Resources

Club History

Fellowship and Shared Interests: The History of the Pancreas Club

by Charles F. Frey, MD

The Founding

At the time of the founding of the Pancreas Club in 1966, the medical and surgical environment was inhospitable to the study of the exocrine pancreas by surgical investigators or surgical trainees. There were no Surgical Department Chairmen who had as their primary interest pancreatic disease. The vast majority of Surgical Department Chairmen were General Surgeons whose focus in research including that funded by NIH was devoted to the study of Portal Hypertension, Biliary, or Peptic Ulcer Disease. NIH funding for diseases of the exocrine pancreas had a low priority as most members of the NIH advisory committees shared the same sentiments as the surgical Department Chairmen. Many surgical departments had 3-4 faculty whose primary interests were liver, biliary, or peptic ulcer disease. It was only the occasional surgical department that had even one faculty member whose major interest was pancreatic exocrine disease.

In the absence of surgical faculty role models having an interest in pancreatic disease most surgical trainees seeking a career in academic surgery could read the “tea leaves.” Many followed the path of least resistance pursuing the study of liver, biliary, or peptic ulcer disease. In so doing they were likely to receive the approbation of their, mentors as well as research funding. Those surgeons choosing the study of disease of the exocrine pancreas were as Robert Frost said following the “road less traveled”. They were usually one of a kind at their institution. Yet, they too wanted to share their ideas and theories about exocrine pancreatic disease with others having similar interests, and benefit from the feedback and insights such exchanges might bring. Compounding their professional isolation was the absence of a National forum devoted to the pancreas, and the difficulty of getting papers whose theme was pancreatic exocrine disease on national programs.

The Pancreas Club was borne out of the need of its members to share ideas with other colleagues having similar interests and benefit from their feedback. Out of this shared experience a sense of fellowship developed among the members of the Pancreas Club, which persists to this day.

The first meeting of the Pancreas Club was organized by Marion Anderson, then, an Associate Professor of Surgery at Northwestern University. There were nine invited including two Canadians, Alan Thompson and Fraser Gurd. Presenters at the first meeting included Alan Thompson, Fraser Gurd, Max Rittenbury, Marion Anderson and Larry Carey. Topics were Proteolytic Enzymes in Acute Hemorrhagic Pancreatitis, Vascular Changes in Hemorrhagic Pancreatitis, Therapy and Research in Pancreatitis. (All presenters except Rittenbury were later to become Surgical Department Chairs.)

The positive effects engendered through interacting and sharing interests and ideas produced a feeling of fellowship, which was further enhanced by an informal dinner hosted by Marion’s wife, Sonia, in their Evanston home. Encouraged by the enthusiasm of the participants, a second meeting was planned the following year. Subsequent meetings were hosted by John Howard in Philadelphia in 1967, Leon Goldman at the University of California, San Francisco in 1968, David Dreiling at the Mount Sinai Hospital in New York in 1969, Edward Paloyan at the University of Chicago in 1970, John Howard at the Sheraton Hotel in Philadelphia in 1971, Englebert Dunphy at the University of California San Francisco in 1972 and David Dreiling at the Mount Sinai Hospital in New York in 1973.

During this period membership in the Pancreas Club expanded slowly through informal contacts between members and acquaintances having an interest in the exocrine pancreas. The peak attendance was 22 at the 1970 Chicago meeting. Membership in the club reached 30. Marion Anderson, freshly appointed Chairman of Surgery at the Ohio Medical School in Toledo in 1969, continued to function as Chairman of the Pancreas Club as well as Secretary and Treasurer until he accepted the Chairmanship at the University of South Carolina in 1972. Dr. Anderson appointed Max Rittenbury an Associate Professor of Surgery at the University of South Carolina to be his successor as Chairman of the Pancreas Club.

