566042 research-article2015
VMJ0010.1177/1358863X14566042Vascular MedicineCreager et al.
Special Article
The Society for Vascular Medicine: The first quarter century
Vascular Medicine 2015, Vol. 20(1) 60–68 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1358863X14566042 vmj.sagepub.com
Mark A Creager1, William R Hiatt2, Alan T Hirsch3, Jeffrey W Olin4, Michael R Jaff 5, John P Cooke6, Thom Rooke7, Joshua A Beckman1 and James B Froehlich8
Abstract The Society for Vascular Medicine was founded in 1989. During the subsequent 25 years, the Society has grown to approximately 500 members and has achieved international recognition while making important contributions to vascular disease education, clinical vascular medicine and biology research, and patient care. In celebration of the Society’s 25th anniversary, its past and current presidents reflect on the Society’s history, challenges, and achievements, and emphasize the vital role of the SVM in the discipline of vascular medicine. Keywords vascular diseases, professional societies, vascular medicine
Mark A Creager, MD, MSVM 1993–1995 The Society for Vascular Medicine and Biology (SVMB), now known as the Society for Vascular Medicine (SVM), was founded by 13 physicians and scientists on 19 March 1989, at a meeting in Anaheim, California (Figure 1). We met with the expressed purposes of creating an organization that would: (1) integrate physicians and scientists to advance the discipline of vascular medicine; (2) provide a forum dedicated to the exchange of ideas, which would facilitate the translation and clinical application of research advances to improve prevention, diagnosis, and treatment of vascular diseases; and (3) be an outlet for vascular medicine education to enhance the knowledge of physicians caring for patients with vascular disorders. Over the ensuing months, we crafted the bylaws and incorporated the SVMB as a not-for-profit corporation in the state of Ohio. Our mission statement adhered to our founding principles and included the following: • To promote and advance the field of vascular medicine and biology, and to maintain the highest standards of practice, research, education, and exchange of scientific information. • To stimulate the formation of fellowship training programs in vascular medicine and research, and the teaching of these disciplines to medical schools and house officer training programs. • To provide consultation to educational institutions, government agencies, and other such organizations.
The strength and vitality of the SVMB stemmed from the leadership of its initial presidents, each of whom was a respected and accomplished vascular medicine physician. The first president of the SVMB was Jess R Young, who served from 1989 to 1991 (Table 1). Jess was Chairman of the Department of Vascular Medicine at the Cleveland Clinic. During his tenure, we built a membership structure. We held our first two scientific meetings: the first took place in March 1990 in New Orleans, Louisiana and was attended by 40 members and guests; the second took place Atlanta, Georgia, in March 1991. Both meetings occurred in geographic and temporal proximity to the annual meeting of the American College of Cardiology (ACC). We
1Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, USA 2University of Colorado School of Medicine, Denver, CO, USA 3University of Minnesota, Minneapolis, MN, USA 4Mt Sinai Medical School of Medicine, New York, NY, USA 5Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 6Houston Methodist Research Institute, Houston, TX, USA 7Mayo Clinic, Rochester, MN, USA 8University of Michigan, Ann Arbor, MI, USA Corresponding author: Mark A Creager, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA Email: [email protected]
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Figure 1. The founding of the Society for Vascular Medicine and Biology in Anaheim, California on 19 March 1989. From left: Drs Alan Hirsch, Marvin Sachs, Philip (Jack) Osmundson, Jay Coffman (then President-Elect), Jess Young (then President), Mark Creager, Michael Weber,Victor Dzau, John (Jack) Spittel Jr, John Joyce, John P Cooke, Sheldon Sheps, James Sowers. (Photograph provided by John P Cooke.) Table 1. Presidents of the Society for Vascular Medicine. Jess R Young, MD, MSVM Jay D Coffman, MD, MSVM Mark A Creager, MD, MSVM William R Hiatt, MD, MSVM Alan T Hirsch, MD, MSVM Jeffrey W Olin, DO, MSVM Jonathan L Halperin, MD, MSVM Michael R Jaff, DO, MSVM John P Cooke, MD, MSVM J Michael Bacharach, MD, MPH, MSVM Thom Rooke, MD, MSVM Joshua A Beckman, MD, MSVM James B Froehlich, MD, FSVM John R Bartholomew, MD, FSVM
1989–1991 1991–1993 1993–1995 1995–1997 1997–1999 1999–2001 2001–2003 2003–2005 2005–2007 2007–2009 2009–2011 2011–2013 2013–2015 President-Elect, 2015–2017
launched an official journal, the Journal of Vascular Medicine and Biology, under the stewardship of Victor Dzau, and we contributed to the formation of the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL), now the Intersocietal Accreditation Commission (IAC), as a founding member society. The SVM Outstanding Vascular Medicine Educator Award, bestowed at our annual scientific sessions each year, is named in honor of Jess Young. The second president of the SVMB was Jay D Coffman, who served from 1991 to 1993. Jay was Professor of Medicine at the Boston University School of Medicine and Chief of the Peripheral Vascular Disease Section at University Hospital (now Boston Medical Center). During Jay’s tenure, the SVM membership grew, and two more annual meetings occurred. One took place in March 1992, at the Mayo Clinic, as we sought to move our venue to members’ institutions to highlight local scientific accomplishments and clinical programs. The next, our fourth scientific
session, occurred in October 1993, and was hosted by the Cleveland Clinic; it included scientific and case presentations from the Cleveland Clinic faculty, and, for the first time, live cases in the vascular laboratory and interventional suite. Jay led by example. He was the consummate mentor and role model, a clinician scientist who devoted his career to the ideal of translating research findings directly to the care of patients. The SVM Young Investigator Awards, also bestowed annually at our annual scientific sessions, is named in his memory. My presidential term, from 1993 to 1995, followed in the footsteps of these two great men. Our progress toward our mission continued. In June 1994, we held our fifth annual meeting in Seattle, Washington alongside the meeting of the Society for Vascular Surgery (SVS), to foster more collaboration between the two organizations. Though still modest, our meeting was growing, and we had 80 attendees, including 60 members of the SVMB and 20 guests from the SVS. Our sixth annual meeting was held in June 1995 in New Orleans, alongside the SVS meeting, and followed the same format as we sought to build interdisciplinary collaboration. Also, in line with our mission to provide consultation to educational institutions, government agencies, and other such organizations, in 1995 we organized and participated in an international symposium called ‘Pharmacotherapy of Claudication: A New Frontier for Vascular Therapies’. This was the first time an entire meeting was devoted to the research, development and release of pharmacologic agents to treat patients with peripheral artery disease (PAD). The Journal of Vascular Medicine and Biology ceased publication in 1994, based on a business decision by the publisher, Blackwell Scientific Publishing. Fortunately, following my term in office, we were able to initiate a new journal, Vascular Medicine, in 1996 with Arnold Publishers, and now with Sage Publications. I was privileged to serve as its editor for 18 years. The journal further established the important role the SVM has in advancing the field of vascular medicine and biology, and in maintaining the highest standards of education and exchange of scientific information. Twenty-five years ago, the founders of SVM(B) hoped that an organization dedicated to vascular medicine would make substantial impact on the field, by promoting science, education and care delivery. We may not have envisioned the great advancements in science and technology that since have been translated and implemented to treat vascular diseases and improve vascular health. We were prescient enough, however, to realize the important contributions that our Society would make in the discipline of vascular medicine through promulgation of new knowledge, education, training, professional development, and implementation of evidenced-based standards of care, and for that we can all be proud.
