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ACG Presidential Address 2021

Greenwald, David MD, FACG

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The American Journal of Gastroenterology: January 2022 - Volume 117 - Issue 1 - p 3-6
doi: 10.14309/ajg.0000000000001574
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Thanks, Samir, for that wonderful introduction. So many great memories and such wonderful times. Samir, I appreciate all the work and thought that went into that collection. More importantly, I can't thank you enough for all you've done for ACG and to help me this past year and I'm so excited for you in the upcoming year.

Well…big news; here we are! All together both in person and via livestream. So let me bring you back 12 months to October of 2020. What you will see is an image and then a video of Mark Pochapin and me, in Central Park in New York, having our own private—code word for safe—exchange of Presidential Medals, masked and with our own version of an elbow bump. This is followed by our spouses, Shari and Beth, cheering us on and then notice the 3 women on a nearby bench and several others just walking by who observed what certainly was an unusual scene for Central Park and then spontaneously applauded as well!

Now for those of you here in attendance, look forward, then turn around, now look left, now look right. Bottom line. Full stop. We are all together again! How amazing is that after 18 months or more of relative isolation. How amazing is that?

First things first. My colleague and friend, Dr. Mark Pochapin, led the ACG and the community of gastroenterologists worldwide through the first 6 months of the COVID-19 pandemic in an extraordinary fashion, demonstrating in no uncertain terms the value of outstanding leadership. When I introduced him last year for his Presidential Address, which was delivered virtually, I asked everyone watching to rise up wherever they were watching and give him the standing ovation that he so deeply deserved. But that must have been really awkward, because it was so private. We have a chance to do it publicly now, and indeed, we must. I'd like Mark to come up (or stand up), and let's show Dr. Mark Pochapin our profound appreciation for all he did during his Presidential year!

It has been a remarkable year—I knew it would be a remarkable year—and from the outset, I saw a focus for the year that clearly would be defined by COVID-19 and then 3 words that start with R—those would be resiliency, respect, and relationships. To keep laser focused on that mission, I posted the words on a yellow sticky on the corner of my computer monitor. It's been there all year. You will note, perhaps amusingly, that just next to that posting is an ACG coffee mug that says “You're on Mute” and is perhaps the item I have used the most this past year.

Let's start by speaking about resiliency. No doubt about it, the challenges related to the COVID-19 pandemic and issues of racial and ethnic inequity and social division have dominated the landscape over the past year. The response by ACG and the community of gastroenterologists is to me the embodiment of resilience. Many of our Members, generally gastroenterologists by training, became COVID doctors and did so seemingly overnight. We began caring for so many critically ill patients who had a new and very scary illness. We had to snap to quickly, pivot (as the language of the day has said), and retrain and reorient ourselves to being on the front lines of a frightening battle while figuring out how to continue doing the critical lifesaving work we do every day. Resiliency carried the day. We did it and continue to take on these new challenges. Truly remarkable. Witness the work of the Endoscopy Resumption Taskforce, led so well by Drs. Neil Stollman and Costas Kefalas, which produced multiple webinars and manuscripts, and summarized crucial information to help guide our members and our patients, just when it was most needed. My thanks to all the members of that Task Force for their spectacular work. Speaking of education and webinars, the ACG Virtual Grand Round series, created at the beginning of the pandemic to fulfill a need for remote education, continues to be a tour de force, with now over 100 presentations and nearly 60,000 attendees. Indeed, Virtual Grand Rounds now has an international presence, with monthly webinars co-hosted by ACG and international GI organizations. ACG stepped up to meet an essential need for GI homeschooling when we could not gather in person, and with Virtual Grand Rounds, ACG continues to lead the way in innovative and creative learning. Now, we are demonstrating how to hold not only an in person but also a hybrid meeting during challenging times, with clear messaging. For example, here with the hashtag “#VaxxedNMasked and learning together.”

I am very proud of how ACG met the challenges raised by specific actions of racial violence and hatred against the Asian, Asian American, and Pacific Islander community over the past year, with an immediate statement condemning the proximate events and then a call to action, which led to transformative change. Indeed, in my opinion, a crown jewel of this past year is the formation of the new ACG Center for Leadership, Ethics and Equity (or LE and E Center as it will be known) formed under the auspices of the ACG Institute and through much hard work by many, including the Institute's Director, Dr. Neena Abraham. You will hear much more about this Center from Dr. Abraham immediately following my remarks, but let me say here that this Center will be the home for all of the ACG's activity in these 3 essential pillars within our organization. Envisioning and creating the LE&E Center is a landmark moment for the College, and positions ACG to be an even stronger leader in these most critical facets of clinical care. It's all really about seizing the moment but transforming the future. I am also proud to report that ACG is introducing a first ever Health Equity Research Award this year, specifically providing a funded pathway for clinical research that promotes Health Equity and improves patient outcomes.

