ELSEVIER
Journal of Back and Musculoskeletal Rehabilitation Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 7-9
The Society for Back Pain Research: how did it start? A. St.J. Dixon* Tregisky, Coverack, Helston, Cornwall TR12 6 TQ, UK
That we should start a Society for research into back pain was, I think, my idea but numerous influences and friends helped with the Society's conception and birth. The Arthritis and Rheumatism Council of Great Britain (the ARC), indirectly had a hand in it. In the 1960s and early 1970s the Council was guided in its assessment of the national burden of rheumatic diseases in the UK by the work of its Epidemiology Research Unit under the direction of Dr. Philip Wood. I was one of the Medical Secretaries of the ARC and sat on all its committees. Dr. Wood produced statistics and charts which showed that back pain was the most common cause of rheumatic suffering and that the loss to industry caused by certified back pain-related absence from work was immense. I was aware from sitting in on the Research Sub-committee of the ARC that the Council, while claiming back pain as part of its remit, was doing virtually nothing about furthering education into back pain nor about stimulating and funding research into back pain. I discussed this mismatch with Will Copeman, then Chairman of the ARC and said it was a bit hypocritical of the ARC to claim back pain as a
"Tel.:
+44 1326 280203; fax: +44 1326 280693.
major cause of rheumatic suffering in its fund raising documents yet to be doing so little about it. I also took the opportunity to list the major victories of research into rheumatic diseases at that time. Those were: the virtual disappearance of rheumatic fever; the disappearance of tuberculosis of bones and joints; the cure of gout and the invention of the prosthetic hip; and that for all the money the ARC had collected and spent on research, its only contribution to any of those major advances had been to refuse a research grant to the late John Charnley! The ARC Research Committee did not have reason to be too proud of its record. Will Copeman took me seriously and in subsequent discussions it was decided to list three priority areas for ARC research. These were: (1) back pain; (2) to develop a knee prosthesis as good as the hip prosthesis; and (3) to search for a possible microbiological cause of rheumatoid arthritis. In the event, identifying back pain as a priority area stimulated only a few more back pain research project applications than might have come to the ARC anyway and most of them were not of a scientific quality which the ARCs prestigious Research Committee felt able to accept. So we were in a catch-22 situation. Poor quality research applications into aspects of back pain
1053·8127/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved.
PIISI053-8127(97)00039-0
8
A. St.J. Dixon / Jou17Ul1 of Back and Musculoskeletal Rehabilitation 9 (1997) 7-9
meant that these would not be funded when they were in competition for funding for research into arthritis. So, no money was made available through this channel. The lack of ring-fenced funding dedicated to back pain research meant there was no imperative for clinical scientists to get into that field of work. Moreover, orthodox rheumatologists were suspicious of the back pain industry, which had to a great extent been taken over by the practitioners of what Brian Inglis had called 'Fringe Medicine' and is now called Complementary Medicine. There was very little hard science in the numerous publications about back pain available at that time. If back pain research was to be fostered from its low starting point we would not be able to do it through the ARC. The Bath Institute for Medical Engineering indirectly had a hand in the Society's formation in that they had appointed as their Director Commander Dickie Rowe, who had previously been Secretary of the Navy League. I had discussed the project with him and he had been in contact with Admiral of the Fleet, Sir Caspar John, son of Augustus John the artist. Sir Caspar had, I think, been recruited to the Executive Committee of the Back Pain Association (BPA), whose founder, patron and moving spirit was Stanley Grundy, the owner of Grundy, Teddington, makers of laboratory equipment and aluminum beer barrels. Mr Grundy supported the idea of a Society for Back Pain Research and sponsored the inaugural meeting which took place in Bath. Present were representatives of the BPA and various doctors and surgeons and others professionally interested in back pain, some of whom are here today. I found Caspar John to be a very nice man but I was later told that he was suspicious of us rheumatologists, thinking that all we wanted was to get our hands on research money. He used to talk about the 'Jayson Dixon' line, implying, I suppose, that we medical slaves in the southern counties would all rush to the desegregated North in a search for research funding! I sat on the BPA executive committee for a while but my heart wasn't in it. Stanley Grundy was convinced from his personal experience that the answer to back pain was chiropractic. He recommended chiropractic treatment to his em-
