history of the first 30 years of the canadian association...

History of the first 30 years of theCanadian Association of

Gastroenterology

L’Association canadienne degastroentérologie,

les 30 premières annéesIVAN T BECK, MD, PHD, FRCPC, FACP, MACG

IN 1992 THE CANADIAN ASSOCIATION

of Gastroenterology (CAG) reachedits 30th anniversary. Much has hap-pened and many changes occurred dur-ing the first 30 years of thisAssociation; this anniversary presentedan opportune time to document someof the major events that occurred dur-ing these years.

My stimulus to become involved inthis undertaking was in 1989 when theRoyal College of Physicians and Sur-geons of Canada (RCPSC) requestedDr Iain Cleator, our President, to con-tribute a chapter to the book, Medical

Specialty Societies of Canada, edited byDr Tom M Morley (1). As I was the ar-chivist and historian of the CAG, DrCleator and the Governing Board ofthe Association requested that I shouldprepare that chapter. Once I started to

review the documents and rememberedand relived some of the major eventswhich constitute the history of theCAG, my enthusiasm rose, and I be-came more and more involved andstimulated to write the chapter on theCAG for Dr Morley’s book. Once com-pleted, this was submitted and the bookwas published in 1991 (1).

I feel that much has happened in1990 and 1991 to warrant an extensionto include the first 30 years of the CAGand thus finish the history at an impor-tant anniversary. Furthermore, becauseof the size of Dr Morley’s book, much ofmy research could not be included inthe manuscript submitted to the Col-lege. While I was writing the abovechapter, I talked to several members ofthe Board, before I was approached byDr Eldon Shaffer, the 29th President of

the Association, who indicated thatthe Board of the CAG would like me towrite an extended book-size history ofour first 30 years. I have now startedwriting this manuscript. However thismonograph may not be ready and avail-able to our membership for some time.Therefore I decided to write this abbre-viated form of our history, which canbe made available rapidly, hopefully foryour enjoyment. Some of this materialwas included in the chapter of Dr Mor-ley’s book and he gave me permissionto reuse this in the present text. Thepresent article provides an extensionon the chapter, and a considerable partof this article is based on my researchcarried out for the larger monographthat I have now started to write.

The present short essay on our his-tory has been compiled in the hopethat younger members of the CAG willunderstand how some of the problemsthat the CAG is dealing with todayoriginated from what happened in thepast. I also hope that this history may

HISTORY OF THE CANADIAN ASSOCIATION OF GASTROENTEROLOGY

Queen’s University, Kingston, OntarioCorrespondence and reprints: Dr Ivan T Beck, Archivist and Historian, Canadian

Association of Gastroenterology, Emeritus Professor of Medicine and Physiology, Queen’sUniversity, Kingston, Ontario K7L 5G2

CAN J GASTROENTEROL VOL 6 NO 6 NOVEMBER/DECEMBER 1992 345

help our recent members to understandthe basic philosophy of the Associationand help them to appreciate how, inspite of its shortcomings, the CAG hascontributed to the development of Ca-nadian gastroenterology.

At the same time, more senior mem-bers of the Association will relive someof the exciting times when they andtheir colleagues were involved in thecreation and the development of theideas that founded the basis of the fu-ture evolution of our Association.

At first I found it difficult to write anunbiased history of the CAG. Thismainly is because I have been involved

with the Association for such a longtime. I was one of the founding mem-bers of the CAG and served as its firstSecretary from 1961 to 1965. After thisI was elected Vice-President, thenPresident-Elect and finally President in1967. Following this I was on the Gov-erning Board as Past-President in 1968and as Chairman of different commit-tees on and off between 1968 and 1980.In 1980, mainly because of my intimateknowledge of the CAG’s background, Iwas asked to serve as archivist and his-torian, and as such I am a nonvotingmember of the Board. Still, I have beenpresent at most of the major discus-sions, and was able to contribute tosome of these.

Thus, I found that in writing this re-view I have had some difficulties deal-ing only with what is written in theminutes and correspondences, withoutremembering the discussions that oc-curred around most of the decisionsmade. Therefore, in order to avoid per-

sonal bias, I had to research everythingI state here and assess carefully whatwas actually written in the minutes andthe correspondences, and what I seemto have remembered.

Another question that I had to de-cide on was whether I should write thisas a personal recollection, and thuswrite about my own contributions inthe first person (eg, I suggested ) or ina more detached fashion (eg, sug -gested by Dr Beck ). I decided on thesecond approach so that the historyshould not only be written in an unbi-ased fashion, but should also appear tobe so. Another decision I had to makewas whether to use short names for peo-ple I have known very well (eg, DickMcKenna versus Dr Richard DMcKenna ). To make this history fac-tual but still easy to read, I have de-cided that after having referred to theshort names in brackets at the first oc-casion of mentioning the name of aperson, to use intermittently either thefull or short names of the participants.Hopefully, in addition to making thisshort synopsis accurate, I have suc-ceeded to make it pleasurable and easyto read.

TABLE 1

List of Canadian general internists and

surgeons who expressed a special in-

terest in gastroenterology before 1950

Edmonton

Dr Walter C MacKenzie

Kingston

Dr Malcolm Brown

Montreal

Dr Antonio Cantero

Dr Yves Chaput

Dr Roger B Dufresne

Dr Gerald W Halpenny

Dr Paul Letendre*

Dr Gavin Miller

Dr Clarence Tidmarsh*

Dr Jacques Tremblay

Dr Saint-Jean Desrosiers*

Quebec

Dr Jean-Paul Dugal*

Saskatoon

Dr Douglas J Buchan

Toronto

Dr John R Bingham

Dr Ernest E Cleaver

Dr H Hetherington

Dr Ernest J Maltby

Dr Fred Rolph

Dr Keith J Roy Wightman

Vancouver

Dr MM Baird

Dr E Christopherson

Dr Rocke Robertson

Dr Roger Wilson

Winnipeg

Dr Neil John McLean

Dr C Burton Stewart

Dr PHT Thorlakson

*Indicates that their practice consisted mainly of pa-

tients with gastroenterological problems

TABLE 2

List of Canadian gastroenterologists

who pioneered the subspecialty of gas-

troenterology in the early 1950s

Halifax

Dr Robert C Dickson

Dr Robert M MacDonald

Quebec

Dr Jean-Paul Dugal

Montreal

Dr Richard D McKenna

Dr Miller C Ballem

Dr Jacques O Gagnon

Dr Paul Letendre

Dr Morris Miller

Dr Gordon Young

Toronto

Dr Charles B Brown

Dr John R Bingham

Dr Louis J Cole

Dr Robert C Dickson

Dr John M Finlay

Dr Paul M O’Sullivan

Winnipeg

Dr Duncan L Kippen

Dr Wendall McLeod

Edmonton

Dr J Alan L Gilbert

Vancouver

Dr Abraham Bogoch

TABLE 3

Gastroenterologists who regularly at-

tended the Montreal-Interhospital Gas-

trointestinal Journal Club

Royal Victoria

Richard D McKenna

Miller C Ballem

Ivan T Beck

Montreal General

Douglas G Kinnear

St Mary’s

Ivan T Beck

Jeno Solymar

Maisonneuve

Florent Thibert

Queen Elizabeth

Robert Bourne

Jewish General

Morris Miller

Isadore W Weintrub

Verdun General

Jacques O Gagnon

Hotel Dieu

Paul Letendre

346 CAN J GASTROENTEROL VOL 6 NO 6 NOVEMBER/DECEMBER 1992

BECK

ORGANIZATION OFTHE ASSOCIATION

Foundation of the AssociationSpecialization in the different areas

of internal medicine was not encour-aged in Canada during the first half ofthis century. There were, however, inmost major cities, physicians and sur-geons who developed a special interestin gastroenterology besides practisinggeneral internal medicine or generalsurgery (Table 1). Modern gastroenter-ology based on the concepts of clinicalinvestigation and the results of newertechnical procedures started to developonly during the second part of this cen-tury. Based on better understanding ofthe pathophysiology of digestive dis-

eases, advances in gastroenterologyduring the past 40 years were rapid.

