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From the EVP/ CEO
It is an incredible honor to be recently confirmed as the EVP/CEO for the CHEST organization. As a 23-year veteran of CHEST, I have had the privilege of working with and for many of our leaders, volunteers, and members. Being only the fifth person to lead the organization in an executive leadership role is both humbling and invigorating. CHEST is a dynamic and innovative organization, with a mission to “champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.” That mission resonates deeply with me on a personal level, because my mother had COPD. Toward the end of her life, I saw firsthand how it impacted her quality of life and her ability to be a mother and grandmother, and I also saw the important role her pulmonologist and re
I am both fortunate and grateful to have such a phenomenal professional staff to work with here at CHEST and to have the outstanding leadership of our Presidents, Past Presidents, Boards, Committees, and NetWorks – all of which have been tremendously supportive during the past 9 months as I filled the Interim EVP role. I am also deeply grateful to those of you who choose to be members and Fellows of CHEST and to be engaged as volunteer leadership, faculty, content experts, authors, and more. It is your time, energy, involvement, and vision that make this organization what it is. The fact that you choose to give some of your valuable time toward helping CHEST achieve its mission and vision is so greatly appreciated by all of us in this organization. Thank you for all that you do for CHEST.
In recent years, the College has continued to realize the following significant achievements:
1. Growth of our educational programs in simulation, skills training, and procedures;
2. The building and of our new global HQ and Innovation, Simulation, and Training Center;
3. An increasingly global footprint as we deliver education to our physician and advance practice provider members and nonmembers in the US and around the world;
4. Increasing development of digital publications and essential content, such as our journal; CHEST®, CHEST-SEEK ™ products, e-learning modules, evidence-based guidelines, and more that can be served up to anyone on any device;
5. Growth and maturation of our CHEST Foundation and its research and service awards;
6. Expansion of patient education initiatives and materials;
7. Development of a data warehouse that will allow us to serve our members and partners more effectively; and
8. Far too many more achievements to list here.
Since taking on the EVP/CEO role, I’ve been asked what do I consider my primary responsibilities to be. I think this is best summed up by Rick Moyers, in The Nonprofit Chief Executive’s Ten Basic Responsibilities (BoardSource, 2006). In it, he outlines the executive’s responsibilities as follows:
1. Commit to the mission.
2. Lead the staff and manage the organization.
3. Exercise responsible financial stewardship.
4. Lead and manage fundraising.
5. Follow the highest ethical standards, ensure accountability, and comply with the law.
6. Engage the board in planning and lead the implementation.
7. Develop future leadership.
8. Build external relationships and serve as an advocate.
9. Ensure the quality and effectiveness of programs.
10. Support the board.
These 10 basic responsibilities provide the framework and foundation for how I plan to serve as EVP/CEO of CHEST. In many cases, I’ve been doing much of this as a senior executive at CHEST for the past 23 years, and I look forward to continuing to build on that foundation.
I am also often asked what my vision for the organization is, as its new EVP/CEO. And my answer is simple: to ensure that the American College of Chest Physicians stays relevant in this environment of change and disruption, that it continues to fulfill its mission, and that members, leadership, volunteers, and staff work together, make a positive impact on patient care, and, ultimately, have fun doing the good work of CHEST. This organization has an outstanding reputation, legacy, and brand. I will do everything I can to maintain and improve upon those key attributes.
It is my ultimate responsibility to ensure that we operationalize the educational programs and activities that align with the strategic plan and achieve the organizational goals of CHEST, which have been set by your Boards and Committees. I look forward to proudly and humbly serving as the CHEST evangelist and advocate to our members, patients, partners, and sister societies. I look forward to hearing from you, our members, about how CHEST is doing, and how we can continue to meet – and exceed – your educational and professional needs.
It is an incredible honor to be recently confirmed as the EVP/CEO for the CHEST organization. As a 23-year veteran of CHEST, I have had the privilege of working with and for many of our leaders, volunteers, and members. Being only the fifth person to lead the organization in an executive leadership role is both humbling and invigorating. CHEST is a dynamic and innovative organization, with a mission to “champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.” That mission resonates deeply with me on a personal level, because my mother had COPD. Toward the end of her life, I saw firsthand how it impacted her quality of life and her ability to be a mother and grandmother, and I also saw the important role her pulmonologist and re
I am both fortunate and grateful to have such a phenomenal professional staff to work with here at CHEST and to have the outstanding leadership of our Presidents, Past Presidents, Boards, Committees, and NetWorks – all of which have been tremendously supportive during the past 9 months as I filled the Interim EVP role. I am also deeply grateful to those of you who choose to be members and Fellows of CHEST and to be engaged as volunteer leadership, faculty, content experts, authors, and more. It is your time, energy, involvement, and vision that make this organization what it is. The fact that you choose to give some of your valuable time toward helping CHEST achieve its mission and vision is so greatly appreciated by all of us in this organization. Thank you for all that you do for CHEST.
In recent years, the College has continued to realize the following significant achievements:
1. Growth of our educational programs in simulation, skills training, and procedures;
2. The building and of our new global HQ and Innovation, Simulation, and Training Center;
3. An increasingly global footprint as we deliver education to our physician and advance practice provider members and nonmembers in the US and around the world;
4. Increasing development of digital publications and essential content, such as our journal; CHEST®, CHEST-SEEK ™ products, e-learning modules, evidence-based guidelines, and more that can be served up to anyone on any device;
5. Growth and maturation of our CHEST Foundation and its research and service awards;
6. Expansion of patient education initiatives and materials;
7. Development of a data warehouse that will allow us to serve our members and partners more effectively; and
8. Far too many more achievements to list here.
Since taking on the EVP/CEO role, I’ve been asked what do I consider my primary responsibilities to be. I think this is best summed up by Rick Moyers, in The Nonprofit Chief Executive’s Ten Basic Responsibilities (BoardSource, 2006). In it, he outlines the executive’s responsibilities as follows:
1. Commit to the mission.
2. Lead the staff and manage the organization.
3. Exercise responsible financial stewardship.
4. Lead and manage fundraising.
5. Follow the highest ethical standards, ensure accountability, and comply with the law.
6. Engage the board in planning and lead the implementation.
7. Develop future leadership.
8. Build external relationships and serve as an advocate.
9. Ensure the quality and effectiveness of programs.
10. Support the board.
These 10 basic responsibilities provide the framework and foundation for how I plan to serve as EVP/CEO of CHEST. In many cases, I’ve been doing much of this as a senior executive at CHEST for the past 23 years, and I look forward to continuing to build on that foundation.
I am also often asked what my vision for the organization is, as its new EVP/CEO. And my answer is simple: to ensure that the American College of Chest Physicians stays relevant in this environment of change and disruption, that it continues to fulfill its mission, and that members, leadership, volunteers, and staff work together, make a positive impact on patient care, and, ultimately, have fun doing the good work of CHEST. This organization has an outstanding reputation, legacy, and brand. I will do everything I can to maintain and improve upon those key attributes.
It is my ultimate responsibility to ensure that we operationalize the educational programs and activities that align with the strategic plan and achieve the organizational goals of CHEST, which have been set by your Boards and Committees. I look forward to proudly and humbly serving as the CHEST evangelist and advocate to our members, patients, partners, and sister societies. I look forward to hearing from you, our members, about how CHEST is doing, and how we can continue to meet – and exceed – your educational and professional needs.
It is an incredible honor to be recently confirmed as the EVP/CEO for the CHEST organization. As a 23-year veteran of CHEST, I have had the privilege of working with and for many of our leaders, volunteers, and members. Being only the fifth person to lead the organization in an executive leadership role is both humbling and invigorating. CHEST is a dynamic and innovative organization, with a mission to “champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.” That mission resonates deeply with me on a personal level, because my mother had COPD. Toward the end of her life, I saw firsthand how it impacted her quality of life and her ability to be a mother and grandmother, and I also saw the important role her pulmonologist and re
I am both fortunate and grateful to have such a phenomenal professional staff to work with here at CHEST and to have the outstanding leadership of our Presidents, Past Presidents, Boards, Committees, and NetWorks – all of which have been tremendously supportive during the past 9 months as I filled the Interim EVP role. I am also deeply grateful to those of you who choose to be members and Fellows of CHEST and to be engaged as volunteer leadership, faculty, content experts, authors, and more. It is your time, energy, involvement, and vision that make this organization what it is. The fact that you choose to give some of your valuable time toward helping CHEST achieve its mission and vision is so greatly appreciated by all of us in this organization. Thank you for all that you do for CHEST.
In recent years, the College has continued to realize the following significant achievements:
1. Growth of our educational programs in simulation, skills training, and procedures;
2. The building and of our new global HQ and Innovation, Simulation, and Training Center;
3. An increasingly global footprint as we deliver education to our physician and advance practice provider members and nonmembers in the US and around the world;
4. Increasing development of digital publications and essential content, such as our journal; CHEST®, CHEST-SEEK ™ products, e-learning modules, evidence-based guidelines, and more that can be served up to anyone on any device;
5. Growth and maturation of our CHEST Foundation and its research and service awards;
6. Expansion of patient education initiatives and materials;
7. Development of a data warehouse that will allow us to serve our members and partners more effectively; and
8. Far too many more achievements to list here.
Since taking on the EVP/CEO role, I’ve been asked what do I consider my primary responsibilities to be. I think this is best summed up by Rick Moyers, in The Nonprofit Chief Executive’s Ten Basic Responsibilities (BoardSource, 2006). In it, he outlines the executive’s responsibilities as follows:
1. Commit to the mission.
2. Lead the staff and manage the organization.
3. Exercise responsible financial stewardship.
4. Lead and manage fundraising.
5. Follow the highest ethical standards, ensure accountability, and comply with the law.
6. Engage the board in planning and lead the implementation.
7. Develop future leadership.
8. Build external relationships and serve as an advocate.
9. Ensure the quality and effectiveness of programs.
10. Support the board.
These 10 basic responsibilities provide the framework and foundation for how I plan to serve as EVP/CEO of CHEST. In many cases, I’ve been doing much of this as a senior executive at CHEST for the past 23 years, and I look forward to continuing to build on that foundation.
I am also often asked what my vision for the organization is, as its new EVP/CEO. And my answer is simple: to ensure that the American College of Chest Physicians stays relevant in this environment of change and disruption, that it continues to fulfill its mission, and that members, leadership, volunteers, and staff work together, make a positive impact on patient care, and, ultimately, have fun doing the good work of CHEST. This organization has an outstanding reputation, legacy, and brand. I will do everything I can to maintain and improve upon those key attributes.
It is my ultimate responsibility to ensure that we operationalize the educational programs and activities that align with the strategic plan and achieve the organizational goals of CHEST, which have been set by your Boards and Committees. I look forward to proudly and humbly serving as the CHEST evangelist and advocate to our members, patients, partners, and sister societies. I look forward to hearing from you, our members, about how CHEST is doing, and how we can continue to meet – and exceed – your educational and professional needs.
Pulmonary Perspectives® China’s Pulmonary Crisis
Over the past 2 years, we had the opportunity to participate in an annual cross-cultural exchange that has broadened our horizons. Xi’an, the ancient capital of China and home of the Terracotta warriors, is a sprawling megapolis similar to Los Angeles. In the southern suburb of Huxian, US trained pulmonary, neurosurgical, and critical care physicians from Cooper University Hospital and Morehouse School of Medicine partnered with physicians of Ji-Ren Teaching Hospital to deliver a Chinese Medical Association accredited continuing medical education conference. The conference agenda included a variety of pulmonary and critical care topics highlighting sepsis, neurovascular disease, and lung cancer screening and diagnosis. We also provided a hands-on workshop for point of care ultrasound, and, in return, received education about Chinese medicine.
We found our hosts appreciative and hospitable, and they treated us with the highest level of respect (the cornerstone of Chinese culture). The audience was receptive and very interested in learning. However, while we were impressed with their rapid growth and interest in incorporating western medicine into their daily practice, it was impossible to overlook the major pulmonary health-care concerns threatening their communities. Tobacco use was omnipresent, and the haze of air pollution made the sky a constant shade of grey. In both public and private spaces, powerful echoes of a once familiar America resonated, and they served to underscore the obstacles the Chinese medical community now faces in caring for their country’s pulmonary health.
