The American Society of Hematology (ASH) turns 50 years old in 2008, and we have much to celebrate. Over those years the Society established its principles: to promote both the art and science of hematology and to hold a high-quality Educational Meeting. ASH membership has grown from a few hundred curious attendees at a planning meeting in 1957 to more than 15 000 members today, and the annual meeting has grown from a scientific session of 5 papers at the planning meeting to more than 500 oral presentations and nearly 2500 poster presentations at the 2007 meeting. The modern ASH promotes cutting-edge science, sponsors research by scholars from all over the globe, helps train the next generation of clinician-scientists, lobbies Congress and several other governmental agencies on behalf of its clinician and scientist members, and publishes the foremost scholarly journal in the field of hematology, Blood, designed to provide its readership with timely reviews, expert opinion on clinical hematology, practice-changing clinical trials, and insightful basic science. The next 50 years of ASH are likely to see many profound changes, but one thing is almost certain—our dedication to fostering clinical and scientific excellence in hematology will continue as the Society's raison d'etre.
William Harvey is credited with describing the circulation of blood in his thesis, Exercitatio Anatomica de Moto Cordi et Sanguinis in Animalibus, in 1628. Ever since, blood has excited and interested people: poets, theologians, politicians, fortune tellers, charlatans, physicians, and scientists. Goethe, in Faust, wrote that it was “Ein ganz besonderer Saft” (a very special juice).1 Its ready accessibility without major damage to men and women led to early studies in the 19th and early 20th centuries. Extensive examinations led to often-heated debates about the origins of blood cells. Classic clinical descriptions of leukemia, pernicious anemia, and hemophilia were published, but without an understanding of their pathophysiology.
The first attempts at transfusing blood from animals to patients were made in 1667 with disastrous results. The first successful transfusions of human blood were performed by Dr James Blundell in 1818; 5 of his 10 attempts proved beneficial. The first successful whole blood transfusion for hemophilia was carried out by Dr Samuel Armstrong Lane in 1840. Dr Karl Landsteiner, recipient of the 1930 Nobel Prize for Physiology or Medicine, and his colleagues' identification of the human blood groups in 1901 and the finding by Dr Richard Lewison at the Mount Sinai Hospital in New York in 1914 that sodium citrate would prevent blood from clotting made effective whole blood transfusions feasible and safer. Dr Bernard Fantus in 1937 in Chicago at Cook County Hospital opened the first blood bank in the United States after the Russians had set up more than 500 blood centers in that country. Transfusions became much more common with World War II. The addition of glucose and other compounds to anticoagulated blood made it possible to store refrigerated blood for up to 42 days, and if properly prepared, for up to 10 years if frozen.
National and regional clubs concerned with hematology were organized and flourished in the 20th century. The Societe Française d'Hematologie is credited as being the first national society and held its initial meeting on November 4, 1931. The New York Society for the Study of Blood was organized in 1945 and is considered to be the oldest “blood club” in the United States.
Origins of the American Society of Hematology
The International Society of Hematology (ISH) was organized in 1946 during sequential meetings in Houston, TX, and Mexico City. Its charter was ratified in 1948 in Buffalo, NY. The seed for the American Society of Hematology (ASH) was planted in August 1956 by Dr William Dameshek, Professor of Medicine at Tufts School of Medicine and an internationally respected hematologist, then presiding over the 6th Congress of the ISH in Boston. Dr Dameshek, together with the medical book and journal publisher, Dr Henry Maurice Stratton, led the planning. The latter hosted a luncheon for 10 hematologists. Dr James L. Tullis, Professor of Medicine at the Harvard School of Medicine and Chairman of Medicine at the Deaconess Hospital, was invited to head a planning committee.
An organizational meeting on April 7, 1957, in Boston's Harvard Club was chaired by Dr Dameshek in the morning and by Dr Tullis in the afternoon.2,3 There was heated debate about the purpose of such an organization and concern about balkanizing academic and clinical medicine. It was, however, agreed that the field had attained sufficient magnitude and maturity to sponsor a separate meeting without becoming the stepchild of some other specialty and organization. A 5-paper scientific session during that meeting included the report of the initial clinical trial of bone marrow transplantation by Dr Joseph Ferrebee and Dr E. Donnell Thomas, the latter president of ASH in 1988 and the 1990 Nobel laureate for Physiology or Medicine. About 150 participants were in attendance initially, but the crowd soon became so large that an adjacent room became necessary.
The first official meeting of the ASH was held in Atlantic City, NJ, on April 26 and 27, 1958, with Dr Tullis as President. The first constitution contained the following objectives: the Society should (1) sponsor an annual high-quality meeting in different parts of the country, but separate from any other society, (2) be inclusive, rather than exclusive, and (3) not try to establish a certifying board (an objective that became moot in 1972). The academic tone and orientation for the Society was set by the election of Dr Carl V. Moore of the Washington University School of Medicine in St Louis, MO, as the second President in 1960.
The Society has grown over the past 50 years from a few hundred to a membership of 15334 with 9771 active, 3485 international, 1246 associate, 15 honorary, and 817 emeritus members listed in the 2007 directory. Attendance at the annual meetings now exceeds 20 000. The competition to have a paper selected for oral presentation at the annual meeting became so great that poster sessions were added in 1982. For the 2007 annual meeting, 5495 abstracts were submitted, of which about 10% were presented in simultaneous platform sessions and 6 presented during the plenary session.
Although always headed by volunteer physician leadership, until recently the operations of the Society were run by association management companies, including Charles B. Slack Inc and Smith-Bucklin Inc. In 1999, Dr Harry Jacob, President of ASH and the ASH Executive Committee, determined it was far wiser to create our own management structure. We were very fortunate when Ms Martha Liggett, who had been Executive Director of ASH when Smith-Bucklin oversaw our operations, was recruited to create our own management team and continue in her role as Executive Director. Under Ms Liggett's leadership, ASH staff has grown to 63, who serve in multiple capacities including education, communications, governmental relations, training and professional development, policy and practice, international and outreach programs, continuing medical education, meetings, membership, publications, finance, and development.
Origins of Blood, the journal of the American Society of Hematology
Dr Henry M. Stratton, a frustrated medical student in Vienna, came to the United States in 1938 via Cuba after learning the craft of publishing. Despite a successful cooperative venture with a prominent textbook publisher in Havana, he moved to the United States and founded the medical publishing house of Grune & Stratton on April 7, 1941, with a Mr L. H. Grunebaum, who did not continue his involvement for long. Originally directed largely to psychiatry, his interests soon shifted to internal medicine. With prescient insight about what might become important, he became enamored with hematology when Dr Siegfried Tannhauser, best known for studies of lipid storage diseases, brought him together with Dr William Dameshek. Rather than another hardcover book, Drs Dameshek and Stratton started Blood: The Journal of Hematology, as a bimonthly publication on January 1, 1946. It was the first English-language hematology periodical. It soon became a monthly publication and the place where academic medicine wished to see its papers on hematology published. Drs Dameshek and Stratton ran the scientifically and fiscally very successful journal with some editorial and political input from an international Editorial Board made up of their friends and associates. When Dr Dameshek suddenly died of a dissecting aortic aneurysm in October 1969, Dr Stratton urgently asked Dr Ernst R. Jaffé, who would become President of ASH in 1983, to take over until Dr Frederick Stohlman could assume the editorship. Dr Stohlman and his wife, Bernadette, died in the crash of the terrorist sabotaged TWA Flight 841 on September 8, 1974; Jaffé was again asked to take over as Editor-in-Chief, a term that continued until December 31, 1977.
In 1976 Blood became the official publication of ASH with changes in its cover, Editorial Board, and editorial operations. On January 1, 1978, Dr Paul A. Marks, who would become President of ASH in 1984, became the first Editor-in-Chief appointed under the aegis of ASH. Five-year terms were established. That post has been held by Drs John W. Adamson, Arthur W. Nienhuis, James D. Griffin, Kenneth Kaushansky, and Sanford J. Shattil. Dr Cynthia Dunbar officially assumes her role as the 11th Editor-in-Chief of Blood today, January 1, 2008.
The volume of outstanding scientific material submitted for consideration for publication increased so greatly that the journal began publishing 2 issues a month in 1990 in 2 volumes per year. It has become an international journal in that more than 50% of the manuscripts are now submitted from outside North America, and nearly that many published papers derive from international authors. The topics published range widely from reviews of topics in hematology, editorials, chemokines, cytokines and interleukins, clinical trials and observations, gene therapy, hematopoiesis, hemostasis and thrombosis, immunobiology, neoplasia, red cells, stem cells in hematology, and transplantation.
In the 1970s and 1980s a movement began for ASH to own its own journal. The costs of maintaining membership data, employing a management firm, and the annual meeting expenses were real concerns of the elected officers. Other societies had found in journals with wide circulations solutions to their fiscal and editorial problems, especially with subscription to the journal a mandatory part of the annual dues. In addition to fiscal considerations, the membership wanted to appoint the editors and to determine editorial policies. In 1988, under the Publications Committee leadership of Dr H. Franklin Bunn, the Society began the process to acquire all the rights to the name Blood, which was signed by Dr Marshall Lichtmann as President of ASH in 1989. ASH assumed complete responsibility for the journal with a phased purchase agreement with the W.B. Saunders Company in 1994, and on January 1, 2000, the Society assumed all responsibilities for journal publications.
With the title Blood firmly in the hands of ASH, the opportunity to fully control the journal arose. Under the leadership of Editor-in-Chief Dr Kenneth Kaushansky, the current President of ASH, the Society hired Ms Sabine Biesler in 1998 to serve as the founding Director of Publications for ASH, and under the guidance of the Publications Committee ASH began to assemble a publications staff. The first issue of Blood handled entirely by the Society was published on January 1, 2000. The next challenge was electronic publishing. The commercial publishing industry had resisted moving the paper- and person-intense process of manuscript submission, review, and publication into the electronic age. Stanford University was the home for HighWire Press, which had emerged as the most effective electronic home for scholarly biomedical publications. Soon after the rise of HighWire, a number of software solutions became available to allow the Blood Editorial Office to solicit, track, and distribute review authors' manuscripts, and then convert accepted papers into publishable form. ScholarOne was selected to bring Blood into the era of all-electronic submission and publication. The first electronic manuscript submission occurred on November 19, 2001, and by June 1, 2002, all submitted manuscripts entered the Blood editorial office as electrons. The result: average manuscript review time was reduced from 41 to 22 days, and the number of submissions to Blood rose from 3148 in 2001, the last year of paper submissions, to 3481 the following year. In 2007, under the guidance of Director of Publications Eleanore Tapscott and Editor-in-Chief Sanford Shattil, it is projected Blood will consider 4584 manuscripts for publication and accept 1044, or 23%. For the past several decades, Blood has held the highest impact factor of any hematology journal.
Maturation of the Society
Political activism came to the Society early in its history, guided by Dr Louis L. Wasserman, President of ASH in 1969, and John Grupenhoff, PhD, an ASH consultant on federal governmental affairs. One of the earliest impacts of this effort was addition of the word “Blood” to the name of the National Heart and Lung Institute of the National Institutes of Health (NIH) in 1976. This change made hematology a more visible scientific discipline, although blood research also had been supported by grants from other institutes at the NIH, especially the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) and the National Cancer Institute (NCI). Dr Grupenhoff also was engaged by the Society to bring to the attention of Congress the important role hematology plays in health care, biomedical research, and teaching. Therefore, members of the Society accompanied him on visits to the halls of Congress to meet with the legislators and their health aides. This function has been assumed by the Committee on Governmental Affairs and the annual grassroots network. Each year the President of ASH delivers testimony to numerous congressional committees, especially those providing oversight of the NIH, the committees lobby members of the House and Senate, and members of the Executive Committee often work with other medical society leaders to voice timely praise and concern over issues pertaining to biomedical science and the practice of hematological medicine.
The Society also has been at the vanguard of promoting cutting-edge science, fellowship, junior faculty, and continuing medical education in hematology, advancing important social agendas, including recognizing underrepresented minority achievements and providing outreach activities to the developing world and establishing important interactions with other medical societies. For example, the ASH Agenda for Research was developed in 2006 and is continually updated. The Research Agenda summarizes the highest priorities for the subspecialty with input from the members of the 14 scientific committees and other scientific leaders of the Society. ASH was the first scientific organization to implement an educational program at its annual meetings. Dr Thomas Hale Ham, President of ASH in 1965, was the moving force behind this highly successful innovation in 1969. His and many others' efforts have been continued by the Education Committee and serve to attract practicing physicians to the annual meetings. In 1983, the entire annual meeting program was certified for Continuing Medical Education credit by the Accrediting Council on CME.
