The thoughtful article by Dr. Gaddis about significant occurrences of reasoned dissent in the history of emergency medicine omitted one important mention. In 1971, Gail V. Anderson, Sr., MD, became America‘s (and perhaps the world‘s) first professor and chair of an academic department of emergency medicine at the University of Southern California. At the time, he was a widely respected obstetrician, gynecologist, and an examiner for the American Board of Obstetrics and Gynecology. When he informed colleagues of his decision to accept the dean’s offer, he was told by many that he was committing “professional suicide.” He dissented, saying that the birth of emergency medicine as an academic specialty needed to happen and proceeded to organize the new department by recruiting faculty members and three initial residents.

The description of the overturning of the “Fifth Vital Sign” by Dr. Gaddis was quite apt. I was ACEP’s representative on an advisory committee to The Joint Commission when the move to make “Pain as the Fifth Vital Sign” was introduced. Despite a number of committee members expressing objections (I recall facetiously suggesting that nausea and vomiting be the 6th vital sign), the flawed concept was instituted. It was gratifying to see that the dissenting efforts of ACEP and others finally bore fruit a few years ago.