Home / About STS / STS 50th Anniversary

STS 50th Anniversary

Looking Back, Moving Forward


Walter H. Merrill, MD, Editor – May 2013

ALMANAC

Consider these notable events that occurred in the years these Presidential Addresses took place.

1986

On January 28, the Space Shuttle Challenger disintegrated 73 seconds after launch, killing the crew of 7 astronauts, including schoolteacher Christa McAuliffe.

1990

The Human Genome Project began this year and was completed in 2003.

The Hubble Space Telescope was launched aboard Space Shuttle Discovery on April 24.

“It is my firm belief that I have a link with the past and a responsibility to the future. I cannot give up. I cannot despair. There’s a whole future, generations to come. I have to keep trying.” – King Hussein

In “The Thoracic Surgical Industrial Complex” (Ann Thorac Surg 1986; 42:124-133), Dr. Albert Starr indicated that the greatest challenge of his time would be the development of the totally implantable heart. According to him, six basic forces shaped the thoracic industrial complex. “There are three positive forces—the pace of technological innovation, entrepreneurial activity, and the flow of capital into the system—and the three opposing forces—government regulation, cost-containment, and the excessive costs of product liability insurance.” He said that lower-risk devices were being developed “at the expense of implantable devices and with the development of the artificial heart weighing in the balance.” He then described four companies that “all sold out to larger companies, three primarily because of product liability problems and to some extent because of the increasing complexity of federal regulation.” As for sources of capital, they were government funding, research and development funds, venture capital, and public offerings. At that time, industry research and development was the source of $180 million.

After discussing the three negative forces, Dr. Starr shared his predictions for the future. He said that “immediate change in the system is unlikely.” One major advantage of the United States is the “huge, homogenous market” with a large number of people that speak the same language and have the same currency. He said that the artificial heart must “bypass the product liability problem.”

Dr. Starr concluded by stating that “the positive forces of technological innovation, entrepreneurial activity, and capital availability will ensure a future of opportunity and growth. The thoracic surgical industry will continue to be a source of great excitement to us and of benefit to our patients.”

In his Presidential Address, “Philosophy 1” (Ann Thorac Surg 1990;49:7-13), Dr. George G. Lindesmith told us that he was reminded to keep his message, “which is in large part philosophical, as understandable as possible.” He went on to say that caring and dedication “are noticeably absent from deliberations and treatises regarding us” and asked, “Does recent history contain a reason or reasons for this loss of prestige by our profession?” He answered his question by outlining the three reasons, which were the cost of care, public funding, and government involvement in the practice of medicine.

Dr. Lindesmith said that increases in physician fees lagged behind increases in the cost of living, and the increase in the total physician reimbursement was due to an increase in volume of service and administrative costs. He noted that since the involvement of Medicare and Medicaid, the “provision of medical care without charge is almost nonexistent in the private hospital.” With government involvement in medical care, there was a huge increase in the volume of patients and the volume of services used per patient. Another factor leading to the rising cost of medical care was administrative expenses.

He asked whether we, as a specialty, could influence change. His answer: Yes. We still have much popularity and esteem compared to other groups, and if we use it well, we can have enormous political clout.

Dr. Lindesmith concluded by highlighting the dedication and commitment required of thoracic surgeons, and noted that they are poorly understood by others. He mentioned the years of training required, the intensity of the work (which he speculated was accompanied by a reduced life expectancy), and the volunteerism exhibited by thoracic surgeons. He said that “thoracic surgeons are good, highly trained, appropriately motivated individuals who provide a caring, quality service that is of great value to our patients. We must continue to struggle collectively and individually for as long as is necessary to preserve the quality, integrity, and honor of our specialty.”


Previous Looking Back, Moving Forward columns: