TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION, VOL. 128, 2017
SECRETARY-TREASURER’S REPORT The 129th Meeting Held at Omni Homestead Resort Hot Springs, Virginia October 20th through October 23rd, 2016
The Omni Homestead Resort, located in Hot Springs, Virginia, was an ideal setting for the 129th meeting of The Climatological. Since 1895 this historic resort has hosted 15 previous Climatological meetings, with the most recent being in 2009. This year’s meeting coincided with the Homestead’s 250th birthday, with complimentary afternoon tea and cake served each afternoon. The autumn colors were spectacular and many attendees took advantage of their free afternoons to hike local trails and/or lounge in the heated pools. The accommodations were comfortable and the staff’s Southern hospitality was exceptional. The total attendance was 262 with 139 members and 123 spouses and guests. In his Friday morning Presidential Address, titled “Physicians and the Pharmaceutical Industry,” David Dale opened with interesting and important historical landmarks but quickly transitioned to discussing contemporary issues. Several examples of extraordinary price increases by the biopharmaceutical industry and its pay scale for executives were cited, and pharma’s role in medical and patient education was also addressed. Concern that doctors have been “bought” by pharma to prescribe expensive drugs rather than cheaper ones have prompted pharmaceutical marketing to reduce physician “perk’s” (i.e., meals, drug samples, educational gifts, etc.) and detailing. Instead, pharma is spending more on direct-to-consumer advertising and shifting to use of social media to market drugs. David concluded by encouraging physicians to engage with industry, the government, and the public at large to find ways to advance disease specific, molecularly-based therapies while pushing hard to hold down the costs of drug development and the cost of medical care. At the annual business meeting held Friday morning, the names of recently deceased members and spouses were shared, followed by a moment of silence to honor them. Memorials were requested for publication in the Transactions. Provisional members presenting papers and their guests were introduced to the attendees and welcomed to the organization. The names of active members eligible for emeritus status (i.e., those who have been members at least 7 years and aged 65 years or older) were presented. The Merrill Lynch end of year lix
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(December 2015) and current financial statements were presented and discussed. No modification in investment strategy was suggested, which follows the recommendation of our financial advisor, Sanford Roy of the Davis, Miller, Roy Group (Merrill Lynch). The ACCA membership was informed that the financial advisor (Sanford Roy) charges no fee for managing the ACCA account or providing financial advice. The Nominations Committee recommendations for new officers and Councilors were presented and unanimously approved by the attendees. The location of future meetings was reviewed without discussion. The attendees were informed that the Article V Bylaw revisions approved by the Council at the 2015 Climatological meeting were not distributed to the membership-at-large with their 2016 February mailing. Hence the Bylaw revisions could not be voted on at this business meeting. Accordingly, they will be distributed in the February 2017 mailing and voted on at the October 2017 Climatological meeting to be held in San Antonio. The Theodore Woodward awardee, Dr. Alan Partin, was announced, along with the recognition that Alan was the first member to receive both the Theodore Woodward and the Mary Allen Engle award. Finally, the members were reminded how to access the Transactions online, including those dating back to the organizations inception. There being no new business, the business portion of the meeting was concluded and the scientific sessions commenced. Tom McLellan PhD, President and CEO of the Treatment Research Institute delivered the Gordon Wilson Lecture Saturday morning. His presentation titled, “The Opiate Epidemic: What Can We Do About It” highlighted the fact that we have previously misunderstood substance abuse problems and institutionalized expensive, ineffective measures to reduce it. Tom presented studies showing that substance abuse induces changes in gene expression, stress response systems and brain circuits controlling motivation, inhibition and reward sensitivity. Furthermore, these changes endure long after abstinence. These changes occur faster and to a greater extent in developing (i.e., adolescent) as compared to adult brains, which may account for why 94% of all addictions are initiated in subjects between 12 to 25 years of age. He showed that opioids are the most prescribed drugs, and most opioid overdoses occur within 24 hours of first prescription or refills. According to Tom, the principles of opioid abuse treatment include recognizing that: (a) “addiction” is an acquired chronic illness for which there is management but no cure; (b) acute-care approaches (e.g., detoxification) are not likely to succeed; and (c) continuing care and monitoring for symptom
