Are you feeling ablated?

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Perhaps it is part of the aging process, or it could be a reaction today’s environment, but it seems as though many of our colleagues in medicine today are suffering from burnout. Encounters at symposia and committee meetings seem rapidly to focus upon how ‘things are not what they used to be’ and fond remembrances of how much fun work was when ISHAGEwas but a glimmer in someone’s brain. Is this truly the case? Or is it that time lends a rosy glow to those long evenings waiting for centrifuges to stop, or the infusions where one bag after another ruptured during thawing? Sitting here in North America it is different to assess whether the malaise is international, or has been fostered by the tremendous upheaval of recent years in the American healthcare system. Certainly, similar symptoms can be seen in transplant physicians in this part of the world, who seems to have to spend more and more of their time immersed in bureaucracy, rather than direct patient care. Perhaps some of that stress has rubbed off on the ‘graft engineers’, who now also have their own mountains of paper to conquer and a bottom-line to meet. Or may be it is that this first generation of investigators and practitioners has lost its first blush of youth and sees the world through a more jaundiced eye. It may even be something as simple as the desire to improve quality of life. This is a profession that frequently requires long and unusual hours, sometimes at short notice. There has been relatively little automation of routine and widely-used but slow processes, such as cell washing, and we have seen protocols become increasingly lengthly by the addition of multiple sequential cell manipulations, or prolonged culture of cells. When added to the burden of documentation, quality assessment–quality control, training programs, continuing education requirements, pressure to publish and garner funding, we may indeed awake some mornings and ask ‘‘Why am I doing this?’’ It is, however, interesting to note how many have stayed in the field, in spite of their continuing wistful talk of ‘‘opening a bed and breakfast place in Tahiti’’. Why is this? Sometimes that answer can be found when we talk of what we do to others. There is often widening of the eyes and comments are made such as ‘‘that must be so rewarding’’, and ‘‘what interesting work—it must be so exciting!’’ That does help to realign reality and restore perspective. We have had good fortune to live in a quite extraordinary time of scientific and medical achievement, and to participate in the birth and maturation of an entirely new field. When ISHAGE was founded there truly was a pioneering spirit in those who gathered to discuss the merits of manipulation of cells for therapy. Those who were at that time regarded as true visionaries (or as slightly demented, depending on one’s degree of cynicism) speculated on transplantation and genetic modification of stem cells— concepts that were widely considered to be possible only many years into the second millennium. Reality, age, patent laws, paperwork, politics, greed, litigation and overblown claims may have taken some of the bloom off the rose, but it is quite extraordinary how much has been achieved in such a short time. Not only did many of those speculations become reality well within a decade, but we now see the field developing in directions that few could have imagined. Cellular therapies are assuming an important place in the therapeutic arsenal for many diseases, the search for stem cells have been ratcheted back several notchs with the goal of growing cells to repopulate almost every organ or tissue. Gene therapy has moved from the correction of congenital abnormalities to a range of new applications in many diseases. Immunotherapy has undergone a resurgence, based upon data primarily generated through HPC transplantation, and promises even greater hope for the future. How have all these changes in both science and attitude been reflected in its fledgling professional society ISHAGE? There is a Chinese proverb that offers a double-edged accolade, ‘‘may you live in interesting times’’. There could be no more fitting motto for both graft engineering and ISHAGE. We have indeed lived in ‘‘interesting Cytotherapy (1999) Vol. 1, No. 4, 269–270