A new identity to meet health care’s future.

The American Thoracic Society (ATS) is no stranger to change. When the society was established in 1905 by a group of physicians interested in therapy for tuberculosis (TB), it was known as the American Sanitorium Association. In 1938, the name was changed to the American Trudeau Society. Finally, in 1960, the society replaced “Trudeau” with “Thoracic,” and that name has stuck.

During that time, the society was not an independent organization but served as the medical arm of the much-larger American Lung Association (ALA), which was also focused on fighting TB. Over the years, both organizations have refined their respective goals, and though they still overlap in some areas, the ATS and the ALA have evolved in very different directions.

Whereas the ALA is now a voluntary health organization devoted to the public health issues associated with lung disease in the United States, the ATS comprises 13,500 professional members working to prevent and fight respiratory disease on an international scale through research, education, patient care, and advocacy. Rather than concentrate on such areas as asthma and lung cancer, as the ALA now does, the ATS’s bailiwick is infectious diseases, chronic obstructive lung disease, pollution, and occupation-related diseases.

Former ATS president Edward R. Block, MD, points out that “the success of the ATS over its 94-year history has been dependent in large part on its ability to recognize the need to change, and on its courage to make the changes necessary to maintain vibrancy and vision to fulfill its many missions.” So in April, the ATS and the ALA embraced that need to change and officially announced their dissolution into independently incorporated organizations working as equal partners. The split will take effect on January 1, 2000. Under the terms of their agreement, the ATS will pay the ALA $11.1 million to purchase and take ownership of its name, the ALA/ATS International Conference, its two journals, dues and membership lists, subscription fees, and depreciated physical assets.

“A separate incorporation makes sense at this time for each organization to most effectively develop and pursue its goals,” says ATS president Jeffrey Glassroth, MD, the George R. and Elaine Love Professor and chair of the Department of Medicine at the University of Wisconsin at Madison. “The old arrangement no longer provided us with the necessary flexibility or authority to serve our members as they needed to be served.”

The organizations will continue working together and continue representing each other on the two Boards of Directors, with each organization having two representatives on the other’s board who share a single vote.

“We will continue working cooperatively with the ATS to increase education about prevention and treatment of lung disease,” says Ernest P. Franck, president of the ALA. “The ATS will attain the autonomy it needs, and the ALA will be able to expand and broaden its partnerships with a variety of other organizations. The incorporation agreement will benefit both organizations as they evolve and grow to meet the challenges of the next century.”

Glassroth says the split allows the ATS to be involved exclusively with the issues of concern to its members, “from accounting systems to email.

“Thus will we be able to focus more efficiently on our members’ needs in general, to more effectively look at physician issues, and to consider physician-patient issues more effectively in this configuration,” he says. “There are simply lots of reasons why this split makes sense.”

And while the society recently has been urging its members to “celebrate the new ATS,” it is less a new organization than one finally able to claim its own identity.

Adapting to the Times
Though originally focused almost exclusively on battling TB, the ATS has had its share of new challenges over the years. Medical science is now battling the resurgence of pneumonia, hantaviruses, and TB that is often multi-drug resistant. The ATS has risen to these challenges, however, and continues to set the standards for prevention, treatment, and control of these and other serious diseases. Consider TB, which though it may not be as rampant in the United States today as it is elsewhere in the world, is still a legitimate concern of US health practitioners.

“TB is clearly prevalent in the United States, and is more prevalent in some segments of society than others,” says Glassroth, who adds that more than 40% of the cases in this country come from immigrants. “Absolute numbers of TB cases are dropping and that is good, but the bad news is that the cases that remain are more difficult to treat and more resource-intensive. [Infection with] HIV has been a factor in some quarters, and there are the problems with drug resistance.”

TB may be easy to overlook in the United States due to the relatively few serious cases, but Glassroth notes that it is still an important disease requiring much more research and attention.

“In some places of the world where they let down their guard, TB can flare up,” he says. “So we must remain vigilant, work hard, and put our resources into this. Worldwide, the job is daunting. We’re making little headway and there is a major coincidence with AIDS.”

In the case of hantaviruses, which in the United States occur primarily in the Southwest and are transmitted via rodent droppings, the disease is not common, but its high fatality rate makes it a priority for the ATS.

“We have learned that we can reduce, if not prevent, hantavirus infection by precautions like spraying rodent droppings with bleach,” Glassroth says. “The public health service people are doing a good job of that. And the number of cases is still modest, but hantaviruses cause devastating systemic disease, with often fatal results, and all we can offer is supportive care.”

In regard to basic health and physiology, Glassroth notes, “there are no national or international boundaries because that kind of information is applicable to a host of other diseases. The lessons we learn here have some applicability abroad, and vice versa. Granted, the information we provide is not one-size-fits-all even within the United States, but management of certain types of cases, drug regimens, and diagnostics do have some applicability elsewhere.”

Emphasizing Education
The ATS’s primary concern has always been the dissemination of scientific information and teaching among professionals to better advance treatment of diseases like TB and hantaviruses. The organization’s most notable activity is its annual International Scientific Conference, recognized as the premiere international forum for physicians and scientists working in pulmonary and critical care medicine.