During the 1950s, a younger groupof physicians who confined their prac-tice to gastroenterology (Table 2)started to feel that there was a need fora subspecialty society. At first, the an-nual meeting of the American Gastro-enterological Association (AGA) wasthe common meeting place for Cana-dian gastroenterologists. Dr Richard D(Dick) McKenna, Chairman of the Di-vision of Gastroenterology at the RoyalVictoria Hospital of McGill University(Montreal, Quebec) was Treasurer ofthe AGA. At each of the AnnualMeetings of the AGA he organized agathering of all Canadians attendingthe convention, and this interaction

among Canadians from all parts of thecountry was one of the factors whichprovided impetus for establishment ofthe CAG.

Another group which was instru-mental in starting the CAG was theMontreal Interhospital Gastrointesti-nal Journal Club. Meetings of thisgroup were held in Dr McKenna’shome where, in a pleasant atmosphere,Montreal gastroenterologists (Englishand French) exchanged informationon exciting new developments in thefield (Table 3). One evening, after aJournal Club meeting, Dick McKenna,Douglas (Doug) Kinnear and IvanBeck started to plan the establishmentof the CAG. Dick McKenna wrote tohis friends and soon reported that therewas encouraging interest throughoutthe country.

On June 21, 1961, this interestedgroup met at the meeting of the Cana-dian Medical Association (CMA) atthe Queen Elizabeth Hotel in Montrealand decided to establish the CanadianAssociation of Gastroenterology/L’As-sociation canadienne de gastroenté-rologie. The Association was to bebuilt on broad principles. It was to bebilingual and to include individuals ofdifferent disciplines: physicians, sur-geons, pediatricians, radiologists andbasic scientists. A Committee of Incor-poration, consisting of Dick McKenna,Ivan Beck, Doug Kinnear and PaulLetendre, was formed. Letters patentincorporating the Corporation underthe provisions of Part II of the Compa-nies Act were issued by the Secretary of

Figure l) Document of incorporation of the Canadian Association of Gastroenterology/L’As-sociation canadienne de gastroenterologie. Signatures: Drs Richard D McKenna, Ivan TBeck, Douglas G Kinnear, Paul Letendre, Robert C Dickson, Robert M MacDonald, MalcolmBrown, KJR Wightman, Walter C MacKenzie, Eric M Nanson, A Bogoch, Duncan M Kippen

Figure 2) Seal of the Canadian Associationof Gastroenterology

CAN J GASTROENTEROL VOL 6 NO 6 NOVEMBER/DECEMBER 1992 347

History of the CAG

State on January 12, 1962; one daylater the Chairman, Dr McKenna, sub-mitted the duly signed memorandum ofagreement (Figure l) to the meeting ofthe temporary Board, and the suggestedbylaws and corporation were accepted.A seal was designed by Ivan Beckwhich depicted the gastrointestinaltract in a stylized form. The drawingwas surrounded by the words CanadianAssociation of Gastroenterology/ L’As-sociation canadienne de gastroenté-rologie Inc January 12, 1962 (Figure 2).The names of the founding membersare shown in Figure l; the initial mem-bers who joined the Association in itsfirst year are listed in Table 4.

Officers of the CanadianAssociation of GastroenterologyThe original officers of the Associa-

tion were the President, immediatePast-President, President-Elect, Vice-President, Secretary and Treasurer.These, with the six councilors (to rep-resent geographic areas, linguisticbackground and specialty interests)constituted the Board of Directors, offi-cially referred to as the GoverningBoard. In 1969 the post of Archivistwas added to the Board. The names ofthe presidents and their year of tenureare shown in Table 5. The photographof Dr McKenna, the first President ofthe CAG, is shown in Figure 3 and

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

Dufresne, Roger B Miller, Morris Wightman, Keith J Roy

Dugal, Jean-Paul Miller, G Gavin Young, Gordon

Finlay, John M

TABLE 5

Presidents of the Canadian Association of Gastroenterology

1961 Richard D McKenna McGill University, Montreal, Quebec

1962 Robert C Dickson Dalhousie University, Halifax, Nova Scotia

1963 Walter C MacKenzie University of Alberta, Edmonton, Alberta

1964 Eric M Nanson University of Saskatchewan, Saskatoon,

Saskatchewan

1965 Paul Letendre Université de Montréal, Montreal, Quebec

1966 Keith J Roy Wightman University of Toronto, Toronto, Ontario

1967 Ivan T Beck Queen’s University, Kingston, Ontario

1968 Abraham Bogoch University of British Columbia, Vancouver, BC

1969 Douglas G Kinnear McGill University, Montreal, Quebec

1970 J Alan L Gilbert University of Alberta, Edmonton, Alberta

197l John M Finlay University of Toronto, Toronto, Ontario

1972 James F Lind University of Manitoba, Winnipeg, Manitoba

1973 Joseph J Sidorov Dalhousie University, Halifax, Nova Scotia

1974 Jacques O Gagnon Université de Montréal, Montreal, Quebec

1975 Richard R Gillies University of Ottawa, Ottawa, Ontario

1976 Bernard J Perey Université de Sherbrooke, Sherbrooke, Quebec

1977 Leslie S Valberg University of Western Ontario, London, Ontario

1978 Wilfred M Weinstein University of Alberta, Edmonton, Alberta

1979 Florent Thibert Université de Montréal, Montreal, Quebec

1980 Jacques Kessler McGill University, Montreal, Quebec

198l Gordon G Forstner University of Toronto, Toronto, Ontario

1982 Cameron Harrison University of British Columbia, Vancouver, BC

1983 Laurington R DaCosta Queen’s University, Kingston, Ontario

1984 William C Watson University of Western Ontario, London, Ontario

1985 Claude C Roy Université de Montréal, Montreal, Quebec

1986 C Noel Williams Dalhousie University, Halifax, Nova Scotia

1987 Alan BR Thomson University of Alberta, Edmonton, Alberta

1988 Aubrey Groll Queen’s University, Kingston, Ontario

1989 Iain Cleator University of British Columbia, Vancouver, BC

1990 Eldon A Shaffer University of Calgary, Calgary, Alberta

1991 Suzanne E Lemire Université Laval, Quebec, Quebec

Figure 3) Photograph of Dr Richard DMcKenna taken in 1962 at the time of hisPresidency. This picture was previouslypublished (2)

348 CAN J GASTROENTEROL VOL 6 NO 6 NOVEMBER/DECEMBER 1992

BECK

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History of the CAG

was also discussed whether the Nomi-nating Committee should not be ex-panded to include members at large.Admissions Committee: The Admis-sions Committee is responsible for rec-ommending membership criteria and toreview the yearly membership applica-tions (chairmen of this committee arelisted in Table 10). It is this committeewhich, under the chairmanship of DrRichard Hamilton, suggested the aboli-tion of the associate membership andthe introduction of the student mem-bership.Finance Committee: The FinanceCommittee has become one of the mostimportant instruments of the Associa-tion (for chairmen see Table 11). Atfirst it only served to advise the CAGon the financial placement of its fundsand propose a budget for the upcomingyear. Since the chairmanship of Dr Su-zanne Lemire, the Committee wasmade responsible for obtaining supportfrom pharmaceutical companies for theeducational aspects of meetings, re-

search fellowship and, in 1989, forfunds required for the Association’s bidfor the World Congress of Gastroenter-ology. This committee has done an ex-cellent job in organizing the financialaspects of the Association and provid-ing guidance to the Treasurer.

