HISTORY OF THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY

History of the first 30 years of the Canadian Association of Gastroenterology L’Association canadienne de gastroentérologie, les 30 premières années

IVAN TBECK, MD, PHD, FRCPC, FACP, MACG

N 1992 THE CANADIAN ASSOCIATION review the documents and remembered the Association, who indicated that Iof Gastroenterology (CAG) reached and relived some of the major events the Board of the CAG would like me to its 30th anniversary. Much has hap- which constitute the history of the write an extended book-size history of pened and many changes occurred dur- CAG, my enthusiasm rose, and I be- our first 30 years. I have now started ing the first 30 years of this came more and more involved and writing this manuscript. However this Association; this anniversary presented stimulated to write the chapter on the monograph may not be ready and avail- an opportune time to document some CAG for Dr Morley’s book. Once com- able to our membership for some time. of the major events that occurred dur- pleted, this was submitted and the book Therefore I decided to write this abbre- ing these years. was published in 1991 (1). viated form of our history, which can My stimulus to become involved in I feel that much has happened in be made available rapidly, hopefully for this undertaking was in 1989 when the 1990 and 1991 to warrant an extension your enjoyment. Some of this material Royal College of Physicians and Sur- to include the first 30 years of the CAG was included in the chapter of Dr Mor- geons of Canada (RCPSC) requested and thus finish the history at an impor- ley’s book and he gave me permission Dr Iain Cleator, our President, to con- tant anniversary. Furthermore, because to reuse this in the present text. The tribute a chapter to the book, Medical of the size of Dr Morley’s book, much of present article provides an extension Specialty Societies of Canada, edited by my research could not be included in on the chapter, and a considerable part Dr Tom M Morley (1). As I was the ar- the manuscript submitted to the Col- of this article is based on my research chivist and historian of the CAG, Dr lege. While I was writing the above carried out for the larger monograph Cleator and the Governing Board of chapter, I talked to several members of that I have now started to write. the Association requested that I should the Board, before I was approached by The present short essay on our his- prepare that chapter. Once I started to Dr Eldon Shaffer, the 29th President of tory has been compiled in the hope that younger members of the CAG will understand how some of the problems Queen’s University, Kingston, Ontario Correspondence and reprints: Dr Ivan T Beck, Archivist and Historian, Canadian that the CAG is dealing with today Association of Gastroenterology, Emeritus Professor of Medicine and Physiology, Queen’s originated from what happened in the University, Kingston, Ontario K7L 5G2 past. I also hope that this history may

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 345 BECK

TABLE 1 TABLE 2 TABLE 3 List of Canadian general internists and List of Canadian gastroenterologists Gastroenterologists who regularly at- surgeons who expressed a special in- who pioneered the subspecialty of gas- tended the Montreal-Interhospital Gas- terest in gastroenterology before 1950 troenterology in the early 1950s trointestinal Journal Club

Edmonton Halifax Royal Victoria Dr Walter C MacKenzie Dr Robert C Dickson Richard D McKenna Kingston Dr Robert M MacDonald Miller C Ballem Dr Malcolm Brown Quebec Ivan T Beck Montreal Dr Jean-Paul Dugal Montreal General Dr Antonio Cantero Montreal Douglas G Kinnear Dr Yves Chaput Dr Richard D McKenna St Mary’s Dr Roger B Dufresne Dr Miller C Ballem Ivan T Beck Dr Gerald W Halpenny Dr Jacques O Gagnon Jeno Solymar Dr Paul Letendre* Dr Paul Letendre Maisonneuve Dr Gavin Miller Dr Morris Miller Florent Thibert Dr Clarence Tidmarsh* Dr Gordon Young Queen Elizabeth Dr Jacques Tremblay Toronto Robert Bourne Dr Saint-Jean Desrosiers* Dr Charles B Brown Jewish General Quebec Dr John R Bingham Morris Miller Dr Jean-Paul Dugal* Dr Louis J Cole Isadore W Weintrub Saskatoon Dr Robert C Dickson Verdun General Dr Douglas J Buchan Dr John M Finlay Jacques O Gagnon Toronto Dr Paul M O’Sullivan Hotel Dieu Dr John R Bingham Winnipeg Paul Letendre Dr Ernest E Cleaver Dr Duncan L Kippen Dr H Hetherington Dr Wendall McLeod Dr Ernest J Maltby Edmonton Dr Fred Rolph Dr J Alan L Gilbert sonal bias, I had to research everything Dr Keith J Roy Wightman Vancouver I state here and assess carefully what Vancouver Dr Abraham Bogoch Dr MM Baird was actually written in the minutes and Dr E Christopherson the correspondences, and what I seem Dr Rocke Robertson to have remembered. Dr Roger Wilson Another question that I had to de- Winnipeg with the Association for such a long cide on was whether I should write this Dr Neil John McLean time. I was one of the founding mem- as a personal recollection, and thus Dr C Burton Stewart bers of the CAG and served as its first write about my own contributions in Dr PHT Thorlakson Secretary from 1961 to 1965. After this the first person (eg, I suggested ) or in *Indicates that their practice consisted mainly of pa- I was elected Vice-President, then a more detached fashion (eg, sug - tients with gastroenterological problems President-Elect and finally President in gested by Dr Beck ). I decided on the 1967. Following this I was on the Gov- second approach so that the history erning Board as Past-President in 1968 should not only be written in an unbi- and as Chairman of different commit- ased fashion, but should also appear to help our recent members to understand tees on and off between 1968 and 1980. be so. Another decision I had to make the basic philosophy of the Association In 1980, mainly because of my intimate was whether to use short names for peo- and help them to appreciate how, in knowledge of the CAG’s background, I ple I have known very well (eg, Dick spite of its shortcomings, the CAG has was asked to serve as archivist and his- McKenna versus Dr Richard D contributed to the development of Ca- torian, and as such I am a nonvoting McKenna ). To make this history fac- nadian gastroenterology. member of the Board. Still, I have been tual but still easy to read, I have de- At the same time, more senior mem- present at most of the major discus- cided that after having referred to the bers of the Association will relive some sions, and was able to contribute to short names in brackets at the first oc- of the exciting times when they and some of these. casion of mentioning the name of a their colleagues were involved in the Thus, I found that in writing this re- person, to use intermittently either the creation and the development of the view I have had some difficulties deal- full or short names of the participants. ideas that founded the basis of the fu- ing only with what is written in the Hopefully, in addition to making this ture evolution of our Association. minutes and correspondences, without short synopsis accurate, I have suc- At first I found it difficult to write an remembering the discussions that oc- ceeded to make it pleasurable and easy unbiased history of the CAG. This curred around most of the decisions to read. mainly is because I have been involved made. Therefore, in order to avoid per-

346 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

Figure 2) Seal of the Canadian Association of Gastroenterology

among Canadians from all parts of the country was one of the factors which provided impetus for establishment of the CAG. Another group which was instru- mental in starting the CAG was the Montreal Interhospital Gastrointesti- nal Journal Club. Meetings of this group were held in Dr McKenna’s home where, in a pleasant atmosphere, Montreal gastroenterologists (English and French) exchanged information on exciting new developments in the field (Table 3). One evening, after a Journal Club meeting, Dick McKenna, Figure l) Document of incorporation of the Canadian Association of Gastroenterology/L’As- Douglas (Doug) Kinnear and Ivan sociation canadienne de gastroenterologie. Signatures: Drs Richard D McKenna, Ivan T Beck started to plan the establishment Beck, Douglas G Kinnear, Paul Letendre, Robert C Dickson, Robert M MacDonald, Malcolm of the CAG. Dick McKenna wrote to Brown, KJR Wightman, Walter C MacKenzie, Eric M Nanson, A Bogoch, Duncan M Kippen his friends and soon reported that there was encouraging interest throughout the country. ORGANIZATION OF eases, advances in gastroenterology On June 21, 1961, this interested THE ASSOCIATION during the past 40 years were rapid. group met at the meeting of the Cana- During the 1950s, a younger group dian Medical Association (CMA) at Foundation of the Association of physicians who confined their prac- the Queen Elizabeth Hotel in Montreal Specialization in the different areas tice to gastroenterology (Table 2) and decided to establish the Canadian of internal medicine was not encour- started to feel that there was a need for Association of Gastroenterology/L’As- aged in Canada during the first half of a subspecialty society. At first, the an- sociation canadienne de gastroenté- this century. There were, however, in nual meeting of the American Gastro- rologie. The Association was to be most major cities, physicians and sur- enterological Association (AGA) was built on broad principles. It was to be geons who developed a special interest the common meeting place for Cana- bilingual and to include individuals of in gastroenterology besides practising dian gastroenterologists. Dr Richard D different disciplines: physicians, sur- general internal medicine or general (Dick) McKenna, Chairman of the Di- geons, pediatricians, radiologists and surgery (Table 1). Modern gastroenter- vision of Gastroenterology at the Royal basic scientists. A Committee of Incor- ology based on the concepts of clinical Victoria Hospital of McGill University poration, consisting of Dick McKenna, investigation and the results of newer (Montreal, Quebec) was Treasurer of Ivan Beck, Doug Kinnear and Paul technical procedures started to develop the AGA. At each of the Annual Letendre, was formed. Letters patent only during the second part of this cen- Meetings of the AGA he organized a incorporating the Corporation under tury. Based on better understanding of gathering of all Canadians attending the provisions of Part II of the Compa- the pathophysiology of digestive dis- the convention, and this interaction nies Act were issued by the Secretary of

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 347 BECK

TABLE 4 Initial members of the Canadian Association of Gastroenterology (joined before end of l962)

Ballem, Miller C Gagnon, Jacques O Munro, Douglas Beck, Ivan T Gilbert, J Alan L Nanson, Eric M Bell, David Halpenny, Gerald W O’Sullivan, Paul M Bingham, John R Harrison, Cameron Pichette, Paul Bogoch, Abraham Hildes, John A Robertson, H Rocke Brown, Berkeley C Hogarth, Jean Rogers, Arnold G Brown, Charles B Kinnear, Douglas G Sherbaniuk, Richard W

Brown, Malcolm G Kippen, Duncan L Sherman, Ludwig Buchan, Douglas J Kowalewski, KP Skoryna, Stanley C Cameron, Douglas G Letendre, Paul Smart, MJ Cantero, Antonio Lind, James F Thibert, Florent Chaput, Yves MacDonald, Robert M Tidmarsh, Clarence J Currie, Don J MacKenzie, Walter C Webster, Donald R Daniel, Edwin E McKenna, Richard D Weder, Carmen H Dickson, Robert C McKenzie, Allan D Weintrub, Isadore W Figure 3) Photograph of Dr Richard D Dufresne, Roger B Miller, Morris Wightman, Keith J Roy McKenna taken in 1962 at the time of his Dugal, Jean-Paul Miller, G Gavin Young, Gordon Presidency. This picture was previously Finlay, John M published (2)

