President’s Desk Column

Dear colleague

March 2001
Paul Bachner, MD

I would like to share with you this month three items of importance that I would ordinarily communicate in a "Dear colleague" letter to CAP members.

First, the American Academy of Dermatology has decided to withdraw from production and circulation a video that suggested that only dermatopathologists were competent to diagnose skin lesions. This video showed a series of patients who had suffered harm as a result of "general" pathologists having "misdiagnosed" pigmented skin lesions. When CAPdelegates viewed the video last fall at the CAPHouse of Delegates meeting in San Diego, they became alarmed and angry. At the request of the House and the Board of Governors, I and John Scott, vice president of the CAP Division of Government and Professional Affairs, met last month with the president, vice president, and numerous staff members of the AAD at their headquarters in Schaumburg, Ill., and requested that the video be withdrawn. I communicated the extreme concern of our members and those of the ASCP (the ASCP Board requested that I do so) about the misleading content and aggressive tone of the video. I pointed out to the AAD leaders that the video was not only offensive to the many general pathologists who have extensive training and experience in dermatopathology but also to many dermatologists who have long-established professional relationships with general pathologists.

We welcome the prompt decision by the AAD executive board to withdraw the video and hope that CAP and AAD leaders can now work together to support the common goal of promoting appropriate physician and patient access to pathology consultation.

Second, in my June 2000 column, I reported on a "scandal" in the United Kingdom concerning organs retained for teaching and research without adequate informed consent having been obtained from the next of kin. The controversy centered around the retention of organs from a large number of children who had died and been subject to autopsy at several well-known hospitals in the United Kingdom. This led to the Royal College of Pathologists developing a document that calls for an informed consent by relatives that would require information to be provided about organs likely to be retained and the distinction between samples of tissue and whole organs. The Royal College recommends improved training for doctors seeking consent and an explanation of the difference between organ and tissue sample retention. This document-and other pertinent information-is available on the Royal College of Pathologists’ Web site www.rcpath.org/siteplan.html.

Within the last month, some of you may have seen media stories again reporting a British government inquiry into the "unethical and illegal stripping of every organ from every child" who had a postmortem between 1988 and 1995 at a Liverpool hospital. The officers and the CAP Board of Governors are concerned that the potential for similar media-driven incidents exists in the United States. For that and other reasons, an ad hoc committee of the Board chaired by Gene Herbek, MD, is preparing a white paper for the Board that will contain recommendations about the ethical and legal implications of organ and tissue transplantation, tissue banking, and the use of organs and tissues for diagnosis, teaching, and research.

The CAP has developed a model autopsy permit (now under review and consideration for revision) that contains recommended language for hospitals seeking permission from next of kin to retain tissue for diagnostic, education, and research purposes. Similar language is probably used widely in this country, but I suspect there is great variation in the extent to which this information is conveyed explicitly to those signing the permit and the degree to which pathology services monitor the process of retaining and disposing of tissues and organs.

I encourage my colleagues, as I did in my June 2000 column, to review their hospitals’ current practices regarding autopsy permit and permission procedures as well as the retention and disposal of tissue, organs, and body parts subsequent to autopsy. Particular attention should be paid to the correlation between permit language and the information provided to relatives. Although the language in autopsy permits commonly requests permission to retain tissues for diagnostic, education, or research purposes, or all three, attention should be directed to conveying information in an understandable manner to the next of kin (informed consent). I urge all pathologists also to remain sensitive to the personal, ethical, and religious beliefs of the next of kin.

Finally, Lee VanBremen, PhD, CAE, the CAP’s executive vice president for the past 10 years, has announced his intention to retire at the end of this year. Lee has been an outstanding EVP, and the College has enjoyed an unprecedented decade of growth during his tenure. He has made contributions in many areas, but perhaps his greatest legacy will be the excellence and professionalism of the CAP staff he has nurtured. A search committee for his successor has been formed composed of me as chair, president-elect Paul Raslavicus, MD, secretary-treasurer Jared Schwartz, MD, PhD, chair of the Board’s compensation committee Harry Zemel, MD, and governors Mary Kass, MD, and Ron Lepoff, MD. A national search firm, SpencerStuart, has been retained as a consulting resource. I know that all of you will join me in extending our deepest appreciation to Lee and our best wishes to him and his wife, Jane, as they plan their retirement to New London, NH, at the end of this year.