Presented by Charles H. Emerson, M.D.
88th Annual Meeting of the American Thyroid Association
October 3-7, 2018
The American Thyroid Association: A Forum for Civil Discourse
Fellow members of the American Thyroid Association, welcome to our 2018 Annual Business Meeting. It has been a great privilege and pleasure to serve as your President during the past year and to meet you here in Washington DC for yet another gathering of our society. Presidential reports are a tradition for almost every organization and ours is no exception. In preparing this report I found it very interesting and informative to read those of my immediate predecessors. Like those in the past three years I am very grateful to Bobbi Smith and her superb staff, Adonia Coates Director of Meetings and Program Services, Sharleene Cano, Director, Publications and Membership, Kelly Hoff, Director Technology and Development, Josette Paige, Manager, Meetings and Finance, and Carrie Prewitt, Membership, Development and Technology Specialist for the smooth operation of the ATA and its continuing innovation and progress.
Going back to the 2015 ATA business meeting at Walt Disney World in Florida, President Robert Smallridge also recalled the growth of the ATA from the time in December 1924 when the Illinois Clinic Club created the American Association for the Study of Goiter (AASG) with 30 charter members. 35 years after its founding the AASG was renamed the American Thyroid Association, reflecting its base in Canada and the United States. Over the years we have achieved healthy growth in size and diversity of our membership. As of last month, we had 1789 members with 910 in the active category, 314 in the corresponding category and the rest in other categories. Among these are 25 in the allied health specialty group. This group includes nurse practitioners, physician assistants, pharmacists and clinical nurse specialists. While I am on the subject of allied health specialists I call you attention to the Bylaws amendment relating to this category to be voted on at this meeting as well as the First Annual ATA Advanced Practice Provider Satellite Symposium at 1:00 PM this coming Saturday. Returning to membership, we now have 23 active members who identify themselves as scientists. Most of the remaining members are physicians who engage in patient care. We are gratified that we have representation from 11 specialties and subspecialties. Our largest active members by specialty are 550 Endocrinologists, 131 Endocrine Surgeons, and 101 Otolaryngologists. One of the points of internal discussion in the past year is how to increase the number of members in underrepresented specialties such as Pathology, Radiology, Nuclear Medicine, and OB-GYN. Our members practice in seven settings with 55 percent being in an academic site and 25 percent in private practice. Other settings are hospital, government, industry, managed care, and administration.
President Smallridge also noted that the first meeting of the AASG, held in early 1925, attracted 200 persons. Now, almost 95 years later, the scope of our meetings continues to grow with record annual meeting attendances last year and again this year. I join with Secretary/COO Victor Bernet in thanking Mabel Ryder and Gregory Randolph, chairpersons of the Program Committee for the 2018 Annual Meeting, and Manisha Shah and R. Michael Tuttle, chairpersons of the Program Committee for the 2018 Spring Symposium on the spectrum of thyroid cancer for the excellent program they and their committees developed. We are particularly impressed with the high quality, comprehensive nature, and innovative features of this year’s annual meeting and the enthusiastic response of those who attended the spring symposium. Our spring symposiums, first instituted in 2002, have been very successful including this year’s symposium in Chicago where we had 410 registrants. Next year, on Friday March 22, our incoming President, Elizabeth Pearce along with Bobbi Smith, Adonia Coates, and Vic Bernet, are planning the 2019 ATA Spring Satellite Symposium on Diagnostic Imaging and Image-Guided Therapies for Thyroid Disease. The meeting, to be held in New Orleans, reflects the ATA’s trend to relate to the entire range of medical specialties.
A year after Dr. Smallridge’s report, President Antonio Bianco highlighted the highly functional organizational structure of the ATA, the development of an Institutional Conflict of Interest Policy, and the ATA’s response to changes in government related medical reimbursement plans. An example that these activities are continuing, is the recent partnership of the ATA with the Endocrine Society and the American Association of Clinical Endocrinologists to counter proposed reductions in CPT codes for fine needle aspiration biopsy, with and without ultrasound guidance. Tony also noted the nascent emergence of ATA support, not simply for individual research grants, but for the infrastructure of basic thyroid research. For the first time the results of this funding will be presented at this year’s annual meeting.
Last year in Victoria President John Morris, recalling his first ATA meeting and those that followed, focusing on the value of the ATA to its membership. John’s citations included an ever-expanding host of benefits that the ATA provides us. If ever the ATA decides to create a President of Sales, John will be the first to be considered. Until then, and even thereafter, it is the duty of all of us to promote membership in the ATA.
John’s highlighting of the word “value” in his report reminded me of that it was a little more than a decade ago that the ATA’s Board spent one of their winter conferences developing statements of the ATA’s Mission and Values. They are now prominently displayed on the ATA’s website. Within them are certain key words and phrases to be keep in mind. These are thyroid biology and thyroid disease, scientific inquiry, clinical excellence, patient advocacy, education, worldwide collaboration, ethical conduct and collegiality. A successor to the ATA articulating its Mission and Values is the Strategic Conferences to discern and update its most pressing and timely goals. Since 1999, the ATA has been gathering key constituencies to engage in self-reflection and future planning. We do this every few years and will do so again in Summer 2019. This will help facilitate the groundwork required to successfully manage the major transitions that the ATA faces in the next few years. Among the most important of these are the transition from Bobbi Smith to a new Executive Director at the end of this decade and the changeover of the ATA Secretary/COO from Victor Bernet to Jacqueline Jonklaas next year. When these times come I will join with the ATA membership in thanking Bobbi and Vic for their dedication to the ATA, the contributions to its growth already alluded to, and for continuing the development of the ATA as a forum for collegiate interchange. For now I will simply thank our Secretary/COO Vic Bernet, for his personable support and guidance in the past year. As to future tributes to Bobbi Smith’s tenure as ATA Executive Director, no mere President’s Report could do this justice even if it were entirely devoted to that subject.