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reduction, improved function, and trained self-management skills are the best treatment options. The lecture was well received and generated a lengthy question and answer period. The seventh Bert and Peggy DuPont Lecture titled, “Election 2016: What This Election Means For U.S. Health Care” was presented Saturday evening by Robert Doherty, the Senior Vice President for Governmental Affairs and Public Policy at The American College of Physicians. With the U.S. Presidential elections less than 3 weeks away, this topic was timely and of great interest among the ACCA members. Bob identified several trends that have defined the political climate in 2016, including changing demographics, declining trust in government, partisanship and gridlock, and rising populism. He discussed what’s at stake for health care by reviewing Hilary Clinton’s and Donald Trump’s views on five key health issues: health coverage and the Affordable Care Act, prescription drug pricing, opioids, firearms, and climate change. He discussed the “big health care issue that the candidates aren’t talking about (yet should); how our health care system is failing doctors and patients alike and what can be one about it.” He views the 2016 election as vital in determining whether we can “heal our broken democracy, beset by distrust, populist rage, partisanship and gridlock.” The Jeremiah Metzger Lecture titled “Cancer in the Twenty-First Century: An Inside View From an Outsider” was delivered Sunday morning by Edward Benz, MD, President and CEO of the Dana Farber Cancer Institute, Harvard Medical School. His outstanding presentation discussed the root cause of cancers – the impact of environment on genes – and how their mutability and heterogeneity make them hard to cure. Although genomics and precision medicine can direct targeted therapy, this approach is currently applicable to less than 10% of cancers. Unfortunately, the dramatic response in selected subsets of patients to targeted therapy is usually short-lived because resistance develops. Furthermore, precision medicine is complicated and expensive. Currently, cancer patients constitute 0.7% of the commercial payer population but account for 10% of health care costs. Accordingly, Ed believes the only real path to sustainability is focusing on prevention (i.e., ban tobacco, vaccinate against HPV and hepatitis, outlaw tanning parlors, encourage sunscreen use, promote healthy eating habits and exercise, reduce alcohol use, and reduce pollutants, etc.) and early detection in order to reduce the number of advanced cancers requiring expensive therapy. Over the next 5 to 10 years he predicted that molecular profiling will be the standard of care; metastasis and resistance will be
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increasingly targeted; “personalized” immunotherapy will be a game changer; and “tumor control” – rather than “tumor killing” – strategies will be a major focus of therapy. MINUTES FROM COUNCIL MEETING President David Dale convened the meeting of the Council at 9:00AM on Thursday, October 19, 2016, at the Omni Homestead Resort. Those in attendance were Frederic Billings III, Lawrence Chan (Vice President), Virginia, Collier, Thomas DuBose, Richard Lange (Secretary-Treasurer), Philip Mackowiak, Anne Moore (Immediate Past President), James Pennington, Andrew Schafer (President-Elect) and Fred Schiffman (Recorder). Not in attendance were Council members Edward Benz and Glenn Morris. Dr. Billings moved, and Dr. DuBose seconded, the motion that the minutes of the 128th meeting of the Association be approved as published in Volume 127 of the Transactions with the following revision. On page 62, Article V, Section 4, should have the following selection printed in bold (indicating that it is a change in the bylaws: “Section 4. The President, President-Elect, Vice-President, Secretary-Treasurer, and Recorder shall enter upon their duties at the close of the annual meeting at which they are elected, and shall hold office until the close of the next annual meeting or until their successors are elected. The President, President-Elect, and Vice-President will serve for 1 year, whereas the Secretary-Treasurer and Recorder may be reelected for several consecutive 1-year terms. The President-Elect shall become President at the close of the next annual meeting. The Immediate Past President will serve a 2-year term on the Council.” The motion carried unanimously. Anne Moore reported that the Nominating Committee, consisting of Peter Ganz, Marc Hochberg, James Marsh, Anne Moore (Chair) Al Mushlin, Mary Nettleman, Jerry Spivak and Richard Lange (ex officio) nominated Ron Sacher for President-Elect (1-year term to begin 2017), Glenn Cobb for Vice President (1-year term to begin 2017), and Richard Page for Council member (4-year term to begin 2017). The Nominating Committee also recommended Richard Lange to continue as SecretaryTreasurer; Fred Schiffman to continue as Recorder; Andrew Schafer to move from President-Elect to President (1-year term to begin October 23, 2016); David Dale to move from President to Immediate Past President; and Anne Moore to move from Immediate Past President
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to Council member. A motion to accept the recommendations of the committee was made by Anne Moore, seconded by Andrew Schafer, and unanimously approved. The names of the members whose death was made known to the Association during the previous year were presented: Robert Capizzi, J. O’Neal Humphries, Patrick Mulrow, and Sherman Mellinkoff. The names of the spouses of members whose death were made known to the Association during the previous year were also presented: Mary Jane “Pidgie” Dismukes, wife of Williams Dismukes, and Sally Flinn, wife of Bob Flinn. Their names will be read to the membership at the first business meeting and members asked to compose memorials for The Transactions. Dr. Schafer moved and Dr. Schiffman seconded the motion that the resignation of David Coleman be accepted. The motion carried unanimously. Dr. Lange will notify the member and his sponsor of the acceptance of Dr. Coleman’s resignation. Terminations for failure to comply with the attendance requirements as stated in the Constitution and By-laws (Article III, Section 5) were addressed by the Council. Dr. Billings moved and Dr. Mackowiak seconded the motion that the membership of Julie Freischlag, who was elected to provisional status in 2014, be extended for 1 more year to allow her to present a paper in 2017 and advance to active membership. This was granted as she provided an acceptable explanation of her inability to comply with the attendance requirements. Because Augustin Choi neglected to present a paper following his election to provisional membership in 2014 and provided no suitable explanation for such, the Council unanimously approved a motion, made by Dr. Billings and seconded by Dr. Mackowiak, to rescind Dr. Choi’s membership. Dr. Lange will notify Dr. Choi and his proposers of this action. For the following individuals who last attended a meeting in 2012 and were not registered for this meeting, the Council unanimously approved the motion, made by Dr. Billings and seconded by Dr. Mackowiak, that authorized the Secretary-Treasurer to do the following: inform Randall Cebul that he must be current with his dues (in arrears since 2013) and plan to attend next year’s meeting so that he can be moved to emeritus (for which he became eligible in 2015): allow Paul Ridker to pay his dues (in arrears since 2015) and commit to attending next year’s meeting to avoid termination: and request Allen Spiegel provide an explanation of his absence and plan to attend next year’s meeting
