A Milestone Year
Anne L. Peters, MD: Hi. I'm Dr Anne Peters. I am at the European Association for the Study of Diabetes (EASD) meetings in Vienna. I am very honored today to be with two individuals whose work I have read for many years: Dr George Alberti and Dr Ele Ferrannini, who are both past presidents of the EASD. We are celebrating the 50th anniversary of the EASD, so we thought it would be a good time to discuss what has been going on in the organization. Let's start with history. Tell me how it began.
K. George M. Alberti, DPhil, FRCP: I will answer that, because I am much more "past" than Ele. The organization started 50 years ago in Montecatini. A very celebrated Swiss diabetologist, Albert Renold, had been head of the Joslin Clinic in the United States and had been to American Diabetes Association (ADA) meetings. He came back to Europe and thought we needed some sort of get-together for people interested in researching diabetes. They called the organization the "European Association for the Study of Diabetes," so it was research-oriented from the beginning, and it was a society of individuals, not nations. National associations and national politics did not come into it at all, and it has remained, very jealously, an individual membership society.
Dr. Peters: Each country has its own diabetes association and then everybody comes together who wants to belong to EASD.
Dr Alberti: Absolutely. The International Diabetes Federation, by contrast, is a society or federation of national societies, and that deals with care and politics, which most of us feel should go away. The initial EASD meetings were interesting. They were small. My first meeting was in Warsaw, where there were 500 to 600 people at the meeting, and that was considered big. There were two parallel sessions and everyone talked to everyone. It was a very good experience at that time for young researchers.
Dr. Peters: How big are the meetings now?
Eleuterio Ferrannini, MD, PhD: EASD has grown incredibly. The attendance runs from 15,000 to 18,000 people, so the tradition of rotating sites in Europe (possibly visiting every country in Europe, including previously Eastern European countries) has gradually been abandoned, because there aren't many places in Europe with big enough convention centers to host the meeting. This is a measure of success. Although EASD was born as a European association, many attendees came from North America and then increasingly from all over the world. The number of countries and delegates from non-European and non-North American countries has increased exponentially.
Dr. Peters: I find it fascinating to wander around and hear all of the languages that are spoken. It is very exciting to see what is happening all over the world.
Dr Alberti: Yes, and because we are a society for individuals, a few even come from Greenland or Antarctica. You are just as welcome to become a member as if you come from a European country.
Staying Focused on Research
Dr. Peters: Has EASD remained true to the original founding principle of being more of a research institution rather than [focused on] policy?
Dr Alberti: It is very much research-focused. With all of the prize lectures and symposia, there is hardly anything that is not research or investigation. Ele can comment on how much of that is basic research and how much is clinical research. The basic scientists don't bother attending many of the national association meetings, but they come to the EASD.
Dr Ferrannini: Unintentionally, the split between clinical research and basic science presented and communicated at EASD has remained relatively constant over the years, and the split has been somewhere around 60% clinical and 40% basic science. That is also reflected in the composition of the papers published in Diabetologia, which is the official journal of the association. Apparently the leadership and the colleagues on the scientific committees have been able to value the basic sciences at a constant level and make sure that clinical and basic sciences were well balanced and represented, and EASD has gone out of its way to offer travel grants for young people to participate in these meetings.
Dr Alberti: That has always been a very strong focus. When I had a big research group, the best work of our research fellows and students was always submitted to the European meeting, and if it was accepted for presentation as a poster or a talk, we made sure that somehow we got them to the meeting. That focus has remained very strong, which gives a very different feel to the meeting from many of the other meetings.
Dr. Peters: I was going to ask about the notion of encouraging younger investigators and younger physicians to go into the field of diabetes. I am very concerned that in the United States, physicians aren't choosing endocrinology, and in particular, diabetes.
Dr Ferrannini: EASD apparently has encouraged young people over the years, because when we did some statistics on the age of the people attending the EASD, we saw a constant proportion of younger doctors and scientists. This goes along with the other initiatives of the EASD. For example, we have the post-graduate courses, both for clinical scientists and basic scientists, during which we offer younger people the chance to present their most recent work with a senior mentor discussing their work; therefore, they become involved with the running of the association.
They can participate in the Rising Star Symposium, which is a recent initiative that has met with a lot of interest and success. They can be on the scientific committee for the selection of the abstracts to be presented. The initial tone and feeling of a community of people genuinely interested in the science of diabetes, despite the explosion of the numbers, has been maintained, particularly at the level of the administration. When it started, a single person-Jim Jackson-ran the entire show for 18 years.
Dr Alberti: He was sitting in half of an office in London.
A 'Non-democratic' Organization
Dr. Peters: How is the EASD organized? Who runs it? How is the president elected, and for how long?
Dr Alberti: The ADA president's term is one year. I joked with one of their administrators last night that the office was just window dressing, and the organization is run by the people working in the office. We have a three-year term. Most of us had served in other capacities before we became president, and the executive committee has a lot of say in the running of the association. Now we have an office with about 18 people in Dusseldorf. It was established there because the president was from Dusseldorf and we were beginning to expand. One of his colleagues became the executive director. He obviously does an enormous amount of work, but policy is very much in the hands of the executive committee.