An Old, Familiar Foe
The China National Tobacco Corporation (CNTC) is the largest tobacco company in the world, as well as China’s most profitable state-owned enterprise (Pratt, A, et al. WHO Report. 2017. ISBN 9789290617907 [http://www.wpro.who.int/china/publications/2017_china_tobacco_control_report_en_web_final.pdf?ua=1]). As such, the CNTC controls every aspect of its production and supply chain with the force of the federal government and also exerts heavy influence over regulatory policy. It controls about 98% of domestic crop production and manages to price cigarettes just short of one American dollar per pack, yet contributes about $170 billion annually to the government (Rich, et al. Nicotine Tob Res. 2012;14[3]:258). This accounted for nearly 7% of total governmental revenue in 2015 (Pratt, 2017).
To date, nearly 44% of the world’s cigarettes are manufactured and consumed in China (Pratt 2017, Rich 2012). In 2015, more than 315 million Chinese adults were daily smokers, or about 28% of the adult population and nearly half of all men (Pratt, 2017). This is about double the proportion of US smokers (about 15.1%) and more than eight times the 36.5 million daily smokers in the United States (CDC Online Tobacco Use Report, 2016 [https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/]). However, to visit China is not only to know a love for tobacco, but also an overwhelming guest and gift culture. Gift giving and hospitality is central to the Chinese identity, from business meetings to afternoon tea. Given their economy and such rich supply, people gift cigarettes to one another at all times for nearly any occasion. Unfortunately, tobacco smoke in China is as inescapable as its health consequences.
The direct effects of smoking on China’s pulmonary health have been catastrophic. Cancers of the lung and bronchus constitute their most common malignancy across both sexes, accounting for the majority of the annual 4.3 million new cancer diagnoses (Chen et al. CA Cancer J Clin. 2016;66[2]:115). In Chinese men, lung cancer is the second most common cancer before the age of 60, and over the age of 75, it is the most common malignancy and also accounts for the majority of that group’s cancer mortality. Women fare only slightly better, with breast cancer being their most common malignancy, but with lung cancer remaining the most pervasive across all age groups, and, by far, the most deadly (Chen, 2016). All told, of the projected 2.8 million cancer deaths occurring in 2015 in China, 21% were directly a result of lung cancer.
Likewise, COPD also threatens China. The Global Burden of Disease study conducted in 2004 demonstrated that nearly 3 million people die of COPD each year. Chinese adults over the age of 40 had an overall prevalence of COPD of 9% for the last decade, though this may be higher given the high rate of underdiagnosis in rural China (Fang X, et al. Chest. 2011;139[4]:920). After 2004, the Chinese Ministry of Health affirmed that COPD was the fourth leading cause of mortality in urban areas, but third in rural ones (Fang, 2011). When investigators analyzed deaths secondary to cor pulmonale coexisting with COPD, they found COPD-related mortality increased to 179.9 for men and 141.3 for women per 100,000 persons, which is about double the COPD mortality for other countries in the Asian-Pacific region (Reilly K, et al. Am J Epidemiol. 2008;167[8]:998). 
Both cancer and COPD in China disproportionately affect those in rural areas and with lower socioeconomic status, with smoking being the most potent causative exposure. On average, the annual direct and indirect per-patient cost of treating COPD amounted to about $2,000, comprising about 40% of a family’s total annual income (Fang, 2011). The cost of treating malignancy is even more expensive, but the higher likelihood of death results in an additional 10% to 20% reduction of family income when a working family member dies (Pratt, 2016). Taken together, and especially since rural Chinese citizens spend close to 20% of their income on tobacco products, the pulmonary health consequences of smoking are a significant driver of both health and economic inequality.
The Air We Breathe
Air pollution comprises a second pulmonary insult to China’s health. The International Agency for Research on Cancer designated particulate matter (PM) as a class I carcinogen (Kurt O, et al. Curr Opin Pulm Med. 2016;22[2]:138). PM forms from combustion of bio-mass fuel, as well as from dust storms or construction. Once particulates are smaller than 2.5 microns (PM2.5), they cause substantial harm to the pulmonary microenvironment. Guo and colleagues demonstrated markedly increased lung cancer risks associated with spatial mapping of ozone and PM2.5 concentrations (Guo Y, et al. Environ Res. 2016;144;60). PM2.5 also doubles the odds of contracting COPD in nonsmoking adults, conferring as much as a three-fold risk of contracting the disease in nonsmoking women (Fang, 2011).
Apart from causing pulmonary disease, studies also implicate air pollution as frequently causing exacerbations of existing disease. One study found an incremental increase in ED visits for respiratory illnesses for every 10 µg/m3 above the median PM2.5 level (Xu, et al. PLoS One. 2016;11(4): e0153099). In 2013, 83% of Chinese lived in places where PM2.5 levels exceeded China’s own ambient air standard. In this cohort, elevated PM2.5 levels contributed directly to 300,000 premature deaths from lung cancer and COPD, with PM2.5 causing 1.2 million premature deaths overall (Liu J, et al. Sci Total Environ. 2016;568;1253).
Moving Forward
The Chinese have few illusions about these pulmonary concerns, and they are making progress. The government recently introduced stricter smoking controls in Beijing and Shanghai and continues to explore ways to decrease emissions. President Xi has put forward strong initiatives to improve the health of the Chinese. However, the nation is trying to balance its national priorities in the context of a fluid, and, at times, perilous geopolitical climate. In some ways, their position is not too dissimilar from the US geopolitical and health-care situation of the 1970s. While challenging, the issue of Chinese health care should not overshadow the remarkable resources or the truly remarkable culture of their people. Friendship, cooperation, the reduction of suffering: these are ideals where all clinicians find common ground, regardless of nationality.
Dr. Mackay is Chief Fellow of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey; Dr. Flenaugh is Associate Professor of Medicine, Division Chief of Pulmonary and Critical Care Medicine, Director of Advance Diagnostic and Interventional Pulmonary, Morehouse School of Medicine, Atlanta, Georgia.
Editor’s Note
This excellent, up-close Pulmonary Perspective details observations of Drs. Mackay and Flenaugh as they have participated in cross-cultural exchanges in 
The American College of Chest Physicians, likewise concerned about pulmonary health in China, has approached the problem on a different front, working closely with partners, such as the Chinese Thoracic Society, the Chinese Association of Chest Physicians, and the Chinese Medical Doctor Association, to implement China’s first ever fellowship program offering standardized training in PCCM for Chinese physicians. Read more at http://www.mdedge.com/chestphysician/article/131179/society-news/pccm-endorsed-pilot-subspecialty-chinese-national-health.
Nitin Puri, MD, FCCP, is the section editor of Pulmonary Perspectives.
Over the past 2 years, we had the opportunity to participate in an annual cross-cultural exchange that has broadened our horizons. Xi’an, the ancient capital of China and home of the Terracotta warriors, is a sprawling megapolis similar to Los Angeles. In the southern suburb of Huxian, US trained pulmonary, neurosurgical, and critical care physicians from Cooper University Hospital and Morehouse School of Medicine partnered with physicians of Ji-Ren Teaching Hospital to deliver a Chinese Medical Association accredited continuing medical education conference. The conference agenda included a variety of pulmonary and critical care topics highlighting sepsis, neurovascular disease, and lung cancer screening and diagnosis. We also provided a hands-on workshop for point of care ultrasound, and, in return, received education about Chinese medicine.
We found our hosts appreciative and hospitable, and they treated us with the highest level of respect (the cornerstone of Chinese culture). The audience was receptive and very interested in learning. However, while we were impressed with their rapid growth and interest in incorporating western medicine into their daily practice, it was impossible to overlook the major pulmonary health-care concerns threatening their communities. Tobacco use was omnipresent, and the haze of air pollution made the sky a constant shade of grey. In both public and private spaces, powerful echoes of a once familiar America resonated, and they served to underscore the obstacles the Chinese medical community now faces in caring for their country’s pulmonary health.
An Old, Familiar Foe
The China National Tobacco Corporation (CNTC) is the largest tobacco company in the world, as well as China’s most profitable state-owned enterprise (Pratt, A, et al. WHO Report. 2017. ISBN 9789290617907 [http://www.wpro.who.int/china/publications/2017_china_tobacco_control_report_en_web_final.pdf?ua=1]). As such, the CNTC controls every aspect of its production and supply chain with the force of the federal government and also exerts heavy influence over regulatory policy. It controls about 98% of domestic crop production and manages to price cigarettes just short of one American dollar per pack, yet contributes about $170 billion annually to the government (Rich, et al. Nicotine Tob Res. 2012;14[3]:258). This accounted for nearly 7% of total governmental revenue in 2015 (Pratt, 2017).
To date, nearly 44% of the world’s cigarettes are manufactured and consumed in China (Pratt 2017, Rich 2012). In 2015, more than 315 million Chinese adults were daily smokers, or about 28% of the adult population and nearly half of all men (Pratt, 2017). This is about double the proportion of US smokers (about 15.1%) and more than eight times the 36.5 million daily smokers in the United States (CDC Online Tobacco Use Report, 2016 [https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/]). However, to visit China is not only to know a love for tobacco, but also an overwhelming guest and gift culture. Gift giving and hospitality is central to the Chinese identity, from business meetings to afternoon tea. Given their economy and such rich supply, people gift cigarettes to one another at all times for nearly any occasion. Unfortunately, tobacco smoke in China is as inescapable as its health consequences.
The direct effects of smoking on China’s pulmonary health have been catastrophic. Cancers of the lung and bronchus constitute their most common malignancy across both sexes, accounting for the majority of the annual 4.3 million new cancer diagnoses (Chen et al. CA Cancer J Clin. 2016;66[2]:115). In Chinese men, lung cancer is the second most common cancer before the age of 60, and over the age of 75, it is the most common malignancy and also accounts for the majority of that group’s cancer mortality. Women fare only slightly better, with breast cancer being their most common malignancy, but with lung cancer remaining the most pervasive across all age groups, and, by far, the most deadly (Chen, 2016). All told, of the projected 2.8 million cancer deaths occurring in 2015 in China, 21% were directly a result of lung cancer.
Likewise, COPD also threatens China. The Global Burden of Disease study conducted in 2004 demonstrated that nearly 3 million people die of COPD each year. Chinese adults over the age of 40 had an overall prevalence of COPD of 9% for the last decade, though this may be higher given the high rate of underdiagnosis in rural China (Fang X, et al. Chest. 2011;139[4]:920). After 2004, the Chinese Ministry of Health affirmed that COPD was the fourth leading cause of mortality in urban areas, but third in rural ones (Fang, 2011). When investigators analyzed deaths secondary to cor pulmonale coexisting with COPD, they found COPD-related mortality increased to 179.9 for men and 141.3 for women per 100,000 persons, which is about double the COPD mortality for other countries in the Asian-Pacific region (Reilly K, et al. Am J Epidemiol. 2008;167[8]:998).
Both cancer and COPD in China disproportionately affect those in rural areas and with lower socioeconomic status, with smoking being the most potent causative exposure. On average, the annual direct and indirect per-patient cost of treating COPD amounted to about $2,000, comprising about 40% of a family’s total annual income (Fang, 2011). The cost of treating malignancy is even more expensive, but the higher likelihood of death results in an additional 10% to 20% reduction of family income when a working family member dies (Pratt, 2016). Taken together, and especially since rural Chinese citizens spend close to 20% of their income on tobacco products, the pulmonary health consequences of smoking are a significant driver of both health and economic inequality.