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to avoid termination. Based on each individual’s response and their compliance with dues, Dr. Lange is to decide whether membership in the Association should be extended or terminated. For the following individuals who last attended a meeting in 2013 and were not registered for this meeting, the Council unanimously approved a motion, made by Dr. Billings and seconded by Dr. Mackowiak, to extend their membership another year, providing they remain current with their dues and plan to attend the 2017 meeting in San Antonio, TX; Dennis Ausiello, David Corry, Charles Czeisler, Michael Fallon, Joseph Fins, Joe “Skip” Garcia, Ronald Hoffman, Richard Kerber, Nigel Key, Stephen Liggett, and Douglas Vaughan. The following members last meeting attendance was 2013 and provided satisfactory explanations of why they were unable to attend the 2016 meeting: Joseph Bonventre, Jamie Conti, and Mark Okusa. John Sedor, whose last attendance meeting was 2012, also provided a satisfactory explanation of why he was unable to attend the meeting. Dr. Lange will notify these members that they must be current in their dues and attend the 2017 Association meeting in San Antonio, TX, in order to maintain their membership. Dr. Faith Fitzgerald, whose last attendance was in 2013, informed the council that she is unable to travel to future meetings. Accordingly, unanimous support from the Council rescinded her membership following a motion by Dr. Billings, and a second by Dr. Mackowiak. The names of the 63 members who were not current in payment of their dues were presented to the Council. For the 23 who are in attendance at the meeting, payment will be obtained prior to departure. The 40 members who are delinquent in payment of the dues and not attending the meeting will be contacted and asked to remit payment before year’s end or risk having their membership rescinded. Dr. Mackowiak moved and Dr. Schiffman seconded the motion that the following 7 members be eligible for transfer from active to emeritus membership: David Hellmann, Katherine High, Sanjiv Kaul, William May, Jr., Alvin Mushlin, Gilbert White, and Joanne Wilson. The motion carried unanimously. These and 2 other members eligible for emeritus status — Maniikam Suthanthiran and Randall Cebul — will be notified by Dr. Lange that they must be current on payment of their dues (i.e., Dr. Cebul) and not have missed three or more consecutive meetings to move from active to emeritus status. Of these, only David Hellmann is registered to attend this meeting.
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Dr. Lange reported that the Climatological has 498 total members, of whom 165 are active, 26 are provisional, and 307 are emeritus. Of the 26 provisional members, 20 are scheduled to present papers at this meeting, 1 will be dismissed for failure to present a lecture within 2 years of election, and the remaining 5 must present a paper at the 2017 meeting in San Antonio to retain their membership. The resignation of 2 active members (Faith Fitzgerald and David Coleman) was accepted. Dr. Billings moved and Dr. DuBose seconded the motion that the following 20 provisional members be advanced to active membership upon presentation of their papers at the annual meeting and timely submission of their manuscript to the Recorder for publication in the Transactions: Jeffrey Balser, Henry Brem, Joseph Cheung, Kathleen Cooney, Stephen Galli, Ellen Gravallese, Gustavo Heudebert, William Kaelin, Farrah Kheradmand, Christine Laine, Jonathan Lewin, Richard Loeser, C. Ronald MacKenzie, Calum MacRae, Sofia Merajver, John Raymond, Don Rockey, Janet Rubin, Joseph Zabner, and Roy Ziegelstein. The Council approved the motion unanimously and recommended the following course of action for the 6 remaining provisional members. For the 2 elected in 2014 a motion by Dr. Schiffman and seconded by Dr. DuBose was unanimously approved by the Council to (a) rescind Augustin Choi’s membership for failure to provide a lecture (or acceptable explanation for noncompliance) within 2 years of election and (b) grant Julie Freischlag a 1 year extension to present paper for conversion to active membership, with failure to do so resulting in termination of her membership. The remaining 4 provisional members who were elected in 2015 – Steven Grinspoon, Elizabeth Phillips, Mark Rosenberg, and James Wooliscroft – must present a paper at the 2017 meeting to retain membership in the organization. The winner of the 2015 Mary Allen Engle Award (i.e., the new member who was most prompt in submitting their edited lecture manuscript to the Recorder) was announced and is Alan Partin. The prize — a bottle of wine — will be supplied by Dr. Schiffman at Saturday’s business meeting. The 2015 Theodore E. Woodward Award (to recognize the presenter at the annual meeting who spoke the most eloquently…. “on the importance of clinical skills in medical practice and teaching”) winner was announced and is Alan Partin who presented a talk entitled, “Clinical Evaluation of an Epigenetic Assay to Predict Missed Cancer in Prostate Biopsy Specimens.” A plaque and check in the amount of $500 will be presented to Alan at the Saturday business meeting.
