“By 2030 all surgical anesthesia will be administered and monitored by computers, with no need for professional medical supervision beyond the surgeon.”¹

mazing what one can find on the Internet! The author posted this prediction on a Web site <www.longbets.org> to stimulate discussion and as a wager to benefit a charitable organization. It is hard to tell if the author is particularly impressed by the possibilities of artificial intelligence or singularly unimpressed by the anesthesiologists he has met. Regardless, the prospect of clinical anesthesiology being the purview of automatons makes me increasingly thankful that ASA has placed such great importance on and trust in its four foundations. While specific recommendations are only beginning to emerge, what seems clear is that the challenges ahead require united, collaborative efforts and actions by ASA, the foundations and the entire anesthesiology community. The foundations provide vision in the face of speculation that we are again at a period in the specialty that calls for redirection.

The Anesthesia Memorial Foundation (AMF), the Anesthesia Patient Safety Foundation (APSF), the Foundation for Anesthesia Education and Research (FAER) and the Wood Library-Museum of Anesthesiology (WLM) are four separate yet complementary 501(c)(3) organizations through which ASA membership can support the specialty. To see that the foundations benefit from their affiliation with the Society, one needs to look no further than the fiscal bottom line. ASA contributes in many ways to each, and the foundations make major contributions to the Society in return. While each functions autonomously, they have been and will remain inextricably interdependent with the Society.

An examination of the names of the founding members, officers and board leaders confirms the proximate relationship to ASA. The foundations collectively possess the human resources and network linkages to provide the impetus to transform anesthesiology in the years ahead.

In October 2002, then-NEWSLETTER Editor Mark J. Lema, M.D., Ph.D., published an article highlighting WLM, APSF and FAER and urged the membership to increase its support of the foundations.² This appeared about a year following the beginning of an ASA “Planned Giving Program” initiated on behalf of the four foundations by past ASA President Ronald A. MacKenzie, D.O., and maintained through Executive Director Ronald A. Bruns and the ASA staff.³ While persuading physicians to adopt a culture of philanthropy has been a slow process, there have been a number of committed individuals who have directed a portion of their resources and estates to the foundations. Greater attention and effort to this in the future is important and essential to advance anesthesiology, pain medicine and perioperative medicine as scientifically based mainstream sectors in health care throughout the next century.

Anesthesia Memorial Foundation
n 1956 the anesthesiology community lost a number of prominent leaders⁴ with the deaths of R. Charles Adams, M.D., Arthur E. Guedel, M.D., Robert B. Hammond, M.D., Henry S. Ruth, M.D., Brian C. Sword, M.D., and J. Rolland Whitacre, M.D. In the fall of that year, the Anesthesia Memorial Foundation was incorporated “to loan or give money to deserving persons to assist them in becoming specialists in anesthesia or for research or study in anesthesia or related fields … and to further the progress of anesthesia in every way possible.”⁴ At the time, the AMF Executive Committee included Scott Smith, M.D., A. William Friend, M.D., B.B. Sankey, M.D., and Mr. John Lansdale, Esq. The ASA Executive Committee of that time officially indicated their enthusiastic support of the foundation.

Several years ago, AMF received a significant bequest to augment the loan fund. Today AMF <societywebsite.com/AnesthesiaFoundation/award.html> continues to manage a revolving loan fund for residents in need and periodically bestows a Book Award of $10,000 for the best monograph in the specialty. The presentation is made at the Annual Meeting of the Academy of Anesthesiology where the author is invited to attend as a guest.

Anesthesia Patient Safety Foundation
PSF <www.apsf.org> was incorporated in September 1985. The first APSF Newsletter was published in 1986 and contains a photo of the original seven-member Executive Committee. Remarkably five of the seven (Ellison C Pierce, Jr., M.D., E.S. Siker, M.D., Joachim S. Gravenstein, M.D., Jeffrey B. Cooper, Ph.D., and Burton A. Dole) stayed active in the foundation’s leadership for 20 years, which speaks to their commitment to this important cause. John H. Eichhorn, M.D., was the original newsletter editor and remained in that post for many years. He subsequently edited a book titled Anesthesia Patient Safety, A Modern History: Selections From the APSF Newsletter — The Formative Years, 1986-1993, which details the activities conducted and issues addressed during those years.⁵ More recently, in 2001, E.S. Siker, M.D., prepared a modern abbreviated history that appears on the APSF Web site.⁶

Among the many corporate contributors and donors to APSF, none has been more generous of his time and substance than Mr. Dole, longtime member of the APSF Corporate Advisory Council, who has been a continuous loyal supporter from APSF’s inception to its present.

The foundation’s work has resulted in significant changes in the practice of anesthesiology such as standards for monitoring, simulators for the training of personnel, the education of practitioners in risk management and a dramatic reduction in anesthesia-related deaths.

APSF has five current initiatives:

• Data Dictionary Task Force: To create a common language that will facilitate analysis of patient care experiences and be a benchmark for safety.

• Automated Information Systems: To yield pooled data, permitting comparisons among institutions.

• High Reliability Organizations: To achieve hospital safety in the perioperative area.

• Long-Term Outcomes: A panel to explore the role of inflammations in long-term postoperative outcomes.