Dr Ferrannini: The executive committee is very slim and agile. The executive committee essentially runs all of the EASD activities, and consists of the president, the vice president, the editor-in-chief of Diabetologia, the honorary treasurer, and the honorary secretary, who is in charge of organizing the annual meeting and the organizer of the post-graduate activities. You are sitting around a table with only five other people. In contrast with many associations and societies in Italy, it is completely non-democratic in the sense that there is no election. There are recommendations.
Dr Alberti: I would use a gentler word than recommendation; it is by co-optation! Once you are singled out, you are interviewed by a few elderly members of the association. Then the general assembly, which meets on the occasion of the annual EASD meeting, ratifies the selection. Typically, the general assembly is attended by four or five people at most. It's at the end of a long day, and it is a comfortable place to sit and snooze gently, and every now and again you stick your hand in the air.
Dr. Peters: Don't ruin the whole situation for us! We have a different idea.
Attracting Young People to Diabetes Medicine
Dr Alberti: I would like to return to a point you made, and that is the issue in the United States, and in the United Kingdom, of attracting enough clinicians to the specialty of diabetes. It is one of the few specialties in which you still talk to patients. You don't have a tube to push and make a lot of money from, or have a lot of excitement doing angiography. We are having trouble attracting good, bright people to diabetes, but if you can get them at the student level (in our diabetes unit at King's Hospital we always have three or four undergraduate students), you can give them an exciting project, get them started, and then attract them as soon as they have qualified. If they go to such meetings as the EASD and capture some of the excitement, you keep them rather than having them stray off into primary care or cardiology.
Dr. Peters: Well, we still need primary care! But I went into endocrinology and diabetes because I was fascinated with the whole field, and I liked thinking and I love doing patient care over time. It's much more exciting to cure cancer; then you're a magician-you've done something amazing. What we do, at our best, is the absence of something bad. But I watch my patients over years, and I find it very satisfying, rather than exciting, that I am able to talk to them: "Gee, you're going off to college; now you are getting rich; send me wedding pictures." It's a different model for young people to look at the virtue in that long-term relationship. For me, it has been wonderful.
Dr Alberti: In a way, it is somewhat like primary care, where you get to know a family. I was seeing the children of patients coming, and then even the grandchildren.
Dr. Peters: I see three generations, and it is wonderful because I am treating the disease and then maybe treating it earlier in the next generation, and preventing it in the grandchildren, if it is type 2 diabetes. I love that scope. You have to create that passion in people.
Dr Alberti: You are paid to be nosy. You have to explore people's home lives, their family lives, and their social situations. I have always found it interesting, but for many young doctors, they prefer more dramatic specialties.
Dr. Peters: We just have to teach them differently.
Dr Ferrannini: The other reason for the scientific success of diabetes, which has been seconded by the activities of the EASD, is that it was initially just about glucose. If you look back at the abstracts presented at the early meetings, many were about type 1 diabetes, because that was diabetes 50 years ago. Now, diabetes branches out into obesity, cardiovascular disease, nephrology, neurology, and ophthalmology. That has expanded the scientific basis to make it very interesting. It is a compendium of internal medicine, and that is why, in the planning of the annual meeting, we have many parallel sessions, all of which are scientific sessions. They are not about the organization of care, which is left for the national societies, but there is a lot of attention to diabetes as a whole-glucose, the genetics, and everything else.
What Does the Future Hold?
Dr. Peters: I have one final question for both of you. If you were president of the EASD starting tomorrow for the next three years, what would you do? What would your agenda be for moving the EASD forward into the future?
Dr Alberti: I would not change the meetings. I think they are fine. I would be putting a lot of emphasis on travel grants for young people, and because the EASD has a good research foundation behind it, [I'd also stress] research grants, but focusing on young people and getting them interested and excited.
Dr. Peters: Good answer.
Dr Ferrannini: I agree with George. One thing that has also developed and grown bigger in more recent years is the European Foundation for the Study of Diabetes (EFSD), which partners with industry to raise money to support research on diabetes, and this is entirely driven by nonprofit systems. It has raised a total of more than 70 million Euros over the past few years, which has become a very valuable source of funding for research all over Europe, with programs extending to previously Eastern European countries, and partnerships with China, Japan, and Southeast Asia. Concomitantly, it is becoming increasingly more difficult and cumbersome to get funding for research from the European community. Most of the grant applications to the European community must be conglomerates or consortia of centers.
Dr Alberti: And you need language education. It is a different vocabulary altogether. Both of the universities where I have worked had an individual who spoke "European grant language" who would help you, but it is an immense amount of work.
Dr Ferrannini: Today, if you have an idea and you want to explore this idea, the place to go is the EFSD, because you can write up your individual grant and budget it the way you want. It will be reviewed by scientific peers and you will get reasonable funding.
Dr Alberti: And you will get an answer within six months, rather than six years.
Dr. Peters: I may move to Europe! That is wonderful. Thank you both very much. This has been Dr. Anne Peters for Medscape.
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Cite this: EASD at 50: What's Driving the Future? - Medscape - Sep 25, 2014.