William R Hiatt, MD, MSVM 1995–1997 During my tenure, there were 171 paying members, significant funding from both the NIH and industry and the Society was growing and financially viable. During those
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Table 2. Selected recent achievements and ongoing initiatives of the Society for Vascular Medicine (2009–2015). • Maintenance of financial solvency in the setting of declining industry report for continuing medical education • Growth of the American Board of Vascular Medicine (ABVM) examinations in general and endovascular medicine • Participation in inter-societal scientific statements, clinical practice guidelines (e.g. lower extremity peripheral artery disease, extracranial cerebrovascular disease, thoracic aorta disease, perioperative guidelines), and appropriate use documents • Development of joint vascular and endovascular medicine board review course with VIVA Physicians • Creation of a vascular medicine-based maintenance of certification (MOC) module • Leadership in accreditation of vascular laboratories, carotid stenting facilities, and venous disease treatment facilities through the Intersocietal Accreditation Commission (IAC)
early days of the Society, I set a priority of collaborative relationships with other vascular societies, particularly the SVS. It seemed that our interests were quite overlapping and that each could add value to the other’s meeting, which would further a productive relationship between the societies. Therefore, during those years, the SVS and SVM had parallel meetings, as well as cross-collaboration in terms of speakers and symposia.1 At the time, this collaboration worked quite well. However, subsequent to my tenure the leadership of the SVM decided that it was logistically challenging to continue such pairing, and, in the interest of creating a separate identity, ultimately split from these associative meetings, which in retrospect was an appropriate decision and direction. Also in the mid-1990s several collaborative projects (Figure 2) were moving forward on an international basis. During the mid- to late-1990s the first transatlantic society consensus document was being crafted. This was led by Professor John Dormandy from London and Professor Robert Rutherford from my institution here at the University of Colorado, both academic vascular surgeons. The initial drafting of this multi-disciplinary, multinational guideline included representatives from vascular surgery, interventional radiology, cardiology/interventional cardiology and vascular medicine. This collaboration was quite successful and at the time seemed to distinguish the vascular societies as being collaborative compared with other organizations in cardiovascular medicine. Also at that time we published an early version of the international guidelines for clinical trials in PAD that included the Food and Drug Administration (FDA), the European Medicine Agency (EMA), and European and US representatives.2 These were exciting times as vascular medicine was growing and differentiating. We were targeting not just our unique clinical practice and expertise, but also trying to create an international environment to foster clinical research activities, to further define new therapeutics and move the scientific basis for clinical care forward. What subsequently happened was continued collaboration through the early 2000s but then over the last several years splits have arisen, particularly in international guidelines, that led to the departure of the vascular surgeons from the TASC III development.3 Thus, our later years have been characterized more as lack of consensus than an ability to achieve consensus. As a result, looking back over the past two and a half decades it is quite apparent that SVM represents a critically important aspect of not just vascular care, but
medical care in general. It is right and proper for our Society to represent our discipline on a stand-alone basis and I fully support that direction taken many years ago. We should continue to focus on our unique clinical expertise, as well as our ability to provide unique educational and research opportunities. The most obvious source of continued inter-society conflict would be in the catheterization lab where the various interventional specialties may often clash, particularly around resource utilization and attempts at dominance of this aspect of clinical vascular care. While that in some ways is not shocking, it certainly is disillusioning compared with the collaborative days of 15 years ago. Nevertheless, our Society should continue to strive to maintain its differentiation and in particular seek American Board of Internal Medicine (ABIM) certification and focus on fellowships in vascular medicine and training the next generation.
Alan T Hirsch, MD, MSVM 1997–1999 As the fifth president of the SVM, I keenly felt the honor of being elected to lead our young vascular society. The concept of public (community) service had long been core to my career choices. Could SVM provide a unique service to support critical vascular public health needs? Beyond the words ‘vascular medicine’ and ‘biology’ in our 1997 societal name, exactly how would SVM channel the skills of its members to achieve our mission? Could it do so with financial integrity? I thought we might achieve our mission by focusing on satisfying key unmet clinical needs in the vascular knowledge marketplace. Historically, most vascular specialty societies were initially designed to ‘protect’ their specialty domain. This was certainly true in 1997. How could SVM achieve a different legacy and achieve recognition by offering a health contribution that was unique and indispensable? To this end, early in my presidency we began by petitioning the American Medical Association (AMA) to recognize vascular medicine as a ‘self-defined’ medical specialty. This may seem inconsequential, but in 1997 it was not. The AMA, ACC, American Heart Association (AHA), nor any other established health society or government agency recognized our existence. A key step toward the later creation of the American Board of Vascular Medicine (ABVM) was to achieve AMA recognition. We achieved this. Thereafter, both the ACC and the AHA provided – with impressive slowness – comparable recognition.
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Figure 2. Societal contributions and collaborative milestones during the first two decades of achievement of the Society for Vascular Medicine (1989–2009). Simultaneous advancements in medical therapy for vascular disease are shown. (Copyright © 2014 Cleveland Clinic. All Rights Reserved.)
We also chose to expand societal membership in a new way, welcoming all who supported our mission, including individuals from other disciplines. I urged that SVM create a ‘community of vascular health professionals’, thus providing co-equal societal leadership and privileges so that vascular medicine specialists, vascular nurses, vascular sonographers, radiologists and surgeons might find common mission. Our membership required engagement, and we discovered the one tool that has long been proven to be effective: free T-shirts. With humor, and for nearly a decade, we produced an ‘informative shirt’ that could be proudly worn to apprise the public and others who we were and what we stood for. In my day, we used every medium available to clarify our role to the nation. In order to tell our story and thus create a new and open societal community, and to provide wide access to our expertise, we created the first ever vascular societal web presence in 1997. In 1997, ‘html’ was new, Netscape was the ‘up-and-coming’ browser, and dial-up modems were used to connect. But, SVM was connected! I also believed that our members and our specialty were uniquely capable of helping this nation achieve two key goals that were not central to any other vascular society. I believed then, and still do, that we should work to: (1) provide the public with easy access to accurate, science-based vascular health information (vascular ‘health literacy’) and (2) provide health professionals with accurate, sciencebased knowledge of non-invasive (vascular medical) health information. Only via access to such knowledge can informed decisions, with adequate patient autonomy and cost-effectiveness, be made. Thus, we embarked on an effort to create the non-profit Vascular Disease Foundation (VDF) that served to combine the efforts of all vascular health professionals to create a broad-based, accurate, free health information campaign for the nation (Figure 2). For over 20 years, this Foundation linked industry, the National Heart, Lung, and Blood Institute (NHLBI), and the Centers for Disease Control and
Prevention with motivated vascular health professionals to serve the public. Loss of industry funding during the 2008 recession – representing a real tragedy of short-sightedness – has left our nation with no comparable informational recourse. The VDF structure will undoubtedly need to be re-created in the future. Finally, vascular medicine implies – by its name – the use of all diagnostic and therapeutic tools to improve health, beyond reliance on invasive care strategies. The heyday of pharmacologic discovery bloomed in the Society’s early days. These vascular ‘medicines’ included new claudication pharmacotherapies (cilostazol), cholesterol modifying agents (statins, niacin and others), antiplatelet medications (aspirin, clopidogrel, and glycoprotein IIb–IIIa receptor antagonists), antithrombotic medications (low molecular weight heparins), thrombolytic medications (streptokinase and tissue plasminogen activator), and the early study of angiogenic factors. We promoted an extremely active ‘knowledge marketplace’ to foster vascular drug discovery, clinical trial development, and international discussion of the implications for achievement of long-term quality outcomes (Figure 2). SVM is critical to national vascular health. The goals that we established in 1997 remain immutable today. We must assure we achieve sustained membership growth. Entire states, metropolitan areas, and health systems have no vascular medicine leadership. We must sustain collegiality amongst all of our members and to those who seek training and mentorship. We must absolutely assure that renewed NHLBI postgraduate vascular medicine training support is re-established. In 2015, we are not now training even a ‘replacement cadre’ of academic vascular medicine faculty. We must support the creation of effective new pharmacologic, behavioral (including exercise-based), preventive and therapeutic interventions, and invasive therapeutic options. We must continue to adjudicate evidence-based guidelines and assure that these vascular guidelines are applied in practice.
