The birth of the spirit of the ETA

It is a great pleasure to be once more in the beautiful city of Athens where two ETA meetings have been held. This Jubilee meeting gives us a nice opportunity to remind the young generations of what happened 4O years ago in Rome, to acknowledge the contribution of many members of the ETA and to evoke some of the pros and cons of our management.

Nowadays, travelling for meetings has become routine but did you ever realize that regular national or international thyroid meetings are just about 50 years old and no more ?

In 1924, the American Goiter Association was founded by thyroid surgeons. In these days, nothing else except surgery could really help thyroid patients. The aims of the American Goiter were essentially directed at thyroid surgery, especially in the field of thyroid cancer and nontoxic goiter. In 1929, Dr S.D. Van Meter, then President of the Goiter Association established an annual prize "to stimulate research toward the basic cause of goiter". This prize is still yearly awarded by the American Thyroid. In August 1927, the first International Goiter Conference was held in Bern, Switzerland. Endemic goiter was largely discussed by the 188 delegates. The importance of iodine prophylaxis using iodized salt was recognized. The second International Conference was again held in Bern in 1933 and the third one in Washington in September 1938. Toasting the American Goiter Association, Dr C. Wegelin from Bern stressed that whereas endemic goiter was present in Switzerland and in the United States as well, "…in accordance with the tempo of living and the tendency toward business, the american goitrous thyroid shows an inclination toward hyperthyroidism, while in Switzerland we tend more contemplative ways and are inclined toward hypothyroidism…". Did anything change ? Exophthalmic goiter was clinically and experimentally discussed and described as a different disease from toxic adenomatous goiter. A microhistometric method applied to a thyrotropin assay was proposed. The possibility that TSH secretion could be controlled by a negative feed-back mechanism was a debated issue. Several papers were also related to the important role of thyroid surgery in the treament of exophthalmic goiter and thyroid cancer. Remember that neither thiourea dérivatives nor radioiodine 131I were available as alternative therapeutic agents.

The devastating years 1940-1945 slowed down thyroid research. Then, it took a few years to reorganize a normal civil life. In the universities, many structural problems had to be solved. The European universities were old-fashioned and lacking in flexibility. Mass education was prevalent and little possibilities were left for modern research. Even more important, there was almost no permanent position to make a career in research.

In the meantime, endocrinology had moved on. In thyroid research, the North-Americans were quite a few steps ahead from the Europeans. A serious gap in technology, particularly in laboratory medicine, had developed between the US and Europe where the main diagnostic tool in the evaluation of thyroid function remained the measurement of the basal metabolic rate. In 1942, radioiodine 131I had already been used in Boston, at the Mass General. In Western Europe, it is only around 1955 that radioiodine will finally be allowed to be produced for medical and scientific purposes. Such a delay resulted from the fact that radioiodine production had remained classified among the US military defence secrets linked to the atomic bomb.

In the field of endocrinology, the thyroid gland becomes a source of great medical and scientific interest. The thyroid gland appears as a unique biological model of an organ essentially dedicated to the synthesis of one single iodoprotein, thyroglobulin, responsible for the synthesis of thyroid hormones. The availability of radioiodine 131I quickly allows to investigate in vivo and in vitro, different critical steps in thyroid hormone synthesis and peripheral metabolism. Significant advances in biochemistry associated with those in electron microscopy and autoradiography provide a number of stimulating information on iodine metabolism, on thyroglobulin and on thyroid cells biochemistry. The reported cases of thyroid inborn errors of metabolism open new approaches in the understanding of thyroid pathophysiology. Disorders of some immunological mechanisms offer new fields in thyroid research. Graves’s disease is associated to an abnormal protein called long-acting thyroid stimulator (LATS) and Hashimoto thyroiditis to destructive thyroid autoantibodies. Last but not least, significant advances in radioimmunoassays allow to measure with a high specificity and sensitivity, different circulating hormones. New tools in thyroid research are constantly developed like paper and gel electrophoresis, paper and column chromatography, protein bound-iodine (PBI) methodology, computerized radioiodine kinetic studies, tissue slices and cultures, etc... Thyroid research is really booming during the period 1955 to 1965.

It would be unfair to say that there was no basic research in Europe in the 1950s.... Thyroxine had been isolated in 1915 by Kendall in the US. In the years 1926 to 1929, Sir Charles Harington at the National Institute for Medical Research (MRC) in London improves the method of isolation of thyroxine from thyroid tissues, demonstrates the orientation of iodine atoms of the thyronine molecule and discusses the biosynthesis of thyroxine from the diiodotyrosines. In 1952, Roche together with Raymond Michel and Serge Lissitzky identified, the 3,5,3'-triiodothyronine molecule (T3) in the hydrolysates of rat thyroid. The same year, Gross and Pitt-Rivers at Mill Hill (London) published on the presence of T3 in the human plasma and demonstrated the antigoitrogenic activity of T3. Studies on thyroxinogenesis, proteolysis and deiodination of thyroglobulin are actively performed at the Collège de France in Paris by Jean Roche, Raymond Michel and Serge Lissitzky.