Addressing gender inequity and advancing the role of women in the College has been top of mind throughout the year, and I am so pleased to report that as of this meeting, women make up 22% of our Board of Trustees, 25% of our Board of Governors, and 36% of the ACG institute Board. This all mirrors our current membership, which includes 21% woman physicians and 24% overall. We continue to be committed to inclusivity as we position the College to flourish in the future. While her appointment is the result of her well recognized expertise in IBD, research and publishing, it is noteworthy that Dr. Mille Long will be one of the 2 new Editors in Chief of The American Journal of Gastroenterology, is also the first female Editor-in-Chief of a major GI journal. Gender inequity is a hugely important topic. Dr. Amy Oxentenko, current ACG Secretary, will be giving The American Journal of Gastroenterology Lecture later this afternoon, entitled “Hiding in Plain Sight, Bringing Women into the Scope of Gastroenterology.” I thank Dr. Oxentenko in advance for her presentation and urge all of you to attend. Additionally, the first woman to lead the ACG Institute, Dr. Neena Abraham, has shown incredible creativity and dynamism in her first year in this important role.

In fact, I am quite proud of all the named lectures for this meeting, many focused on the ways we have led and continue to do so in clinical gastroenterology. These include Dr. William Chey, who will be giving the J. Edward Berk Lecture, “The End of the Beginning: Megatrends in Gastroenterology,” and who will talk about the emerging role of integrated care and digital health and how it will transform the way we care for patients with digestive disorders. Dr. Darrell Gray, who will be the Emily Couric lecturer speaking on “Changing The Narrative on Colorectal Cancer Prevention: Translating Stories to Partnership, Policy and Practice,” and Dr. Marla Dubinsky who will teach us about “Navigating the Road from Precision to Prevention in IBD” as she gives the David Graham lecture. I thank all of them for bringing these critically important topics into sharp focus for us. The other named lecture, the David Sun Lecture, was presented during the ACG Postgraduate Course on Saturday by one of my mentors and a legend in the world of gastroenterology, Dr. Jerry Waye, who spoke on “Colon Polyps: Going and Gone.” And I was so thrilled when Dr. Tom Frieden, former CDC Director in the Obama administration and former Commissioner of Health in NYC and a fellow Resident in Internal Medicine with me at Columbia Presbyterian in New York years ago, accepted my invitation to the ACG meeting this year. Later this morning we will hear from him on “COVID, Colons and Collective Action: What's Next for Health and Healthcare in the U.S. and Internationally?”

Indeed, resilience requires great leadership, and ACG continues to spearhead leadership training. I could not be more excited to report the continued growth of the Young Physician Leadership Scholars Program, enthusiastically started by Drs. David Hass and Mark Pochapin 4 years ago (thank you both) and to report the new ACG Advanced Leadership Development Program, aimed at those in the middle of their careers. Both of these programs strengthen the future leaders of the ACG and the GI community; this investment in the future is a critical step in developing a pipeline of excellent future leaders in gastroenterology, and I applaud those who have worked so hard to make this happen.

Finally, resilience requires flexibility and innovation. I have already mentioned the ACG Institute for Clinical Research and Education and its current leader, Dr. Neena Abraham. The Institute and the ACG have now granted more than $24 million dollars to 667 investigators for research directly relating to the practice of clinical gastroenterology career development. This extensive financial support fosters clinical innovation. The achievements of funded investigators is paramount in clinical gastroenterology, and these funded investigators are part of our vibrant future. Returning to the COVID-19 pandemic, I have heard so many stories of resiliency through the year. Our members met the challenge to find ways to do incredible things: first to work remotely, and then to return to work, to return to endoscopy, to promote vaccination by self-example and a rich social media presence, and to battle back on behalf of our patients who have been devastated by the pandemic—over 730,000 deaths due to COVID-19 in this country alone.

