2003 Presidential Address
Authors: Norman J. Siegel
Journal: Journal of the American Society of Nephrology (2004)

It is truly a high honor to report on the status of the American Society of Nephrology (ASN). As a pediatric nephrologist, it is rather fitting, if not ironic, to have been able to participate—and hopefully contribute—to a time of critical morphogenesis, enormous growth, and defining development of our Society. To illustrate these changes I have chosen an ancient proverb: “Tell me, I will forget; Show me, I may remember; Involve me, I will comprehend.” I will tell you about the goals of our society and how we are structured to achieve them. I will show you the means by which these goals can be achieved, and I will challenge you to become involved, not just in the ASN but in the preservation of our intellectual heritage and our discipline. The overall long-term goal of the ASN is to become the leading professional organization in nephrology. To achieve this goal the ASN must represent the broad spectrum of professionals involved in the discipline from basic scientist to practicing nephrologist, provide activities and programs in which the full spectrum of our membership will seek to participate, and significantly influence funding and public policy. In reality, no society on its own can achieve excellence in all of these domains. To obtain the best result for our colleagues and our patients, the ASN is committed to establishing and implementing effective collaborations and synergistic interactions with other renal societies, both domestic and international, and with governmental agencies. Over the past several years, the ASN has reached out to other renal organizations to build and enhance interactions: (1) an active liaison with at least one other society is maintained by each member of the council; (2) input concerning appointments to committees and advisory groups has been sought; (3) collaborations on symposia, clinical nephrology conferences, and postgraduate education (PGE) courses have been encouraged and are noted throughout the annual meeting program; and (4) joint sponsorship of grants, training programs, and travel fellowships has been undertaken. Our long-term goals are exemplified by our interactions with the National Kidney Foundation and the National Institutes of Health during this past year. In close collaboration with Brian Periera, the president of the National Kidney Foundation, the interactions between of our societies have been revitalized and coordinated efforts on several important projects have been undertaken: (1) the Joint National Commission report on hypertension (1) and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial publication (2); (2) a shared listing of all nephrology residency programs has been developed; and (3) an alignment of research grants offered by both societies so that a continuum of funding opportunities, which do not overlap or compete, is available to students through senior investigators. Beginning almost 3 yr ago, the ASN in collaboration with several renal societies championed the creation of the Kidney Disease Clinical Initiative at the National Institute of Diabetes and Digestive and Kidney Diseases to provide an impetus for clinical research and innovative therapeutic trials. This important initiative culminated in the establishment and funding of 11 Concept Development Awards, which have resulted in the formation of several new research consortia, focused on significant clinical issues ranging from dialysis to glomerular disease. We have worked closely with the leadership of the National Kidney Disease Education Project to provide to you appropriate information so that the interpretation of serum creatinine can be improved. Undoubtedly, this is the first small step on the long journey to conquering the devastating and ubiquitous effects of chronic kidney disease. During the 2003 annual meeting, several sessions on chronic kidney disease were developed in coordination with other societies, and the establishment of a Chronic Kidney Disease Advisory Group led by past president Roland Blantz signifies the ASN commitment to this complex, multifaceted problem. To be able to achieve our mission, it is critically important that the appropriate support structures be in place. The ASN Council (Table 1) is a preeminent group of leaders who are elected by you and are ultimately responsible for ensuring that your needs are met and incorporated into the fabric of the society’s programs. Their commitment and dedication is strong, and I can assure you that unanimity is not their forte. Open and honest discussion and debate is the rule no matter how small the topic. John Stokes has completed a 6-yr term as secretary-treasurer of the ASN. In appreciation of his exceptional service, dedication, insight, and leadership, the ASN Council has awarded him the Presidential Medal. To support the multiple activities and programs needed to achieve our goals, Dr. Karen Campbell, the extraordinarily proficient executive director of the ASN, provides adept and astute leadership of an outstanding and dedicated staff that understands and is devoted to the ideals