Because of the Finance Committee’sfrequent interactions with the pharma-ceutical industry, in 1991 Dr MalcolmC Champion was appointed Chairmanof the Industry Relations Committee, asubcommittee of the Finance Commit-tee, and asked to review (in conjunc-tion with the Ethics Committee) themethods by which conflict of interest

between the CAG and different mem-bers of the pharmaceutical industrycould be avoided. Their report has nowbeen submitted and clearly stated thatmeetings can obtain CAG support andofficially be accepted as a CAG spon-sored event only if the meeting wasfully organized by the CAG without in-put from the pharmaceutical industry.Having submitted this report, the In-dustry Relations Committee has nowbeen dissolved. Any CAG supportedevent has to be approved by the Chair-man of the Education Committee,have the finances reviewed by the Fi-

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nance Committee and be accepted bythe Board.Program Committee: The ProgramCommittee was made responsible fororganization of the scientific, businessand social aspects of the annual meet-ings. In the first years, when the Asso-ciation held its assembly together withthat of the CMA, this committee hadlittle to do, as there was only a one-dayscientific meeting and a combined so-cial and business lunch. The task of theProgram Committee became more de-manding once the CAG meeting wasmoved to coincide with that of theRCPSC. Coordination with theRCPSC, the Canadian Society forClinical Investigation (CSCI) andother national societies became neces-sary both at the scientific and social lev-els. Between 1977 and 1984, Dr Laur-ington R (Larry) DaCosta played amajor role in achieving better coopera-tion with other societies and in the re-organization of the annual meeting,first as secretary and then as president.Presently a standing committee exists,consisting of the CAG President(Chairman), Past-President, Secretary,Chairman of the Local ArrangementCommittee, the Research Committeeand the Education Committee. In addi-tion, there are appointed readers tojudge the anonymously submitted ab-stracts. In recent years the organizationof the program has become a majorproblem, because in addition to inter-actions with other societies, the CAGtried to satisfy its many constituents:gastroenterologists, surgeons, other cli-nicians in private practice, clinicalteachers as well as clinical investigatorsand basic scientists. A major change oc-curred in 1992, when on the request ofDr John Wallace, Chairman of the Re-search Committee, the Board agreedthat abstracts be read and judged by theResearch Committee. Time will tellwhether this will lead to a better selec-tion of abstracts.Local Organizing Committee: The Lo-cal Organizing Committee consists ofprominent gastroenterologists of thecity where the annual meeting is held.They are responsible for finding the ap-propriate location for the scientific andbusiness meetings, arranging the social

events, and organizing and printing theprogram.Postgraduate and Education Commit-tees: Throughout the years, five differ-ent committees dealt with postgraduateand continuing medical education(chairmen are presented in Table 12).The Postgraduate Education Commit-tee, established in 1962, reports on thestatus of postgraduate training in Can-ada and recommends methods to beadopted for postgraduate training ingastroenterology. In 1967 the CAG of-ficially requested the RCPSC to estab-lish gastroenterology as one of the rec-ognized subspecialities of internalmedicine. A request for the recognitionof the specialty of pediatric gastroenter-ology was made at a later date. In 1968the RCPSC established a SpecialtyCommittee in Gastroenterology (mem-bers are presented in Table 13). In May

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C�� J G�� V�� 6 N� 6 N��/D�� 1992 345

History of the CAG

1968, the Postgraduate EducationCommittee of the CAG held a jointmeeting with the Specialty Committeeof the Royal College. These commit-tees established some of the salientpoints of the training requirements andthe methods of examination in gastro-enterology. In view of the new issues tobe dealt with in postgraduate educa-tion, on the recommendation of DrDoug Kinnear, in 1969 the Postgradu-ate Education Committee was renamedas the Training and Education Com-mittee. The terms of reference of thiscommittee were to deal with standardsfor Royal College Fellowships in gastro-enterology, selection of examiners andaccreditation of training programs. In1971 this committee, chaired by Dr JoeSidorov, submitted its report on the de-sirable attributes of a gastroenterologistand on the requirements for accredita-tion of training programs.

The first Royal College examina-tion in gastroenterology was held in1971. (Examination Board membersfrom 1971 to 1992 are listed in Table14). The experience of the first years ofthis examination was reviewed by DrSidorov (3). Once the college acceptedgastroenterology as a specialty, the fi-nal decision making shifted from theTraining and Education Committee tothe Royal College Specialty Commit-tee. Therefore, in 1973, the CAG de-cided that the Chairman of the Royal

College Specialty Committee inGastroenterology become automaticallythe Chairman of the Training and Edu-cation Committee of the CAG. Thisallowed the Chairman of the RoyalCollege Committee to report to the

CAG on examinations, training pro-gram approvals, manpower require-ments, etc.

To deal with problems related to therunning of the individual training pro-grams, a Committee of Program Direc-tors was established in 1974. At thestart, with Dr William C (Bill) Watsonas its Chairman, this committee actedon its own and provided independentinput to the Board. The subsequentChairman, Dr Florent Thibert, was alsoChairman of the Royal College Com-mittee on Gastroenterology. Becauseevery Program Director was also a ‘Co-rresponding Member’ of the Royal Col-lege Specialty Committee, the annualmeetings of the two committees werecombined. Thus, sometimes it was diffi-cult to discern whether the Chairman’sreport to the CAG was that of theRoyal College Committee or that ofthe Committee of Program Directors.

In 1977 the CAG adopted theRoyal College Committee in Gastro-enterology as the CAG Committee onTraining and Education, and theChairman of the Royal College Com-mittee in Gastroenterology becameex-officio member of the CAG Gov-erning Board. This meant that thesame person reported for the CAGCommittee on Training and Educa-tion, Program Director’s Committeeand simultaneously represented theRoyal College. This led to considerableconfusion, and when Dr Larry DaCostabecame Chairman of the Committee in1986 he proposed that the Chairman ofthe Royal College Committee shouldnot be a member of the CAG. On thebasis of this, the Training and Educa-tion Committee was dissolved and aseparate Chairman was appointed tothe Education Committee and the Pro-gram Director’s Committee. Howeverin spite of, or perhaps because of, theclose interactions of these Committees,the CAG had tremendous input in theorganization and structuring of post-graduate training in gastroenterology.It is not an exaggeration to state thatwithout the CAG, gastroenterologywould not be a subspecialty in Canada.

While the training of gastrointesti-nal residents was a function of theCommittee of the Program Directors

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350 C�� J G�� V�� 6 N� 6 N��/D�� 1992

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and of the Royal College SpecialtyCommittee in Gastroenterology, nei-ther of these committees dealt withcontinuing medical education. In thespring of 1985 a new committee, theEducation Committee, was establishedto deal mainly with continuing medicaleducation and to organize the educa-tional aspects of the annual meeting.Research Committee: The ResearchCommittee was established in 1969

with Dr James Lind as its first chairman(chairmen are listed in Table 15). Re-sponsibilities of this committee in-cluded examining the year-to-yearstatus of gastrointestinal research inCanada and coordinating with fund-raising agencies. Later this committeewas directed to review and adjudicatethe two student research prizes (one es-tablished by the CAG and the other bythe Canadian Foundation for Ileitis and

Colitis [CFIC]), the applications for thetwo Research Fellowships (supportedby Merck Frosst Canada Inc and Jans-sen Pharmaceutica) and, recently, theSummer Student Award (supported bySmithKline Beecham). The committeeis responsible for organization of re-search symposia and research work-shops at the CAG annual meeting.Endoscopy Committee: An EndoscopyCommittee was initiated in May 1973

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C�� J G�� V�� 6 N� 6 N��/D�� 1992 345

