Vein Magazine Medical Director, Dr. Steven Elias, Introduces the Fall 2015 Issue.

“Strange how people who suffer together have stronger connections than people who are most content...you always said people don’t do what they believe in...they do what’s most convenient then they repent.” -Bob Dylan's “Brownsville Girl,” Knocked Out Loaded, Columbia Records, 1986.

This is serious stuff. The whole song “Brownsville Girl” has been described by many as one of Dylan’s greatest works. The music critic Robert Christgau, said “It is one of the greatest and ridiculous epics of Dylan’s ridiculous epics.” The song is co-written by the playwright and actor Sam Shepard. It’s 11 minutes long but this is serious stuff. Read the lines from the song again; there is a lot that can be applied to two very important issues of our little world of veins. Two issues that we cover in this issue of VEIN:

• Societal cooperation and integration
• The ethics of vein care

Usually my column tries to entertain and engage you, the reader, so that I can highlight topics we cover each issue. This time I’m going straight. I’m telling you this is serious stuff. The first two lines of the song apply to “serious stuff” #1: societal cooperation and integration. The last two lines describe “serious stuff” #2: the ethics of vein care.

Regarding societal issues, Peter Pappas gives us a very thoughtful piece about how the ACP and AVF can and should become one society. This is a follow up to the story he wrote in our Fall 2014 issue entitled “Speaking With One Voice.” Go back and read it to really understand Peter’s thought process. In this issue, he presents a very cogent discussion backed by facts. Mel Rosenblatt gives his version on the same theme. Mel’s thoughts are given as a commentary and extension of Peter’s article. These two articles from two past presidents of two major venous societies are powerful food for thought and action. We should not dismiss the idea of a merge as almost everyone would benefit. Size matters. Let’s be honest, in order to accomplish this, egos and testosterone (estrogen) will need to be left at the door. Size matters.

The economy of scale will be less costly for all if there is one society. Operating costs, membership costs, journal costs etc. would most likely be lower on a per capita-basis. The Industry has been calling for this privately and publically for many years. It is costly and time consuming for the industry to support two organizations that basically have the same goals. To be blunt, the current and almost current leaders of each society will need to be true leaders and operate from principle, not from personality. In the end, principle almost always trumps personality. “What’s in it for me?” needs to be supplanted by “What’s in it for us?” Enough of this, you get my point. This is serious stuff.

The ethics of vein care or lack thereof is the second “serious stuff” we deal with in this issue. Read the roundtable discussion article that Tom O’Donnell Jr. moderates with panelists Jose Almeida, Steve Elias, Mitch Goldman, Jennifer Heller and Mark Isaacs (by the way, Mitch Goldman came up with this concept. Thanks Mitch). The discussion revolves around what seems to be a growing minority of “vein specialists” who perhaps are treating the wrong patients for the wrong reasons. There has been some talk of this among ourselves privately but we thought a public airing is appropriate at this time. Vascular Insights has had a series of “Right Doctor, Right Patient, Right Reasons” as sponsored symposium at meetings: AVF, NY Venous, IVC that has touched upon this. The response was overwhelmingly positive. We have all seen patients that have been treated elsewhere for the wrong reasons and now they want to know from you “Why aren’t I feeling better?” What to do about these bad actors is the focus of our roundtable. This is serious stuff.

This issue, we pull back the covers and shine a very bright light on this serious stuff. I do believe that a lot of the problem is due to money and egos. Or to put it another way:

“Got in trouble and needed a hand from a friend of mine...this old friend he had a figure in mind...it was nothing illegal, just a little bit funny...he said “’C’mon don’t tell me that the rich don’t know...sooner or later it comes down to money...and your waist deep in the big muddy.’" Bruce Springsteen's “The Big Muddy,” Lucky Town, Columbia Records, 1992.

We need to remember to think about where we are and where we want to be both as a venous society and as a venous individual. We need to do the right thing on principle and not on personality. It’s not about me; it’s about us. Serious stuff.