2002 Thomas G. Wharton Memorial Lecture

“Entropy of the Perfusion Profession: Fact or Fiction?”

Ronald M. Babka, C.C.P.
Knoxville, Tennessee

Members of The Academy, ladies and gentlemen, let me first say that it is an honor and privilege to address you as this year’s President of The Academy. First I want to thank you for the privilege of being your President and second, I am proud to be a part of The Academy. Because of its unique design and nature, it affords us the opportunity to come together, to share knowledge and to seek new advances that we as perfusionists must consider our obligation to our patients and our profession. Before I address some of the historical aspects of our Academy as portrayed by past presidents, I would like to talk a little about Thomas G. Wharton.

I first met Tom in 1976. At that time he was the Executive Director of the American Board of Cardiovascular Perfusion (ABCP). I would communicate with Tom almost on a daily basis, as I was trying to find out my results of the board examination that I had completed. Then on August 30,1976 I received a letter from 2 Talcott Road, Suite 7, Park Ridge, Illinois from Tom that as of that date I was a CCP. That letter was signed by Charlie Reed on a letterhead that reads like a history book. Upon receiving the letter I called to thank Tom for putting up with my constant barrage of calls. Tom was always gracious and understanding and a true professional. Tom congratulated me and offered me a bit of advice in continuing with the education of the perfusionist and the profession. He truly believed that we needed to maintain excellence, versatility and endurance for our professional survival. With his keen sense of the future he helped in a way he was not able to see, by fostering a mission of The Academy that he so desperately wanted to maintain. Through his dedication and perseverance has evolved an Academy to a level, which he would be proud.

Historically, The Academy has had the benefit of having a group of past presidents that have worked for the resonance of perfusion science and technology as a combined objective to prevent a deterioration of the profession. In 1980 and 1981 President Dobbs oversaw the most difficult task a president could take upon himself. The development of the first two meetings of The Academy with a frank debate on real perfusion issues such as perfusion accidents, an unprecedented and provocative issue. These meetings opened the door for science and technology to address real issues dealing with the profession and totally dissolving the political issues. Following the meeting in 1981, Jeri and many other distinguished participants opened the most important aspect of the Academy’s unique nature that of the Fireside Chats. Here the perfusion community has an opportunity to roll up their sleeves and tackle complex issues of science and technology and to develop new configurations for mechanical and clinical improvements. In 1982, with the hard work of President Horgan, we straddled a bit addressing the legal aspect of perfusion and our future specifically referring to state licensure and our interdisciplinary relationships. This had made us more aware that government and science and technology must have cooperation in order to benefit the public and overcome technologic hurdles. In 1983, President Kurusz reiterated the importance of continuing education in the field of perfusion and stressed the importance of The Academy as a catalyst for perfusion education. Mark Kurusz addressed The Academy with eloquence and reiterated the AACP’s sole purpose and I quote, “This year’s Academy program is a testament to the fundamental belief in perfusionist education. The American Academy’s sole objective, the reason we come here for two and a half days is education.” Mr. Kurusz’s dedication and loyalty to The Academy is impeccable. His forum on perfusion education and manpower fostered the ideas on closing the gap between perfusion science and perfusion education. In 1984, President Reed addressed The Academy with an end of the golden era of perfusion. His thoughts echoed a poignant perspective that we must be contributing participants in our profession and dare ourselves to develop a greater technological advance in perfusion. In 1985, President Lawrence historically addressed The Academy with a provocative analysis of Dr. Alexis Carrel. His insight left us proud to be in perfusion not just for monetary gain but as researchers in a field of science that constantly needs better education and technology. In 1986, President Hill demonstrated that within our profession exists a symbiotic relationship between all the perfusion organizations to continue with there unique missions in a most cost effective manner, thereby producing as in the Venn diagram a perfect product when all the groups converge. In 1987, President Meserko presented us with the business of perfusion with a caveat that still endures today. That is, each perfusion team needs to identify its task as in providing quality to our patients and not just service even as our function is critiqued in terms of dollars spent. In 1988, our beloved friend the affable President Stofer, presented us with the shortage crisis. His wisdom portrayed the dilemma as a result of perfusionists’ greed and apathy, which still exists today. His words echoed a statement that we as perfusionists need to set aside greed and apathy and practice self governance by getting involved with your organizations for in so doing will develop a motivation of survival. In 1989, President Mesher reiterated our mission by pointing out that The Academy had awarded $45,000.00 in grants to keep the commitment of The Academy alive, which was always to support the educational process. In 1990, President Dennis Williams poignantly demonstrated that the perfusion profession needs to be policing itself so as not to create a glut of perfusionists. By maintaining high standards of education and calling on the schools of perfusion to choose altruistic candidates for their schools then our profession will have a quantity of perfusionists of the highest quality. In 1991, The Academy was brought up to date on health-care financing and its effect on perfusion. In 1992, President Terry Crane eloquently told us that the mission of The Academy must never change. He told us that The Academy is the hallmark of what an organization must be in order to fulfill a commitment to perfusion education. By 1993, President McDonald reiterated a common theme in the Wharton lecture and that was The Academy must continue its present mission and its focus on education. He said that we as a profession must never waiver on our commitment to excellence and to fulfill our obligation to our profession we in fact must support The Academy since it is the only organization of perfusion professionals that requires commitment of its members and conduct beyond reproach. In 1994, President Sue Reaves noted that in order for us as a profession to survive we must never “fail to impart the intangible aspects of education.” Her words echoed the challenges we face with a warning to be careful in that history has a way of repeating itself. The Academy by its very nature is the only organization that forces us to learn and listen not just attend a meeting for without it, the era of “pump tech” could easily be restored. In 1995, the immortal President Richmond, asked us to recognize the love we should have for ourselves and profession. His plea was for us to be professional and responsible and above all be honest and not to deceive ourselves, our profession and our organization. In 1996, President Diane Clark continued with the focus The Academy must have in order to benefit the public, and that is to continue with its mission of education. She warned us not to become resistant to change as long as our mission was not changed. Our annual meetings must never dilute our educational agenda by having society meetings and other activities that puts political agendas ahead of the educational agenda. She noted that if we were to look at a fork in the road for The Academy regarding its commitment, we should never transform its dedication to perfusion education into societal politics. In 1997, President Berryessa challenged us as a profession to practice self control and to be proactive as a perfusionist in our organization for the mutual benefit of our profession. In 1998, President Palanzo echoed his thoughts with a call for all to be proactive in The Academy. He proceeded with a narrative on why we should encourage and stimulate research and at the same time improve ourselves by becoming a participant in the scientific debate on perfusion, not just an individual that jabbers like a scientist out of an act of hubris. In 1999, President Delgado wanted us as a profession to seek ways of creating a more symbiotic relationship amongst all our organizations in order to reach a more peaceful coexistence. In 2000, President Chan professed that we strive to maximize our professionalism by seeking the highest level of performance. He states that we must practice restraint in criticism of our peers so as to avoid fostering rumors that cleave a division amongst ourselves. He asked us all to be more involved with The Academy and our profession by being a contributor and doing it now, rather than another day. Last year President Groom asked us to believe in ourselves and what we do, and to do it to our maximum potential and learn from our great Academy new frontiers in our field that we need to apply to our practices.

