AFIP Closure a Sad Time for U.S.Health Care

I always think of the AFIP, Armed Forces Institute of Pathology, as the final word in any difficult anatomic pathology case. As a medical student in the 1970’s, and as an Army physician in the 1980’s the AFIP was the final word on any diagnostic pathology question.   Microscope slides were sent to the AFIP whenever there was a question as to whether a biopsy was cancer or not, what grade of cellular abnormality existed, or really any other debate or uncertainty arose about a pathologic diagnosis.  When I was reminded today that the AFIP is closing in September as a casualty of the 2005 base closure decisions I was saddened to see that this proud and storied center of excellence has no longer been functioning for the last few months as the world’s premier diagnostic pathology resource.

The AFIP is most well known in recent years as a consulting resource for pathologic diagnosis to both the military and civilian medical, dental and veterinary community. Less well known is that it had a three part mission.  It was also an educational center of excellence and a research facility.  It has a proud history as a forensic pathology resource also.

The decision to close the AFIP was a part of the Defense Base Closure and Realignment Commission report to President Bush in 2005.  The repercussions of the loss of this historic resource have been the subject of many criticisms, but the decision has stood.  Some argue that we will be less able to rapidly respond to potential bioterrorism now.  Others like the WHO feel the loss of a resource for third world physicians for pathologic examination of surgical specimens will make the practice of good surgical care more difficult in some areas of the world.

One of the unique advantages of the AFIP is that it has been the central repository of many of the most interesting and challenging pathologic cases in the US and the world since 1862.  Over 150 years of existence the AFIP has accumulated over 3 million cases, 50 million paraffin slides, and 10 million formalin fixed tissue specimens in one location.  This resource has made the AFIP one of the premier places to study pathology and has allowed the pathologists at the AFIP to be widely recognized as world leaders in their field.

For anyone interested the history of the AFIP is being celebrated and documented in a coffee-table style book available at the U.S. Government bookstore in a book called Legacy of Excellence: The Armed Forces Institute of Pathology 1862-2011.  The cost is $65.00. Some of the most interesting highlights for me include:

  • 1865: The precursor of the AFIP, the Army Medical Museum did the autopsy on President Lincoln
  • 1866: Somewhat ironically the Army Medical Museum moved to the Ford Theatre which closed as a theatre shortly after the assassination of President Lincoln.
  • 1870: The Surgeon General staff published The Medical and Surgical History of the War of Rebellion: 1861-1865.
  • 1930: James Earl Ash MD was a major proponent of the role of the Army Medical Museum in diagnostic pathology. The American Registry of Pathology was established at the museum.
  • 1946: As its role in diagnostic and forensic pathology increased the Army Medical Museum became a division of the newly formed Army Institute of Pathology.
  • 1949: AIP renamed the Armed Forces Institute of Pathology to emphasize the tri-service role of the AFIP.  A new building at the Walter Reed Army Medical Center was designated as a new building site.
  • 1996: The AFIP teamed with Russian scientists to recreate fragments of the 1918 pandemic influenza virus.
  • 2001:  The AFIP plays a leading role in the forensic pathologic examinations after the 9-11 attacks.
  • 2005: AFIP scientists announce that they have fully reconstituted the 1918 influenza virus genome.
  • 2006: The AFIP received its 3 millionth pathology specimen.

The loss of the AFIP may not have a huge impact on the excellence of pathology in the U.S. healthcare system.  In the information age sharing of microscopic views of specimens can be accomplished through many different vehicles.  Still having a single government funded and universally respected repository of expertise and knowledge will be missed.  It is a sign of tough times economically for our country and a loss of institutional pride.  Myself I just feel like an era has passed and that we may regret this decision in the future.

12 Responses to AFIP Closure a Sad Time for U.S.Health Care

  1. As the nephew of James Earle Ash,MD,it gives me pause to hear of the closure of the AFIP. I started going there when I was about 10 with “Unk”..the basement was my favorite area!! At the ripe old age of 15,I was able to spend a few weeks in the “basement” of Walter Reed…(There were to be many more to come!!) Translate,autopsies-many!! It was a truly interesting and meaningful experience and most obviously another time-can anyone of us now see a 15 year old being offered a true exposure to the wide world of medicine at that age,to say the least. At the end of my first two week “initiation” I was given the old colored pin test,which I seemed to pass with very little effort. As I went on to Swarthmore to prepare for Medical School-(for that was what “Unk “) had dictated,and then obviously to Penn for medical school,Viet Nam took over and that was that.Even with the changing stance re:medical school admissions,I was older,(and perhaps a bit wiser) and so chose the Law as a profession. While I do remember my first Law Book,I also remember quite well the first book that was given to me that I could read, understand,and which captured my imagination-The Pathology Of Tropical Diseases!!-by Ash and Spitz

