Past President’s perspective

It’s January 1, 2022, as I write, and my CHEST presidency came to an end last night as the fireworks lit up the sky. With COVID-19 waxing and waning across the United States and around the world, I have been a wartime president. CHEST has not been able to do a number of the things that we would normally have done in person, including that there has not been an in-person CHEST annual meeting during my entire presidency. We have, nonetheless, achieved some important things that I will share with you.

If you’re a typical CHEST member, you probably don’t spend a lot of time wondering about CHEST’s finances, nor should you. Nevertheless, CHEST – your organization – does have to be fiscally responsible if we desire to continue our educational and research missions, and that is the job of your Board of Regents, your presidents, and your professional staff at the CHEST headquarters. I’m happy to tell you that your organization is in healthy financial condition, in spite of a challenging economic environment and, being forced into remote, online annual meetings and board reviews for 2 years. What that means to us and to you is that we get to maintain and improve our full array of educational activities, including our annual meeting, our journal, our board reviews, our hands-on courses at the CHEST headquarters, and our web content. And, we get to accelerate our advocacy activities for our patients and for the clinical folks who care for them (us!). CHEST is primed for emerging from this pandemic stronger, because we have had to make the most of every dollar we have, and more innovative, because that’s how we have done it. We are ready for new ways of interacting and for innovative new ways of delivering education, sponsoring research, fostering networking, and leading in the clinical arena of chest medicine.

During my time as CHEST President, many of us have become progressively more aware of the blatant inequities that continue in society – and, yes, even in medicine. Perhaps more than anything, it both saddens and angers me when anyone values or devalues someone else’s life because of the color of their skin, who they feel attracted to or love, the sex they were born with or their knowledge that nature gave them the wrong physical characteristics for their gender, what physical impairments they have, where they were born, where they were educated - or not, what language is their first language, or what opportunities they were presented with in their lives. Everyone deserves the opportunity to be who and what they are and to be respected for who they are, and everyone deserves the opportunity to excel. The strongest collaborations have diverse constituents with unified goals, and I want for CHEST to be among the strongest of professional collaborations. It has been deeply important to me during my presidency to champion these values, and we have worked hard to make CHEST an inclusive and diverse organization. Much remains to be done, but we did make some good progress this year.

We established a spirometry working group to look at the science around race-based adjustments for normal values, to call out if there are mistakes or omissions in that approach, and to propose the work that needs to be done to correct them. We invited the American Thoracic Society and the Canadian Thoracic Society to join us in this effort. Race is a social construct, not a physiologic principle, and some data suggest that apparent differences in physiology could actually reflect differences in socioeconomic status of study participants. In similar work, our nephrology colleagues demonstrated that apparent differences in normal glomerular filtration rate (GFR) are related to socio-economic and health care access issues; they called for labs to no longer report race-based norms for creatinine and GFR values. Our colleagues believe that race-based GFR norms have harmed patients by promoting delay in treatments aimed at preventing dialysis or by causing delays in the initiation of dialysis. In our world, asbestos companies have argued that African American and other populations of color should receive lower asbestosis settlements on the basis that they began with lower predicted lung function and, therefore, had been less damaged by exposure to asbestos. I am very interested to see our working group’s output. I think it could result in landmark changes in our evaluation and treatment of patients with lung diseases.

 

A very important undertaking for us this year was a top to bottom analysis of our own practices around diversity, equity, and inclusion. We started by taking lessons from the CHEST Foundation-sponsored listening tour across the nation. Many of our patients of color lack adequate access to the care they need, which informs our efforts in advocacy and health policy. We also learned that, as a profession, we have not earned the trust of our patients of color, and we must take steps to remedy that. CHEST began this effort by developing the First 5 Minutes program, which teaches all of us how to take the first moments of our interactions with patients to enhance our empathy and to establish trusting relationships with them. You will hear more about this program in the months to come.