My friends, that brings us to today. The purpose of this symposium is to educate us to the contemporary issues of our field of science. This is the reason we are here, or rather should be here. In this ere of red ink, other professional organizations are abandoning their fiscal responsibility to pursue scientific papers and jazzy shows offending many. The Academy has worked overtime to practice fiscal restraint, offer excellent debate and seek solutions to the issues that face us as a profession. My friends in observing the present day politics of our profession and in extracting from personal conversation and correspondence, we need The Academy and its mission for the benefit of our professional survival. The goal of continuing education with fiscal responsibility to the benefit of the entire membership of The Academy rather than to benefit a few is an ongoing challenge that I say is not being conducted by any other organization of perfusion. However, The Academy must not rest to meet this challenge on a daily basis. As a whole The Academy must continue to increase its professional marketing and expand its membership, and not worry about members who leave the ranks of active or associate. The Academy must not become subservient to any other organization and resist any temptation to exceed its budgetary requirements while still conducting a quality scientific conference. This conference has indeed met the challenge. The panel on Systemic Inflammatory Response Syndrome (SIRS) topic featuring guests Craig Vocelka, Dr. Matheis from Jostra and representatives Mr Aniuk from Cobe, Ms Svee from Medtronic, Ms Charron from Terumo, as well as the OPCAB and the Neurocognitive panels featuring Drs. Cooley, Mack and Stump, Aaron Hill and Linda Mongero bring to us a new search for knowledge in these areas whereby we can learn more, enhance the mastery of our skills and successfully apply what we learn. The popular Fireside Chats, truly at the core of our conference, has brought forth topics this year such as Electronic Data Users Group, Biopassive and Bioactive Surfaces, Blood Compoment Therapy and Microplegia. These subjects to debate have extended our role into new ventures of perfusion technology and expand The Academy’s presence in the perfusion community. Since the beginning The Academy has attracted over 6600 perfusion researchers and scientists to its conference to hear and discuss and debate distinguished colleagues who present their research in the scientific sessions. This year The Academy proudly acknowledges those who are presenting their research. The scientific sessions offers valuable original research to keep us as a group informed as to the new areas of research, so we can understand and participate in the important decisions involving perfusion science and technology. The Academy is also proud of its relationship with the journal Perfusion. This major resource is a most cited perfusion journal that reaches all members of the academy both here and abroad. The peer review journal offers excellence in editorials, graphics and featured articles dealing with perfusion science. The Academy’s venture with Perfusion has been a notable success. The research from these proceedings have a direct avenue to be published into the journal and offer to the researcher the most widely perfusion based audience for their work. And finally, one of the most important aspects of our conference is the Perfusion Instructors’ Workshop. The future driving force of our profession is our students and The Academy demands that each student is given optimal instruction for the benefit of the public. The workshop featuring Ms. Blackwell this year, is designed to encourage instructors to produce excellent perfusion scientific management and also to evaluate clinical performance of our perfusion students. The Academy takes great pride in this workshop for it enhances the education of perfusion science in the perfusion schools, which are the proving grounds for our most talented students.