A weak point in Europe for clinical research remained linked to the fact that most of the departments of Endocrinology were run by distinguished clinicians with little laboratory connection or experience. They were however a few exceptions like Cassano in Roma, De Visscher in Louvain, Fellinger in Vienna, Malamos in Athens, Querido in Leiden, Vanotti in Lausanne or Wayne in Glasgow.

Realizing the American leadership in medical education and research, young European doctors are encouraged to get experience and training in North-America. In the United States, quite a large number of thyroid centers have developed and the topics in thyroid research are numerous. Very important to be stressed again is the fact that in the US, routine clinical work, clinical investigation and basic science are constantly integrated, thus pushing the investigators from the patient’s bed to the laboratory bench. Teamwork is another main characteristic of the US medical organization while in Europe, individualism and isolation often remains the classical situation.

Most of the young European researchers did not know each other. They had almost to wait to be in the States to get a chance to meet ! I was at the Massachusetts General Hospital (Boston) in 1958 with John Stanbury when Jacques Dumont landed in the same place. I did not know him before even if our respective universities are just 20 miles distant from each other.

In 1960, the Fourth International Goiter Conference took place, jointly organized by the American Goiter Association and the London Thyroid Club. Out of 104 orally-presented papers (there were no posters in these days), almost 50% of papers were from Western Europe. The European thyroid research was expanding but we still had to attend the American Thyroid annual meetings to meet our European thyroid colleagues and to learn about what was going on in thyroid research in Western Europe. Contacts with the Eastern countries were limited for political reasons, and often frustrating.

In 1965 at the Fifth Thyroid Conference (not a Goiter Conference anymore ! ), a European board clearly emerged to organize the congress with the cooperation of the American Thyroid Association and the London Thyroid Club. Prof. Cataldo Cassano (Italy) was the President, assisted by four Vice Presidents R. Greene (UK), S. Milcu (Rumania), F.R. Keating jr. (USA) and J. Roche (France). The Secretary of the Conference was Mario Andreoli (Italy). The Program Committee was made of L. Califano, Chairman (Naples) and J. Roche, co-Chairman (France), M. De Visscher (Belgium), Gilbert-Dreyfus (France), Krüskemper (Germany), B.A. Lamberg (Finland), R. Pitt-Rivers (UK), J. Robbins (USA) and S. Taylor (UK). The Van Meter prize assay was presented by J. Oppenheimer on "The metabolism and physiological significance on thyroxine-binding-prealbumin”. The Dunhill Memorial lecture was delivered by S.H. Wollman on “The heterogeneity of the thyroid gland”.

This Rome conference remains as a big success in our memory, and this, not only because of its excellent scientific program but also because of the wonderful Italian hospitality which gave us the feeling that we were really belonging to a very large family, the thyroid family. Those present at that time will remember among different events, the evening party at the San Angelo Castle overlooking the city. One “non-scientific” reason of the success of this conference was also the extraordinary friendship between the European and American delegates. Very active thyroid centers had started flourishing in Western Europe and those in charge of these centers were most happy to welcome their mentors.

It is in that atmosphere that an unplanned lunch meeting was held during the Rome Conference at the initiative of a few “young Turks”, gathering some seniors and juniors together. A clear-cut project had progressively emerged: to create a European thyroid association responsible for organizing a thyroid annual meeting and to stimulate scientific exchanges between the European thyroid centers. Those present – Donald Alexander (UK), Mario Andreoli (Italy), Paul Bastenie (Belgium), Christian Beckers (Belgium), Michel De Visscher (Belgium), Jacques Dumont (Belgium), André Ermans (Belgium), Francisco Escobar del Rey (Spain), Raymond Greene (UK), Demetri Koutras (Greece), Axel Lamberg (Finland), Serge Lissitzky (France),), Raymond Michel (France), Jacques Nunez (France), Rosalind Pitt-Rivers (UK), Jean Roche (France), Gaetano Salvatore (Italy) and a few others unanimously decided the foundation of the European Thyroid Association (ETA) – Association Européennes de Recherches sur la Glande Thyroïde (AET) . The aims of the ETA–AET were to strengthen the relationships between all the European thyroid centers, to favor the scientific exchanges and to stimulate various kinds of scientific cooperation. Jean Roche was proposed as President, Raymond Greene as Vice-President, Christian Beckers as Secretary General and Demetrios Koutras as Treasurer. The other Executive Committee members were Jacques Dumont, Francisco Escobar del Rey, Axel Lamberg, Serge Lissitzky, Stephan Milcu, Jacques Nunez, Rosalind Pitt-Rivers and Gaetano Salvatore. A temporary Executive Committee was formed having as immediate responsibility to organize in 1967 our first meeting in Louvain (Belgium) and our first General Assembly due to approve the decisions taken in Rome and the statutes of the newly born association.

