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Annual meeting keynote address: Animal agriculture and emerging social ethics for animals.

Businesses and professions must stay in accord with social ethics, or risk losing their autonomy. A major social ethical issue that has emerged in the past three decades is the treatment of animals in various areas of human use. This point can be illustrated with numerous examples across all areas of animal use. These examples reflect society's moral concern having outgrown the traditional ethic of animal cruelty that began in biblical times and is encoded in the laws of all civilized societies. There are five major reasons for this new social concern, most importantly, the replacement of husbandry-based agriculture with industrial agriculture. This loss of husbandry to industry has threatened the traditional fair contract between humans and animals, and resulted in significant amounts of animal suffering arising on four different fronts. Because such suffering is not occasioned by cruelty, a new ethic for animals was required to express social concerns. Since ethics proceed from preexisting ethics rather than ex nihilo, society has looked to its ethic for humans, appropriately modified, to find moral categories applicable to animals. This concept of legally encoded rights for animals has emerged as a plausible vehicle for reform. The meaning of this ethical movement for animal agriculture is examined. Animal agriculture should explore ways to replace the animal husbandry lost to industrialization.

Animal Husbandry↗

In times of change learners inherit the earth. The 1997 presidential address.

Neurosurgery, as traditionally practiced, is changing. Eric Hoffer observed, "In times of change learners inherit the earth; while the learned find themselves beautifully equipped to deal with a world that no longer exists." Historically, learners have possessed certain attributes. They anticipate rather than react to change. They become essential facilitators within their altered environment. They are effective advocates for principled behavior and ethical practices. They skillfully communicate the new and technically arcane with a common touch. Learners also understand the lessons of history. The potential of process technology, illustrated by Morton's 1846 application of already well-understood science, in essence, to transform the profession of surgery by making painless operations possible, is one example. Voluntary professional associations such as organized neurosurgery can also learn from the contrasting experiences of the Donner Party and the Utah Pioneers as they made their way down the same canyon of the Wasatch mountain range during the summers of 1846 and 1847, respectively. Group dynamics during those two episodes differed strikingly. It was the vanguard party of Utah Pioneers who exemplified the characters of learners. They acted with unity, common purpose, and careful preparation designed to benefit those who followed them. Years from now, how will the current individual and institutional behavior of neurosurgeons and their associations be judged? An interval assessment is suggested at the April, 2012 American Association of Neurological Surgeons Annual Scientific Meeting. From that perspective, will it be determined that the neurosurgical discipline acted presciently, as would those Hoffer describes as learners? Will neurosurgery be said to have understood and thereby profited from the lessons of history? These are pertinent questions. The answers, considered as a proposed progress report 15 short years from now, could accurately predict the scientific and professional position that neurological surgery will occupy in the future. Deserved long-term success based on the effective, far-sighted behavior exhibited by learners is my confident expectation.

Communication↗

A neurosurgical way of life. The 1998 presidential address.

The author provides a review of the relationship between Harvey Cushing and William Osler. Dr. Osler's influence on Cushing's role as a leader in neurosurgery is examined. Some basic principles of a neurosurgical "Way of Life" are reviewed.

History, 19th Century↗

Fast forwarding: the evolution of neurosurgery. The 2005 presidential address.

Despite the major social and economic reorganization of medical practice that has taken place during the past 40 years, neurosurgery-the most fascinating specialty in all of clinical medicine-has grown and prospered. Today, this specialty is poised for an era of spectacular advancement and improvement in care; however, significant problems with the potential to retard this growth face neurosurgery. Among these problems is the medical liability situation, which has the potential to destabilize neurosurgical practices and the current health care delivery system. Other issues facing neurosurgery include the potential for loss of the unique nature of the specialty through a conversion to shift-worker surgeons and increasing reliance on profit-seeking institutions for financial stability and liability protection. Lifestyle choices are of growing importance and currently discourage women from entering the field. With a growing knowledge base, there is the recognition that it may not be possible for most individuals to master all aspects of the specialty. There is continued confusion about manpower needs. In addition, some neurosurgeons are choosing to practice in ways that fail to meet the neurosurgeon's obligations to society. There is a growing number of neurosurgeons who dislike providing trauma coverage and there is the potential for some neurosurgeons to give up intracranial neurosurgery. The author believes that it is not competition that will improve the delivery of neurosurgical care and allow for continued growth, but cooperation, and that it will be possible to alleviate many of our problems through increased regionalization of neurosurgical care delivery. This proposal has the potential to promote the formation of neurosurgical teams, ameliorate the problem of physician fatigue, allow greater development of subspecialty skills, and ease the burden of trauma call. It should allow satisfactory solutions to lifestyle considerations and encourage more women to enter the field of neurosurgery. Such a transformation would encourage advances in care to be brought rapidly into the clinical setting and allow neurosurgery to be practiced at the very highest level.

Curriculum↗