, is designed to remind us of the common threads linking all clinical research and its dependence on basic biologic science.

However, despite these changes in the meeting, which reflected the evolution of clinical investigation, what has not changed during the 56 years since I attended my first meeting has been the ASCI’s devotion to rigorous science. Membership in the Society and publication in its prestigious journal remain twin badges of honor, which are so very important at a time when we are witnessing increasing hype, spin, and commercialization of research.

Happy 100th ASCI! May your positive influence on clinical investigation and academic medicine continue unabated during your second century.

Footnotes

Conflict of interest: The author has declared that no conflict of interest exists.

Reference information: J. Clin. Invest.118::1228–1230 (2008). doi:10.1172/JCI34653.

References

1. Braunwald, E. 1975. Can medical schools remain the optimal site for the conduct of clinical investigation? Presidential address before the 67th annual meeting of the American Society for Clinical Investigation, Atlantic City, New Jersey, 5 May 1975. J. Clin. Invest. 56:i-vi.
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