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Jeffrey W Olin, DO, MSVM 1999–2001 #6 … or, as my friends called me, ‘6’. Does anyone remember who the sixth president of the United States was? That’s right, John Quincy Adams (JQA), son of the former president #2 John Adams. What was JQA known for? He sought to modernize the American economy and promote education. John Quincy Adams played a key role in paying off a large portion of the national debt. Sound familiar? In my days, 1999–2001, we had more money than we knew what to do with (i.e. we modernized the SVM economy). But let’s be clear, I do not take credit for any of this. The money was raised by others, and I just happened to be treasurer and president when we were flush. You have already heard about the educational efforts of the Society from those who came before me and those after me. The thing I am most proud of is our Society’s role in education. We educate trainees, doctors in the community, and, most importantly, the public. In JQA’s days, they arrived at the presidency much in the way that all of us did: by giving years of service to a cause we greatly believe in. By the time we (as in all of the past presidents) were president, we had served on the board of trustees for several 2-year terms, followed by terms as secretary, treasurer, president-elect, president (and then pastpresident), each for 2 years. That is a minimum of 14 years of intense service for a very good cause. Besides the fact that I was president 15 years ago (who can remember details from 15 years ago?), it is very difficult to remember exactly what I did during the 2 years of my presidency as opposed to when I was president-elect (17 years ago), or treasurer (19 years ago), or a board member (21 years ago). For me, it was a continuum. Like a continuous variable as opposed to a dichotomous variable. I had some role in all of the things we did at some point. I was president-elect when Alan Hirsch was president (we made a very strong team) and past-president when Jonathan Halperin was president. So you can see, I was between two hard-working, brilliant physicians. How can I remember what I did? I look at it as ‘what we did’. In my first presidential address, entitled ‘Society for Vascular Medicine and Biology: A Vision for the Future’, I began with a quote from a southern, black, uneducated abolitionist; a woman who I admire greatly4: We ain’t where we wanna be, We ain’t where we oughta be, We ain’t where we gonna be, But we sure ain’t where we was. Sojourner Truth (1797–1883)
Essentially she was saying that she and her people accomplished a lot but they were nowhere near where they would like to be. In 1997, when I was president-elect, SVMB was the host to the Royal Society of Angiology for the first transatlantic inter-society vascular medicine meeting in Boston. In 1999, the 2nd transatlantic inter-society vascular medicine meeting took place in Edinburgh, Scotland
and was jointly sponsored by SVMB, the Royal Society of Angiology and the Swedish Society for Vascular Medicine. In 1999 and 2000, five societies participated in the Vascular Centers of Excellence Conference in Chicago sponsored by the SVMB, ACC, SVS, ISCVS (International Society of Cardiovascular Surgeons) and SIR (Society of Interventional Radiology). I still smile (actually laugh) when I think of what went on at some of those meetings. Under the leadership of Alan Hirsch, we received an unrestricted educational grant from Otsuka Pharmaceutical (makers of Pletal®) to produce the PAD Primary Care series. We had a lot of money and a small number of people (as compared to other societies), yet we were making a big difference. Also around this time, Mark Creager, the founding Editor-in-Chief of Vascular Medicine, elevated the level of the journal: we were indexed and had a worldwide distribution. We accomplished a lot, but not nearly enough. In my second presidential address, I asked the question: ‘Is Vascular Medicine a Viable Specialty’?5 It was at this time my entire thinking about vascular medicine changed. The ABIM did not want another specialty, as their influence as general internists had been eroded over the years by specialization and sub-specialization. It was then that I realized: if we want to survive, we will have to do it as a sub-specialty of cardiovascular medicine. And in the 15 years that have gone by, that is exactly what has happened. Everyone in the cardiology community knows what vascular medicine is. The AHA has a council on peripheral vascular disease and the ACC has a significant portion of its scientific program on vascular medicine. The president-elect (Mark Creager) of the AHA is a vascular medicine specialist! So all is good – and while it could be better, ‘we sure ain’t where we was’.
Michael R Jaff, DO, MSVM 2003–2005 My time as president of the SVM was during the golden era of vascular medicine. SVM membership was growing, competition between procedural specialists was starting to heat up, and opportunities for the SVM to have a lasting impact on the patients we all served took center stage. First, after learning everything I knew from my predecessor, Jonathan Halperin, the two of us successfully pursued a series of three peer-reviewed monographs in Circulation on the topic of venous thromboembolic disease.6 These were labeled as Society for Vascular Medicine (and Biology) publications, and brought great notice and a solid income stream to the SVM. The SVM also became supporters and authors of the first multi-specialty position paper on carotid artery stenting.7 Second, was the clear need to establish board certification in vascular medicine. A small group of us investigated how other specialties had accomplished this, and we decided to pursue this as an independent, freestanding board. The SVM could not own this, based on the obvious conflict. Bruce Gray and I hired an attorney who had experience with this, and we incorporated the American Board of Vascular Medicine (www.vascularboard.org). That was
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Creager et al. an exciting moment, but the hard work was yet to come. We needed to recruit experts to develop the first examination. When I think of some of the greats who helped write the first exam, the name that rises to the top was Norman Hertzer, MD, the Emeritus Chief of Vascular Surgery at the Cleveland Clinic, and someone who trained me how to think about vascular surgery. Of course the giants of vascular medicine were active participants, but Dr Hertzer, who did not have to volunteer his time, stepped in and made his mark on the process and content of the ABVM exams. The ABVM exams (both general and endovascular) have performed so well that we are now embarking on recertification. Thanks to the efforts of many, we are knocking on the door of both the American Board of Medical Specialties and the American Osteopathic Board of Internal Medicine to gain specialty recognition, with our fingers tightly crossed. During my tenure, the SVM also continued to support the VDF, a public advocacy and awareness organization represented by all specialty organizations with an interest and commitment to patients with vascular diseases. The SVM always had a major role in the VDF, with several of our presidents serving as presidents of the VDF. During my term as SVM president, I secured the largest single grant to the VDF. One of my greatest professional career highlights was working with the SVM board of trustees to steer the ship in the direction of establishing vascular medicine as a specialty to be reckoned with in the management of patients with vascular disease.
John P Cooke, MD, MSVM 2005–2007 I served the Society from 2005 to 2007, and my thoughts on this period have previously been published in our Society journal.8 The mission of our Society has been, and always will be, to improve the recognition and care of vascular diseases; to foster education and research in vascular medicine; and to provide leadership regarding issues related to vascular health. Although this mission had been served very well by a happy few, I felt that we needed to draw upon a larger group of our members, and to create the Society leaders of the future. To channel that potential energy in a way that served the Society, I introduced a comprehensive committee structure, as well as regular meetings with milestones and timelines. That organization operated very well indeed, thanks to the inspired work of the committee chairs and members. Our Membership Committee, led by Josh Beckman, increased our membership numbers by 76%. Michael Jaff and his committee members successfully filled the coffers of the Society. Heather Gornik led our Advocacy Committee, together with Alan Hirsch and his Committee on Inter-societal Relations (and his work through the VDF and PAD Coalition). One of their victories came on 3 August 2006 when the Senate passed a resolution designating 18–22 September 2006 as National Peripheral Arterial Disease Awareness Week. Passage of this resolution coincided with
the launch of the first national awareness campaign (the ‘Stay in Circulation’ campaign) to increase public and health care provider awareness about PAD. Another mechanism for influencing the field is through the creation of scholarly and thoughtful documents regarding guidelines and best practices. James Froehlich led our Communications Committee, which produced and/or reviewed about 24 position papers during my tenure. The ABVM held its first certifying exams in September 2005 and again in 2006. In its first 2 years, over 500 individuals took these national examinations in general vascular medicine and/or endovascular medicine. The successful launch of the ABVM represented a watershed moment for vascular medicine, providing validation for our sub-specialty. The inception of the ABVM began with a bold decision in 2004 by then President Michael Jaff and the Trustees to invest $300,000 in the formation of the ABVM. Bruce Gray worked tirelessly to organize the ABVM, to oversee its administration, and to execute the certifying examinations in Vascular and Endovascular Medicine. To honor the individuals that create value for the Society and for our discipline, I created the honorary title of ‘Master of the Society for Vascular Medicine (MSVM)’. The vigor of our Society depends upon the unflagging commitment and thoughtful leadership of these individuals. The first MSVM recipients were Drs Michael Jaff, Mark Creager, and Alan Hirsch. During my tenure, I felt that the name of our Society needed to be modified to reflect the changes taking place in the field and within our Society. The trustees were unanimous in their support for the name change, and a clear majority of the fellows voted to approve. We dropped the words ‘and Biology’ from the title of our Society. This was by no means a retreat from the research mission of the Society. The name change reflected our view that vascular medicine includes all aspects of research, including clinical, translational, as well as basic vascular biology. Another reason to drop the ‘B’ was to acknowledge the changing composition of our constituency, who are largely endovascular and general vascular practitioners. Nevertheless, there will always be vascular biologists amongst our membership, and I count myself as one.