CHEST is dedicated to ensuring that all of our members have equitable opportunities to take part in our learning activities, both as participants and as developers. Likewise, we want any member who desires to advance in our organization to have wide open opportunity to develop and use their skills. We hired a consulting firm who specializes in aiding nonprofits with their diversity, equity, and inclusion goals to help us find our weaknesses in that area. They spent several months interviewing members at all stages of their careers and in a variety of job types, with the goal of determining what it is like to be a CHEST member of color, a woman, a member of the LGBTQIA community, or a member of any group that has been made to feel “other.” We are currently working to turn their findings into concrete steps to make CHEST the most diverse and inclusive medical society possible. Finally, our consultants are helping us to ensure that the people we hire to work for our organization full time have equitable opportunities in their workplace, and that CHEST headquarters feels inclusive and is diverse for them.

COVID-19 rages on. In fact, daily case numbers at this writing are skyrocketing, higher than at any time during the pandemic, and hospitalization rates, while lower than with some of the previous waves, are following. Many of us are stressed, and in many of our ICUs, we have fewer nurses than we did at the outset of the pandemic. The CHEST COVID-19 task force continues on the job, though, with fresh content to match the current circumstances. These dedicated individuals, who I recognized with a Presidential Citation for 2021, have worked since the early days of the pandemic to scour the literature and the landscape to find the right data and the right experts to inform the topical infographics, reviews, webinars, and podcasts that are freely available to all and are posted on the CHEST website. I hope that you have availed yourself of the material there, and, if not, you have missed some valuable learning opportunities. Missed them in real time, that is; they are all on the site for you to use at will. We are optimistic that someday soon, there will be less of a need for the COVID-19 task force, but the members are all ready to continue their work until that time comes..

I’ve highlighted just a few of the higher profile things that CHEST achieved in 2021. It would be impossible for me to cover all that CHEST has accomplished this past year. My sources tell me that during my presidency, we generated, signed on, or declined to join nearly 100 advocacy statements on topics ranging from recall of home CPAP machines to access to appropriate supplemental oxygen for patients with interstitial lung disease, to the acquisition of a nebulizer company by a tobacco company. We held successful board review sessions and repeated our all online, yet interactive, version of the CHEST annual meeting, with more than 4,000 total attendees– not as large as an in-person meeting, but not terribly far off, either. I will add that our program chairs and their committee pivoted from a meeting in Vancouver to a meeting in Orlando to, with only 6 weeks’ notice, a meeting in the ether. We are fortunate to have worked with such talented and dedicated individuals, and all of us owe them a lot for their efforts.

If, as I say, I have been a wartime president, then the worldwide viral pandemic that directly affects those of us in chest medicine has been the war. In spite of the current tsunami of cases, I am optimistic that the war ends relatively soon. CHEST will not simply return to normalcy, though. Dr. David Schulman, a brilliant and innovative educator, has taken the leadership reins of the organization, and I foresee exhilarating times ahead.

We are making it through a challenging environment, and CHEST is stronger for it. I will look forward to seeing all of you in Nashville, when we, at long last, can look one another in the eye, shake one another’s hand, and enjoy the experience of the CHEST annual meeting together. And if you don’t mind me asking, when you see me in Nashville, will you please do exactly that?

It’s January 1, 2022, as I write, and my CHEST presidency came to an end last night as the fireworks lit up the sky. With COVID-19 waxing and waning across the United States and around the world, I have been a wartime president. CHEST has not been able to do a number of the things that we would normally have done in person, including that there has not been an in-person CHEST annual meeting during my entire presidency. We have, nonetheless, achieved some important things that I will share with you.

If you’re a typical CHEST member, you probably don’t spend a lot of time wondering about CHEST’s finances, nor should you. Nevertheless, CHEST – your organization – does have to be fiscally responsible if we desire to continue our educational and research missions, and that is the job of your Board of Regents, your presidents, and your professional staff at the CHEST headquarters. I’m happy to tell you that your organization is in healthy financial condition, in spite of a challenging economic environment and, being forced into remote, online annual meetings and board reviews for 2 years. What that means to us and to you is that we get to maintain and improve our full array of educational activities, including our annual meeting, our journal, our board reviews, our hands-on courses at the CHEST headquarters, and our web content. And, we get to accelerate our advocacy activities for our patients and for the clinical folks who care for them (us!). CHEST is primed for emerging from this pandemic stronger, because we have had to make the most of every dollar we have, and more innovative, because that’s how we have done it. We are ready for new ways of interacting and for innovative new ways of delivering education, sponsoring research, fostering networking, and leading in the clinical arena of chest medicine.

