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Many of the landmark discoveries in biomedical science were based on individual brilliance and talent. However, over the years it became apparent that the pathogenesis of various diseases, and of autoimmune disorders in particular, is complex and requires a multidisciplinary approach. For example, the search for disease susceptibility genes in human diseases demands intensive collaboration between clinicians, geneticists, molecular biologists, and biostatisticians. Furthermore, the technological revolution in the field of biomedical research requires international collaboration to exchange the necessary expertise. International meetings, although very useful for the scientific community, have their limitations. By their nature, such meetings can increase subspecialisation and in overview sessions the large numbers of participants may be counterproductive for personal contact. This can be a particular barrier to younger members of the scientific community who wish to get involved with other groups. However, it will fall to these young scientists to strengthen the network to target diseases.
Despite many similarities among scientific groups on either side, the Atlantic Ocean has proved to be a major barrier to such effort. Meeting the demand for a forum for young rheumatologists, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) established an exchange programme in 1997 between European and American scientists in the field of rheumatology. The first exchange took place in 1998. Since then each year, three junior academic scientists accompanied by one senior rheumatologist of ACR and EULAR, respectively, travel across the ocean to visit academic centres for a one week trip. These site visits are organised by EULAR in Europe and the ACR in the USA directly after the annual scientific meetings of both organisations. European and American faculty members are selected from applicants by scientific committees of EULAR and ACR.
This year, the European delegation consisted of junior faculty members from the Universities of Regensburg, Germany (UM-L), Gent, Belgium (DE), and Vienna, Austria (MA). Drs Hasan Yazici (University of Istanbul, Turkey) and Audrey Nelson (Mayo Clinic Foundation, Rochester, MN) served as senior faculty members.
2002 SITE VISITS
To show the value of this programme, we describe our experiences of the 2002 site visits, which took place after the annual ACR meeting in New Orleans. The first academic centre we visited was the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS, Bethesda, Maryland), hosted by the NIAMS intramural director, Dr Peter Lipsky and by Dr Barbara Mittleman. A very interesting morning session consisted of presentations by the heads of the division and clinical scientists giving an overview of their current work. Thus, Drs Paul Plotz, Daniel Kastner, Peter Lipsky, Rocky Tuan, Gabor Illei, and Raphaela Goldbach-Mansky provided insights into a wide variety of research topics ranging from autoimmune diseases to tissue engineering. Also informative was the insight into the effort of NIAMS to set up outpatient clinics in different ethnic areas of Washington DC to recruit patients of various minorities and to study key clinical and epidemiological aspects of certain rheumatic diseases. We were also updated on the clinical trial programme of NIAMS open to patients with particular diseases, and not necessarily restricted to patients from the USA.
In the afternoon, we travelled to Boston to the Brigham and Woman’s Hospital. Our host, Dr Michael Weinblatt, welcomed us together with Drs Peter Schur, David Lee, and Paul Anderson. The next morning we were informed of the history and current structure of the hospital and got to know about the research and clinical activities of the division through lectures by faculty members Drs Anderson, Lee, I-Cheng, Katz, Solomon, and Shadick. We were also able to give short presentations of our own work, followed by vivid, interesting discussions. The visit concluded with a tour conducted by Dr Weinblatt of the outpatient rheumatology clinic. It was remarkable that despite all the differences in health systems between Europe and the USA, particularly the health insurance system, outpatient clinics and the physicians’ offices look very much alike on both sides of the Atlantic.
The next flight carried us south to New York City. Here we were welcomed by our hosts Drs Mary Crow and Stephen Paget. In the morning there was a presentation of a clinical case by a rheumatology fellow to the entire rheumatology faculty of the Hospital of Special Surgery (HSS), Cornell Medical Centre. This was a particularly interesting experience because none of us had clinical training in an American medical centre. This presentation was followed by a visit of the group to a patient’s bedside. As the visit to the HSS lasted for a whole day, each of us had the opportunity to visit individually several faculty members (among them Drs Crow, Salmon, Ivashkiv, Pricop, and Kirou). This had the advantage of allowing us to focus on areas of mutual interest which might lead to potential scientific collaborations. In the afternoon there was time for our scientific presentations, which were again followed by a discussion.
“American and European rheumatology will benefit greatly from such exchanges”
Our final visit was to the Mayo Clinic in Rochester, Minnesota. We were welcomed in the airport arrival hall by Dr Steven Ytterberg who hosted this visit together with Dr Audrey Nelson. He explained to us that the Mayo Clinic is not only a clinical centre but is also involved in running the airport of the city, which is instrumental in flying in patients from around the world, underlining the clinic’s international character. It was surprising to see an office of the clinic in the arrival hall of the airport. In the evening Dr Ytterberg organised an informal meeting at his own house where we met other faculty members including Dr Eric Matteson. On the last day of the programme we visited the various facilities belonging to the Mayo Clinic, including the recently opened Gonda Building and met the senior and junior faculty members of the rheumatology division headed by Dr Luthra. Dr Sherine Gabriel explained to us how the Mayo Clinic has played a leading role in epidemiology and health services because of its detailed records of all patients in the county since 1910. Dr Chella David presented his most recent work on the role of HLA genes in experimental arthritis. Drs Weyand and Goronzy updated us on their advances of CD28null T cells in rheumatoid arthritis and vasculopathies. From Drs Storgard, Ruggieri, and Manek we learnt that the Mayo Clinic is expanding its research interests in rheumatology to angiogenesis, bioinformatics, and degenerative joint diseases.
This exchange programme was filled with information and fascinating personal interactions. We are very grateful to our hosts and to all those who contributed to this outstanding scientific week conducted in an amicable atmosphere. All of us highly appreciated the programme and had a memorable time. We encourage all young scientists in the field of rheumatology to join this programme on both sides of the Atlantic. We are convinced that this scientific exchange will strengthen the international collaboration between the USA and Europe.
Although this programme will hardly ever show immediate measurable benefit, we are convinced that both American and European rheumatology will deeply benefit from such exchanges and dearly hope that this programme will continue.
We thank Dr Audrey Nelson and Dr Hasan Yazici, both for their efforts in making our trip so successful and for their thoughtful suggestions for this account. We also would like to thank EULAR and the ACR for their support.