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From: The Rheumatologist, March 2009

Get a Read on Rheumatology’s Past

The History of the Bulletin on the Rheumatic Diseases

by Doyt L. Conn, MD

What happened to the Bulletin on the Rheumatic Diseases? This was a question posed to me by a Central American rheumatologist this past summer at the PANLAR meeting in Guatemala City, Guatemala. I told him the Bulletin was dead. The last issue of the Bulletin was on Behçet’s disease, by Kenneth Calamia, MD, and Merhrdad Mazlumzadeh, MD, volume 53, number 2, 2004, and was an online publication.

Those in leadership positions at the Arthritis Foundation (AF) in 2004 abruptly discontinued the Bulletin without discussing their decision with the Bulletin’s editorial board. Those on the editorial board of the Bulletin (including myself) wanted to do a final issue giving the history of the Bulletin and provide some explanations for its demise. That idea was rejected, and we were told that the Bulletin was not necessarily dead. We were told that it was premature to declare the Bulletin dead and that it was inappropriate to broadcast this to the ACR or anybody else. That was January 2005. I think that now we can say the Bulletin is dead.

There are at least three reasons that the AF decided to discontinue the Bulletin: 1) The foundation was not able to secure pharmaceutical industry funding; 2) there was a perception that such a publication was not needed; and 3) the evolving mission of the AF at that time did not include supporting such a publication.

I think that it is important for the new generations of rheumatologists, as well as for the older rheumatologists who remember the Bulletin well, to highlight the history of the Bulletin. The Bulletin played an important role in the education of physicians, residents, and students. I will provide the background to the saga of its last days.

Some History

The Bulletin was conceived during the optimistic time that followed the introduction of cortisone into clinical medicine in 1949.1 The first issue was published by the New York Chapter of the Arthritis and Rheumatism Foundation in September 1950.2 A year later, the National Arthritis and Rheumatism Foundation (ARA) undertook its publication. The ARA sponsored the Bulletin until 1987. Up to 1987, the ARA was a professional and lay organization combined. The ARA published Arthritis & Rheumatism, the Primer on the Rheumatic Diseases, and the Bulletin on the Rheumatic Diseases. In 1987, the ARA became the ACR, the professional organization, and the AF became the lay organization.2 The AF assumed the publication of the Primer on the Rheumatic Diseases and the Bulletin on the Rheumatic Diseases. The ACR continued to publish Arthritis & Rheumatism.

The Bulletin was started in 1950, a year after the appearance of the first publication describing the benefit of cortisone in the treatment of rheumatoid arthritis.1 The initial success of cortisone was publicized widely in the lay as well as the professional press, and the word spread dramatically. There was a state of optimism in the public and the medical profession about the possibility of successfully treating and maybe curing inflammatory arthritic diseases. This resulted in the need for information about arthritic diseases for the public and the medical profession. Another important factor that contributed to this optimism and stimulated the funding of nonprofit organizations and federally funded research was the fact that World War II was over, and the United States economy was expanding with the adult population at work. In this environment, the Bulletin was born.

The first editor, Joseph J. Bunim, MD, stated in his introduction that, “the need for such a publication was made evident by the realization that although much remained unknown in this complex field, much of what was known was not reaching the practicing physician.” The purpose of the Bulletin was “to keep doctors abreast of the more important clinical advances and changing concepts of rheumatic diseases promptly and simply.”3 This continued to be the purpose of the Bulletin.

The editors over the years who have insured the quality and continuity of the Bulletin are:

1950–1961 Joseph J. Bunim, MD

1962–1965 Ronald W. Lamont–Havers, MD

1966–1982 Gerald P. Rodman, MD

1983–1990 Evelyn V. Hess, MD

1991–1998 John S. Sergent, MD

1998–2004 Doyt L. Conn, MD

Fifty years ago, the information that the physicians had to guide management came from textbooks and, in the realm of rheumatic diseases, from the Bulletin on Rheumatic Diseases and from Rheumatism Reviews. The American Association for the Study and Control of Rheumatism, which became the American Rheumatism Association, was a physician group organized in 1934.4 In that year, the organization initiated a yearly or biyearly review of the rheumatism literature, called Rheumatism Reviews. This continued through 1978.