During my time as CHEST President, many of us have become progressively more aware of the blatant inequities that continue in society – and, yes, even in medicine. Perhaps more than anything, it both saddens and angers me when anyone values or devalues someone else’s life because of the color of their skin, who they feel attracted to or love, the sex they were born with or their knowledge that nature gave them the wrong physical characteristics for their gender, what physical impairments they have, where they were born, where they were educated - or not, what language is their first language, or what opportunities they were presented with in their lives. Everyone deserves the opportunity to be who and what they are and to be respected for who they are, and everyone deserves the opportunity to excel. The strongest collaborations have diverse constituents with unified goals, and I want for CHEST to be among the strongest of professional collaborations. It has been deeply important to me during my presidency to champion these values, and we have worked hard to make CHEST an inclusive and diverse organization. Much remains to be done, but we did make some good progress this year.

We established a spirometry working group to look at the science around race-based adjustments for normal values, to call out if there are mistakes or omissions in that approach, and to propose the work that needs to be done to correct them. We invited the American Thoracic Society and the Canadian Thoracic Society to join us in this effort. Race is a social construct, not a physiologic principle, and some data suggest that apparent differences in physiology could actually reflect differences in socioeconomic status of study participants. In similar work, our nephrology colleagues demonstrated that apparent differences in normal glomerular filtration rate (GFR) are related to socio-economic and health care access issues; they called for labs to no longer report race-based norms for creatinine and GFR values. Our colleagues believe that race-based GFR norms have harmed patients by promoting delay in treatments aimed at preventing dialysis or by causing delays in the initiation of dialysis. In our world, asbestos companies have argued that African American and other populations of color should receive lower asbestosis settlements on the basis that they began with lower predicted lung function and, therefore, had been less damaged by exposure to asbestos. I am very interested to see our working group’s output. I think it could result in landmark changes in our evaluation and treatment of patients with lung diseases.

 

A very important undertaking for us this year was a top to bottom analysis of our own practices around diversity, equity, and inclusion. We started by taking lessons from the CHEST Foundation-sponsored listening tour across the nation. Many of our patients of color lack adequate access to the care they need, which informs our efforts in advocacy and health policy. We also learned that, as a profession, we have not earned the trust of our patients of color, and we must take steps to remedy that. CHEST began this effort by developing the First 5 Minutes program, which teaches all of us how to take the first moments of our interactions with patients to enhance our empathy and to establish trusting relationships with them. You will hear more about this program in the months to come.

CHEST is dedicated to ensuring that all of our members have equitable opportunities to take part in our learning activities, both as participants and as developers. Likewise, we want any member who desires to advance in our organization to have wide open opportunity to develop and use their skills. We hired a consulting firm who specializes in aiding nonprofits with their diversity, equity, and inclusion goals to help us find our weaknesses in that area. They spent several months interviewing members at all stages of their careers and in a variety of job types, with the goal of determining what it is like to be a CHEST member of color, a woman, a member of the LGBTQIA community, or a member of any group that has been made to feel “other.” We are currently working to turn their findings into concrete steps to make CHEST the most diverse and inclusive medical society possible. Finally, our consultants are helping us to ensure that the people we hire to work for our organization full time have equitable opportunities in their workplace, and that CHEST headquarters feels inclusive and is diverse for them.

COVID-19 rages on. In fact, daily case numbers at this writing are skyrocketing, higher than at any time during the pandemic, and hospitalization rates, while lower than with some of the previous waves, are following. Many of us are stressed, and in many of our ICUs, we have fewer nurses than we did at the outset of the pandemic. The CHEST COVID-19 task force continues on the job, though, with fresh content to match the current circumstances. These dedicated individuals, who I recognized with a Presidential Citation for 2021, have worked since the early days of the pandemic to scour the literature and the landscape to find the right data and the right experts to inform the topical infographics, reviews, webinars, and podcasts that are freely available to all and are posted on the CHEST website. I hope that you have availed yourself of the material there, and, if not, you have missed some valuable learning opportunities. Missed them in real time, that is; they are all on the site for you to use at will. We are optimistic that someday soon, there will be less of a need for the COVID-19 task force, but the members are all ready to continue their work until that time comes..