State on January 12, 1962; one day later the Chairman, Dr McKenna, sub- TABLE 5 mitted the duly signed memorandum of Presidents of the Canadian Association of Gastroenterology agreement (Figure l) to the meeting of 1961 Richard D McKenna McGill University, Montreal, Quebec the temporary Board, and the suggested 1962 Robert C Dickson Dalhousie University, Halifax, Nova Scotia bylaws and corporation were accepted. 1963 Walter C MacKenzie University of Alberta, Edmonton, Alberta A seal was designed by Ivan Beck 1964 Eric M Nanson University of Saskatchewan, Saskatoon, which depicted the gastrointestinal Saskatchewan tract in a stylized form. The drawing 1965 Paul Letendre Université de Montréal, Montreal, Quebec was surrounded by the words Canadian 1966 Keith J Roy Wightman University of Toronto, Toronto, Ontario 1967 Ivan T Beck Queen’s University, Kingston, Ontario Association of Gastroenterology/ L’As- 1968 Abraham Bogoch University of British Columbia, Vancouver, BC sociation canadienne de gastroenté- 1969 Douglas G Kinnear McGill University, Montreal, Quebec rologie Inc January 12, 1962 (Figure 2). 1970 J Alan L Gilbert University of Alberta, Edmonton, Alberta The names of the founding members 197l John M Finlay University of Toronto, Toronto, Ontario are shown in Figure l; the initial mem- 1972 James F Lind University of Manitoba, Winnipeg, Manitoba bers who joined the Association in its 1973 Joseph J Sidorov Dalhousie University, Halifax, Nova Scotia first year are listed in Table 4. 1974 Jacques O Gagnon Université de Montréal, Montreal, Quebec 1975 Richard R Gillies University of Ottawa, Ottawa, Ontario Officers of the Canadian 1976 Bernard J Perey Université de Sherbrooke, Sherbrooke, Quebec Association of Gastroenterology 1977 Leslie S Valberg University of Western Ontario, London, Ontario The original officers of the Associa- 1978 Wilfred M Weinstein University of Alberta, Edmonton, Alberta tion were the President, immediate 1979 Florent Thibert Université de Montréal, Montreal, Quebec Past-President, President-Elect, Vice- 1980 Jacques Kessler McGill University, Montreal, Quebec President, Secretary and Treasurer. 198l Gordon G Forstner University of Toronto, Toronto, Ontario These, with the six councilors (to rep- 1982 Cameron Harrison University of British Columbia, Vancouver, BC resent geographic areas, linguistic 1983 Laurington R DaCosta Queen’s University, Kingston, Ontario 1984 William C Watson University of Western Ontario, London, Ontario background and specialty interests) 1985 Claude C Roy Université de Montréal, Montreal, Quebec constituted the Board of Directors, offi- 1986 C Noel Williams Dalhousie University, Halifax, Nova Scotia cially referred to as the Governing 1987 Alan BR Thomson University of Alberta, Edmonton, Alberta Board. In 1969 the post of Archivist 1988 Aubrey Groll Queen’s University, Kingston, Ontario was added to the Board. The names of 1989 Iain Cleator University of British Columbia, Vancouver, BC the presidents and their year of tenure 1990 Eldon A Shaffer University of Calgary, Calgary, Alberta are shown in Table 5. The photograph 1991 Suzanne E Lemire Université Laval, Quebec, Quebec of Dr McKenna, the first President of the CAG, is shown in Figure 3 and

348 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

.ECKHA " Photos of successive presidents of the Canadian Association of Gastroenterology

photographs of subsequent presidents, it was suggested that councilors should were requested to have demonstrated taken at the time of their presidency, be appointed by regions to facilitate a active involvement (rather than emi- are shown in Figure 4. The names of more important local input from the nence) in areas related to gastroenterol- secretaries, treasurers and archivists of membership to the Board. This sugges- ogy. At the same time ‘student member- the Association are shown in Table 6 tion is being reviewed and will be pre- ship’ was established for residents, fellows and those of councilors in Table 7. sented to the membership. and graduate students. The 1987 President, Dr Alan Thomson, suggested that to introduce Membership Committees novel ideas to the Association six ‘ad The original membership rulings A summary of the committees of the hoc councilors’ should be appointed to were strict. Election to ‘active member- CAG is presented in Table 9. The join the Board. These ad hoc council- ship’ was open to physicians, surgeons original standing committees were the ors were selected from the younger and scientists who had attained emi- Nominating Committee, Admissions members of the Association and were nence in their work in subjects pertain- Committee and Finance Committee. expected to participate in the delibera- ing to the digestive system. ‘Associate Several ad hoc committees were estab- tion of the Governing Board but had members’ had to possess such qualifica- lished and dissolved according to the no votes. It rapidly became clear that tions as to give promise of advance- needs of the Association. these colleagues did not feel entirely at ment to active membership. Associate Nominating Committee: The Nomi- home on the Board and that they did members could not hold office and nating Committee consists of the Presi- not contribute as much as they could, could not vote. Active members at the dent, Past-President, President-Elect mainly because of their limited under- age of 65 years could be made ‘senior and Secretary. They propose names of standing of the Association; most of members’ on request. ‘Honorary mem- the new slate of officers to the Board them subsequently were appointed to bers’ were physicians, surgeons and sci- which then submits these for approval another committee to become ac- entists who had attained pre-eminence to the general membership. Recently it quainted with the ongoing issues of the in gastroenterology and metabolism. A was questioned whether this method of CAG. This did not turn out to be a suc- list of honorary members is given in Ta- nomination to the Board leads to in- cess (see section on relation of the ble 8. In 1974 the associate member- breeding; several steps have been taken Board and membership) and, therefore, ship was dropped, abolishing the dou- to overcome this, such as inclusion of the issue of ad hoc councilors is being ble standard of membership. ad hoc councilors to the Board and this reviewed. At the January 1992 meeting Candidates for active membership year’s proposal of regional councilors. It

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 349 BECK

TABLE 6 TABLE 7 Secretaries, Treasurers and Archivists Councilors and Ad Hoc Councilors of the Board of the Canadian Association of Gastro- Bogoch, Abraham 1961-64 Kepkay, David L 1977-80 enterology Brown, Malcolm G 196l-63 Lukie, Bryan E 1977-80 Secretaries Letendre, Paul 1961-62 Diamant, Nicholas E 1980-81 Ivan T Beck (Montreal) 1961-65 MacDonald, Robert M 1961-62 Groll, Aubrey 1980-81 John M Finlay (Toronto) 1965-69 Nanson, Eric 1961-62 Shaffer, Eldon A 1980-82 Richard R Gillies (Ottawa) 1969-73 Wightman, Keith J Roy 1961-64 Beaudin, David J 1981-83 Ralph E Warren (Toronto) 1973-77 Harrison, R Cameron 1963-65 Ste Marie, Micheline T 1981-83 Laurington R DaCosta Kippen, Duncan L 1963-67 Williams, C Noel 1981-83 (Kingston) 1977-81 McKenna, Richard D 1963-67 Blendis, Laurence 1982-84 Michael Lichter (Montreal) 1981-86 O’Sullivan, Paul M 1964-65 Deneault, Jocelyn J 1982-84 David Lloyd (London) 1986-88 Dugal, Jean-Paul 1964-67 Hamilton, J Richard 1983-85 James A Barrowman (St John’s) 1988-90 McKenzie, Allan D 1965-67 Baker, Selwyn 1984-86 Richard N Fedorak Gilbert, J Alan L 1966-68 Cleator, Iain G 1984-86 (Edmonton) 1990-present Sidorov, Joseph J 1966-71 Kinnear, Douglas G 1984-86 Treasurers Buchan, Douglas J 1968-70 Barrowman, James A 1985-87 Douglas G Kinnear (Montreal) 1961-67 Gagnon, Jacques 1968-69 Heathcote, Jenny 1985-87 Douglas L Thomson (Montreal) 1967-70 Lind, James 1968-69 Gall, Grant D 1986-88 Florent Thibert (Montreal) 1970-77 McPhedran, Norman T 1968-70 Cohen, Max M 1987-88 Isadore W Weintrub (Montreal) 1977-81 Gillies, Richard R 1969-70 Clermont, Richard 1987-89 Andre P Archambault McCorriston, James R 1969-71 Sullivan, Stephen N 1987-89 (Montreal) 1981-85 Thibert, Florent 1970-71 Danzinger, Rudolph 1988-90 Alvin Newman (Toronto) 1985-89 Lacerte, Marcel 1970-72 Depew, William T 1988-90 Lawrence J Worobetz Hildes, John A 1971-71 Lahaie, Raymond G 1989-90 (Saskatoon) 1989-present Sherbaniuk, Richard W 1971-73 MacSween, Miller H 1989-90 Archivists Kinnear, Douglas G 1972-73 Chaun, Hugh 1990-92 Richard D McKenna (Montreal) 1969-7l Valberg, Leslie S 1972-74 Sutherland, Lloyd R 1990-92 Douglas J Buchan (Saskatoon) 197l-80 Perey, Bernard 1972-74 Bourdages, Raymond 1990-93 Dr Ivan T Beck (Kingston) 1980-present MacDonald, Walter C 1972-74 Keith, Roger 1990-93 Hamilton, John D 1973-75 Scully, Linda J 1991-94 Potvin, Laurent 1973-75 Cockeram, Alan W 1991-94 Weinstein, Wilfred M 1974-76 Ad Hoc Councilors was also discussed whether the Nomi- Harrison, Cameron 1975-76 Goodacre, Robert L 1989-92 nating Committee should not be ex- Roy, Claude C 1975-76 Paterson, William G 1988-91 panded to include members at large. Thompson, W Grant 1975-76 Reynolds, Richard P 1988-91 Admissions Committee: The Admis- Gagnon, Jacques Omer 1975-79 Pare, Pierre 1988-91 sions Committee is responsible for rec- Watson, William C 1976-79 Lam, Edwin 1988-91 ommending membership criteria and to Badley, Bernard 1977-79 Yacyshyn, Bruce R 1988-91 review the yearly membership applica- Devroede, Ghislain 1977-80 tions (chairmen of this committee are listed in Table 10). It is this committee which, under the chairmanship of Dr Richard Hamilton, suggested the aboli- search fellowship and, in 1989, for between the CAG and different mem- tion of the associate membership and funds required for the Association’s bid bers of the pharmaceutical industry the introduction of the student mem- for the World Congress of Gastroenter- could be avoided. Their report has now bership. ology. This committee has done an ex- been submitted and clearly stated that Finance Committee: The Finance cellent job in organizing the financial meetings can obtain CAG support and Committee has become one of the most aspects of the Association and provid- officially be accepted as a CAG spon- important instruments of the Associa- ing guidance to the Treasurer. sored event only if the meeting was tion (for chairmen see Table 11). At Because of the Finance Committee’s fully organized by the CAG without in- first it only served to advise the CAG frequent interactions with the pharma- put from the pharmaceutical industry. on the financial placement of its funds ceutical industry, in 1991 Dr Malcolm Having submitted this report, the In- and propose a budget for the upcoming C Champion was appointed Chairman dustry Relations Committee has now year. Since the chairmanship of Dr Su- of the Industry Relations Committee, a been dissolved. Any CAG supported zanne Lemire, the Committee was subcommittee of the Finance Commit- event has to be approved by the Chair- made responsible for obtaining support tee, and asked to review (in conjunc- man of the Education Committee, from pharmaceutical companies for the tion with the Ethics Committee) the have the finances reviewed by the Fi- educational aspects of meetings, re- methods by which conflict of interest