ployees if they complained of back pain and he would expect them to make a rapid recovery and be promptly back at work. They were hardly likely not to. I was nervous about this but as the BPA was the only organisation in the field, we needed to work with it. I think I served as the first Chairman of the Society for Back Pain Research. I learnt a lot from the meetings of the Society but I did not have an abiding interest in doing back pain research myself because of my other commitments. Rather naively, I had seen the BPA as the equivalent of the ARC and that the Society for Back Pain Research would stand in relation to the BPA much as the then Heberden Society stood in relation to the ARC, i.e. that it would be funded by the BPA and secretarial and office facilities provided for it. In the event, and partly because of the perceived built-in bias of the BPA, the relationship became one of arm's length although we were happy to accept that the BPA would fund an annual prize of £50 for the best paper read to the Society. There was one other important feature of the Society. It was at that time breaking new ground in accepting anyone as members who were interested in back pain research, whatever their label. So we had chiropractors, osteopaths, psychologists and physiotherapists as well as people with various medical qualifications. The only criterion was that they would publish or had published their observations on back pain and would accept peer group discussion with the other members. It is difficult to imagine the need for it today, but I went to the British Medical Association headquarters in Tavistock House and consulted with their Medical Ethics specialist to make sure that I would not be in danger of being struck off the Medical Register for consorting with unqualified practitioners. I did, however, come under criticism from Dr Michael Mason who had succeeded Will Copeman as Chairman of the ARC. He said it was wrong to set up a Research Society based upon a symptom rather than a disease, but I received welcome support from Professor Eric Bywaters. There is nothing quite so uncharitable as a
A. St.J. Dixon / Journal of Back and Musculoskeletal Rehabilitation 9 (J997) 7-9
Charity which believes that another Charity is straying on to its territory. So it was arranged that Sir John Wall, a member of the BPA executive, should be invited to sit on the Executive Committee of the ARC as well, so as to coordinate efforts and avoid rivalry. In the event he made little contribution and soon stopped coming. Another notable character from the BPA Executive Committee was the late John Coates, millionaire head of the Coates printing ink empire. John Coates suffered from, but had mastered, severe ankylosing spondylitis. I asked him, and he accepted, to become President of the National Ankylosing Spondylitis Society which I had founded with patients in Bath. I got to know him well. I was also interested in osteoporosis and was founder chairman of the National Osteoporosis
9
Society. My personal contributions to back pain research have been minimal. There was one study which showed that osteoporotic subjects lost the normal circadian variation in spinal height which Dr Troup had described. Another project with Malcolm Jayson and the late George Kersley seemed to show that it did not matter how you treated patients suffering from enduring back pain as the same proportion got better in the same amount of time whatever you did. It was never published, as the study design and the numbers were not sufficient to make it statistically convincing. However, the National Ankylosing Spondylitis Society and the National Osteoporosis Society, both of which had started as self-help societies for sufferers, later began funding research in their respective fields of spinal disease.
Journal of Back and Musculoskeletal Rehabilitation Journal of Back and Musculoskeletal Rehabilitation 9 (1997) 7-9
The Society for Back Pain Research: how did it start? A. St.J. Dixon* Tregisky, Coverack, Helston, Cornwall TR12 6 TQ, UK
That we should start a Society for research into back pain was, I think, my idea but numerous influences and friends helped with the Society's conception and birth. The Arthritis and Rheumatism Council of Great Britain (the ARC), indirectly had a hand in it. In the 1960s and early 1970s the Council was guided in its assessment of the national burden of rheumatic diseases in the UK by the work of its Epidemiology Research Unit under the direction of Dr. Philip Wood. I was one of the Medical Secretaries of the ARC and sat on all its committees. Dr. Wood produced statistics and charts which showed that back pain was the most common cause of rheumatic suffering and that the loss to industry caused by certified back pain-related absence from work was immense. I was aware from sitting in on the Research Sub-committee of the ARC that the Council, while claiming back pain as part of its remit, was doing virtually nothing about furthering education into back pain nor about stimulating and funding research into back pain. I discussed this mismatch with Will Copeman, then Chairman of the ARC and said it was a bit hypocritical of the ARC to claim back pain as a
"Tel.:
+44 1326 280203; fax: +44 1326 280693.
major cause of rheumatic suffering in its fund raising documents yet to be doing so little about it. I also took the opportunity to list the major victories of research into rheumatic diseases at that time. Those were: the virtual disappearance of rheumatic fever; the disappearance of tuberculosis of bones and joints; the cure of gout and the invention of the prosthetic hip; and that for all the money the ARC had collected and spent on research, its only contribution to any of those major advances had been to refuse a research grant to the late John Charnley! The ARC Research Committee did not have reason to be too proud of its record. Will Copeman took me seriously and in subsequent discussions it was decided to list three priority areas for ARC research. These were: (1) back pain; (2) to develop a knee prosthesis as good as the hip prosthesis; and (3) to search for a possible microbiological cause of rheumatoid arthritis. In the event, identifying back pain as a priority area stimulated only a few more back pain research project applications than might have come to the ARC anyway and most of them were not of a scientific quality which the ARCs prestigious Research Committee felt able to accept. So we were in a catch-22 situation. Poor quality research applications into aspects of back pain
1053·8127/97/$17.00 © 1997 Elsevier Science Ireland Ltd. All rights reserved.