The Air We Breathe
Air pollution comprises a second pulmonary insult to China’s health. The International Agency for Research on Cancer designated particulate matter (PM) as a class I carcinogen (Kurt O, et al. Curr Opin Pulm Med. 2016;22[2]:138). PM forms from combustion of bio-mass fuel, as well as from dust storms or construction. Once particulates are smaller than 2.5 microns (PM2.5), they cause substantial harm to the pulmonary microenvironment. Guo and colleagues demonstrated markedly increased lung cancer risks associated with spatial mapping of ozone and PM2.5 concentrations (Guo Y, et al. Environ Res. 2016;144;60). PM2.5 also doubles the odds of contracting COPD in nonsmoking adults, conferring as much as a three-fold risk of contracting the disease in nonsmoking women (Fang, 2011).
Apart from causing pulmonary disease, studies also implicate air pollution as frequently causing exacerbations of existing disease. One study found an incremental increase in ED visits for respiratory illnesses for every 10 µg/m3 above the median PM2.5 level (Xu, et al. PLoS One. 2016;11(4): e0153099). In 2013, 83% of Chinese lived in places where PM2.5 levels exceeded China’s own ambient air standard. In this cohort, elevated PM2.5 levels contributed directly to 300,000 premature deaths from lung cancer and COPD, with PM2.5 causing 1.2 million premature deaths overall (Liu J, et al. Sci Total Environ. 2016;568;1253).
Moving Forward
The Chinese have few illusions about these pulmonary concerns, and they are making progress. The government recently introduced stricter smoking controls in Beijing and Shanghai and continues to explore ways to decrease emissions. President Xi has put forward strong initiatives to improve the health of the Chinese. However, the nation is trying to balance its national priorities in the context of a fluid, and, at times, perilous geopolitical climate. In some ways, their position is not too dissimilar from the US geopolitical and health-care situation of the 1970s. While challenging, the issue of Chinese health care should not overshadow the remarkable resources or the truly remarkable culture of their people. Friendship, cooperation, the reduction of suffering: these are ideals where all clinicians find common ground, regardless of nationality.
Dr. Mackay is Chief Fellow of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey; Dr. Flenaugh is Associate Professor of Medicine, Division Chief of Pulmonary and Critical Care Medicine, Director of Advance Diagnostic and Interventional Pulmonary, Morehouse School of Medicine, Atlanta, Georgia.
Editor’s Note
This excellent, up-close Pulmonary Perspective details observations of Drs. Mackay and Flenaugh as they have participated in cross-cultural exchanges in
The American College of Chest Physicians, likewise concerned about pulmonary health in China, has approached the problem on a different front, working closely with partners, such as the Chinese Thoracic Society, the Chinese Association of Chest Physicians, and the Chinese Medical Doctor Association, to implement China’s first ever fellowship program offering standardized training in PCCM for Chinese physicians. Read more at http://www.mdedge.com/chestphysician/article/131179/society-news/pccm-endorsed-pilot-subspecialty-chinese-national-health.
Nitin Puri, MD, FCCP, is the section editor of Pulmonary Perspectives.
Over the past 2 years, we had the opportunity to participate in an annual cross-cultural exchange that has broadened our horizons. Xi’an, the ancient capital of China and home of the Terracotta warriors, is a sprawling megapolis similar to Los Angeles. In the southern suburb of Huxian, US trained pulmonary, neurosurgical, and critical care physicians from Cooper University Hospital and Morehouse School of Medicine partnered with physicians of Ji-Ren Teaching Hospital to deliver a Chinese Medical Association accredited continuing medical education conference. The conference agenda included a variety of pulmonary and critical care topics highlighting sepsis, neurovascular disease, and lung cancer screening and diagnosis. We also provided a hands-on workshop for point of care ultrasound, and, in return, received education about Chinese medicine.
We found our hosts appreciative and hospitable, and they treated us with the highest level of respect (the cornerstone of Chinese culture). The audience was receptive and very interested in learning. However, while we were impressed with their rapid growth and interest in incorporating western medicine into their daily practice, it was impossible to overlook the major pulmonary health-care concerns threatening their communities. Tobacco use was omnipresent, and the haze of air pollution made the sky a constant shade of grey. In both public and private spaces, powerful echoes of a once familiar America resonated, and they served to underscore the obstacles the Chinese medical community now faces in caring for their country’s pulmonary health.
An Old, Familiar Foe
The China National Tobacco Corporation (CNTC) is the largest tobacco company in the world, as well as China’s most profitable state-owned enterprise (Pratt, A, et al. WHO Report. 2017. ISBN 9789290617907 [http://www.wpro.who.int/china/publications/2017_china_tobacco_control_report_en_web_final.pdf?ua=1]). As such, the CNTC controls every aspect of its production and supply chain with the force of the federal government and also exerts heavy influence over regulatory policy. It controls about 98% of domestic crop production and manages to price cigarettes just short of one American dollar per pack, yet contributes about $170 billion annually to the government (Rich, et al. Nicotine Tob Res. 2012;14[3]:258). This accounted for nearly 7% of total governmental revenue in 2015 (Pratt, 2017).
To date, nearly 44% of the world’s cigarettes are manufactured and consumed in China (Pratt 2017, Rich 2012). In 2015, more than 315 million Chinese adults were daily smokers, or about 28% of the adult population and nearly half of all men (Pratt, 2017). This is about double the proportion of US smokers (about 15.1%) and more than eight times the 36.5 million daily smokers in the United States (CDC Online Tobacco Use Report, 2016 [https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/]). However, to visit China is not only to know a love for tobacco, but also an overwhelming guest and gift culture. Gift giving and hospitality is central to the Chinese identity, from business meetings to afternoon tea. Given their economy and such rich supply, people gift cigarettes to one another at all times for nearly any occasion. Unfortunately, tobacco smoke in China is as inescapable as its health consequences.
The direct effects of smoking on China’s pulmonary health have been catastrophic. Cancers of the lung and bronchus constitute their most common malignancy across both sexes, accounting for the majority of the annual 4.3 million new cancer diagnoses (Chen et al. CA Cancer J Clin. 2016;66[2]:115). In Chinese men, lung cancer is the second most common cancer before the age of 60, and over the age of 75, it is the most common malignancy and also accounts for the majority of that group’s cancer mortality. Women fare only slightly better, with breast cancer being their most common malignancy, but with lung cancer remaining the most pervasive across all age groups, and, by far, the most deadly (Chen, 2016). All told, of the projected 2.8 million cancer deaths occurring in 2015 in China, 21% were directly a result of lung cancer.
Likewise, COPD also threatens China. The Global Burden of Disease study conducted in 2004 demonstrated that nearly 3 million people die of COPD each year. Chinese adults over the age of 40 had an overall prevalence of COPD of 9% for the last decade, though this may be higher given the high rate of underdiagnosis in rural China (Fang X, et al. Chest. 2011;139[4]:920). After 2004, the Chinese Ministry of Health affirmed that COPD was the fourth leading cause of mortality in urban areas, but third in rural ones (Fang, 2011). When investigators analyzed deaths secondary to cor pulmonale coexisting with COPD, they found COPD-related mortality increased to 179.9 for men and 141.3 for women per 100,000 persons, which is about double the COPD mortality for other countries in the Asian-Pacific region (Reilly K, et al. Am J Epidemiol. 2008;167[8]:998).
Both cancer and COPD in China disproportionately affect those in rural areas and with lower socioeconomic status, with smoking being the most potent causative exposure. On average, the annual direct and indirect per-patient cost of treating COPD amounted to about $2,000, comprising about 40% of a family’s total annual income (Fang, 2011). The cost of treating malignancy is even more expensive, but the higher likelihood of death results in an additional 10% to 20% reduction of family income when a working family member dies (Pratt, 2016). Taken together, and especially since rural Chinese citizens spend close to 20% of their income on tobacco products, the pulmonary health consequences of smoking are a significant driver of both health and economic inequality.
The Air We Breathe
Air pollution comprises a second pulmonary insult to China’s health. The International Agency for Research on Cancer designated particulate matter (PM) as a class I carcinogen (Kurt O, et al. Curr Opin Pulm Med. 2016;22[2]:138). PM forms from combustion of bio-mass fuel, as well as from dust storms or construction. Once particulates are smaller than 2.5 microns (PM2.5), they cause substantial harm to the pulmonary microenvironment. Guo and colleagues demonstrated markedly increased lung cancer risks associated with spatial mapping of ozone and PM2.5 concentrations (Guo Y, et al. Environ Res. 2016;144;60). PM2.5 also doubles the odds of contracting COPD in nonsmoking adults, conferring as much as a three-fold risk of contracting the disease in nonsmoking women (Fang, 2011).
Apart from causing pulmonary disease, studies also implicate air pollution as frequently causing exacerbations of existing disease. One study found an incremental increase in ED visits for respiratory illnesses for every 10 µg/m3 above the median PM2.5 level (Xu, et al. PLoS One. 2016;11(4): e0153099). In 2013, 83% of Chinese lived in places where PM2.5 levels exceeded China’s own ambient air standard. In this cohort, elevated PM2.5 levels contributed directly to 300,000 premature deaths from lung cancer and COPD, with PM2.5 causing 1.2 million premature deaths overall (Liu J, et al. Sci Total Environ. 2016;568;1253).
Moving Forward
The Chinese have few illusions about these pulmonary concerns, and they are making progress. The government recently introduced stricter smoking controls in Beijing and Shanghai and continues to explore ways to decrease emissions. President Xi has put forward strong initiatives to improve the health of the Chinese. However, the nation is trying to balance its national priorities in the context of a fluid, and, at times, perilous geopolitical climate. In some ways, their position is not too dissimilar from the US geopolitical and health-care situation of the 1970s. While challenging, the issue of Chinese health care should not overshadow the remarkable resources or the truly remarkable culture of their people. Friendship, cooperation, the reduction of suffering: these are ideals where all clinicians find common ground, regardless of nationality.
Dr. Mackay is Chief Fellow of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey; Dr. Flenaugh is Associate Professor of Medicine, Division Chief of Pulmonary and Critical Care Medicine, Director of Advance Diagnostic and Interventional Pulmonary, Morehouse School of Medicine, Atlanta, Georgia.
Editor’s Note
This excellent, up-close Pulmonary Perspective details observations of Drs. Mackay and Flenaugh as they have participated in cross-cultural exchanges in
The American College of Chest Physicians, likewise concerned about pulmonary health in China, has approached the problem on a different front, working closely with partners, such as the Chinese Thoracic Society, the Chinese Association of Chest Physicians, and the Chinese Medical Doctor Association, to implement China’s first ever fellowship program offering standardized training in PCCM for Chinese physicians. Read more at http://www.mdedge.com/chestphysician/article/131179/society-news/pccm-endorsed-pilot-subspecialty-chinese-national-health.
Nitin Puri, MD, FCCP, is the section editor of Pulmonary Perspectives.
CHEST NetWorks Submassive PE, antibiotic resistance, advanced practice providers
Cardiovascular Medicine and Surgery
Catch 22 of Submassive Pulmonary Emboli
Venous thromboembolism (including deep vein thrombosis (DVT) and pulmonary embolism [PE]) occurs in approximately 1 per 1,000 patients (Piran S, Schulman S. Thromb J. 2016;14[S1]:23) and can be fatal. Pulmonary embolus severity is classified as low risk, intermediate-risk/submassive PE, and massive PE. There is significant controversy about the management of submassive PE, which is defined as PE with right-sided heart strain (elevated troponin or B-type natriuretic peptide, right-axis deviation on ECG, or e
David J. Nagel, MD
Steering Committee Member
Olivier Axler, MD, FCCP
Vice-Chair
Chest Infections
Antibiotic Resistance
One-hundred years ago, infectious diseases caused 5 of the 10 most common causes of deaths in the United States. In 2016, only one infection remained on this list (influenza/pneumonia) (MMWR Morb Mortal Wkly Rep. 2017;66:413).
How medicine has improved with antibiotics. An unfortunate and unintended consequence of widespread antibiotic use has been the progressive resistance to these drugs. It is estimated that, if current trends continue, 10 million lives a year will be at risk from resistant organisms by 2050 (O’Neill, J. (2016). https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf).
Pathogens acquire antibiotic resistance by passing genetic material to one another through plasmids, bacteriophages, or naked DNA. Once acquired, resistance manifests via a number of mechanisms under the stress imposed by antibiotics (Levy SB, et al. Nat Med. 2004;10:S122). 
