Armed Forces Institute of Pathology

Share | Who was the genius who decided to close the AFIP as an "obscure little agency" with no current military relevance?  Nature476, 270-272 (2011)

Announced in 2005 as part of an armed forces budget cut, AFIP will close its doors 15 September. The AFIP budget was only 93 million, yet its value to clinical medicine world wide was and is beyond calculation. AFIP would be nearing its 150th anniversary, founded by General Wm. Hammond in 1862.

AFIP with pathology specimens including: 55 million slides, 31 million paraffin blocks and 500,000 wet specimens and some 800 expert employees with the most advanced equipment for the analysis and identification of submitted tissue; acted as a backup and final arbitrator of difficult medical diagnosis. AFIP received more than 50,000 requests for second opinion each year, making changes or additions to over half of these. The diagnostic capabilities were greater than even the teaching hospitals, and the AFIP was recognised world wide in this regard.

For example as given by Alison Mccook's article in Nature, two high-grade lymphomas can be difficult to distinguish using the usual staining techniques. AFIP, however can distinguish these two using molecular and immunohistochemical techniques that most hospitals lack. The two lymphomas have very different treatments. Treating the wrong diagnosis could result in the patients death. There are many such cases with critical need for a correct diagnosis.

Given that 15% of diagnoses are wrong in the first place and as many as 50% are found inadequate or wrong at autopsy, the loss of AFIP, which provided a low cost backup for us all, amounts to an international tragedy.

Once again, persons given the high level and studied responsibility for making decisions effecting clinical medicine, who do not know anything about medicine create more problems than they solve.

In the course of my clinical years, I sent specimens to AFIP maybe only two times, but each was critical to the patient, and the answer made a difference. What I remember them mostly for, however, was the tray of some 200 microscope slides depicting various pathologies sent on loan for study at little or no cost -- as a student, priceless.