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Fred Schiffman provided the Recorder’s report which noted a significant delay in delivery of the Transactions to the membership due to reorganization of the publisher’s staffing and delay in timely submission of manuscripts by our guest (i.e., Metzger and DuPont) lecturers. To prevent the latter from occurring in the future, the Secretary-Treasurer recommended that only half the honorarium be provided at the time of the lecture and the other half be paid upon submission of an acceptable manuscript. In addition, it was recommended that the lectures be recorded so that they can be transcribed, edited, and submitted to the publisher if the speaker does prepare a manuscript in a timely manner. The end of year (Dec. 2015) and current (as of October 7, 2016) financial statements were presented and discussed. It was reported that the Association’s net assets as of December 31, 2014, were $590,515.81. The Council was informed that investment income should be no more than one-third of the total income of the non-profit organization in order to maintain its non-profit status with the IRS. The Council was reminded that The Climatological has set a goal of maintaining enough funds to cover the costs of two meetings (~$500,000) should unforeseen circumstances prevent the organization from holding meetings already under contract. No modification in the current investment strategy was recommended, which follows the advice of our financial advisor, Sanford Roy of the Davis, Miller, Roy Group (Merrill Lynch). The Council was informed that Sanford Roy charges no fee for managing the ACCA account or providing financial advice. The Council members were notified that Postlethwaite and Netterville, A Professional Accounting Corporation had not yet finalized the 2015 audit. When completed, the audit will be submitted to the Council, Finance Committee, and Audit Committees for review and comment before submission for publication in the 128th volume of the Transactions. The established dates and sites for upcoming meetings are as follows: October 19–22, 2017 La Cantera Resort and Spa, San Antonio, TX October 18–21, 2018 Ritz Carlton, Sarasota, FL October 17–20, 2019 Grand Hotel Marriott, Point Clear, GA Old Business: As noted in the previous Transactions, Dr. Billings also reported that a special Constitution and Bylaws Committee consisting of Jeremiah Barondess, John Oates, and Robert Carey considered ways to change our constitution and bylaws so that the term of Past Presidents on the
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Council be reduced from 4 years to 2 years. This would allow both for more of the membership to serve on the Council and also for a reduction in the number of years of service required of the Past Presidents. A recommendation was made that: 1) the two Immediate Past Presidents be kept on the Council for 2 years each, 2) the newly nominated councilors be nominated from the membership at large and one of those councilors would not necessarily be a Past President as is our current practice, and 3) the Nominating Committee each year would be charged with nominating a President-Elect, a Vice-President and two councilors. To accomplish it, a motion was made by Dr. Dale and seconded by Dr. Howley that Article V of the Bylaws be changed accordingly (changes shown in bold):
ARTICLE V—OFFICERS Section 1. The officers of this Association shall consist of a President, a President-Elect, the 2 most recent Past Presidents, a VicePresident, a Secretary-Treasurer, and a Recorder, who with eight other members, shall constitute the Council of the Association. Section 2. Nominations. The officers and Council members shall be nominated by a Nominating Committee of at least five members, which committee shall be appointed by the President and notified to the members of the Association in the February letter. The report of the Nominating Committee will be given at the first business meeting with the advice and consent of Council. Section 3. Elections. The election of officers and Council members shall take place at the business meeting. A majority of votes cast shall constitute an election. Section 4. The President, President-Elect, Vice-President, SecretaryTreasurer, and Recorder shall enter upon their duties at the close of the annual meeting at which they are elected, and shall hold office until the close of the next annual meeting or until their successors are elected. The President, President-Elect, and Vice-President will serve for 1 year, whereas the Secretary-Treasurer and Recorder may be reelected for several consecutive 1-year terms. The President-Elect shall become President at the close of the next annual meeting. The Immediate Past President will serve a 2-year term on the Council. Each of the two most recent Past Presidents (Dr. Moore and Dr. Billings) may be elected to serve two additional one year terms.
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Section 5. Members of the Council, other than the officers, shall hold office for 4 years, two members being elected at each annual meeting. Section 6. Vacancies. Any vacancy occurring among the officers of the Association during the year may be filled by the Council. This change to the Bylaws will be provided to the members at large in the February mailing and voted on at the 2017 meeting. New Business: After careful consideration of the qualifications of all nominees, Council elected the following 21 individuals to provisional membership in the Association: Abul Abbas, Dale Abel, Myles Brown, Kathleen Cho, Phyllis Dennery, Jonathan Epstein, Eric Fearon, Gary Firestein, Judy Garber, Mark Geraci, Sherita Hill Golden, Marvin Konstam, Jon Licht, W. Conrad Liles, Barry London, Jeanne Marrazzo, Elizabeth Ofili, David Pinsky, Sumanth Prabhu, Harry Selker, and Selwyn Vickers. The Association’s 2016 Committee memberships were provided to the Council for informational purposes: Nominating Committee: Anne Moore (Chair), Peter Ganz, Marc Hochberg, James Marsh, Al Mushlin, Mary Nettleman, Jerry Spivak, and Richard Lange (ex officio) Woodward Committee (confidential): Frederic Billings, Anne Moore, and Phil Mackowiak Audit Committee: Richard Page (Chair), Stephen Baum, Cam Patterson It was reported that the Association will number 519 total members, with 26 provisional, 311 emeritus, and 182 active members after (a) 20 members transfer from provisional to active status upon presentation of a paper at the October 2016 meeting; (b) 9 qualified active members transition to emeritus membership; (c) 1 resignation from active (David Coleman) and 1 termination of a provisional member (Augustin Choi) is communicated; and (d) 21 new provisional members are elected. Council reaffirmed its policy of not having members of Council sponsor or second nominations for membership in the Association. The meeting adjourned at 2:30PM.
