The State of Hemostasis-Thrombosis Research at ASH

An interview with Bruce Furie, MD

Dr. Furie, a long-standing member of ASH and co-winner of the 1984 William Dameshek Prize, is a physician-scientist focused on hemostasis and thrombosis. He is chief of the Division of Hemostasis-Thrombosis at the Beth Israel Deaconess Medical Center, professor of medicine at Harvard Medical School, and president of the International Society on Thrombosis and Haemostasis. He helped initiate the Special Symposium on the Basic Science of Hemostasis and Thrombosis in 2006 in conjunction with the ASH annual meeting. We asked Dr. Furie to comment on the state of hemostasis/thrombosis research at ASH with respect to the special symposium.

The Hematologist: How has the hemostasis/thrombosis community changed over the years? 

Dr. Furie: When I first entered the field it was dominated by physicians (mainly hematologists) who practiced clinical medicine and maintained laboratory interests. Most had a Y chromosome.  Given the biological nature of laboratory testing in this field, there was a strong emphasis on standardization of clinical laboratory practice. Subsequently the field has matured tremendously, in part because many basic scientists became interested in the molecular basis and pathobiology of disease. Furthermore, the biotechnology revolution that started in the 1980s focused on treatments relevant to this field: recombinant factor VIII, recombinant factor IX, recombinant tissue plasminogen activator, and recombinant factor VIIa. Hemostasis and thrombosis proved an attractive and well-funded field of activity in the basic sciences because of its link to important diseases and human health. As such, a high proportion of principal investigators in this field are PhD scientists, and women are now well represented.

The Hematologist: What was the reason for initiating the Special Symposium on the Basic Science of Hemostasis and Thrombosis in 2006?

Dr. Furie: The complexion of the ASH meeting has changed since I entered the field. For many years the hemostasis/thrombosis community alternated their scientific sessions annually between ASH and the American Heart meetings. But over the past 15 years or so, the ASH meeting has increasingly featured malignant hematology at the expense of some of the traditional fields of non-malignant hematology. While this reflects, in a positive way, the explosion in understanding of and novel therapies for leukemia, lymphoma, and myeloma, it reduced participation by folks interested in hemostasis and thrombosis. Meeting content in the field decreased, important work was presented elsewhere, and attendance from this community diminished — particularly among PhDs. My approach to rectifying this situation was to propose a meeting-within-a-meeting. As a three-year experiment supported by then ASH President Kanti Rai and the Executive Committee, Drs. Mortimer Poncz, Barbara Furie, and I organized the first Special Symposium on the Basic Science of Hemostasis and Thrombosis at the ASH meeting in Orlando in 2006.

The Hematologist: How would you judge its success?

Dr. Furie: The session was held at what many might consider an unpopular time: Tuesday afternoon, after the formal ASH meeting was over. For most, attendance required staying an extra night in Orlando. ASH asked us to estimate attendance so that they could book the proper size auditorium. We guessed 200 attendees since the program was organized on short notice, could not be adequately advertised, and required changes in departure schedules of participants.  In fact, more than 1,200 people signed in, and an additional auditorium was commandeered so that interested individuals could be accommodated. By these criteria, this initial symposium was a success. However, the real questions are whether, over multiple years, the ASH meeting will remain a vibrant place for hemostasis/thrombosis research and an attractive meeting for basic scientists in the field.

The Hematologist: What format did you use for this session?

Dr. Furie: We invited six speakers, each of whom gave 30-minute plenary presentations. These were selected on the basis of their publication of seminal work over the previous year. Morty Poncz argued, and rightly so, that the high quality of abstracts and the small number of oral presentations concerning hemostasis and thrombosis at the ASH meeting precluded many young investigators from having the experience of an oral presentation. Therefore, we also had six simultaneous sessions for oral presentation of selected abstracts presented during the regular ASH meeting as posters. We felt that the quality of these abstracts matched those selected for oral presentation at the regular ASH meeting — an indication of the depth of quality of the submitted abstracts.

The Hematologist: How were the subsequent special symposia in Atlanta 2007 and San Francisco 2008 organized?

Dr. Furie: The chairs of the Scientific Committees on Hemostasis, Platelets, and Thrombosis and Vascular Biology took over the responsibility for the symposium after the first year. I did attend, and both sessions attracted large audiences. In San Francisco, the organizers elected to divide the session into two parts: the invited speaker presentations early in the morning and the oral communications earlier in the afternoon on Tuesday, the final day of the ASH meeting. 

The Hematologist: What are the challenges of this special symposium?

Dr. Furie: The major challenge is finding the right times for these sessions without lengthening the ASH meeting, while at the same time keeping the density of interesting activities high so that there is no idle time for this community. 

The Hematologist: Why is it important to keep this community within the ASH umbrella? And how do these issues speak to the broader question of clinical training in hematology? 

Dr. Furie: I am a hematologist, and I believe that hemostasis and thrombosis are parts of hematology. I would not like to see hemostasis and thrombosis migrate into a separate specialty or become part of cardiovascular medicine. Current hematology consult practice in a busy general hospital is dominated by consultations in this field, and 20 percent to 25 percent of the hematology subspecialty board exam is on thrombosis and coagulation. The hemostasis/thrombosis section of most of the popular hematology textbooks, including the one that I co-edit, represents about 20 percent of the book. Nonetheless, I remain concerned about the quality of training in hematology that is offered in some combined hematology-oncology programs. Oncology practice can overwhelm the training components of combined fellowship programs as the common solid tumors (lung, breast, prostate, and colon cancers) are often the dominant clinical exposure for young physicians. I would like to see the development of completely separate clinical fellowship programs in oncology and in hematology.