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August 2005
Feature Story
I represent the College of American Pathologists, but I testify also
on behalf of the American Pathology Foundation, American Society for Clinical
Pathology, Association of Pathology Chairs, and Association for Molecular
Pathology. On behalf of our organizations, I strongly urge you to reject
the Department of Defense recommendation to close the Armed Forces Institute
of Pathology as part of a larger plan to relocate functions of the Walter
Reed installation in Washington, DC. I recognize you have a difficult
job to do. However, a decision to close the AFIP is no small matter. It
has far-reaching implications not only for the military but also for civilian
medicine and, as such, should be evaluated in a larger context than simply
its military function. I urge the commission to keep in mind that once
you dismantle 150 years of unmatched professional medical and scientific
expertise, there is no turning back.
The AFIP was established in 1862 as part of the Army Medical Museum to
serve as a repository for disease specimens obtained from Civil War soldiers.
In 1888, civilian medical professionals were allowed access to the museum’s
educational facilities—creating a nexus between its military and
civilian role that continues to this day. The AFIP’s mission is to support
the U.S. Department of Defense and serve the American people by providing
medical expertise in diagnostic consultation, education, and research
to enhance the health and well-being of the people it serves.
The Armed Forces Institute of Pathology is much more than its name implies.
It is much more than an Armed Forces medical facility and much more than
pathology. In fact, the institute is a sophisticated team of more than
800 military and civilian medical professionals capable of providing answers
to complex, difficult cases. What makes the AFIP unique and so valuable
is its broad range of expertise, spanning 22 subspecialty departments
in conjunction with the world’s largest tissue repository providing significant
research and education opportunities.
The recommendation to dismantle and retain, in piecemeal fashion, only
certain components of the AFIP and to warehouse its massive tissue repository
would deprive the medical community here and abroad of a virtually irreplaceable
resource for disease research and patient care. Throughout its history,
this national treasure of more than 3 million cases, 50 million paraffin
blocks, and 10 million formalin-fixed tissue specimens—many rare
and unusual—have helped us expand our knowledge of disease and given
rise to curative therapies for previously untreatable and often fatal
diseases. During the late 19th and early 20th centuries, staff of the
Army Medical Museum, which became the AFIP, conducted research on infectious
diseases that revealed the cause of yellow fever and contributed to development
of a vaccine for typhoid. In 1997, AFIP pathologists published a complete
genetic characterization of the 1918 Spanish influenza virus that killed
more than 20 million people worldwide, including 675,000 in America and
43,000 of our troops in Europe. This publication was based on tissue specimens
in the AFIP archives from a World War I soldier, and its findings are
critical to preventing a similar pandemic in the future.
AFIP research also played a role in the discovery that a rare gastrointestinal
tumor affecting 10,000 Americans annually could be treated with Gleevec,
a drug recently approved for treating leukemia. This discovery was the
direct result of studies done of tumors diagnosed at the AFIP and filed
in the tissue repository.
The AFIP also maintains 40,000 specimens in registries for POWs, Agent
Orange, and operations Desert Storm and Iraqi Freedom, among others. This
benefits thousands of our deployed forces and veterans by helping to identify
disease trends and long-term health effects associated with military service.
The tissue repository is now more important than ever because new DNA
technology allows us to conduct new studies—not possible before—using
patient specimens from the past. Such studies include the human genome
as well as thousands of specific genetic abnormalities. Think of the possibilities!
Unfortunately, the Department of Defense proposal allows only for the
repository to be stored. The proposal makes no provision for maintenance,
access to specimens, or the involvement of expert pathologists and others
needed to sustain this dynamic resource for future research and education.
Expertise in pathology is essential to effectively apply the wealth of
information to be gained from study of the repository’s materials.
Eliminating AFIP’s consultative services as contemplated by the Department
of Defense would adversely affect patient care. No longer would military
or civilian physicians be able to rely on the AFIP’s expertise for a definitive
diagnosis on their most difficult cases. Last year, AFIP pathologists
rendered a major change to the initial diagnosis in 1,086 cases, significantly
altering patient treatment and saving lives. Consults are provided by
leading pathologists in key specialties covering virtually every facet
of medicine imaginable, from infectious and parasitic disease to environmental
pathology, animal health, and toxicology. AFIP’s civilian mission is important
to its military function. For instance, civilian consults allow for the
collection of rare and unusual diseases that otherwise could not be examined
or compared in a meaningful way. The medical knowledge gained from the
AFIP’s civilian services can be applied in diagnosing members of the military
as well as addressing diseases in the field.
Going beyond traditional methods of consultation, the AFIP also operates
the world’s largest and most advanced telepathology diagnostic consultation
program. With 27 robotic microscopes at Army medical treatment facilities
around the globe, the AFIP provides deployed military physicians with
real-time diagnoses.
Also lost in closing the AFIP would be its prolific contributions to
training health providers from numerous specialties to be competent and
current in their field. The AFIP provided training and educational instruction
in 2004 to more than 7,400 medical and other professionals and awarded
more than 360,000 hours of continuing medical education. Because the AFIP
responds to consultations on thousands of difficult cases each year, it
is well positioned to provide educational opportunities that could not
be easily replicated elsewhere. For instance, the AFIP offers courses
using recent cases where a diagnosis was in question and concentrates
on how to reach a proper diagnosis. The AFIP offers live courses and seminars
as well as Internet courses. In fact, VA and military hospitals can connect
with the AFIP to receive video-teleconference lectures on a wide range
of topics. Simply put, the AFIP advances the knowledge and competency
of pathologists and other medical professionals and has long been the
center of civilian and military short- and long-term specialty fellowships.
Finally, the AFIP has a crucial role to play in homeland security. It
is one of the few facilities in the country with the capacity and expertise
to respond to a bioterrorist attack. This includes rapid diagnosis and
the know-how to manage infectious disease epidemics. AFIP scientists have
developed a new test to detect biological toxins such as cholera at subatomic
levels, far superior to those currently in use. The institute has also
collaborated with the private sector to develop a biothreat detector using
Raman spectroscopy. This system received the highest performance score
for a portable biothreat detector among those recently tested at the Johns
Hopkins Applied Physics Laboratory. Since Sept. 11, 2001, speculations
have centered on the manner of the next terrorist assault—not if
or when but how. Whatever form of bioterrorist attack, the AFIP has the
expertise to assist in a rapid understanding and diagnosis of the agent.
This important contribution to strengthening our nation’s ability to respond
to a biological attack will be lost if the AFIP is shut down.
In conclusion, the AFIP has a vital role to play in advancing medicine
and securing the homeland. To cast off key elements, such as the tissue
repository, and eliminate others would break the connections from which
the AFIP draws its strength as a nationally and internationally recognized
leader in medical research, education, and consultation. With this in
mind, the CAP urges the commission to reject the Department of Defense’s
recommendation. The fate of the AFIP should not be decided through the
Defense Base Closure and Realignment Commission process, but rather through
a broader discussion that takes into account all aspects of the AFIP mission.
The Defense Base Closure and Realignment Commission will report its
closure recommendations to the president in September. |
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