350 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

nance Committee and be accepted by TABLE 8 TABLE 9 the Board. List of Honorary Members Committees of the Canadian Associa- tion of Gastroenterology Program Committee: The Program Dr Charles H Best Committee was made responsible for Toronto, Ontario* Standing Committees organization of the scientific, business Dr Henry L Bockus Nominating Committee and social aspects of the annual meet- Philadelphia, Pennsylvania, USA* Admissions Committee ings. In the first years, when the Asso- Dr Charles F Code Finance Committee Rochester, Minnesota, USA ciation held its assembly together with Ad Hoc Committees Dr Robert Clark Dickson Program Committee that of the CMA, this committee had Halifax, Nova Scotia* Local Organizing Committees little to do, as there was only a one-day Dr Eric M Nanson Committees dealing with Post Graduate Saskatoon, Saskatoon * scientific meeting and a combined so- and Continuing Medical Education Dr Morton I Grossman cial and business lunch. The task of the Post Graduate Education Committee Los Angeles, California, USA* Program Committee became more de- Training and Education Committee Dr Franz J inglefinger manding once the CAG meeting was Royal College of Physicians and Boston, Massachusetts, USA* moved to coincide with that of the Surgeons Specialty Committee in Sir Francis Avery Jones Gastroenterology RCPSC. Coordination with the London, United Kingdom Program Directors Committee RCPSC, the Canadian Society for Dr Paul Letendre Education Committee Clinical Investigation (CSCI) and Montreal, Quebec* Research Committee other national societies became neces- Dr Ernest J Maltby sary both at the scientific and social lev- Toronto, Ontario* Endoscopy Committee International Liaison Committee els. Between 1977 and 1984, Dr Laur- Dr G Gordon McHardy Ethics Committee ington R (Larry) DaCosta played a NewOrleans, Louisiana, USA Dr Walter C MacKenzie Industry Relations Committee major role in achieving better coopera- Edmonton, Alberta* Advisory Committee On Manpower tion with other societies and in the re- Dr H Rocke Robertson Royal College of Physicians and organization of the annual meeting, Montreal, Quebec Surgeons/Canadian Medical first as secretary and then as president. Dr Douglas L Thomson Association Maintenance of Presently a standing committee exists, Montreal, Quebec* Competence Committee consisting of the CAG President Dr Clarence J Tidmarsh (Chairman), Past-President, Secretary, Montreal, Quebec* Chairman of the Local Arrangement Dr DR Webster Montreal, Quebec* Committee, the Research Committee Dr Keith J Roy Wightman and the Education Committee. In addi- Toronto, Ontario* TABLE 10 tion, there are appointed readers to *Deceased Chairmen of the Admissions judge the anonymously submitted ab- Committee stracts. In recent years the organization of the program has become a major events, and organizing and printing the Kippen, Duncan L (Winnipeg) 1961-64 problem, because in addition to inter- program. Ballem, C Miller (Montreal) 1964-65 Gilbert, J Alan L (Edmonton) 1965-67 actions with other societies, the CAG Postgraduate and Education Commit- Lind, James F (Winnipeg) 1967-68 tried to satisfy its many constituents: tees: Throughout the years, five differ- O’Sullivan, Paul M (Toronto) 1968-69 gastroenterologists, surgeons, other cli- ent committees dealt with postgraduate Bingham, John R (Toronto) 1969-7l nicians in private practice, clinical and continuing medical education Prokipchuk, Edward J teachers as well as clinical investigators (chairmen are presented in Table 12). (Toronto) 1971-72 and basic scientists. A major change oc- The Postgraduate Education Commit- Hamilton, John R (Toronto) 1972-73 curred in 1992, when on the request of tee, established in 1962, reports on the Badley, Bernard WD (Halifax) 1973-76 Dr John Wallace, Chairman of the Re- status of postgraduate training in Can- Lacerte, Marcel (Quebec) 1976-77 search Committee, the Board agreed ada and recommends methods to be Baillargeon, Jacques that abstracts be read and judged by the adopted for postgraduate training in (Montreal) 1977-79 Research Committee. Time will tell gastroenterology. In 1967 the CAG of- Deneault, Jocelyn J (Ottawa) 1979-81 whether this will lead to a better selec- ficially requested the RCPSC to estab- Ghent, Cameron N (London) 1981-83 Beaudin, David J (St John’s) 1983-84 tion of abstracts. lish gastroenterology as one of the rec- Danzinger, Rudolph G Local Organizing Committee: The Lo- ognized subspecialities of internal (Winnipeg) 1984-85 cal Organizing Committee consists of medicine. A request for the recognition Gall, D Grant (Calgary) 1985-86 prominent gastroenterologists of the of the specialty of pediatric gastroenter- Scott, Gerald W (Edmonton) 1986-87 city where the annual meeting is held. ology was made at a later date. In 1968 Haddad, Henry (Sherbrooke) 1987-88 They are responsible for finding the ap- the RCPSC established a Specialty Leddin, Desmond J (Halifax) 1988-91 propriate location for the scientific and Committee in Gastroenterology (mem- Goodacre, Robert L (Hamilton) 1991-92 business meetings, arranging the social bers are presented in Table 13). In May

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TABLE 11 TABLE 12 CAG on examinations, training pro- Chairmen of the Finance Committee Chairmen of Committees dealing with gram approvals, manpower require- Postgraduate and Continuing Medical Kinnear, Douglas G (Montreal) 1967-68 ments, etc. Education Thomson, Douglas L (Montreal) 1968-69 To deal with problems related to the Beck, Ivan T (Kingston) 1969-73 Postgraduate Education Committee* running of the individual training pro- Lacerte, Marcel (Quebec) 1973-74 Kinnear, Douglas G (Montreal) 1963-68 grams, a Committee of Program Direc- Crispin, John S (Winnipeg) 1974-75 McKenna, Richard D tors was established in 1974. At the (Montreal) 1968-69 Weintrub, Isadore W (Montreal) 1975-77 start, with Dr William C (Bill) Watson Training and Education CommitteeV Anderson, Frank H (Vancouver) 1977-79 as its Chairman, this committee acted Sidorov, Joseph E (Halifax) 1969-72 Mishkin, Seymour (Montreal) 1979-81 on its own and provided independent Shaffer, Eldon A (Calgary) 1981-82 Gilbert, J Alan L (Edmonton) 1972-74 input to the Board. The subsequent Blendis, Laurence M (Toronto) 1982-83 Royal College Specialty Committee in Chairman, Dr Florent Thibert, was also Lemire, Suzanne E (Quebec) 1983-90 Gastroenterology Champion, Malcolm C Gilbert, J Alan L (Edmonton) 1970-74 Chairman of the Royal College Com- (Ottawa) 1990-93 Gillies, Richard R (Ottawa) 1974-82 mittee on Gastroenterology. Because Chairmen of the Ad Hoc Industry Thibert, Florent (Montreal) 1982-86 every Program Director was also a ‘Co- Relation Committee DaCosta, Laurington R rresponding Member’ of the Royal Col- Champion, Malcolm C (Kingston) 1986-present lege Specialty Committee, the annual W (Ottawa) 1991-92 Program Directors Committee meetings of the two committees were Watson, William C (London) 1974-82 combined. Thus, sometimes it was diffi- Thibert, Florent (Montreal) 1982-86 cult to discern whether the Chairman’s DaCosta, Laurington R (Kingston) 1986-87 report to the CAG was that of the 1968, the Postgraduate Education Beck, Ivan T (Kingston) 1987-89 Royal College Committee or that of Committee of the CAG held a joint Sutherland, Lloyd the Committee of Program Directors. meeting with the Specialty Committee (Calgary) 1989-present In 1977 the CAG adopted the of the Royal College. These commit- Education Committee Royal College Committee in Gastro- tees established some of the salient Shaffer, Eldon A (Calgary) 1985-89 enterology as the CAG Committee on points of the training requirements and Connon, Joseph J Training and Education, and the the methods of examination in gastro- (Toronto) 1989-present Chairman of the Royal College Com- enterology. In view of the new issues to Canadian Association of Gastroenterology mittee in Gastroenterology became Representative to Royal College of Physi- be dealt with in postgraduate educa- cians and Surgeons of Canada/Canadian ex-officio member of the CAG Gov- tion, on the recommendation of Dr Medical Association Maintenance of erning Board. This meant that the Doug Kinnear, in 1969 the Postgradu- Competence Committee same person reported for the CAG ate Education Committee was renamed van Rosendaal, Guido 1991 Committee on Training and Educa- as the Training and Education Com- *The Postgraduate Education Committee was re- tion, Program Director’s Committee named the Training and Education Committee in mittee. The terms of reference of this 1969 and was given new terms of reference; VAs of and simultaneously represented the committee were to deal with standards 1973 the Chairman of the Royal College Specialty Royal College. This led to considerable Committee on Gastroenterology(appointed bythe for Royal College Fellowships in gastro- College) was ‘nominated’ bythe Canadian Asso - confusion, and when Dr Larry DaCosta enterology, selection of examiners and ciation of Gastroenterology(CAG) as the Chairman became Chairman of the Committee in of the CAG Training and Education Committee. In accreditation of training programs. In 1977 the Training and Education Committee was 1986 he proposed that the Chairman of 1971 this committee, chaired by Dr Joe abolished and the Royal College Specialty Commit- the Royal College Committee should tee replaced this Committee of the CAG. In 1985 Sidorov, submitted its report on the de- the CAG re-established its own Education Commit- not be a member of the CAG. On the sirable attributes of a gastroenterologist tee, and the Chairman of the Royal College basis of this, the Training and Educa- stopped being a member of the CAG Board; WBe- and on the requirements for accredita- tween 1982 and 1986 the Chairman of the Royal tion Committee was dissolved and a tion of training programs. College Committee on Gastroenterologyacted as separate Chairman was appointed to the ‘Coordinator’ of program directors. From 1987 a The first Royal College examina- ‘Chairman’ of the Program Director’s Committee the Education Committee and the Pro- tion in gastroenterology was held in represented the program directors view to the gram Director’s Committee. However 1971. (Examination Board members Board in spite of, or perhaps because of, the from 1971 to 1992 are listed in Table close interactions of these Committees, 14). The experience of the first years of the CAG had tremendous input in the this examination was reviewed by Dr organization and structuring of post- Sidorov (3). Once the college accepted graduate training in gastroenterology. gastroenterology as a specialty, the fi- College Specialty Committee in It is not an exaggeration to state that nal decision making shifted from the Gastroenterology become automatically without the CAG, gastroenterology Training and Education Committee to the Chairman of the Training and Edu- would not be a subspecialty in Canada. the Royal College Specialty Commit- cation Committee of the CAG. This While the training of gastrointesti- tee. Therefore, in 1973, the CAG de- allowed the Chairman of the Royal nal residents was a function of the cided that the Chairman of the Royal College Committee to report to the Committee of the Program Directors

350 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

TABLE 13 Specialty Committee in Gastroenterology: Alphabetical listing of Committee Members. Approved by Council in 1968

Corre- Corre- Name Chairman Nucleus sponding Ex-officio Name Chairman Nucleus sponding Ex-officio Anderson, FH 1989-92 Kinnear, DG 1968-72 1976-78 , 1978-80 1980-88 Archambault, AP 1987-88 1984-87 Kopelman, H 1990-92 Badley, BWD 1978-80 198l-83 Lahaie, RG 1988-90 Baillargeon, J 1972-74, Leddin, D 1991 1978-80 Baker, S 1978-84 Levy, G 1991 Barrowman, JA 1987-90 1982-86 Lloyd, DA 1987-88 Beaudry, R 1976-78, 1978-80 MacDonald, WC 1976-80 1982-85 1982-84 Beck, IT 1968-72 1976-86 Martin, F 1980-82 1982-86 Bogoch, A 1976-78 McHattie, JD 1989-92 Bondy, DC 1976-78 Menard, D 1987-92 1992-94 Chew, CK 1976-78 Pichette, LP 1968-72 Connon, JJ 1978-84 Prokipchuk, EJ 1976-78 DaCosta, LR 1987-90 1982-86 1992 1990-92 Reynolds, RPE 1990-92 Depew, W 1989-92 Roy, C 1974-76, 1989-90 1983-86 Diamant, NR 1976-78 Sainte-Marie, M 1987-92 Durie, PR 1989-92 Scott, RB 1976-80 1989-92 Finlay, J 1972-76 Seaton, T 1978-82 Forstner, GC 1972-74 Shaffer, EA 1982-86 Gall, DG 1976-80 1989-90 Sherbaniuk, RW 1968-74 Gilbert, JAL 1968-74 Shipman, RT 1980-82 Gillies, RR 1974-82 1972-74 Sidorov, J 1970-76 1974-76 Giroux, Y 1980-83 Steinbrecher, U 1986-89 Goodacre, R 1989-92 Sullivan, SN 1989-90 Goresky, C 1989-92 Sutherland, LR 199l-92 1987-90 Groll, A 1972-74 Thibert, F 1982-86 1972-76 1975-77 Haddad, H 1985-88 Thompson, WG 1980-84, 1984-86 1987-92 Hamilton, JR 1974-76 1976-78 Thomson, ABR 1982-92 1987-89 Heathcote, EJL 199l-92 Villeneuve, J-P 199l-92 Hershfield, NB 1978-82 Watson, WC 1978-82 1976-78, 1982-86 Hunt, R 1982-88 Wensel, RH 1974-78 1978-82 Jeejeebhoy, K 1972-76, Whittaker, JS 199l-92 1989-92 Kepkay, DL 1978-80 Williams, CN 1982-86 199l-92 Kessler, JL 1972-74, Worobetz, LJ 1985-88 1976-82

and of the Royal College Specialty with Dr James Lind as its first chairman Colitis [CFIC]), the applications for the Committee in Gastroenterology, nei- (chairmen are listed in Table 15). Re- two Research Fellowships (supported ther of these committees dealt with sponsibilities of this committee in- by Merck Frosst Canada Inc and Jans- continuing medical education. In the cluded examining the year-to-year sen Pharmaceutica) and, recently, the spring of 1985 a new committee, the status of gastrointestinal research in Summer Student Award (supported by Education Committee, was established Canada and coordinating with fund- SmithKline Beecham). The committee to deal mainly with continuing medical raising agencies. Later this committee is responsible for organization of re- education and to organize the educa- was directed to review and adjudicate search symposia and research work- tional aspects of the annual meeting. the two student research prizes (one es- shops at the CAG annual meeting. Research Committee: The Research tablished by the CAG and the other by Endoscopy Committee: An Endoscopy Committee was established in 1969 the Canadian Foundation for Ileitis and Committee was initiated in May 1973

