Incoming ACAAI president plans to prioritize community-academic collaboration

Key takeaways:

• Gailen D. Marshall Jr., MD, PhD, FACP, FACAAI, has decades of academic and clinical experience.
• The organization will continue to support clinics with their practice management struggles.

For the past 40 years, Gailen D. Marshall Jr., MD, PhD, FACP, FACAAI, has lived a hybrid kind of life bridging academia and clinical practice.

“I get to go literally from the laboratory to the bedside and back again,” Marshall told Healio. “It’s been the best of both worlds.”

Marshall will rely on this experience as he takes the reins as president of the American College of Allergy, Asthma & Immunology during its 2023 Annual Scientific Meeting, Nov. 9-13, in Anaheim, California.

“The main emphasis of my presidency will be to foster and promote the partnership between practicing community allergists and academic allergist-immunologists,” Marshall said.

A career in service

Marshall’s road to his multiple current positions at University of Mississippi Medical Center, including the R. Faser Triplett Sr MD Chair of Allergy and Immunology and executive director of the Mississippi Clinical Research and Trials Center, began with a passion for science during his youth.

“From the time I was a kid, I always wanted to be a researcher,” Marshall said.

After college, Marshall went to graduate school to obtain a master’s degree and doctorate in immunology. Trusted advisors and other colleagues then encouraged him to go to medical school, because that would ultimately make his research more relevant to patients.

“I was actually a basic scientist who went to medical school,” he said.

Marshall initially believed that once he got his doctor of medicine degree, he would go back to the laboratory full time.

“But, in fact, I fell in love with clinical medicine in my first year of medical school,” he said.

Marshall then became an allergist because of his research background in immunology and his interest in regulating the immune system of patients.

“At the time I trained, the two big areas in medicine that involved immune regulations were vaccines and allergy shots,” Marshall said. “It was on the basis of understanding how allergy shots worked and how they helped patients that I decided to become an allergist-immunologist.”

For decades, Marshall has been balancing his duties in the laboratory and in the clinic.

“Although I have always been very interested in maintaining a clinical practice in order to help patients take care of their illnesses,” he said, “it was a compelling desire to understand the causes and mechanisms of these illnesses and investigate new potential treatments that made it clear to me that my career would be in academic allergy/immunology as both a clinician investigator and a practicing allergist-immunologist, not just as someone who was at the bench all the time,” he said.

Marshall has been involved with ACAAI for years as well, he explained, serving as editor in chief of Annals of Allergy, Asthma & Immunology from 2006 to 2021.

“Now, since I have retired as editor, the good part is that I don’t have to look at manuscripts every single day,” he said. “The bad part is that I don’t get to look at manuscripts every single day.”

Marshall called this period an exciting time, adding that he also was a member of the ACAAI’s Board of Regents and was vice president and president elect in addition to serving in various other roles.

Today’s challenges

The incidences of allergic and nonallergic mast cell diseases in our society are increasing, Marshall said.

“When I was in training 30-plus years ago, to see an adult with food allergy was distinctly unusual,” he said. “Now we see them all the time, virtually every day in clinic.”

Marshall noted multiple theories for these increases, including changes in diet and the environment, particularly differences in intensity and duration of psychological stress.

“Studies including some that our research group has done have demonstrated that the risk for allergic disease does indeed increase in highly stressed individuals,” he said. “ In our modern world, we all live with a higher intensity and duration of stress. Children are living in a much more stressed world than we did when we were kids.”

The technology that is available for treating allergic diseases has exploded, Marshall said. But while more therapeutic options are available, he continued, they are putting stress on the payers that must support them. Additionally, the long-term benefits of these therapies remain to be seen, simply because they are so new, he continued.

“We don’t know that any of these things work well long-term simply because they haven’t been around long enough to know with certainty,” he said.

Marshall added that it costs a lot more to take care of an allergic patient now compared with 20 years ago, even after adjusting for inflation.

“Is the benefit to the patient now clearly better? Is their quality of life better? Is their longevity better? Is their disease controlled better?” he asked. “There are many papers that say yes, but there are other papers that say no. Only time will tell for sure.”

Marshall called this ambiguity a problem because stakeholders may sometimes be making decisions based more on the money involved rather than the ultimate benefit of the patient.

“The College has been taking a leadership role in making sure that the treatments, policies and legislation we endorse and support are best clinical practices with an eye toward the cost and the benefit,” Marshall said.

Allergy and asthma clinics also are tackling many of the same problems that other specialties are facing, he continued.

“We’re in the same boat that all of medicine is in right now,” he said.

These issues include decreasing reimbursements, increasing nonclinical regulations and responsibilities, and increasing requirements for prior authorization to do things that are clearly indicated medically.

“All of these things can detract from not only the joy but the efficiency of our patient care, whether the clinician is in community practice or an academic,” Marshall said.

These situations impact academic practices as well, Marshall said, including those that treat underserved and underinsured populations.

“The old idea that academic practices weren’t ’real world’ because all we took care of were poor people that didn’t have any money and you just did it anyway is not true today,” he said. “The academic practicing clinician has to work every bit as hard for his or her income as the community practice. So, it is mutually beneficial for community and academic allergists to learn from and support one another.”

These common challenges will drive Marshall’s prioritization of collaboration between community and academic clinicians in research, practice management and other areas to better serve patients and professionals alike during his presidency, he said.

“My priority as president is to demonstrate that we as allergist-immunologists need to be as unified a community as we can regardless of what our practice situation is,” Marshall said.

Facilitating collaboration

Earlier this year, ACAAI president Kathleen May, MD, launched a partnership between community and academic allergists focused on education that Marshall intends to continue.

“We’re going to continue it specifically related to scholarship and research with the idea of defining why a community allergist-immunologist would care about participating research projects in the community and facilitating the partnerships for them to successfully participate,” Marshall said.

“Similarly, why would an academic allergist-immunologist want to be engaged in research that’s in a community practice setting?” he added. “The answer is because there’s potential for a quicker applicability of the results of that type of research to the direct benefit of patients, regardless of the practice background of their provider.”

Patients of academic allergists and of community allergists are the same people, Marshall said.

“They suffer with the same diseases. They have the same need for therapy,” he said. “Developing and fostering the partnership between practicing community and academic allergist-immunologists is going to be the main emphasis of my presidency.”

For example, the ACAAI Foundation Community Grant Program funds innovative projects that address barriers to asthma and allergy care, particularly among underserved populations. Awards range up to $10,000 for planning and exploration to up to $25,000 for implementation.

“During my presidency, we plan to expand on that. We want to provide a way that the community allergist who wants to do research could do it in partnership with established academic investigators and provide collaborations for academic clinical investigators to work with community clinicians,” Marshall said.

“The goal is to see how we can best partner together with the idea of producing information that will have a more rapid, direct benefit to our patients,” he said.

Marshall is grateful for the opportunity to lead these programs too.

“I am absolutely honored and humbled to be able to be the president of this great organization for a year,” he said.

“It is not something to which I aspired, but it’s something that I embrace with gratitude and commitment to do the very best for the membership, so that we can all benefit our patients to the best degree that we possibly can,” he said.