I am a hematologist who cares for patients with bleeding or clotting problems, disorders of iron metabolism, or abnormal blood cell counts. I direct basic and clinical research projects in hemophilia, thrombosis, anemia, and thrombocytopenia. I consider the American Society of Hematology (ASH) to be my professional home. Therefore, I was distressed to learn that the ASH Executive Committee has endorsed the term “classical hematology” to refer to my subspecialty.1
Despite practicing as an academic hematologist for more than 30 years, I was not familiar with the term “classical hematology.” So, I did what my students are now often doing: I asked ChatGPT. I received the following response to the query “What is classical hematology?”:
“Classical hematology is a subcategory of hematology that specifically deals with the study of blood and blood-forming tissues using traditional methods and techniques. Modern hematology, on the other hand, encompasses a wider range of techniques and approaches, including molecular and genetic testing, as well as newer treatments such as stem cell transplants. It also includes the study of the immune system and how it relates to blood disorders.”
Unfortunately, this definition did not make me feel any better. I like to think of myself as a contemporary clinician and scientist who uses the latest techniques and approaches. Why, I wondered, is a hematologist who treats hemophilia with gene therapy considered more “classical” and less “modern” than one who treats Hodgkin lymphoma with ABVD? As highlighted in “50 Years in Hematology: Research That Revolutionized Patient Care,” published to commemorate ASH’s 50th anniversary, we have seen momentous advances in our understanding and treatment of blood diseases over many decades, throughout the entire spectrum of hematology — including blood cancers and other blood disorders. No hematologic disorder is patently more classical than another.
Proponents of the term “classical hematology” point to the problematic nature of alternative descriptors such as “benign hematology” or “non-malignant hematology.”2,3 I agree with this viewpoint but consider “classical hematology” to be equally unsatisfactory. To me, “classical hematology” evokes the image of a dead or dying discipline analogous to the study of classical languages, philosophy, or archaeology. This image is particularly troubling now, at a time when we have so many exciting new research and clinical advances, such as factor VIII mimetics, RNA therapeutics, gene therapies for hemophilia and hemoglobinopathies, targeted therapies for coagulation and complement disorders, new immunotherapeutic targets for cytopenias, novel transplantation approaches, and genomic-directed diagnosis and therapy for a wide range of blood disorders. I worry that the term “classical hematology” has negative connotations that may slow the already-dwindling pipeline of hematologists in training to a trickle.4 Fellows are attracted by exciting new science and therapeutics, not the classics. As an alternative, I applaud ASH’s initiatives to promote single-board hematology fellowship training (just don’t brand it as “classical”).5
In their Viewpoint essay promoting the term “classical hematology,” Dr. Hanny Al-Samkari and colleagues related the story of Beaver College, which attracted more first-year student applications and climbed in college rankings after changing its name to Arcadia University.2 The authors suggested that rebranding our specialty as “classical hematology” might spur a similar burst in popularity. I think this is unlikely; changing our brand to “classical hematology” is more akin to changing Beaver College to Dinosaur College.
Moreover, labeling me as a classical hematologist is unnecessary. There is no unmet need among my patients or colleagues to understand what type of doctor I am — to my patients I am a “blood doctor” and to my medical colleagues I am a “hematologist.” Other medical specialties have not adopted this approach, for good reason. I have not encountered “classical cardiologists” or “classical pulmonologists,” and, if I did, I might wonder about their credentials.
Within our specialty, hematologists can choose to focus their research and practice on one or more of the blood disorders (e.g., leukemia, lymphoma, plasma cell disorders, stem cell transplantation, cellular therapy, hemophilia, thrombosis, hemoglobinopathies, thrombocytopenia, myeloproliferative neoplasms, bone marrow failure) or a combination of these disorders. At the University of Iowa, we have trained hematologists who have gone on to successful careers combining expertise in thrombosis with lymphoma or leukemia — should we call them classical or malignant hematologists? I prefer to call all of us just what we are: hematologists!
References
Reply: Dr. Lentz raises several salient points in his letter. Hematology is a broad medical specialty at the vanguard of science and innovation. However, as past President Jane N. Winter, MD, indicates, there is a critical workforce shortage of hematologists who study and care for patients with diseases such as hemophilia, bone marrow failure, thrombotic microangiopathies, hemoglobinopathies, etc. These conditions are anything but benign. Referring to these disorders as what they are not (malignant) is a disservice. It also implies that physicians who care for patients with leukemia, multiple myeloma, and lymphoma are “malignant” hematologists. Every point brought up by Dr. Lentz was raised in our ASH Executive Committee deliberations, and everyone agreed that there was no perfect name to capture this important subset of hematologists. Moreover, our society is known as the American Society of Hematology, our subspecialty boards are in hematology, and our leading textbooks use the term hematology, not classical hematology, in their titles.
A major objective of the ASH Executive Committee was to address the critical workforce shortage of hematologists and to be able to count and then support them in laboratory and clinical research. ASH does not endeavor to change anyone’s identity. I too, refer to myself as a hematologist and not as a classical hematologist. I see patients with life-threatening hemolytic anemias and bone marrow failure states but often diagnose and treat patients with malignant conditions. Bone marrow transplantation using HLA-haploidentical donors is something I routinely employ for malignant and non-malignant blood disorders. The outgrowth of this nomenclature was the Hematology-Focused Fellowship Training Program (HFFTP). As a result, clinical and research training in hematology (benign and malignant) without training in solid tumor oncology has never been stronger. ASH is also seeing an increase in training grant applications in “classical hematology,” and now we can measure this. There are many imperfect names in our field. For example, most patients with a lupus anticoagulant do not have lupus and the disease predisposes to clotting, not bleeding.
ChatGPT is the wave of the future, but it too is still learning. In fact, its intelligence relies on data before 2022, when the ASH executive committee made its recommendation of the term classical hematology. I know Dr. Lentz and the Executive Committee will be cheering ASH on as we help promulgate and support an increasing number of individuals who train primarily in classical hematology so that exciting advances in hemophilias, hemoglobinopathies, thrombotic microangiopathies, and even catastrophic antiphospholipid antibody syndrome (who came up with that one?) continue. We also hope that updated versions of artificial intelligence recognize training in single-board hematology as one of the fastest growing specialties in internal medicine. Then we and our patients won’t care what they call themselves.
— Robert A. Brodsky, MD, President, American Society of Hematology
