Fig. 4.1
Edward Mason, MD
Edward Mason writes about those days:
The postgraduate course was started because of the increasing number of surgeons performing obesity surgery, who were communicating and sharing experiences and ideas by phone. Nicola Scopinaro, MD, from Genoa and surgeons from Sweden were early attendees. In 1977, there were 28 presentations and symposia listed for the meeting, which was held April 28 and 29 and called the Gastric Bypass Workshop. I found a copy of the bound paperback of 187 pages recording transcript of the 1977 meeting, which was distributed after the meeting. The last article is about plans for a Gastric Bypass Registry. The Workshop transcript was distributed a month after the meeting. It includes the presentations and discussion that were recorded and transcribed.
Long-term results and prospective and larger trials began to contribute to the knowledge base, culminating in the first NIH consensus conference on December 4, 1978. This conference was of pivotal importance. It was at this conference that the jejunal ileal bypass was shown to have substantial problems, and restriction (gastric bypass and vertical banded gastroplasty) was established as a credible procedure. The society was formed on this strong scientific foundation.
John Kral writes:
Having attended the Iowa City colloquia, the academic surgeons J D Halverson, J P O’Leary, H J Sugerman and myself, at the colloquia in 1983, met in a pub during the lunch break to propose expanding the colloquia to the format of scientific meetings with membership, program committees, minutes, abstract selection and “democratic” principles. That afternoon, June 3, 1983 at an impromptu business meeting of the attendees a proposal for the formation of a society for the study of obesity surgery was made and accepted.
The aims of the society were to “develop guidelines for patient care, promote research into the outcomes and quality of bariatric surgeries and encourage an exchange of ideas among researchers and surgeons” [1]. In deference to Mason, the term “bariatric”—a continuation of his tradition of the colloquia—was adopted. In 1984, the first annual meeting of the American Society for Bariatric Surgery was held in Iowa City. The meeting attracted more than 150 participants and 36 oral presentations. After meeting again in 1985 in Iowa City, the society chose to rotate annually between different venues.
The original officers were the following: Edward Mason, MD, president; Boyd Terry, MD, secretary–treasurer; and Patrick O’Leary, MD, program committee chair. Initially, terms of office were 2 years in duration. However, as the work of running the society increased, the term of office decreased to 1 year in 1989 for the term of Cornelius Doherty. In recognition of his leadership in bariatric surgery, the Edward E. Mason Founders Lecture was established and given for the first time on June 2, 1989, by H. William Scott Jr., MD, from Vanderbilt.
In the early days of the academic effort to define the science of the surgical treatment of obesity, there was support by the NIH in convening a consensus conference and presentations of critical data at the Society for Surgery of the Alimentary Tract, the American Surgical Association, and the Western Surgical Association meetings. Many of the early surgeon scientists were also active in the American College of Surgeons (Ward Griffen, MD, and Patrick O’Leary, MD).
The majority of The majority of surgeon leaders who returned comments for this chapter feel leaders who commented feel there were serious barriers in trying to mainstream their research and surgical treatment of obesity into their departments and community hospitals. The formalization of the society served to promote the ability to provide a forum for exchange of ideas, research, and best practice and education of its members; however, it also established a political force within American surgery and served to promote access to care for the surgical treatment of obesity. The criticism and perception by the surgical establishment had a profound impact on the character of the society and drove some decisions (both good and bad) from a group that felt on the defensive. Perhaps, in many ways, this reflects the very real discrimination and prejudice that patients who suffer from obesity also feel. A fiercely independent and entrepreneurial character is firmly entrenched in the society’s foundation. These echoes of the underdog reappear throughout the 30-year history of the ASMBS and continue to contribute to the development of our specialty and the identity of the society that serves to forward its practice.
The nascent society continued to encounter a difficult environment full of opportunity. Cornelius Doherty, a private practice surgeon recruited to join Edward Mason in IU, and president of ASBS from 1989 to 1990, writes:
The early surgeons in our field operated at a time when the prejudice against surgical treatment of severe obesity was at its zenith. Organized medicine had abandoned them with indifference. Third-party payers were denying patient access to surgery arbitrarily. Professional liability carriers were stopping availability of coverage or charging exorbitant premiums. Plaintiff attorneys were predatory about filing cases. My agenda during my Presidency was to position the ASBS in the best possible way to plea the case for acceptance of surgical treatment of severe obesity at the National Consensus Development Conference of 1991. I had early notice that this conference would occur. I worked to that end tirelessly. I spearheaded the appointment of Lars Sjostrom as an Honorary Life Time Member of the ASBS. The team from ASBS effectively presented decisive data that advanced the recognition of the value of bariatric surgery.
