Presidential address: Our heritage and our future

Dr Gardner T hank you, Dr Crawford, for your very kind and overly generous introduction. People who know me well recognize the exaggerations, but for the rest of you, please take everything he said as the gospel truth. I am standing here as president of The American Association for Thoracic Surgery thanks to a lot of good fortune and, even more important, thanks to some very good people. As I remarked when I was leaving Johns Hopkins for Philadelphia, what I had become professionally at that time was about one third the result of my own efforts and two thirds a result of the Hopkins environment and my colleagues there. Whatever we have accomplished at the University of Pennsylvania has been the result of teamwork, and the team has included my superb colleagues in cardiothoracic surgery and anesthesia, a great teaching environment, and some staunch supporters. Casey Stengel said, “Managing a baseball team is getting paid for home runs someone else hits.” That has certainly been my story at Penn. I am very grateful to the numerous people over the years who have nurtured and supported my efforts and especially to my current colleagues in Philadelphia. Very special thanks also go to my wife, Nina; to our 4 children, Julie, Joby, Emily, and Nick; and to my close friends for the love, support, and happiness that I have received from each of them. Two years ago, in his excellent presidential address to this Association entitled “The Innovation Imperative,” Toby Cosgrove began by stating: “For thoracic surgeons, this is the best of times and the worst of times.” That was May 2000, when the United States was at the prosperous apex of a peaceful and benign international society, where goodwill and mutual respect reigned. We were in the midst of an unprecedented and sustained economic boom that, as Toby pointed out, was powering the entrepreneurial dreams of millions of people. At that same AATS meeting, we heard predictions of the anticipated effect of genetically based medicine by Craig Venter, a visionary scientist who had forced the pace of development of the human genome project by bold personal leadership and by gaining support for the project from the private sector. Now, just 2 years later, Americans have been shaken by the horror of September 11. We have had to confront a profound hatred and accept that our society, of which we have been so confident, is not seen as benevolent and generous by many people for whom we feel no malice. Even before that searing day in September, the entrepreneurial glow had faded, and the bubble, although perhaps not burst, had, at least, become a lot smaller. Even the human genome project has been forced to confront the harsh demands that are encountered when a vision moves into the implementation stage. Back in May 2000, what were the factors that Toby said were responsible for the worst-of-times circumstances? He cited the serious erosion of reimbursement for surgical services; increasing competition from other medical specialists, in particular from interventional cardiologists; escalating malpractice actions; and a loss of societal respect and esteem for the medical profession on the basis of a barely From the Department of Cardiothoracic Surgery, The Hospital of the University of Pennsylvania, Philadelphia, Pa.