Ending and New Beginning

For reasons to which I am not privy Dr. Rittenbury issued no call for a meeting in 1974, and as a result none took place. Charlie Frey, Professor of Surgery at the University of Michigan and Bill Schiller, Professor of Surgery at the Medical School of Northern Ohio at Toledo, undertook an assessment of interest among former and prospective members in reconstituting the Pancreas Club. Those consulted included Marion Anderson, Brad Aust, Alec Walt, David Dreiling, Dan Elliot, Robert Zeppa, Larry Carey, Francis Gurd, Robert Hermann, Isadore Cohn, Robert Condon, Ken Warren, Andrew Warshaw, John Cameron, John Howard and John Ranson all of whom encouraged Charlie and Bill to undertake the lead role in this effort.

Incorporation of the Club as a non-profit organization

A constitution and by laws were developed by Charlie and Bill. The Pancreas Club was then incorporated in the State of Michigan in 1975. Charlie and Bill and John Ranson drove from Ann Arbor, Michigan to East Lansing, Michigan and signed the incorporation papers. Subsequent to this in 1975 with pro bono help from the law firm of Conlin, and Conlin in Ann Arbor, Michigan, an IRS non-profit status was obtained from the U.S. Treasury.

Program Format and Its Evolution

Invited Speakers

The first scientific meeting of the Pancreas Club under the aegis of Charlie and Bill consisted of invited speakers who were asked to address topics deemed important by the co-chairmen, that is, the latest cutting edge clinical or basic research on disease of the exocrine pancreas. Attendance at the 1975 meeting hosted by Bradley Aust, Chairman of Surgery at the University of Texas in San Antonio, Texas was gratifying to the new co-chairmen. There were over 40 attendees doubling the size of any previous Pancreas Club meeting. The formation of the program based on solicitation of speakers invited to address specific topics was repeated for the next two years.

Submitted Abstracts

By 1978 Charlie and Bill recognized that the interest in the study of diseases of the exocrine was gaining momentum in the United States and elsewhere in the world, and it was no longer possible to know all those involved in its study much less the specifics of their research. Therefore, a scientific program based on solicitation of speakers who requested to present their work was no longer “cutting edge.” The 1979 program was drawn entirely from a call for abstracts and selected by a program committee including Charlie and Bill.

Poster Sessions

In 1984 abstracts were numerous enough and of sufficient quality to warrant poster sessions in addition to what had previously been a program consisting of oral presentations, followed by a generous allotment of time for discussion and feedback.

How to do it sessions

Bill Traverso at the Mason Clinic in Seattle, Washington introduced in 1996 a “How To Do It Session” which consisted of national and international experts presenting their approach to some facet of pancreatic disease management. This popular innovation is now a regular part of the annual meeting.

Membership and Dues

Dues and membership rules are simple. There are no requirements for membership other than to be a physician and to have an interest in the exocrine pancreas. Historically, membership has increased mainly by word of mouth. The membership requirement is met by payment of dues. There are no requirements regarding attendance at the annual meeting, nor is there any chasing after dues of those who have been members and have failed to pay in subsequent years. Non dues paying members are dropped from the rolls after three years of non-payment. Perhaps, surprisingly to some this membership structure has served the Pancreas Club well. Individuals interested in participating in the activities of the Club can do so without going through a battery of forms, letters of recommendation and other hoops common to many other organizations. This format is especially friendly to residents in training who become full-fledged members by payment of dues.

Conversely, individual members whose career direction or professional interest in the pancreas has diminished can discontinue their participation by non-payment of dues. Paradoxically, non-attendance by some members permitted the Club until recent years to subsidize our annual banquet, as the annual dues included the dinner costs. Oftentimes the cost of the member’s dinner was more than the member’s dues. Famous for its epicurean dinners planned by the local arrangement chairman following the end of the scientific program, the costs tended to escalate from year to year as each host tried to improve on the previous year’s success. In effect those members who paid their dues and did not attend the dinner subsidized those attending.