Among the best studied is enzymatic degradation of the antibiotic. This occurs when beta-lactamases degrade penicillin. A second mechanism alters cell transport, thereby blocking cell entry or actively ejecting the antibiotic from the cell. Finally, overexpression or alteration of the antibiotic target may render a drug ineffective at inhibiting any vital cell function.
At the pace with which resistance now develops, the medical community faces a crisis, whereby infections caused by evolving superbugs are no longer effectively controlled by the available menu of antimicrobial agents.
This challenge must be met collectively by the more prudent prescribing of antibiotics, potentially with the help of rapid diagnostics; isolation of patients potentially infected with resistant organisms; and a focus on developing newer drugs that defy known resistant mechanisms.
Marc Feinstein, MD, FCCP
Steering Committee Member
Clinical Pulmonary Medicine
COPD and sleep-disordered breathing; A missing comorbid condition
Subjective, as well as objective, sleep complaints are common in patients with COPD (Krachman S, et al. Proc Am Thorac Soc. 2008;5[4]:536), and sleeping difficulties are ranked the third most frequent complaint (behind dyspnea and fatigue) in patients with COPD (Kinsman RA, et al. Chest. 1983;83[5]:755). Also, sleep quality is poor, and patients with moderate to severe COPD may have higher-than-expected incidence of OSA (Soler X, et al. Ann Am Thorac Soc. 2015;12[8]:1219).
Unfortunately, sleep is usually not assessed during a COPD evaluation. Up to 27% of patients with COPD without hypoxia during wakefulness can experience important desaturation during sleep, so called nocturnal oxygen desaturation (NOD) (Fletcher EC, et al. Chest. 1987;92[4]:604), that may lead to pulmonary hypertension (Chaouat A, et a
Although identification and effective treatment of COPD comorbidities are becoming the cornerstone of COPD management, sleep-disordered breathing has not been identified in current guidelines yet as a true potential contributor in poor outcomes despite emergent clinical evidence. Multidisciplinary programs, such as pulmonary rehabilitation, that improve dyspnea, exercise capacity, and quality of life may also positively impact sleep (Soler X, et al. COPD. 2013;10[2]:156). Because of the background of the staff involved, the comprehensive approach to patient assessment, and access to number of COPD subjects, pulmonary rehabilitation may be an optimal opportunity to assess sleep and identify an important comorbid condition often overlooked in patients with more advanced COPD.
Xavier Soler, MD, PhD
Steering Committee Member
Interprofessional Team
Finding Home
Outside our internal medicine curriculum, there is no formal pulmonary training or post-masters fellowship in pulmonary medicine for Advanced Practice Providers (APPs). Because of this, APPs are left to their own devices to fill educational gaps. To perform at the level expected by the physicians I work for, journal reviews and memorizing guidelines were not going to be enough. Since there is no formal pulmonary APP society, there were no peers to reach out to either. Off to conferences I went. 
At first, I found CHEST daunting. After all, it’s run by the American College of Chest “Physicians,” not Nurse Practitioners. I spent most of the first day with my nametag turned around worried I’d be found out as a nonphysician attendee who snuck in. And then the unthinkable happened, I ran into another unicorn—another APP seeking the same information, only her nametag was turned the right way. The best advice she gave was to attend the Interprofessional NetWork meeting. This was ground zero of the conference as far as I was concerned. There I found myself surrounded by RTs, RNs, NPs, PAs, and yes, even physicians.
Over the years, as I’ve gotten further involved with CHEST NetWorks, I have found from top to bottom CHEST striving to incorporate APPs and advance our education. From including us in the FCCP program, reducing conference pricing for APPs, and focusing this year’s conference theme around being team focused, CHEST is creating a home for APPs.
Corinne Preston Young, FNP, FCCP
Steering Committee Member
Cardiovascular Medicine and Surgery
Catch 22 of Submassive Pulmonary Emboli
Venous thromboembolism (including deep vein thrombosis (DVT) and pulmonary embolism [PE]) occurs in approximately 1 per 1,000 patients (Piran S, Schulman S. Thromb J. 2016;14[S1]:23) and can be fatal. Pulmonary embolus severity is classified as low risk, intermediate-risk/submassive PE, and massive PE. There is significant controversy about the management of submassive PE, which is defined as PE with right-sided heart strain (elevated troponin or B-type natriuretic peptide, right-axis deviation on ECG, or e
David J. Nagel, MD
Steering Committee Member
Olivier Axler, MD, FCCP
Vice-Chair
Chest Infections
Antibiotic Resistance
One-hundred years ago, infectious diseases caused 5 of the 10 most common causes of deaths in the United States. In 2016, only one infection remained on this list (influenza/pneumonia) (MMWR Morb Mortal Wkly Rep. 2017;66:413).
How medicine has improved with antibiotics. An unfortunate and unintended consequence of widespread antibiotic use has been the progressive resistance to these drugs. It is estimated that, if current trends continue, 10 million lives a year will be at risk from resistant organisms by 2050 (O’Neill, J. (2016). https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf).
Pathogens acquire antibiotic resistance by passing genetic material to one another through plasmids, bacteriophages, or naked DNA. Once acquired, resistance manifests via a number of mechanisms under the stress imposed by antibiotics (Levy SB, et al. Nat Med. 2004;10:S122).
Among the best studied is enzymatic degradation of the antibiotic. This occurs when beta-lactamases degrade penicillin. A second mechanism alters cell transport, thereby blocking cell entry or actively ejecting the antibiotic from the cell. Finally, overexpression or alteration of the antibiotic target may render a drug ineffective at inhibiting any vital cell function.
At the pace with which resistance now develops, the medical community faces a crisis, whereby infections caused by evolving superbugs are no longer effectively controlled by the available menu of antimicrobial agents.
This challenge must be met collectively by the more prudent prescribing of antibiotics, potentially with the help of rapid diagnostics; isolation of patients potentially infected with resistant organisms; and a focus on developing newer drugs that defy known resistant mechanisms.
Marc Feinstein, MD, FCCP
Steering Committee Member
Clinical Pulmonary Medicine
COPD and sleep-disordered breathing; A missing comorbid condition
Subjective, as well as objective, sleep complaints are common in patients with COPD (Krachman S, et al. Proc Am Thorac Soc. 2008;5[4]:536), and sleeping difficulties are ranked the third most frequent complaint (behind dyspnea and fatigue) in patients with COPD (Kinsman RA, et al. Chest. 1983;83[5]:755). Also, sleep quality is poor, and patients with moderate to severe COPD may have higher-than-expected incidence of OSA (Soler X, et al. Ann Am Thorac Soc. 2015;12[8]:1219).
Unfortunately, sleep is usually not assessed during a COPD evaluation. Up to 27% of patients with COPD without hypoxia during wakefulness can experience important desaturation during sleep, so called nocturnal oxygen desaturation (NOD) (Fletcher EC, et al. Chest. 1987;92[4]:604), that may lead to pulmonary hypertension (Chaouat A, et a
Although identification and effective treatment of COPD comorbidities are becoming the cornerstone of COPD management, sleep-disordered breathing has not been identified in current guidelines yet as a true potential contributor in poor outcomes despite emergent clinical evidence. Multidisciplinary programs, such as pulmonary rehabilitation, that improve dyspnea, exercise capacity, and quality of life may also positively impact sleep (Soler X, et al. COPD. 2013;10[2]:156). Because of the background of the staff involved, the comprehensive approach to patient assessment, and access to number of COPD subjects, pulmonary rehabilitation may be an optimal opportunity to assess sleep and identify an important comorbid condition often overlooked in patients with more advanced COPD.
Xavier Soler, MD, PhD
Steering Committee Member
Interprofessional Team
Finding Home
Outside our internal medicine curriculum, there is no formal pulmonary training or post-masters fellowship in pulmonary medicine for Advanced Practice Providers (APPs). Because of this, APPs are left to their own devices to fill educational gaps. To perform at the level expected by the physicians I work for, journal reviews and memorizing guidelines were not going to be enough. Since there is no formal pulmonary APP society, there were no peers to reach out to either. Off to conferences I went.
At first, I found CHEST daunting. After all, it’s run by the American College of Chest “Physicians,” not Nurse Practitioners. I spent most of the first day with my nametag turned around worried I’d be found out as a nonphysician attendee who snuck in. And then the unthinkable happened, I ran into another unicorn—another APP seeking the same information, only her nametag was turned the right way. The best advice she gave was to attend the Interprofessional NetWork meeting. This was ground zero of the conference as far as I was concerned. There I found myself surrounded by RTs, RNs, NPs, PAs, and yes, even physicians.
Over the years, as I’ve gotten further involved with CHEST NetWorks, I have found from top to bottom CHEST striving to incorporate APPs and advance our education. From including us in the FCCP program, reducing conference pricing for APPs, and focusing this year’s conference theme around being team focused, CHEST is creating a home for APPs.
Corinne Preston Young, FNP, FCCP
Steering Committee Member
Cardiovascular Medicine and Surgery
Catch 22 of Submassive Pulmonary Emboli
Venous thromboembolism (including deep vein thrombosis (DVT) and pulmonary embolism [PE]) occurs in approximately 1 per 1,000 patients (Piran S, Schulman S. Thromb J. 2016;14[S1]:23) and can be fatal. Pulmonary embolus severity is classified as low risk, intermediate-risk/submassive PE, and massive PE. There is significant controversy about the management of submassive PE, which is defined as PE with right-sided heart strain (elevated troponin or B-type natriuretic peptide, right-axis deviation on ECG, or e
David J. Nagel, MD
Steering Committee Member
Olivier Axler, MD, FCCP
Vice-Chair
Chest Infections
Antibiotic Resistance
One-hundred years ago, infectious diseases caused 5 of the 10 most common causes of deaths in the United States. In 2016, only one infection remained on this list (influenza/pneumonia) (MMWR Morb Mortal Wkly Rep. 2017;66:413).
How medicine has improved with antibiotics. An unfortunate and unintended consequence of widespread antibiotic use has been the progressive resistance to these drugs. It is estimated that, if current trends continue, 10 million lives a year will be at risk from resistant organisms by 2050 (O’Neill, J. (2016). https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf).
Pathogens acquire antibiotic resistance by passing genetic material to one another through plasmids, bacteriophages, or naked DNA. Once acquired, resistance manifests via a number of mechanisms under the stress imposed by antibiotics (Levy SB, et al. Nat Med. 2004;10:S122).
Among the best studied is enzymatic degradation of the antibiotic. This occurs when beta-lactamases degrade penicillin. A second mechanism alters cell transport, thereby blocking cell entry or actively ejecting the antibiotic from the cell. Finally, overexpression or alteration of the antibiotic target may render a drug ineffective at inhibiting any vital cell function.
At the pace with which resistance now develops, the medical community faces a crisis, whereby infections caused by evolving superbugs are no longer effectively controlled by the available menu of antimicrobial agents.
This challenge must be met collectively by the more prudent prescribing of antibiotics, potentially with the help of rapid diagnostics; isolation of patients potentially infected with resistant organisms; and a focus on developing newer drugs that defy known resistant mechanisms.
Marc Feinstein, MD, FCCP
Steering Committee Member
Clinical Pulmonary Medicine
COPD and sleep-disordered breathing; A missing comorbid condition
Subjective, as well as objective, sleep complaints are common in patients with COPD (Krachman S, et al. Proc Am Thorac Soc. 2008;5[4]:536), and sleeping difficulties are ranked the third most frequent complaint (behind dyspnea and fatigue) in patients with COPD (Kinsman RA, et al. Chest. 1983;83[5]:755). Also, sleep quality is poor, and patients with moderate to severe COPD may have higher-than-expected incidence of OSA (Soler X, et al. Ann Am Thorac Soc. 2015;12[8]:1219).
