Fall 2020 (Volume 30, Number 3)
Once Upon a Time in Canadian Rheumatology: 1974-84, a CRA Decade Long Before Biologics and JAK Inhibitors
By Dr. Manfred Harth, CRA President, 1982-1984
Remembrance of things past is not necessarily the remembrance of things as they were.
– Marcel Proust
I was asked to reminisce about the period when I was involved in the leadership of the CRA, that is the 1974-1984 decade. I was a member at-large of the Executive Committee from 1974 to 1976, out of office for two years, then Secretary in 1978-80, Vice-President in 1980-82, and President in 1982-84.
Some may remember that in those days CRA stood for Canadian Rheumatism Association, which was a name change from the original 1936 designation of Canadian Rheumatic Disease Association. The CRA from 1974-84 was a much smaller and poorer organization than the current CRA. Our meetings were initially short, lasting one day only, and on a modest scale. Eventually the Royal College asked us and other specialty societies to join their meeting. We welcomed this as the College paid for many of the meeting expenses involved.
It was not until 1972 that the Royal College introduced the fellowship examination for rheumatology. Until then, most rheumatologists were internists who usually had had one to two years of training in the specialty and spent at least 50% of their clinical time in rheumatology.
Metro Ogryzlo, who had founded the Journal of Rheumatology in 1974, hoped that the CRA could take it over, but we did not have the required financial resources. The CRA did adopt it as its official organ, leaving it to individual members to decide on whether they would subscribe.
Toronto had dominated Canadian rheumatology for years, but the 1970s and 1980s saw other Canadian academic rheumatology centres increasingly engaged in research and post-graduate training. A friendly (well, not always!) rivalry ensued and CRA meetings were the better for it.
There was a very close relation between the Arthritis Society (TAS) and CRA. TAS was led by Edward Dunlop, a blinded war hero and an extraordinary man whose contributions to Canadian rheumatology remain unequalled. The CRA instituted an annual lecture to honour him and Rita Dottridge, his close associate. It was thanks to TAS that Rheumatic Diseases Units were established with dedicated inpatient beds, and essential health care professionals attached to them. TAS paid for many rheumatology fellowships at a time when departments of medicine were somewhat reluctant to fully support the development of our specialty. TAS gave scholarships to newly appointed young faculty, and offered research grants assessed by peer review.
The CRA hosted the 1974 meeting of PANLAR (then the Pan-American League against Rheumatism, now the Pan-American League of Associations of Rheumatology) in Toronto, although the major organizing work was done by TAS.
It was in this decade that we started the Ian Watson and the Phil Rosen Awards (the latter honouring a CRA president with an outstanding record of service).
In 1976, a committee of CRA members who had participated in a Medical Manpower Study, sponsored by the Royal College and the Federal Department of Health, reported that the ratio of rheumatologists per population was 1/180,000. In 1983, the CRA Manpower Committee published a study of Canadian rheumatology training programs and found that 61 trainees had completed the required two years in the 1973-78 period, thus raising our hopes that the above ratio might improve slowly.
Rheumatology started attracting an increasing number of female trainees, and we began seeing more women with full-time or part-time academic appointments, or in independent practice.
Big Pharma’s interest in rheumatology was modest. We were using antimalarials, gold, penicillamine, steroids, azathioprine, cyclophosphamide, and scores of different nonsteroidal anti-inflammatory drugs (NSAIDs); we had just started prescribing sulfasalazine. A few daring souls had tried methotrexate. Nothing there to attract much support.
The available immunologic laboratory tests allowed better assessment of various rheumatologic conditions. Imaging in rheumatology had advanced somewhat with the introduction of CAT scans and scintigraphy. Magnetic resonance imaging (MRI) machines were starting to be installed in teaching hospitals. Diagnostic ultrasound in rheumatology was still in its infancy.
It was, overall, a time of modest progress in our organization, paralleled by modest advances in therapy. We were much better at diagnosis than treatment. Not quite the dark ages, but quite a few years away from the “Renaissance.”
Manfred Harth, MD, FRCPC
Emeritus Professor of Medicine,
University of Western Ontario