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 345 BECK

TABLE 14 (chairmen are presented in Table 16). Royal College of Physicians and Surgeons of Canada Examiners in Gastroenterol- The first terms of reference were to rep- ogy since 1971 resent the CAG in the World Organi- English board Thompson, William G 1981-83,’84-86* zation of Digestive Endoscopy (Organi- Badley, Bernard 1975-80,’81-83* Thomson, Alan BR 1981-86,’87-89* zation Mondiale d’Endoscopie Beck, Ivan T 1977-84 Valberg, Leslie S 1974 Digestive [OMED]). The committee Dacosta, Laurington R 1985-89,’ 90-92* Williams, Christoper N 1987-90 was reactivated with Dr Ivan Beck as its Finlay, John M 1971, ‘72-74*,’75-77 French Board Chairman in 1974. It was to report on Gilbert, James AL 1971-74 Archambault, AP 1975-77,’78-80,’81-83* guidelines for the training of gastroin- Heathcote, Elizabeth JL 1984-89 Beaudry, Rene 1975-77,’78-80* testinal endoscopists and to suggest cri- Jabbari, Mansour 1984-87 Beck, Ivan T 1978-84 teria for minimal facilities necessary for Jeejeebhoy, KN 1971-74 Boivin, Michel 1991-92 Kessler, Jacques 1973-78 Giroux, Yvon 1978-80,’81-83* safe endoscopic practice. This report Kinnear, Douglas G 1977,’78-80* Jabbari, Mansour 1985-87 was used as the basis for training re- Lahaie, Raymond G 1987 Jobin, Gilles 1988-92 quirements in gastroenterology and was Lloyd, David A 1985-87 Lahaie, Raymond G 1987,’88-90* sent to the Royal College and different MacDonald, Walter C 1976-80 Martin, Francois 1990 provincial licensing bodies. It was pub- Moore, Terrence L 1989-92 Menard, Daniel B 1987-91,’92-94* lished and was made available to hospi- Patel, Dilip G 1988-92 Meunier, Pierre 1984-86 tals for information (4,5). In 1977 this Poleski, Martin Henry 1991-92 Pare, Pierre 1986-92 committee was discontinued, but was Prokipchuk, Edward J 1978-84 Philippon, Fernand 1971-74 re-established in 1979 under the chair- Sherbaniuk, Richard W 1971-74 Thibert, Florent 1971,’72-77* manship of Dr Ronald Wensel. The Sidorov, Joseph J 1971-73,’74-77* Pediatric Board new committee was to review the Steinbrecher, Urs 1990-92 Kopelman, Hinda 1991-92 guidelines laid down by the first com- Stone, RM 1971 Sherman, Philip 1990-92 mittee and, if necessary, set up new Sutherland, Lloyd R 1988-92 Ste-marie, Micheline 1991-92 ones. In its final report Dr Wensel did * Chairman of the board not propose any changes from those laid down by the first committee. In 1985, TABLE 15 TABLE 16 during the chairmanship of Dr Aubrey Chairmen of the Research Chairmen of the EndoscopyCommittee Groll, a set of proposed informed con- Committee Beck, Ivan T (Kingston) 1971-73 sents was prepared. When the Cana- Lind, James F (Winnipeg) 1969-72 Beck, Ivan T (Kingston) 1974-78 dian Association of General Surgeons Preshaw, Roy M (Toronto) 1972-74 Wensel, Ronald H (Edmonton) 1979-81 (CAGS) established its own subcom- Jeejeebhoy, Khursheed N Archambault, Andre P mittee on endoscopy, the CAG Com- (Toronto) 1974-79 (Montreal) 1981-83 mittee was directed to coordinate its Forstner, Gordon G (Toronto) 1979-82 Badley, Bernard WD (Halifax) 1983-84 guidelines with those of the CAGS Thomson, Alan BR (Edmonton) 1982-85 Groll, Aubrey (Kingston) 1984-85 Committee. Unfortunately, none of Freeman, Hugh J (Vancouver) 1985-86 Cleator, Iain (Vancouver) 1985-86 the subsequent committee chairmen Collins, Steven M (Hamilton) 1986-89 Clermont, Richard J (Montreal) 1986-87 Depew, William T (Kingston) 1989-91 Connon, Joseph J (Toronto) 1987-88 could achieve this. In her Presidential Wallace, John L (Calgary) 1991-93 Marcon, Norman E (Toronto) 1988-91 Address, Dr Lemire asked the incoming Chairman of the Ethics Committee Bailey, Robert J (Alberta) 1991-93 chairman of this committee, Dr Robert Sidorov, J Joseph (Halifax) 1989-92 (Bob) Bailey, to attempt to re-examine this issue with the CAGS to establish joint criteria for medical and surgical TABLE 17 endoscopy training. This is becoming Chairmen of International Liaison Committees even more important at present, be- Foreign Relations Secretary International Liaison Secretary cause the criteria for training need to be Beck, Ivan T (Montreal) 1962-65 Watson, William C (London) 1983-86 revised in the light of the newly intro- Finlay, John M (Toronto) 1965-69 Newman, Alvin (Toronto) 1986-87 duced therapeutic procedures. Dr Lloyd Gillies, Richard R (Ottawa) 1969-73 Hunt, Richard H (Hamilton) 1987-90 Sutherland, Chairman of the Program International Liaison Relations Committee Sutherland, Lloyd (Calgary) 1991-94 Director’s Committee, has brought be- Gilbert, J Alan L (Edmonton) 1973-77 Chairmen of Committees for bids for the fore the Board a recent proposal from World Congress the RCPSC Specialty Committee on Liaison Representative to OMGE Watson, William C (London) 1982* gastroenterology for the minimal re- Watson, William C (London) 1981-83 Watson, William C (London) 1986V quirements for endoscopic training in W Thomson, Alan BR (Edmonton) 1990 the specialty of gastroenterology. OMGE Organisation Mondiale de Gastroenterologie – World Organization of Gastroenterology. *For 1986 International Liaison Committee: Congress; VFor 1990 Congress; WFor 1994 Congress The International Liaison Committee

350 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

TABLE 18 TABLE 19 Organizing and Advisory Committee for Location of annual meetings 1962-92 the bid for the 1994 World Congress Winnipeg, Manitoba June 1962 Vancouver, BC January 1978 Organizing Committee Toronto, Ontario June 1963 Montreal, Quebec February 1979 John Brown (Vancouver) Vancouver, BC June 1964 Ottawa, Ontario June 1980 Iain Cleator (Vancouver) Montreal, Quebec May 1965 Toronto, Ontario September 1981 Richard Hunt (Hamilton) Edmonton, Alberta June 1966 Quebec, Quebec September 1982 Alan Thomson (Edmonton) Quebec, Quebec June 1967 Calgary, Alberta September 1983 C Noel Williams (Halifax) Toronto, Ontario January 1968 Montreal, Quebec September 1984 Advisory Committee Vancouver, BC January 1969 Vancouver, BC September 1985 Selwyn Baker (Winnipeg) Montreal, Quebec January 1970 Toronto, Ontario September 1986 Jim Barrowman (St John’s) Ottawa, Ontario January 1971 Winnipeg, Manitoba September 1987 Ivan Beck (Kingston) Toronto, Ontario January 1972 Ottawa, Ontario September 1988 Laurie Blendis (Toronto) Edmonton, Alberta January 1973 Edmonton, Alberta September 1989 Malcolm Champion (Ottawa) Montreal, Quebec January 1974 Toronto, Ontario September 1990 Hugh Chaun (Vancouver) Winnipeg, Manitoba January 1975 Quebec, Quebec September 1991 Steve Collins (Hamilton) Quebec, Quebec January 1976 Ottawa, Ontario September 1992 Ed Daniel (Hamilton) Toronto, Ontario January 1977 Rudy Danzinger (Winnipeg) BC British Columbia Ghislain Devroede (Sherbrooke) Gordon Forstner (Toronto) Grant Gall (Calgary) Carl Goresky (Montreal) Committee for International Relations meetings, the CAG – similar to other Aubrey Groll (Kingston) was established in 1973 to represent the medical societies – has become depend- Dick Hamilton (Montreal) CAG at the AIGE and the OMGE ent on support from the pharmaceutical Pierre Huet (Montreal) meetings. Dr William (Bill) Watson, as industry. To ascertain that this does not Khursh Jeejeebhoy (Toronto) chairman of this committee from lead to ethical conflicts, the CAG es- Bernard Langer (Toronto) 1981-86, submitted two Canadian bids tablished an Ethics Committee under Suzanne Lemire (Quebec) Gary Levy (Toronto) to hold the World Congress of Gastro- the chairmanship of Dr Sidorov to deal Norm Marcon (Toronto) enterology in Toronto. Unfortunately with ethical issues concerning the As- Francois Martin (Montreal) both bids were unsuccessful and the sociation. Included in the terms of ref- Tom McDonald (London) Congress was held in Sao Paolo, Brazil erence was the relationship of the CAG Dan Menard (Sherbrooke) in 1986 and in Sydney, Australia in with the pharmaceutical industry (for Gerry Morris (Kingston) 1990. In 1988 the CAG decided to the latter, see the deliberations of the Pierre Pare (Quebec) make another bid to hold the 1994 Industry Relations Committee). On Claude Roy (Montreal) World Congress in Vancouver. Dr the suggestion of the Ethics Commit- Eldon Shaffer (Calgary) Alan Thomson chaired the committee tee, the 1992 McKenna Memorial Lec- Joe Sidorov (Halifax) to organize the bid. He worked indefati- turer, Dr Francisco Vilardell from Bar- Steve Strasberg (Toronto) gably and organized a strong Working celona, Spain will talk on ethical issues Lloyd Sutherland (Calgary) Committee (Table 18), members of in gastroenterology. Bruce Taylor (Toronto) which were invited as visiting profes- Grant Thompson (Ottawa) sors to several countries and thus trav- The New Constitution Larry Worobetz (Saskatoon) elled as ‘ambassadors’ for the Canadian Due to the many changes in com- bid during 1989 and 1990. Unfortu- mittee structure, it was decided that a nately this bid was also lost and the new constitution was needed and that 1994 Congress will be held in Los An- this should be available for the 25th an- geles, California. At present the new niversary of the Association. On the was established in 1973 (chairmen are Chairman of the International Liaison suggestion of Dr DaCosta, Dr Iain presented in Table 17). However, in Committee, Dr Lloyd Sutherland, is Cleator was to obtain legal help and 1962 the CAG became a member of the negotiating with representatives of the submit a proposal for the new charter. World Organization of Gastroenterol- World Congress to establish several sat- After several revisions by the Board, ogy (Organization Mondiale de Gastro- ellite meetings in Vancouver. the new constitution was incorporated entérologie [OMGE]) and in 1963, of Ethics Committee: The Ethics Com- under the provisions of Part II of the the Asociacion Interamericana de Gas- mittee was established in 1989 with Joe Corporation’s Act, RSC, 1970, C32, as troenterologia (AIGE). At first the sec- Sidorov as chairman (Table 15). With amended. The document deals with retary of the CAG acted as the Foreign diminishing support for research from the new membership rules and estab- Relations Secretary. With increasing government and the increasing cost of lishes the new terms of reference of the involvement in international affairs, a the educational programs of CAG officers and committees. It became the

