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Founding ESDR: A Network of Pioneers and Visionaries Was Born

2020; Elsevier BV; Volume: 140; Issue: 9 Linguagem: Inglês

10.1016/j.jid.2020.03.975

1523-1747

Sam Shuster, Thomas Florestan,

Climate Change Communication and Perception

Prof Sam Shuster (born on 24 August 1927, London) was a founding board member and then the President of the European Society for Dermatological Research (ESDR). He is a Fellow of the Royal College of Physicians, member of various dermatological and science associations, and an honorary member of many foreign academy societies. He is an emeritus professor of dermatology from the University of Newcastle Upon Tyne, United Kingdom. Shuster (Figure 1) was interviewed by Thomas Florestan (ESDR, Geneva, Switzerland) and Meike Wendt from Schönith Media (Munich, Germany) at his home in Woodbridge, United Kingdom, on 2 December 2019. The interview has been condensed to fit the Journal format. ESDR: Would you please introduce yourself? Sam Shuster: I'm Sam Shuster. I'm very geriatric. I used to be a dermatologist and a clinical researcher and now I'm just stagnating in this delightful place for oldies. ESDR: How and why did you get involved in the founding of ESDR? Sam Shuster: Well, dermatology back then is really difficult to explain or understand … [it] was stone age and dermatologists were really like descriptive botanists. They were describing the marvellous appearance of rashes…. But, it had started in several places - in America they were doing some research; a little bit here and there but not enough for someone like myself who had been a clinical researcher in general medicine and endocrinology when I came into dermatology. I was invited to join and start research going in the Institute of Dermatology and I wanted to see what sort of research others were doing. And then, at a meeting in Birmingham (UK), I met two like-minded people, Michel Prunierias … and, Klaus Wolff. We decided at that meeting that we ought to consider setting something up in Europe so we could develop our research. And that's how it began. ESDR: Did it feel like a revolution? Sam Shuster: We knew it was a revolution in a way … people around us, mainly clinicians, thought it was a revolution. They objected to doing anything other than seeing and treating patients. They thought that what we were doing was absurd … [but] it felt like we were doing the logical thing, which was to understand what we were looking at, what we were treating and to develop it. Apart from that - intellectual curiosity! How on earth can you just look at a bloody rash and not do anything about it. It was intellectual curiosity and the need that everyone felt at the time to advance research…. ESDR: What was your vision at the beginning of ESDR? Sam Shuster: At the beginning we thought really rather different things. We thought naturally in our lines of past thinking and research…. I had seen the research methods of Thomas Lewis [who] was a great British researcher - a sort of Sherlock Holmes - and it was that approach I liked: the bedside analysis, where you did a little bit and got a lot. So between us we had that slightly different approach. My approach, which perhaps was dominant, because I was doing rather more research, was very much of the sort of clinical research that brought in physiology. I call it "coarse biology". You were looking for big things. So you wanted, when you looked at the skin, to know how the organ worked as an organ. You wanted to know how the epidermis worked, how the sweat glands worked, how the sebaceous glands worked, and how did this integrate into the rest of the body. We had a big battle to fight there because dermatologists that thought about causes (and there weren't many) tended to think … psychologically - that skin disease was the result of a mental disaster or the reflection of a systemic disorder - it was your bad kidney or rotten liver that was the cause of your rash. So we had a battle with that sort of preconception and had to work step by step to change it. I also played a dirty trick, but fun. I did a series of studies which showed the converse, that skin disease was causing systemic disturbance. I did a lot of work which created the new idea "skin can cause systemic disorder" not just that "systemic disorder can cause skin disease" and it helped to right the balance. So we were off, far more basically than today, to work at the skin as a diseased organ - a bit of diseased physiology and chemistry to begin with. Regarding the society, we needed a name for our new organiZation, and ESDI was the most obvious. But I argued that the passivity of "investigation" could preclude the search for novelty. So "research" replaced investigation, and voila, ESDR. ESDR: Do you remember the first meeting you attended? Sam Shuster: The first meeting … I don't remember an awful lot about it … I remember more about how we set it up. It was at Noordwijk, because that was where the first meeting of the European Clinical Science group was being held… and we had … predominantly Europeans in our meetings. Almost everyone that came gave papers … in their own little area they were working in…. So it was a pretty elementary meeting and early day stuff. But one thing we did … we were determined that whatever was done was going to be science - hard science. And we were very strong on this in the early meetings and it caused a lot of anxiety I know. We were very tough on presentations and we really cut people down rather brutally. … We