European Journal of Clinical Investigation (1979) 9,235-236
Presidential address
WALTER A. MULLER
A good presidential address, which in another society is called ‘The State of the Union Message’, is a mixture of self-admiration (‘aren’t we good’), mutual commiseration (‘isn’t life difficult’), nostalgia for the past (‘the good old times’) and promises of a brighter future (‘tomorrow must be better’). I shall try to do justice to all these aspects, and place our Society today in the context of a 12 year history which has seen four phases of development. The birth of the Society. For Europe, a continent of many nations, it was a major step to talk across state borders. This was done, however, by a relatively small group of clinical investigators who recognized the stimulating effect on clinical research originating from common discussions of individual projects. They modelled our Society on the ‘young turks’ of the American Society for Clinical Investigation (ASCI) even though there were no ‘old turks’ to revolt against. This was symbolized by Sir Gordon Wolstenholme who donated the Fez to remind us of our American cousins, and to disguise some of the grey hairs of our presidents. The members of the new Society knew one another personally, and in retrospect we can say that life in the Societythen really was the ‘good olddays’. Only plenary sessions were held at the first meetings. The bright and promising child. The next phase was the natural development of such a positive start, namely the healthy rapid growth of the Society. In the annual reports the graphs always showed upgoing lines. Nordwijk and Scheveningen were the venues for these pleasant experiences. Expansion, however, as with economic expansion, carried with it the danger of excess selfconfidence. In order to have as many abstracts as possible presented at the Annual Meetings, such a large number of subspeciality sessions were placed on the programme that I do not have to exaggerate too much to say that the venue became a federation meeting of subspeciality clubs, some of which were quite small. Puberty hasproblems. When this phase was reached, attendance at the meetings dropped and financial problems, partly linked to our Journal, dampened our youthful optimism. We even had to consider intensive care treatment at that time. 001 4-2972/79/0800-0235$02.00
01979 Blackwell Scientific Publications
Recoveryphase. This can be called the stage of ‘back to the general ward’. The financial problems of the Journal were solved by separating it from the Society -at least for a few years-and this allowed the Society’s role in Europe to crystallize. We were not to become a federation of subspeciality societies (there are already several such organizations and most are good), but were to remain a forum in which clinical investigation is discussed across the subspecialities and where topics are presented which are of interest to all clinical researchers. It is important that we should recognize and accept this concept, because any other attitude would lead to competition with other societies, which is neither our prime objective, nor is it part of our bye-laws. Linked with this realization came the experiment of postgraduate teaching in the form of the evening debates and update lectures which have proved highly successful. It is a privilege, therefore, to be able to tell you that this year the state of the Society isgood(‘aren’t we good!’?). Our fnances are in positive balance. The number of abstracts submitted, the number of registrations for the meeting, and the number of new members have all increased, and the first two have reached record figures. Through the generosity of the Bayer company we can offer travel assistance to our younger colleagues, and last, but by no means least, our Journal is in a healthy state with respect to the number of papers submitted, its physical appearance, its finances, and, dare I say, its quality. Its editorials have become a particularly attractive feature. Does today’s happy state mean that the Society ‘has made it’ to the maturity of adulthood? Such a view could easily lead to overconfidence, but I feel sure we will succeed provided that we all, you and I, support the Society and its goals. What can we learn from the history of the Society which I have outlined, and how can we avoid another recession? First, and I repeat this, the strength of our Society remains the discussion of medicine across the subspecialities. The general sessions at our meeting are vital to the life of the Society, and we should even consider more active exchange between the disciplines in subspeciality sessions. A second, and possibly more important, issue, is to ask who is genuinely interested in a Society like ours and in its Journal? After thinking about this question, and having discussed it with many people inside and outside the Society, I have come to the following con-
235
236
WALTER A . MULLER