The system worked well until the successful and highly popular Boston meeting in 1993 hosted by Andy Warshaw. A huge turnout for the meeting and dinner, which included spouses and significant others who paid only a small percentage of the cost of the dinner, caused the proportion of dues paying members attending to be so high that there was an insufficient number of non attendees to subsidize the dinner. The problem was compounded by the unusually high turnout of spouses and significant others who paid even less than the members! At this meeting and thereafter it became necessary to add a surcharge for the dinner in order to maintain financial solvency of the Club. Currently, the annual fee is $ 75.00 for all members including medical students and residents.

Financial support from industry

The dinners are still subsidized to some degree not only by dues paying members who do not attend the meeting, but also indirectly by contributions from industry to the costs of the meeting. Industry contributions were first received in 1991, and initially, were in the range of three to four thousand dollars a year. Recently, under the leadership of Richard Bell, Michael Sarr, William Nealon and then Bill Traverso, these contributions from industry have reached five figures.

Annual Meeting Locations

Annual dues were kept under seventy-five dollars for many years. By holding the annual meeting at University facilities rather than in hotels whenever possible, considerable cost savings were realized. The disadvantage of using University facilities is principally geographic. In most cities, university facilities are not in a downtown area near the Digestive Disease Week convention facility. Members of the Pancreas Club having major responsibilities associated with the Digestive week then find it difficult to get back and forth between the university meeting site and the convention site. The Pancreas Club meetings have always been held in Association with the Society of Surgery of the Alimentary Tract (SSAT) usually the day preceding the meeting of the SSAT. A majority of the members of the Pancreas Club are surgeons. Most of the surgical members of the Pancreas Club are also members of the SSAT. When the SSAT became a part of Digestive Disease week in 1973, the Sunday meeting time of the Pancreas Club conflicted with the Sunday time of the SSAT Postgraduate course. However, members of The Pancreas Club chose by ballot to continue with the Sunday format except when the SSAT Postgraduate Course had a pancreatic theme.

Relationship of the Pancreas Club with Other Organizations

American Pancreatic Association

Association with other organizations and other meeting times have received serious consideration. In 1980, Charlie Frey co-chairman representing the Pancreas Club and Paul Webster, President representing the American Pancreatic Association, discussed the possibility of combining the two organizations’ annual meetings back to back. Each organization would continue to have its own program. The American Pancreatic Association was formed about the same time as the Pancreas Club. Membership of the APA was composed principally of gastroenterologists and basic science investigators. The desirability of combining the meeting times back to back of an organization predominately composed of surgeons with one predominantly composed of gastroenterologists and basic scientists both of whom had as their focus the study of the exocrine pancreas seemed compelling.

However, the proposed relationship foundered as the membership of the two organizations could not agree on a meeting time. The surgeon members of the Pancreas Club desired to continue their relationship with the SSAT and were dismayed at the prospect of meeting again so soon after the American College of Surgeons meeting held in October. (The American Pancreatic Association meeting was always held in Chicago the first week of November). The gastroenterologist members of the APA did not want to give up their November meeting time as it coincided with the liver meetings concomitantly being held in Chicago. Much has changed with both organizations since then and perhaps this issue may be re-explored.

Society of the Surgery of the Alimentary Tract (SSAT)

The Pancreas Club has never had a formal relationship with the SSAT even though it almost always has met the day before the SSAT meeting and most surgical members of the Pancreas Club are SSAT members. In fact, several key members of the Pancreas Club have been officers in SSAT. Presidents of the SSAT include John Cameron, Bob Hermann, John Ransom, Michael Sarr, and Andy Warshaw and Carlos Pellegrini. Charlie Frey and Tom White were First Vice Presidents and Joseph E. Fisher was Treasurer. Richard Bell and now Bill Traverso have been the Recorder for the SSAT.