From its start in 1950 until 1987, the Bulletin was sponsored by the ARA, then after 1987 by the AF. From 1992 to 2004, the Bulletin was sponsored by pharmaceutical companies through the AF.5 Because of this, there might be an assumption that the Bulletin was industry influenced. I can say, as the last editor, that the pharmaceutical sponsors did not influence editorial content or perspective. From 2000 through 2003, the Bulletin was offered on the Internet through the AF Web site and by print. It was offered only through the Internet in 2004 because there was no pharmaceutical funding. The decision by the AF to make the publication of the Bulletin contingent upon pharmaceutical funding probably marked the Bulletin’s demise. This is because most pharmaceutical-funded enterprises outside of their industry are usually short term–oriented and opportunistic.

An idea of the influence of the Bulletin can be seen by its circulation numbers. The circulation numbers of the print Bulletin for 2001 was 51,608. The largest professional group subscribing were family practitioners. The breakdown was as follows in 2001:

  • Family practitioners: 18,114
  • General internists: 5,998
  • Rheumatologists: 5,804
  • ARHPs: 6,750
  • Medical Students: 2,331
  • Orthopedics: 3,064

The number of online subscribers in 2002 was approximately 9,000.

Today’s Sources for Rheumatology Information

Today, physicians caring for patients with rheumatic diseases can obtain their information from multiple sources: textbooks, journals, sources on the Internet, meetings, many pharmaceutical publications, and the ubiquitous pharmaceutical detail person ready to comment on the virtues of their particular products. However, the abundance of information today, much of it sponsored or instigated by the pharmaceutical industry, might pose a dilemma for the practicing physician. The physician today, like the physician of years ago, desires to provide the best care for patients. To do this, physicians must rely on scientifically sound information. The physician today is busy and cannot sort through the stacks of publications or all of the sources on the Internet. The physician must have available a recognizable source of reliable information that is accurate and succinct. The best way to accomplish this is to obtain information sponsored by reputable organizations such as the National Institutes of Health, university medical centers, the ACR, and the AF. There are Internet sources of information, such as UpToDate.

The ACR in November 2006 launched its monthly print publication, The Rheumatologist, which is directed to rheumatologists and rheumatology health professionals. This publication reviews scientific information, selected rheumatic diseases, education, economics, human-interest stories, and activities of the ACR and ARHP. It fulfills a need. It is a modern resurrection of the Bulletin for the rheumatologist and reflects the spectrum of issues of interest to the rheumatologist. It is interesting to note that economic issues were not considered to be pertinent 50 years ago as the Bulletin was conceived and perpetuated, but economic issues have become as important to the practicing rheumatologist today as the science.

The rheumatologist’s needs are probably met today with the various publications sponsored by the ACR, including The Rheumatologist. As for the other physicians—such as the primary care physician, internist, and medicine residents—for now, I guess, we will leave their rheumatic disease education to whatever sources they can find. I suspect the succinct, pertinent, and up-to-date information provided to them by the Bulletin has not been replaced.

Dr. Conn is professor of medicine in the division of rheumatology at Emory University School of Medicine in Atlanta.

References

  1. Hench PS, Kendall EC, Slocum CH, Polley HF. The effect of a hormone of the adrenal cortex (1-Hydroxy-11-Dehydrocorticosterone: Compound E) and of pituitary adrenocorticotrophic hormone on rheumatoid arthritis. Proc Staff Meet Mayo Clin. 1949;24:181-197.
  2. Kelley WN. A new role for the ARA in guiding our destiny. Arthritis Rheum. 1987;30:1201-1204.
  3. Bunim JJ. Introduction. Bull Rheum Dis. 1954;Volumes I–IV, 1950–1954.
  4. Smythe CJ, Freyberg RH, McEwen C. History of Rheumatology in the United States. Arthritis Foundation. 1985;31.
  5. Grayzel AI. Message from the Arthritis Foundation. Bull Rheum Dis. 1992;41:1.

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