clusion; those interested in our Society are clinical researchers who maintain their links with, and their interest in, general cfinicaf medicine. This sounds trivial, but it might be the reason why our big brother, the ASCI, is so healthy. Indeed, most if not all the members of the ASCI are responsible for patient care on general medical wards for at least 3 months every year. They call this the ‘attending system’. These researcher-clinicians come to the meeting of their society to hear ‘what’s new in medicine’ across the whole spectrum of the subspecialities. In Europe, only a minority of countries have anything comparable to this attending system. The United Kingdom and some German universities probably come closest to it, although even then some departments have wards run by subspecialists. Most units, however, admit patients with general medical problems. On the continent, specialists, even after a broad training in general medicine, usually cease to have responsibility for general patient care and advise exclusively in their subspecialities. It is clear that with such a system, the gastroenterologist must lose interest in cardiac performance, and the cardiologist no longer cares about inflammatory bowel disease. In the extreme, entire hospitals are devoted to individual subspecialities. Why should such
a cardiologist come to our meetings when he gets more complete postgraduate education in his field at the European cardiology meeting? We could accept the development of different autonomous subspecialities, and might possibly, then, have to endure their consequences. Alternatively, we may-as I do-defend general internal medicine, and bring clinical investigators back to patient care where the questions about disease arise. As we all know, only actioe responsibility for the patients can reactivate these interests in general medicine. Although I recognize the danger of converting good researchers into bad clinicians, I am convinced about the importance of strong links between clinical research and patient care within the same individual. For our Society this represents a challenge to help shaping the structure of future medicine across Europe. Instead of passively accepting new members according to their existing interests, we should try actively to influence the curricula of young clinical scientists to obtain future members according to our convictions. If we can set these structures aright, we shall have good reasons to be optimistic for the next phase of the Society. The future can only be better!
Editorial Comment The May issue of the British Medical Bulletin focusses comprehensively on basic and applied research into reproduction, emphasizing that we lack much basic information from which new contraceptive developments can be derived. Papers in this issue, edited by R. V. Short, complement the following editorial and review early embryonic and fetal development, sex determination and differentiation, parturition, gonadotrophin control and secretion, testicular activity, prostaglandin control of reproduction, human infertility and new contraceptive research.
Presidential address
WALTER A. MULLER
A good presidential address, which in another society is called ‘The State of the Union Message’, is a mixture of self-admiration (‘aren’t we good’), mutual commiseration (‘isn’t life difficult’), nostalgia for the past (‘the good old times’) and promises of a brighter future (‘tomorrow must be better’). I shall try to do justice to all these aspects, and place our Society today in the context of a 12 year history which has seen four phases of development. The birth of the Society. For Europe, a continent of many nations, it was a major step to talk across state borders. This was done, however, by a relatively small group of clinical investigators who recognized the stimulating effect on clinical research originating from common discussions of individual projects. They modelled our Society on the ‘young turks’ of the American Society for Clinical Investigation (ASCI) even though there were no ‘old turks’ to revolt against. This was symbolized by Sir Gordon Wolstenholme who donated the Fez to remind us of our American cousins, and to disguise some of the grey hairs of our presidents. The members of the new Society knew one another personally, and in retrospect we can say that life in the Societythen really was the ‘good olddays’. Only plenary sessions were held at the first meetings. The bright and promising child. The next phase was the natural development of such a positive start, namely the healthy rapid growth of the Society. In the annual reports the graphs always showed upgoing lines. Nordwijk and Scheveningen were the venues for these pleasant experiences. Expansion, however, as with economic expansion, carried with it the danger of excess selfconfidence. In order to have as many abstracts as possible presented at the Annual Meetings, such a large number of subspeciality sessions were placed on the programme that I do not have to exaggerate too much to say that the venue became a federation meeting of subspeciality clubs, some of which were quite small. Puberty hasproblems. When this phase was reached, attendance at the meetings dropped and financial problems, partly linked to our Journal, dampened our youthful optimism. We even had to consider intensive care treatment at that time. 001 4-2972/79/0800-0235$02.00
01979 Blackwell Scientific Publications