Digestive Disease Week

At the time SSAT became a part of Digestive Disease Week in 1973, exploratory talks were initiated by Charlie Frey and Bill Schiller with members of the Digestive Disease Week to determine whether the Pancreas Club could have a meeting day assigned. These talks bore no fruit. Once again in 1988, when Bob Hermann (a key member of the Pancreas Club) was President of the Society of Surgery of the Alimentary Tract, he actively pursued a formal relationship for the Pancreas Club with Digestive Disease Week. At that time the Digestive Disease Week would have required the Pancreas Club to give up its Sunday meeting time for a half day meeting some time during the week in conjunction with the SSAT. The membership of the Pancreas Club opposed these conditions. In 1998, Michael Sarr, Co-Chairman of the Pancreas Club, and at the same time Chairman of the SSAT Program Committee was able for the first time to successfully arrange hotel space for the Orlando, Florida meeting through the offices of Digestive Disease Week.

Membership Background

Medical Speciality

The Pancreas Club was founded by surgeons. Surgeons have remained the most numerous element among its members. Being a surgeon has never been a requirement of membership. Participation by gastroenterologists and basic scientists occurred in the earliest years of the Club and their membership has grown. In 1984 when there were 105 members, the membership included 20 Surgical Department Chairmen, 6 Gastroenterologists, 2 Canadians, 2 Swiss, 6 from the British Isles, 2 Portuguese and one German.

In the year 2000, there were 374 members of the Pancreas Club. Two hundred Ninety Five (78.8%) were Surgeons, 33 (8.8%) Gastroenterologists, 8 (2.1%) Pathologists, 2 (.05%), 1 (.025%) Preventive Medicine, and the Specialty unknown in 35 members. Fifty-nine of the Surgical members were Department or Division Chiefs, as were 11 of the 33 Gastroenterologists, and 4 of the Pathologists.

International Membership

The Pancreas Club has evolved into an international organization with a very significant percentage of its members from foreign countries. In the year 2000, two hundred sixty four of our members provided the Pancreas Club roster with addresses in the United States, 42 in Japan, 21 in Germany, 10 in Italy, 8 in the United Kingdom, 4 each in Sweden and Brazil, 3 each in Portugal, Argentina and Switzerland, 2 each in Canada, Finland, Greece, Mexico, and South Africa, 1 each in Australia, Chile, France, Hungary, Norway and Spain.

Publications

Members have always been encouraged to submit for presentation at the annual meeting the results of their newest cutting edge clinical or bench research. Members have been willing to do so since an oral or poster presentation at the Pancreas Club meeting does not preclude them from presenting their material or publishing it in some other forum. In fact the searching in depth discussion of an oral presentation at the Pancreas Club annual meeting often provides a valuable critique or insight helpful to the author. Thanks to Hiram Polk, since 1984, a summary of the four scientific sessions at the Pancreas Club’s annual meeting has been published in the American Journal of Surgery. The “How To Do It” session of the Pancreas Club’s annual meeting is being published in The Journal of Gastrointestinal Surgery.

Leadership of the Pancreas Club

Marion Anderson while an Associate Professor of Surgery at Northwestern University founded the Pancreas Club and was its Chairman from 1966-1972. Max Rittenbury, Associate Professor of Surgery at the University of South Carolina, was appointed Chairman by Marion Anderson and served from 1973-1974. Charles Frey Professor of Surgery at the University of Michigan and William Schiller Professor of Surgery at the Northern Medical School of Ohio in Toledo reconstituted the Pancreas Club in 1975 after a year’s lapse in which no meeting occurred in 1974. They served as Co-Chairmen for 20 years from 1975-1995. In 1995, Charles Frey was Professor and the Executive Vice Chairman of the Department of Surgery at the University of California Davis Medical Center. William Schiller was Professor of Surgery at the University of Arizona and Chief of the Trauma and Burn Center at the Maricopa Hospital in Scottsdale, Arizona.

In the spring of 1994, Charlie and Bill formed a 15 member Advisory Committee from among the “younger” members of the Pancreas Club. Many of the members of the Advisory Committee had served as members of the Program Committee. The Advisory Committee was charged with two tasks: 1) Reexamine the goals and structure of the Pancreas Club; 2) Devise a governance structure for the Pancreas Club in anticipation of the retirement of the two long time Co-Chairmen. The timing of the change in leadership was designed to coincide with their 20th year at the helm of the organization. In the fall of 1994, the Advisory Council met and nominated a slate of three officers to act as Co-Chairmen of the Pancreas Club, Inc. effective following the 1995 annual meeting.