Twelve of the fourteen surgeon speakers at the 1991 NIH Consensus Development Conference, “Gastrointestinal Surgery for Severe Obesity,” were ASBS members. In a breakfast meeting at Brennan’s in New Orleans, Michael Sarr, MD; Edward Mason, MD; John Kral, MD; Patrick O’Leary, MD; Cornelius Doherty, MD; and Harvey Sugerman, MD, set the agenda for the conference. These surgeons were able to present compelling data that influenced the panel of nonsurgical experts to express a positive overall position in the Consensus Conference Statement, which paved the way for improved acceptance of gastric restrictive or bypass procedures for patients affected by severe obesity and influencing third-party payers. Thus, in many ways, advocacy for access to care was involved in the original mandate of the society. The society was focused during this time on getting at least 200 surgeon members so that they could qualify as a registered society with the American College of Surgeons. There was significant growth in the specialty of MBS, especially with the broader knowledge by patients that there may be an effective treatment for this disease. The NIH Consensus Conference was the pivotal event of this time and has stood the test of time. The 1991 guidelines still provide the backdrop against which decisions are made about whether a patient has access to surgery both in the United States and even around the world.
The society leadership reflects a strong commitment to both private practice and academic practice. Although there has never been a formal ratio established in the bylaws, traditionally one-half of the Executive Council has come from private practice with a rotation of the presidency from one year to the next between academic and private practice. As more surgeons in private practice have been publishing peer-reviewed literature, serve to teach and train residents and fellows, participate in the quality program, and serve on and lead committees—along with the requirement by many academic surgical departments for high-volume practice and the employment by major hospital systems of physicians—the lines delineating private practice from academic practice have blurred. There remains, however, a very strong belief that both aspects of practice should be represented in the decisions of the society. Surgeons drove some of the pivotal developments in the specialty in private practice (Table 4.1 and Fig. 4.2 presidents of ASBS/ASMBS).
Table 4.1
The presidents of ASMBS
Presidents of ASBS/ASMBS | |
|---|---|
1983–1985 | Edward E. Mason, MD, PHD (A) |
1985–1987 | John D. Halverson, MD (A) |
1987–1989 | J. Patrick O’Leary, MD (A) |
1989–1990 | Cornelius Doherty, MD (PP/A) |
1990–1991 | George S. M. Cowan Jr., MD (A) |
1991–1992 | John H Linner, MD (PP) |
1992–1993 | Boyd E. Terry, MD (A) |
1993–1994 | Otto L. Willibanks, MD (PP) |
1994–1995 | Mervyn Deitel, MD (A) |
1995–1996 | Alex M. C. MacGregor, MD (PP) |
1996–1997 | Kenneth G. MacDonald (A) |
1997–1998 | S. Ross Fox, MD (PP) |
1998–1999 | Henry Buchwald, MD, PhD (A) |
1999–2000 | Latham Flanagan, Jr. MD (PP) |
2000–2001 | Robert E. Brolin, MD (A) |
2001–2002 | Kenneth B. Jones, MD (PP) |
2002–2003 | Walter J. Pories, MD (A) |
2003–2004 | Alan C. Wittgrove, MD (PP) |
2004–2005 | Harvey J. Sugerman, MD (A) |
2005–2006 | Neil Hutcher, MD (PP) |
2006–2007 | Philip R. Schauer, MD (A) |
2007–2008 | Kelvin Higa, MD (PP), first president of ASMBS |
2008–2009 | Scott Shikora, MD (A) |
2009–2010 | John Baker, MD (PP) |
2010–2011 | Bruce Wolfe, MD (A) |
2011–2012 | Robin Blackstone, MD (PP) |
2012–2013 | Jaime Ponce, MD (PP) |
2013–2014 | Ninh T. Nguyen, MD (A) |
Fig. 4.2
Past presidents of the American Society for Metabolic and Bariatric Surgery, Obesity Week 2014. From left to right: Phil Schauer, MD; Patrick O’Leary, MD; Robin Blackstone, MD; Harvey Sugerman, MD; Bruce Wolfe, MD; Mervyn Deitel, MD; Scott Shikora, MD; Kelvin Higa, MD; John Baker, MD; Jaime Ponce, MD; Alan Wittgrove, MD; Ken Jones, MD; Henry Buchwald, MD; Robert Brolin, MD; Latham Flanagan, MD; Ken MacDonald, MD
The Era of Rapid Growth 1989–2004
The original structure of the society was established in the bylaws and has evolved throughout time. Officers were nominated by a nominating committee, and except for two elections, the slate of officers was unanimously selected. The first divergence occurred when Harvey Sugerman, MD, was nominated, but George S. M. Cowan, MD, was elected in 1989. The second when Titus Duncan, MD, was nominated by the committee and Robin Blackstone, MD, was nominated from the floor by Harvey Sugerman, MD, and elected through the first email vote in the history of the society. Both of these pivotal events occurred during a time of change in the direction and focus of the society. During the presidency of Bruce Wolfe, MD, the bylaws regarding elections were rewritten and passed by the membership, allowing for electronic voting and nomination of established proven leaders (committee chairs, presidents of state chapters, and chairs of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program [MBSAQIP] committees). Our society is unique in allowing the membership to directly nominate the leadership and has as its goal that the system is transparent, fair, and results in a meritocracy approach to governance.