Thom Rooke, MD, MSVM 2009–2011 The president of the SVM serves the membership by addressing problems that concern either (1) the Society itself, or (2) the specialty of vascular medicine. During my tenure I had the opportunity to do both. Problems facing the SVM. When I became president in 2010, the pillow fight we’d been waging against the economic recession abruptly morphed into a battle for survival – one we might not win. Corporate sponsorship from drug and device companies was drying up; worse, it was clear that the financial support we had received from industry in the past wouldn’t be returning to previous levels. Our financial trajectory demanded an urgent, radical change in SVM
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Joshua A Beckman, MD, MSVM 2011–2013
Figure 3. President Rooke addressing the Society membership in 2010.
operations. During my presidential address to the membership in 2010 (Figure 3), I carefully explained our situation (we’re going broke) and offered my vision of the future (… we’re gonna pay a lot, lot more, and spend a lot, lot less …). It was well received (Figure 4). However, with the help of our management firm (The Sherwood Group, Deerfield, IL, USA) we initiated a painful financial restructuring process (one that increased dues, decreased meeting expenses, eliminated the presidential limousine, etc.). The process would accelerate in President Beckman’s following term. Problems facing the specialty of vascular medicine. In 2011, I climbed atop the presidential soapbox and addressed a personal concern (side note: that’s the best part about being president—you get to address your personal concerns and people are forced to listen). My issue involved medicine’s continuing fixation on ‘science’ over ‘art’. I’m a strong believer that the optimal practice of vascular medicine requires a balance between these distinct aspects (seriously, don’t we all believe this to be true?), but I worry that some of our membership – especially the young ones who’ve trained entirely in the ‘evidence-based era’ – can become so focused on the science aspects that they don’t fully appreciate the importance of the ‘art’ in medicine. (Who can blame them? We have countless guidelines to learn and follow, board exams to pass, and Vascular Jeopardy contests to win.) But we live in a real world. What happens when the evidence turns out to be wrong (and it will be wrong a lot of the time)? How do you know that the available evidence is relevant for your patient? What if good evidence simply isn’t available (as may be the case for the various rare or uncommon diseases that vascular specialists often encounter)? The 2011 presidential address on the importance of ‘Common Sense’ (which I delivered at the Boston meeting while dressed as Thomas Paine) served as a gentle reminder that ‘evidence-based medicine’ is a worthy goal, but right now it can’t replace logic, experience, or humanity— especially in those situations for which randomized clinical trials, meta-analyses, etc., are unavailable or don’t apply. And that, it seems, is still the biggest part of vascular medical practice.
By 2011, SVM had ensconced itself well in the national vascular landscape, participating in the building of our specialty by increasing its visibility, becoming the premier source of vascular education, and working to move towards ABIM certification for vascular medicine specialists (Table 2). However, it was at this same moment that SVM began to feel the effects of severe financial constraints. Pharmaceutical support for continuing medical education declined by more than 40% over the course of the previous 6 years (Figure 5) and SVM was facing great difficulties affording the goals of our Society. As a result, in 2012, SVM leadership, including our board of trustees, conducted a strategic planning session to define our core mission, reorganize our finances, create a 12–18 month plan of projects, and set a path to achieve our long-term goals. We put all of our energy towards two goals: to be the leading source of vascular education and to achieve ABIM certification. From 2011 to 2013, the Society struggled, like many of the smaller medical societies, but we leaned harder on our membership and found new ways to fund the programs necessary to advance our mission. These were the steps necessary for survival. In the process, we came together as a society, recognizing that we are the reason that we struggle and we are the reason we will succeed.
James B Froehlich, MD, FSVM 2013–2015 So, if you have persevered and read this far, you’ve heard about the ups and downs, expectations and plans, successes and failures—all of which can also be summed up in one word: progress. This brings us to me, the current and 13th presidency of the SVM, and the very exciting celebration of our 25th anniversary (Figure 6). It’s been a journey of selfinvention, reinvention, and increasing self-awareness. Along the way we’ve learned two important things. First, we have a unique and important voice in the field of medicine. Second, we have used it effectively to disseminate information and educate about vascular medicine, as well as influence the care of patients with vascular disease. This is success by any measure. As I look at the Society today, and where we are going, I see great progress. Thanks to Thom Rooke and Josh Beckman’s leadership, over the past 5 years we have been working to re-define SVM, and to build on our foundations and rebellious adolescence. This has meant conceiving of the Society as much more than a great meeting of like minds, but rather to stretch our imaginations and begin new projects— even taking chances. We have made great progress, and learned much in the process, by petitioning the ABIM to recognize vascular medicine as a distinct specialty of internal medicine. Now, with our independence and identity well established, we are forging new partnerships with other societies. We have begun a partnership with the SVS in the creation of vascular medicine Quality Improvement registries.
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Figure 4. President Rooke addressing the Society membership in 2010. (Drawing reproduced with permission by Gene Bassett.)
Figure 5. Pharmaceutical support for continuing medical education by year. (Adapted from the Accreditation Council for Continuing Medical Education Annual Report Data – 2010.)
try partners as well as academic institutions to create opportunities for research and education. In reflecting on 25 years of the SVM, one cannot help but recognize that this is a rare thing we have here. There are few societies like ours in which members truly work in so much the same field. Through the many contributions and accomplishments described in the foregoing discussion, our members have shown themselves to be an organization of people whose dedication, intellectual curiosity, and camaraderie make this Society, other than my family, the group with which I am most proud to be associated. I would like to end with frequently quoted words defining success, often incorrectly attributed to Emerson. They were, in fact, penned by Bessie Anderson Stanley, of Lincoln, Kansas, a little over 100 years ago, in a slightly different form: Success To laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics and endure the betrayal of false friends; To appreciate beauty, to find the best in others; To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; To know even one life has breathed easier because you have lived.
Figure 6. A quorum of our past, present, and future presidents at the 2014 Scientific Sessions of the Society for Vascular Medicine, La Jolla, California. From left: John R Bartholomew, Jim Froehlich, Joshua Beckman, J Michael Bacharach, John Cooke, Alan Hirsch, Jeffrey Olin, Thom Rooke, Mark Creager. (Photograph provided by Lee Ann Clark.)
We have created a growing catalog of educational materials, webinars, and textbooks, which exemplify our dedication to the dissemination of medical knowledge related to vascular disease. And we have entered into collaborations with indus-
This is to have succeeded. Bessie Anderson Stanley (1879–1952)
As Bessie Stanley wisely observed, to leave the world a better place is the definition of success. As all of the foregoing discussions well described, the SVM has clearly succeeded. But it is important to remember that success is an ongoing process. Our next phase will be one in which we leverage the talent and expertise within our Society to broaden our mission, strengthen our voice, and continually turn SVM’s view outward. We have always
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known what a great and talented Society we have. We shall continue to share our knowledge and expertise, for that is our greatest mission, and the definition of our success. Acknowledgements The authors thank Ms Ellen Brinza and Ms Pamela Kreigh for editorial assistance in preparing this manuscript.
Declaration of conflicting interest The authors declare that there is no conflict of interest.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Hiatt WR, Creager MA, Cooke JP, Hirsch AT. Building a partnership between vascular medicine and vascular surgery: A coalition for the future of vascular care. J Vasc Surg 1996; 23: 918–925.
2. Labs KH, Dormandy JA, Jaeger KA, Stuerzebecher C, Hiatt WR. Trans-atlantic conference on clinical trial guidelines in PAOD (peripheral arterial occlusive disease) clinical trial methodology. Eur J Vasc Endovasc Surg 1999; 18: 253–265. 3. Norgren L, Hiatt WR, Jaff MR. Response to ‘Statement from the European Society of Vascular Surgery and the World Federation of Vascular Surgery Societies’ Inter-Society Consensus Document (TASC) III and International Standards for Vascular Care (ISVaC). Eur J Vasc Endovasc Surg 2014; 47: 461. 4. Olin JW. Presidential address: Society for Vascular Medicine and Biology: a vision for the future. Vasc Med 2000; 5: 205–207. 5. Olin JW. Presidential address: Is vascular medicine a viable specialty? Vasc Med 2001; 6: 129–131. 6. Jaff MR, Halperin JL. Series of monographs on venous thromboembolic disease. Circulation 2003; 107: I–2. 7. Rosenfield K, Babb JD, Cates CU, et al. Clinical competence statement on carotid stenting: Training and credentialing for carotid stenting—multispecialty consensus recommendations: a report of the SCAI/SVMB/SVS Writing Committee to develop a clinical competence statement on carotid interventions. J Am Coll Cardiol 2005; 45: 165–174. 8. Cooke JP. SVMB Presidential address: Vascular medicine: past, present and future. Vasc Med 2007; 12: 215–218.
