We Are What We Make: Transforming Research in Anesthesiology: The 45th Rovenstine Lecture

THIS lectureship honors Emery Andrew Rovenstine, M.D., who was a distinguished anesthesiologist, Chair of the Department of Anesthesiology, New York University Medical Center and Director of Anesthesia, Bellevue Hospital, a founder and past president of the American Board of Anesthesiology, past president of American Society of Anesthesiologists (ASA), and recipient of the Society’s 1957 Distinguished Service Award. The Rovenstine Lecture was established in 1962 and today is the 45th commemorative lecture. I did not know Dr. Rovenstine, but I have read his writings. Let me sum him up as an extraordinary early leader in anesthesiology whose lifetime of service had an enormous impact on our specialty and does to this day. I hope you all understand the privilege it is to give a lecture in his honor. I realize that I stand between you and lunch—a dangerous place for anyone in front of anesthesiologists since lunch breaks are most unpredictable and always needed. Aware of this, I am reminded of a vignette reported by Alexander Heard, B.A., M.A., Ph.D. (Chancellor Emeritus, Vanderbilt University, Nashville, Tennessee) on the occasion of an annual “Dixie Dinner” in New York hosted by the Southern Society (made up of wellheeled but displaced Southerners in that big city) where “the speaker was introduced exactly at midnight and with great fanfare to give ‘his address’—(realizing the lateness of the hour) the honoree arose, gave his house number and street name in Princeton, NJ, and sat down. ” You are not that fortunate. We (all who practice anesthesiology) are what we (those anesthesiologists who are in academia) make. Our academic departments have three missions: (1) education, (2) clinical service, and (3) research. We are especially proud of the excellent physicians we educate and the clinical care we provide. We must excel in these two, and we do. However, today I will focus on our research mission, something we do less well, and that needs transformation. In choosing this subject, I am aware of the admonition given by Rhodes in his wonderful book, The Creation of the Future: The Role of the American University: “little has changed in the century that has passed since Horace Mann declared that to disperse an angry mob, all that would be necessary would be to announce a lecture on education,” and I would add research to this. There are several reasons to focus on anesthesiology research: First, it is something that I have been committed to since the summer before I began medical school. Second, I think it is an area in which academic anesthesiology can and must do better. Third there has been a flurry of worry expressed in our journal, ANESTHESIOLOGY, and elsewhere of late. Finally, I have always been convinced that unless we question what we do and what we know through research, we will never improve by doing things new and better. The General Electric slogan of the 1960s, “Progress is our most important project,” has been and always will be my professional credo. It must be the motto of anesthesiology as well. The remainder of this lecture is in three parts: (1) the present status of research, (2) a root cause analysis of our research performance, and (3) a plan to improve the current state of our research.