The transition to the Era of Rapid Growth and the rise of integrated health are marked by the transition of the leadership to George Cowan, MD. Controversy erupted after the election and resulted in the loss of some of the leading academic surgeons including Harvey Sugerman and John Kral from the society’s ranks, although both continued to do key research in the field. Integrated health providers were present throughout the early period, but their participation became much more organized and there was increased diversity of disciplines.
This period of the society saw tremendous growth in the numbers of procedures and diversity of procedures including the use of devices in large numbers of patients. Increasing numbers of surgeons operating without a knowledge base or programmatic structure led to an increase in complications with a rise in malpractice premiums. Many insurance companies dropped benefits due to the sharp upturn in cost. Scrutiny of the data generated at this time showed a lack of rigor, and there was a growing public awareness of the increase in the numbers of patients with obesity. These challenges foreshadowed the next era of the society’s growth.
At the time, Boyd Terry, MD, became president (1991–1992), the society had just struggled through a major schism of its membership because of problems regarding the use of dues for the journal and bylaw uncertainty. In addition, a major “faction” controversy was raging between biliopancreatic diversion and duodenal switch. The society emerged with more focus on representation from different regions of the country and an emphasis on communication and well-focused objectives for committee work. Surgeons within the society were concerned that their success with gastric bypass would be eroded by the adoption of untested “extreme” procedures that caused more harm than good. This theme, existing in 1991, has had an echo throughout the history of the society. “Faction wars” erupted again when the Food and Drug Administration (FDA) approved the first device to be used in the treatment of obesity: the adjustable gastric band (AGB). With the increase in public scrutiny, surgeons who practiced unproven technology outside of Institutional Review Board (IRB) guidance came under increasing scrutiny and pressure not to offer unproven and untested procedure variations like the gastric plication or banded gastric bypass or plication of the fundus in a patient with a band. Part of this theme comes through repeatedly because the public and many of our medical and surgical colleagues believe that we are advocating surgery in order to line our own pockets. Even when we present valid and strong evidence, we have trouble convincing them, in part because of this historical context. This tension between commercialism and scientifically based procedure indications continues to the modern era of the society. The society has taken a firm stand on these issues, discouraging the use of procedures that do not have sufficient evidence of safety and effectiveness from being performed outside IRB guidance. The society has developed a process for evaluating procedures and determining when the evidence is sufficient to support them through the Clinical Issues Committee.
ASBS began to achieve its political goals of formal participation in American surgery when it was voted a membership in the American College of Surgeons Board of Governors 1998. Patrick O’Leary, MD, had just joined the Executive Council of the Board of Governors, and when the request by Henry Buchwald, MD, came through, he was pivotal in getting it approved. Still, there were substantial barriers in the academic world. Particularly harsh was some of the criticism coming out of the surgical leadership of the University of Louisville, Kentucky, where one prominent surgeon declared bariatric surgery “charlatanism.” Within the academic establishment, surgeons who were involved in the surgical treatment of obesity were not well respected, their papers were not given credibility or even published, and their careers were at risk. Henry Buchwald, MD, recounts that when he became the president of ASBS, his chairman commented, “You have just killed your career.”
Integrated Health
Early on, awareness of the critical input and support of a variety of professionals in addition to surgeons was recognized. This was followed by the formation of the Allied Health Sciences Committee (AHSC) in June 1990 with Georgeann Mallory, RD, as the first chair. The committee included registered dietitians, exercise physiologists, bariatric physicians and psychologists, and midlevel providers (both nurse practitioners and physician assistants). The membership of this committee, which elects its own president and council, has grown. Contributions both to the peer-reviewed literature and to clinical pathways of care as recognized in the accreditation standards, have emerged to enhance the management of patients before, during, and after surgery. With the growing needs of the society, Georgeann Mallory, RD, who worked with Dr. Alex Macgregor, the 10th president of the ASBS, was appointed as executive director in 1993. She also served as the first chair of the AHSC.
Mary Lou Walen was appointed the second chair of the AHSC. She writes:
As Chair of the AHSC, it was important to me that all those working with patients receive education and information about the operations; complications; all aspects of care including working with the hospital both clinical and administration; learning about how to get paid for treating the patients; involving the primary care physicians and the specialists in becoming members of the treatment team; keeping the patients motivated and fully informed.
During Walden’s chairmanship, workshops were developed and included in the program on clinical issues, patient education, insurance challenges, nutrition, psychology, and other topics; an allied health keynote speaker was added to the program; the AHSC chair was invited to all ASMBS Executive Council meetings; the committee requested to become a section and the Allied Health Sciences Committee became the Allied Health Sciences Section; and the president of the section became an elected position serving a 2-year term (Table 4.2
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