The 34th President of the United States, Dwight D. Eisenhower, once remarked that plans are worthless, but planning is everything. Although the ATA may be guided by its mission statements and goals, it is the interactions of persons and groups within and without that turn its dreams and goals into reality. With this in mind I would like to share my vision of what constitutes the essence of the ATA and other successful groups and organizations.
First let me note that one increasingly prominent group activity of the ATA is its development of Guidelines and Statements. In that regard the ATA website currently lists eleven guidelines and nine surgical statements. One of Dr. Bernet’s achievements in the past year was to spearhead the evolution of the committee structure that supports our guidelines. Guidelines and Statements are products of groups who interact with each other through speech, the printed word and even non-verbal cues. They seek to convert the existing state of knowledge into well-organized recommendations. As to how knowledge is acquired, the Stanford Encyclopedia of Philosophy speaks of the debate as to whether it is rationalism or empiricism that is the basis for this. To quote their 2004 publication, “Rationalists claim that there are significant ways in which our concepts and knowledge are gained independently of sense experience; empiricists claim that sense experience is the ultimate source of all our concepts and knowledge” (https://plato.stanford.edu/entries/rationalism-empiricism/). The scientific method, a tenet of the ATA, provides support for both viewpoints as we develop hypotheses (Rationalism), perform experiments and studies based on these hypotheses (Empiricism), record the outcomes (Empiricism), interpret the outcomes (Rationalism) and develop further hypothesis (Rationalism). The assignment Rationalism and Empiricism within parentheses in the preceding sentence was based on the assumption of differences that are, in my mind, “more apparent than real”. For example, Rationalism has a great deal to do with the confidence we have acquired, since the spectrums for light and sound were discovered, that the visual and auditory information we perceive on a daily basis has its limitations.
In most guideline statements the major criteria for a strong recommendation is that it must be “evidence-based” and, for weaker recommendations, expert opinion suffices. It is my impression that evidence-based knowledge is widely considered to be a surrogate for empiricism and expert opinion-based ideas for rationalism, albeit expertly executed! Unfortunately, in my opinion (expert or not) this is a misconception as it does not place empiricism and rationalism on an even plain as far as the determinants of knowledge or for that matter, the crafting of guidelines and statements. After all, they must not only be knowledge based, but also rational. Time does not permit more digression but is seems apparent that, after thousands of years without resolution, the debate between empiricism and rationalism will never be resolved. However, just as there are fashions every aspect of public life, such is the case for the relative credit assigned to rational and empirical thinking by organizations. Moreover, this also fluctuates in the minds of individuals. As a consequence, no two or more individuals or groups have identical perceptions and thoughts at the same time regarding any subject. This being the case it does not do the ATA or any other organization any good if it is merely a forum for discussion without recognizing that discussion and communication in all its modes must be a civil and guided by ethical and humanitarian values. Today I would like to recognize the warm collegiality of the ATA and reassure you that the ATA staff and its governance strive to ensure that we contribute to this by maintaining hospitable environs for all our activities.
Speaking of civil discourse, I hope all of you grasp the irony that, in using the President’s report as a Bully Pulpit, I may be undermining the very views I espouse. It is too late, however, to repair this. Rather I would like to continue in this vein by making brief reference to another widely expressed view – namely that the ATA meeting is the most important thing we do. There is no doubt that without our annual meeting our society would be poor indeed; this is so apparent that it does not require explanation. It is also literarily true since, as Bobbi Smith and our Treasurer Julie Ann Sosa are so aware, more than half of the ATA’s operating budget is derived from its annual meeting. But in addition to the annual meeting there are many other things that the ATA does to qualify it as a mature non-profit organization. Many of these are aptly summarized in our Executive Director’s and Secretary/COO reports. I would simply like to recognize our publications, Thyroid, Clinical Thyroidology and Video Endocrinology as key aspects of what we do and note the inarguably outstanding achievement of Thyroid Editor-in-Chief Peter Kopp in propelling Thyroid to its latest impact factor of 7.557. Let us also recognize not only the support of the Editorial Board, authors, Mary Ann Liebert, Inc., publishers, and the ATA staff in this achievement, but also those who review for Thyroid with little or no recognition or remuneration. Their work is truly safe-guarding the integrity of the medical literature. For those of you who make this contribution, thank you. If you are unable to do so please, please, include the name of one or two potential reviewers and their e-mail addresses in responding to invitations to review papers. I suggest that the most useful names for Drs Kopp and Inabnet are not those who are widely recognized, but rather your junior colleagues and those in other institutions who are just beginning to achieve recognition.
Today, the first complete day of our annual meeting, has been so very enjoyable. As the meeting progresses it reveals so many people whose efforts, contributions, and collegiality are deserving of our thanks. I hope that during the rest of the meeting we can all show our appreciation to our guests and ATA members as well as obtain satisfaction from our own contributions to ATA life.
Charles H. Emerson
President, American Thyroid Association