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VMJ0010.1177/1358863X14566042Vascular MedicineCreager et al.
Special Article
The Society for Vascular Medicine: The first quarter century
Vascular Medicine 2015, Vol. 20(1) 60–68 © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1358863X14566042 vmj.sagepub.com
Mark A Creager1, William R Hiatt2, Alan T Hirsch3, Jeffrey W Olin4, Michael R Jaff 5, John P Cooke6, Thom Rooke7, Joshua A Beckman1 and James B Froehlich8
Abstract The Society for Vascular Medicine was founded in 1989. During the subsequent 25 years, the Society has grown to approximately 500 members and has achieved international recognition while making important contributions to vascular disease education, clinical vascular medicine and biology research, and patient care. In celebration of the Society’s 25th anniversary, its past and current presidents reflect on the Society’s history, challenges, and achievements, and emphasize the vital role of the SVM in the discipline of vascular medicine. Keywords vascular diseases, professional societies, vascular medicine
Mark A Creager, MD, MSVM 1993–1995 The Society for Vascular Medicine and Biology (SVMB), now known as the Society for Vascular Medicine (SVM), was founded by 13 physicians and scientists on 19 March 1989, at a meeting in Anaheim, California (Figure 1). We met with the expressed purposes of creating an organization that would: (1) integrate physicians and scientists to advance the discipline of vascular medicine; (2) provide a forum dedicated to the exchange of ideas, which would facilitate the translation and clinical application of research advances to improve prevention, diagnosis, and treatment of vascular diseases; and (3) be an outlet for vascular medicine education to enhance the knowledge of physicians caring for patients with vascular disorders. Over the ensuing months, we crafted the bylaws and incorporated the SVMB as a not-for-profit corporation in the state of Ohio. Our mission statement adhered to our founding principles and included the following: • To promote and advance the field of vascular medicine and biology, and to maintain the highest standards of practice, research, education, and exchange of scientific information. • To stimulate the formation of fellowship training programs in vascular medicine and research, and the teaching of these disciplines to medical schools and house officer training programs. • To provide consultation to educational institutions, government agencies, and other such organizations.
The strength and vitality of the SVMB stemmed from the leadership of its initial presidents, each of whom was a respected and accomplished vascular medicine physician. The first president of the SVMB was Jess R Young, who served from 1989 to 1991 (Table 1). Jess was Chairman of the Department of Vascular Medicine at the Cleveland Clinic. During his tenure, we built a membership structure. We held our first two scientific meetings: the first took place in March 1990 in New Orleans, Louisiana and was attended by 40 members and guests; the second took place Atlanta, Georgia, in March 1991. Both meetings occurred in geographic and temporal proximity to the annual meeting of the American College of Cardiology (ACC). We
1Brigham
and Women’s Hospital, Harvard Medical School, Boston, MA, USA 2University of Colorado School of Medicine, Denver, CO, USA 3University of Minnesota, Minneapolis, MN, USA 4Mt Sinai Medical School of Medicine, New York, NY, USA 5Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 6Houston Methodist Research Institute, Houston, TX, USA 7Mayo Clinic, Rochester, MN, USA 8University of Michigan, Ann Arbor, MI, USA Corresponding author: Mark A Creager, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA Email: [email protected]
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Figure 1. The founding of the Society for Vascular Medicine and Biology in Anaheim, California on 19 March 1989. From left: Drs Alan Hirsch, Marvin Sachs, Philip (Jack) Osmundson, Jay Coffman (then President-Elect), Jess Young (then President), Mark Creager, Michael Weber,Victor Dzau, John (Jack) Spittel Jr, John Joyce, John P Cooke, Sheldon Sheps, James Sowers. (Photograph provided by John P Cooke.) Table 1. Presidents of the Society for Vascular Medicine. Jess R Young, MD, MSVM Jay D Coffman, MD, MSVM Mark A Creager, MD, MSVM William R Hiatt, MD, MSVM Alan T Hirsch, MD, MSVM Jeffrey W Olin, DO, MSVM Jonathan L Halperin, MD, MSVM Michael R Jaff, DO, MSVM John P Cooke, MD, MSVM J Michael Bacharach, MD, MPH, MSVM Thom Rooke, MD, MSVM Joshua A Beckman, MD, MSVM James B Froehlich, MD, FSVM John R Bartholomew, MD, FSVM
1989–1991 1991–1993 1993–1995 1995–1997 1997–1999 1999–2001 2001–2003 2003–2005 2005–2007 2007–2009 2009–2011 2011–2013 2013–2015 President-Elect, 2015–2017
launched an official journal, the Journal of Vascular Medicine and Biology, under the stewardship of Victor Dzau, and we contributed to the formation of the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL), now the Intersocietal Accreditation Commission (IAC), as a founding member society. The SVM Outstanding Vascular Medicine Educator Award, bestowed at our annual scientific sessions each year, is named in honor of Jess Young. The second president of the SVMB was Jay D Coffman, who served from 1991 to 1993. Jay was Professor of Medicine at the Boston University School of Medicine and Chief of the Peripheral Vascular Disease Section at University Hospital (now Boston Medical Center). During Jay’s tenure, the SVM membership grew, and two more annual meetings occurred. One took place in March 1992, at the Mayo Clinic, as we sought to move our venue to members’ institutions to highlight local scientific accomplishments and clinical programs. The next, our fourth scientific
session, occurred in October 1993, and was hosted by the Cleveland Clinic; it included scientific and case presentations from the Cleveland Clinic faculty, and, for the first time, live cases in the vascular laboratory and interventional suite. Jay led by example. He was the consummate mentor and role model, a clinician scientist who devoted his career to the ideal of translating research findings directly to the care of patients. The SVM Young Investigator Awards, also bestowed annually at our annual scientific sessions, is named in his memory. My presidential term, from 1993 to 1995, followed in the footsteps of these two great men. Our progress toward our mission continued. In June 1994, we held our fifth annual meeting in Seattle, Washington alongside the meeting of the Society for Vascular Surgery (SVS), to foster more collaboration between the two organizations. Though still modest, our meeting was growing, and we had 80 attendees, including 60 members of the SVMB and 20 guests from the SVS. Our sixth annual meeting was held in June 1995 in New Orleans, alongside the SVS meeting, and followed the same format as we sought to build interdisciplinary collaboration. Also, in line with our mission to provide consultation to educational institutions, government agencies, and other such organizations, in 1995 we organized and participated in an international symposium called ‘Pharmacotherapy of Claudication: A New Frontier for Vascular Therapies’. This was the first time an entire meeting was devoted to the research, development and release of pharmacologic agents to treat patients with peripheral artery disease (PAD). The Journal of Vascular Medicine and Biology ceased publication in 1994, based on a business decision by the publisher, Blackwell Scientific Publishing. Fortunately, following my term in office, we were able to initiate a new journal, Vascular Medicine, in 1996 with Arnold Publishers, and now with Sage Publications. I was privileged to serve as its editor for 18 years. The journal further established the important role the SVM has in advancing the field of vascular medicine and biology, and in maintaining the highest standards of education and exchange of scientific information. Twenty-five years ago, the founders of SVM(B) hoped that an organization dedicated to vascular medicine would make substantial impact on the field, by promoting science, education and care delivery. We may not have envisioned the great advancements in science and technology that since have been translated and implemented to treat vascular diseases and improve vascular health. We were prescient enough, however, to realize the important contributions that our Society would make in the discipline of vascular medicine through promulgation of new knowledge, education, training, professional development, and implementation of evidenced-based standards of care, and for that we can all be proud.
