Pathologists Protest Defense Site's Closure

By Christopher Lee
Washington Post Staff Writer
Sunday, February 4, 2007

Medical specialists and former military officials are protesting the planned dismantling of a Defense Department health agency whose origin dates to the Civil War, saying the move would eliminate an invaluable tool in the diagnosis and understanding of disease.

The Armed Forces Institute of Pathology is scheduled to be broken up as part of the federal base-closing process that will shutter Walter Reed Army Medical Center by 2011. The AFIP board of governors will meet today to make final recommendations about how to proceed.

The institute is a descendant of the Army Medical Museum, created in 1862 to be a repository for tissue specimens from injured and diseased Civil War soldiers. With more than 800 employees, the AFIP provides pathology consultation, research and medical education for the military, other federal agencies and the civilian medical community. It has a repository of 95 million tissue samples that helps government scientists track disease and provide second opinions in difficult pathology cases.

"It's sort of like the Supreme Court for pathology," said Gretchen Schaefer, a spokeswoman for the College of American Pathologists.

The institute made headlines last year when a team reconstructed the virus behind the 1918-19 Spanish flu, which killed 50 million people worldwide. The team used material from the AFIP collection -- tiny dried pieces of lung tissue from two soldiers who had died in the pandemic -- as a source of virus fragments, which were then amplified and reassembled into a working virus. The project is helping scientists understand what made the 1918 flu so contagious and so fatal as they seek ways to combat future pandemics.

But agency officials and outside experts say work of that caliber will no longer be possible after the breakup of the institute, with some functions moving to other Defense Department facilities and others discontinued. In particular, they object to plans to outsource to civilian laboratories the 55,000 second-opinion pathology consultations AFIP specialists provide each year, along with some initial-diagnosis work, and to move the tissue repository to another Defense facility in the Washington area. More than 400 support staff members and scientists would lose their jobs, said Prakash Jha, a pathologist at the agency.

The pathologists and other scientists at the institute have unmatched expertise and routinely handle the hardest cases, such as determining whether biopsied bone tissue is cancerous, said Vernon W. Armbrustmacher, the retired Air Force colonel who headed the agency from 1991 to 1995.

"There's a great variety in the way these things present, and to give a reliable answer requires a lot of experience," he said. "I don't think there's a comparable organization that looks at these kinds of problems in that depth."

Moreover, the repository -- which government scientists draw upon in analyzing new samples and add to in the course of their work -- will stagnate "like a library that can't get new books," he said.

Stephen L. Jones, principal deputy assistant secretary of defense for health affairs, said that the agency has done "tremendous work" but that commercial laboratories are capable of doing the civilian pathology consultations. He said the base-closing process and reviews by the institute's governing board have ensured that critical functions will be preserved.

Between the work of the Base Realignment and Closure Commission and the institute's board, Jones said, he thinks "we will not lose any capabilities that are necessary for national security purposes."

Jones said the department is studying ways to ensure that the tissue repository remains useful. "We want to make maximum benefits of any assets that it may have, from a research or an advancement-of-science standpoint," he said.

The agency's advocates, unconvinced, have urged the Defense Department to consider transferring the pathology services and other functions to the Uniformed Services University of the Health Sciences in Bethesda, a move that would keep the scientific expertise in-house and ensure continued growth of the tissue repository. That idea has been backed by 30 groups, including the American Medical Association, the American Society for Clinical Pathology and the National Association of Medical Examiners, and by at least seven Democratic lawmakers, including Sen. Edward M. Kennedy (Mass.) and Rep. Chris Van Hollen (Md.).

BearingPoint, hired by the Defense Department as a consultant, also recommended that course in a report last year, concluding that retaining the pathology functions would help with homeland security missions such as rapidly responding to bioterrorism. That option would cost $18.2 million, however, compared with about $5 million for outsourcing the work, according to BearingPoint.

Staff writer David Brown contributed to this report.

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