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 345 BECK

TABLE 20 1962. Subsequent meetings up to 1967 these courses were published in a series Annual lecturers, the Richard D (except for the one in 1965) continued of books entitled Modern Concepts in McKenna lecturers and the Richard D to be held together with that of the Gastroenterology (6-8). A different type McKenna Memorial lecturers CMA. In May 1965 the CAG hosted a of postgraduate course was initiated in Annual lecturers joint convention with the American 1992 by Drs Alan Thomson and Gary 1963 Dr G Gordon McHardy Gastroenterological Association in Levy (it was not held during the An- 1964 Dr Charles F Code Montreal. As of January 1968, meet- nual Meeting of the CAG). This inter- 1965 *Professor GAD Haslewood ings of the Association were held in esting new event is described in some 1966 Dr Thomas A Watson conjunction with those of the Royal detail in the section on regional and 1967 Dr Maurice Dufresne College of Physicians and Surgeons of specific meetings. Richard D McKenna lecturers Canada and the CSCI. Table 19 shows As of 1985, research workshops 1968 Dr Henry L Bockus 1969 Dr Morton I Grossman the location of the meetings from were organized to allow for free ex- 1970 Dr George A Hallenback 1962-92. The many changes which oc- change of ideas among investigators. 197l Dr Franz J Ingelfinger curred in the structure of the program The first one was organized by Ivan 1972 Professor Sheila Sherlock reflected the changing requirements of Beck in 1985 on esophageal motility. Professor AndrewW Kay Canadian gastroenterology. At first, The speakers were clinicians, biomedi- 1973 Dr Irwin M Arias mainly individual papers were pre- cal engineers and gastrointestinal tech- 1974 Dr Kurt J Isselbacher sented. As of 1963 there was an annual nicians. Subsequently, workshops were 1975 Dr William Summerskill lecture given by an invited guest (Ta- held in 1988 on the enteric nervous Richard D McKenna Memorial lecturers ble 20). In 1968 the name of this lec- system (organized by Drs Steven Col- 1976 Professor Henri Sarles ture was changed to the Richard D lins and Ed Daniel) and in 1989 on ani- 1977 Dr Rene Menguy McKenna Lecture. As the knowledge mal models of intestinal inflammation 1978 Dr Howard M Spiro base in gastroenterology expanded, (organized by Dr Collins). The 1990 1979 Dr Alan F Hoffman symposia, courses, workshops and spe- workshop, put together by Dr Jean Mo- 1980 Professeur JJ Bernier cial lectures were added to the program risset, dealt with the use of cell and tis- 1981 Dr Ivan T Beck to fulfill the educational and research sue culture techniques in 1982 Dr Phillip P Toskes 1983 Professeur Henri Bismuth objectives of the Association. Conse- gastrointestinal, pancreatic and hepa- 1984 Dr Thomas R Hendrix quently, the duration of the meetings tobiliary research. Drs John Wallace 1985 Dr John M Dietschy had to be extended to encourage the and Mary Perdue arranged for the 199l 1986 Dr Martin C Carey submission of the increasing number of workshop on epithelial permeability. 1987 Professor R Hermon Dowling Canadian scientific achievements. Poster sessions started in 1985 1988 Dr Leslie S Valberg Combined sessions with the CSCI, mainly because the symposia, work- 1989 Dr Claude C Roy to present individual research papers shops and the course did not allow time 1990 Dr John K MacFarlane and a symposium of common interest, for the oral presentations of all the ex- 199l Dr Wilfred Weinstein were started in 1972. Since 1975, joint cellent papers submitted. Poster ses- 1992 Professor Francisco Vilardell symposia were held with the RCPSC, sions proved to be a great success, *This was a Canadian Association of the CSCI, the Canadian Society of En- providing excellent opportunities for Gastroenterology-American Gastroenterological Association jointlysponsored lecture given during docrinology, the Canadian Foundation personal interactions among investiga- the Combined meeting of the two Associations in for Diseases of the Liver (CFDL), the tors. Montreal in May1965 Canadian Association for the Study of The Richard D McKenna Lecture Liver Diseases (CASL) and several was introduced in 1968. Dr Richard other societies. The first joint sympo- McKenna, the founder and first presi- sium with the CAGS was held in 1979. dent of the Association, became ill in constitution of the Association as of The concept of a yearly postgradu- 1965 and retired from the active prac- 1986 and is available to our member- ate course to be held during the CAG tice of gastroenterology. With the ship in both official languages. meeting was conceived by Larry Da- unanimous approval of the member- Costa. The first course, Scientific Basis ship, in 1968 Dr Beck was instrumental MEETINGS OF THE CANADIAN for Therapeutic Decisions in Gastroin- in renaming the annual lecture to the ASSOCIATION OF GASTROEN- testinal Diseases, was organized by Dr yearly Richard D McKenna Lecture. TEROLOGY Alan Thomson and was held in Sep- The first Richard D McKenna lecturer tember 1984 during Dr Larry DaCosta’s was Dr Henry Bockus, who at that time Annual Meetings of the Canadian As- presidency. Since that time this one- was one of the most distinguished gas- sociation of Gastroenterology day course is held annually. It is di- troenterologists of the western world. The first scientific meeting was held rected towards the clinical gastroenter- From then on the yearly Richard D in conjunction with the Annual Meet- ologists, but as it is held during the McKenna lecture became the highlight ing of the CMA at the Fort Garry Hotel Royal College meeting, many inter- of the annual meetings. The invited in Winnipeg, Manitoba, on June 19, nists and surgeons also attend. Some of lecturers were internationally known

350 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

TABLE 21 TABLE 22 Research Lectures Titles of symposia co-sponsored by CAG

1981 Stephen Robert Bloom, Reader in Medicine, Royal 1969 “The Exocrine Pancreas” organized by Drs Ivan T Beck and Postgraduate School of Medicine, London, England: Newer Duncan G Sinclair, Queen’s University, Kingston, Ontario Aspects of Gut Endocrinology 1977 “L’Alcool et les Maladies de l’Appareil Digestif” organized by 1982 Leslie S Valberg, MD, Professor of Medicine, University Dr Marcel Lacerte, Laval University, Quebec, Quebec of Western Ontario, London, Ontario: State of Iron Absorption 1986 “Focus on Misoprostil (Prostaglandins)” organized by Dr and Related Diseases Alan BR Thomson, Toronto, Ontario 1983 John Bienenstock, MD, Professor of Medicine and Pa- 1987 “Workshop on Motility” and “Regional Meeting Gastroenter- thology, McMaster University, Hamilton, Ontario: The Mucosal ologists of the Eastern Provinces” organized by Dr Noel Williams, Immunologic Network: Its Significance in the Physiology of Halifax, Nova Scotia* the Intestine 1987 The International Course on Therapeutic Endoscopy, organ- 1984 Gordon G Forstner, MD, Professor of Paediatrics and ized by Drs Norman E Marcon, Paul Kortan and Gregory Haber, The Physiology, University of Toronto, Toronto, Ontario: Pancre- Wellesley Hospital, University of Toronto, Toronto, Ontario atic Insufficiency: Some Lessons from Cystic Fibrosis 1988 “Trends in Inflammatory Bowel Disease” organized by Drs LR Sutherland, CN Williams and Francois Martin, Lake Louise, Al- 1985 Joseph S Davison, PhD, Professor of Medical Physiol- berta ogy, Heritage Medical Scientist, Dept of Medical Physiology, Health Sciences Centre, University of Calgary, Calgary, Al- 1989 “Modern Concepts in Nutritional Support” organized by Drs A berta: The Integration of Gastrointestinal Functions by the Groll and WT Depew, followed by a Postgraduate Course on “Cur- Nervous System rent Issues in Gastroenterology” organized by Drs IT Beck and WT Depew, Queen’s University, Kingston, Ontario 1986 Jean Morisset, PhD, Professor of Biology, Université de Sherbrooke, Sherbrooke, Quebec: The Importance of Gas- 1989 “International Course on Therapeutic Endoscopy”, organized by Drs Norman Marcon, Paul Kortan, Gregory Haber and Gabor trointestinal Hormones in the Control of Pancreatic Growth Kandel, The Wellesley Hospital, University of Toronto, Toronto, and Their Possible Role in the Management of Pancreatic Ontario Diseases 1990 “Trends in Inflammatory Bowel Disease Therapy” organized 1987 John Brown, PhD, Professor, Dept of Physiology, Univer- by Drs L Sutherland, F Martin, R Farmer, G Hellers and N Wil- sity of British Columbia, Vancouver, British Columbia: Gastro- liams, Halifax, Nova Scotia intestinal Regulation of Insulin Release 1991 “The Fifth International Course on Therapeutic Endoscopy”, 1988 Edwin E Daniel, PhD, Professor of Physiology and Phar- organized by Drs Norman Marcon, GB Haber, PP Kortan and GP macology, McMaster University, Hamilton, Ontario: GI Motility Kandel, The Wellesley Hospital, University of Toronto, Toronto, Ontario 1989 Ivan T Beck, MD, PhD, Professor of Medicine and Physi- 1992 “Consensus Conference on Gastroesophageal Reflux Dis- ology, Queen’s University, Kingston, Ontario: The Mechanism ease”, organized by Drs IT Beck, JJ Connon, S E Lemire and ABR of the Ethanol-Induced Acute Small Intestinal Injury Thomson, Ottawa, Ontario 1990 Hector Orrego, MD, Professor of Medicine and Phar- 1992 “Postgraduate Course in Gastroenterology” organized by Drs macology, University of Toronto, Toronto, Ontario: Alcoholic ABR Thomson and Gary A Levy, Lake Louise, Alberta Liver Disease 1992 “Trends in Inflammatory Bowel Disease Therapy”, sponsored 199l N Diamant, MD, Professor of Medicine and Physiology, by Interfalk Canada Inc and The Canadian Association of Gastro- University of Toronto, Toronto, Ontario: The Vagus and Motor- enterology, organized by Drs F Martin, R McLeod, LR Sutherland and CN Williams, SE Lemire, RG Farmer, G Hellers, Quebec, ing in the Gut (Because Dr Diamant could not be at the Quebec meeting, this lecture will be given in 1992) 1992 Grant D Gall, MD, Professor of Paediatrics, University of *Subsequent Regional Meetings of the Eastern provinces were also cospon- sored bythe Canadian Association of Gastroenterology Calgary, Calgary, Alberta: Adaptation of the Mucosa to In- testinal Injury

investigators and clinical scientists and of the CFIC prize Ms Jo-Anne Fox investigators – subsequent lecturers (Table 20). In 1976, after the death of (PhD candidate from Queen’s Univer- should be Canadians (Table 21). Dr McKenna, the lecture was renamed sity, Kingston, Ontario, a student of Dr Student research awards were intro- the Richard D McKenna Memorial Ivan Beck). duced in 1977 to stimulate gastrointes- Lecture. The only social event between 1961 tinal research and to motivate The annual research lecture series and 1971 was a business luncheon, at- postgraduate trainees to submit their was proposed in 1981 by Dr Gordon tended by all participants. The first an- papers to the CAG. Winners of the Forstner. The first lecturer was Dr Ste- nual dinner was organized in 1972 by prize present their papers at the annual phen Robert Bloom from London, Eng- Dr John M (Jack) Finlay at the annual meeting. The CAG and the CFIC each land. Although his lecture was a great meeting in Toronto. The annual din- established a prize. The first winner of success, it was decided that – in order to ner has become a treasured tradition of the CAG prize was Dr Arni Sekar acquaint the membership with work the Association where old friends meet (trainee of Dr Grant Thompson, Uni- carried out by outstanding Canadian in a relaxed atmosphere. versity of Ottawa, Ottawa, Ontario) The printing and organizing of the

