“There is no turning back”—is
  AFIP facing demise?

August 2005
Feature Story

I represent the College of American Pathologists, but I testify also on behalf of the American Pathology Foundation, American Society for Clinical Pathology, Association of Pathology Chairs, and Association for Molecular Pathology. On behalf of our organizations, I strongly urge you to reject the Department of Defense recommendation to close the Armed Forces Institute of Pathology as part of a larger plan to relocate functions of the Walter Reed installation in Washington, DC. I recognize you have a difficult job to do. However, a decision to close the AFIP is no small matter. It has far-reaching implications not only for the military but also for civilian medicine and, as such, should be evaluated in a larger context than simply its military function. I urge the commission to keep in mind that once you dismantle 150 years of unmatched professional medical and scientific expertise, there is no turning back.

The AFIP was established in 1862 as part of the Army Medical Museum to serve as a repository for disease specimens obtained from Civil War soldiers. In 1888, civilian medical professionals were allowed access to the museum’s educational facilities—creating a nexus between its military and civilian role that continues to this day. The AFIP’s mission is to support the U.S. Department of Defense and serve the American people by providing medical expertise in diagnostic consultation, education, and research to enhance the health and well-being of the people it serves.

The Armed Forces Institute of Pathology is much more than its name implies. It is much more than an Armed Forces medical facility and much more than pathology. In fact, the institute is a sophisticated team of more than 800 military and civilian medical professionals capable of providing answers to complex, difficult cases. What makes the AFIP unique and so valuable is its broad range of expertise, spanning 22 subspecialty departments in conjunction with the world’s largest tissue repository providing significant research and education opportunities.

The recommendation to dismantle and retain, in piecemeal fashion, only certain components of the AFIP and to warehouse its massive tissue repository would deprive the medical community here and abroad of a virtually irreplaceable resource for disease research and patient care. Throughout its history, this national treasure of more than 3 million cases, 50 million paraffin blocks, and 10 million formalin-fixed tissue specimens—many rare and unusual—have helped us expand our knowledge of disease and given rise to curative therapies for previously untreatable and often fatal diseases. During the late 19th and early 20th centuries, staff of the Army Medical Museum, which became the AFIP, conducted research on infectious diseases that revealed the cause of yellow fever and contributed to development of a vaccine for typhoid. In 1997, AFIP pathologists published a complete genetic characterization of the 1918 Spanish influenza virus that killed more than 20 million people worldwide, including 675,000 in America and 43,000 of our troops in Europe. This publication was based on tissue specimens in the AFIP archives from a World War I soldier, and its findings are critical to preventing a similar pandemic in the future.

AFIP research also played a role in the discovery that a rare gastrointestinal tumor affecting 10,000 Americans annually could be treated with Gleevec, a drug recently approved for treating leukemia. This discovery was the direct result of studies done of tumors diagnosed at the AFIP and filed in the tissue repository.

The AFIP also maintains 40,000 specimens in registries for POWs, Agent Orange, and operations Desert Storm and Iraqi Freedom, among others. This benefits thousands of our deployed forces and veterans by helping to identify disease trends and long-term health effects associated with military service.

The tissue repository is now more important than ever because new DNA technology allows us to conduct new studies—not possible before—using patient specimens from the past. Such studies include the human genome as well as thousands of specific genetic abnormalities. Think of the possibilities! Unfortunately, the Department of Defense proposal allows only for the repository to be stored. The proposal makes no provision for maintenance, access to specimens, or the involvement of expert pathologists and others needed to sustain this dynamic resource for future research and education. Expertise in pathology is essential to effectively apply the wealth of information to be gained from study of the repository’s materials.

Eliminating AFIP’s consultative services as contemplated by the Department of Defense would adversely affect patient care. No longer would military or civilian physicians be able to rely on the AFIP’s expertise for a definitive diagnosis on their most difficult cases. Last year, AFIP pathologists rendered a major change to the initial diagnosis in 1,086 cases, significantly altering patient treatment and saving lives. Consults are provided by leading pathologists in key specialties covering virtually every facet of medicine imaginable, from infectious and parasitic disease to environmental pathology, animal health, and toxicology. AFIP’s civilian mission is important to its military function. For instance, civilian consults allow for the collection of rare and unusual diseases that otherwise could not be examined or compared in a meaningful way. The medical knowledge gained from the AFIP’s civilian services can be applied in diagnosing members of the military as well as addressing diseases in the field.

Going beyond traditional methods of consultation, the AFIP also operates the world’s largest and most advanced telepathology diagnostic consultation program. With 27 robotic microscopes at Army medical treatment facilities around the globe, the AFIP provides deployed military physicians with real-time diagnoses.

Also lost in closing the AFIP would be its prolific contributions to training health providers from numerous specialties to be competent and current in their field. The AFIP provided training and educational instruction in 2004 to more than 7,400 medical and other professionals and awarded more than 360,000 hours of continuing medical education. Because the AFIP responds to consultations on thousands of difficult cases each year, it is well positioned to provide educational opportunities that could not be easily replicated elsewhere. For instance, the AFIP offers courses using recent cases where a diagnosis was in question and concentrates on how to reach a proper diagnosis. The AFIP offers live courses and seminars as well as Internet courses. In fact, VA and military hospitals can connect with the AFIP to receive video-teleconference lectures on a wide range of topics. Simply put, the AFIP advances the knowledge and competency of pathologists and other medical professionals and has long been the center of civilian and military short- and long-term specialty fellowships.

Finally, the AFIP has a crucial role to play in homeland security. It is one of the few facilities in the country with the capacity and expertise to respond to a bioterrorist attack. This includes rapid diagnosis and the know-how to manage infectious disease epidemics. AFIP scientists have developed a new test to detect biological toxins such as cholera at subatomic levels, far superior to those currently in use. The institute has also collaborated with the private sector to develop a biothreat detector using Raman spectroscopy. This system received the highest performance score for a portable biothreat detector among those recently tested at the Johns Hopkins Applied Physics Laboratory. Since Sept. 11, 2001, speculations have centered on the manner of the next terrorist assault—not if or when but how. Whatever form of bioterrorist attack, the AFIP has the expertise to assist in a rapid understanding and diagnosis of the agent. This important contribution to strengthening our nation’s ability to respond to a biological attack will be lost if the AFIP is shut down.

In conclusion, the AFIP has a vital role to play in advancing medicine and securing the homeland. To cast off key elements, such as the tissue repository, and eliminate others would break the connections from which the AFIP draws its strength as a nationally and internationally recognized leader in medical research, education, and consultation. With this in mind, the CAP urges the commission to reject the Department of Defense’s recommendation. The fate of the AFIP should not be decided through the Defense Base Closure and Realignment Commission process, but rather through a broader discussion that takes into account all aspects of the AFIP mission.

The Defense Base Closure and Realignment Commission will report its closure recommendations to the president in September.