President's Report, August 2013
Richard N. Mitchell, MD, PhD
To the Members of the Society for Cardiovascular Pathology,
As the leaves begin to turn, and the calendar flips into fall, I hope that this finds you recharged from your summer vacations and ready to tackle the new academic year. Since the USCAP meeting in Baltimore in March, the SCVP has been quite active.
- Diagnostic and Prognostic Value of C4D Staining in Transplant Endomyocardial Biopsies: Gerald Berry
- Predicting the Development of Cardiac Allograft Vasculopathy: Michael Fishbein
- Novel Prognostic Tissue Markers in Congestive Heart Failure: James R. Stone
We will also be feting our 2014 Distinguished Achievement Award recipient, Dr. Jagdish Butany, who will tell us about the "Four Faces of Prosthetic Heart Valves" (Congratulations Jag!).
Important announcement about dues:
- Saturday educational session at USCAP with an SCVP social hour
- Access to the Members Only SecondSlide site where interesting cases are shown and shared
- Participation in cardiovascular pathology consensus documents
- Opportunity to meet and interact with global leaders in cardiovascular pathology
- Annual awards banquet
- Medicolegal matchmaking service
Since the March annual meeting, a handful of the SCVP leadership has developed a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) for our Society. This is attached as a Word document. The bottom line is that SCVP has a large number of strengths and opportunities; indeed, ours is a pathology specialty with extremely high clinical relevance, and we have robust long-standing affiliations with industry groups, device and therapeutics innovators, and forensic medicine. However, SCVP is also hampered by a perception that there's not much "new" in CV pathology, and its a specialty that can only rarely support a full-time FTE; most of us do something else in parallel with our CV pathology job. Consequently, it's increasingly difficult to attract younger pathologists and investigators lured by the siren song of neoplasia or other areas of pathology.
I think that we can help change that perception. There are three areas in particular that I think can become the equivalent of the "endomyocardial biopsy" in driving new enthusiasm (and recruits) for cardiovascular pathology.
On the first bullet point alone, we should be increasingly incorporating genetic analyses of entities that currently get only rather broad diagnoses. Thus, polymorphisms in dilated cardiomyopathy or mitral valve myxomatous degeneration; cytokine and inflammatory marker profiles in rejection or atherosclerotic plaque; and ion channel sequencing in patients with arrhythmias or sudden cardiac death should be routinely included along with the morphologic diagnosis. One might argue that such information currently has no therapeutic implication. However, this is where we take a page from the neoplasia playbook; pathologists performed immunohistochemical and genetic analyses years before there were targeted therapies, and it was probably that information that ultimately drove the ability to develop and target drugs. It is not unreasonable to suggest that knowing the genetic underpinnings of a dilated cardiomyopathy or even an atherosclerotic plaque may well make a difference in the subsequent medical management. To quote SCVP Councilor Mike Seidman:
"The role of autopsy in these contexts also becomes more clear, as we are well into the era of identifying germ line genetic predictors of phenotypes, even the most complex of them, and thus can contribute to informing surviving family members of their risk not just for Mendelian traits, but very soon also (admittedly more vaguely) for complex traits. The appeal of cardiovascular pathology to younger folk then becomes more clear...it is a field in its infancy with respect to translational research, and it specifically ALLOWS people to pursue a second subspecialty or area of interest, be that formal research, epidemiology, molecular genetic pathology, etc. Speaking as a trained cardiovascular and molecular genetic pathologist, I can say that interpretation of genetic variants pertaining even to Mendelian cardiac disease (cardiomyopathy, arrhythmia, etc.) is easier when the phenotype is better understood, and I think this will only become more true."
It is imperative that we find a way to compete with all the bells and whistles that make neoplasia pathology so attractive for trainees; it will be the best way to recruit new blood and bring new energy into our Society. Cardiovascular Pathology really does have the potential to be a specialty with wide-open opportunities for junior investigators and pathology trainees with interests in molecular biology, myocardial regeneration, and imaging. SCVP should help lead the way by educating ourselves in these areas, reaching out to the geneticists, radiologists, stem cell biologists, and engineers for collaborations, and encouraging up-and-coming residents and fellows to get additional training in these areas.
Each year at our annual meeting, there is a flurry of activity, enthusiasm, and best intentions as we focus (at least for a week-end) on the Society, and the opportunities that we have through the combined efforts and critical mass of such a dedicated group of talented pathologists. Much of this energy carries forward throughout the year with the consensus documents and CV tutorials that SCVP members help to generate; these bring rigor, uniformity, and reproducibility to cardiovascular diagnoses, and also provide the Society with national and international visibility and relevance. The Journal is also developing an expanding readership, with high quality manuscripts from leaders in the cardiovascular community increasingly being sent to Cardiovascular Pathology as a first stop, and not the "fall-back" option.
But.As the annual meeting recedes into the past, and as we all get back to our regular jobs and activities, SCVP matters often get put on a back burner. Grants, teaching, research, administration, writing---all the other things in our academic lives-vie for our attentions. This is not to advocate that SCVP should top our daily to-do lists, but difficult issues such as member recruitment, strategic partnerships with other Societies, and garnering stable industrial support for our academic mission require ongoing attention.
So.I invite you to participate in the discussion; this is a dialogue that's important to have for the health of our specialty. Specifically, please take a moment to send me an e-mail about:
With very best wishes, and I look forward to working with you.
Richard N. Mitchell, MD, PhD
President, Society for Cardiovascular Pathology