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 345 BECK

TABLE 23 (9). The second symposium was organ- supported by generous donations to the Visiting research professors ized by Dr Marcel Lacerte in 1977 at CAG by a long list of pharmaceutical Jeejeebhoy, Khursheed N Laval University (Quebec City, Que- manufacturers. (Toronto) 198l-1982 bec) on “L’alcool et les maladies de It was a real pleasure to see the qual- Roy, Claude (Montreal) 1982-1983 l’appareil digestif” (10). As of 1986, af- ity of submissions and how well they Shaffer, Eldon A (Calgary) 1983-1984 ter a considerable hiatus, several local were prepared. The meetings started at Hamilton, Richard J and special meetings were sponsored or 06:30 and finished at 23:00 with the af- (Toronto) 1984-1985 co-sponsored by the CAG (11-15). For ternoons (13:00 to 17:00) free for ski- Hunt, Richard H (Hamilton) 1986-1987 a list of these see Table 22. ing, skating etc. However the most Blendis, Laurence M (Toronto) 1987-1988 One of the new and exciting events important aspect of the free time was Barrowman, James A which occurred this year was the first achieved by trainee-faculty interaction (St John’s) 1989-1990 CAG Consensus Conference organ- at a social level. This allowed the train- Heathcote, E Jenny L ized by Drs Alan Thomson, Suzanne ees of different programs to get to know (Toronto) 1990-1991 Lemire, Joe Connon and Ivan Beck. It each other and thus have an opportu- Williams, Norman (Halifax) 199l-1992 was held in Ottawa between January 17 nity to discuss their various programs. Dr Stephen Strasberg was nominated as Visiting to 19, 1992. Gastroesophageal reflux They also could mix easily with faculty Research Professor but could not accept in 1985- 86. No one was appointed in 1988-89 disease was selected as the subject be- of their and other programs. This cause of the controversies which exist course, more than the annual meeting regarding its pathophysiology and held in the umbrage of the large crowds treatment. Specific areas of contro- of the Royal College, allowed for most annual program booklet is the duty of versy were introduced to the 40 care- participants to appreciate the strength the chairman of the Local Organizing fully chosen participants by selected of Canadian gastroenterology and the Committee. Once the Association speakers, and then discussed in small CAG. started to meet in conjunction with the groups of seven to 12. The group ses- Royal College, the scientific program sions were summarized by the session Visiting research professorships of the CAG was published in the chairman and presented for further dis- To improve the visibility of gastro- RCPSC program. Chairmen of the Lo- cussion to the entire group of partici- intestinal research in Canada the Re- cal Organizing Committee have often pants. Agreement was achieved on search Committee under the chair- reported that there are major problems most issues, and the results of the con- manship of Dr Gordon G Forstner with preparing this program, mainly ference have been publiched in The proposed the establishment of a Visit- because of the need to coordinate it Canadian Journal of Gastroenterology ing Research Professorship. This post is with that of other societies and the of- (16). This conference represents a new held by a Canadian researcher who vis- ten late release of the final program by beginning in a process of consensus its the majority of Canadian universi- the RCPSC. In spite of these difficul- opinions which will be organized on ties. A list of Visiting Professors is ties the membership requested that the other subjects. given in Table 23. CAG should continue to print its own The second novelty introduced this program booklet, mainly because a year was a new type of postgraduate ISSUES OF SPECIFIC separate program: maintains the iden- course which was held separately from INTEREST tity of the Association; combines all the annual meeting. It was organized by CAG scientific papers, special lectures Drs Alan Thomson and Gary Levy, and Bilingualism and symposia, whether they are organ- was held at Lake Louise, Alberta from Maintenance of bilingualism was ized by the CAG alone or in conjunc- April 8 to 12, 1992. The purpose of this –and remains – a prime concern of the tion with other societies; provides the course was to arrange for close interac- CAG. The original organizers came dates and locations of the social and tions among most gastroenterology from both the French and English com- business meetings; contains a list of the trainees and a wide range of faculty. munity. From the beginning, every ef- current officers of the CAG; and hon- There were up-to-date workshops and fort was made to project a bilingual ours previous Presidents and McKenna plenary sessions given by faculty. The image. However, the finances of the Lecturers by printing each year a list of exciting parts of the meeting were the CAG were never sufficient to have an all Past-Presidents and McKenna Lec- daily sessions where clinical and re- efficient translating service for all turers. search trainees gave papers on unusual documents. From time to time volun- clinical cases or on their recent re- teers (eg, Drs Jacques Gagnon, Marcel Regional and specific meetings search. To ascertain that all trainees Lacerte, Florent Thibert, Andre Ar- These meetings started in 1969 could come, they were invited to sub- chambault and Suzanne Lemire) trans- when the CAG, in conjunction with mit and to present case reports of un- lated documents and programs. From the Medical Research Council and usual cases or to present their research 1974 to 1985 the program was printed Queen’s University, co-sponsored a work. Thus, they became faculty and in both languages. Unfortunately, an symposium on the exocrine pancreas their transportation and stay could be ongoing accurate translating service

350 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

into French could not be continuously versa, leading to close and continuous consist of mainly senior academics. maintained. A major problem for trans- interaction between the membership The issue was again raised by Dr Alan lating the program of the CAG into and the Board. Thom- son during his presidency in French was the late release of the final As the number of the members in- 1988, and on his suggestion six younger CAG program by the RCPSC office. creased, the Board has appeared to be- members were appointed as ad hoc Therefore on the recommendation of come increasingly isolated, and the councilors to form a link between the Dr Claude Roy, since 1985 all major Executive has made numerous deci- Board and the membership (for details events in the program, such as the sions which were then presented to the see section on Officers of the Associa- Richard D McKenna Memorial Lec- membership, sometimes with very little tion). ture, the Research Lecture, the titles of time for discussion at the general meet- Unfortunately these councilors did symposia, and all business and social ing. By 1974 Joe Sidorov, in his Past- not improve communication mainly events, are printed in both languages President’s Report, emphasized the because, even though they were (the titles of papers submitted in Eng- need for better communication be- younger, they were not necessarily rep- lish or in French are printed in the lan- tween the Board and the membership. resentative of the membership at large. guage in which they were originally He stated that it is essential that the Several of our members continued to submitted). Several attempts were Board be supplied with a list of names feel apart from the decisions made by made to attract members of the Quebec of members who were interested and the CAG. This was well-expressed in a Association of Gastroenterology into capable of organizational work, and 1990 letter by Sam Lee from Calgary, the CAG. On the recommendation of that they should be given the opportu- Alberta, in which he wrote “There is a Dr Alan Thomson, the 1986 constitu- nity to contribute to the Association. widespread feeling, justified or not, tion was translated into French, and a He also proposed that a list of nomina- among many of the rank and file CAG major drive to increase membership, tions to the Board should be sent im- members, that the CAG is controlled with special emphasis on enrolling mediately after the semi-annual by an ‘old boys’ club”. more French members, was undertaken meeting to all members, asking them to The Board of the CAG took these during the presidency of Dr Claude Roy supply additional nominations. complaints very seriously. During his in 1985. This effort continues. Dr Sidorov considered that the sec- presidency, Dr Eldon Shaffer organized ond problem was the lack of communi- a meeting in October 1990 to discuss Examination in gastroenterology cation between the membership and the strategic plan of the Association The first examination in gastroen- the Board. Because of the pressure of and to establish better ways of interac- terology was held in 1971. Of major time, the annual business meeting was tion between the Board and member- concern to the program directors was run very efficiently and economically, ship. At this meeting it became clear the high failure rate. Dr Leslie Valberg yet did not represent a clear picture of from the discussion that the major reorganized the examinations by hav- what was actually accomplished, nor problem was that the CAG tries to sat- ing the examiner observe the candi- did it give any opportunity for discus- isfy many constituents with varying in- dates during the history and physical sion and criticism by the general mem- terests. Among these are the practising examination. This revealed that the bership. Without knowing the extent clinicians of different disciplines, clini- major reason for the high failure rate and the amount of work accomplished cal investigators and basic scientists. was inadequate preparation of candi- by various committees and the Gov- This mix of membership has a major dates in these areas. The standards of erning Board, the general membership impact on the program as laboratory the examinations and their method of could not appreciate the degree of scientists are not interested in clinical conducting them have been reviewed progress and might feel that not a lot papers, while some of the practising cli- by Joe Sidorov (3). was happening. nicians are not attracted to the basic Based on his proposal, the business science sessions. Relation of the Board meeting was extended and a major A decision was made at the strategic and membership change in the membership of the Board planning meeting to have the begin- At the time of the establishment of occurred during the next few years. ning of the meeting mainly of interest the Association in 1962, the initial Many of the posts were filled with indi- to clinicians and the second part to sat- membership of the Association was 51; viduals in their thirties. Among these isfy the clinical investigators and basic 11 of these sat on the Board. One year were Dr Grant Thompson as Council- scientists. Thus, it was decided that the later, with the first past-president on lor, Dr Marcel Lacerte as Chairman of course should always be the first day the Board, this number increased to 12. the Finance Committee and Dr Larry and that during the second day there The initial members and the members DaCosta as Secretary. Involvement of should be clinical symposia, clinical pa- who joined within the next few years young people in the workings of the pers and posters. In the third and fourth were all close friends. The Board al- Association was maintained through- days of the meeting there should be tered sufficiently rapidly to allow con- out the years, but the younger people of workshops, and basic science papers stant change from active member to the Board in time became ‘establis- and posters. This plan, however, may membership on the Board and vice hment’ and the Board again started to turn out to be very difficult to main-