and goals of our society. This group has proven itself not only capable of carrying out the defined activities of the Society but able to respond to new ideas with energy and enthusiasm. There is no doubt, however, that the ultimate success of this society is dependent not only on the members of the council, the executive director, and staff but a host of other individuals. Our spouses and significant others tolerate not only our physical absence but the diversion of our thoughts and attention. Without their, often silent, commitment, considerably less would be possible. In addition, all of us must acknowledge others within our division or our practice who have been willing to absorb the extra time to facilitate our participation.Table 1: ASN Council 2003For our society to achieve its stated goal, the decisions made by the ASN Council must be consistent with the interest of the broad and diverse membership of the society while sustaining a focus on excellence. To harness the considerable talent and expertise of the ASN membership, a number of committees and advisory groups have been organized over the past 3 to 4 years (Table 2). These groups have been very active and called on frequently to assist the council in evaluating and responding to specific issues as well as suggesting new initiatives and programs.Table 2: ASN committees and advisory groupsTo ensure that council decisions are well informed and consistent with the broad diversity of the membership of this society, a Board of Advisors (Table 3), which is composed of distinguished individuals who encompassed the full spectrum of our membership, was created this year. This group will provide essential advice and counsel on matters dealing with research, education, publications, government relations, and patient care. Although the first formal meeting of the Board of Advisors occurred at the 2003 annual meeting, the council has relied on input from this board concerning several important decisions during the past year.Table 3: American Society of Nephrology Board of AdvisorsOur society has and will maintain an unwavering commitment to scientific investigations, the promotion of research, and the promulgation of new knowledge. The council has made several very important decisions that will effectively advance our leadership role in both domains. During the past year, a detailed reevaluation of the ASN grant portfolio was undertaken and a commitment made to an ambitious expansion of this essential component of our society’s activities over the next 4 years. Three topic focused grants—the Merrill Transplant grant co-sponsored with the American Society of Transplantation, the Geriatric Nephrology grant co-sponsored with the American Society of Physicians, and a Health Services grant co-sponsored with the Renal Physicians Association—will be continued, and new opportunities to expand this aspect of the grants program will be pursued. Our Student Scholar Grant has been revised to make it more flexible but consistent with immersing young, interested, and talented students in nephrologic research. The Gottschalk Independent Career Development grants will be a primary focus of the ASN Grant Program and will be expanded from two to six awards yearly, each providing $100,000/yr for 2 years to enhance the transition of young faculty from mentored researchers to independent investigators. One of these new career development grants will be co-sponsored by the Kidney and Urologic Foundation of America beginning in 2004. The Scherbenske bridging grants, which provide funding for faculty whose research proposals are highly meritorious but do not quite reach the funding level, will be expanded to six awards per year, and the funding will double to $100,000/award. New Directions for Established Investigators grants will be implemented to allow seasoned investigators an opportunity to explore new previously untried areas of research. In addition, Special Travel Grants, which are designed to stimulate cross-fertilization and exploration of new ideas by allowing members to attend high-quality scientific meetings not sponsored by renal societies, will be continued. When fully implemented over the next 4 years, the ASN Research Grant Program will provide $2,500,000 yearly in funding. The signature event that represents our society’s commitment to both scientific inquiry and education is the annual meeting. The magnitude of this endeavor is enormous and represents the hard work of ASN staff and dedicated members of this society (12,100 attendees). Melissa Reese, the director of the ASN Annual Meeting Programs, is a talented and dedicated individual who is critical to the success of this meeting. The scientific component of this meeting is attributable to the hard work of the Program Committee (Table 4). I was fortunate in having chosen an absolutely stellar individual to serve as the chair of the 2003 Program Committee. Bruce Molitoris encompassed leadership, guidance, and perspective that brought this committee together and has stimulated synergistic interactions and creative thinking. The Program Committee transformed their ideas into the essential components of this