ATS, ALA say their union is over: Now who gets custody of TB?

Will public health get left out in the cold? The consensus: Not likely

Now that the American Lung Association (ALA) and the American Thoracic Society (ATS) have announced their impending divorce, some public health practitioners are left wondering about the fate of their kids. Who, for example, will look after the interests of TB? With out the streetwise ALA to act as its conscience, what will compel the lofty ATS to keep an eye on public health?

That’s what’s been worrying Lee Reichman, MD, MPH, director of the National TB Center at the New Jersey Medical School in Newark. "ATS is governed by the physician-scientists of the world. It concerns itself with physician-reimbursement issues and stuff like that," says Reichman. As for the ALA, its activities are slanted toward advocacy and public education, with campaigns that focus on public health issues — TB, clean air, stop-smoking campaigns, and the search for a cure for asthma.

For the moment, there appears to be little cause for alarm — not as long as the ATS is ruled by the likes of past president (and card-carrying TB expert) Phil Hopewell, MD, or incoming head Jeff Glassroth, MD, formerly a member of the Advisory Council for the Elimination of Tuberculosis and now chairman of the department of medi cine at the University of Wisconsin in Madison.

But, adds Reichman, who knows what might happen in a post-Glassroth era? The two organizations will split officially at the start of next year. With revenue-generating activities that include an annual international conference, which drew a record-setting crowd of more than 16,000 this year in San Diego, and the publication of two prestigious, peer-reviewed journals, the ATS clearly has been chafing in the close confines of the original arrangement. "ATS was the cash cow," he says. "But ALA owned every piece of ATS, right down to the name and the logo."

The multimillion-dollar settlement ATS paid for its freedom presumably helped salve financial wounds at the ALA, an organization portrayed in some recent press accounts as on the verge of taking in laundry and desperately searching for a cause — any cause — it might use to woo back the public’s financial support.

The ALA’s death notices strike most as premature. "Sure, the ALA’s had a stretch of tough going," Glassroth says. "But basically it’s a healthy organization, not just at the local level but also nationally, where they’ve had an enormous impact on issues like the fight against tobacco."

Still, most ALA insiders don’t dispute that the organization has seen better days. "There’s been a weakening of programming over the past two decades that corresponds to the weakening of Lung Association funding," concedes Charles Ahlers, longtime TB spokesman for the ALA’s New York state chapter. "But it’s part of a national trend that stems from a decline in volunteerism in the nation as a whole."

As far as TB is concerned, Ahlers and others with ties to "Lung Land," as the organization is affectionately known, avow that chapters in high-incidence states will continue to carry the torch for the TB cause. And despite the rocky start for its AsthmAttack campaign, ALA insiders say the organization’s beleaguered national staff are gamely dusting themselves off, thanks to a new strategy that supplants three national asthma research centers with 13 centers that have strong local ties.

That brings up another issue. To revive its flagging fortunes, what if the ALA buddies with a new professional partner?

"ALA may or may not decide to use ATS as their prime medical consultant," says Reichman, himself a past president of ALA. "Many of us want them to do that, but it’s conceivable that ALA could ally itself with the Allergy Society, the American College of Chest Physicians, or God knows what. Or, ATS could ally with one of those organizations. All sorts of things could happen."

Although he concedes that ATS and ALA interests no longer overlap as neatly as they once did, Glassroth says no such thing will happen and, for the foreseeable future, the two entities will work together just as before. "Where we’ve typically collaborated in the past, that will probably continue," he says. "And if you look at ATS’s history, you’ll see we’ve always advocated for TB research. We may actually broaden our TB advocacy a bit."

The dreaded rebound relationship

Did he say "broaden"?

"Well, a lot of people in ATS are very strong supporters of the International Union Against Tuberculosis Lung Disease [IUATLD]," notes Charles Daley, MD, president of the California TB Controllers Association. "Maybe the IUATLD could do an even better job with TB if ATS gave them more money. To me, it’s a natural pairing."

If only the Paris-based IUATLD didn’t have such a cumbersome handle, adds Daley, thoughtfully. "It needs a catchier name — something the guy on the street can relate to," he says.

"That’s the first I’ve heard of such a thing," counters Reichman. "Anyway, it’s far too premature to say that ATS is going to ally itself with the North American IUATLD."

Like devoted grandparents gamely working to keep the family together, state chapters of thoracic physicians and their counterpart ALA state chapters say they will continue in their present relationship — according to which local thoracic chapters must answer to local ALA chapters.

"In fact, most members of state thoracic societies don’t even bother to join the ATS, " says Zenda Bowie, vice president for community affairs at the Georgia ALA. Lately, Bowie adds, she’s been fielding calls from local thoracic physicians puzzled to learn that the two organizations weren’t separate legal entities to begin with.

Reichman agrees that for folks on both sides of the ATS/ALA fence, the split likely won’t have much immediate impact. "There’s been tension between the two organizations for at least the past 100 years. But most practicing physicians who make up the membership of the ATS didn’t even know the difference between the two. They just want a nice meeting to go to where they can hear the latest stuff, and to get a good journal."