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Blood, 15 December 2002, Vol. 100, No. 13, pp. 4257-4258
EDITORIAL
Celebrate hematology
Editorials in the pages of Blood over the past 5 years
have included commentaries upon several disturbing events involving scholarly publications: a pernicious affront to the integrity of
publications of multicenter hematology/oncology clinical trials, a
frontal assault on the peer-review process, and growing concerns over
the integrity of clinical and basic research brought to the fore by
egregious examples of scientific misconduct. But other editorials have
commented upon the major milestones of hematologic investigation and
how, as we enter the third millennium, the future appears unlimited due
to that rich history. With this last editorial I seek to celebrate
hematology and count our triumphs, as well as look forward to passing
the baton to an able new Editor. One can make a compelling argument that there has been no better time
for hematology than the present. Although practitioners of the clinical
art must deal with diagnosis related groups, dwindling reimbursements, and ever-changing documentation and billing
requirements, we also have unprecedented tools to diagnose and treat
the ills of our patients. One only needs to look back 10 years, prior
to the availability of sophisticated flow cytometry and polymerase chain reaction, to appreciate the skill with which we now diagnose hematologic malignancies and detect their early relapse. Or look back
just 3 years to a time when a patient with chronic myelogenous leukemia
faced the toxicities of either alkylating agents, hydroxyurea, or
interferon therapy, with the hope (!) that the toxicity of transplantation awaited them, rather than taking a pill and going into
remission. Targeted therapy is upon us, not just for CML but also for
all sorts of malignancies. How many times have you heard someone state,
"Molecular biology is the future of medicine"? In fact, such
oracles are incorrect; molecular biology is the present of medicine.
Look back to the 2001 annual meeting of the American Society of
Hematology for proof: the plenary abstract presented by Yeoh and
colleagues using gene-chip analysis to predict the response to
standard therapy of childhood acute lymphoblastic leukemia. Look at the
September 15 issue of Blood to find the molecular
explanation for thrombotic thrombocytopenic purpura (TTP).
These examples demonstrate that we have clearly entered the molecular
age of hematology. I do not intend to belittle the problems facing the
clinical practice of hematology or internal medicine, only to praise
the fabulous opportunities we now have at our disposal to help our
patients overcome the morbidity and mortality of benign and malignant
hematologic disorders. The present is also a golden age for hematologic investigation. With
medical schools granting MD/PhD degrees at a solid pace, and many
"late bloomers" (MD physician-scientists who received their
scientific training after medical school) entering hematologic investigation and many other related endeavors, the future seems bright
for further progress such as that highlighted above. Again, I do not
intend to belittle those who counsel diligence, pushing for greater
opportunities to help differentiate nascent investigators of the 21st
century along the "proper pathway," but the rewards of a career in
investigational medicine are many, as I have often been heard to
murmur, "I can't believe I get paid to do this!" Although pure hematology has seen tremendous success, one can make the
case that much of the future of the field will be mined from
interdisciplinary opportunities. Just as medical investigation has
evolved from the lone investigator entering the lab and emerging with a
"hallelujah" discovery to an approach requiring multiple investigators each contributing their particular technical expertise, so too is hematology of the future likely to make critical leaps due to
the key contributions of investigators in other disciplines of
medicine. I speak not only of the obvious, learning iron absorption with gastroenterologists or studying cerebral vascular accidents in
patients with sickle cell anemia with our colleagues in
neurology, but perhaps more importantly I refer to relying on
our colleagues in other disciplines of internal medicine for insights
into the truly cross-disciplinary topics of vascular biology, cell
cycling and apoptosis, signal transduction, and immunology and
inflammation. In my new day-job heading a Department of Internal
Medicine, I have learned that an investigator from one organ-based
division in the department often has far more in common with another
individual from a different division who happens to also study vascular
biology or signal transduction, than with a colleague from the same
division who has a different cross-disciplinary focus. Therefore, I
believe that it behooves hematologists who study the immune basis of
graft rejection or TTP to embrace rheumatologists who study autoimmune phenomena, or for oncologists who investigate the molecular mechanisms of growth-factor signal transduction to enter into collaborations with
reproductive endocrinologists who study the actions of prolactin. To
extend the analogy further, perhaps we will soon see review articles in
Blood by noted medical geneticists or nephrologists or cardiologists. This argument aside, it must be said that both the state of
hematology and Blood are strong. The journal has undergone
many transitions over the past 5 years, from a migratory existence moving with each Editor to planting firm roots in Washington, DC, from
being shepherded by a commercial publisher to self-publishing, from
commercial management to self-management, from a labor-intensive, paper-based tracking system to a state-of-the-art, electronic submission and tracking system, and to our present capacity to nearly
instantaneously publish accepted papers online. The impact factor of
Blood has steadily increased for the past 4 years, and we
remain the premier periodical for clinical and basic research in
hematology, witnessed by a 55% rise in submissions over the past 4 years. None of these statistics would be possible if not for the
outstanding substrate available, the research conducted by
investigators who regularly submit their best work to
Blood. With this last editorial it is also fitting that I thank several
individuals and their associates for making the last 5 years challenging and fulfilling. I thank my former mentors Clem Finch and
John Adamson, for pointing me toward hematology and toward the career
of a physician-scientist, Sabine Beisler and her staff at
Blood, particularly Andrew Harmon, Todd Reitzel, and the
newly indoctrinated Deb Zimmer, for their professionalism and devotion to crafting an outstanding product, to the current and 4 past-presidents of ASH, Bob Handin, Beverly Mitchell, Ed Benz, Harry
Jacob, and Barry Collar, for their timely advice and even more timely
beneficial neglect, to Marty Liggett, for making the transition to
self-management of ASH seamless, to the Associate Editors with whom I
have had the pleasure to serve, Fred Appelbaum, Frank Bunn, Michael
Caligiuri, Michael Cleary, Cynthia Dunbar, Connie Eaves, Dan Longo, Wim
Fibbe, Tom Ganz, Jerry Groopman, Evan Sadler, Sandy Shattil, and Marty Tallman, whose intelligence, hard work, integrity, and devotion were
essential to any success we have had over the past 5 years, to the many members of our Editorial Board and the reviewers, without whom the rigorous peer review responsible for the excellence that is Blood would cease to exist, and most of all to my
spouse of 26 years, Lauren, and our progeny Alexis and Joshua, for
loaning me out for a sizable portion of the past 5 years. As
regards the future, I feel very reassured: with Sandy Shattil and his
group of Associate Editors taking on the journal, Blood will
be in great hands; and the future for hematology and
Blood looks nothing less than spectacular.
Kenneth Kaushansky, MD
Editor-in-Chief San Diego, CA
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