meeting addressing timely state-of-the-art basic and clinical issues: four state-of-the-art lectures, 45 symposia, 41 free communications, three poster sessions with 1250 posters per session, and the Brenner Endowed lecture. The core element of this meeting, the exchange of scientific knowledge, is enriched by the international composition of submitted abstracts (4523 abstracts from 56 countries) and a large number of international attendees for which the ASN is most appreciative.Table 4: Program Committee 2003The educational component of this meeting is, in large measure, attributable to the Postgraduate Education Committee. Robert Narins, who is the ASN Director of Postgraduate Education Programs, provides the energy and enthusiasm that powers our PGE activities. Members of the PGE Committee (Table 5) contributed enormous amounts of time and effort to ensure that the educational components of this meeting (11 PGE courses, 22 Clinical Nephrology Conferences, 17 official noon and evening symposia, a clinical-pathology conference, and Blagg Endowed lectureship) and our Annual Board Review Course are directed at pertinent contemporary issues in clinical nephrology. To extend both the scientific and the educational content of our annual meeting, three regional meetings will be launched in 2004 (New York, Chicago, and Los Angeles).Table 5: Postgraduate Education Committee 2003In a similar manner, our two publications also represent our society’s steadfast commitment to scientific endeavors and educational advances. The Journal of the American Society of Nephrology (JASN), under the able leadership of Editor-in-Chief William Couser and Deputy Editor Alison Eddy, has continued to attract outstanding scientific papers and maintains the highest impact factor in nephrologic research. The editors and editorial board have made innovative changes to JASN to promote the translation of discoveries in basic and clinical research to bedside application and to ensure that both basic and patient-oriented research find a home in our society’s journal. After several years of deliberation and debate and with the advice of the Board of Advisors, the council made several important decisions so that JASN will be able to serve all members of our society. First and foremost, the highest quality science, both basic investigations and clinical research, should continue to be the primary focus of JASN. Second, if required, resources will be available so that papers of high quality in all aspects of nephrology can be accommodated in JASN. Nephrology Self Assessment Program, under the direction of Richard Glassock, provides an excellent resource for renewal of knowledge and will become an integral component of the American Board of Internal Medicine (ABIM) recertification process. Moreover, to serve our international members, these materials are being made available to nephrologists outside the United States, and we are pursuing additional opportunities in this regard. We have also made a commitment to explore and develop a third journal, which will be devoted to educational materials, will provide timely reviews of state-of-the-art information to promote the translation of scientific discoveries to clinical application, and will disseminate informed information concerning public policy and related issues. At the 2003 Annual Meeting, a new membership category was launched: Fellow of the American Society of Nephrology (FASN) was developed by an international committee and endorsed by the Board of Advisors to honor individuals who have excelled in research or patient care and have been active participants in ASN programs. Criteria to achieve FASN designation have been carefully constructed so that all members of our society, no matter what their special interest or country of origin, are eligible. The first FASN certificate has been awarded to Dr. Robert Narins, an individual whose innovation, concepts, drive, and motivation have been of enormous impact to all members of our society. A full-time director for public policy, Paul Smedberg, has joined our ASN team. Paul has recently been elected to the Executive Committee of Association of American Medical Colleges Medical Research Group and his efforts, combined with that of the Policy and Public Affairs Committee, are already apparent. During this past year, the ASN has been directly involved in several important issues. Funding for research by the National Institutes of Health and by the Veterans Administration system is precarious and needs careful, meticulous advocacy and attention. The recently revised reimbursement for the care of dialysis patients is of critical importance to all nephrologists and requires an ongoing dialogue with the Centers for Medicare and Medicaid Services (CMS). During the 2003 Annual Meeting, these important issues as well as chronic kidney disease and quality improvements were discussed in several special sessions. During the next year, the Policy and Public Affairs Committee will be restructured to provide focused attention on issues relating to research and to matters that directly affect the clinical practice of nephrology. I encourage you to avail yourself