30 Years of Lung Day 1981-2011

David J Pierson MD Pulmonary & Critical Care Medicine Harborview Medical Center University of Washington June 17, 2011

30 Years of Lung Day • How the first Lung Day happened • What things were like at the time 

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The division; the fellowship  Diseases and their management  Medical education . of Lung Day Evolution  Formats; venues; topics; speakers  Logistics; sponsorship; industry relations Lung Day and the realities of today

Harry R Kimball MD • Medical residency UW 1962-4 • Medical Chief Resident UW 1967-8 • Trained in ID & pulmonary • Private practice,Yakima 1973-87 • Head, GIM, Tufts/NEMC 1987-91 • President ABIM 1991-2003 • Special Advisor to the Dean, UW School of Medicine, 2004 - present • WTS Pulmonary Hall of Fame, 2005

Faculty, UW Pulmonary Division ~1981 Culver

Ralph

Albert

Springmeyer

Martin

Pierson

Hlastala

Schoene

Butler

Not pictured: Lakshmi, Marini, Robertson

Hudson

Tyler

January 1981: What the World (and the Practice of Pulmonary Medicine) Was Like • No personal computers (for most of us), faxes, cell phones, email, or electronic medical records • No PubMed, UpToDate, or Power Point • No evidence-based medicine; CPGs; protocols • We had ICUs, Swan-Ganz catheters, and PEEP, but no pulse oximeters or integrated electronic monitors • No pressure support or flow-triggering • We didn’t know about auto-PEEP, VILI, or VAP • We saw a lot of barotrauma

ARDS Management At HMC in the 1980s

7 Chest Tubes

January 1981: What the World (and the Practice of Pulmonary Medicine) Was Like • No critical care boards • No DRGs, no HIPAA • For COPD, we had metaproterenol, isoetharine, and theophylline  No

albuterol, anticholinergics, ICS, or LABAs

 No

Medicare LTOT guidelines

 No

ATS or GOLD guidelines

 No

pulmonary rehab

• We were just learning about sleep apnea  No

nasal CPAP

January 1981: What the World (and the Practice of Pulmonary Medicine) Was Like • Infectious diseases had pretty much been controlled  Polio  Smallpox  Pneumonia  Tuberculosis

• No HIV-AIDS • No MRSA, VRE, multiple-resistance HAP-HCAP-VAP • No C difficile • No MDRTB

January 1981: What the World (and the Culture of Medicine) Was Like • Hospitals, clinics, and health insurance plans did not advertise directly to the public • It was considered unethical for physicians to advertise • Advertising for drugs and other medical products was aimed solely at physicians • Pharmaceutical representatives were an everyday presence in hospitals and physicians’ offices • Physicians worked long hours; the concept of fixed, assigned working hours existed only in a few nonclinical specialties and emergency rooms • There were no restrictions on resident work hours

History of PCCM as a Specialty Critical Care

PFTs

Sleep

Bronchoscopy

RT Tuberculosis

COPD

Lung Ca

HIV/AIDS

VAP/VILI

Other Infections

Asthma

Occ/Envir

ILD etc

New Infections

1950

1960

1970

1980

1990

2000

2010

First Lung Day, January 23, 1981 • Publicity, logistics, and record keeping handled by WAMI office • Included rounds with LDH & DJP • 60 attendees • Boehringer-Ingelheim furnished coffee and donuts • Lunch in International District

Third Lung Day, January 22, 1982 • Glaser Auditorium, Swedish Hospital • 5 lectures: – Brownie Schoene: Everest expedition follow-up – Steve Springmeyer: BAL — clinically useful? – Tom Robertson: VO2 and VCO2 during mechanical ventilation – Jerry Beekman: Hyperalimentation and weaning – Sam Hammar: Dx/Rx of SCLC

• 2 case conferences

Lung Day Venues • Harborview Hall 1981, 1981, 1982 • Swedish 1982 • UW CDMRC 1982 • UW Waterfront Activity Center – 6 times • SeaTac Red Lion – twice (ALAW-TB) • UW Center for Urban Horticulture  Every