Now, we as a profession must look to our future. Entropy as defined by the American Heritage dictionary is an inevitable and steady deterioration of a system or society. I have titled this lecture as Entropy: Fact or Fiction, because the question is, are we in a steady decline as a profession. Back in 1981, when I was on the ABCP, we were faced with the dilemma to abandon OJT certification and move the profession forward or keep OJT certification. The pressure from various factions within the surgeons’ group was enormous to halt the 1981 deadline and not allow ourselves self governance. The profession was in a steady decline back then and the process almost ceased to exist. Thanks to Earl Lawrence, Aaron Hill, Bill Horgan, Jerry Richmond and the rest of the board, we as a group won the battle and proceeded to reverse the trend so as to not only govern ourselves but to become leaders in this field. As we proceed into the new millennium, we must constantly ask ourselves if we are in control of our own destiny. As we proceed through this conference, are we participating as individuals in the discussion phase of all the sessions? If not, then perhaps apathy is the choice for you as a professional. If so, then entropy will creep in and we will go back to an era of 1981 in a sense that we will not be able to govern ourselves and someone else will do it for us. As a professional it is your responsibility to participate either as a discussant, presenter or moderator in order for us all to learn and advance ourselves. Tom Wharton’s legacy was not just start up capital for The Academy, but mostly a philosophy to bring together the best minds in our profession to learn from each other, to discover new solutions to our problems and perhaps even to generate new technologies that will change the course of our field. Is, for example OPCAB here to stay as a modality of therapy as hospitals and surgeons have the temerity to market this procedure? Are we as a profession doing our part to improve our techniques to make CPB even safer or even perhaps bring the pump into the cardiac catheterization laboratory to help generate a safer angioplasty procedure? The answer to the question of entropy, I will leave up to each and every one of you. However, as a profession we must change to foster excellence in the education of our students and in the application of our science. Also we must clearly define the versatility of our technology and to be a participant in seeking solutions to the problems that derives from the technology. We must carry on by fostering new innovation and invention. I challenge each of you today to focus on continuing to allow us to govern ourselves by getting involved in each area of this conference and debating with your colleagues in the discussion phases the presented areas of research. As Einstein said, “it is important for the common good to foster individuality: for only the individual can produce the new ideas, which the community needs for its continuous improvement and requirements.”

As a whole The Academy is in good shape and Tom Wharton would certainly be proud of this organization. We are fortunate to have a new dedicated Executive Director and National Office Administrator, David and Jill Palanzo, whom have done an excellent job in running the National Office. David and Jill have made the transition very smooth. I must say it was a pleasure to work with them throughout this year of my service and The Academy is grateful for their excellent work and is thankful that we have such a talented team that will be with The Academy.

As I see it, we face three main challenges as an organization in order to accomplish our future goals and continue our mission. We still need to increase our membership attendance at our annual meetings. Historically we have only 49% of our active members attend our annual meeting and 17% of our associate members attend the annual meeting. In addition we need to increase our dedicated total membership as well. Currently we have 93 active members and 250 associate members. Membership in The Academy is an honor and privilege and not a right. We need to increase our roles of perfusionists whom are worthy of this honor and desire to be a participant in The Academy. We should continue to increase our fiscal reserves by attracting a higher all around attendance at our meetings and attracting more perfusion sponsors and appreciating our current sponsors. These challenges are important for us to meet, as new changes in our field demands that we as an organization must be more productive.

Finally, as the President of The Academy this year, I must say again it was an honor and privilege to serve. Next year will mark the 50th anniversary of the heart lung machine and I ask all of you to support The Academy by presenting, discussing, debating and attending next year’s conference. Support next year’s President John Toomasian, my good friend and colleague. At the conclusion of this meeting I am proud to say that I will be leaving The Academy in much better hands that will decide newer directions for The Academy. But with one very important mission in mind and that is to continue with the education of the perfusionist for the benefit of our patients, because none of us knows when our very existence may be dependent upon the technology that we practice.