Remarks from Dr. Michael Strauss upon receiving the 2023 UHMS Behnke Award

June 18, 2023, San Diego, California

It is indeed a great honor to receive the premier award of the Undersea and Hyperbaric Medical Society. Dr. Behnke, although retired at the time, was a willing audience for my novel ideas about diving medicine upon my entry into the Navy 56-years ago. His inspiration motivated me to continue a 46-year affiliation with the Navy and evolve these ideas into papers and diving texts. Not only that, as a personal friend he let me use his sword to complete my military uniform for my wedding ceremony 49-years ago. Consequently, receiving this award has special significance for me and motivated me to put in writing the 3-topics I addressed in my acceptance responses.

As a customary starting point, I must give thanks to those who made this award possible: First, to Dr. Paul Cianci who nominated me for this honor and those who supported the nomination, Second, to my mentor Dr. George Hart who deserves praise beyond adequate expression for persuading me to join him in Long Beach, mentor me to become the most knowledgeable orthopaedist in hyperbaric medicine, to fully support my Navy and diving activities, and to serve as a business partner for our clinical activities. In this day and age, it is incredible to believe that we had a business arrangement based on mutual trust and devoid of any writing agreements–or even handshakes. Third, I am deeply indebted to the Navy, for the learning opportunities, training, diving, orthopaedic, and world-wide travel and friendship activities it afforded me. Fourth, I am thankful to the UHMS honoring me with this award, but even more so for allowing me to share more than 50 presentations at our meetings and articles in the Undersea and Hyperbaric Medicine Journal. And finally, but not least, to my family who are here this evening for fully supporting me on official–often times accompanying me–and not so official junkets, and helping in generating my writings. My wife, Wendy, my greatest fan, yet severest critic always managed to keep the “home fires burning” for all my diverse and away-time activities.

My next focus is about challenges facing hyperbaric medicine. First, and most concerning is the dearth of hyperbaric contributions from academic medical centers. When I first became involved with clinical applications of hyperbaric oxygen 46 years ago, there were about 40 medical centers who treated conditions requiring HBO–and most of these were for threatened loss of life or limb diagnoses with many papers generate from their experiences. Today, the numbers of facilities treating emergencies have not substantially increased although there are now an estimated 1500 centers that treat outpatient, non-emergency conditions. The reason for this is reimbursements are not provided for inpatient HBO treatments due to establishment of the DRG (Diagnostic Related Group) system where the hospital is reimbursed for a pre-determined amount for the admitting diagnosis. This becomes a “Catch-22” situation. Why would hospital administrators fund services for which they receive no reimbursements? This, to me, explains the dearth of academic medical centers’ contributions to the HBO literature. A recent orthopaedic surgery article summarized the METRC’s (Major Extremity Trauma Research Consortium’s) on-going, funded projects. Of the $150 million dollars funded and over 500 investigators participating, not one study mentioned using HBO. As Dr. Julius Jacobsen so stated in his remarkably perceptive 1984 Internal College of Hyperbaric Medicine Presidential Address, HBO will not survive unless well controlled studies are produced. At our ASM meeting this year, there was a “glimmer of hope. “Dr. Parambir Bulai demonstrated through his own perseverance and resourcefulness the value of HBO for inflammatory bowel syndromes while working at the Northwestern Medical Center in Evanston, Illinois. The bottom line, we as a society, need to convince payers that “cutouts” for emergency inpatient HBO treatments be made. The rewards are manifold with not only improving patients’ outcomes, but also for the stimulation of research to validate HBO’s usefulness and for discovering new indications—as Dr. Bulai single handedly has done.

A second concern is relying on the Wagner grading system to justify HBO treatments. It is archaic (first published 44 years ago), relays on a single observation to decide whether or not HBO treatments are justified, and has no published validating or reliable studies. It lends itself to upcoding the subjective observations to obtain reimbursements for HBO treatments. There is a great need for the UHMS endorsing an objective wound scoring system using several assessments with easily observable findings to grade each assessment. The Apgar score for determining newborn vitality is an excellent model for such a grading system.

Finally, our Undersea and Hyperbaric Medicine journal impact factors hovers around one. I propose that “Wound Care” be added to the journal title. With about a third of our ASM presentations dealing with wound care as well as publications in the Journal, adding this title to the journal has the potential for attracting more quality articles, increasing readership and improving our journal’s impact factor. A few years ago, the Aerospace Medicine journal added Aviation and Environmental Medicine to its title. Its impact factor has continued to improve.

A final, departing consideration is what are my plans for the future. First, I am fortunate to be in a position where I am able to remain a tertiary consultant and surgeon for wounds that are not healing as expected. In the process I mentor bright and motivated residents for these problems–a source of great satisfaction. Now that my Diving Science…Revisited text is in print, I am revising my MasterMinding Wounds text. Like my diving text revision, the revision is to be much different than the original version. With 46-years of working with wounds, I have developed many novel ideas and techniques that I want to share with others. Presently, I have four papers in various stages of submission for publication and many more ideas for future writings. Finally, I unequivocally offer my services to the UHMS to help with their educational and administrative programs–especially with the 3-concerns mentioned above.

In summary, I relate to Robert Frost’s poem, “The Road not Taken.” Had I taken the other road I wonder where I would be at this time. The road taken has been an enlightening, exhilarating and extraordinary opportunity and one that has allowed me to develop exceptional relationships with experts in a variety of disciplines