History of the CAG

(chairmen are presented in Table 16).The first terms of reference were to rep-resent the CAG in the World Organi-zation of Digestive Endoscopy (Organi-zat ion Mondiale d’EndoscopieDigestive [OMED]). The committeewas reactivated with Dr Ivan Beck as itsChairman in 1974. It was to report onguidelines for the training of gastroin-testinal endoscopists and to suggest cri-teria for minimal facilities necessary forsafe endoscopic practice. This reportwas used as the basis for training re-quirements in gastroenterology and wassent to the Royal College and differentprovincial licensing bodies. It was pub-lished and was made available to hospi-tals for information (4,5). In 1977 thiscommittee was discontinued, but wasre-established in 1979 under the chair-manship of Dr Ronald Wensel. Thenew committee was to review theguidelines laid down by the first com-mittee and, if necessary, set up newones. In its final report Dr Wensel didnot propose any changes from those laiddown by the first committee. In 1985,during the chairmanship of Dr AubreyGroll, a set of proposed informed con-sents was prepared. When the Cana-dian Association of General Surgeons(CAGS) established its own subcom-mittee on endoscopy, the CAG Com-mittee was directed to coordinate itsguidelines with those of the CAGSCommittee. Unfortunately, none ofthe subsequent committee chairmencould achieve this. In her PresidentialAddress, Dr Lemire asked the incomingchairman of this committee, Dr Robert(Bob) Bailey, to attempt to re-examinethis issue with the CAGS to establishjoint criteria for medical and surgicalendoscopy training. This is becomingeven more important at present, be-cause the criteria for training need to berevised in the light of the newly intro-duced therapeutic procedures. Dr LloydSutherland, Chairman of the ProgramDirector’s Committee, has brought be-fore the Board a recent proposal fromthe RCPSC Specialty Committee ongastroenterology for the minimal re-quirements for endoscopic training inthe specialty of gastroenterology.International Liaison Committee:The International Liaison Committee

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350 C�� J G�� V�� 6 N� 6 N��/D�� 1992

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was established in 1973 (chairmen arepresented in Table 17). However, in1962 the CAG became a member of theWorld Organization of Gastroenterol-ogy (Organization Mondiale de Gastro-entérologie [OMGE]) and in 1963, ofthe Asociacion Interamericana de Gas-troenterologia (AIGE). At first the sec-retary of the CAG acted as the ForeignRelations Secretary. With increasinginvolvement in international affairs, a

Committee for International Relationswas established in 1973 to represent theCAG at the AIGE and the OMGEmeetings. Dr William (Bill) Watson, aschairman of this committee from1981-86, submitted two Canadian bidsto hold the World Congress of Gastro-enterology in Toronto. Unfortunatelyboth bids were unsuccessful and theCongress was held in Sao Paolo, Brazilin 1986 and in Sydney, Australia in1990. In 1988 the CAG decided tomake another bid to hold the 1994World Congress in Vancouver. DrAlan Thomson chaired the committeeto organize the bid. He worked indefati-gably and organized a strong WorkingCommittee (Table 18), members ofwhich were invited as visiting profes-sors to several countries and thus trav-elled as ‘ambassadors’ for the Canadianbid during 1989 and 1990. Unfortu-nately this bid was also lost and the1994 Congress will be held in Los An-geles, California. At present the newChairman of the International LiaisonCommittee, Dr Lloyd Sutherland, isnegotiating with representatives of theWorld Congress to establish several sat-ellite meetings in Vancouver.Ethics Committee: The Ethics Com-mittee was established in 1989 with JoeSidorov as chairman (Table 15). Withdiminishing support for research fromgovernment and the increasing cost ofthe educational programs of CAG

meetings, the CAG – similar to othermedical societies – has become depend-ent on support from the pharmaceuticalindustry. To ascertain that this does notlead to ethical conflicts, the CAG es-tablished an Ethics Committee underthe chairmanship of Dr Sidorov to dealwith ethical issues concerning the As-sociation. Included in the terms of ref-erence was the relationship of the CAGwith the pharmaceutical industry (forthe latter, see the deliberations of theIndustry Relations Committee). Onthe suggestion of the Ethics Commit-tee, the 1992 McKenna Memorial Lec-turer, Dr Francisco Vilardell from Bar-celona, Spain will talk on ethical issuesin gastroenterology.

The New ConstitutionDue to the many changes in com-

mittee structure, it was decided that anew constitution was needed and thatthis should be available for the 25th an-niversary of the Association. On thesuggestion of Dr DaCosta, Dr IainCleator was to obtain legal help andsubmit a proposal for the new charter.After several revisions by the Board,the new constitution was incorporatedunder the provisions of Part II of theCorporation’s Act, RSC, 1970, C32, asamended. The document deals withthe new membership rules and estab-lishes the new terms of reference of theofficers and committees. It became the

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C�� J G�� V�� 6 N� 6 N��/D�� 1992 345

History of the CAG

constitution of the Association as of1986 and is available to our member-ship in both official languages.

MEETINGS OF THE CANADIANASSOCIATION OF GASTROEN-

TEROLOGY

Annual Meetings of the Canadian As-sociation of Gastroenterology

The first scientific meeting was heldin conjunction with the Annual Meet-ing of the CMA at the Fort Garry Hotelin Winnipeg, Manitoba, on June 19,

1962. Subsequent meetings up to 1967(except for the one in 1965) continuedto be held together with that of theCMA. In May 1965 the CAG hosted ajoint convention with the AmericanGastroenterological Association inMontreal. As of January 1968, meet-ings of the Association were held inconjunction with those of the RoyalCollege of Physicians and Surgeons ofCanada and the CSCI. Table 19 showsthe location of the meetings from1962-92. The many changes which oc-curred in the structure of the programreflected the changing requirements ofCanadian gastroenterology. At first,mainly individual papers were pre-sented. As of 1963 there was an annuallecture given by an invited guest (Ta-ble 20). In 1968 the name of this lec-ture was changed to the Richard DMcKenna Lecture. As the knowledgebase in gastroenterology expanded,symposia, courses, workshops and spe-cial lectures were added to the programto fulfill the educational and researchobjectives of the Association. Conse-quently, the duration of the meetingshad to be extended to encourage thesubmission of the increasing number ofCanadian scientific achievements.

Combined sessions with the CSCI,to present individual research papersand a symposium of common interest,were started in 1972. Since 1975, jointsymposia were held with the RCPSC,the CSCI, the Canadian Society of En-docrinology, the Canadian Foundationfor Diseases of the Liver (CFDL), theCanadian Association for the Study ofLiver Diseases (CASL) and severalother societies. The first joint sympo-sium with the CAGS was held in 1979.

The concept of a yearly postgradu-ate course to be held during the CAGmeeting was conceived by Larry Da-Costa. The first course, Scientific Basisfor Therapeutic Decisions in Gastroin-testinal Diseases, was organized by DrAlan Thomson and was held in Sep-tember 1984 during Dr Larry DaCosta’spresidency. Since that time this one-day course is held annually. It is di-rected towards the clinical gastroenter-ologists, but as it is held during theRoyal College meeting, many inter-nists and surgeons also attend. Some of

these courses were published in a seriesof books entitled Modern Concepts in

Gastroenterology (6-8). A different typeof postgraduate course was initiated in1992 by Drs Alan Thomson and GaryLevy (it was not held during the An-nual Meeting of the CAG). This inter-esting new event is described in somedetail in the section on regional andspecific meetings.

As of 1985, research workshopswere organized to allow for free ex-change of ideas among investigators.The first one was organized by IvanBeck in 1985 on esophageal motility.The speakers were clinicians, biomedi-cal engineers and gastrointestinal tech-nicians. Subsequently, workshops wereheld in 1988 on the enteric nervoussystem (organized by Drs Steven Col-lins and Ed Daniel) and in 1989 on ani-mal models of intestinal inflammation(organized by Dr Collins). The 1990workshop, put together by Dr Jean Mo-risset, dealt with the use of cell and tis-sue culture techniques ingastrointestinal, pancreatic and hepa-tobiliary research. Drs John Wallaceand Mary Perdue arranged for the 199lworkshop on epithelial permeability.