This year’s meeting, held in San Diego, drew some 16,000 attendees, 60% from the United States, who attended sessions dedicated to pneumonia, asthma, critical care, pediatric pulmonology, sleep apnea, environmental and occupational lung diseases, nursing studies, cell biology, lung structure and function, AIDS, and TB. Approximately 39% of the ATS membership is involved in either private or institutional practice, and some 75% of the society’s members hail from the United States.

The ATS also regularly sponsors courses in respiratory epidemiology in South America to educate young physicians, and prior to the annual meeting, the society holds postgraduate courses containing more cutting-edge clinical information. In keeping with its focus on education, the ATS has earned full accreditation by the Accreditation Council on Continuing Medical Education for direct sponsorship of educational activities as well as joint sponsorships with ATS chapters and local lung associations.

The ATS also works with the ALA to support an array of research projects, and represents initiatives that engender research, though the group has always been very careful to target advocacy within the bounds of its not-for-profit status. The organization’s current work is more about educating the public and lawmakers about needs relating to research, patient advocacy, and health policy makers—particularly needs that are relevant to respiratory health. Glassroth says the ATS does quite a bit of work collating existing data into health statements, rather than being in charge of primary research efforts. The group is, however, exploring the feasibility of developing a more all-encompassing research program.

The ATS also publishes two journals for its members, the American Journal of Respiratory and Critical Care Medicine® and the American Journal of Respiratory Cell and Molecular Biology®, which are well respected in their field, and are featured frequently in both the mainstream and the trade press. The ATS’s membership benefits include receipt of those two journals—both of which are available online at www.atsjournals.org—as well as a regular newsletter, timely statements, and position papers on topics relevant to lung health and disease and related issues.

In addition to sharing information among members, the ATS also recognizes outstanding work in pertinent fields. The society offers the J. Burns Amberson Lecturer Award, given to someone with a career of “major and continuing contributions to pulmonary science or clinical practice”; the Trudeau Medal, awarded for lifelong major contributions to the prevention, diagnosis, and treatment of lung disease through leadership in research, education, or clinical care; the ATS Distinguished Achievement Award, given for outstanding contributions to the mission of the ATS; and the ATS Recognition Award for Scientific Accomplishments, given for scientific contributions to the understanding, prevention, and treatment of lung disease. The ATS awards committee also has just established a public service award to recognize an individual who has made significant contributions in lung-related public health or public service.

Meeting Goals and Making Progress
Several recent changes to the organization reflect the goals of the incoming president. Glassroth was installed in the position at the International Conference in April, and he will be succeeded in April 2000 by president-elect William J. Martin II, MD, director of pulmonary, allergy, critical care, and occupational medicine and the Floyd and Reba Smith Professor of Medicine at Indiana University Medical Center, Indianapolis.

One of Glassroth’s stated goals has been to get more women and minorities involved in the ATS, and so the organization’s membership committee has established a Women’s Mentoring Program to create a professional and personal support network for female members.

“Within the organization, there’s a distinct minority of female members,” Glassroth says. “I’d say around 23% of our members are women, and to what extent of the overall profession we’re representative, I can’t tell you. But I want to get those numbers up, and help people within those minority groups progress professionally.

“We will consider the Women’s Mentoring Program a pilot, then think about broadening it for parallel groups,” he says. “I have a particular eye on getting people on committees whose background can contribute to this discussion, as well. Ultimately, we want to see our minority members’ numbers increase over time, and we hope to help achieve those goals with some of the things we’re doing.”

Glassroth has also expressed an interest in helping the “new ATS” get its funding, infrastructure, and finances in order following the split with the ALA. To that end, he has formed an Ad Hoc Revenue Development Committee to explore new opportunities for funding the program, and officers have met with representatives of the corporate sector to determine if they will be able to provide new funding.

The ATS is only helped in meeting its goals by interaction with other national and international organizations, so in addition to continuing to maintain a relationship with the ALA, the society maintains a council of chapter representatives—members who also represent local thoracic societies.

“That way we get input from local societies so we can better coordinate activities with them and give them a voice in the structure of the ATS,” Glassroth says. “In the past, our relationship has been more indirect, through the board of the ALA, but more recently we are trying to formalize that relationship and are planning to reserve a seat on our board for an officer to preserve those relationships, as well as to cultivate more of them.”

The ATS is a society that aims to serve its members’ needs, and so in an effort to keep on top of what those needs are, it recently issued a survey to members, netting a 40% return. The ATS is planning a second mailing to solidify issues that need to be addressed, but Glassroth says the organization found the first survey to be very helpful.

“Overall, people were happy with the International Conference and the journals that they receive, though there is some desire to have the ATS speak more forcefully and actively on physician issues,” Glassroth says. “There are some restraints on this since we are nonprofit, so we are trying to define how we should proceed within the boundaries of that status.

“Above all,” Glassroth adds, “I want to commit to this membership, and serve those in our new organization”—a “new” organization that is nearly a century old and still changing with the times to meet the medical challenges of the future.

For more information about the American Thoracic Society, call (212) 315-8700, or go to its Web site at www.thoracic.org.

Liz Finch is an associate editor of RT Magazine.