Seattle Lung Day since 1988

 Today’s

conference is 26th time here

First 15 years of Lung Day: Outside Guest Speakers Peter Bates

Bob McCaffrey

Jim Russell

Julie Gerberding

Ken Moser

Marvin Sackner

Philip Hopewell

Louise Nett

Merle Sande

Steve Jenkinson

Paul Pepe

Marvin Schwarz

John Luce

Tom Petty

Irwin Ziment

Neil MacIntyre

Lee Reichman

Clifford Zwillich

First 15 Years of Lung Day: Non-PCCM UW Speakers Len Altman (all/immunol)

Rick Johnson (ID)

Dave Ashbaugh (thor surg)

Ron Maier (surgery)

Soo Borson (psychiatry)

Bob Pearlman (GIM)

Tom Edwards (anesth/pain)

Greg Redding (peds)

Dave Godwin (radiology)

Linda Rosenstock (occ med)

Hunter Handsfield (ID)

Val Rusch (surgery

John Harlan (heme-onc)

Ernie Weymuller (OTO)

Lung Day Themes (1st 15 years)

Interstitial lung disease

Tuberculosis (2)

Sleep apnea/respiratory drive

HIV/AIDS

Chronic lung disease

Ethics & the ICU

The pulmonary circulation

Critical care

Trauma and the lungs

Respiratory care

History of Lung Day • Semiannually 1981-1990 • Annually in June since 1990 • Today’s conference is: – 39th Seattle Lung Day – 52th overall

Lung Day and the Washington Thoracic Society Annual Conference • WTS conference was traditionally held in the fall, at rotating sites (eg, Port Ludlow, Lake Chelan, Winthrop). • Attendance dwindled during the 1980s. • 1990: A decision was made to combine winter Lung Day with WTS meeting. • January 1991: 1st joint conference held, at Enzian Inn, Leavenworth. • Jan 20-22, 2012: 22nd Leavenworth meeting.

“Pulmonary Jeopardy” - Lung Day 1995

Chairs, UW Department of Medicine 1981-2011

Philip J Fialkow, 1980-90

Paul G Ramsey, 1990-97

William J Bremner, 1998-present

Division Heads, PCCM, 1981-2011

John Butler 1965-1985

Leonard D Hudson 1985-2003

Robb W Glenny 2003-present

Division Portrait - Lung Day 2010

57 Faculty Members at 6 Locations

Direct-to-Consumer Advertising:

Hospitals

New York Times Magazine, June 5, 2011

Direct-toConsumer Advertising:

Hospitals

Seattle Times June 5, 2011

Direct-toConsumer Advertising:

Hospitals

Seattle Times June 6, 2011

Direct-to-Consumer Advertising: Individual Physicians

Newsweek, May 30, 2011

Direct-to-Consumer Advertising: Prescription Drugs

National Geographic, May 2011

1981-2011: The Changing Relationship between Medical Education and the Pharmaceutical Industry

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“Lilly bags” for all medical students Liver rounds Sponsored lunches Pharmaceutical reps in clinic, on wards, in doctors’ offices Ubiquitous pens, pads, etc Grand rounds  Coffee & donuts  Speakers

1981-2011: The Changing Relationship between Lung Day and the Pharmaceutical Industry

• Coffee and donuts • Lunch 

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The annual “dim sum dash” to the International District Speakers’ dinner Sponsoring outside speakers Educational grants for expenses Exhibits

Lung Day and Continuing Medical Education Credits

• Discussed repeatedly over the years • Category I credits have been included in WTS-hosted meetings, granted by ATS

• All CME credits for UW-hosted conferences must be issued by the UW CME office

• Lung Day would effectively become a CME course, run by the CME office 

Cost to attendees ~ $75-100 range

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Big changes for planners & speakers

Another Thing That Has Changed: The Syllabus

For This Year’s Syllabus (Power Points of Talks, etc): http://depts.washington.edu/pulmcc/conferences/lungday/index.html

How the Practice of Pulmonary and Critical Care Medicine has Changed Since 1981

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Lung-protective ventilation Spontaneous breathing trials Noninvasive ventilation Advances in imaging; interventional radiology Interventional pulmonology; EBUS Infection control Checklists Reducing sedation; mobilization

Lung Day After 30 Years • Critical care update • Clinical case conference • Making your ICU work better