In 1995 at the annual business meeting, the leadership slate nominated by the Advisory Committee were elected and took over responsibility for the future operation of the Pancreas Club. These new officers were Richard Bell, Professor of Surgery at the University of Washington in Seattle (shortly in line to become Chairman of the Department of Surgery at Northwestern University where the Pancreas Club had been founded), William Nealon, Professor of Surgery at the University of Texas Galveston, and Michael Sarr Professor of Surgery at the Mayo Clinic (and shortly in line to become President of the Society for Surgery of the Alimentary Tract). These individuals would begin to rotate off as Co-Chairmen one at a time commencing in the Year 2000. Richard Bell who had assumed operational control of the Pancreas Club’s finances was the first to step down and was replaced by William Traverso, Clinical Professor of Surgery at the University of Washington in Seattle and Chief of Pancreatico-Biliary Surgery at the Virginia Mason Clinic. Michael Sarr, scheduled to step down in 2001 will be replaced by Douglas Evans at the MD Anderson Cancer Center in Houston, Texas.

Character of the Organization

There has been a conscious effort by the leadership of the Pancreas Club to minimize the trappings of officership e.g. making long self-congratulatory speeches, delegating head tables at the annual dinner or presenting long reports at the business meeting, etc. The leadership has been democratic in the sense of being accessible and approachable and attempting to assess the wishes of its members by questionnaire on any major question of importance to the organization, whether it be the time of the annual meeting, publication policy, relationship to other professional scientific organizations, or change in leadership.

The real strength of the organization has been the members themselves. Their abstract submissions to the Program Committee are the heart of the Scientific Program. The many outstanding moderators of the scientific session who have as well provided written summaries of the sessions and directed the discussions deserve great credit for adding insight and perspective to the presentations. These have included among others Edward Bradley, John Brooks, John Cameron, Robert Hermann, Howard Reber, Andrew Warshaw and members of the Advisory Council, as well as past and present officers of the Club. The moderators have been responsible for the written summaries of their sessions for inclusion in the American Journal of Surgery.

The local chairmen in charge of the annual meetings have consistently done an outstanding job as hosts and made the environment of the annual meetings and dinners something to be looked forward to. Many of the local Chairmen such as Elmo Cerise in New Orleans, Babs Moossa in both Chicago and San Diego, and Bradley Aust in San Antonio have served two or more stints as Local Arrangement Chairmen. The Chairmen of the two Surgical Departments in the United States who have devoted major resources of their departments to the study of the exocrine pancreas, John Cameron at Johns Hopkins and Andrew Warshaw at Harvard, have given unstinting support to the Pancreas Club. Their personal participation as moderators at the Scientific Sessions and involvement of their faculty and residents and the constant flow of abstracts to the program committee have contributed immensely to the interest in and the strength of the organization.

Similarly, the contributions of our international membership such as Hans Beger’s Department in Ulm, Germany, Markus Büchlers’ Department in Berne, Switzerland and Seiki Matsuno’s Department in Sendai, Japan have similarly contributed to the strength of the program and interest in the Pancreas Club both in the United States and abroad.

The enduring success of the Pancreas Club under a succession of chairmen can be attributed to three elements:

• Members are encouraged to present their latest and most current research be it basic or clinical. Members feel free to do so knowing they are free to present or publish their material elsewhere.
• Members know they will get useful feedback about their work from some of the most respected world authorities on pancreatic exocrine disease during the discussion period following their presentations. These discussions are frank, lively, and insightful to the presenter and members alike.
• A sense of fellowship is engendered by the discussions formal and informal, and by the camaraderie of the annual dinner banquet. The dinner meetings have often been enlivened with joke telling by someone like Ken Warren, Roger Keith, Andy Warshaw, Aaron Fink, Martin Sarner, Babs Moossa, or Ed Bradley. Our international members are always introduced at the dinner.