Unfortunately, sleep is usually not assessed during a COPD evaluation. Up to 27% of patients with COPD without hypoxia during wakefulness can experience important desaturation during sleep, so called nocturnal oxygen desaturation (NOD) (Fletcher EC, et al. Chest. 1987;92[4]:604), that may lead to pulmonary hypertension (Chaouat A, et a
Although identification and effective treatment of COPD comorbidities are becoming the cornerstone of COPD management, sleep-disordered breathing has not been identified in current guidelines yet as a true potential contributor in poor outcomes despite emergent clinical evidence. Multidisciplinary programs, such as pulmonary rehabilitation, that improve dyspnea, exercise capacity, and quality of life may also positively impact sleep (Soler X, et al. COPD. 2013;10[2]:156). Because of the background of the staff involved, the comprehensive approach to patient assessment, and access to number of COPD subjects, pulmonary rehabilitation may be an optimal opportunity to assess sleep and identify an important comorbid condition often overlooked in patients with more advanced COPD.
Xavier Soler, MD, PhD
Steering Committee Member
Interprofessional Team
Finding Home
Outside our internal medicine curriculum, there is no formal pulmonary training or post-masters fellowship in pulmonary medicine for Advanced Practice Providers (APPs). Because of this, APPs are left to their own devices to fill educational gaps. To perform at the level expected by the physicians I work for, journal reviews and memorizing guidelines were not going to be enough. Since there is no formal pulmonary APP society, there were no peers to reach out to either. Off to conferences I went.
At first, I found CHEST daunting. After all, it’s run by the American College of Chest “Physicians,” not Nurse Practitioners. I spent most of the first day with my nametag turned around worried I’d be found out as a nonphysician attendee who snuck in. And then the unthinkable happened, I ran into another unicorn—another APP seeking the same information, only her nametag was turned the right way. The best advice she gave was to attend the Interprofessional NetWork meeting. This was ground zero of the conference as far as I was concerned. There I found myself surrounded by RTs, RNs, NPs, PAs, and yes, even physicians.
Over the years, as I’ve gotten further involved with CHEST NetWorks, I have found from top to bottom CHEST striving to incorporate APPs and advance our education. From including us in the FCCP program, reducing conference pricing for APPs, and focusing this year’s conference theme around being team focused, CHEST is creating a home for APPs.
Corinne Preston Young, FNP, FCCP
Steering Committee Member
Building bridges: CHEST Foundation collaborations
Partnering with like-minded advocates and organizations strengthens our collective voice to improve patient outcomes. We choose to partner with others who share our values in creating sustainable, long-lasting change by engaging clinicians, patients, caregivers, and the public on the importance of understanding lung health.
Pulmonary Fibrosis Foundation
Allergy & Asthma Network
Over the past 2 years, our relationship with the Allergy & Asthma Network (AAN) has grown to include collaborative disease awareness campaigns, co-branded and co-created patient education materials in asthma and COPD, and an exciting expansion of the platforms we utilize to reach patients. Partnering with the AAN has allowed us to reach new audiences and bring asthma and COPD education to local communities with opportunities, including:
- A Lifetime television segment on Access Health that focuses on asthma education;
- Co-hosted asthma Twitter chats reaching thousands of clinicians and patients; and
- “The Air We Breathe,” an Atlantic Live Summit in Chicago which focused on the relationship between air quality and respiratory health.
COPD Foundation
The COPD Foundation, along with Allergy & Asthma Network, have partnered with us to support our Lung Health Experience, a lung health expo touring Oklahoma City, Nashville, Chicago, and Toronto in 2017. The Lung Health Experience focuses on bringing lung health experts to the public in a comfortable, relaxed, and fun setting. The COPD Foundation and AAN have attended these events to provide the public with educational materials on lung diseases, which support the spirometry screenings performed by local respiratory therapists. We thank the Allergy & Asthma Network and the COPD Foundation for their outstanding support.
It is with these and many other partnerships that the CHEST Foundation is able to elevate its mission to champion lung health and provide local communities with an opportunity to interact with clinicians and physicians outside of a hospital setting. These experiences and collaborations are the key to strengthening the patient and clinician conversation and bridging the gap to improve patient care and outcomes.
Partnering with like-minded advocates and organizations strengthens our collective voice to improve patient outcomes. We choose to partner with others who share our values in creating sustainable, long-lasting change by engaging clinicians, patients, caregivers, and the public on the importance of understanding lung health.
Pulmonary Fibrosis Foundation
Allergy & Asthma Network
Over the past 2 years, our relationship with the Allergy & Asthma Network (AAN) has grown to include collaborative disease awareness campaigns, co-branded and co-created patient education materials in asthma and COPD, and an exciting expansion of the platforms we utilize to reach patients. Partnering with the AAN has allowed us to reach new audiences and bring asthma and COPD education to local communities with opportunities, including:
- A Lifetime television segment on Access Health that focuses on asthma education;
- Co-hosted asthma Twitter chats reaching thousands of clinicians and patients; and
- “The Air We Breathe,” an Atlantic Live Summit in Chicago which focused on the relationship between air quality and respiratory health.
COPD Foundation
The COPD Foundation, along with Allergy & Asthma Network, have partnered with us to support our Lung Health Experience, a lung health expo touring Oklahoma City, Nashville, Chicago, and Toronto in 2017. The Lung Health Experience focuses on bringing lung health experts to the public in a comfortable, relaxed, and fun setting. The COPD Foundation and AAN have attended these events to provide the public with educational materials on lung diseases, which support the spirometry screenings performed by local respiratory therapists. We thank the Allergy & Asthma Network and the COPD Foundation for their outstanding support.
It is with these and many other partnerships that the CHEST Foundation is able to elevate its mission to champion lung health and provide local communities with an opportunity to interact with clinicians and physicians outside of a hospital setting. These experiences and collaborations are the key to strengthening the patient and clinician conversation and bridging the gap to improve patient care and outcomes.
Partnering with like-minded advocates and organizations strengthens our collective voice to improve patient outcomes. We choose to partner with others who share our values in creating sustainable, long-lasting change by engaging clinicians, patients, caregivers, and the public on the importance of understanding lung health.
Pulmonary Fibrosis Foundation
Allergy & Asthma Network
Over the past 2 years, our relationship with the Allergy & Asthma Network (AAN) has grown to include collaborative disease awareness campaigns, co-branded and co-created patient education materials in asthma and COPD, and an exciting expansion of the platforms we utilize to reach patients. Partnering with the AAN has allowed us to reach new audiences and bring asthma and COPD education to local communities with opportunities, including:
- A Lifetime television segment on Access Health that focuses on asthma education;
- Co-hosted asthma Twitter chats reaching thousands of clinicians and patients; and
- “The Air We Breathe,” an Atlantic Live Summit in Chicago which focused on the relationship between air quality and respiratory health.
COPD Foundation
The COPD Foundation, along with Allergy & Asthma Network, have partnered with us to support our Lung Health Experience, a lung health expo touring Oklahoma City, Nashville, Chicago, and Toronto in 2017. The Lung Health Experience focuses on bringing lung health experts to the public in a comfortable, relaxed, and fun setting. The COPD Foundation and AAN have attended these events to provide the public with educational materials on lung diseases, which support the spirometry screenings performed by local respiratory therapists. We thank the Allergy & Asthma Network and the COPD Foundation for their outstanding support.
It is with these and many other partnerships that the CHEST Foundation is able to elevate its mission to champion lung health and provide local communities with an opportunity to interact with clinicians and physicians outside of a hospital setting. These experiences and collaborations are the key to strengthening the patient and clinician conversation and bridging the gap to improve patient care and outcomes.
The Global Impact of Respiratory Disease – Second Edition
The Global Impact of Respiratory Disease – Second Edition was released by the Forum of International Respiratory Societies (FIRS) at the World Health Assembly May 25, 2017, in Geneva, Switzerland, calling attention to the global burden of lung disease and the benefits of prevention and clean air.
We often take our breathing and our respiratory health for granted, but respiratory diseases are a leading cause of death and disability in the world. Sixty-five million people suffer from COPD, and 3 million die of it each year, now making it the third leading cause of death worldwide.1,2 Asthma affects 334 million people in the world and is the most common chronic disease of childhood.3 Pneumonia kills millions of people annually and is a leading cause of death among children under 5 years old.4 Over 10 million people develop TB, and 1.4 million die of it each year, making it the most common deadly infectious disease.5 Lung cancer kills 1.6 million people each year and is the most deadly cancer.6 Globally, at least 2 billion people are exposed to indoor toxic smoke, 1 billion inhale outdoor pollutant air, and 1 billion are exposed to tobacco smoke. Many of us, and the world, are naïve to these staggering realities.
The American College of Chest Physicians® (CHEST), together with FIRS, is working hard to change these realities. CHEST, and our more than 19,000 members around the world, want a better future, one that has less suffering. We want a future that enables and allows everyone to breathe freely.
The 2017 Global Impact of Respiratory Disease report objectively speaks to these issues and outlines an eight-step action plan to impact these serious concerns. It highlights the importance of prevention, control, and cure of these diseases and announces that promotion of respiratory health must be a top priority for health-care systems and decision-makers. In emphasizing that these goals are achievable, it also highlights the reality that the prevention and cure of respiratory diseases are among the most cost-effective health interventions available – a “best-buy” in the view of the World Health Organization (WHO). In addition to reducing so much suffering, investment in respiratory health will pay manifold dividends in longevity, healthy living days, and national economies.
Darcy Marciniuk, MD, FCCP, FRCPC, and Co-Chair of the Report notes, “The Global Impact of Respiratory Disease” report calls attention to the importance of respiratory health in the world. The report and these efforts are required to ensure respiratory health becomes a top priority in global decision-making.”
In addition to focusing attention to the importance of respiratory health in the world and ensuring it becomes a global priority, the 2017 Global Impact of Respiratory Disease report also includes practical information for our members. The report summarizes the current state of our understanding with the “Big 5”: COPD, asthma, pneumonia, lung cancer, and TB, as well as with the environment and clean air, sleep-disordered breathing, pulmonary hypertension, and pulmonary embolism. It highlights key controllable factors, such as a reduction in tobacco smoking and improvement in air quality, which includes reduction in second-hand tobacco smoke, smoke from indoor fire, and unhealthy public and workplace air. The report underlines the value of trained health-care professionals and the need for health-care systems and policies to support those trained professionals. Finally, it emphasizes the reality that investment in respiratory research is more than the hope for today – it is the promise and a genuine commitment for tomorrow. CHEST’s involvement in this important project is only one component of our global engagement and impact. We support and help to educate lung specialists and health-care teams, no matter where they live and work. Our journal CHEST®, and other education offerings, are used every day and in every part of the world. The American College of Chest Physicians® focuses on the prevention, diagnosis, and treatment of chest diseases by providing innovative education and advancing best patient outcomes around the globe.
About the Forum of International Respiratory Societies (FIRS) Formed in 2001, the Forum of International Respiratory Societies (FIRS) is composed of the leading international respiratory societies, with more than 70,000 members who devote their working lives to respiratory health and disease. The goal of FIRS is to speak with one voice in promoting respiratory health worldwide and to call for action to reduce, prevent, cure, and control the terrible burden of respiratory disease.
References
1. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases, a comprehensive approach. 2007.
2. Burney PG, Patel J, Newson R, et al. Global and regional trends in COPD mortality, 1990-2010. Eur Respir J. 2015;45(5):1239-47.
3. International Study of Asthma and Allergies in Childhood (ISAAC). Global Asthma Report. 2014.
4. World Health Organization. Pneumonia: the forgotten killer of children. Geneva: World Health Organization; 2006.
5. World Health Organization. Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016.
6. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
The Global Impact of Respiratory Disease – Second Edition was released by the Forum of International Respiratory Societies (FIRS) at the World Health Assembly May 25, 2017, in Geneva, Switzerland, calling attention to the global burden of lung disease and the benefits of prevention and clean air.