Let's talk about colorectal cancer screening for a moment. We all know a significant amount of routine health care maintenance, including CRC screening, was put on pause by many patients throughout this pandemic, and the result is a clearly documented rise in the incidence of later stage colorectal cancers, which in turn will predictably lead to increased mortality from CRC in the coming years and decades. ACG has been loud and effective voice supporting our patients, advocating for the need to continue regular screening. Witness the enormously successful “Tune it Up: A Concert to Raise Awareness of Colorectal Cancer” in March 2021, with special thanks to Dr. Ben Levy for his vision and hard work. ACG continued its decade long advocacy work for CRC screening, with success achieved in December 2020 with the passage of the Removing Barriers to Colorectal Cancer Screening Act. Many thanks to Dr. James Hobley for his outstanding work on legislative affairs as Chair of ACG's Legislative and Public Policy Committee and to Brad Conway, Vice President for Public Policy for his tireless efforts. ACG also led the way promoting the change in guidelines for CRC screening for average risk individuals to age 45, with the innovative and creative “Ride or Stride for 45” campaign, an enormous success by all accounts and well recognized all over social media. My thanks to everyone who participated and in particular to Ms. Anne-Louise Oliphant, ACG Vice President for Communications, for her vision, drive, and never-ending enthusiasm.

Okay, let's turn to the second R, respect. One of the clear lessons of the pandemic and the social unrest in our world has been the need to listen carefully and respect each other. Vaccine hesitancy, for example, has been an enormous issue, and often can be addressed successfully by respecting an individual's concerns, really listening to what they are saying, and then working with them to provide accurate information. I was fortunate to author an article for the ACG magazine—the magazine is amazing by the way—earlier this year entitled “Fight Fear with Facts,” addressing vaccine hesitancy. I am incredibly proud of our network of ACG Governors, both nationally and internationally, and now numbering 78, who also listen carefully to the members in their region and provide a grass roots conduit for information sharing between ACG members and the ACG office and leadership. This group, led by the Chair of the Board of Governors, Dr. Pat Young, and the Vice Chair, Dr. Dayna Early, is a vital part of what makes ACG special, and I commend them for their outstanding work and thank all the Governors individually for their service. We are lucky to have such a talented group. ACG also has 23 Committees working for you, the members. Again, extraordinary leaders and outstanding committee work are the hallmark features, and the results, relevant guidelines, premier educational events, active policy action and so much more is the tangible result.

This would be a great moment to reflect on our Journals, and all that they have achieved. The American Journal of Gastroenterology, affectionately known as the Red Journal, has innovated this year with special issues on Women's Health in Gastroenterology and Hepatology and Changing Landscape in Clinical Practice, as well as just terrific podcasts. We must collectively thank the 2 outgoing co-Editors-in-Chief, Drs. Brennan Spiegel and Brian Lacy, who have led the publication expertly for 6 years, and along with their team of Associate Editors who must be congratulated for their extraordinary service and dedication. The new Journal co-Editors-in-Chief will be Drs. Millie Long and Jasmohan Bajaj, and we look forward to the future with their strong leadership. Clinical and Translational Gastroenterology, or CTG, continues to be a critically important publication of the ACG, and is now under the editorship of Dr. Brian Jacobson, and I thank him for his innovations and outstanding work. Rounding out the triad of offerings is the ACG Case Reports Journal, with co-Editors-in-Chief Drs. Katherine Fallon and Judy Trieu.

Finally, my congratulations and heartfelt thanks to this year's Postgraduate Course Directors, Drs. Millie Long and David Hass, the largest postgraduate course in our specialty and presented in both an in-person and livestreaming version. So yes, a true hybrid meeting. This is no small feat, and I greatly admire the focus they put on educational excellence in this year's Postgraduate Course and the ease with which they met each challenge along the way. The entire ACG educational team, especially Meredith Phillips, the Vice president for Research and Learning and her team, also deserve much recognition and so much credit for the work that makes the entire array of education programs of the ACG happen, and who is responsible for the success here.

Which brings me to the final R, relationships. Again, look around please. Really look around. What you see is comradery, collegiality, and friendship. We would be nowhere without those. There is no doubt it's a big part of the reason you came here—to reconnect with your friends, your teachers, and your colleagues. Those relationships are everything. Many of us went into gastroenterology because of strong role models, and these lifelong relationships are what get us through each day, each month, each year. My advice: nurture those friendships and treasure those relationships; they are special.