PIISI053-8127(97)00039-0
8
A. St.J. Dixon / Jou17Ul1 of Back and Musculoskeletal Rehabilitation 9 (1997) 7-9
meant that these would not be funded when they were in competition for funding for research into arthritis. So, no money was made available through this channel. The lack of ring-fenced funding dedicated to back pain research meant there was no imperative for clinical scientists to get into that field of work. Moreover, orthodox rheumatologists were suspicious of the back pain industry, which had to a great extent been taken over by the practitioners of what Brian Inglis had called 'Fringe Medicine' and is now called Complementary Medicine. There was very little hard science in the numerous publications about back pain available at that time. If back pain research was to be fostered from its low starting point we would not be able to do it through the ARC. The Bath Institute for Medical Engineering indirectly had a hand in the Society's formation in that they had appointed as their Director Commander Dickie Rowe, who had previously been Secretary of the Navy League. I had discussed the project with him and he had been in contact with Admiral of the Fleet, Sir Caspar John, son of Augustus John the artist. Sir Caspar had, I think, been recruited to the Executive Committee of the Back Pain Association (BPA), whose founder, patron and moving spirit was Stanley Grundy, the owner of Grundy, Teddington, makers of laboratory equipment and aluminum beer barrels. Mr Grundy supported the idea of a Society for Back Pain Research and sponsored the inaugural meeting which took place in Bath. Present were representatives of the BPA and various doctors and surgeons and others professionally interested in back pain, some of whom are here today. I found Caspar John to be a very nice man but I was later told that he was suspicious of us rheumatologists, thinking that all we wanted was to get our hands on research money. He used to talk about the 'Jayson Dixon' line, implying, I suppose, that we medical slaves in the southern counties would all rush to the desegregated North in a search for research funding! I sat on the BPA executive committee for a while but my heart wasn't in it. Stanley Grundy was convinced from his personal experience that the answer to back pain was chiropractic. He recommended chiropractic treatment to his em-
ployees if they complained of back pain and he would expect them to make a rapid recovery and be promptly back at work. They were hardly likely not to. I was nervous about this but as the BPA was the only organisation in the field, we needed to work with it. I think I served as the first Chairman of the Society for Back Pain Research. I learnt a lot from the meetings of the Society but I did not have an abiding interest in doing back pain research myself because of my other commitments. Rather naively, I had seen the BPA as the equivalent of the ARC and that the Society for Back Pain Research would stand in relation to the BPA much as the then Heberden Society stood in relation to the ARC, i.e. that it would be funded by the BPA and secretarial and office facilities provided for it. In the event, and partly because of the perceived built-in bias of the BPA, the relationship became one of arm's length although we were happy to accept that the BPA would fund an annual prize of £50 for the best paper read to the Society. There was one other important feature of the Society. It was at that time breaking new ground in accepting anyone as members who were interested in back pain research, whatever their label. So we had chiropractors, osteopaths, psychologists and physiotherapists as well as people with various medical qualifications. The only criterion was that they would publish or had published their observations on back pain and would accept peer group discussion with the other members. It is difficult to imagine the need for it today, but I went to the British Medical Association headquarters in Tavistock House and consulted with their Medical Ethics specialist to make sure that I would not be in danger of being struck off the Medical Register for consorting with unqualified practitioners. I did, however, come under criticism from Dr Michael Mason who had succeeded Will Copeman as Chairman of the ARC. He said it was wrong to set up a Research Society based upon a symptom rather than a disease, but I received welcome support from Professor Eric Bywaters. There is nothing quite so uncharitable as a
A. St.J. Dixon / Journal of Back and Musculoskeletal Rehabilitation 9 (J997) 7-9
Charity which believes that another Charity is straying on to its territory. So it was arranged that Sir John Wall, a member of the BPA executive, should be invited to sit on the Executive Committee of the ARC as well, so as to coordinate efforts and avoid rivalry. In the event he made little contribution and soon stopped coming. Another notable character from the BPA Executive Committee was the late John Coates, millionaire head of the Coates printing ink empire. John Coates suffered from, but had mastered, severe ankylosing spondylitis. I asked him, and he accepted, to become President of the National Ankylosing Spondylitis Society which I had founded with patients in Bath. I got to know him well. I was also interested in osteoporosis and was founder chairman of the National Osteoporosis
9
Society. My personal contributions to back pain research have been minimal. There was one study which showed that osteoporotic subjects lost the normal circadian variation in spinal height which Dr Troup had described. Another project with Malcolm Jayson and the late George Kersley seemed to show that it did not matter how you treated patients suffering from enduring back pain as the same proportion got better in the same amount of time whatever you did. It was never published, as the study design and the numbers were not sufficient to make it statistically convincing. However, the National Ankylosing Spondylitis Society and the National Osteoporosis Society, both of which had started as self-help societies for sufferers, later began funding research in their respective fields of spinal disease.