Poster sessions started in 1985mainly because the symposia, work-shops and the course did not allow timefor the oral presentations of all the ex-cellent papers submitted. Poster ses-sions proved to be a great success,providing excellent opportunities forpersonal interactions among investiga-tors.

The Richard D McKenna Lecturewas introduced in 1968. Dr RichardMcKenna, the founder and first presi-dent of the Association, became ill in1965 and retired from the active prac-tice of gastroenterology. With theunanimous approval of the member-ship, in 1968 Dr Beck was instrumentalin renaming the annual lecture to theyearly Richard D McKenna Lecture.The first Richard D McKenna lecturerwas Dr Henry Bockus, who at that timewas one of the most distinguished gas-troenterologists of the western world.From then on the yearly Richard DMcKenna lecture became the highlightof the annual meetings. The invitedlecturers were internationally known

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350 C�� J G�� V�� 6 N� 6 N��/D�� 1992

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investigators and clinical scientists(Table 20). In 1976, after the death ofDr McKenna, the lecture was renamedthe Richard D McKenna MemorialLecture.

The annual research lecture serieswas proposed in 1981 by Dr GordonForstner. The first lecturer was Dr Ste-phen Robert Bloom from London, Eng-land. Although his lecture was a greatsuccess, it was decided that – in order toacquaint the membership with workcarried out by outstanding Canadian

investigators – subsequent lecturersshould be Canadians (Table 21).

Student research awards were intro-duced in 1977 to stimulate gastrointes-tinal research and to motivatepostgraduate trainees to submit theirpapers to the CAG. Winners of theprize present their papers at the annualmeeting. The CAG and the CFIC eachestablished a prize. The first winner ofthe CAG prize was Dr Arni Sekar(trainee of Dr Grant Thompson, Uni-versity of Ottawa, Ottawa, Ontario)

and of the CFIC prize Ms Jo-Anne Fox(PhD candidate from Queen’s Univer-sity, Kingston, Ontario, a student of DrIvan Beck).

The only social event between 1961and 1971 was a business luncheon, at-tended by all participants. The first an-nual dinner was organized in 1972 byDr John M (Jack) Finlay at the annualmeeting in Toronto. The annual din-ner has become a treasured tradition ofthe Association where old friends meetin a relaxed atmosphere.

The printing and organizing of the

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1981 Stephen Robert Bloom, Reader in Medicine, RoyalPostgraduate School of Medicine, London, England: NewerAspects of Gut Endocrinology

1982 Leslie S Valberg, MD, Professor of Medicine, Universityof Western Ontario, London, Ontario: State of Iron Absorptionand Related Diseases

1983 John Bienenstock, MD, Professor of Medicine and Pa-thology, McMaster University, Hamilton, Ontario: The MucosalImmunologic Network: Its Significance in the Physiology ofthe Intestine

1984 Gordon G Forstner, MD, Professor of Paediatrics andPhysiology, University of Toronto, Toronto, Ontario: Pancre-atic Insufficiency: Some Lessons from Cystic Fibrosis

1985 Joseph S Davison, PhD, Professor of Medical Physiol-ogy, Heritage Medical Scientist, Dept of Medical Physiology,Health Sciences Centre, University of Calgary, Calgary, Al-berta: The Integration of Gastrointestinal Functions by theNervous System

1986 Jean Morisset, PhD, Professor of Biology, Université deSherbrooke, Sherbrooke, Quebec: The Importance of Gas-trointestinal Hormones in the Control of Pancreatic Growthand Their Possible Role in the Management of PancreaticDiseases

1987 John Brown, PhD, Professor, Dept of Physiology, Univer-sity of British Columbia, Vancouver, British Columbia: Gastro-intestinal Regulation of Insulin Release

1988 Edwin E Daniel, PhD, Professor of Physiology and Phar-macology, McMaster University, Hamilton, Ontario: GI Motility

1989 Ivan T Beck, MD, PhD, Professor of Medicine and Physi-ology, Queen’s University, Kingston, Ontario: The Mechanismof the Ethanol-Induced Acute Small Intestinal Injury

1990 Hector Orrego, MD, Professor of Medicine and Phar-macology, University of Toronto, Toronto, Ontario: AlcoholicLiver Disease

199l N Diamant, MD, Professor of Medicine and Physiology,University of Toronto, Toronto, Ontario: The Vagus and Motor-ing in the Gut (Because Dr Diamant could not be at themeeting, this lecture will be given in 1992)

1992 Grant D Gall, MD, Professor of Paediatrics, University ofCalgary, Calgary, Alberta: Adaptation of the Mucosa to In-testinal Injury

C�� J G�� V�� 6 N� 6 N��/D�� 1992 345

History of the CAG

annual program booklet is the duty ofthe chairman of the Local OrganizingCommittee. Once the Associationstarted to meet in conjunction with theRoyal College, the scientific programof the CAG was published in theRCPSC program. Chairmen of the Lo-cal Organizing Committee have oftenreported that there are major problemswith preparing this program, mainlybecause of the need to coordinate itwith that of other societies and the of-ten late release of the final program bythe RCPSC. In spite of these difficul-ties the membership requested that theCAG should continue to print its ownprogram booklet, mainly because aseparate program: maintains the iden-tity of the Association; combines allCAG scientific papers, special lecturesand symposia, whether they are organ-ized by the CAG alone or in conjunc-tion with other societies; provides thedates and locations of the social andbusiness meetings; contains a list of thecurrent officers of the CAG; and hon-ours previous Presidents and McKennaLecturers by printing each year a list ofall Past-Presidents and McKenna Lec-turers.

Regional and specific meetingsThese meetings started in 1969

when the CAG, in conjunction withthe Medical Research Council andQueen’s University, co-sponsored asymposium on the exocrine pancreas

(9). The second symposium was organ-ized by Dr Marcel Lacerte in 1977 atLaval University (Quebec City, Que-bec) on “L’alcool et les maladies del’appareil digestif” (10). As of 1986, af-ter a considerable hiatus, several localand special meetings were sponsored orco-sponsored by the CAG (11-15). Fora list of these see Table 22.

One of the new and exciting eventswhich occurred this year was the firstCAG Consensus Conference organ-ized by Drs Alan Thomson, SuzanneLemire, Joe Connon and Ivan Beck. Itwas held in Ottawa between January 17to 19, 1992. Gastroesophageal refluxdisease was selected as the subject be-cause of the controversies which existregarding its pathophysiology andtreatment. Specific areas of contro-versy were introduced to the 40 care-fully chosen participants by selectedspeakers, and then discussed in smallgroups of seven to 12. The group ses-sions were summarized by the sessionchairman and presented for further dis-cussion to the entire group of partici-pants. Agreement was achieved onmost issues, and the results of the con-ference have been publiched in The

Canadian Journal of Gastroenterology

(16). This conference represents a newbeginning in a process of consensusopinions which will be organized onother subjects.

The second novelty introduced thisyear was a new type of postgraduatecourse which was held separately fromthe annual meeting. It was organized byDrs Alan Thomson and Gary Levy, andwas held at Lake Louise, Alberta fromApril 8 to 12, 1992. The purpose of thiscourse was to arrange for close interac-tions among most gastroenterologytrainees and a wide range of faculty.There were up-to-date workshops andplenary sessions given by faculty. Theexciting parts of the meeting were thedaily sessions where clinical and re-search trainees gave papers on unusualclinical cases or on their recent re-search. To ascertain that all traineescould come, they were invited to sub-mit and to present case reports of un-usual cases or to present their researchwork. Thus, they became faculty andtheir transportation and stay could be

supported by generous donations to theCAG by a long list of pharmaceuticalmanufacturers.