I’ve highlighted just a few of the higher profile things that CHEST achieved in 2021. It would be impossible for me to cover all that CHEST has accomplished this past year. My sources tell me that during my presidency, we generated, signed on, or declined to join nearly 100 advocacy statements on topics ranging from recall of home CPAP machines to access to appropriate supplemental oxygen for patients with interstitial lung disease, to the acquisition of a nebulizer company by a tobacco company. We held successful board review sessions and repeated our all online, yet interactive, version of the CHEST annual meeting, with more than 4,000 total attendees– not as large as an in-person meeting, but not terribly far off, either. I will add that our program chairs and their committee pivoted from a meeting in Vancouver to a meeting in Orlando to, with only 6 weeks’ notice, a meeting in the ether. We are fortunate to have worked with such talented and dedicated individuals, and all of us owe them a lot for their efforts.

If, as I say, I have been a wartime president, then the worldwide viral pandemic that directly affects those of us in chest medicine has been the war. In spite of the current tsunami of cases, I am optimistic that the war ends relatively soon. CHEST will not simply return to normalcy, though. Dr. David Schulman, a brilliant and innovative educator, has taken the leadership reins of the organization, and I foresee exhilarating times ahead.

We are making it through a challenging environment, and CHEST is stronger for it. I will look forward to seeing all of you in Nashville, when we, at long last, can look one another in the eye, shake one another’s hand, and enjoy the experience of the CHEST annual meeting together. And if you don’t mind me asking, when you see me in Nashville, will you please do exactly that?

It’s January 1, 2022, as I write, and my CHEST presidency came to an end last night as the fireworks lit up the sky. With COVID-19 waxing and waning across the United States and around the world, I have been a wartime president. CHEST has not been able to do a number of the things that we would normally have done in person, including that there has not been an in-person CHEST annual meeting during my entire presidency. We have, nonetheless, achieved some important things that I will share with you.

If you’re a typical CHEST member, you probably don’t spend a lot of time wondering about CHEST’s finances, nor should you. Nevertheless, CHEST – your organization – does have to be fiscally responsible if we desire to continue our educational and research missions, and that is the job of your Board of Regents, your presidents, and your professional staff at the CHEST headquarters. I’m happy to tell you that your organization is in healthy financial condition, in spite of a challenging economic environment and, being forced into remote, online annual meetings and board reviews for 2 years. What that means to us and to you is that we get to maintain and improve our full array of educational activities, including our annual meeting, our journal, our board reviews, our hands-on courses at the CHEST headquarters, and our web content. And, we get to accelerate our advocacy activities for our patients and for the clinical folks who care for them (us!). CHEST is primed for emerging from this pandemic stronger, because we have had to make the most of every dollar we have, and more innovative, because that’s how we have done it. We are ready for new ways of interacting and for innovative new ways of delivering education, sponsoring research, fostering networking, and leading in the clinical arena of chest medicine.

During my time as CHEST President, many of us have become progressively more aware of the blatant inequities that continue in society – and, yes, even in medicine. Perhaps more than anything, it both saddens and angers me when anyone values or devalues someone else’s life because of the color of their skin, who they feel attracted to or love, the sex they were born with or their knowledge that nature gave them the wrong physical characteristics for their gender, what physical impairments they have, where they were born, where they were educated - or not, what language is their first language, or what opportunities they were presented with in their lives. Everyone deserves the opportunity to be who and what they are and to be respected for who they are, and everyone deserves the opportunity to excel. The strongest collaborations have diverse constituents with unified goals, and I want for CHEST to be among the strongest of professional collaborations. It has been deeply important to me during my presidency to champion these values, and we have worked hard to make CHEST an inclusive and diverse organization. Much remains to be done, but we did make some good progress this year.

We established a spirometry working group to look at the science around race-based adjustments for normal values, to call out if there are mistakes or omissions in that approach, and to propose the work that needs to be done to correct them. We invited the American Thoracic Society and the Canadian Thoracic Society to join us in this effort. Race is a social construct, not a physiologic principle, and some data suggest that apparent differences in physiology could actually reflect differences in socioeconomic status of study participants. In similar work, our nephrology colleagues demonstrated that apparent differences in normal glomerular filtration rate (GFR) are related to socio-economic and health care access issues; they called for labs to no longer report race-based norms for creatinine and GFR values. Our colleagues believe that race-based GFR norms have harmed patients by promoting delay in treatments aimed at preventing dialysis or by causing delays in the initiation of dialysis. In our world, asbestos companies have argued that African American and other populations of color should receive lower asbestosis settlements on the basis that they began with lower predicted lung function and, therefore, had been less damaged by exposure to asbestos. I am very interested to see our working group’s output. I think it could result in landmark changes in our evaluation and treatment of patients with lung diseases.

