Abstract
The World Federation of Neurology (WFN) is now the major international association for clinical neurologists. But in his overview of the organization’s first 50 years, Johan Aarli (Fig. 1) makes it clear that to establish itself in this position the World Federation overcame many difficulties and complex adverse circumstances through the efforts of a succession of individuals with the necessary commitment and powers of persuasion.
Figure 1.
Johan A. Aarli.
The specialty of clinical neurology developed in the latter half of the 19th century. By the 20th century, there was a perceived need for international collaboration to promote further developments in this field of study and a need for the dissemination of information and education of doctors seeking training in neurology. These needs had to be satisfied against a background of two World Wars, political ferment and complex financial crises.
But, on the positive side, the WFN has benefited from generations of distinguished and committed neurologists. It has also benefited from advances in communication through the internet, air travel and telephone conferencing. Thus, it must be remembered that in 1930, a meeting of fellow neurologists had to be set up by surface mail, travel was by ship and face-to-face discussions took place at a pre-arranged meeting venue. Now the process that we take for granted is almost instantaneous.
The WFN was established to create an academic forum for research, training and the exchange of friendship and ideas. In 1957, in Brussels, as the culmination of preliminary talks between three individuals, the first seed of the WFN was planted and its first constitution and by-laws were written. These individuals were Houston Merritt (USA), Ludo van Bogaert (Belgium) and Pearce Bailey (USA). They overcame doubters:
Sir Francis Walshe ‘Neurology is at a cross-roads …’
Sir Geoffrey Jefferson ‘Where else has it ever been? …’
Importantly, Merritt and Bailey obtained a generous grant of annual funds for 5 years from the US National Institutes of Health. The resolution to charge for annual membership at $2 per member had limited success, and over the next 5 years the financial situation became critical. It was saved by the work of two members who were elected in 1965 by the Council of Delegates of the WFN in Vienna. They were Macdonald Critchley, President; and Henry Miller, Secretary-Treasurer General. For the WFN, the Critchley/Miller era (1965–73) was critical because the American funding had run out and the Federation was sliding towards bankruptcy.
THE HISTORY OF THE WORLD FEDERATION OF NEUROLOGY: THE FIRST 50 YEARS By Johan A. Aarli 2014. Oxford: Oxford University Press Price: £39.99 ISBN: 978-0-19-871306-7
It would be hard to imagine a more improbable duo to save the WFN in crisis than Macdonald Critchley and Henry Miller. If Macdonald Critchley was a highly intelligent Don Quixote then Henry Miller was an equally articulate but provocative Sancho Panza. But between them, and with the support of John Walton, they persuaded the Federation delegates that, without a research arm, the WFN would be impotent, and that a WFN Research Committee should be formed in place of its semi-independent predecessor, and finally that its Chairman should have a seat on the WFN Executive Committee. The Research Committee was born in a spirit of antagonism but quickly grew into a creature of compromise, and matured into an essential strength of the Federation.
One of the delights of this book is the pen-portraits of the various protagonists in the history of the WFN. Aarli seems to remember many of those named above, and is able to give vivid personal descriptions of their strengths and weaknesses. He also includes a brief background of what was taking place in the world, so that the reader is able to understand how the WFN was affected by world events. Thus, during Macdonald Critchley’s presidency he mentions Soviet troops invading Czechoslovakia, the Vietnam War, Armstrong landing on the moon, and China becoming a member of the United Nations. He also reminds us that neuroimaging with CT began in 1971 and that the Nobel Prize for Physiology or Medicine in 1967 was awarded to Granit, Hartline and Wald for their work on the physiology and neurochemistry of vision.
John Walton succeeded to the Presidency in 1989 and Aarli describes his 8 years in the Presidency as the ‘coming of age’ of the WFN. During his time, Walton made the WFN a UK company limited by guarantee and a registered charity under UK law with the considerable tax benefits that ensued. And he revised the committee structure and gave the committees defined responsibilities. In 1985, at a World Congress in Hamburg, it had been agreed that a proportion (later set at 50%) of the profits of the Congresses should be given to the WFN. From 1989, every four-yearly Congress turned in significant profits, allowing the WFN to maintain a capital financial base on which it became able to support a variety of projects and initiatives. The WFN charged dues from each member society, and these—together with royalties earned from its scientific journals—gave an annual income sufficient to establish and maintain a permanent Secretariat in London.
Since 1997 (Buenos Aires World Congress), the WFN had consolidated its position as the organization to improve neurological health worldwide by the prevention and treatment of disorders of the nervous system, and to promote research and educational standards in neurology.