  2. Dear Mr. Warren,In response:The two phtoos you refer to were part of an exhibit called “Research Matters: 9/11, The Armed Forces Institute of Pathology Responds.” The exhibit was de-installed some time ago, so the phtoos are not on display now. Therefore, it is incorrect to say in your January 2008 blog that the museum “has unveiled an exhibit” because you are talking about something that happened several years ago.A team of more than 70 AFIP personnel (military, federal employees, and civilian contractors) was assembled, including members of every branch of service, to perform forensic pathology, forensic odontology, forensic anthropology, photographic work, and DNA services to identify victims. AFIP staff was sent to the Dover Port Mortuary at Dover Air Force Base in Delaware, to the Pentagon crash site, and to Somerset County, Pa. At the AFIP’s Armed Forces DNA Identification Laboratory (AFDIL), more than 45 forensic scientists and support personnel provided critical DNA expertise. Therefore, it is incorrect to say that “Reservists” were “Called Onto Duty” because the AFIP personnel were not reservists. Also, it is incorrect to say they were called “with Foreknowledge” because they received orders to deploy after the 911 attacks. Tech. Sgt. Briscese is one of several photographers whose phtoos were displayed in the exhibit. The names and titles of the other photographers are posted on the museum’s web site. So, it is incorrect to say this was just “also unveiled.”The photographer you accuse of being part of a conspiracy was part of a team of AFIP personnel who were dispatched to the site. If you check MapQuest, you’ll see that it is a short drive from the AFIP, which is headquartered at Walter Reed Army Medical Center, to the Pentagon. So, it is incorrect to dispute how he was able to get “onto the scene so early.”You also say “Why such banal images are being used in a medical museum exhibit is another question.” The Museum is part of the AFIP. For many years the Museum annually devoted one new exhibit to the work of its parent organization. One year, that new exhbit was “Research Matters: 9/11, The Armed Forces Institute of Pathology Responds.” The curators of that exhibit made a decision to not use any images of victims who could be identified by surviving family and friends. That seems sensible doesn’t it, as opposed to your comment of them being “banal.” And as far as your two photo captions: In the first, how do you know the fire in that spot is chiefly aviation fuel? And even if it is, how do you know the firefighters are using water? In the second photo, how can you see behind the building in front of the fire to know that firefighters aren’t there? I have no idea what point you are trying to make regarding your belief that it is noon…

  3. Dr. Pullen

    I am an academic cardiologist who recently learned about the closure of the AFIP. Sad. Do you know who inherited its vast collection of preserved hearts and their related histologic sections?

    Thanks.

    Philip B. Oliva, M.D/

  4. We have enjoyed the greatness of a great country. Our strengths made us great, inspite of our weaknesses. We must be so careful not to lose sight of the true values of our past, the substance of personal knowledge, and our cumulative knowledge. We have responsibility to those to come. My heart is saddened to see us allow the AFIP to die.

  5. I assisted in research in the Dept. of Radiation Injury (a cold war thing) in summers of 1956 and 1957 during medical school. Some great names passed thru there. Sadly, there is no replacement, only migration of a concept. I am surprised it persisted as long as it did, considering the dead hand of civilian and military bureaucracy that hung over it. No doubt it was the enthusiasm of the people involved that gave it longevity. I have great memories. RIP AFIP.

  6. I am saddened to see this place close. In the spring of 1987 they were the ones who diagonesed me with undifferentiated sarcoma and the three cancers that was affecting me as an infant. I know there are several others who are thankful as I am for the work they have done and the lives they have saved.

  7. Just when I was looking for the final authority in Pathology, I was takenaback by its untimely closure. However, anyone could suggest a similar authority as I wanted to submit a classical case of Antono-Goldman lesion of the pelvis?

  8. I was really shocked to learn closure of AFIP fasicle publication. I purchased all the fasclcles right from the 1st series to the 14th fascicle of 4th series published last. I was really greatful for the books, for my studies as student and also as a Pathology Practitioner. PRAMOD PUROHIT, KOLHAPUR, INDIA

  9. I worked at the AFIP back in the early 90’s and I didn’t really realize at that time the true significance of this world renowed institution. It is with my deepest regret that I didn’t stay the course there with fellow co-workers. I agree with the statement at the end of the article that closing this institution’s doors may not be without regret at some point. But we all realize the tough economic climate that we are in now. I will just end this comment by saying that I will always have nice memories of excoworkers and friends during my short experience at AFIP.

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