It was a real pleasure to see the qual-ity of submissions and how well theywere prepared. The meetings started at06:30 and finished at 23:00 with the af-ternoons (13:00 to 17:00) free for ski-ing, skating etc. However the mostimportant aspect of the free time wasachieved by trainee-faculty interactionat a social level. This allowed the train-ees of different programs to get to knoweach other and thus have an opportu-nity to discuss their various programs.They also could mix easily with facultyof their and other programs. Thiscourse, more than the annual meetingheld in the umbrage of the large crowdsof the Royal College, allowed for mostparticipants to appreciate the strengthof Canadian gastroenterology and theCAG.

Visiting research professorshipsTo improve the visibility of gastro-

intestinal research in Canada the Re-search Committee under the chair-manship of Dr Gordon G Forstnerproposed the establishment of a Visit-ing Research Professorship. This post isheld by a Canadian researcher who vis-its the majority of Canadian universi-ties. A list of Visiting Professors isgiven in Table 23.

ISSUES OF SPECIFICINTEREST

BilingualismMaintenance of bilingualism was

–and remains – a prime concern of theCAG. The original organizers camefrom both the French and English com-munity. From the beginning, every ef-fort was made to project a bilingualimage. However, the finances of theCAG were never sufficient to have anefficient translating service for alldocuments. From time to time volun-teers (eg, Drs Jacques Gagnon, MarcelLacerte, Florent Thibert, Andre Ar-chambault and Suzanne Lemire) trans-lated documents and programs. From1974 to 1985 the program was printedin both languages. Unfortunately, anongoing accurate translating service

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350 C�� J G�� V�� 6 N� 6 N��/D�� 1992

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into French could not be continuouslymaintained. A major problem for trans-lating the program of the CAG intoFrench was the late release of the finalCAG program by the RCPSC office.Therefore on the recommendation ofDr Claude Roy, since 1985 all majorevents in the program, such as theRichard D McKenna Memorial Lec-ture, the Research Lecture, the titles ofsymposia, and all business and socialevents, are printed in both languages(the titles of papers submitted in Eng-lish or in French are printed in the lan-guage in which they were originallysubmitted). Several attempts weremade to attract members of the QuebecAssociation of Gastroenterology intothe CAG. On the recommendation ofDr Alan Thomson, the 1986 constitu-tion was translated into French, and amajor drive to increase membership,with special emphasis on enrollingmore French members, was undertakenduring the presidency of Dr Claude Royin 1985. This effort continues.

Examination in gastroenterologyThe first examination in gastroen-

terology was held in 1971. Of majorconcern to the program directors wasthe high failure rate. Dr Leslie Valbergreorganized the examinations by hav-ing the examiner observe the candi-dates during the history and physicalexamination. This revealed that themajor reason for the high failure ratewas inadequate preparation of candi-dates in these areas. The standards ofthe examinations and their method ofconducting them have been reviewedby Joe Sidorov (3).

Relation of the Boardand membership

At the time of the establishment ofthe Association in 1962, the initialmembership of the Association was 51;11 of these sat on the Board. One yearlater, with the first past-president onthe Board, this number increased to 12.The initial members and the memberswho joined within the next few yearswere all close friends. The Board al-tered sufficiently rapidly to allow con-stant change from active member tomembership on the Board and vice

versa, leading to close and continuousinteraction between the membershipand the Board.

As the number of the members in-creased, the Board has appeared to be-come increasingly isolated, and theExecutive has made numerous deci-sions which were then presented to themembership, sometimes with very littletime for discussion at the general meet-ing. By 1974 Joe Sidorov, in his Past-President’s Report, emphasized theneed for better communication be-tween the Board and the membership.He stated that it is essential that theBoard be supplied with a list of namesof members who were interested andcapable of organizational work, andthat they should be given the opportu-nity to contribute to the Association.He also proposed that a list of nomina-tions to the Board should be sent im-mediately after the semi-annualmeeting to all members, asking them tosupply additional nominations.

Dr Sidorov considered that the sec-ond problem was the lack of communi-cation between the membership andthe Board. Because of the pressure oftime, the annual business meeting wasrun very efficiently and economically,yet did not represent a clear picture ofwhat was actually accomplished, nordid it give any opportunity for discus-sion and criticism by the general mem-bership. Without knowing the extentand the amount of work accomplishedby various committees and the Gov-erning Board, the general membershipcould not appreciate the degree ofprogress and might feel that not a lotwas happening.

Based on his proposal, the businessmeeting was extended and a majorchange in the membership of the Boardoccurred during the next few years.Many of the posts were filled with indi-viduals in their thirties. Among thesewere Dr Grant Thompson as Council-lor, Dr Marcel Lacerte as Chairman ofthe Finance Committee and Dr LarryDaCosta as Secretary. Involvement ofyoung people in the workings of theAssociation was maintained through-out the years, but the younger people ofthe Board in time became ‘establis-hment’ and the Board again started to

consist of mainly senior academics.The issue was again raised by Dr AlanThom- son during his presidency in1988, and on his suggestion six youngermembers were appointed as ad hoccouncilors to form a link between theBoard and the membership (for detailssee section on Officers of the Associa-tion).

Unfortunately these councilors didnot improve communication mainlybecause, even though they wereyounger, they were not necessarily rep-resentative of the membership at large.Several of our members continued tofeel apart from the decisions made bythe CAG. This was well-expressed in a1990 letter by Sam Lee from Calgary,Alberta, in which he wrote “There is awidespread feeling, justified or not,among many of the rank and file CAGmembers, that the CAG is controlledby an ‘old boys’ club”.

The Board of the CAG took thesecomplaints very seriously. During hispresidency, Dr Eldon Shaffer organizeda meeting in October 1990 to discussthe strategic plan of the Associationand to establish better ways of interac-tion between the Board and member-ship. At this meeting it became clearfrom the discussion that the majorproblem was that the CAG tries to sat-isfy many constituents with varying in-terests. Among these are the practisingclinicians of different disciplines, clini-cal investigators and basic scientists.This mix of membership has a majorimpact on the program as laboratoryscientists are not interested in clinicalpapers, while some of the practising cli-nicians are not attracted to the basicscience sessions.

A decision was made at the strategicplanning meeting to have the begin-ning of the meeting mainly of interestto clinicians and the second part to sat-isfy the clinical investigators and basicscientists. Thus, it was decided that thecourse should always be the first dayand that during the second day thereshould be clinical symposia, clinical pa-pers and posters. In the third and fourthdays of the meeting there should beworkshops, and basic science papersand posters. This plan, however, mayturn out to be very difficult to main-

C�� J G�� V�� 6 N� 6 N��/D�� 1992 345

History of the CAG

tain, mainly because the program willhave to be correlated with that of theCSCI, the CAGS and the CASL.

On the basis of discussions at themeeting, a strategic plan was proposed;this was published in the July l, 1991 is-sue of the Newsletter and presented atthe General Membership Meeting. Ofinterest is that no comments were re-ceived regarding the plan either afterthe circulation of the Newsletter or atthe general meeting of the member-ship. Thus the 1991 Strategic Plan hasnow been accepted by the CAG. ThePlan starts with a Mission Statement,according to which the CAG is to fos-ter optimal gastrointestinal health forCanadians, and continues with its goalsand objectives. (The plan is docu-mented in Table 24). Also, under mis-cellaneous considerations the CAGendorsed the establishment of a Diges-tive Diseases Foundation of Canada(for details of this foundation reviewthe section on Research Support).

Manpower issuesManpower issues played an impor-

tant role during the past 25 years. Inthe 1960s, based on the report of Jus-tice Emmett Hall, it was generally ac-cepted that there was an under-production of physicians in general,and this was also the case for gastroen-terologists. Universities were requestedto increase enrollment of medical stu-dents, and gastroenterology programswere encouraged to enroll a greaternumber of trainees. The situationchanged in 1970 when Dr RamsayGunton, Chairman of the SpecialtyDevelopment and Manpower Commit-tee of the Royal College published hisreview (17). Although Dr Guntonstated that his finding “does not neces-sarily represent Royal College policy oraffirmed data” and that “the establish-ment of physician/population ratio andestimates of requirements based on lo-cal opinion is imprecise”, he concludedthat there was an over-production ofgastroenterologists.