This task was achieved by a succession of distinguished and committed neurologists worldwide, supported by Trustees and a Council of Delegates from every country affiliated to the Federation (117 in 2014). It has also been achieved by establishing some 40 research groups (many publishing their own journal) affiliated to the WFN Research Committee and organizing their own meetings as well as advising the organization at World Congresses of speakers and topics. It is true to say that the enormous success of World Congresses has been primarily attributable to the work of the Research Committees and their Chairmen.
As its name implies, the WFN is a federation of national, regional, and continental groupings of neurologists. Through these diverse groupings, the WFN represents neurologists worldwide at the World Health Organisation (WHO) and membership dues of $3 per member per annum have remained unchanged for many years.
The need for a global health organization was first recognized after World War II and the WHO was established in 1948, on 7th April—World Health Day. The focus by the WHO on ‘health’, as opposed to taking ‘illness and diseases’ as the focus for public health activities, led to the need for negotiation by the WFN. Thus the WHO placed neurology within its organization as a part of ‘mental health’ or psychiatry. To neurologists ‘brain health’ was a more acceptable term to use when referring to neurological diseases. But this semantic argument was finally accepted by the WHO only after Aarli had achieved two reforms.
The first reform was to align the geographical groupings of countries in the WFN to approximately the same format as the WHO. This led to a ‘neurological atlas’, establishing resources for neurology across the world, and defining inequities and needs across regional and income groups in different countries.
The second related to the International Classification of Diseases (ICD) drawn up by the WHO. This classification clearly made a distinction between mental illness and physical–neurological diseases. The WHO recruited the WFN to revise ICD for neurology. This task was started by Aarli and is aimed to be complete in 2015 under the chairmanship of the current President of the WFN, Dr Raad Shakir.
Thus after a somewhat lengthy and laborious process of discussions, negotiation and hard work, neurology is at last accepted as distinct from mental health, having different epidemiological and educational needs.
The WFN also contributes to the education of neurologists in training and to research, especially epidemiological research. And it assists with the arrangements for meetings and programmes in each region. Aarli has been particularly active in creating ‘The Africa Initiative’, which aims to establish training programmes, support new national neurological associations, develop travelling fellowships and support public health activities in Africa. These activities are outlined in this book.
This ferment of activity in the WFN has not been without its problems. Two senior officers have suffered imprisonment, and one Vice President-elect was accused (wrongly) of financial improprieties (the Chief Prosecutor resigned as soon as he was compelled to admit error). A chapter is devoted to personal accounts by two of the individuals involved.
The WFN is generally known to practising clinical neurologists for the World Congresses of Neurology (WCN) that it organizes with, and in, countries throughout the world. These Congresses are popular, with delegate numbers now exceeding 7000 and each Congress lasting 8 days. They are expensive, but the support of commercial interests mitigates the expense for some, and the WFN contributes bursaries for many hundreds of delegates from developing countries. But the WCN are popular chiefly as a result of the quality of the programme. Invited keynote speakers (often including a Nobel Prize winner) will introduce major topics in neurological practice and are followed by invited experts with different special interests who present their views and research. Free communications of research from young neurologists are chosen by the Research Committee. But the meetings consist of more than a diet of academic presentations. Introduced in 2001 at the London WCN, ‘Neurological Tournaments’ have proved very popular. Teams from different countries compete daily in a knock-out quiz of obscure neurological knowledge. The host country draws up the questions and chairs the tournament with the Final Round on the last day of the Congress.
The Congresses have been consistently and increasingly successful but there is always the risk that a large international meeting, which these Congresses have become, may be affected adversely by world events or even targeted for political reasons. For the WFN there have been several ‘near misses’.
For example, the organizing committee for the 2001 Congress in London had to find a venue suitable for a conference likely to attract many thousands of delegates. It had been a tradition that the Congress was held in September, but when the proprietors of the venue ‘Earls Court’ reported no availability in September 2001, the decision was made to move the date of the Congress to June. This proved to be a fortunate choice as delegates otherwise would have been travelling around the time of the 9/11 atrocity in New York. Similarly, in 1997 the Congress in Argentina (Buenos Aires) was a considerable financial success for the WFN. But this would have turned to complete failure if the collapse of the Argentine currency in 1998 had happened 6 months earlier. Even in Sydney in 2005, on the first day of the Congress the police announced that they had just averted a bomb plot in the city. Congress organization has been lucky to avoid disasters that could have damaged it fatally.
The WFN has therefore not only survived but evolved, flourished and succeeded over the 50 years of its history. Aarli’s comprehensive account of the history and the structure of the WFN is in a nicely presented volume. His personal experience of the Presidency and knowledge of most of the personalities in the story give it authenticity and there is an informative preface by Lord Walton, who has played a major role in the development of the Federation. It will be read with interest by neurologists who want to learn more about this important organization and by those who have a connection with the WFN.