It is easy to propose the founding of a new association. More difficult is to keep the people moving ahead to work out the details that make the success or not, of a new project... Each of our presidents and secretaries have experienced that ! In these pioneering years of the ETA and in spite of the differences in cultures and languages, a generous and constant support was received from all the members and this, not only at the time of the meeting but all the year around. This longstanding enthusiasm has really been a striking feature of the spirit of the ETA at the start. Another characteristic has been the personal commitment of each member of the Executive Committee in the management of our Association.

At the Louvain first ETA meeting, we were about 100 delegates. All efforts were made to have a scientific and social structure of the meeting stimulating the personal and scientific contacts. The meeting was held in the university halls. English was the main language, at least for the slides. Those with difficulties in English (particularly during the discussions) were informally helped by some of the delegates. Beside the scientific sessions themselves, social opportunities to meet were numerous from the get-together party in the De Visscher’s house, the receptions offered by the Rector of our University founded in 1423 and the banquet at the Arenberg Castle. Everyone was present in Arenberg. Important tactical detail: the banquet ticket was included in the registration fees as the other social activities, a rule that we kept for several years and which was certainly reinforcing the links between the members. The organizers of the Istanbul meeting last year successfully revived the tradition of the early years of the ETA.

In May 1968, some unrest hit the French universities and a few other universities in the neighbourhood. One of the consequences of this turmoil was the cancellation of most of the medical congresses in France. For the ETA, September 1968 was the time of its 2nd meeting to be held in Marseille. Serge Lissitzky and myself finally succeeded in convincing the students to let us have the meeting on the university campus. In this somewhat "revolutionary" atmosphere, I can tell you that the General Assembly has been quite an experience as some of our colleagues here present will remember .... but the Executive Committee and the ETA survived while in the French universities, new mandarins replaced the old ones. This is life !

To evoke the birth of the spirit of the European Thyroid, we needed to recall why it had been important to start the ETA, to remember the very first steps of our association and how the academic and research atmosphere in Europe was in the 1960s.

The spirit of the ETA developed itself on the basis of two basic requirements that is to say the organization of meetings of high scientific level and the development of a network of strong human connections.

The quality of our meeting programs is well recognized. However, there is one question to be addressed to ourselves. When launching the ETA, one of the basic ideas had been to have clinicians and basic scientists sharing their observations and discussing their results. Such an integration did not work as we had hoped. The content of the scientific programs became progressively unbalanced and favoured basic sciences rather than clinical investigation. Excellent papers on thyroid molecular biology, genetics, thyroid biochemistry or cell receptors to thyroid hormones became the major part of our programs while many clinical problems were remaining untouched. As a result, one observed a steady decrease in the presence of thyroid clinicians and endocrinologists who just went elsewhere to get the information and the training they needed. For years, the Executive Committee did not pay much attention to this evolution, except recently. This progressive lack of contacts between basic scientists and clinicians has been a strategical mistake that our sister societies have not done. While all the clinicians appreciate every day the amazing contribution of basic research, particularly molecular biology and immunology, in the understanding of the pathophysiology of thyroid diseases and in the development of excellent diagnostic methods, very little from basic sciences has ever contributed to discover new tracks in the therapy of thyroid diseases. The clinician is still treating his patients as 50 years ago. If our will remains to succeed in "…the promotion of research in the thyroid field (fundamental and clinical) and the improvement of our knowledge of the thyroid gland and its diseases.. " as written in our statutes, we all do have to quickly re-establish the connections between the two groups of thyroidologists.

In the pioneering years, it was easier to manage a group of 100 people than it is now with a larger family ! However, more people mean also more resources provided that the tasks are correctly distributed. This is one more responsibility that our President and our Secretary General have endorsed with the Executive Committee and this is to be acknowledged. In this perspective, it is basic that the ETA Boards get on business to fulfil the tasks entrusted to them.

To conclude, let us stress again that at its birth, the spirit of the ETA has been to create a network of human and scientific relationships within Europe. After 40 years of development, the goals of the ETA remain unchanged. New working conditions have appeared which have to be challenged as the new ways of communication through the web. If we keep our enthusiasm, our imagination and our sense of responsibility, no doubt that the ETA will continue to achieve its objectives and will stay in good health for many years.

Christian Beckers
ETA Secretary general (1967-1972)