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SECRETARY-TREASURER’S REPORT The 129th Meeting Held at Omni Homestead Resort Hot Springs, Virginia October 20th through October 23rd, 2016
The Omni Homestead Resort, located in Hot Springs, Virginia, was an ideal setting for the 129th meeting of The Climatological. Since 1895 this historic resort has hosted 15 previous Climatological meetings, with the most recent being in 2009. This year’s meeting coincided with the Homestead’s 250th birthday, with complimentary afternoon tea and cake served each afternoon. The autumn colors were spectacular and many attendees took advantage of their free afternoons to hike local trails and/or lounge in the heated pools. The accommodations were comfortable and the staff’s Southern hospitality was exceptional. The total attendance was 262 with 139 members and 123 spouses and guests. In his Friday morning Presidential Address, titled “Physicians and the Pharmaceutical Industry,” David Dale opened with interesting and important historical landmarks but quickly transitioned to discussing contemporary issues. Several examples of extraordinary price increases by the biopharmaceutical industry and its pay scale for executives were cited, and pharma’s role in medical and patient education was also addressed. Concern that doctors have been “bought” by pharma to prescribe expensive drugs rather than cheaper ones have prompted pharmaceutical marketing to reduce physician “perk’s” (i.e., meals, drug samples, educational gifts, etc.) and detailing. Instead, pharma is spending more on direct-to-consumer advertising and shifting to use of social media to market drugs. David concluded by encouraging physicians to engage with industry, the government, and the public at large to find ways to advance disease specific, molecularly-based therapies while pushing hard to hold down the costs of drug development and the cost of medical care. At the annual business meeting held Friday morning, the names of recently deceased members and spouses were shared, followed by a moment of silence to honor them. Memorials were requested for publication in the Transactions. Provisional members presenting papers and their guests were introduced to the attendees and welcomed to the organization. The names of active members eligible for emeritus status (i.e., those who have been members at least 7 years and aged 65 years or older) were presented. The Merrill Lynch end of year lix
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(December 2015) and current financial statements were presented and discussed. No modification in investment strategy was suggested, which follows the recommendation of our financial advisor, Sanford Roy of the Davis, Miller, Roy Group (Merrill Lynch). The ACCA membership was informed that the financial advisor (Sanford Roy) charges no fee for managing the ACCA account or providing financial advice. The Nominations Committee recommendations for new officers and Councilors were presented and unanimously approved by the attendees. The location of future meetings was reviewed without discussion. The attendees were informed that the Article V Bylaw revisions approved by the Council at the 2015 Climatological meeting were not distributed to the membership-at-large with their 2016 February mailing. Hence the Bylaw revisions could not be voted on at this business meeting. Accordingly, they will be distributed in the February 2017 mailing and voted on at the October 2017 Climatological meeting to be held in San Antonio. The Theodore Woodward awardee, Dr. Alan Partin, was announced, along with the recognition that Alan was the first member to receive both the Theodore Woodward and the Mary Allen Engle award. Finally, the members were reminded how to access the Transactions online, including those dating back to the organizations inception. There being no new business, the business portion of the meeting was concluded and the scientific sessions commenced. Tom McLellan PhD, President and CEO of the Treatment Research Institute delivered the Gordon Wilson Lecture Saturday morning. His presentation titled, “The Opiate Epidemic: What Can We Do About It” highlighted the fact that we have previously misunderstood substance abuse problems and institutionalized expensive, ineffective measures to reduce it. Tom presented studies showing that substance abuse induces changes in gene expression, stress response systems and brain circuits controlling motivation, inhibition and reward sensitivity. Furthermore, these changes endure long after abstinence. These changes occur faster and to a greater extent in developing (i.e., adolescent) as compared to adult brains, which may account for why 94% of all addictions are initiated in subjects between 12 to 25 years of age. He showed that opioids are the most prescribed drugs, and most opioid overdoses occur within 24 hours of first prescription or refills. According to Tom, the principles of opioid abuse treatment include recognizing that: (a) “addiction” is an acquired chronic illness for which there is management but no cure; (b) acute-care approaches (e.g., detoxification) are not likely to succeed; and (c) continuing care and monitoring for symptom
