James C. Eisenach, M.D.
ASA Monitor 07 2016, Vol.80, 32-33.
James C. Eisenach, M.D., is F.M. James III Professor of Anesthesiology and Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
In April, Harold Varmus, Nobel Prize laureate for the discovery of oncogenes and former director of the National Institutes of Health, commented in Science on the transformation of oncology.1 He noted that, in the 1960s, oncology was largely separated from the rest of medicine, oftentimes into physically separate hospitals. It was a field that had stagnated, relying on morphologic description of tumors and resigned to mostly minimally effective treatments for conditions that were considered hopeless.
Imagine the transformation that has occurred in oncology from then to now, with vaccines to prevent cancer, biomarkers and screens for early cancer diagnosis. These are arguably the most sophisticated treatments in the family of medicine with personalized approaches based on rapid genetic analysis of the cancer. Oncology is a vibrant specialty, offering hope where none had existed and generating new knowledge that has led to a 1 to 2 percent per year reduction in cancer mortality for more than a decade.
Now consider anesthesiology today and its many advances over the past several decades. We are on the cusp of a similar transformation. Like oncology in the 1960s, the core of anesthesiology today is largely separated from the rest of medicine, physically segregated within the confines of procedural suites. Anesthetic drugs, techniques and monitors developed over the past 30-plus years have rendered death or major morbidity from anesthesia itself extremely rare. However, in some ways, the commonly held myopic view of patient safety confined to the few hours a patient spends in the procedural suite has led to stagnation of the specialty to the point that some question whether anesthesiology is the practice of medicine or a technical craft.
Yet it is without a doubt: Anesthesiology is the practice of medicine, a practice based on science and guided by scientific discovery. More than three decades of research defining the risks of the perioperative period beyond the confines of the procedural suite represent one of many indications that we are primed for transformation – not stagnation.
From postoperative cognitive dysfunction to myocardial infarction, stroke, acute kidney or lung injury, and chronic pain or opioid addiction after surgery, we not only have identified the magnitude of the problem, but we also have developed and increasingly replicated predictive tools to identify patients at risk.
Over the past 30 years, the Foundation for Anesthesia Education and Research (FAER) has become anesthesiology’s catalyst for transformation. Through its focus on academic career development and research support, FAER transforms people, patient care and, through the discovery and application of new scientific knowledge by its grantees, the clinical practice of anesthesiology.
An analysis of the scholarly productivity of former FAER grant recipients indicated that more than 40 percent have received subsequent NIH funding.2 This funding translates to ongoing improvements in medicine and demonstrates to our nation’s policymakers the value of anesthesiologists and anesthesiology research in advancing patient health and safety. It means that FAER grantees have made substantial contributions to the working knowledge of how we practice anesthesia.
So whether you spend your time in the operating room, PACU, ICU, pain clinic or another setting, and whether you work in private or academic practice, your work is influenced by knowledge generated through scientific discovery, and it is quite likely that the person or people who generated that knowledge have received support from FAER during their careers.
FAER’s ability to transform medicine is in large measure a result of consistent support from ASA. Thanks to the significant contributions of ASA and our donors, FAER has been successful in helping develop the current generation of investigators who have brought us to where we are today and are chiefly responsible for advancing the daily clinical practice of every anesthesiologist.
But our work is not yet finished; we are still “on the cusp.” In many ways we control whether and how anesthesiology will be transformed in the next 30 years. Most important is taking medical ownership of this patient safety issue, with risks orders of magnitude greater than anesthetic deaths in the procedural suite. Surgeons and the other proceduralists focus primarily on patient selection, advancing procedural methods and reducing classic complications considered directly related to the procedure. Anesthesiologists resist the thought of taking ownership of the postoperative medical complications, considering that we are not responsible for the patient beyond PACU discharge. So surgery remains dangerous, with little or no progress in major morbidity or mortality in the past decade compared to significant progress in these measures in non-surgical patients with serious medical conditions.3
We control whether we apply the observational research of the past 30 years to participate more meaningfully in discussions of risks prior to surgery, and monitor more appropriately and consistently for major organ injury in the days following surgery. And we determine whether we raise general awareness of these all-too-common injuries that lead to 30-day perioperative mortality being the third-leading cause of death in the United States 4 and of morbidity that can lead to lifelong suffering.
And, critically, we decide whether we participate in the generation of new knowledge that transforms care in the specialty. Harold Varmus noted the dearth of federal support for research in oncology in the 1960s.1 Today the number of federal research dollars spent on oncology per cancer patient is substantially greater than that spent to understand and treat patients with chronic pain. Anesthesiology remains near the bottom of medical specialties in terms of federal research support.
Moving forward, to transform anesthesiology into a vibrant contributor to improve public health and patient safety within the family of medicine, we need to attract, develop and support the next generation of anesthesiology investigators in both clinical and basic science. This will require not only ASA’s continued support of FAER – both financially and through infrastructure – but also the support of ASA members.
You can transform anesthesiology, patient care and your clinical practice through support of scientific discovery and FAER. Learn about the latest scientific advances being discovered, apply that scientific knowledge to your daily practice, advocate for research and support the ASA’s premier research foundation – FAER – through your personal generosity. The act of giving demonstrates your commitment to the future of anesthesiology, a transformation we need in order for the specialty to thrive and for us to continue to improve the care of our patients.
Varmus H . The transformation of oncology. Science. 2016; 352(6282):123–123.
Pagel PS, Hudetz JA . Scholarly productivity and National Institutes of Health funding of Foundation for Anesthesia Education and Research grant recipients. Anesthesiology. 2015;123(3):683–691.
Wang Y, Eldridge N, Metersky ML, et al. National trends in patient safety for four common conditions, 2005-2011. N Engl J Med. 2014;370(4):341–351.
Bartels K, Karhausen J, Clambey ET, Grenz A, Eltzschig HK . Perioperative organ injury. Anesthesiology. 2013;119(6):1474–1489.