There has been a great vitality to this informal organization and camaraderie among its members over the years during which the Exocrine Pancreas has moved from an orphan status to a central position within the scientific and surgical communities. Most of our members would endorse the sentiment embodied in the statement “I love the pancreas.” Within the Pancreas Club, Inc. our members have found the opportunity to share the latest in cutting edge basic and clinical research in an international forum of peers, which provides insight and helpful feedback. The usefulness this annual scientific meeting brings to the members of the Pancreas Club, Inc. causes many to come back year after year.

History

John Malone Howard Father of Pancreatology

A Founding Member of the Pancreas Club
August 15, 1919 – March 18, 2011

John Howard was the Father of Pancreatology. He was present at the first meeting of the Pancreas Club in 1966 at Northwestern and in a way could be considered one of the founding members although the group was not solidified until Charles Frey and William Schiller began organizing the meetings in 1975. John tracked down Wirsung’s copper plate and the seven known imprints (look at the home page of the Pancreas Club) and then wrote the story of Wirsung in JACS in 1998. He visited Whipple’s childhood missionary home in Iran and he was at the Vatican Archives in search of Whipple’s signature after Whipple had saved the U.S. Ambassador to the Vatican for FDR in 1938. He then wrote the exhaustive two volume treatise – The Life and Times of Allen Oldfather Whipple. In a letter to the Pancreas Club in October 5, 2007 John notes “It is a scholarly biography of the “Father of Pancreatic Surgery” and the influence of his wonderful mother on his character. Over a decade of preparation went into the two volume set of over 1000 pages.” Truly a remarkable treatise about the Father of Pancreatic Surgery by the Father of Pancreatology.

However it was his book Surgical Diseases of the Pancreas with George Jordan that began the evolution of the science of pancreatology in 1960, a time when little was known of this mysterious gland whose duct was first described long ago by Johann Wirsung in 1652 yet our knowledge did not begin to mature until long after insulin was first isolated in 1921. The latter was made possible by a surgeon’s knowledge (Banting) that the exocrine enzymes were interfering with the isolation process of the illusive hormone and ligating the blood supply to the pancreas would atrophy the gland. Subsequently, during this first part of the 20th Century, little else was known about the exocrine pancreas. Perhaps that was why John was attracted to this retroperitoneal organ. To quote Charlie Frey:

“John in 1960 published the first comprehensive textbook on pancreatic disease with his co-author George Jordan. Better than anyone had previously, he described and differentiated the natural history of Gallstone and Alcoholic pancreatitis. That book was the bible on the pancreas and the most influential text on the pancreas for about 20 years. I met John at the American Surgical Association meeting in 1964 when I was giving a paper with Frank Glenn, Chairman of Surgery at Cornell-New York Hospital on the operative management of Gallstone pancreatitis. John and I have been seeing each other at Surgical meetings ever since.”

In 2007 John had published 464 journal articles, book chapters and books – just 43% were on the pancreas – but to understand the evolution of pancreatology one must read the books of John Howard – these include the 3 very different editions of Surgical Diseases of the Pancreas, 1960, 1986, and 1998, the History of the Pancreas. Mysteries of a Hidden Organ, 2002, and the 2 volume treatise – The Life and Times of Allen O. Whipple, 2009 (available through KarenReitz@utoledo.edu).

John died peacefully after a very short (1 week) illness with CHF. He was 92. He was lucid until the day before his death, and actively participated in the decision to enter hospice (he was \”enrolled\” in hospice for about 2 days). He is survived by his second wife, former college sweetheart Sarah, as well as a large family.

John Howard’s Obiturary from the Toledo Blade is at:

http://www.legacy.com/obituaries/toledoblade/obituary.aspx?n=john-m-howard&pid=149426554&fhid=6367

Contributions may be made to the University of Toledo Foundation (with a note in the memo for J.M. Howard Endowed Professorship), P.O. Box 586, Toledo, OH 43697.