Gifts and bequests from the estate of Dr Stratton were designed to fund postdoctoral research training and research grants in the names of the Henry and Lillian Stratton Foundation Awards and the Stratton-Jaffé Scholar Awards. The first award from the latter program was given to Dr Carol A. Westbrook in 1983.
In 2003 the Society began offering the Clinical Research Training Institute, a year-long course that begins with a summer workshop where participants refine their own research proposals, followed by several sessions throughout the year designed to provide the nascent clinical investigator the tools and mentoring networks necessary for a successful career in patient-oriented research. Later this year the Society will graduate its 100th participant from this highly successful program.
Dr Helen M. Ranney, President of ASH in 1974, was the first woman President and was among the first women to lead a major medical subspecialty society. Dr Ranney helped to start the movement to make Blood the official journal of ASH. Four other women, Drs Jane F. Desforges in 1985, Dorothea Zucker-Franklin in 1995, Beverly S. Mitchell in 2001, and Nancy Berliner in 2009 have served or will serve as ASH President. In 2004, the Minority Recruitment Initiative was launched to encourage more members of underrepresented minorities to enter the field of hematology.
In 2004 the International Members Committee of ASH conceived of and began to support the International Consortium on Acute Promyelocytic Leukemia, an initiative designed to provide the infrastructure necessary to spread the tremendous successes achieved in this form of leukemia in North America, Europe, and Japan to the developing world. At present this effort includes Mexico, Brazil, and Uruguay. Other outreach activities of the Society include providing Blood, Hematology (the ASH Education Program book), and numerous other educational materials to more than 100 institutions in 45 different countries and opportunities for hematologists from the developing world to study in laboratories and clinics in North America and Europe.
Because so much of clinical hematology has become involved with malignant disorders, joint symposia with the American Society of Clinical Oncology (ASCO) are presented at the annual meetings, and with that Society ASH developed a Rational Use of Erythropoietin practice guideline based only on the irrefutable evidence supporting use of the hormone. Disorders of blood coagulation also fall within the purview of practicing and research hematologists. Collaboration with the American Heart Association's Council on Thrombosis and Hemostasis provided joint sessions at ASH in 1994 and for a few years thereafter. An innovative new postannual meeting session on hemostasis and thrombosis was begun in 2006 and was highly successful.
The Society's focus on research, teaching, training, and clinical medicine is reflected in several annual awards. The Ham-Wasserman Lecture is delivered annually, usually by a distinguished non-American hematologist. The E. Donnell Thomas Lecture is given each year by a distinguished American hematologist. The William Dameshek Prize is presented each year to recognize a recent outstanding contribution to the field of hematology, and the Henry M. Stratton Medal is given to honor an individual whose contributions were made over a period of several years. In 2006, the ASH Outstanding Mentor Awards, one in the basic sciences and one in clinical research, were created to recognize preceptors for their contributions to the training and polishing of the next generation of hematologists.
The exhibits by pharmaceutical and scientific instrument companies have provided very significant financial support for ASH and have resulted in scheduling the Friday Satellite Symposia on the day before the official opening of the Society's annual meeting since 1991. These industry-sponsored symposia have facilitated and expanded attendance, often with high-quality presentations. However, to reduce the Society's dependence on corporate support, a Task Force on Development was appointed in 2003 to solicit contributions from noncorporate sources such as the members, the NIH, and philanthropic foundations. This effort evolved into the standing Committee on Development in 2006. Examples of the work of this committee are the efforts currently under way to raise an endowment to support the very successful Clinical Research Training Institute in perpetuity.
For the future
Without a crystal ball, the future cannot be predicted. However, it can be expected that the community of hematologists in the United States and throughout the world will continue to make advances in understanding the cellular and molecular bases of human disease and the best means by which to prevent, ameliorate, or cure them. ASH is well positioned to provide support for the research, continuing education, and clinical practice of current hematologists, and provide the village necessary for the mentoring of our next generations.
The authors are grateful to Dr Helen M. Ranney for review, suggestions, and arguments.