Yesterday, Today and Tomorrow; 50 years of epidemiology
Reproduced from Issue 126 of Arthritis Today
Mary Ingram looks back on how the Arthritis Research Campaign's Epidemiology Unit has changed over the past half century.
The arc Epidemiology Unit based at Manchester University celebrates its Golden Jubilee in November this year. This pioneering unit, funded by the Arthritis Research Campaign, has been very successful in demonstrating the impact of musculoskeletal diseases on the individual and society as a whole , and improving knowledge about the causes and consequences of the major rheumatic diseases. The EU has also gained an international reputation as a centre of excellence for epidemiological research.
In 1954 when the idea of a 'Mobile Field Unit' was first proposed to the Scientific Coordinating Committee of the Empire Research Council (ERC), as arc was then called it was, seen as a three to five year project. Fifty years later the unit is still going strong. The foresight of the ERC and the drive of Professor Jonas Kellgren, holder of the first Chair in Rheumatology in the UK at Manchester University, got the Mobile Field Unit off the ground together with a commitment from the ERC of £30,000 (over half its accumulated funds) on equipping the team and an annual outlay of £6-7,000 for salaries. Its purpose was to investigate the frequency and occurrence of the major rheumatic diseases in communities. In a press release at the time, Dr W.S.C. Copeman, chairman of the ERC commented that: “the project is the most exciting and ambitious the council has undertaken”.
The first director was Dr John S Lawrence, a rheumatologist, who had previously worked with Professor Kellgren on a research project looking at rheumatism in miners at the Bedford Colliery, in Leigh in Lancashire. This research formed the basis of one of the first studies that was undertaken by the MFU in which 700 people in Leigh were examined and x-rayed. Over the next 14 years Dr Lawrence and his team travelled the length and breadth of the UK – from Annandale in Scotland to Cornwall, studying rheumatic diseases in different populations. Travelling around the country presented many challenges for the researchers and lessons were learned along the way. A survey in rural Wensleydale had to done in two parts because many farmers were unable to attend the first session in August, as bad weather had delayed the hay harvest, and so the team had to return the following April. The team also travelled further afield to places such as Jamaica and Montana in the USA, where in November 1961, the survey had to be abandoned due to severe weather conditions, and completed the following spring. Here also the local Blackfoot people gave the MFU staff names - Dr Lawrence was 'Chief White Eagle', the radiographer 'Princess Hollerini and Holy', and the laboratory assistant 'Princess Killsmany'.
Early surveys used borrowed equipment but in 1958 the MFU took delivery of a Mobile X-Ray and Laboratory Unit. Funded by a Wellcome grant of £13,000 and specifically designed for the MFU it was the only one of its type in the world. Comprising two vans, the mobile unit housed a reception room, changing cubicles, an X-Ray room and darkroom (so that films could be processed quickly), an office and examination room. In fact, everything needed for the survey was considered including the purchase of a Hillman Husky estate car for use on home visits and to ferry respondents to and from the examination centre. The results of these pioneering large surveys have revolutionised our understanding about the occurrence of the major rheumatic disorders, and are still used by researchers today.
On Dr Lawrence's retirement in 1968, Professor Philip Wood was appointed as director and the MFU became the ARC Epidemiology Research Unit. Many of the EU's activities at this time were aimed specifically at improving the care of arthritis sufferers and highlighting problems such as disability, and are still in use or maintained today. A register of rheumatologists in the UK was set up and is used to identify those areas of the country where patients do not have access to, or where there is a future need for rheumatologists. The classification of diseases, in particular musculoskeletal conditions, and the development of ways of measuring resulting disability was another main focus of the work of the EU. Working with the World Health Organisation, Professor Wood and his staff produced the chapter on musculoskeletal disorders for the International Classification of Diseases 9th edition, and later the 10th edition. This important resource, used world-wide by clinicians and researchers, standardises the way we identify and define specific conditions, and so making the comparison of research results from different studies effective. Later Professor Wood oversaw the production of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). This was used by local authorities to collect information about how the needs of people with arthritis were met by local services, and for monitoring trends in the occurrence, severity and service provision for people with arthritis in the local community.
The appointment of Professor Alan Silman as director in 1989 heralded a new era. The late 80's had seen advances in epidemiology brought about by the development of new computer technology. The EU began again to undertake large-scale population surveys. Pioneering work continued with the establishment of the first ever community-based register of patients with inflammatory joint disease located in Norfolk (NOAR). This unique study has contributed greatly to our understanding of inflammatory arthritis. Large-scale population studies have also been undertaken looking at chronic widespread pain and osteoporosis. Technological advances in molecular biology and genetic analysis have made possible the search for the role of genetic factors which influence disease susceptibility and severity. EU research nurses travel thousands of miles each year collecting blood samples from affected patients and their families. Information about the resulting DNA is stored in a national repository and made available to researchers all over the world.
The unique nature of many aspects of the EU's work internationally has throughout the years resulted in extensive collaborations with individuals and groups from many countries. The unit has been the coordinating centre for many major collaborative studies including most recently a study of childhood arthritis.
The on-going commitment of arc allows the EU to continue its groundbreaking research programme. In November 2004, the EU will start its Golden Jubilee Year with an international symposium at Manchester Conference Centre. The theme will be Rheumatic Disease Epidemiology, Yesterday, Today and Tomorrow and will feature eminent speakers from the world of rheumatology who have been associated with the EU over the years. Other celebratory events are planned including an Open Day in the Unit during 2005, an exhibition in the University of Manchester Stopford Building foyer, and fundraising activities. Further details will be available on our website http://www.arc.man.ac.uk
- Mary Ingram is the librarian and information officer at the arc Epidemiology Unit.
