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.