William R Hiatt, MD, MSVM 1995–1997 During my tenure, there were 171 paying members, significant funding from both the NIH and industry and the Society was growing and financially viable. During those
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Table 2. Selected recent achievements and ongoing initiatives of the Society for Vascular Medicine (2009–2015). • Maintenance of financial solvency in the setting of declining industry report for continuing medical education • Growth of the American Board of Vascular Medicine (ABVM) examinations in general and endovascular medicine • Participation in inter-societal scientific statements, clinical practice guidelines (e.g. lower extremity peripheral artery disease, extracranial cerebrovascular disease, thoracic aorta disease, perioperative guidelines), and appropriate use documents • Development of joint vascular and endovascular medicine board review course with VIVA Physicians • Creation of a vascular medicine-based maintenance of certification (MOC) module • Leadership in accreditation of vascular laboratories, carotid stenting facilities, and venous disease treatment facilities through the Intersocietal Accreditation Commission (IAC)
early days of the Society, I set a priority of collaborative relationships with other vascular societies, particularly the SVS. It seemed that our interests were quite overlapping and that each could add value to the other’s meeting, which would further a productive relationship between the societies. Therefore, during those years, the SVS and SVM had parallel meetings, as well as cross-collaboration in terms of speakers and symposia.1 At the time, this collaboration worked quite well. However, subsequent to my tenure the leadership of the SVM decided that it was logistically challenging to continue such pairing, and, in the interest of creating a separate identity, ultimately split from these associative meetings, which in retrospect was an appropriate decision and direction. Also in the mid-1990s several collaborative projects (Figure 2) were moving forward on an international basis. During the mid- to late-1990s the first transatlantic society consensus document was being crafted. This was led by Professor John Dormandy from London and Professor Robert Rutherford from my institution here at the University of Colorado, both academic vascular surgeons. The initial drafting of this multi-disciplinary, multinational guideline included representatives from vascular surgery, interventional radiology, cardiology/interventional cardiology and vascular medicine. This collaboration was quite successful and at the time seemed to distinguish the vascular societies as being collaborative compared with other organizations in cardiovascular medicine. Also at that time we published an early version of the international guidelines for clinical trials in PAD that included the Food and Drug Administration (FDA), the European Medicine Agency (EMA), and European and US representatives.2 These were exciting times as vascular medicine was growing and differentiating. We were targeting not just our unique clinical practice and expertise, but also trying to create an international environment to foster clinical research activities, to further define new therapeutics and move the scientific basis for clinical care forward. What subsequently happened was continued collaboration through the early 2000s but then over the last several years splits have arisen, particularly in international guidelines, that led to the departure of the vascular surgeons from the TASC III development.3 Thus, our later years have been characterized more as lack of consensus than an ability to achieve consensus. As a result, looking back over the past two and a half decades it is quite apparent that SVM represents a critically important aspect of not just vascular care, but
medical care in general. It is right and proper for our Society to represent our discipline on a stand-alone basis and I fully support that direction taken many years ago. We should continue to focus on our unique clinical expertise, as well as our ability to provide unique educational and research opportunities. The most obvious source of continued inter-society conflict would be in the catheterization lab where the various interventional specialties may often clash, particularly around resource utilization and attempts at dominance of this aspect of clinical vascular care. While that in some ways is not shocking, it certainly is disillusioning compared with the collaborative days of 15 years ago. Nevertheless, our Society should continue to strive to maintain its differentiation and in particular seek American Board of Internal Medicine (ABIM) certification and focus on fellowships in vascular medicine and training the next generation.
Alan T Hirsch, MD, MSVM 1997–1999 As the fifth president of the SVM, I keenly felt the honor of being elected to lead our young vascular society. The concept of public (community) service had long been core to my career choices. Could SVM provide a unique service to support critical vascular public health needs? Beyond the words ‘vascular medicine’ and ‘biology’ in our 1997 societal name, exactly how would SVM channel the skills of its members to achieve our mission? Could it do so with financial integrity? I thought we might achieve our mission by focusing on satisfying key unmet clinical needs in the vascular knowledge marketplace. Historically, most vascular specialty societies were initially designed to ‘protect’ their specialty domain. This was certainly true in 1997. How could SVM achieve a different legacy and achieve recognition by offering a health contribution that was unique and indispensable? To this end, early in my presidency we began by petitioning the American Medical Association (AMA) to recognize vascular medicine as a ‘self-defined’ medical specialty. This may seem inconsequential, but in 1997 it was not. The AMA, ACC, American Heart Association (AHA), nor any other established health society or government agency recognized our existence. A key step toward the later creation of the American Board of Vascular Medicine (ABVM) was to achieve AMA recognition. We achieved this. Thereafter, both the ACC and the AHA provided – with impressive slowness – comparable recognition.
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Figure 2. Societal contributions and collaborative milestones during the first two decades of achievement of the Society for Vascular Medicine (1989–2009). Simultaneous advancements in medical therapy for vascular disease are shown. (Copyright © 2014 Cleveland Clinic. All Rights Reserved.)
We also chose to expand societal membership in a new way, welcoming all who supported our mission, including individuals from other disciplines. I urged that SVM create a ‘community of vascular health professionals’, thus providing co-equal societal leadership and privileges so that vascular medicine specialists, vascular nurses, vascular sonographers, radiologists and surgeons might find common mission. Our membership required engagement, and we discovered the one tool that has long been proven to be effective: free T-shirts. With humor, and for nearly a decade, we produced an ‘informative shirt’ that could be proudly worn to apprise the public and others who we were and what we stood for. In my day, we used every medium available to clarify our role to the nation. In order to tell our story and thus create a new and open societal community, and to provide wide access to our expertise, we created the first ever vascular societal web presence in 1997. In 1997, ‘html’ was new, Netscape was the ‘up-and-coming’ browser, and dial-up modems were used to connect. But, SVM was connected! I also believed that our members and our specialty were uniquely capable of helping this nation achieve two key goals that were not central to any other vascular society. I believed then, and still do, that we should work to: (1) provide the public with easy access to accurate, science-based vascular health information (vascular ‘health literacy’) and (2) provide health professionals with accurate, sciencebased knowledge of non-invasive (vascular medical) health information. Only via access to such knowledge can informed decisions, with adequate patient autonomy and cost-effectiveness, be made. Thus, we embarked on an effort to create the non-profit Vascular Disease Foundation (VDF) that served to combine the efforts of all vascular health professionals to create a broad-based, accurate, free health information campaign for the nation (Figure 2). For over 20 years, this Foundation linked industry, the National Heart, Lung, and Blood Institute (NHLBI), and the Centers for Disease Control and
Prevention with motivated vascular health professionals to serve the public. Loss of industry funding during the 2008 recession – representing a real tragedy of short-sightedness – has left our nation with no comparable informational recourse. The VDF structure will undoubtedly need to be re-created in the future. Finally, vascular medicine implies – by its name – the use of all diagnostic and therapeutic tools to improve health, beyond reliance on invasive care strategies. The heyday of pharmacologic discovery bloomed in the Society’s early days. These vascular ‘medicines’ included new claudication pharmacotherapies (cilostazol), cholesterol modifying agents (statins, niacin and others), antiplatelet medications (aspirin, clopidogrel, and glycoprotein IIb–IIIa receptor antagonists), antithrombotic medications (low molecular weight heparins), thrombolytic medications (streptokinase and tissue plasminogen activator), and the early study of angiogenic factors. We promoted an extremely active ‘knowledge marketplace’ to foster vascular drug discovery, clinical trial development, and international discussion of the implications for achievement of long-term quality outcomes (Figure 2). SVM is critical to national vascular health. The goals that we established in 1997 remain immutable today. We must assure we achieve sustained membership growth. Entire states, metropolitan areas, and health systems have no vascular medicine leadership. We must sustain collegiality amongst all of our members and to those who seek training and mentorship. We must absolutely assure that renewed NHLBI postgraduate vascular medicine training support is re-established. In 2015, we are not now training even a ‘replacement cadre’ of academic vascular medicine faculty. We must support the creation of effective new pharmacologic, behavioral (including exercise-based), preventive and therapeutic interventions, and invasive therapeutic options. We must continue to adjudicate evidence-based guidelines and assure that these vascular guidelines are applied in practice.