We often take our breathing and our respiratory health for granted, but respiratory diseases are a leading cause of death and disability in the world. Sixty-five million people suffer from COPD, and 3 million die of it each year, now making it the third leading cause of death worldwide.1,2 Asthma affects 334 million people in the world and is the most common chronic disease of childhood.3 Pneumonia kills millions of people annually and is a leading cause of death among children under 5 years old.4 Over 10 million people develop TB, and 1.4 million die of it each year, making it the most common deadly infectious disease.5 Lung cancer kills 1.6 million people each year and is the most deadly cancer.6 Globally, at least 2 billion people are exposed to indoor toxic smoke, 1 billion inhale outdoor pollutant air, and 1 billion are exposed to tobacco smoke. Many of us, and the world, are naïve to these staggering realities.
The American College of Chest Physicians® (CHEST), together with FIRS, is working hard to change these realities. CHEST, and our more than 19,000 members around the world, want a better future, one that has less suffering. We want a future that enables and allows everyone to breathe freely.
The 2017 Global Impact of Respiratory Disease report objectively speaks to these issues and outlines an eight-step action plan to impact these serious concerns. It highlights the importance of prevention, control, and cure of these diseases and announces that promotion of respiratory health must be a top priority for health-care systems and decision-makers. In emphasizing that these goals are achievable, it also highlights the reality that the prevention and cure of respiratory diseases are among the most cost-effective health interventions available – a “best-buy” in the view of the World Health Organization (WHO). In addition to reducing so much suffering, investment in respiratory health will pay manifold dividends in longevity, healthy living days, and national economies.
Darcy Marciniuk, MD, FCCP, FRCPC, and Co-Chair of the Report notes, “The Global Impact of Respiratory Disease” report calls attention to the importance of respiratory health in the world. The report and these efforts are required to ensure respiratory health becomes a top priority in global decision-making.”
In addition to focusing attention to the importance of respiratory health in the world and ensuring it becomes a global priority, the 2017 Global Impact of Respiratory Disease report also includes practical information for our members. The report summarizes the current state of our understanding with the “Big 5”: COPD, asthma, pneumonia, lung cancer, and TB, as well as with the environment and clean air, sleep-disordered breathing, pulmonary hypertension, and pulmonary embolism. It highlights key controllable factors, such as a reduction in tobacco smoking and improvement in air quality, which includes reduction in second-hand tobacco smoke, smoke from indoor fire, and unhealthy public and workplace air. The report underlines the value of trained health-care professionals and the need for health-care systems and policies to support those trained professionals. Finally, it emphasizes the reality that investment in respiratory research is more than the hope for today – it is the promise and a genuine commitment for tomorrow. CHEST’s involvement in this important project is only one component of our global engagement and impact. We support and help to educate lung specialists and health-care teams, no matter where they live and work. Our journal CHEST®, and other education offerings, are used every day and in every part of the world. The American College of Chest Physicians® focuses on the prevention, diagnosis, and treatment of chest diseases by providing innovative education and advancing best patient outcomes around the globe.
About the Forum of International Respiratory Societies (FIRS) Formed in 2001, the Forum of International Respiratory Societies (FIRS) is composed of the leading international respiratory societies, with more than 70,000 members who devote their working lives to respiratory health and disease. The goal of FIRS is to speak with one voice in promoting respiratory health worldwide and to call for action to reduce, prevent, cure, and control the terrible burden of respiratory disease.
References
1. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases, a comprehensive approach. 2007.
2. Burney PG, Patel J, Newson R, et al. Global and regional trends in COPD mortality, 1990-2010. Eur Respir J. 2015;45(5):1239-47.
3. International Study of Asthma and Allergies in Childhood (ISAAC). Global Asthma Report. 2014.
4. World Health Organization. Pneumonia: the forgotten killer of children. Geneva: World Health Organization; 2006.
5. World Health Organization. Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016.
6. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
The Global Impact of Respiratory Disease – Second Edition was released by the Forum of International Respiratory Societies (FIRS) at the World Health Assembly May 25, 2017, in Geneva, Switzerland, calling attention to the global burden of lung disease and the benefits of prevention and clean air.
We often take our breathing and our respiratory health for granted, but respiratory diseases are a leading cause of death and disability in the world. Sixty-five million people suffer from COPD, and 3 million die of it each year, now making it the third leading cause of death worldwide.1,2 Asthma affects 334 million people in the world and is the most common chronic disease of childhood.3 Pneumonia kills millions of people annually and is a leading cause of death among children under 5 years old.4 Over 10 million people develop TB, and 1.4 million die of it each year, making it the most common deadly infectious disease.5 Lung cancer kills 1.6 million people each year and is the most deadly cancer.6 Globally, at least 2 billion people are exposed to indoor toxic smoke, 1 billion inhale outdoor pollutant air, and 1 billion are exposed to tobacco smoke. Many of us, and the world, are naïve to these staggering realities.
The American College of Chest Physicians® (CHEST), together with FIRS, is working hard to change these realities. CHEST, and our more than 19,000 members around the world, want a better future, one that has less suffering. We want a future that enables and allows everyone to breathe freely.
The 2017 Global Impact of Respiratory Disease report objectively speaks to these issues and outlines an eight-step action plan to impact these serious concerns. It highlights the importance of prevention, control, and cure of these diseases and announces that promotion of respiratory health must be a top priority for health-care systems and decision-makers. In emphasizing that these goals are achievable, it also highlights the reality that the prevention and cure of respiratory diseases are among the most cost-effective health interventions available – a “best-buy” in the view of the World Health Organization (WHO). In addition to reducing so much suffering, investment in respiratory health will pay manifold dividends in longevity, healthy living days, and national economies.
Darcy Marciniuk, MD, FCCP, FRCPC, and Co-Chair of the Report notes, “The Global Impact of Respiratory Disease” report calls attention to the importance of respiratory health in the world. The report and these efforts are required to ensure respiratory health becomes a top priority in global decision-making.”
In addition to focusing attention to the importance of respiratory health in the world and ensuring it becomes a global priority, the 2017 Global Impact of Respiratory Disease report also includes practical information for our members. The report summarizes the current state of our understanding with the “Big 5”: COPD, asthma, pneumonia, lung cancer, and TB, as well as with the environment and clean air, sleep-disordered breathing, pulmonary hypertension, and pulmonary embolism. It highlights key controllable factors, such as a reduction in tobacco smoking and improvement in air quality, which includes reduction in second-hand tobacco smoke, smoke from indoor fire, and unhealthy public and workplace air. The report underlines the value of trained health-care professionals and the need for health-care systems and policies to support those trained professionals. Finally, it emphasizes the reality that investment in respiratory research is more than the hope for today – it is the promise and a genuine commitment for tomorrow. CHEST’s involvement in this important project is only one component of our global engagement and impact. We support and help to educate lung specialists and health-care teams, no matter where they live and work. Our journal CHEST®, and other education offerings, are used every day and in every part of the world. The American College of Chest Physicians® focuses on the prevention, diagnosis, and treatment of chest diseases by providing innovative education and advancing best patient outcomes around the globe.
About the Forum of International Respiratory Societies (FIRS) Formed in 2001, the Forum of International Respiratory Societies (FIRS) is composed of the leading international respiratory societies, with more than 70,000 members who devote their working lives to respiratory health and disease. The goal of FIRS is to speak with one voice in promoting respiratory health worldwide and to call for action to reduce, prevent, cure, and control the terrible burden of respiratory disease.
References
1. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases, a comprehensive approach. 2007.
2. Burney PG, Patel J, Newson R, et al. Global and regional trends in COPD mortality, 1990-2010. Eur Respir J. 2015;45(5):1239-47.
3. International Study of Asthma and Allergies in Childhood (ISAAC). Global Asthma Report. 2014.
4. World Health Organization. Pneumonia: the forgotten killer of children. Geneva: World Health Organization; 2006.
5. World Health Organization. Global Tuberculosis Report 2016. Geneva: World Health Organization; 2016.
6. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
Making it Personal Through a Career of Service
Ronald M. Fairman, MD, held center stage Friday to present his presidential address, highlighting the personal side of vascular surgery and a career of service.
After acknowledging his family, friends, mentors, the international surgeon community, and his “family” at the University of Pennsylvania, he took the audience on “an abbreviated journey” to share events he hoped would resonate.
“Yes, it is true I was born at Penn and I am still there,” he joked. A rotation on the Penn Vascular Service led him to vascular surgery. “I was drawn to many aspects of the specialty: really sick patients, the opportunity to do tons of surgery, fast pace, the engagement of the faculty” and more.
He started his own private practice after his fellowship. With hard work and a 24/7 schedule, he built a large practice with staff, incorporated and began running a business. Feeling good about his contributions to his hospital, he requested new imaging equipment. The request was denied, with the CFO telling Dr. Fairman, “you are a financial loser for our hospital,” because length of stay for his ruptured AAA patients was much longer than the national average. “I was a loser because my patients were surviving,” he said, astonished that this CFO didn’t understand this. He told the CFO, “If I am a financial loser, I’m outa here. … This was personal and yes, I got the equipment for our vascular lab.”
He told several patient stories, including that of one who nearly died, but whose wife refused to let Dr. Fairman give up on. Complications arose from a left-behind sponge and Dr. Fairman ultimately had to operate again. He told the couple a large settlement would certainly be theirs if they sued, which they refused to do. Indeed they sent Christmas cards for years. “This was personal,” Dr. Fairman said.
In the 1990s, with health care changing, he decided he needed to re-create his career. He returned to Penn; hospital officials, – who “had discovered I wasn’t a financial loser after all” – were not happy. And patients followed him. “It was personal and I provided a valued service,” he said.
He took advantage of a new emphasis on clinical trials that allowed researchers to advance endovascular aortic and carotid therapies, among others, and the division became nationally recognized. The specialty became interesting to him again.
A 2007 malpractice case brought him low. During this self-described “dark time,” SVS member Dr. David Gillespie put together a volunteer program to send members to Landstuhl, Germany, to provided additional vascular support for soldiers wounded in Iraq and Afghanistan. As a result of his inspiring two-week tour of duty, Dr. Fairman recovered “my sense of service, duty, and mission.” Between 2007 and 2014, 177 SVS members participated, with 28 members performing multiple tours of duty. “Talk about making it personal and commitment to service!” he said.
Dr. Fairman also discussed his efforts at Penn to discuss the financial component of worth and service, in advance of his address. The exercise was illuminating. “For every dollar we primarily generate on the inpatient side, at least another dollar is generated for other services,” he said.
He also highlighted many Society achievements and initiatives, including:
- An emphasis on quality outcomes; communicating the value of membership; practice guidelines, government relations work, and increased collaboration with other organizations.
- The relevance and value of VAM.
- A new initiative with the American College of Surgeons, the Vascular Validation Project, to create Vascular Centers of Excellence. “This will be of vital importance to the future success of our specialty and you will hear more about this over the next year,” he promised.
- Efforts for the SVS to support members who increasingly practice in outpatient centers.
- Alignment around “advocacy, practice, education, the vascular team and you, our membership.”
- Integrating community-practice members into the SVS leadership and governance.
He ended with “pearls” of advice for the younger audience, including considering their careers as a sprint, not a marathon. Collaborate when possible, but retain ownership. Don’t be afraid to make career changes and fail. Remain flexible, reinvent yourself. Don’t flip out too often (which elicited a laugh from attendees). Retain professional passion. Start new programs. Become a mentor. Remember the mission is to serve patients.
“But above all else, keep your eye on the prize, those things that keep you human and grounded and help you maintain your humility,” he said. “You will make it highly personal and you will make a difference to your patients through a career of service.”
Paraphrasing U.S. Rep. Shirley Chisholm’s quote that “Service is the rent we pay for the privilege of living on this earth,” he applied it to vascular surgeons, who have a purpose to serve patients. “Service is the rent we pay for the privilege of patient care. It is deeply personal,” he said.
“Colleagues, thank you for allowing me to be your president this past year,” he concluded. “In this highly dangerous and volatile world, may God bless all of us and our mission to our patients.”
Ronald M. Fairman, MD, held center stage Friday to present his presidential address, highlighting the personal side of vascular surgery and a career of service.
