Zoccali: Dr. Shaldon, you are one of the leading founders of the ERA-EDTA and a longsighted man. Does the ERA-EDTA as it is now coincide with the Society you envisaged several years ago?
Shaldon: I participated in the formation of EDTA at a banquet in the Apothecary's Hall in the City of London on September 2nd 1963. The concept was born during a symposium on acute renal failure held at the Royal Free Hospital, London on that day. William Drucker, David Kerr and myself thought it would be instructive to have an association to discuss the problems of acute and chronic renal failure and their treatment by dialysis (Fig 1). The first name that was suggested was "West European Dialysis Association or WEDA" as there was already a West European Society of Clinical Chemistry. However, this name did not appeal to the French and so we agreed to call the Society the European Dialysis and Transplant Association. The first meeting was held in Amsterdam in 1964, and by 1965 Jean Hamburger wanted us to remove the T from the name in order not to compete with the newly formed International Society of Transplantation. This request was not accepted by council. In the 70's there was a strong move to change the name to European Society of Nephrology, which was again resisted and finally in 1996 the European Renal Association was added to EDTA to create ERA-EDTA. The recent suggestion that EDTA be dropped from the name seems unreasonable in that both from a historical viewpoint (as the oldest of the Dialysis and Transplant Societies) and from an interest of membership viewpoint as judged by abstract submissions; dialysis is certainly still a major interest of the Society. Thus to answer your question, I think that this Society has evolved to further education about prevention as well as treatment of renal diseases. The pejorative connotation associated with the use of the term dialysis should not be allowed to influence the decision to change the name of the Association.
Zoccali: You have been in contact and pursued joint projects with several clinical and basic science investigators worldwide. Who is the colleague that you consider the most creative?
Shaldon: I was fortunate enough to meet Charles Dinarello at the beginning of the eighties, and I would consider that he has the greatest gift of creativity in many fields. To watch him use his hands in the laboratory or the kitchen is to remember that in applied science one needs a good pair of hands as well as a first class brain. It would be unjust not to mention two other colleagues who were almost in the same league, Jonas Bergstroem and Karl Koch. Again, both of them were extremely competent workers in the laboratory themselves and gifted with green fingers, an aptitude of which I was always envious.
Zoccali: Which is the scientific paper(s) that influenced you most?
Shaldon: Curiously enough, I was most influenced by Sir Karl Popper's book "The Logic of Scientific Discovery" and R.A Fisher's "Design of Experiments". The former taught me to believe you could never prove a hypothesis and the superiority of inductive reasoning over deductive and the latter was fundamental in teaching me how important the control of variables was in clinical research.
Zoccali: Do you believe that the creativity of the individual investigator is bound to become less important than before as medical research is increasingly organized as a concerted effort of several trans-national teams?
Shaldon: Absolutely not. I believe that what you are referring to is loosely called "evidence based medicine". I think this is a useful tool but with extreme limitations which are rarely understood. Particularly as statistical associations do not prove causality unless they conform to the paradigm of the day, and the latter tends to change every decade or so.
Zoccali: Which is your strongest professional interest now?
Shaldon: Detecting Scientific Fraud which is clearly on the increase as the need for impact publications is essential for academic success.
Zoccali: Which improvements in dialysis technology do you foresee in the near future? Do you think that daily dialysis may become a standard?
Shaldon: I do not foresee any fundamental improvements in dialysis technology in the near future. If the patient population on dialysis continues to increase in numbers, age and comorbidities I doubt that daily dialysis will grow to be more than a niche market.
Zoccali: Do you think that in 20 years or so dialysis may be largely supplanted by renal transplantation as a treatment of end stage renal failure?
Shaldon: It would be nice to think so, but I doubt if 20 years will be long enough. In addition, renal transplantation has rarely been definitively curative and so dialysis may always be need as a backup situation.
Zoccali: Your frankness during discussions at scientific meetings is considered equal to your intellectual acumen. Do you feel that scientific discussions are becoming too diplomatic and therefore fairly boring?
Shaldon: I was educated in a frank school of scientific presentation in the late 50's at the Medical Research Society meetings in UK. Frank and sometimes abusive criticism of young research workers presentations by senior members was part of the show. How you coped under fire was considered important for your future. Today, large meetings and crowded schedules have removed the intimacy of the earlier days and free communication sessions have become very dull. In addition, the enormous plethora of repetitive meetings allow opinion leaders to repeat Powerpoint presentations in a road show fashion, which although very professional is rather boring especially on second hearing.
Zoccali: Which is the best initiative that the major scientific societies of nephrology can take to help developing countries to build up affordable dialysis programs at least for acute patients?
Shaldon: I think the educational programs that ERA-EDTA are sponsoring are the best and effective way forward. However, the development of dialysis programs in developing countries is largely an economic problem of the best use of medical resources, both human and financial. I am not sure that it should take a high priority over more cost effective use of these resources.
Zoccali: Do you think that entering nephrology is a rewarding professional option for a young doctor?
Shaldon:
I think one should regard Nephrology as a Speciality and not enter it until
you are fully trained in Internal Medicine. The fast track into Nephrology should
be discouraged.
Fig. 1
Read this talk by Dr. Shaldon on 40 years of dialysis experience!