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Jeffrey W Olin, DO, MSVM 1999–2001 #6 … or, as my friends called me, ‘6’. Does anyone remember who the sixth president of the United States was? That’s right, John Quincy Adams (JQA), son of the former president #2 John Adams. What was JQA known for? He sought to modernize the American economy and promote education. John Quincy Adams played a key role in paying off a large portion of the national debt. Sound familiar? In my days, 1999–2001, we had more money than we knew what to do with (i.e. we modernized the SVM economy). But let’s be clear, I do not take credit for any of this. The money was raised by others, and I just happened to be treasurer and president when we were flush. You have already heard about the educational efforts of the Society from those who came before me and those after me. The thing I am most proud of is our Society’s role in education. We educate trainees, doctors in the community, and, most importantly, the public. In JQA’s days, they arrived at the presidency much in the way that all of us did: by giving years of service to a cause we greatly believe in. By the time we (as in all of the past presidents) were president, we had served on the board of trustees for several 2-year terms, followed by terms as secretary, treasurer, president-elect, president (and then pastpresident), each for 2 years. That is a minimum of 14 years of intense service for a very good cause. Besides the fact that I was president 15 years ago (who can remember details from 15 years ago?), it is very difficult to remember exactly what I did during the 2 years of my presidency as opposed to when I was president-elect (17 years ago), or treasurer (19 years ago), or a board member (21 years ago). For me, it was a continuum. Like a continuous variable as opposed to a dichotomous variable. I had some role in all of the things we did at some point. I was president-elect when Alan Hirsch was president (we made a very strong team) and past-president when Jonathan Halperin was president. So you can see, I was between two hard-working, brilliant physicians. How can I remember what I did? I look at it as ‘what we did’. In my first presidential address, entitled ‘Society for Vascular Medicine and Biology: A Vision for the Future’, I began with a quote from a southern, black, uneducated abolitionist; a woman who I admire greatly4: We ain’t where we wanna be, We ain’t where we oughta be, We ain’t where we gonna be, But we sure ain’t where we was. Sojourner Truth (1797–1883)
Essentially she was saying that she and her people accomplished a lot but they were nowhere near where they would like to be. In 1997, when I was president-elect, SVMB was the host to the Royal Society of Angiology for the first transatlantic inter-society vascular medicine meeting in Boston. In 1999, the 2nd transatlantic inter-society vascular medicine meeting took place in Edinburgh, Scotland
and was jointly sponsored by SVMB, the Royal Society of Angiology and the Swedish Society for Vascular Medicine. In 1999 and 2000, five societies participated in the Vascular Centers of Excellence Conference in Chicago sponsored by the SVMB, ACC, SVS, ISCVS (International Society of Cardiovascular Surgeons) and SIR (Society of Interventional Radiology). I still smile (actually laugh) when I think of what went on at some of those meetings. Under the leadership of Alan Hirsch, we received an unrestricted educational grant from Otsuka Pharmaceutical (makers of Pletal®) to produce the PAD Primary Care series. We had a lot of money and a small number of people (as compared to other societies), yet we were making a big difference. Also around this time, Mark Creager, the founding Editor-in-Chief of Vascular Medicine, elevated the level of the journal: we were indexed and had a worldwide distribution. We accomplished a lot, but not nearly enough. In my second presidential address, I asked the question: ‘Is Vascular Medicine a Viable Specialty’?5 It was at this time my entire thinking about vascular medicine changed. The ABIM did not want another specialty, as their influence as general internists had been eroded over the years by specialization and sub-specialization. It was then that I realized: if we want to survive, we will have to do it as a sub-specialty of cardiovascular medicine. And in the 15 years that have gone by, that is exactly what has happened. Everyone in the cardiology community knows what vascular medicine is. The AHA has a council on peripheral vascular disease and the ACC has a significant portion of its scientific program on vascular medicine. The president-elect (Mark Creager) of the AHA is a vascular medicine specialist! So all is good – and while it could be better, ‘we sure ain’t where we was’.
Michael R Jaff, DO, MSVM 2003–2005 My time as president of the SVM was during the golden era of vascular medicine. SVM membership was growing, competition between procedural specialists was starting to heat up, and opportunities for the SVM to have a lasting impact on the patients we all served took center stage. First, after learning everything I knew from my predecessor, Jonathan Halperin, the two of us successfully pursued a series of three peer-reviewed monographs in Circulation on the topic of venous thromboembolic disease.6 These were labeled as Society for Vascular Medicine (and Biology) publications, and brought great notice and a solid income stream to the SVM. The SVM also became supporters and authors of the first multi-specialty position paper on carotid artery stenting.7 Second, was the clear need to establish board certification in vascular medicine. A small group of us investigated how other specialties had accomplished this, and we decided to pursue this as an independent, freestanding board. The SVM could not own this, based on the obvious conflict. Bruce Gray and I hired an attorney who had experience with this, and we incorporated the American Board of Vascular Medicine (www.vascularboard.org). That was
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Creager et al. an exciting moment, but the hard work was yet to come. We needed to recruit experts to develop the first examination. When I think of some of the greats who helped write the first exam, the name that rises to the top was Norman Hertzer, MD, the Emeritus Chief of Vascular Surgery at the Cleveland Clinic, and someone who trained me how to think about vascular surgery. Of course the giants of vascular medicine were active participants, but Dr Hertzer, who did not have to volunteer his time, stepped in and made his mark on the process and content of the ABVM exams. The ABVM exams (both general and endovascular) have performed so well that we are now embarking on recertification. Thanks to the efforts of many, we are knocking on the door of both the American Board of Medical Specialties and the American Osteopathic Board of Internal Medicine to gain specialty recognition, with our fingers tightly crossed. During my tenure, the SVM also continued to support the VDF, a public advocacy and awareness organization represented by all specialty organizations with an interest and commitment to patients with vascular diseases. The SVM always had a major role in the VDF, with several of our presidents serving as presidents of the VDF. During my term as SVM president, I secured the largest single grant to the VDF. One of my greatest professional career highlights was working with the SVM board of trustees to steer the ship in the direction of establishing vascular medicine as a specialty to be reckoned with in the management of patients with vascular disease.
John P Cooke, MD, MSVM 2005–2007 I served the Society from 2005 to 2007, and my thoughts on this period have previously been published in our Society journal.8 The mission of our Society has been, and always will be, to improve the recognition and care of vascular diseases; to foster education and research in vascular medicine; and to provide leadership regarding issues related to vascular health. Although this mission had been served very well by a happy few, I felt that we needed to draw upon a larger group of our members, and to create the Society leaders of the future. To channel that potential energy in a way that served the Society, I introduced a comprehensive committee structure, as well as regular meetings with milestones and timelines. That organization operated very well indeed, thanks to the inspired work of the committee chairs and members. Our Membership Committee, led by Josh Beckman, increased our membership numbers by 76%. Michael Jaff and his committee members successfully filled the coffers of the Society. Heather Gornik led our Advocacy Committee, together with Alan Hirsch and his Committee on Inter-societal Relations (and his work through the VDF and PAD Coalition). One of their victories came on 3 August 2006 when the Senate passed a resolution designating 18–22 September 2006 as National Peripheral Arterial Disease Awareness Week. Passage of this resolution coincided with
the launch of the first national awareness campaign (the ‘Stay in Circulation’ campaign) to increase public and health care provider awareness about PAD. Another mechanism for influencing the field is through the creation of scholarly and thoughtful documents regarding guidelines and best practices. James Froehlich led our Communications Committee, which produced and/or reviewed about 24 position papers during my tenure. The ABVM held its first certifying exams in September 2005 and again in 2006. In its first 2 years, over 500 individuals took these national examinations in general vascular medicine and/or endovascular medicine. The successful launch of the ABVM represented a watershed moment for vascular medicine, providing validation for our sub-specialty. The inception of the ABVM began with a bold decision in 2004 by then President Michael Jaff and the Trustees to invest $300,000 in the formation of the ABVM. Bruce Gray worked tirelessly to organize the ABVM, to oversee its administration, and to execute the certifying examinations in Vascular and Endovascular Medicine. To honor the individuals that create value for the Society and for our discipline, I created the honorary title of ‘Master of the Society for Vascular Medicine (MSVM)’. The vigor of our Society depends upon the unflagging commitment and thoughtful leadership of these individuals. The first MSVM recipients were Drs Michael Jaff, Mark Creager, and Alan Hirsch. During my tenure, I felt that the name of our Society needed to be modified to reflect the changes taking place in the field and within our Society. The trustees were unanimous in their support for the name change, and a clear majority of the fellows voted to approve. We dropped the words ‘and Biology’ from the title of our Society. This was by no means a retreat from the research mission of the Society. The name change reflected our view that vascular medicine includes all aspects of research, including clinical, translational, as well as basic vascular biology. Another reason to drop the ‘B’ was to acknowledge the changing composition of our constituency, who are largely endovascular and general vascular practitioners. Nevertheless, there will always be vascular biologists amongst our membership, and I count myself as one.
