In a special episode of the “Allergy, Asthma & Immunology Innovations” podcast, co-hosts Kortney Kwong Hing and Payel Gupta, MD interview board-certified allergist Gailen Marshall, MD, FACAAI. Dr. Marshall is the 2024 President of the American College of Allergy, Asthma & Immunology (ACAAI).
This episode is produced in partnership with ACAAI.
Dr. Marshall discusses what ACAAI does and why it matters to patients. He discusses his work in psychoneuroimmunology, which sheds light on how both external and internal environments impact allergic reactions. Dr. Marshall addresses his presidential initiative CAAPER, which bridges the gap between community and academic allergists. And he discusses ACAAI’s resources, which empower patients to take control of their treatment journey.
You can listen to or download the podcast on ItchPodcast.com anytime, anywhere. The podcast can also be downloaded at:
Full Transcript of ACAAI President Gailen Marshall, MD Interview
Kortney: Do you ever wonder what the organizations that allergists are involved in actually do, and whether they’re beneficial for patients? Like, should you care if your doctor is a member of them? Well, today we interview the president of the American College of Allergy, Asthma, and Immunology, Dr. Gailen Marshall, who explains to us what the college does, why it’s beneficial for patients, and his future plans as president. You’re listening to The Itch. A podcast exploring all things allergy, asthma, and immunology.
Dr. Gupta: Hi, Dr. Marshall. Thank you so much for joining us today. Dr. Marshall is the current president of the American College of Allergy, Asthma & Immunology. And today we’re going to get to know him better and get to know a little bit more about what the American College of Allergy, Asthma & Immunology does and how they are supporting patients through all of their work.
So Dr. Gailen, could you tell us a little bit about your career and everything that you’ve done?
Dr. Marshall: It’s a pleasure to be here with you all today. And thank you very much for the kind invitation. I’m a native Texan who moved to Mississippi about 20 years ago. And I’ve been here ever since with my wife and two dogs.
I grew up actually wanting to be a researcher from the time I was in junior high school. My research interest is very relevant. All of us as clinicians know that when a patient walks in the room, if he or she is anxious or depressed or under a lot of stress, they’re going to have more trouble than if they’re not.
And it turns out within that field, there is a field of study that I have been engaged in since the early 1990s called psychoneuroimmunology. It’s how the mind affects the immune system and identifying the neuroendocrine pathways. We’ve been engaged in that for some time and are currently really engaged in it as a risk factor for long COVID and the immune problems that are associated with long COVID that can be ameliorated, if not cured, by a change in mindset.
An individual that can learn to relax – we do things like yoga, tai chi, meditation, relaxation, intentional prayer. There’s a whole list of these things that are done. We have several psychologists that we work with who are very interested in this. And it’s very robust how it works. It identifies risk factors, not only for disease activity in what we do in allergist and immunologist’s offices, but actually for the disease itself.
Individuals who live in very highly stressed environments, we’ve talked for years – and I know you know this, Dr. Gupta – about the external environmental impact on allergy. Well, this is the internal environmental impact on allergy. And they work negatively together, but we’re learning that they can work positively together.
And we have been fortunately well-funded by the NIH to be able to investigate some of these things. And we’re not far away from launching actual clinical trials to see that this makes a difference in outcomes of individuals.
The two models we’ve looked at, interestingly enough, are chronic urticaria or hives, because everybody knows if you wake up in an ant bed, you’re going to be stressed out. And then the other one is asthma. Those are the two that we’ve been looking at. So that’s a long answer to a fairly straightforward question.
Dr. Gupta: Thank you so much, Dr. Marshall. A couple of things. Number one, I love the research that you’re doing because this is the mind-body connection that is just so important that we know for so many conditions. And actually, urticaria and asthma are the two conditions that I talk about this probably the most.
And so we want to ask you, what does the American College of Allergy, Asthma & Immunology do?