Relationships between our sister societies have meant so much this past year, and I want to express my sincere thanks to the leaders of each of those societies and their Executive Directors for working collaboratively on so many important issues, especially related to COVID recommendations, public policy, and reimbursement issues as well as striving to push ABIM [American Board Internal Medicine] to improve the clinical relevancy and ease of use of the maintenance of certification programs.

The Board of Trustees of the American College of Gastroenterology is an incredible group of colleagues. I cannot thank this group enough for their support and guidance through this difficult past year and always—to me they are a constant source of wisdom and strength. We gathered frequently as you saw, through Zoom and now in person during the pandemic to address crucial issues in our field; those discussions set the direction and path for the organization. It is a true honor to work with this extraordinary group, and I really need to recognize what they have done. So, thank you.

To my predecessor and fellow New Yorker, Dr. Mark Pochapin, words cannot easily express how meaningful it was to join you as you courageously led the ACG through the early phases of the COVID-19 pandemic. I have always learned so much from you about leadership and empathy; I value our friendship greatly.

And I am so pleased that the next President of the ACG will be my good friend, Dr. Samir Shah. We have been privileged to work side by side frequently this year—Samir is always there when you need anything done—and the ACG could not be in more capable hands in the year to come. Samir, I am so excited for you as you become President later his afternoon.

You should all be very much aware of just how incredible the staff of the ACG is, but let me remind you. Everything you see from ACG, and certainly this wonderful hybrid meeting before you, is the product of an unbelievable group of people who are completely dedicated and working on your behalf tirelessly each and every day. I have come to know this remarkable group over the years; watching even more closely this year shed light on their profound excellence. And the ACG's Executive Director, Brad Stillman, is just simply the best. No more need be said at all. Thanks to the entire ACG team and to Brad.

My colleagues at Mount Sinai have supported me throughout my years there, and in particular this year, and so a special shout out to Dr. Bruce Sands, our Division Chief, and Drs. Chris DiMaio, Satish Nagula, and Nikhil Kumta for their help this past year.

This leads me to mentorship. Mentorship is a huge part of those relationships, that R word I was discussing. Excellent mentorship is just so important. I have heard it said that a truly great mentor is hard to find and impossible to forget. I think that is true. I have been blessed with outstanding mentors, really too numerous to count and certainly too numerous to mention. But, I will single out 3: Drs. Larry Brandt, Irving Pike and Jerry Waye, all of whom had substantial impacts on my career. Their guidance every step of the way has been impactful and invaluable. My colleagues in the New York GI community through the NYSGE have also had an enormous impact on me, and I am filled with appreciation for their trust and wisdom. Finally, I want very much to acknowledge the many ACG presidents, many whom are here today, over the past years who helped give me the opportunity to be here today. I am forever appreciative of what you have done.

Which brings me to the most important relationship, my family. My father is a physician in Internal Medicine, now retired, and clearly my role model for a career in Medicine. I watched him closely as I was growing up. He cared for his patients; they were they were His patients—he treated each one with dignity and respect, and I certainly noticed and decided I wanted to do the same. And my mother, who in addition to raising my 2 brothers and me, studied mathematics to get an advanced degree at a time when it was nearly unheard of for a woman to do that, and she did it nights after we went to sleep and on weekends. I noticed that too, of course, and credit many of my core values from those close observations. My brothers have also been a great source of inspiration, close friendship, and are just plain fun to be around.

To Beth and our children, Allison and Michael, your support and your way of keeping me grounded through all these years is that special ingredient that only you can provide. You've helped me in so many ways, and we really, really have shared so much. That's the most amazing thing! You are truly my world.

As I bring this to a close, I'd like to offer a piece of advice, which follows after reflecting (another one of those R words) on what clearly has been a difficult and challenging year. Here's the advice: Small acts of kindness go a long way, are easy to do, and add up to meaningful impact. I try to approach each day that way, and urge you to try to do the same. Colin Powell passed away the week. There is a story being shared of someone stopping to help him when his car developed a flat tire, and following that act of kindness he posted on social media and said, “Let's just take care of each other.” So kind, so wise, so relevant to resiliency, to respect and to relationships.

People have asked me a lot recently how the year has been. Here is the answer. Serving as President of the American College of Gastroenterology has been by far the most gratifying thing I've done, by far, in my professional career. Helping others in the ACG do so much for our members and for our patients has been simply extraordinary. I am honored that you all allowed me that privilege, and I am deeply, deeply grateful for having had the opportunity to lead this truly great organization. My most sincere thanks to all of you.

© 2021 by The American College of Gastroenterology