 

A very important undertaking for us this year was a top to bottom analysis of our own practices around diversity, equity, and inclusion. We started by taking lessons from the CHEST Foundation-sponsored listening tour across the nation. Many of our patients of color lack adequate access to the care they need, which informs our efforts in advocacy and health policy. We also learned that, as a profession, we have not earned the trust of our patients of color, and we must take steps to remedy that. CHEST began this effort by developing the First 5 Minutes program, which teaches all of us how to take the first moments of our interactions with patients to enhance our empathy and to establish trusting relationships with them. You will hear more about this program in the months to come.

CHEST is dedicated to ensuring that all of our members have equitable opportunities to take part in our learning activities, both as participants and as developers. Likewise, we want any member who desires to advance in our organization to have wide open opportunity to develop and use their skills. We hired a consulting firm who specializes in aiding nonprofits with their diversity, equity, and inclusion goals to help us find our weaknesses in that area. They spent several months interviewing members at all stages of their careers and in a variety of job types, with the goal of determining what it is like to be a CHEST member of color, a woman, a member of the LGBTQIA community, or a member of any group that has been made to feel “other.” We are currently working to turn their findings into concrete steps to make CHEST the most diverse and inclusive medical society possible. Finally, our consultants are helping us to ensure that the people we hire to work for our organization full time have equitable opportunities in their workplace, and that CHEST headquarters feels inclusive and is diverse for them.

COVID-19 rages on. In fact, daily case numbers at this writing are skyrocketing, higher than at any time during the pandemic, and hospitalization rates, while lower than with some of the previous waves, are following. Many of us are stressed, and in many of our ICUs, we have fewer nurses than we did at the outset of the pandemic. The CHEST COVID-19 task force continues on the job, though, with fresh content to match the current circumstances. These dedicated individuals, who I recognized with a Presidential Citation for 2021, have worked since the early days of the pandemic to scour the literature and the landscape to find the right data and the right experts to inform the topical infographics, reviews, webinars, and podcasts that are freely available to all and are posted on the CHEST website. I hope that you have availed yourself of the material there, and, if not, you have missed some valuable learning opportunities. Missed them in real time, that is; they are all on the site for you to use at will. We are optimistic that someday soon, there will be less of a need for the COVID-19 task force, but the members are all ready to continue their work until that time comes..

I’ve highlighted just a few of the higher profile things that CHEST achieved in 2021. It would be impossible for me to cover all that CHEST has accomplished this past year. My sources tell me that during my presidency, we generated, signed on, or declined to join nearly 100 advocacy statements on topics ranging from recall of home CPAP machines to access to appropriate supplemental oxygen for patients with interstitial lung disease, to the acquisition of a nebulizer company by a tobacco company. We held successful board review sessions and repeated our all online, yet interactive, version of the CHEST annual meeting, with more than 4,000 total attendees– not as large as an in-person meeting, but not terribly far off, either. I will add that our program chairs and their committee pivoted from a meeting in Vancouver to a meeting in Orlando to, with only 6 weeks’ notice, a meeting in the ether. We are fortunate to have worked with such talented and dedicated individuals, and all of us owe them a lot for their efforts.

If, as I say, I have been a wartime president, then the worldwide viral pandemic that directly affects those of us in chest medicine has been the war. In spite of the current tsunami of cases, I am optimistic that the war ends relatively soon. CHEST will not simply return to normalcy, though. Dr. David Schulman, a brilliant and innovative educator, has taken the leadership reins of the organization, and I foresee exhilarating times ahead.

We are making it through a challenging environment, and CHEST is stronger for it. I will look forward to seeing all of you in Nashville, when we, at long last, can look one another in the eye, shake one another’s hand, and enjoy the experience of the CHEST annual meeting together. And if you don’t mind me asking, when you see me in Nashville, will you please do exactly that?