had a bad reputation at first in that a lot of people were scared to give papers but we were determined that what was going to be presented would fulfil scientific standards and pretty soon people realised that you wouldn't get away with the sort of crap that had passed in the past in dermatology. It was solid, hard science, but … after a few meetings, it was maintained. ESDR: What was the content and format of the annual meeting? Sam Shuster: The format was that we had various guys up on the podium in charge but with strict instructions that people had to present within a set time and plenty of time for discussion. Having done that, there were lots of battles at first, because people didn't usually do that. People went on too long. There wasn't enough discussion. It wandered all over the place, and some Chairs were better than others at keeping it strict. So that was the first battle and, in a way, we were less concerned with content than with the sort of standards that would allow good discussion. It didn't work well at first. It did take several meetings to get that going; but our main concern was that people would have a chance to present their best science that the meeting would help them to make their work more scientific and everyone had a chance to discuss and to learn. What didn't come up at the early meetings, but came up later, was the idea of having parallel sessions. I was dead against that. I thought that early on we had to learn about the skin as an total organ. And so, like it or not, if you were interested in nerves you had to sit in when people were discussing epidermis. If you were concerned about pharmacology, you had to sit in with people talking immunology. We all had to sit and learn about all items in the field so we got a feel of the whole field. And I think that was important in the early days; we began to understand the whole field in which we were working. So we tried to maintain that amongst us, and we had discussions amongst our organising Board committee to try to keep it that way. ESDR: How many delegates attended the first meeting? Sam Shuster: I can't remember. It was somewhere between 100 and 150. Not bad considering. They came from all over Europe. Not a fantastic number but the people who came were very keen. ESDR: How important was the European idea? Sam Shuster: I think that was essential. The Americans had started research and got it going in a reasonable way. And so it was important, in a way, to compete. And I think the competition helped us develop. It had to be European. Our European standard of clinical dermatology was high and well respected worldwide. But not our research. We had to show that we in Europe could do research, so it was important to involve people from all the European countries. And we did that; we had a Board representing different European countries; and it was also important that in choosing the first Board, we had people who encouraged research who were also well-respected clinicians. That ensured we weren't going to be dismissed by clinicians, or frozen out by them. And the Board selected did help and encouraged European research. ESDR: What was the major contribution of the ESDR meetings? Sam Shuster: I don't think we made a major discovery. We made lots of quite interesting small discoveries. I think the main contribution was as a science forum which encouraged people in methods and thinking; that helped a lot. We saw that the standards of scientific thought and the standards of scientific investigation went up enormously. Initially we had scientific pieces presented as if they were clinical. Our response was a bit wicked; we mocked them so that people became aware they had to present at a good scientific standard or be teased. This had a very good effect, and people came back with scientific studies at a much higher level. They were not the sort of studies you see nowadays. The techniques were primitive in comparison. I mean if you wanted to measure something you would use a ruler! It was primitive. But we used those primitive methods in a way that we could quantify, analyse and show the effects on properties of different skin components. And so, the major effect, I think, was that we set in motion a solid standard of scientific approach, so that as new techniques came, you used them to answer solid scientific questions. There was no messing about. You couldn't come with nonsense. You would be shot down. And that was the great advance - the ESDR became a scientific club. ESDR: What does the ESDR mean to you personally? Sam Shuster: It means a hell of a lot because starting personally as a clinician who went into research … to me it was important that more people were into solid skin research and not doing the sort of things they did before. Dermatology had a lousy reputation. It was thought good diagnostically but cerebrally, it didn't exist; because the dermatological contribution was visual, it didn't allow you to think in the clinical process. So to me it was important that we became a thinking discipline. And you became a thinking discipline only when you put more into the discipline than ocular recognition, and the more would only come from research. So, to me it was vitally important that the skin became a research organ. And now it has indeed become an advanced research organ! For example, if you want to look at genetic, immunological or pharmacological things, the skin is marvellous; it's an organ you can go to directly. If you want to do lots of research, you go to the skin. It's an organ where you can think biologically. And to see this science developing in a European context where we could all get together - that's what it really meant to me. ESDR: So the science developed a lot and also the ESDR? Sam Shuster: The ESDR developed…. I could see people beginning to come from other parts of the world. The Americans started to come. The Japanese started to come. You could see that Europe now was a focus for research. And that surprised me, how much and how quickly it happened. But it delighted us all. We weren't just advertising, we were just doing good scientific work, and that resulted in people coming to join in because they saw that this was good science. ESDR: Over the years was there a highlight you can remember… a special meeting? Sam Shuster: No, I can't remember a specific highlight. I remember as various techniques came in, immunological techniques, as isotopic techniques - those were interesting and extraordinary….The highlights I remember were comic ones where we had battles between people…. No, I don't think we ever had an absolutely cracking breakthrough. The field developed uniformly and with it the level of scientific thinking. ESDR: Why is the meeting still so important? Sam Shuster: I think you have got to meetings as a scientist, just like an artist, show your work. And you have got to show it for several reasons. One is that you have to have other people say that it's rubbish … or "okay, that's interesting but not very" or "okay, but have you thought of that?". You can't do it yourself - it's like a parent and child; you think they are marvellous and someone else must tell you the way in which they are not. So that's one reason: you have got to have discussion. But if you didn't create an idea, your other scientific role is to try to pull it down. That tests the strength of the argument if it can resist attack, that…. Another reason is to disseminate ideas. Many a time, I have come back from a meeting, and while I have been listening … maybe to some daft paper, half dreaming about it, I have got the solution to a problem I have not been able to solve.… And the final reason is social. Scientists are social beings just like others, and by working together, learning about other people, where you can collaborate and get your work done…. That's essential. So for all those reasons you have got to have an organisation. And the ESDR … I am sure it is continuing in that way. ESDR: So we started with about 100 people now around 1200. Sam Shuster: Not bad !... I went about 4-5 years ago - the first time I had been for ages. And I realised the quality was excellent because I couldn't understand a bloody thing! The techniques were amazing. And they were all so aware of them. They were using them as if they were just nothing. Things that I would have given my left arm, my right arm and my head to have been able to work with. Marvellous techniques. I think all that is marvellous. What I don't know and this is a problem in science in general, is how well science still has an insight into the broader problems. And this is a general problem with science at all stages of development. You are a good scientist if you hit on a good topic. A lot of good topics come from sitting back and looking at the generalities…I hope there are within the ESDR people still able to give that broader scientific base so that you select subjects that are worthwhile. ESDR: Looking back, what were the important decisions made by the ESDR Board during your time as a Board member? Sam Shuster: There were some good ones. In no particular order. It was decided that the meeting had to be in English. This was a difficult one at first. People from several countries objected. 50 years ago … things were different. it was a bit of a battle but we got it through. Next thing that was … very difficult was age limitation. I thought after 45 you could still be a member but couldn't be active in creating the moves of the society. People didn't like that and we had to go to 50. And we know one or two managed to escape that at the beginning. But that was essential when seniority was so age-linked. Another thing, was that you could not stay in an official position more than a few years…. That was vital because in many clinical societies people stayed until only their corpse was on the committee. The other thing we started off with was to prevent tourism we stayed in the same place. We started off in Noordwijk and then moved to Amsterdam … and we stayed with Rudi Cormane organising meetings for some years. After which the ESDR was strong enough and could move without tourism. So those were early important things. The other was … not a rule book … but a culture, the culture of producing high science and being critical of low science … and enough time for discussion…. ESDR: So, a world without ESDR? Sam Shuster: Oh, that would be horrible. Imagine, you are doing science and there was nowhere to discuss it and no-one would be interested in science. Imagine a world of books without libraries. Imagine a world of paintings without galleries…. Obviously, in Europe we have to have an ESDR [otherwise] it would mean we are in a world with no interest…. I would hate to think of the world without the ESDR and somewhere where we could discuss the interesting and important things that are going on around us. Thomas Florestan: https://orcid.org/0000-0002-7695-4623 The authors state no conflict of interest. This article is published as part of a supplement sponsored by the European Society for Dermatological Research.