The statistics quoted are interesting,as Dr Gunton suggested that there wasa need of one per 50,000 population forendocrinologists and only one per70,000 for gastroenterologists. A com-

bined Government, Royal College andCMA Committee, the ‘RequirementsCommittee on Physician Manpower,’was established to review Canadianmanpower needs in the specialties. Torespond to this Committee the CAGestablished an ‘Advisory Committeeon Manpower’ under the chairmanshipof Dr Alan Gilbert. The report of thisAdvisory Committee of the CAG wasconsidered by the Requirements Com-mittee to be one of the most illustriousof the approximately 30 working partyreports. In spite of this, the opinion ofthe main committee – there are toomany gastroenterologists – remainedunchanged.

A second review proving the needfor more gastroenterologists was sub-mitted by Dr Larry DaCosta. The majorproblem in predicting future manpowerneeds according to Dr DaCosta’s com-mittee was the difficulty in determin-ing a baseline, ie, who (at the time ofthe survey), was a practising gastroen-terologist. The committee found theCMA data base inaccurate, because itwas compiled without specific prereq-uisites. These prerequisites were estab-lished by the committee and the listprepared by them was compared withthat prepared by the CMA.

The final outcome of this work isshown in Table 25 and, based on re-gional predictions of program directorsand practising gastroenterologists, therequired numbers needed to reach a de-sirable gastroenterology/population ra-tio is shown in Table 26. Based on theexpected retirement age and manyother factors (eg, more part-time physi-cians, changes in physicians’ life expec-tations, increasing age of patients,more complex diagnostic and thera-peutic procedures, and work involvedwith patients before and after livertransplants etc) the CAG committeedemonstrated a much higher need forgastroenterologists than was suggestedby the joint CMA, RCPSC and gov-ernment ‘Requirements Committee onPhysicians Manpower’. Despite theseexcellent submissions, the projectedmanpower requirements for gastroen-terology were reduced, and the supportfor gastroenterology residents has beencut by most provinces.

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1) Research into Digestive Diseases

2) Education

3) High ethical standards in practice

4) Quality health care delivery

5) Communications between members– locally, regionally andat national meetings

6) Increased representation to:

a) governments

b) the Royal College

c) other organizations

7) The profile of C.A.G. and CanadianGastroenterologists

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1) To promote research into normalgastrointestinal function anddigestive diseases

2) To enhance professional education

3) To develop standards on ethicalconduct and for bioethics in GIresearch

4) To promote quality health caredelivery for our patients

5) To improve communicationsbetween members

6) To increase our representation toGovernment – become proactivein establishing fee standards withprovincial governments – monitorthe adequacy of facilities andresources for GI care throughoutCanada – inform government ofdeficiencies or excesses

7) To enhance the profile of C.A.G.and Canadian Gastroenterologists

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8) Establish a Digestive DiseasesFoundation of Canada with aNational Office with an ExecutiveDirector to plan and manage thefinancial affairs of C.A.G. to bettercoordinate all our efforts

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As usual, issues that appeared tohave been settled are constantly beingreopened by government. In 1989 theFederal/Provincial/Territorial Confer-ence of Deputy Ministers of Health(CDMH) decided to seek a review ofthe regional and national approachesto physician resource policy in Canadain order to establish a national, and insome cases regional, strategy of actionfor physician manpower. In 1990, Mor-ris L Barer, PhD, from the Centre forHealth Services and Policy Research ofthe University of British Columbia andGreg L Stoddart, PhD, from the Centreof Health Economics, McMaster Uni-versity, (Hamilton, Ontario) werecommissioned by the CDMH to pre-pare a strategy discussion addressingthe physician resource managementproblems. After minimal consultationwith the profession and none withleaders of the specialties (eg, no con-tact with CAG), in the summer of1991 these health economists submit-ted to the CDMH a report on futurephysician management (18).

Among other statements, the reportrecommended a 10% reduction in theenrollment of students to medicalschools and a simultaneous reductionin residency posts by 10%. This report

was discussed at the Bi-Annual Meet-ing of Subspecialties of the RCPSC. DrSteven Collins was the CAG represen-tative. The RCPSC had a written re-sponse to the Barer Report inDecember 1991 and was scheduled torespond in January 1992. The RCPSCmade a presentation along with fiveother national medical organizations tothe Ministers of Health Conference inBanff, Alberta, on January 27, 1992. Inspite of these presentations the Barer-Stoddart report was accepted by theCDMH and the proposed changes arenow being put into action by the differ-ent provincial governments. Thus,planning for manpower has been nowfully removed from the hands of physi-cians.

Research supportStimulation of basic and clinical re-

search was one of the most assiduouslypursued objectives of the Association.As early as 1963, Dr McKenna was ap-pointed Chairman of a Fund RaisingCommittee. Unfortunately, funds nec-essary to support the legal expensesneeded to establish a charitable organi-zation were not available, and DrMcKenna’s efforts did not succeed.During the reorganization of the Medi-

cal Research Council of Canada(MRC) in 1968, the CAG requestedthat the MRC should establish a gas-troenterology panel. This request wasnot granted, and even today the paneldealing with gastroenterology consistsof a combined group of researchers ingastroenterology, hematology andnephrology with only three gastroen-terologists usually on the panel. Withthe recent appointment of Dr HenryFriesen as President of MRC, ‘the Mis-sion’, organization and peer review pro-cesses of the Council are now being re-viewed and hopefully the CAG maymake successful representation for es-tablishment of an extended Gastroen-terology Committee.

In addition to grants from MRC, re-search in liver diseases has been sup-ported by the CFDL. The CFIC was es-tablished in 1974. It provides operatingfunds for research in intestinal diseases.Furthermore, after stiff competitionamong university gastroenterologyunits, on the basis of a recommenda-tion from an International AdvisoryCommittee, the CFIC established twomajor Intestinal Disease ResearchUnits, one at McMaster University andthe other at the University of Calgary(Calgary, Alberta). The original direc-

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History of the CAG

tor of the McMaster Unit was Dr Rich-ard Hunt and presently the unit is di-rected by Dr Steve Collins, and thedirector of the Calgary unit is Dr GrantGall. These units have greatly contrib-uted to the understanding of the effectof inflammation on intestinal physiol-ogy and pathology.

For training of investigators in thefield of gastroenterology, studentshipsand fellowships are available fromMRC. These are adjudicated by theMRC with no input from the CAG.During the past few years the CAG wassuccessful in obtaining funds for a sum-mer studentship from SmithKlineBeecham, and for research fellowshipsupport from Merck Frosst Canada In-corporated and from Janssen Pharma-ceutica. The recipients for these fellow-ships are judged by the CAG ResearchCommittee on a yearly basis and theawards are given to the applicant basedmainly on the training and backgroundof the candidate.

A very different competition for re-search fellowships was initiated byGlaxo Canada Inc. This competitionwas for ongoing research fellowshipsupport provided to selected universitygastroenterology training programs.The objective and method of adjudica-tion of this three-year fellowship wasbased on the successful achievementsof the two CFIC intestinal diseases re-search units. Thus, the objective of theGlaxo Research Fellowship in Gastro-enterology was to provide trainingwhich would lead to the establishmentof a core of clinician investigators inCanadian university centres. The con-cept of the fellowship was that Fellowswill develop their research skills best inwell-supervised units where there wasclose cooperation between clinical andbasic science training.