Recoveryphase. This can be called the stage of ‘back to the general ward’. The financial problems of the Journal were solved by separating it from the Society -at least for a few years-and this allowed the Society’s role in Europe to crystallize. We were not to become a federation of subspeciality societies (there are already several such organizations and most are good), but were to remain a forum in which clinical investigation is discussed across the subspecialities and where topics are presented which are of interest to all clinical researchers. It is important that we should recognize and accept this concept, because any other attitude would lead to competition with other societies, which is neither our prime objective, nor is it part of our bye-laws. Linked with this realization came the experiment of postgraduate teaching in the form of the evening debates and update lectures which have proved highly successful. It is a privilege, therefore, to be able to tell you that this year the state of the Society isgood(‘aren’t we good!’?). Our fnances are in positive balance. The number of abstracts submitted, the number of registrations for the meeting, and the number of new members have all increased, and the first two have reached record figures. Through the generosity of the Bayer company we can offer travel assistance to our younger colleagues, and last, but by no means least, our Journal is in a healthy state with respect to the number of papers submitted, its physical appearance, its finances, and, dare I say, its quality. Its editorials have become a particularly attractive feature. Does today’s happy state mean that the Society ‘has made it’ to the maturity of adulthood? Such a view could easily lead to overconfidence, but I feel sure we will succeed provided that we all, you and I, support the Society and its goals. What can we learn from the history of the Society which I have outlined, and how can we avoid another recession? First, and I repeat this, the strength of our Society remains the discussion of medicine across the subspecialities. The general sessions at our meeting are vital to the life of the Society, and we should even consider more active exchange between the disciplines in subspeciality sessions. A second, and possibly more important, issue, is to ask who is genuinely interested in a Society like ours and in its Journal? After thinking about this question, and having discussed it with many people inside and outside the Society, I have come to the following con-
235
236
WALTER A . MULLER
clusion; those interested in our Society are clinical researchers who maintain their links with, and their interest in, general cfinicaf medicine. This sounds trivial, but it might be the reason why our big brother, the ASCI, is so healthy. Indeed, most if not all the members of the ASCI are responsible for patient care on general medical wards for at least 3 months every year. They call this the ‘attending system’. These researcher-clinicians come to the meeting of their society to hear ‘what’s new in medicine’ across the whole spectrum of the subspecialities. In Europe, only a minority of countries have anything comparable to this attending system. The United Kingdom and some German universities probably come closest to it, although even then some departments have wards run by subspecialists. Most units, however, admit patients with general medical problems. On the continent, specialists, even after a broad training in general medicine, usually cease to have responsibility for general patient care and advise exclusively in their subspecialities. It is clear that with such a system, the gastroenterologist must lose interest in cardiac performance, and the cardiologist no longer cares about inflammatory bowel disease. In the extreme, entire hospitals are devoted to individual subspecialities. Why should such
a cardiologist come to our meetings when he gets more complete postgraduate education in his field at the European cardiology meeting? We could accept the development of different autonomous subspecialities, and might possibly, then, have to endure their consequences. Alternatively, we may-as I do-defend general internal medicine, and bring clinical investigators back to patient care where the questions about disease arise. As we all know, only actioe responsibility for the patients can reactivate these interests in general medicine. Although I recognize the danger of converting good researchers into bad clinicians, I am convinced about the importance of strong links between clinical research and patient care within the same individual. For our Society this represents a challenge to help shaping the structure of future medicine across Europe. Instead of passively accepting new members according to their existing interests, we should try actively to influence the curricula of young clinical scientists to obtain future members according to our convictions. If we can set these structures aright, we shall have good reasons to be optimistic for the next phase of the Society. The future can only be better!
Editorial Comment The May issue of the British Medical Bulletin focusses comprehensively on basic and applied research into reproduction, emphasizing that we lack much basic information from which new contraceptive developments can be derived. Papers in this issue, edited by R. V. Short, complement the following editorial and review early embryonic and fetal development, sex determination and differentiation, parturition, gonadotrophin control and secretion, testicular activity, prostaglandin control of reproduction, human infertility and new contraceptive research.