After acknowledging his family, friends, mentors, the international surgeon community, and his “family” at the University of Pennsylvania, he took the audience on “an abbreviated journey” to share events he hoped would resonate.
“Yes, it is true I was born at Penn and I am still there,” he joked. A rotation on the Penn Vascular Service led him to vascular surgery. “I was drawn to many aspects of the specialty: really sick patients, the opportunity to do tons of surgery, fast pace, the engagement of the faculty” and more.
He started his own private practice after his fellowship. With hard work and a 24/7 schedule, he built a large practice with staff, incorporated and began running a business. Feeling good about his contributions to his hospital, he requested new imaging equipment. The request was denied, with the CFO telling Dr. Fairman, “you are a financial loser for our hospital,” because length of stay for his ruptured AAA patients was much longer than the national average. “I was a loser because my patients were surviving,” he said, astonished that this CFO didn’t understand this. He told the CFO, “If I am a financial loser, I’m outa here. … This was personal and yes, I got the equipment for our vascular lab.”
He told several patient stories, including that of one who nearly died, but whose wife refused to let Dr. Fairman give up on. Complications arose from a left-behind sponge and Dr. Fairman ultimately had to operate again. He told the couple a large settlement would certainly be theirs if they sued, which they refused to do. Indeed they sent Christmas cards for years. “This was personal,” Dr. Fairman said.
In the 1990s, with health care changing, he decided he needed to re-create his career. He returned to Penn; hospital officials, – who “had discovered I wasn’t a financial loser after all” – were not happy. And patients followed him. “It was personal and I provided a valued service,” he said.
He took advantage of a new emphasis on clinical trials that allowed researchers to advance endovascular aortic and carotid therapies, among others, and the division became nationally recognized. The specialty became interesting to him again.
A 2007 malpractice case brought him low. During this self-described “dark time,” SVS member Dr. David Gillespie put together a volunteer program to send members to Landstuhl, Germany, to provided additional vascular support for soldiers wounded in Iraq and Afghanistan. As a result of his inspiring two-week tour of duty, Dr. Fairman recovered “my sense of service, duty, and mission.” Between 2007 and 2014, 177 SVS members participated, with 28 members performing multiple tours of duty. “Talk about making it personal and commitment to service!” he said.
Dr. Fairman also discussed his efforts at Penn to discuss the financial component of worth and service, in advance of his address. The exercise was illuminating. “For every dollar we primarily generate on the inpatient side, at least another dollar is generated for other services,” he said.
He also highlighted many Society achievements and initiatives, including:
- An emphasis on quality outcomes; communicating the value of membership; practice guidelines, government relations work, and increased collaboration with other organizations.
- The relevance and value of VAM.
- A new initiative with the American College of Surgeons, the Vascular Validation Project, to create Vascular Centers of Excellence. “This will be of vital importance to the future success of our specialty and you will hear more about this over the next year,” he promised.
- Efforts for the SVS to support members who increasingly practice in outpatient centers.
- Alignment around “advocacy, practice, education, the vascular team and you, our membership.”
- Integrating community-practice members into the SVS leadership and governance.
He ended with “pearls” of advice for the younger audience, including considering their careers as a sprint, not a marathon. Collaborate when possible, but retain ownership. Don’t be afraid to make career changes and fail. Remain flexible, reinvent yourself. Don’t flip out too often (which elicited a laugh from attendees). Retain professional passion. Start new programs. Become a mentor. Remember the mission is to serve patients.
“But above all else, keep your eye on the prize, those things that keep you human and grounded and help you maintain your humility,” he said. “You will make it highly personal and you will make a difference to your patients through a career of service.”
Paraphrasing U.S. Rep. Shirley Chisholm’s quote that “Service is the rent we pay for the privilege of living on this earth,” he applied it to vascular surgeons, who have a purpose to serve patients. “Service is the rent we pay for the privilege of patient care. It is deeply personal,” he said.
“Colleagues, thank you for allowing me to be your president this past year,” he concluded. “In this highly dangerous and volatile world, may God bless all of us and our mission to our patients.”
Ronald M. Fairman, MD, held center stage Friday to present his presidential address, highlighting the personal side of vascular surgery and a career of service.
After acknowledging his family, friends, mentors, the international surgeon community, and his “family” at the University of Pennsylvania, he took the audience on “an abbreviated journey” to share events he hoped would resonate.
“Yes, it is true I was born at Penn and I am still there,” he joked. A rotation on the Penn Vascular Service led him to vascular surgery. “I was drawn to many aspects of the specialty: really sick patients, the opportunity to do tons of surgery, fast pace, the engagement of the faculty” and more.
He started his own private practice after his fellowship. With hard work and a 24/7 schedule, he built a large practice with staff, incorporated and began running a business. Feeling good about his contributions to his hospital, he requested new imaging equipment. The request was denied, with the CFO telling Dr. Fairman, “you are a financial loser for our hospital,” because length of stay for his ruptured AAA patients was much longer than the national average. “I was a loser because my patients were surviving,” he said, astonished that this CFO didn’t understand this. He told the CFO, “If I am a financial loser, I’m outa here. … This was personal and yes, I got the equipment for our vascular lab.”
He told several patient stories, including that of one who nearly died, but whose wife refused to let Dr. Fairman give up on. Complications arose from a left-behind sponge and Dr. Fairman ultimately had to operate again. He told the couple a large settlement would certainly be theirs if they sued, which they refused to do. Indeed they sent Christmas cards for years. “This was personal,” Dr. Fairman said.
In the 1990s, with health care changing, he decided he needed to re-create his career. He returned to Penn; hospital officials, – who “had discovered I wasn’t a financial loser after all” – were not happy. And patients followed him. “It was personal and I provided a valued service,” he said.
He took advantage of a new emphasis on clinical trials that allowed researchers to advance endovascular aortic and carotid therapies, among others, and the division became nationally recognized. The specialty became interesting to him again.
A 2007 malpractice case brought him low. During this self-described “dark time,” SVS member Dr. David Gillespie put together a volunteer program to send members to Landstuhl, Germany, to provided additional vascular support for soldiers wounded in Iraq and Afghanistan. As a result of his inspiring two-week tour of duty, Dr. Fairman recovered “my sense of service, duty, and mission.” Between 2007 and 2014, 177 SVS members participated, with 28 members performing multiple tours of duty. “Talk about making it personal and commitment to service!” he said.
Dr. Fairman also discussed his efforts at Penn to discuss the financial component of worth and service, in advance of his address. The exercise was illuminating. “For every dollar we primarily generate on the inpatient side, at least another dollar is generated for other services,” he said.
He also highlighted many Society achievements and initiatives, including:
- An emphasis on quality outcomes; communicating the value of membership; practice guidelines, government relations work, and increased collaboration with other organizations.
- The relevance and value of VAM.
- A new initiative with the American College of Surgeons, the Vascular Validation Project, to create Vascular Centers of Excellence. “This will be of vital importance to the future success of our specialty and you will hear more about this over the next year,” he promised.
- Efforts for the SVS to support members who increasingly practice in outpatient centers.
- Alignment around “advocacy, practice, education, the vascular team and you, our membership.”
- Integrating community-practice members into the SVS leadership and governance.
He ended with “pearls” of advice for the younger audience, including considering their careers as a sprint, not a marathon. Collaborate when possible, but retain ownership. Don’t be afraid to make career changes and fail. Remain flexible, reinvent yourself. Don’t flip out too often (which elicited a laugh from attendees). Retain professional passion. Start new programs. Become a mentor. Remember the mission is to serve patients.
“But above all else, keep your eye on the prize, those things that keep you human and grounded and help you maintain your humility,” he said. “You will make it highly personal and you will make a difference to your patients through a career of service.”
Paraphrasing U.S. Rep. Shirley Chisholm’s quote that “Service is the rent we pay for the privilege of living on this earth,” he applied it to vascular surgeons, who have a purpose to serve patients. “Service is the rent we pay for the privilege of patient care. It is deeply personal,” he said.
“Colleagues, thank you for allowing me to be your president this past year,” he concluded. “In this highly dangerous and volatile world, may God bless all of us and our mission to our patients.”
Check Out the SVS Expanded Member Benefits Portfolio
The Society for Vascular Surgery has its very own member affinity program, offering members access to best-in-class products and services coupled with special member discounts.
The portfolio includes a number of insurance, financial and private-practice related products that will assist members in their day-to-day lives. The result: a selection of financial and practice solutions to protect and benefit your families, incomes, practices, offices and staff – even your own slice of cyberspace.
For more information, visit vsweb.org/AffinityProgram, call 855-533-1776 or email [email protected].
The Society for Vascular Surgery has its very own member affinity program, offering members access to best-in-class products and services coupled with special member discounts.
The portfolio includes a number of insurance, financial and private-practice related products that will assist members in their day-to-day lives. The result: a selection of financial and practice solutions to protect and benefit your families, incomes, practices, offices and staff – even your own slice of cyberspace.
For more information, visit vsweb.org/AffinityProgram, call 855-533-1776 or email [email protected].
The Society for Vascular Surgery has its very own member affinity program, offering members access to best-in-class products and services coupled with special member discounts.
The portfolio includes a number of insurance, financial and private-practice related products that will assist members in their day-to-day lives. The result: a selection of financial and practice solutions to protect and benefit your families, incomes, practices, offices and staff – even your own slice of cyberspace.
For more information, visit vsweb.org/AffinityProgram, call 855-533-1776 or email [email protected].
Political Action Committee Reception Is Thursday
A meal and conversation with Rep. Paul Ryan (R-WI), Speaker of the U.S. House of Representatives. An existing relationship with Dr. Tom Price, now secretary of the U.S. Department of Health & Human Services. Working relationships with others in office who make national health care decisions affecting SVS members. Such benefits happen because of the SVS Political Action Committee.
The SVS PAC works for vascular surgeons – ONLY vascular surgeons – to ensure SVS access to U.S. representatives and senators to discuss issues that have a major impact on members and their patients. Contributions help elect or re-elect candidates who can be helpful with such issues.
The SVS PAC will hold a reception and “thank you” for those donors who have contributed to the PAC since Jan. 1, 2016. This includes donations received during the 2017 Vascular Annual Meeting.
The reception will be held from 7:00 to 8:30 p.m. Thursday, June 1, in the La Costa Room at the Marriott Marquis.
Contributions are critically important to the future of members, their profession and their practices, PAC leaders say.
“A good offense – great advocacy – is the best defense when confronted with so many unknowns today,” said Carlo A. Dall’Olmo, former SVS PAC chair. “The challenges are obvious, and they are present on both sides of the aisle. … (contributions) to the SVS/PAC will allow us to advocate at every opportunity.”
Thursday, June 1
7:00 – 8:30 p.m.
Marriott Marquis, La Costa Room
South Tower, fourth floor
PAC Reception
A meal and conversation with Rep. Paul Ryan (R-WI), Speaker of the U.S. House of Representatives. An existing relationship with Dr. Tom Price, now secretary of the U.S. Department of Health & Human Services. Working relationships with others in office who make national health care decisions affecting SVS members. Such benefits happen because of the SVS Political Action Committee.
The SVS PAC works for vascular surgeons – ONLY vascular surgeons – to ensure SVS access to U.S. representatives and senators to discuss issues that have a major impact on members and their patients. Contributions help elect or re-elect candidates who can be helpful with such issues.
The SVS PAC will hold a reception and “thank you” for those donors who have contributed to the PAC since Jan. 1, 2016. This includes donations received during the 2017 Vascular Annual Meeting.
The reception will be held from 7:00 to 8:30 p.m. Thursday, June 1, in the La Costa Room at the Marriott Marquis.
Contributions are critically important to the future of members, their profession and their practices, PAC leaders say.
“A good offense – great advocacy – is the best defense when confronted with so many unknowns today,” said Carlo A. Dall’Olmo, former SVS PAC chair. “The challenges are obvious, and they are present on both sides of the aisle. … (contributions) to the SVS/PAC will allow us to advocate at every opportunity.”
Thursday, June 1
7:00 – 8:30 p.m.