It was initiated as a pilot project atQueen’s University in 1985 and afterits apparent success (two of three train-ees entered academic gastroenterol-ogy), in 1988 all Canadian universitycentres were invited to compete. TheCentres were judged by an interna-tional panel. Five units received theseFellowships: University of Alberta(ABR Thomson), University of Cal-gary (EA Shaffer), McMaster Univer-

sity (RH Hunt), University of Toronto(Peter R Durie) and Queen’s Univer-sity (IT Beck). In 1989 a second com-petition was opened and fellowshipsupport was provided to the pediatricunits of St Justin Hospital in Montreal,Quebec (C Roy) and the Departmentof Pediatrics at the University of Cal-gary (GD Gall). These fellowshipshave been of major importance in de-veloping clinical scientists in the fieldof gastroenterology, and have helpedmaintain and develop further thesetraining programs.

Within the past two years, in an at-tempt to establish a comprehensiveCanadian Digestive Diseases Founda-tion, Dr Jean-Francois Loumeau, Di-rector of Medical Communications,Glaxo Canada Inc, approached DrsRichard Hunt, Suzanne Lemire, IvanBeck and Alan Thomson with a pro-posal which indicated that to improvelong term financial support for gastro-enterology, Glaxo Canada was pre-pared to support financially theexpenses, including the legal expensesof, establishing a Digestive DiseasesFoundation of Canada.

The purpose of this Foundation willbe to raise funds for the support of re-search, education and patient care forpeople suffering from diseases of the di-gestive tract. After negotiations withthe CFIC and CFDL, an organizationalchart has been developed which in-cludes input from the above charitableorganizations. The Medical AdvisoryBoard consists principally of the mem-bers of the CAG Board. Thus, 28 yearsafter the first attempt by Dr McKennato establish such a foundation (whichfailed at that time because of lack offunds), the establishment of the Diges-tive Diseases Foundation of Canadahas now been included into the strate-gic plan of the CAG and it appearsfunds will be available for its initiation.

The Journal of the AssociationSince the late 1970s, the CAG

needed to publish Canadian articles ongastroenterology, proceedings of sym-posia held under the aegis of the CAGand abstracts of the Annual Meeting.In 1982 Dr Carl Goresky, the new edi-tor of Clinical and Investigative Medi-

cine (CIM) wrote to our President, DrGordon Forstner, to request that CIMbecome the official journal of theCAG. On the basis of this correspon-dence the Board accepted CIM asCAG’s journal. This agreement en-tailed that the name of CAG shouldappear on the cover of the journal inboth languages and that a member ofthe Governing Board should sit on thejournals Editorial Board. Although DrEldon Shaffer was on the Board ofCIM, the Journal did not carry thename of the CAG, and editorial inputfrom the CAG was minimal.

In 1986 Drs Alan Thomson andNoel Williams indicated that a newjournal The Canadian Journal of Gastro-

enterology (CJG) will be published.They stated that the Editor would beprepared to publish proceedings of sym-posia and abstracts at no cost to the As-sociation. Drs Thomson and Williamswould be Editors-in-Chief with an elitegroup of CAG members serving as As-sociate Editors and a Canadian and in-ternational panel as members of theEditorial Board. They suggested thatthis Journal should be accepted as theofficial journal of the CAG. There wasconsiderable discussion regarding therole of the CAG in this journal, in par-ticular because the publisher’s desirewas to give control of the editorialboard and content to the Association.Unfortunately, because of previouscommitments to CIM, the Board con-cluded it could not accept the CJG asits official journal. However it was de-cided that the CAG should fully sup-port and encourage the new CJG withactive participation on the EditorialBoard and by giving guidance to edito-rial policy. Since its establishment,thanks to the hard work of its Editors(Drs Thomson and Williams) the CJGhas grown and prospered. It publishedmany symposia of the Association(11-15), and recently has achieved list-ing in Current Contents. The issue ofre-examining the possibility of makingthe CJG the official publication of theCAG has been rediscussed in 1991.This year’s president, Dr SuzanneLemire, appointed Dr Des Leddin toform a committee which should review

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and report to the 1992 Board Meetingon this issue.

Canadian Association ofGastroenterology-sponsored textbook

in gastroenterologyDuring the past three years, Drs El-

don Shaffer and Alan Thomson wereinvolved in the editing of a CAG spon-sored textbook of gastroenterology,First Principles of Gastroenterology, The

Basis of Disease and an Approach to Man-

agement (19). Chapters were written byCanadians only and the book is beingtranslated by Dr Andre Archambaultinto French. This text is a majorachievement and a tribute to the edi-tors and members of the CAG.

RELATIONS WITH OTHERNATIONAL AND

INTERNATIONALMEDICAL SOCIETIES

Canadian Medical AssociationThe first meetings of the CAG were

held in conjunction with those of theCMA and close links developed. Oncethe CAG combined its meeting withthe RCPSC, ties with the CMA becameless important. Although the CAGhad representation at the GeneralCouncil of the CMA, this representa-tion was sporadic at best (Table 27)mainly because the CMA Councilrarely discussed issues related to gastro-enterology, and unless the delegate wasfamiliar with the workings of the CMACouncil, his or her participation wouldbe ineffective. The financial cost tosend the same representative over sev-eral years to the CMA meeting, irre-spective of where it was held, wouldhave been too expensive. With im-proved finances, Dr Bruce Yacyshynhas been appointed to attend the 1991and 1992 CMA Council meetings.

Royal College of Physiciansand Surgeons Of Canada

Since the meeting of the CAG wasmoved to coincide with that of theRCPSC, very close relationships devel-oped between the two associations.This became even closer once gastro-enterology was accepted as a subspe-cialty. There are many common goals:

establishment of an excellent AnnualMeeting, training of gastroenterolo-gists, examinations, reviews of pro-grams and many other educational is-sues (20). For details see PostgraduateEducation Committee, Specialty Com-mittee in Gastroenterology, Trainingand Education Committee, Committeeof Program Directors, Education Com-mittee and CAG representative toMaintenance of Competence.

Canadian Society forClinical Investigation

Throughout the years the commoninterest in basic research has led tocombining the first part of the CAGmeeting with that of the CSCI. Sched-uling was not always easy, but the jointabstract form introduced by the RoyalCollege has overcome many of the dif-ficulties.

Other Canadian societies with gastro-enterological interests

For many years the CAG has triedto satisfy the different interests of itsconstituents: basic scientists, endo-scopists, hepatologists, medical gastro-enterologists, pediatricians andsurgeons – this was not always easy.The creation of an endoscopic societywas avoided by establishing an Endo-scopic Committee. An active ResearchCommittee caters to basic scientistsand clinical investigators. The loss ofhepatologists to the CASL in a smallcountry like Canada, with few investi-gators, could have led to a rift in thegastroenterological community. How-ever, the CAG wished the new societywell, provided a small token sum to theestablishment of the CASL and ar-ranged for joint sessions at the AnnualMeeting. Most members of the CASLremained members of the CAG andmany individuals may be sitting simul-taneously on the boards of both socie-ties.

Canadian Associationof General Surgeons

The establishment of the CAGShas led to a loss of surgical papers to theCAG, but combined sessions with theCAGS during the Royal College Meet-ing have overcome some of these prob-

lems. The controversial issues relatingto endoscopy have been discussed inthe section on the Endoscopy Commit-tee.

The Canadian Associationof Gastroenterology

and its international relationsThe CAG became a member of the

OMGE and AIGE as of 1962 and 1963,respectively. Canadian gastroenterolo-gists are well-known abroad, thanks totheir scientific contributions to thefield (21). The Association made sev-eral bids to get the World Congress tocome to Canada, and this has been re-viewed in the section on the Interna-tional Liaison Committee.

CONCLUSIONDuring the past 30 years, the CAG

has made tremendous strides. Scientificdevelopments in the field of gastroen-terology have been immense (2,20).For those who have started this Asso-ciation, it has been a great pleasure toobserve the resilience with which theCAG has made adjustments to theconstantly changing needs generatedby the unrelenting developments of thescience, understanding, teaching andpractice of gastroenterology. Dealingwith most of the situations, the Asso-ciation responded well, but there wereareas where it could have done muchbetter. It is hoped that changes duringthe next 30 years will similarly be excit-

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