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reduction, improved function, and trained self-management skills are the best treatment options. The lecture was well received and generated a lengthy question and answer period. The seventh Bert and Peggy DuPont Lecture titled, “Election 2016: What This Election Means For U.S. Health Care” was presented Saturday evening by Robert Doherty, the Senior Vice President for Governmental Affairs and Public Policy at The American College of Physicians. With the U.S. Presidential elections less than 3 weeks away, this topic was timely and of great interest among the ACCA members. Bob identified several trends that have defined the political climate in 2016, including changing demographics, declining trust in government, partisanship and gridlock, and rising populism. He discussed what’s at stake for health care by reviewing Hilary Clinton’s and Donald Trump’s views on five key health issues: health coverage and the Affordable Care Act, prescription drug pricing, opioids, firearms, and climate change. He discussed the “big health care issue that the candidates aren’t talking about (yet should); how our health care system is failing doctors and patients alike and what can be one about it.” He views the 2016 election as vital in determining whether we can “heal our broken democracy, beset by distrust, populist rage, partisanship and gridlock.” The Jeremiah Metzger Lecture titled “Cancer in the Twenty-First Century: An Inside View From an Outsider” was delivered Sunday morning by Edward Benz, MD, President and CEO of the Dana Farber Cancer Institute, Harvard Medical School. His outstanding presentation discussed the root cause of cancers – the impact of environment on genes – and how their mutability and heterogeneity make them hard to cure. Although genomics and precision medicine can direct targeted therapy, this approach is currently applicable to less than 10% of cancers. Unfortunately, the dramatic response in selected subsets of patients to targeted therapy is usually short-lived because resistance develops. Furthermore, precision medicine is complicated and expensive. Currently, cancer patients constitute 0.7% of the commercial payer population but account for 10% of health care costs. Accordingly, Ed believes the only real path to sustainability is focusing on prevention (i.e., ban tobacco, vaccinate against HPV and hepatitis, outlaw tanning parlors, encourage sunscreen use, promote healthy eating habits and exercise, reduce alcohol use, and reduce pollutants, etc.) and early detection in order to reduce the number of advanced cancers requiring expensive therapy. Over the next 5 to 10 years he predicted that molecular profiling will be the standard of care; metastasis and resistance will be
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increasingly targeted; “personalized” immunotherapy will be a game changer; and “tumor control” – rather than “tumor killing” – strategies will be a major focus of therapy. MINUTES FROM COUNCIL MEETING President David Dale convened the meeting of the Council at 9:00AM on Thursday, October 19, 2016, at the Omni Homestead Resort. Those in attendance were Frederic Billings III, Lawrence Chan (Vice President), Virginia, Collier, Thomas DuBose, Richard Lange (Secretary-Treasurer), Philip Mackowiak, Anne Moore (Immediate Past President), James Pennington, Andrew Schafer (President-Elect) and Fred Schiffman (Recorder). Not in attendance were Council members Edward Benz and Glenn Morris. Dr. Billings moved, and Dr. DuBose seconded, the motion that the minutes of the 128th meeting of the Association be approved as published in Volume 127 of the Transactions with the following revision. On page 62, Article V, Section 4, should have the following selection printed in bold (indicating that it is a change in the bylaws: “Section 4. The President, President-Elect, Vice-President, Secretary-Treasurer, and Recorder shall enter upon their duties at the close of the annual meeting at which they are elected, and shall hold office until the close of the next annual meeting or until their successors are elected. The President, President-Elect, and Vice-President will serve for 1 year, whereas the Secretary-Treasurer and Recorder may be reelected for several consecutive 1-year terms. The President-Elect shall become President at the close of the next annual meeting. The Immediate Past President will serve a 2-year term on the Council.” The motion carried unanimously. Anne Moore reported that the Nominating Committee, consisting of Peter Ganz, Marc Hochberg, James Marsh, Anne Moore (Chair) Al Mushlin, Mary Nettleman, Jerry Spivak and Richard Lange (ex officio) nominated Ron Sacher for President-Elect (1-year term to begin 2017), Glenn Cobb for Vice President (1-year term to begin 2017), and Richard Page for Council member (4-year term to begin 2017). The Nominating Committee also recommended Richard Lange to continue as SecretaryTreasurer; Fred Schiffman to continue as Recorder; Andrew Schafer to move from President-Elect to President (1-year term to begin October 23, 2016); David Dale to move from President to Immediate Past President; and Anne Moore to move from Immediate Past President
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to Council member. A motion to accept the recommendations of the committee was made by Anne Moore, seconded by Andrew Schafer, and unanimously approved. The names of the members whose death was made known to the Association during the previous year were presented: Robert Capizzi, J. O’Neal Humphries, Patrick Mulrow, and Sherman Mellinkoff. The names of the spouses of members whose death were made known to the Association during the previous year were also presented: Mary Jane “Pidgie” Dismukes, wife of Williams Dismukes, and Sally Flinn, wife of Bob Flinn. Their names will be read to the membership at the first business meeting and members asked to compose memorials for The Transactions. Dr. Schafer moved and Dr. Schiffman seconded the motion that the resignation of David Coleman be accepted. The motion carried unanimously. Dr. Lange will notify the member and his sponsor of the acceptance of Dr. Coleman’s resignation. Terminations for failure to comply with the attendance requirements as stated in the Constitution and By-laws (Article III, Section 5) were addressed by the Council. Dr. Billings moved and Dr. Mackowiak seconded the motion that the membership of Julie Freischlag, who was elected to provisional status in 2014, be extended for 1 more year to allow her to present a paper in 2017 and advance to active membership. This was granted as she provided an acceptable explanation of her inability to comply with the attendance requirements. Because Augustin Choi neglected to present a paper following his election to provisional membership in 2014 and provided no suitable explanation for such, the Council unanimously approved a motion, made by Dr. Billings and seconded by Dr. Mackowiak, to rescind Dr. Choi’s membership. Dr. Lange will notify Dr. Choi and his proposers of this action. For the following individuals who last attended a meeting in 2012 and were not registered for this meeting, the Council unanimously approved the motion, made by Dr. Billings and seconded by Dr. Mackowiak, that authorized the Secretary-Treasurer to do the following: inform Randall Cebul that he must be current with his dues (in arrears since 2013) and plan to attend next year’s meeting so that he can be moved to emeritus (for which he became eligible in 2015): allow Paul Ridker to pay his dues (in arrears since 2015) and commit to attending next year’s meeting to avoid termination: and request Allen Spiegel provide an explanation of his absence and plan to attend next year’s meeting