Dr. Marshall: So the American College of Allergy, Asthma & Immunology started life as the American College of Allergy back during World War II in 1942. And as a group of people that got together – what might be of interest is to know that the term allergy is actually a fairly recent term in medicine. There were two, what we would now call clinician scientists who worked together in New York, Clemens von Pirquet and Bela Schick, and they together coined the term allergy. And the field was born out of that, even though, if you read in medical history, hay fever didn’t start in the 20th century.
It wasn’t as well recognized. Asthma has been around. Hippocrates describes diseases that were clearly asthma. They weren’t called that. So, the field is fairly young. As the field began to move forward in 1942, a group of clinicians got together and formed an organization to exchange information, a collegial organization. This is what works for my patient. This is what doesn’t work. Medicine in those days – medical research, certainly clinical research – was very sort of hit and miss here and there, done informally, not anything like what we do now. But the American College of Allergy, as it was called, the College, which is how we refer to it – so the College existed and then over the years expanded its name as various areas emerged, for example, clinical immunology.
We learned that there were children that were born that would die in infancy of overwhelming infection. And in the very limited way we understood the immune system in those days, we knew that they had things that went wrong with it. And now that whole field itself – it is its own area of independent research and practice.
And then we begin to learn as things moved into the latter half of the 20th century, that asthma – which had always been considered to essentially be a bronchospastic disease – I’m having an asthma attack, which means that I’m having bronchospasm, so give me something to relax the muscle, and then my asthma will go away.We began to understand, number one, that didn’t always happen. And we began to understand it was because of inflammation in the lungs of these individuals. And indeed the emphasis changed from taking care of the episode to treating the underlying cause with the idea of minimizing or preventing the episode.
So we began to understand the immunology part, or the inflammation part of asthma, and allergists and immunologists sort of, I won’t say they took it over, but we certainly became primary providers for patients who have asthma.
So the name then expanded again and became the American College of Allergy, Asthma & Immunology, which it is today.
And the important thing about it that I think distinguishes the College is that we’re very much into the mindset of advocating for the patient. I mentioned Bela Schick earlier. Bela Schick is sort of like the patron saint of the College if you will, and it’s because Schick famously said the quote about patient care and research.
First the patient, second the patient, third the patient, fourth the patient, fifth the patient. And then maybe science. Now for me, I’ve taken the word maybe out of that. And I think that most of us would as well. And indeed, the average community clinician is far more scientific today than his or her predecessor from just 20 years ago.
I can’t even imagine the time when Schick was in practice back in the early part of the 20th century. So the College is a combination of individuals, there’s over 6, 000 members that are providers, both physicians and mid-level providers, as well as allied health and interested scientists that have a common bond of finding information that can be as directly useful to the patient as possible.
Kortney: I love that it’s patient, patient, patient, patient, patient. But I don’t think a lot of patients actually know about the College. And I know that there’s the website, but how does the College work with patients? Do you do patient outreach, or how do patients find out about you guys?
Dr. Marshall: So they have a variety of different mechanisms. They have webinars, and the webinars are put online. We have a communications office. And they go through patient advocacies, there are several advocacy groups that are related to food allergy, that are related to asthma, that are related to atopic dermatitis. So we work through those. The key thing, and I think most patients with any kind of chronic illness understand, is that you can find anything on the internet you want, anything.
That’s the downside of the internet. But the upside is you can find all the appropriate information if you can get it from places that you can trust. And what you want are places that have been vetted in such a way that there are individuals with expertise and with a no, shall we say sinister motive underneath of why they would transmit that information to you.
Point being, they’re not trying to sell you anything. And the College website is not trying to sell patients anything. They’re trying to provide information to make their patients more informed, which is good not only for the patient, but it’s good for our members who are trying to communicate with the patient in a way to optimize their care.
And the people that seem to do the best in the College are people that take a great deal of joy and satisfaction from taking some of these high ethereal terms and making them more plain and clear to people. There’s a big difference in trying to explain and be clear and being condescending or talking over somebody’s head.
Kortney: As a patient who likes to comb the internet for everything possible about what I’ve been diagnosed with, so if I want to find out the latest research for when I go to my next doctor’s appointment, I can say, this is what I want. This is what’s new and shiny and exactly what my body needs. Is it the College website that I would go to first?
Dr. Marshall: Even though we’re a professional organization, we’re very patient oriented. We work and take very seriously feedback from patients and the public about the user friendliness of our website. So people can do exactly what you just said. They can go onto the website and there’s a search function. You can type in asthma and it will pop up the resources that would be of use to you as a patient because we have a separate patient and member site.
And a lot of people say, ‘Oh, well, you don’t want us to see it.’ No, it’s not that. But certainly we talk at a different level to providers who have. educational and clinical expertise. Their background is different from that of the patient. We’re not hiding anything. We’re not saying two different messages, but we’re giving the messages to two different audiences.
And then we look for ways where there can be an interface of that. And that’s another characteristic of our website in that context. How can patients be involved with the American College of Allergy, Asthma & Immunology if they want to? So if a patient really wants to be involved with the college, It’s a pretty straightforward way to do it.
They can go into the webpage, ACAAI.org. There’s a patient site there, and there are opportunities for patients to provide feedback. There are opportunities to participate in questionnaires that would be asked, and there are opportunities for them to participate in webinars and interact. Webinars are very important to us because we get feedback from the patient perspective which influences not only our education plan, but it also influences how we take care of patients.
Kortney: As a patient, it’s actually really important, if you have the time, and I like to do this as well, is to participate because you’re not allowed to complain about healthcare if it’s bothering you if you don’t actually find a way to, you know, make a difference. And I feel like we have the opportunity to lend our voice as patients, and sometimes people don’t know where that is, but this is a great resource, and thank you so much for sharing that.
Dr. Gupta: Can you tell us a little bit about the “Find a Doctor” tool on the American College of Allergy, Asthma & Immunology website? Because I think that that’s one of the most important resources that the college provides to patients.
Dr. Marshall: It’s a logical question to ask, why an allergist? Why not a different kind of doctor to take care of my nasal problems, to take care of my asthma, to take care of my allergic skin disease? Well, an allergist is specially trained.All of us have gone through primary training after medical school in either internal medicine or pediatrics, and some do both. And then we spend 2-3 years in fellowship training to learn about the specific diseases that are affected, how to best recognize them, how to best take care of them.And we all have on our radar screen someday, how to ultimately participate in their cure. It’s not going to come next year, but it’s coming. And we as subspecialists do that better than other physicians who may be more skilled in other areas of medicine. So then the question is, ‘Okay, I’m a patient or I’m a patient family member, and I want to find an allergist, but I live in a community that I don’t know where the nearest one is.’Or I live in a metropolitan area, there’s probably a hundred of them around here. How do I pick an allergist and immunologist for me?
There is a “Find an allergist” focus that’s on the homepage of the College website. And basically it asks you your zip code, the radius you’re willing to travel. And then if you live somewhere in a rural area far away, you can expand it.One of the things that is happening is that more and more allergists are doing telehealth. So you may be able to find, ‘Okay, I live a hundred miles away from the nearest allergist, but she does telehealth and is willing to make a new patient appointment with me.’
Kortney: So you’re the new president, and is there anything that you have planned for the future of the College? Is there any dream that you have when you retire one day and you said, ‘I did this.’ What is that you want to accomplish?
Dr. Marshall: I understand your question, Kortney, but I’d like to modify the answer a little bit. What I would like to do is when I finally hang it up, I can say ‘We did this.’ So I thought about, well, ‘What can I do that would help the idea of community based research move forward?’