Marriott Marquis, La Costa Room
South Tower, fourth floor
PAC Reception
A meal and conversation with Rep. Paul Ryan (R-WI), Speaker of the U.S. House of Representatives. An existing relationship with Dr. Tom Price, now secretary of the U.S. Department of Health & Human Services. Working relationships with others in office who make national health care decisions affecting SVS members. Such benefits happen because of the SVS Political Action Committee.
The SVS PAC works for vascular surgeons – ONLY vascular surgeons – to ensure SVS access to U.S. representatives and senators to discuss issues that have a major impact on members and their patients. Contributions help elect or re-elect candidates who can be helpful with such issues.
The SVS PAC will hold a reception and “thank you” for those donors who have contributed to the PAC since Jan. 1, 2016. This includes donations received during the 2017 Vascular Annual Meeting.
The reception will be held from 7:00 to 8:30 p.m. Thursday, June 1, in the La Costa Room at the Marriott Marquis.
Contributions are critically important to the future of members, their profession and their practices, PAC leaders say.
“A good offense – great advocacy – is the best defense when confronted with so many unknowns today,” said Carlo A. Dall’Olmo, former SVS PAC chair. “The challenges are obvious, and they are present on both sides of the aisle. … (contributions) to the SVS/PAC will allow us to advocate at every opportunity.”
Thursday, June 1
7:00 – 8:30 p.m.
Marriott Marquis, La Costa Room
South Tower, fourth floor
PAC Reception
Before the Parade Passes By, Be Sure to Cross the Street
Are we in Pamplona, Spain, or San Diego, California?
The differences might blur Saturday morning; it won’t be Pamplona’s running of the bulls in front of the San Diego Convention Center, but a cattle drive of long-horned cattle. And this frontier drive may create a few difficulties getting to and from the Vascular Annual Meeting.
The cattle will travel on Harbor Drive, the street directly in front of the San Diego Convention Center, VAM’s home and the VAM headquarters hotel, the Marriot Marquis San Diego Marina.
The route will affect the ability to cross Harbor Drive (from other hotels, for example) and will delay anyone attempting to leave the Marriott via car or taxi while the parade is passing by.
For those staying in San Diego after VAM, the fair opens June 2 and runs through July 4. Fun includes panning for gold, a Wild West saloon with an old-fashioned player piano, and chance encounters with notorious outlaws such as Jesse James and Black Bart.
Are we in Pamplona, Spain, or San Diego, California?
The differences might blur Saturday morning; it won’t be Pamplona’s running of the bulls in front of the San Diego Convention Center, but a cattle drive of long-horned cattle. And this frontier drive may create a few difficulties getting to and from the Vascular Annual Meeting.
The cattle will travel on Harbor Drive, the street directly in front of the San Diego Convention Center, VAM’s home and the VAM headquarters hotel, the Marriot Marquis San Diego Marina.
The route will affect the ability to cross Harbor Drive (from other hotels, for example) and will delay anyone attempting to leave the Marriott via car or taxi while the parade is passing by.
For those staying in San Diego after VAM, the fair opens June 2 and runs through July 4. Fun includes panning for gold, a Wild West saloon with an old-fashioned player piano, and chance encounters with notorious outlaws such as Jesse James and Black Bart.
Are we in Pamplona, Spain, or San Diego, California?
The differences might blur Saturday morning; it won’t be Pamplona’s running of the bulls in front of the San Diego Convention Center, but a cattle drive of long-horned cattle. And this frontier drive may create a few difficulties getting to and from the Vascular Annual Meeting.
The cattle will travel on Harbor Drive, the street directly in front of the San Diego Convention Center, VAM’s home and the VAM headquarters hotel, the Marriot Marquis San Diego Marina.
The route will affect the ability to cross Harbor Drive (from other hotels, for example) and will delay anyone attempting to leave the Marriott via car or taxi while the parade is passing by.
For those staying in San Diego after VAM, the fair opens June 2 and runs through July 4. Fun includes panning for gold, a Wild West saloon with an old-fashioned player piano, and chance encounters with notorious outlaws such as Jesse James and Black Bart.
How to Welcome a Patient Advisor to Your Research Team
When it comes to caring for those with vascular disease, who better to tell surgeons and researchers the effects of various treatments than … patients?
Patients who have completed a comprehensive Patient Advisors Course will provide their perspective Thursday afternoon in “Patient Advisors Program,” 2:30 to 3:30 p.m., with a reception to further the conversation immediately afterward, from 3:30 to 4:30 p.m.
This session has been more than a year in the making, the fruition of a project funded by the Patient-Centered Outcomes Research Institute on “Connecting Patients and Researchers to Engage in Patient-Centered Vascular Disease Research.” Adrienne Faerber, PhD, at the Dartmouth Institute for Health Policy and Clinical Research is leading the project in partnership with SVS member Philip Goodney, MD.
The patients attending VAM have completed an online course aimed at patient collaboration with researchers and clinicians. Researchers, clinicians, and clinical leaders all should find the session valuable, said Dr. Faerber. Major funding agencies are moving toward requiring patients to give their input on research proposals, she said.
“And clinicians who want to improve their care of patients and clinical leaders who want to learn about leading change initiatives will want to listen to what they have to say as well.
“Patients are the experts in living with vascular diseases and we should be listening to them.”
Their experience encompasses far more than just their treatment, Dr. Faerber said of patients, with questions – even if they don’t know to ask them – that involve far more than “stent or surgery.”
“Surgeons tend to think of risks and benefits of procedures. But patients find the post-operative recovery a really important part of the experience,” she said. Surgeons should discuss pain management and any lifestyle restrictions; for example, a patient might not know until after surgery that he cannot drive for six or eight weeks.
“In the patient-centered view, that’s a huge issue,” she said.
“Providing good care goes beyond recommending a treatment,” said Dr. Faerber. “Clinicians need their patients’ input as to what they want, their values and beliefs.” Considering all those factors, plus lifestyle, “may change your thinking on the treatment decision.”
The Thursday session includes an orientation to patient-centered research and patient advisors, conversations with patients about their experiences and how clinics and hospitals can improve the patient experience of those with vascular care plus clinician and researcher reactions.
Dr. Matthew Corriere will discuss parallels between the patients’ stories to his work evaluating what matters to patients undergoing treatment, and Dr. Philip Goodney will describe how patient advisors have helped him improve his research portfolio.
The reception following the session will provide an opportunity to talk with the patient advisors and find out more about adding a Patient Advisor to a research or quality improvement team.
For more information, visit patientadvisorscourse.com.
Thursday, June 1
2:30 – 3:30 p.m.
SDCC, Room 17B
Patient Advisors Program
Moderators: Adrienne Faerber, PhD and Philip Goodney, MD
3:30 – 4:30 p.m.
SDCC, Room 17B
Patient Advisors Program Reception
When it comes to caring for those with vascular disease, who better to tell surgeons and researchers the effects of various treatments than … patients?
Patients who have completed a comprehensive Patient Advisors Course will provide their perspective Thursday afternoon in “Patient Advisors Program,” 2:30 to 3:30 p.m., with a reception to further the conversation immediately afterward, from 3:30 to 4:30 p.m.
This session has been more than a year in the making, the fruition of a project funded by the Patient-Centered Outcomes Research Institute on “Connecting Patients and Researchers to Engage in Patient-Centered Vascular Disease Research.” Adrienne Faerber, PhD, at the Dartmouth Institute for Health Policy and Clinical Research is leading the project in partnership with SVS member Philip Goodney, MD.
The patients attending VAM have completed an online course aimed at patient collaboration with researchers and clinicians. Researchers, clinicians, and clinical leaders all should find the session valuable, said Dr. Faerber. Major funding agencies are moving toward requiring patients to give their input on research proposals, she said.
“And clinicians who want to improve their care of patients and clinical leaders who want to learn about leading change initiatives will want to listen to what they have to say as well.
“Patients are the experts in living with vascular diseases and we should be listening to them.”
Their experience encompasses far more than just their treatment, Dr. Faerber said of patients, with questions – even if they don’t know to ask them – that involve far more than “stent or surgery.”
“Surgeons tend to think of risks and benefits of procedures. But patients find the post-operative recovery a really important part of the experience,” she said. Surgeons should discuss pain management and any lifestyle restrictions; for example, a patient might not know until after surgery that he cannot drive for six or eight weeks.
“In the patient-centered view, that’s a huge issue,” she said.
“Providing good care goes beyond recommending a treatment,” said Dr. Faerber. “Clinicians need their patients’ input as to what they want, their values and beliefs.” Considering all those factors, plus lifestyle, “may change your thinking on the treatment decision.”
The Thursday session includes an orientation to patient-centered research and patient advisors, conversations with patients about their experiences and how clinics and hospitals can improve the patient experience of those with vascular care plus clinician and researcher reactions.
Dr. Matthew Corriere will discuss parallels between the patients’ stories to his work evaluating what matters to patients undergoing treatment, and Dr. Philip Goodney will describe how patient advisors have helped him improve his research portfolio.
The reception following the session will provide an opportunity to talk with the patient advisors and find out more about adding a Patient Advisor to a research or quality improvement team.
For more information, visit patientadvisorscourse.com.
Thursday, June 1
2:30 – 3:30 p.m.
SDCC, Room 17B
Patient Advisors Program
Moderators: Adrienne Faerber, PhD and Philip Goodney, MD
3:30 – 4:30 p.m.
SDCC, Room 17B
Patient Advisors Program Reception
When it comes to caring for those with vascular disease, who better to tell surgeons and researchers the effects of various treatments than … patients?
Patients who have completed a comprehensive Patient Advisors Course will provide their perspective Thursday afternoon in “Patient Advisors Program,” 2:30 to 3:30 p.m., with a reception to further the conversation immediately afterward, from 3:30 to 4:30 p.m.
This session has been more than a year in the making, the fruition of a project funded by the Patient-Centered Outcomes Research Institute on “Connecting Patients and Researchers to Engage in Patient-Centered Vascular Disease Research.” Adrienne Faerber, PhD, at the Dartmouth Institute for Health Policy and Clinical Research is leading the project in partnership with SVS member Philip Goodney, MD.
The patients attending VAM have completed an online course aimed at patient collaboration with researchers and clinicians. Researchers, clinicians, and clinical leaders all should find the session valuable, said Dr. Faerber. Major funding agencies are moving toward requiring patients to give their input on research proposals, she said.
“And clinicians who want to improve their care of patients and clinical leaders who want to learn about leading change initiatives will want to listen to what they have to say as well.
“Patients are the experts in living with vascular diseases and we should be listening to them.”
Their experience encompasses far more than just their treatment, Dr. Faerber said of patients, with questions – even if they don’t know to ask them – that involve far more than “stent or surgery.”
“Surgeons tend to think of risks and benefits of procedures. But patients find the post-operative recovery a really important part of the experience,” she said. Surgeons should discuss pain management and any lifestyle restrictions; for example, a patient might not know until after surgery that he cannot drive for six or eight weeks.
“In the patient-centered view, that’s a huge issue,” she said.
“Providing good care goes beyond recommending a treatment,” said Dr. Faerber. “Clinicians need their patients’ input as to what they want, their values and beliefs.” Considering all those factors, plus lifestyle, “may change your thinking on the treatment decision.”
The Thursday session includes an orientation to patient-centered research and patient advisors, conversations with patients about their experiences and how clinics and hospitals can improve the patient experience of those with vascular care plus clinician and researcher reactions.
Dr. Matthew Corriere will discuss parallels between the patients’ stories to his work evaluating what matters to patients undergoing treatment, and Dr. Philip Goodney will describe how patient advisors have helped him improve his research portfolio.
The reception following the session will provide an opportunity to talk with the patient advisors and find out more about adding a Patient Advisor to a research or quality improvement team.
For more information, visit patientadvisorscourse.com.
Thursday, June 1
2:30 – 3:30 p.m.
SDCC, Room 17B
Patient Advisors Program
Moderators: Adrienne Faerber, PhD and Philip Goodney, MD
3:30 – 4:30 p.m.
SDCC, Room 17B
Patient Advisors Program Reception