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to avoid termination. Based on each individual’s response and their compliance with dues, Dr. Lange is to decide whether membership in the Association should be extended or terminated. For the following individuals who last attended a meeting in 2013 and were not registered for this meeting, the Council unanimously approved a motion, made by Dr. Billings and seconded by Dr. Mackowiak, to extend their membership another year, providing they remain current with their dues and plan to attend the 2017 meeting in San Antonio, TX; Dennis Ausiello, David Corry, Charles Czeisler, Michael Fallon, Joseph Fins, Joe “Skip” Garcia, Ronald Hoffman, Richard Kerber, Nigel Key, Stephen Liggett, and Douglas Vaughan. The following members last meeting attendance was 2013 and provided satisfactory explanations of why they were unable to attend the 2016 meeting: Joseph Bonventre, Jamie Conti, and Mark Okusa. John Sedor, whose last attendance meeting was 2012, also provided a satisfactory explanation of why he was unable to attend the meeting. Dr. Lange will notify these members that they must be current in their dues and attend the 2017 Association meeting in San Antonio, TX, in order to maintain their membership. Dr. Faith Fitzgerald, whose last attendance was in 2013, informed the council that she is unable to travel to future meetings. Accordingly, unanimous support from the Council rescinded her membership following a motion by Dr. Billings, and a second by Dr. Mackowiak. The names of the 63 members who were not current in payment of their dues were presented to the Council. For the 23 who are in attendance at the meeting, payment will be obtained prior to departure. The 40 members who are delinquent in payment of the dues and not attending the meeting will be contacted and asked to remit payment before year’s end or risk having their membership rescinded. Dr. Mackowiak moved and Dr. Schiffman seconded the motion that the following 7 members be eligible for transfer from active to emeritus membership: David Hellmann, Katherine High, Sanjiv Kaul, William May, Jr., Alvin Mushlin, Gilbert White, and Joanne Wilson. The motion carried unanimously. These and 2 other members eligible for emeritus status — Maniikam Suthanthiran and Randall Cebul — will be notified by Dr. Lange that they must be current on payment of their dues (i.e., Dr. Cebul) and not have missed three or more consecutive meetings to move from active to emeritus status. Of these, only David Hellmann is registered to attend this meeting.
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Dr. Lange reported that the Climatological has 498 total members, of whom 165 are active, 26 are provisional, and 307 are emeritus. Of the 26 provisional members, 20 are scheduled to present papers at this meeting, 1 will be dismissed for failure to present a lecture within 2 years of election, and the remaining 5 must present a paper at the 2017 meeting in San Antonio to retain their membership. The resignation of 2 active members (Faith Fitzgerald and David Coleman) was accepted. Dr. Billings moved and Dr. DuBose seconded the motion that the following 20 provisional members be advanced to active membership upon presentation of their papers at the annual meeting and timely submission of their manuscript to the Recorder for publication in the Transactions: Jeffrey Balser, Henry Brem, Joseph Cheung, Kathleen Cooney, Stephen Galli, Ellen Gravallese, Gustavo Heudebert, William Kaelin, Farrah Kheradmand, Christine Laine, Jonathan Lewin, Richard Loeser, C. Ronald MacKenzie, Calum MacRae, Sofia Merajver, John Raymond, Don Rockey, Janet Rubin, Joseph Zabner, and Roy Ziegelstein. The Council approved the motion unanimously and recommended the following course of action for the 6 remaining provisional members. For the 2 elected in 2014 a motion by Dr. Schiffman and seconded by Dr. DuBose was unanimously approved by the Council to (a) rescind Augustin Choi’s membership for failure to provide a lecture (or acceptable explanation for noncompliance) within 2 years of election and (b) grant Julie Freischlag a 1 year extension to present paper for conversion to active membership, with failure to do so resulting in termination of her membership. The remaining 4 provisional members who were elected in 2015 – Steven Grinspoon, Elizabeth Phillips, Mark Rosenberg, and James Wooliscroft – must present a paper at the 2017 meeting to retain membership in the organization. The winner of the 2015 Mary Allen Engle Award (i.e., the new member who was most prompt in submitting their edited lecture manuscript to the Recorder) was announced and is Alan Partin. The prize — a bottle of wine — will be supplied by Dr. Schiffman at Saturday’s business meeting. The 2015 Theodore E. Woodward Award (to recognize the presenter at the annual meeting who spoke the most eloquently…. “on the importance of clinical skills in medical practice and teaching”) winner was announced and is Alan Partin who presented a talk entitled, “Clinical Evaluation of an Epigenetic Assay to Predict Missed Cancer in Prostate Biopsy Specimens.” A plaque and check in the amount of $500 will be presented to Alan at the Saturday business meeting.