Thom Rooke, MD, MSVM 2009–2011 The president of the SVM serves the membership by addressing problems that concern either (1) the Society itself, or (2) the specialty of vascular medicine. During my tenure I had the opportunity to do both. Problems facing the SVM. When I became president in 2010, the pillow fight we’d been waging against the economic recession abruptly morphed into a battle for survival – one we might not win. Corporate sponsorship from drug and device companies was drying up; worse, it was clear that the financial support we had received from industry in the past wouldn’t be returning to previous levels. Our financial trajectory demanded an urgent, radical change in SVM
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Joshua A Beckman, MD, MSVM 2011–2013
Figure 3. President Rooke addressing the Society membership in 2010.
operations. During my presidential address to the membership in 2010 (Figure 3), I carefully explained our situation (we’re going broke) and offered my vision of the future (… we’re gonna pay a lot, lot more, and spend a lot, lot less …). It was well received (Figure 4). However, with the help of our management firm (The Sherwood Group, Deerfield, IL, USA) we initiated a painful financial restructuring process (one that increased dues, decreased meeting expenses, eliminated the presidential limousine, etc.). The process would accelerate in President Beckman’s following term. Problems facing the specialty of vascular medicine. In 2011, I climbed atop the presidential soapbox and addressed a personal concern (side note: that’s the best part about being president—you get to address your personal concerns and people are forced to listen). My issue involved medicine’s continuing fixation on ‘science’ over ‘art’. I’m a strong believer that the optimal practice of vascular medicine requires a balance between these distinct aspects (seriously, don’t we all believe this to be true?), but I worry that some of our membership – especially the young ones who’ve trained entirely in the ‘evidence-based era’ – can become so focused on the science aspects that they don’t fully appreciate the importance of the ‘art’ in medicine. (Who can blame them? We have countless guidelines to learn and follow, board exams to pass, and Vascular Jeopardy contests to win.) But we live in a real world. What happens when the evidence turns out to be wrong (and it will be wrong a lot of the time)? How do you know that the available evidence is relevant for your patient? What if good evidence simply isn’t available (as may be the case for the various rare or uncommon diseases that vascular specialists often encounter)? The 2011 presidential address on the importance of ‘Common Sense’ (which I delivered at the Boston meeting while dressed as Thomas Paine) served as a gentle reminder that ‘evidence-based medicine’ is a worthy goal, but right now it can’t replace logic, experience, or humanity— especially in those situations for which randomized clinical trials, meta-analyses, etc., are unavailable or don’t apply. And that, it seems, is still the biggest part of vascular medical practice.
By 2011, SVM had ensconced itself well in the national vascular landscape, participating in the building of our specialty by increasing its visibility, becoming the premier source of vascular education, and working to move towards ABIM certification for vascular medicine specialists (Table 2). However, it was at this same moment that SVM began to feel the effects of severe financial constraints. Pharmaceutical support for continuing medical education declined by more than 40% over the course of the previous 6 years (Figure 5) and SVM was facing great difficulties affording the goals of our Society. As a result, in 2012, SVM leadership, including our board of trustees, conducted a strategic planning session to define our core mission, reorganize our finances, create a 12–18 month plan of projects, and set a path to achieve our long-term goals. We put all of our energy towards two goals: to be the leading source of vascular education and to achieve ABIM certification. From 2011 to 2013, the Society struggled, like many of the smaller medical societies, but we leaned harder on our membership and found new ways to fund the programs necessary to advance our mission. These were the steps necessary for survival. In the process, we came together as a society, recognizing that we are the reason that we struggle and we are the reason we will succeed.
James B Froehlich, MD, FSVM 2013–2015 So, if you have persevered and read this far, you’ve heard about the ups and downs, expectations and plans, successes and failures—all of which can also be summed up in one word: progress. This brings us to me, the current and 13th presidency of the SVM, and the very exciting celebration of our 25th anniversary (Figure 6). It’s been a journey of selfinvention, reinvention, and increasing self-awareness. Along the way we’ve learned two important things. First, we have a unique and important voice in the field of medicine. Second, we have used it effectively to disseminate information and educate about vascular medicine, as well as influence the care of patients with vascular disease. This is success by any measure. As I look at the Society today, and where we are going, I see great progress. Thanks to Thom Rooke and Josh Beckman’s leadership, over the past 5 years we have been working to re-define SVM, and to build on our foundations and rebellious adolescence. This has meant conceiving of the Society as much more than a great meeting of like minds, but rather to stretch our imaginations and begin new projects— even taking chances. We have made great progress, and learned much in the process, by petitioning the ABIM to recognize vascular medicine as a distinct specialty of internal medicine. Now, with our independence and identity well established, we are forging new partnerships with other societies. We have begun a partnership with the SVS in the creation of vascular medicine Quality Improvement registries.
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Figure 4. President Rooke addressing the Society membership in 2010. (Drawing reproduced with permission by Gene Bassett.)
Figure 5. Pharmaceutical support for continuing medical education by year. (Adapted from the Accreditation Council for Continuing Medical Education Annual Report Data – 2010.)
try partners as well as academic institutions to create opportunities for research and education. In reflecting on 25 years of the SVM, one cannot help but recognize that this is a rare thing we have here. There are few societies like ours in which members truly work in so much the same field. Through the many contributions and accomplishments described in the foregoing discussion, our members have shown themselves to be an organization of people whose dedication, intellectual curiosity, and camaraderie make this Society, other than my family, the group with which I am most proud to be associated. I would like to end with frequently quoted words defining success, often incorrectly attributed to Emerson. They were, in fact, penned by Bessie Anderson Stanley, of Lincoln, Kansas, a little over 100 years ago, in a slightly different form: Success To laugh often and much; To win the respect of intelligent people and the affection of children; To earn the appreciation of honest critics and endure the betrayal of false friends; To appreciate beauty, to find the best in others; To leave the world a bit better, whether by a healthy child, a garden patch or a redeemed social condition; To know even one life has breathed easier because you have lived.
Figure 6. A quorum of our past, present, and future presidents at the 2014 Scientific Sessions of the Society for Vascular Medicine, La Jolla, California. From left: John R Bartholomew, Jim Froehlich, Joshua Beckman, J Michael Bacharach, John Cooke, Alan Hirsch, Jeffrey Olin, Thom Rooke, Mark Creager. (Photograph provided by Lee Ann Clark.)
We have created a growing catalog of educational materials, webinars, and textbooks, which exemplify our dedication to the dissemination of medical knowledge related to vascular disease. And we have entered into collaborations with indus-
This is to have succeeded. Bessie Anderson Stanley (1879–1952)
As Bessie Stanley wisely observed, to leave the world a better place is the definition of success. As all of the foregoing discussions well described, the SVM has clearly succeeded. But it is important to remember that success is an ongoing process. Our next phase will be one in which we leverage the talent and expertise within our Society to broaden our mission, strengthen our voice, and continually turn SVM’s view outward. We have always
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known what a great and talented Society we have. We shall continue to share our knowledge and expertise, for that is our greatest mission, and the definition of our success. Acknowledgements The authors thank Ms Ellen Brinza and Ms Pamela Kreigh for editorial assistance in preparing this manuscript.
Declaration of conflicting interest The authors declare that there is no conflict of interest.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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2. Labs KH, Dormandy JA, Jaeger KA, Stuerzebecher C, Hiatt WR. Trans-atlantic conference on clinical trial guidelines in PAOD (peripheral arterial occlusive disease) clinical trial methodology. Eur J Vasc Endovasc Surg 1999; 18: 253–265. 3. Norgren L, Hiatt WR, Jaff MR. Response to ‘Statement from the European Society of Vascular Surgery and the World Federation of Vascular Surgery Societies’ Inter-Society Consensus Document (TASC) III and International Standards for Vascular Care (ISVaC). Eur J Vasc Endovasc Surg 2014; 47: 461. 4. Olin JW. Presidential address: Society for Vascular Medicine and Biology: a vision for the future. Vasc Med 2000; 5: 205–207. 5. Olin JW. Presidential address: Is vascular medicine a viable specialty? Vasc Med 2001; 6: 129–131. 6. Jaff MR, Halperin JL. Series of monographs on venous thromboembolic disease. Circulation 2003; 107: I–2. 7. Rosenfield K, Babb JD, Cates CU, et al. Clinical competence statement on carotid stenting: Training and credentialing for carotid stenting—multispecialty consensus recommendations: a report of the SCAI/SVMB/SVS Writing Committee to develop a clinical competence statement on carotid interventions. J Am Coll Cardiol 2005; 45: 165–174. 8. Cooke JP. SVMB Presidential address: Vascular medicine: past, present and future. Vasc Med 2007; 12: 215–218.
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