1983-85 ASMBS President
Most Important Event
Creation of the ASBS.
The most important event during 1983 was a vote to form ASBS. I had been invited as an honorary guest for a meeting to be held in Tokyo in 1983 to form a Japanese obesity society. I had read that one could see that obesity was a problem in Japan by watching school children leaving school at the end of the day. I decided that if the Japanese thought increasing obesity required a society, then we certainly needed one. I asked Tom Blommers to make plans to convert our 7th year post-graduate course into a society. Tom was the son of a professor of psychology at the University of Iowa, a graduate student working on his thesis in Spanish, and working in our out-patient clinic. Betty Savage, secretary to our Chief of Surgery, changed Tom’s duties from general surgery to assisting me with our expanding obesity surgery program.
We began an annual postgraduate course for surgical treatment of obesity in the spring of 1973. Tom made the plans so that all we needed to do at the 1983 meeting was to vote on becoming the American Society for Bariatric Surgery. I did establish a program committee and we decided that a new president would be elected yearly to begin office in 1985. There was some disagreement regarding use of Bariatric instead of Obesity in the ASBS name. I wanted to lessen patient un-justified self-blame for obesity. I don’t remember any objections to forming the society except for one person who claimed that there were too many surgical societies. Tom continued to manage ASBS from Iowa City until the society took over. That will surely be covered by the appropriate president of the year.
My personal comment is about my first associate in study of gastric bypass, Chikashi Ito. We met in Iowa City on September 1965 when I returned from Edmonton where I had spent two weeks in their library and attended a meeting on gastric physiology. Chikashi made arrangements to come to Iowa City through friends who had spent time in Owen H. Wangensteen’s department at the University of Minnesota in Minneapolis. Ito was referred to Robert Tidrick, Chief of Surgery at the University of Iowa. Tidrick hired Ito and arranged his arrival to correspond to my return from “vacation”. Ito was a practicing general surgeon in Sapporo, Japan. I knew nothing about these arrangements until we met in Iowa City. He brought his wife and two daughters so that they could all experience life in Iowa City.
Ito had come to work in our surgery research laboratory for three years but had no research proposal. While in Edmonton I had designed a plan for study of gastric bypass using a Billroth II gastrectomy model but leaving the excluded stomach in place. I had also just heard R A Gregory lecture at a meeting in Edmonton about his isolation of gastrin with the help of H J Tracy. I asked Ito to help me with my plan to study gastric bypass in animals and to begin with an experiment designed to show that if a large portion of the parietal cell bearing stomach was bypassed along with the antrum there would be sufficient acid to inhibit secretion of gastrin so that there would not be gastrin induced stomal ulcers. In 1976, when an immunoassay for gastrin was available, we were able to confirm in patients that post-prandial gastrin levels in the blood were suppressed by gastric bypass.
Ito never performed obesity surgery in patients but his three years of work in our surgery research laboratory, made gastric bypass predictably safe. In 1973 while I was visiting Ito in Sapporo, he invited me to watch him perform a gastrectomy for cancer. The cancer had been found with one of their fluoroscopic fitted vehicles and confirmed by gastroscopy but when we examined the removed specimen on the floor of the operating room, the tumor was very small. Ito was a superb surgeon and person. Ito died from colon cancer August 6, 2013 at age 83. He is survived by two daughters who were in Iowa City and twin daughters who are younger. Ito was an honorary member of ASMBS.
Owen H. Wangensteen believed that a Vagotomy should have been added to gastric bypass and commented about this when I presented a paper at a meeting of the American Surgical Association in 1976. He repeated these comments in a book he and his wife Sarah published in 1978, The Rise of Surgery From Empiric Craft to Scientific Discipline. Adding a Vagotomy would have made the operation irreversible, which would have been contrary to the design of our animal experiment model. Great care was taken to preserve innervation of the stomach including pouches prepared for collection of stomach acid or collection of pancreatic secretions. Ward Griffen introduced Roux-en-Y reconstruction which is different from the sub-total gastrectomy with a short loop, retro colonic gastroenterostomy, which Wangensteen used when I was in training at the University of Minnesota in Minneapolis (1945-1953) and which I copied for our research model in 1965. Griffen’s RYGB became the gastric bypass of choice by most surgeons in 1977 when he published his experience with the operation. RYGB decreased esophageal reflux of digestive juices. We were asked to confine our comments to the organization of ASBS but I have provided a little history from before 1983 as part of my personal comments, especially with regard to Chikashi Ito, who was an honorary member of ASBS. Ward Griffen is also an honorary member.
In addition, Dordana is getting along miraculously. We have been blessed thus far. We are both taking more naps but continuing driving the car, shopping, and taking care of our own house. Dordana reads a book each day and chooses them from our public library. They are in large print. I swim 12-18 laps at 10:30 after lunch five days a week. Without the lunch I get hypoglycemia. This has been good for my 3 years of type 2-diabetes which I treat by blocking dipeptidyl peptisase4 with Januvia. You may have read in my Bariatric Times column “Ask Ed” (Google Bariatric Times Mason) about dumping for diabetes, which stimulates the L-cells in the ileum and rectum to secrete glucagon-like peptide-1 (GLP-1). The American Surgical Association gave me a Medallion April 3rd for Distinguished Service to Surgery. I have been writing an autobiography since 1999. Dordana continues Nutrition work with the two of us as subjects at ages 91 and 93. Thanks be to God as we Presbyterians say.
Wishing you and yours well.