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Fred Schiffman provided the Recorder’s report which noted a significant delay in delivery of the Transactions to the membership due to reorganization of the publisher’s staffing and delay in timely submission of manuscripts by our guest (i.e., Metzger and DuPont) lecturers. To prevent the latter from occurring in the future, the Secretary-Treasurer recommended that only half the honorarium be provided at the time of the lecture and the other half be paid upon submission of an acceptable manuscript. In addition, it was recommended that the lectures be recorded so that they can be transcribed, edited, and submitted to the publisher if the speaker does prepare a manuscript in a timely manner. The end of year (Dec. 2015) and current (as of October 7, 2016) financial statements were presented and discussed. It was reported that the Association’s net assets as of December 31, 2014, were $590,515.81. The Council was informed that investment income should be no more than one-third of the total income of the non-profit organization in order to maintain its non-profit status with the IRS. The Council was reminded that The Climatological has set a goal of maintaining enough funds to cover the costs of two meetings (~$500,000) should unforeseen circumstances prevent the organization from holding meetings already under contract. No modification in the current investment strategy was recommended, which follows the advice of our financial advisor, Sanford Roy of the Davis, Miller, Roy Group (Merrill Lynch). The Council was informed that Sanford Roy charges no fee for managing the ACCA account or providing financial advice. The Council members were notified that Postlethwaite and Netterville, A Professional Accounting Corporation had not yet finalized the 2015 audit. When completed, the audit will be submitted to the Council, Finance Committee, and Audit Committees for review and comment before submission for publication in the 128th volume of the Transactions. The established dates and sites for upcoming meetings are as follows: October 19–22, 2017 La Cantera Resort and Spa, San Antonio, TX October 18–21, 2018 Ritz Carlton, Sarasota, FL October 17–20, 2019 Grand Hotel Marriott, Point Clear, GA Old Business: As noted in the previous Transactions, Dr. Billings also reported that a special Constitution and Bylaws Committee consisting of Jeremiah Barondess, John Oates, and Robert Carey considered ways to change our constitution and bylaws so that the term of Past Presidents on the
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Council be reduced from 4 years to 2 years. This would allow both for more of the membership to serve on the Council and also for a reduction in the number of years of service required of the Past Presidents. A recommendation was made that: 1) the two Immediate Past Presidents be kept on the Council for 2 years each, 2) the newly nominated councilors be nominated from the membership at large and one of those councilors would not necessarily be a Past President as is our current practice, and 3) the Nominating Committee each year would be charged with nominating a President-Elect, a Vice-President and two councilors. To accomplish it, a motion was made by Dr. Dale and seconded by Dr. Howley that Article V of the Bylaws be changed accordingly (changes shown in bold):
ARTICLE V—OFFICERS Section 1. The officers of this Association shall consist of a President, a President-Elect, the 2 most recent Past Presidents, a VicePresident, a Secretary-Treasurer, and a Recorder, who with eight other members, shall constitute the Council of the Association. Section 2. Nominations. The officers and Council members shall be nominated by a Nominating Committee of at least five members, which committee shall be appointed by the President and notified to the members of the Association in the February letter. The report of the Nominating Committee will be given at the first business meeting with the advice and consent of Council. Section 3. Elections. The election of officers and Council members shall take place at the business meeting. A majority of votes cast shall constitute an election. Section 4. The President, President-Elect, Vice-President, SecretaryTreasurer, and Recorder shall enter upon their duties at the close of the annual meeting at which they are elected, and shall hold office until the close of the next annual meeting or until their successors are elected. The President, President-Elect, and Vice-President will serve for 1 year, whereas the Secretary-Treasurer and Recorder may be reelected for several consecutive 1-year terms. The President-Elect shall become President at the close of the next annual meeting. The Immediate Past President will serve a 2-year term on the Council. Each of the two most recent Past Presidents (Dr. Moore and Dr. Billings) may be elected to serve two additional one year terms.
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Section 5. Members of the Council, other than the officers, shall hold office for 4 years, two members being elected at each annual meeting. Section 6. Vacancies. Any vacancy occurring among the officers of the Association during the year may be filled by the Council. This change to the Bylaws will be provided to the members at large in the February mailing and voted on at the 2017 meeting. New Business: After careful consideration of the qualifications of all nominees, Council elected the following 21 individuals to provisional membership in the Association: Abul Abbas, Dale Abel, Myles Brown, Kathleen Cho, Phyllis Dennery, Jonathan Epstein, Eric Fearon, Gary Firestein, Judy Garber, Mark Geraci, Sherita Hill Golden, Marvin Konstam, Jon Licht, W. Conrad Liles, Barry London, Jeanne Marrazzo, Elizabeth Ofili, David Pinsky, Sumanth Prabhu, Harry Selker, and Selwyn Vickers. The Association’s 2016 Committee memberships were provided to the Council for informational purposes: Nominating Committee: Anne Moore (Chair), Peter Ganz, Marc Hochberg, James Marsh, Al Mushlin, Mary Nettleman, Jerry Spivak, and Richard Lange (ex officio) Woodward Committee (confidential): Frederic Billings, Anne Moore, and Phil Mackowiak Audit Committee: Richard Page (Chair), Stephen Baum, Cam Patterson It was reported that the Association will number 519 total members, with 26 provisional, 311 emeritus, and 182 active members after (a) 20 members transfer from provisional to active status upon presentation of a paper at the October 2016 meeting; (b) 9 qualified active members transition to emeritus membership; (c) 1 resignation from active (David Coleman) and 1 termination of a provisional member (Augustin Choi) is communicated; and (d) 21 new provisional members are elected. Council reaffirmed its policy of not having members of Council sponsor or second nominations for membership in the Association. The meeting adjourned at 2:30PM.
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