You think about now, we’re going from the olden days where everything was on a paper chart. If you wanted to do chart reviews, they used to have chart rooms in the hospital. They were rooms just stacks and stacks and stacks and stacks. And if you wanted to do chart reviews, you had to Drag them down and spend hours and hours and things you can now do in seconds to minutes.The problem is the following. Our community-based practice system is still very hybrid. There are still those, particularly people my age, who still have paper charts. They’re not changing out of necessity. There are people in Dr. Gupta’s category that are probably fully electronic. But even with that, their system doesn’t necessarily talk to my system, which doesn’t even necessarily talk to another university system.So what we have developed this year, my presidential initiative that we’re working to implement, is called the Community and Academic Allergist Partnership in Education and Research, CAAPER for short. And in the midst of this is developing a mechanism to identify important questions.
I’ll give you a classic example. Here’s a new area that everybody’s all excited about in allergy and immunology-based specialties now are the so-called biologics. And these are a category of medicines that are mechanism-based. They target a specific mechanism and they look for a response from the individual from that. Do they get better? Do they not get better? There’s more than one of these that go after more or less the same thing.
One of the questions is which one is better, but within any given practice, there’s a limited thing because we know there are other things besides just the biologic that may influence how they respond. The bigger the database that you can get, the more you can address that.Those are the kind of research projects that we want to see, that are community-based, that will require a partnership, but you need to do this in the recognition of the partnership. Here in the university, I have access to all kinds of resources that are oriented toward research, because that’s a major part of what we do in clinical practice.
Unless the individual provider has made his or her own decision, that’s not what they do. What they do is that they see and take care of patients, but they gather information because an academic person has a grant from the National Institutes of Health that supports part of her salary, or maybe even all of her salary. She has expertise, and what to do with this data is there. And we form this partnership with the community docs and the academic docs to get them together to ask and answer pragmatic, clinical, patient-oriented questions. That’s what CAAPER is all about, and we’re really excited about getting that off the ground.And there’s a lot of excitement about the importance of doing this, and if I live long enough, and I hope and pray that I will, it’s to see that that project will take a life of its own. They won’t remember what year it was developed. They’ll remember how it works five years from now, 10 years from now, and the impact it can have on patient care. That will be the satisfying part for me, not the part that it’s got my name associated with it.
Dr. Gupta: It’s really exciting for me to hear as a patient that there is all of this research going on where you’re taking what’s actually happening in the clinic and doing research on that because I think that as patients we feel like everything is done in a vacuum. And so sometimes you don’t feel like your real-life experience is also taken into account when research is being done, and it sounds like with the CAAPER initiative, that’s going to change. That sounds awesome, and I’m excited to see the rollout and hopefully participate myself.Dr. Marshall: Great, I was hoping you’d say that part. And the key of this is that we want to make this as user friendly as possible.
Dr. Gupta: I’ve really enjoyed being a part of the College as a physician. I feel like I learned so much from mentors in the space that have been in the field and know the history of how patients have experienced different diseases and, you know, what the treatments were.I just love the research that’s being done. All of the knowledge that we get from the meeting, from the resources that are online. It’s just a very supportive organization and I think that there’s just a lot of resources for patients. and physicians alike, so I really appreciate it and congratulations on being the president and thank you for all the work that you’re doing because I know it’s a lot of hard work.
Dr. Marshall: Thank you very much, Dr. Gupta. It’s a real pleasure to be with you all today.
Dr. Gupta: Thank you for listening to today’s episode. Remember that all information you hear today is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and or medical treatment of a qualified physician or healthcare provider. And also, don’t forget to subscribe to our podcast, and if you have a second, help spread the word by rating our podcast and sharing with your friends and family, who might also be interested in learning more about allergies, asthma, and immunology.You can always stay up to date by checking out our Instagram. The itch podcast, where you can leave questions you are itching to know, or check out our website, which is www.itchpodcast.com, which contains more information about the subjects we covered in today’s episode and every episode. Until next time, have a fabulous week.
810304 Eaton Place, Suite 100