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 345 BECK

TABLE 24 tain, mainly because the program will bined Government, Royal College and Canadian Association of Gastroenterol- have to be correlated with that of the CMA Committee, the ‘Requirements ogy strategic plan (1990) CSCI, the CAGS and the CASL. Committee on Physician Manpower,’ On the basis of discussions at the was established to review Canadian A. MISSION STATEMENT meeting, a strategic plan was proposed; manpower needs in the specialties. To Key ingredients: To foster optimal this was published in the July l, 1991 is- respond to this Committee the CAG gastrointestinal health for Canadians sue of the Newsletter and presented at established an ‘Advisory Committee B. GOALS: the General Membership Meeting. Of on Manpower’ under the chairmanship By promoting: interest is that no comments were re- of Dr Alan Gilbert. The report of this 1) Research into Digestive Diseases ceived regarding the plan either after Advisory Committee of the CAG was 2) Education the circulation of the Newsletter or at considered by the Requirements Com- the general meeting of the member- mittee to be one of the most illustrious 3) High ethical standards in practice ship. Thus the 1991 Strategic Plan has of the approximately 30 working party 4) Quality health care delivery now been accepted by the CAG. The reports. In spite of this, the opinion of 5) Communications between members Plan starts with a Mission Statement, the main committee – there are too – locally, regionally and according to which the CAG is to fos- many gastroenterologists – remained at national meetings ter optimal gastrointestinal health for unchanged. 6) Increased representation to: Canadians, and continues with its goals A second review proving the need a) governments and objectives. (The plan is docu- for more gastroenterologists was sub- b) the Royal College mented in Table 24). Also, under mis- mitted by Dr Larry DaCosta. The major cellaneous considerations the CAG problem in predicting future manpower c) other organizations endorsed the establishment of a Diges- needs according to Dr DaCosta’s com- 7) The profile of C.A.G. and Canadian tive Diseases Foundation of Canada mittee was the difficulty in determin- Gastroenterologists (for details of this foundation review ing a baseline, ie, who (at the time of the section on Research Support). the survey), was a practising gastroen- C. OBJECTIVES terologist. The committee found the 1) To promote research into normal Manpower issues CMA data base inaccurate, because it gastrointestinal function and digestive diseases Manpower issues played an impor- was compiled without specific prereq- tant role during the past 25 years. In uisites. These prerequisites were estab- 2) To enhance professional education the 1960s, based on the report of Jus- lished by the committee and the list 3) To develop standards on ethical tice Emmett Hall, it was generally ac- prepared by them was compared with conduct and for bioethics in GI cepted that there was an under- that prepared by the CMA. research production of physicians in general, The final outcome of this work is 4) To promote quality health care and this was also the case for gastroen- shown in Table 25 and, based on re- delivery for our patients terologists. Universities were requested gional predictions of program directors 5) To improve communications to increase enrollment of medical stu- and practising gastroenterologists, the between members dents, and gastroenterology programs required numbers needed to reach a de- 6) To increase our representation to were encouraged to enroll a greater sirable gastroenterology/population ra- Government – become proactive number of trainees. The situation tio is shown in Table 26. Based on the in establishing fee standards with provincial governments – monitor changed in 1970 when Dr Ramsay expected retirement age and many the adequacy of facilities and Gunton, Chairman of the Specialty other factors (eg, more part-time physi- resources for GI care throughout Development and Manpower Commit- cians, changes in physicians’ life expec- Canada – inform government of tee of the Royal College published his tations, increasing age of patients, deficiencies or excesses review (17). Although Dr Gunton more complex diagnostic and thera- 7) To enhance the profile of C.A.G. stated that his finding “does not neces- peutic procedures, and work involved and Canadian Gastroenterologists sarily represent Royal College policy or with patients before and after liver affirmed data” and that “the establish- transplants etc) the CAG committee OTHER CONSIDERATIONS ment of physician/population ratio and demonstrated a much higher need for 8) Establish a Digestive Diseases estimates of requirements based on lo- gastroenterologists than was suggested Foundation of Canada with a National Office with an Executive cal opinion is imprecise”, he concluded by the joint CMA, RCPSC and gov- Director to plan and manage the that there was an over-production of ernment ‘Requirements Committee on financial affairs of C.A.G. to better gastroenterologists. Physicians Manpower’. Despite these coordinate all our efforts The statistics quoted are interesting, excellent submissions, the projected as Dr Gunton suggested that there was manpower requirements for gastroen- Eldon A Shaffer, MD, FRCPC, FACP a need of one per 50,000 population for terology were reduced, and the support President endocrinologists and only one per for gastroenterology residents has been Canadian Association of Gastroenterology 70,000 for gastroenterologists. A com- cut by most provinces.

360 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

TABLE 25 Gastroenterologist:populationratio in 1987

Region 1 Region 2 Region 3 Region 4 Region 5 Canada BC Alberta Sask Manitoba Ontario Quebec PEI NB Nfld NS Present number 24 26 8 13 128 124 0 7 8 11 349 Number per region 50 21 128 124 26 349 Number per popula- tion ratio 1:121,250 1:91,230 1:126,380 1:82,680 1:71,910 1:52,980 0:126,800 1:101,48 1:70,950 1:79,710 1:73,060 0 Number per popula- tion region 1:105,640 1:99,330 1:71,910 1:52,980 1:87,750 1:73,060 BC British Columbia; NB New Brunswick; Nfld Newfoundland; NS Nova Scotia; PEI Prince Edward Island; Sask Saskatchewan TABLE 26 Recommended gastroenterologist:populationratio for 1986

Region 1 Region 2 Region 3 Region 4 Region 5 Canada BC Alberta Sask Manitoba Ontario Quebec PEI NB Nfld NS Present number 24 26 8 13 128 124 0 7 8 11 349 Number per popula- 1:73,060 tion ratio 1:105,640 1:99,330 1:71,910 1:52,980 1:87,750 Recommended number 31 34 11 18 142 137 2 10 11 13 409 Number per popula- tion region 1:81,260 1:71,930 1:64,820 1:47,950 1:63,380 1:62,340 BC British Columbia; NB New Brunswick; Nfld Newfoundland; NS Nova Scotia; PEI Prince Edward Island; Sask Saskatchewan

As usual, issues that appeared to was discussed at the Bi-Annual Meet- cal Research Council of Canada have been settled are constantly being ing of Subspecialties of the RCPSC. Dr (MRC) in 1968, the CAG requested reopened by government. In 1989 the Steven Collins was the CAG represen- that the MRC should establish a gas- Federal/Provincial/Territorial Confer- tative. The RCPSC had a written re- troenterology panel. This request was ence of Deputy Ministers of Health sponse to the Barer Report in not granted, and even today the panel (CDMH) decided to seek a review of December 1991 and was scheduled to dealing with gastroenterology consists the regional and national approaches respond in January 1992. The RCPSC of a combined group of researchers in to physician resource policy in Canada made a presentation along with five gastroenterology, hematology and in order to establish a national, and in other national medical organizations to nephrology with only three gastroen- some cases regional, strategy of action the Ministers of Health Conference in terologists usually on the panel. With for physician manpower. In 1990, Mor- Banff, Alberta, on January 27, 1992. In the recent appointment of Dr Henry ris L Barer, PhD, from the Centre for spite of these presentations the Barer- Friesen as President of MRC, ‘the Mis- Health Services and Policy Research of Stoddart report was accepted by the sion’, organization and peer review pro- the University of British Columbia and CDMH and the proposed changes are cesses of the Council are now being re- Greg L Stoddart, PhD, from the Centre now being put into action by the differ- viewed and hopefully the CAG may of Health Economics, McMaster Uni- ent provincial governments. Thus, make successful representation for es- versity, (Hamilton, Ontario) were planning for manpower has been now tablishment of an extended Gastroen- commissioned by the CDMH to pre- fully removed from the hands of physi- terology Committee. pare a strategy discussion addressing cians. In addition to grants from MRC, re- the physician resource management search in liver diseases has been sup- problems. After minimal consultation Research support ported by the CFDL. The CFIC was es- with the profession and none with Stimulation of basic and clinical re- tablished in 1974. It provides operating leaders of the specialties (eg, no con- search was one of the most assiduously funds for research in intestinal diseases. tact with CAG), in the summer of pursued objectives of the Association. Furthermore, after stiff competition 1991 these health economists submit- As early as 1963, Dr McKenna was ap- among university gastroenterology ted to the CDMH a report on future pointed Chairman of a Fund Raising units, on the basis of a recommenda- physician management (18). Committee. Unfortunately, funds nec- tion from an International Advisory Among other statements, the report essary to support the legal expenses Committee, the CFIC established two recommended a 10% reduction in the needed to establish a charitable organi- major Intestinal Disease Research enrollment of students to medical zation were not available, and Dr Units, one at McMaster University and schools and a simultaneous reduction McKenna’s efforts did not succeed. the other at the University of Calgary in residency posts by 10%. This report During the reorganization of the Medi- (Calgary, Alberta). The original direc-

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 3 5 BECK tor of the McMaster Unit was Dr Rich- sity (RH Hunt), University of Toronto cine (CIM) wrote to our President, Dr ard Hunt and presently the unit is di- (Peter R Durie) and Queen’s Univer- Gordon Forstner, to request that CIM rected by Dr Steve Collins, and the sity (IT Beck). In 1989 a second com- become the official journal of the director of the Calgary unit is Dr Grant petition was opened and fellowship CAG. On the basis of this correspon- Gall. These units have greatly contrib- support was provided to the pediatric dence the Board accepted CIM as uted to the understanding of the effect units of St Justin Hospital in Montreal, CAG’s journal. This agreement en- of inflammation on intestinal physiol- Quebec (C Roy) and the Department tailed that the name of CAG should ogy and pathology. of Pediatrics at the University of Cal- appear on the cover of the journal in For training of investigators in the gary (GD Gall). These fellowships both languages and that a member of field of gastroenterology, studentships have been of major importance in de- the Governing Board should sit on the and fellowships are available from veloping clinical scientists in the field journals Editorial Board. Although Dr MRC. These are adjudicated by the of gastroenterology, and have helped Eldon Shaffer was on the Board of MRC with no input from the CAG. maintain and develop further these CIM, the Journal did not carry the During the past few years the CAG was training programs. name of the CAG, and editorial input successful in obtaining funds for a sum- Within the past two years, in an at- from the CAG was minimal. mer studentship from SmithKline tempt to establish a comprehensive In 1986 Drs Alan Thomson and Beecham, and for research fellowship Canadian Digestive Diseases Founda- Noel Williams indicated that a new support from Merck Frosst Canada In- tion, Dr Jean-Francois Loumeau, Di- journal The Canadian Journal of Gastro- corporated and from Janssen Pharma- rector of Medical Communications, enterology (CJG) will be published. ceutica. The recipients for these fellow- Glaxo Canada Inc, approached Drs They stated that the Editor would be ships are judged by the CAG Research Richard Hunt, Suzanne Lemire, Ivan prepared to publish proceedings of sym- Committee on a yearly basis and the Beck and Alan Thomson with a pro- posia and abstracts at no cost to the As- awards are given to the applicant based posal which indicated that to improve sociation. Drs Thomson and Williams mainly on the training and background long term financial support for gastro- would be Editors-in-Chief with an elite of the candidate. enterology, Glaxo Canada was pre- group of CAG members serving as As- A very different competition for re- pared to support financially the sociate Editors and a Canadian and in- search fellowships was initiated by expenses, including the legal expenses ternational panel as members of the Glaxo Canada Inc. This competition of, establishing a Digestive Diseases Editorial Board. They suggested that was for ongoing research fellowship Foundation of Canada. this Journal should be accepted as the support provided to selected university The purpose of this Foundation will official journal of the CAG. There was gastroenterology training programs. be to raise funds for the support of re- considerable discussion regarding the The objective and method of adjudica- search, education and patient care for role of the CAG in this journal, in par- tion of this three-year fellowship was people suffering from diseases of the di- ticular because the publisher’s desire based on the successful achievements gestive tract. After negotiations with was to give control of the editorial of the two CFIC intestinal diseases re- the CFIC and CFDL, an organizational board and content to the Association. search units. Thus, the objective of the chart has been developed which in- Unfortunately, because of previous Glaxo Research Fellowship in Gastro- cludes input from the above charitable commitments to CIM, the Board con- enterology was to provide training organizations. The Medical Advisory cluded it could not accept the CJG as which would lead to the establishment Board consists principally of the mem- its official journal. However it was de- of a core of clinician investigators in bers of the CAG Board. Thus, 28 years cided that the CAG should fully sup- Canadian university centres. The con- after the first attempt by Dr McKenna port and encourage the new CJG with cept of the fellowship was that Fellows to establish such a foundation (which active participation on the Editorial will develop their research skills best in failed at that time because of lack of Board and by giving guidance to edito- well-supervised units where there was funds), the establishment of the Diges- rial policy. Since its establishment, close cooperation between clinical and tive Diseases Foundation of Canada thanks to the hard work of its Editors basic science training. has now been included into the strate- (Drs Thomson and Williams) the CJG It was initiated as a pilot project at gic plan of the CAG and it appears has grown and prospered. It published Queen’s University in 1985 and after funds will be available for its initiation. many symposia of the Association its apparent success (two of three train- (11-15), and recently has achieved list- ees entered academic gastroenterol- The Journal of the Association ing in Current Contents. The issue of ogy), in 1988 all Canadian university Since the late 1970s, the CAG re-examining the possibility of making centres were invited to compete. The needed to publish Canadian articles on the CJG the official publication of the Centres were judged by an interna- gastroenterology, proceedings of sym- CAG has been rediscussed in 1991. tional panel. Five units received these posia held under the aegis of the CAG This year’s president, Dr Suzanne Fellowships: University of Alberta and abstracts of the Annual Meeting. Lemire, appointed Dr Des Leddin to (ABR Thomson), University of Cal- In 1982 Dr Carl Goresky, the new edi- form a committee which should review gary (EA Shaffer), McMaster Univer- tor of Clinical and Investigative Medi-