• Audible Alarms: Workshop and task force made up of anesthesiology and corporate partners to study efficacy and limitations.

Foundation for Anesthesia Education and Research
AER <www.faer.org> has quietly undertaken the task of trying to close the 10-fold research support gap that exists between anesthesiology and the highly research-oriented specialties. Anesthesiology, with almost 40,000 ASA members, ranks sixth in medical specialty size with 5 percent of practicing physicians but receives only 0.5 percent of National Institutes of Health dollars. It may be argued that this small research and development effort is one reason that anesthesiology is frequently viewed as a service department in academic health centers and a candidate for automation. These perceptions must change through our efforts and support, or the dire prophecy that medical anesthesiology will disappear as a specialty by 2030, as was predicted at the beginning of this article, may be fulfilled.

FAER research award amounts were increased in 2001. This year a Mentored Research Training Grant will be offered for the first time, and the Research in Education Grant has been increased.⁷ In addition FAER has initiated an Academy of Mentors that will hold its first organizational meeting this fall on Friday, October 22, at the ASA Annual Meeting in Las Vegas, Nevada. With an increase in grant applications and fundable proposals as scored by Michael K. Cahalan, M.D., and the ASA Committee on Research, the FAER board increased the award program budget. Nonetheless FAER was unable to fund all the meritorious grants in 2003 and 2004. Future growth as a scientifically based medical discipline depends upon generating a higher level of annual funding for the grant programs.

FAER is addressing this need with ASA leadership, subspecialty societies and component societies, corporate sponsors, national foundations and individual donors. FAER will work to expand its base of support for 2005 through collaborative efforts with other ASA foundations and the Ad Hoc Committee on ASA’s 100th Anniversary.

Wood Library-Museum of Anesthesiology
hile WLM <www.ASAhq.org/wlm/> was formed in the 1930s, on July 21, 1950, the New York State Board of Regents granted a provisional charter. An absolute charter was granted on February 29, 1952.⁸

The collection of the WLM’s printed materials and equipment was housed in various buildings throughout the years, under the guardianship of Paul M. Wood, M.D., with the various locations ranging from a drug company building to a boat house on Long Island. In February 1960, Leo V. Hand, M.D., then ASA President, “suggested the possibility of the Society offering space in the air-conditioned basement of the Park Ridge headquarters building.”⁸ The library’s first major gift was from Oscar Schwidetsky, M.D., an instrument maker of Becton, Dickinson & Co., who bequeathed 10 percent of his estate as a leadership gift to WLM.⁹

WLM is a world-class resource that should make ASA members justifiably proud and is a prime example of the way in which bequests can help a foundation grow. In recent years, the WLM has expanded under the leadership of Librarian Patrick P. Sim, his staff and a long succession of dedicated presidents and trustees who have given generously of their time and substance to this renowned institution. For example John W. Pender, M.D., left a leadership gift to support the Living History Collection. George S. Bause, M.D., has been a major donor to the museum, and Charles C. Tandy, M.D., and others have given to the rare books collection, which is largely unrivaled across the globe.

As they evolve, the ASA foundations remain our best prospects to serve as engines of change to effect the advances necessary for anesthesiology to transform and survive whatever challenges the future may hold.

We must accept the challenge and take the long bet that proposes replacing medical anesthesiology with a robot by 2030. I am unwilling to believe you can write an algorithm to replace the judgment exercised by a vigilant, well-trained, experienced physician in the care of patients during anesthesia and the perioperative period.

To accomplish our goals, ASA and the foundations will require ongoing commitment and resources from the rank-and-file membership who currently support these activities through their dues and gifts. We believe leadership gifts and bequests can be increased over time and that a demonstrated record of responsible stewardship will speak for itself in earning the confidence of our colleagues to invest in this cause.


References:

1. Altman JI. Prediction 43. <www.longbets.org/43>. Accessed on August 10, 2004.

2. Lema MJ. The foundation(s) of our success. ASA Newsl. 2002; 66(10):1, 24.

3. MacKenzie RA. American Society of Anesthesiologists, Anesthesia Legacies. 2001; Spring.

4. History of the Anesthesia Memorial Foundation. <societywebsite.com/AnesthesiaFoundation/History2.html>. Accessed on August 10, 2004.

5. Eichhorn JH. Historical perspective. Anesthesia Patient Safety, A Modern History: Selections From the APSF Newsletter — The Formative Years, 1986-1993. Anesthesia Patient Safety Foundation; 1997.

6. Siker ES. A Brief History of the APSF. <www.apsf.org/History>. Accessed on August 10, 2004.

7. Foundation for Anesthesia Education and Research. Facts 2004 (June). Grant Announcements. 2.

8. Betcher AM. The Wood Library-Museum of Anesthesiology. Historical development of the Library-Museum. Anesthesiology. 1961; 22(4):618-635.

9. Sim P. Wood Library-Museum of Anesthesiology. Founding History and Data: The first five years. [Personal communication].

Alan D. Sessler, M.D., is President, Foundation for Anesthesia Education and Research, and Professor and Chair Emeritus, Mayo Clinic, Rochester, Minnesota.