of the opportunity to participate in either or both of these important aspects of the ASN’s Policy and Public Affairs agenda. The activities and programs developed and sponsored by our society offer many opportunities for your involvement. I want, however, to turn our attention to two broader issues that have a tremendous affect on our discipline and require a renewed involvement and comprehension from all of us. Evidenced by our membership in the ASN, we are a diverse international admixture of scientists and clinicians dedicated to understanding the kidney. In his treatise (3), based on the comparative anatomy of the kidney, entitled From Fish to Philosopher, Homer Smith expands our scope by suggesting that the study and mastery of the kidney obligates us to the preservation of an intellectual heritage of wisdom and thought. Although we may, at times, view ourselves as different in both purpose and mission, in truth we are entwined by a common bond: Seek the truth and do not harm. We also share a common trust: Science and patient care cannot become the hostage of politics. No matter our native tongue, our ethnic origin, our religious belief, our social ideology, or our political persuasion, every one of us must be involved in the process of safeguarding the advancement of knowledge and the protection of the patients who have entrusted their welfare to us. The preservation of intellectual freedom and the exchange of knowledge must be an issue in which all of us are willing to become involved and certainly a concern that requires our comprehension, respect, and advocacy. To sustain and advance our discipline, each of us has another critical obligation. We must nurture and guide the growth and development of our younger colleagues. Mentorship requires an extraordinary commitment to the advancement and achievements of others: Altruism in its truest sense. However, this is not unique or limited to the academic environment or any particular country or culture. Guidance, advice, and support for younger colleagues are as applicable in the clinical practice of our discipline as it is in the research environment. Helping a young colleague to understand and learn from a complex clinical encounter or adapting to a new patient care environment is as critical as encouraging a young scientist to reconsider an experiment, envision an alternative hypothesis, or resubmit a grant. The judgment required to sustain any professional career is based on experience. We must, however, be cognizant of the reality observed by Samuel Clemens: Good judgment is based on experience, but experience is derived from bad judgment. Your involvement as an active mentor will ease the burden of developing good judgment and will minimize the bad experiences. To underscore the importance of these concepts, Bruce Molitoris and I chose to honor two individuals who exemplify mentorship by asking them to co-chair the plenary sessions at the 2003 Annual Meeting. Robert Schrier, a past president of this society and many other societies, has been an outspoken advocate for faculty and an important motivator of young scientists. Bob’s insight and enthusiasm for research were critically important in Bruce’s early career development and stimulated his pursuit of science. Michael Kashgarian has been the quintessential mentor for me. Mike’s admonition to me 30 yr ago when my first fledgling experiment went awry—“Use sharper blades and get more experience”—holds true today; the blades have changed to new molecular probes, but the experience, buffered by his mentorship, continues to evolve. This is not a theoretical construct or hypothetical suggestion. Every day, take the time to acknowledge an excellent presentation, challenge a young colleague to search even more deeply for the answers to an important scientific or clinical problem, and provide assurances that reaching for excellence in research and in clinical care both are rewarding endeavors and not mutually exclusive. For those of you who are likely to be recipients of this advice, accept praise humbly, take up the challenges, and extend your reach for new discoveries. Moreover, rely on the input of those who have developed good judgment so that you will not have to recapitulate their bad experiences. As world events become more turbulent and our professional lives more complex, it behooves all of us to pause for a moment and heed the advice of Kingman Brewster, the 17th president of Yale University: “Your moments of highest satisfaction, your deepest sense of accomplishment will come not in proportion to the fees you earn but from a sense that you have made a critical and constructive difference to your client, your patient, or your parishioner. You will find that the regard in which you were held by your professional peerage will ultimately depend more upon the quality of your service than on the level of your income.” I hope that your involvement in the ASN, your commitment to the preservation of our intellectual heritage, and your active implementation of the art of mentorship will be as satisfying for each of you as the opportunity to serve as president of this society has been enriching for me.