360 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

and report to the 1992 Board Meeting establishment of an excellent Annual TABLE 27 on this issue. Meeting, training of gastroenterolo- Canadian Association of Gastroenterol- ogy representatives to Canadian Medi- gists, examinations, reviews of pro- cal Association council Canadian Association of grams and many other educational is- Gastroenterology-sponsored textbook sues (20). For details see Postgraduate Kippen, Duncan L 1966-67 in gastroenterology Education Committee, Specialty Com- Buchan, Douglas 1968 During the past three years, Drs El- mittee in Gastroenterology, Training Finlay, John 1969 don Shaffer and Alan Thomson were and Education Committee, Committee Bogoch, Abe 1970 involved in the editing of a CAG spon- of Program Directors, Education Com- Sidorov, Joseph 197l Gillies, Richard 1972-73 sored textbook of gastroenterology, mittee and CAG representative to Finlay, John 1974 First Principles of Gastroenterology, The Maintenance of Competence. Basis of Disease and an Approach to Man- Williams, C Noel 198l Baker, Selwyn 1986 agement (19). Chapters were written by Canadian Society for Roy, Claude 1987 Canadians only and the book is being Clinical Investigation Yacyshyn, Bruce 1991-92 translated by Dr Andre Archambault Throughout the years the common into French. This text is a major interest in basic research has led to achievement and a tribute to the edi- combining the first part of the CAG tors and members of the CAG. meeting with that of the CSCI. Sched- uling was not always easy, but the joint RELATIONS WITH OTHER abstract form introduced by the Royal lems. The controversial issues relating NATIONAL AND College has overcome many of the dif- to endoscopy have been discussed in INTERNATIONAL ficulties. the section on the Endoscopy Commit- MEDICAL SOCIETIES tee. Other Canadian societies with gastro- Canadian Medical Association enterological interests The Canadian Association The first meetings of the CAG were For many years the CAG has tried of Gastroenterology held in conjunction with those of the to satisfy the different interests of its and its international relations CMA and close links developed. Once constituents: basic scientists, endo- The CAG became a member of the the CAG combined its meeting with scopists, hepatologists, medical gastro- OMGE and AIGE as of 1962 and 1963, the RCPSC, ties with the CMA became enterologists, pediatricians and respectively. Canadian gastroenterolo- less important. Although the CAG surgeons – this was not always easy. gists are well-known abroad, thanks to had representation at the General The creation of an endoscopic society their scientific contributions to the Council of the CMA, this representa- was avoided by establishing an Endo- field (21). The Association made sev- tion was sporadic at best (Table 27) scopic Committee. An active Research eral bids to get the World Congress to mainly because the CMA Council Committee caters to basic scientists come to Canada, and this has been re- rarely discussed issues related to gastro- and clinical investigators. The loss of viewed in the section on the Interna- enterology, and unless the delegate was hepatologists to the CASL in a small tional Liaison Committee. familiar with the workings of the CMA country like Canada, with few investi- Council, his or her participation would gators, could have led to a rift in the be ineffective. The financial cost to gastroenterological community. How- CONCLUSION send the same representative over sev- ever, the CAG wished the new society During the past 30 years, the CAG eral years to the CMA meeting, irre- well, provided a small token sum to the has made tremendous strides. Scientific spective of where it was held, would establishment of the CASL and ar- developments in the field of gastroen- have been too expensive. With im- ranged for joint sessions at the Annual terology have been immense (2,20). proved finances, Dr Bruce Yacyshyn Meeting. Most members of the CASL For those who have started this Asso- has been appointed to attend the 1991 remained members of the CAG and ciation, it has been a great pleasure to and 1992 CMA Council meetings. many individuals may be sitting simul- observe the resilience with which the taneously on the boards of both socie- CAG has made adjustments to the Royal College of Physicians ties. constantly changing needs generated and Surgeons Of Canada by the unrelenting developments of the Since the meeting of the CAG was Canadian Association science, understanding, teaching and moved to coincide with that of the of General Surgeons practice of gastroenterology. Dealing RCPSC, very close relationships devel- The establishment of the CAGS with most of the situations, the Asso- oped between the two associations. has led to a loss of surgical papers to the ciation responded well, but there were This became even closer once gastro- CAG, but combined sessions with the areas where it could have done much enterology was accepted as a subspe- CAGS during the Royal College Meet- better. It is hoped that changes during cialty. There are many common goals: ing have overcome some of these prob- the next 30 years will similarly be excit-

CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 3 5 BECK ing and that the young members who young colleagues that the history of the will help the next generations to reach have recetnly joined the Association first 30 years has been compiled . His- the best possible decisions in the fu- will bring about the alterations req- tory tends to revolve in cycles, and er- ture. uired by the oncoming changes in sci- rors committed inthe past are much too ble 5. ence and social structure. It is for these often repeated. Hopefully this review The photograph of Dr McKenna, the

ACKNOWLEDGEMENTS:There are many to whom I would like outstandingclinicalgastroenterologyin all areas of the worldand ad- to express my thanks and appreciation. Family, friends, colleagues mire those who are investigators and teachers in Canadian and and co-workers made it possible for me to write this history. First of American universities. all my family – Marjorie(my wife), Cindy (my daughter)and my par- I am most thankful to my colleagues at Queen’s University (King- entswithoutwhoseunderstandingand unbrokensupportI wouldnot ston, Ontario)especially Larry DaCosta and Peter Dinda, who have been able to spend the time needed for the researchand writing helped in all aspects of my career, and to my previous trainees, Bill of this paper. Throughout the years they granted me many extra Depew, Bill Paterson, Steve Vanner and Mikael Buell, who have all hours away from the family which allowed me to maintain my clini- made me proud of their achievements.Drs Douglas (Doug)Kinnear, cal and basic research as well as my clinical teaching. This involve- John M (Jack)Finlay, Alan Thomson and Larry DaCosta read this mentin academicmedicinehelpedme to maintainmy relationswith manuscriptand I am grateful for their suggestions.I am grateful to Dr colleagues and friends who were in the forefront of Canadian gastro- Iain Cleator,Presidentof the CAGin 1989,who persuadedme to ac- enterology. It was these contacts who allowed me to remain in- cept the challenge of writing the chapter in the History of the Asso- volved, and this involvementprovided me with the personal memo- ciation for Dr Morley’s book and to Dr Eldon Shaffer and Suzanne ries needed to write this history. Lemire, Presidents of 1990 and 1991, respectively, for their support I would also like to thank my teachers and students. Without the and stimulus to accept to write the history of the first 30 years of the influence of the spirit of McGill University (Montreal, Quebec)of CAG. My thanks are also due to Dr Alan Thomson, one of my most the 1950s and ‘60s, the Royal Victoria Hospital (Montreal,Quebec) cherished previous students, for his editorial in this issue. of that time, my PhD supervisor, JSL Browne – and specifically the Thanks are due to Mrs Ann MacDermaid and Dr Shirley Spragge, teaching and enthusiasm of Richard McKenna – I would never have Archivists of Queen’s University, for classifying and organizing the been so deeply involvedin academicgastroenterology.Just as impor- data which provided the basis of the history of the CAG. More im- tant were my students, who continued to stimulate my enthusiasm. portantly my gratitude is extended to my secretary, Heather Without my pride in their achievements I could not have enjoyed Beveridge,for her assistancein obtainingand classifyingthe data de- medicineto the same extentthat I did duringthe 30 years which pro- posited in the Archives and for her outstanding organization in typ- vided the basis for this history. I am proud of those who are practising ing of this manuscript.

364 CAN JGASTROENTEROL VOL 6NO 6NOVEMBER/DECEMBER 1992 History of the CAG

REFERENCES 8. Shaffer E, Thomson ABR. Modern of a Symposium, Halifax, Nova Scotia. l. Beck IT. The Canadian Association of Concepts in Gastroenterology, vol III. Can J Gastroenterol 1990;4:261-483. Gastroenterology in Medical Specialty New York: Plenum Publishing 15. Marcon N, Haber G, Kortan P, Societies of Canada. Morley TP, ed. Corporation, 1992. Kandel G. Proceedings of the Fourth Toronto: Associated Medical Services 9. Beck IT, Sinclair DG. The Exocrine International Course on Therapeutic Inc, 1991:323-42. Pancreas. Proceedings of Symposium Endoscopy. The Wellesley Hospital, 2. Beck IT. Canadian gastroenterology: held at Queen’s University, Toronto, 1989. Can J Gastroenterol Yesterday, today and tomorrow. Clin Kingston, Ontario, 1969. London: JA 1990;4:527-667. Invest Med 1982;5:93-107. Churchill, 1971. 16. Beck IT, Connon J, Lemire S, 3. Sidorov JJ. Evaluation of Training 10. Lacerte M. Le Symposium Thomson ABR, and other participants. Programs in Clinical Gastroenterology, international sur l’alcool et les maladies Canadian Consensus Conference on Canadian Experience, 1971-1981. de l’appareil digestif. La Vie medicale the Treatment of Gastroesophageal Scand J Gastroenterol 1988;23(Suppl au Canada français. 1977;6:1019-31. Reflux Disease. Can J Gastroenterol 144):82-5. 11. Sutherland L, Williams CN. Trends in 1992;6:277-89. 4. Gillies RR, Perey, B, Beck IT. Inflammatory Bowel Disease Therapy 17. Gunton RW. Manpower Needs Gastrointestinal endoscopy – boon or 1986. Proceedings of a Symposium, in Internal Medicine. Ann R Coll Phys beast? Can Med Assoc J Montreal, 1986. Dig Dis Sci Surg Canada 1973;6:136-42. 1976;114:589-90. 1987;32(Suppl):5S-107S. 18. Barer ML, Stoddart G.L. Toward 5. Beck IT, Crispin JS, Groll A, 12. Thomson ABR, Williams CN. Trends Integrated Medical Resource Policies Sherbaniuk RW. Gastrointestinal in Inflammatory Bowel Disease for Canada: l. Background, process Endoscopy: Criteria for Training Therapy 1988. Proceedings of a and perceived problems. Can Med Doctors. CGA Committee on Symposium, Lake Louise, Alberta. Assoc J 1992;146:346-51. Endoscopy. Ont Med Rev Can J Gastroenterol 19. Thomson ABR, Shaffer EA, eds. First 1975;42:559-61. 1988;2(Suppl):lA-119A. Principles of Gastroenterology. The 6. Thomson ABR, DaCosta LR, 13. Groll A, Depew W. Modern concepts Basis of Disease and An Approach to Watson WC. Modern Concepts in in nutritional support – 1989. Management, Sponsored by the Gastroenterology, vol 1. New York: Symposium, Queen’s University, Canadian Association of Plenum Publishing Corporation, Kingston, 1989. Can J Gastroenterol Gastroenterology. Mississauga: Astra 1986. 1990;4(Suppl):lA-111A. Pharma, 1992. 7. Thomson ABR, Shaffer E. Modern 14. Thomson ABR, Williams CN. 20. Shephard DAE. The Royal College Concepts in Gastroenterology, vol II. Trends in Inflammatory Bowel of Physicians and Surgeons of Canada, New York: Plenum Publishing Disease Therapy 1990. Proceedings The Pursuit of Unity, 1960-1980. Corporation, 1989. Ottawa, 1985. 21. Kirsner JB. The Development of American Gastroenterology. New York: Raven Press, 1990. M EDIATORSof INFLAMMATION

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