THE WORLD NEEDS MORE ENDOCRINOLOGY!

Throughout the world, the number of patients with endocrine diseases is increasing, posing a vast challenge and a stress on healthcare structures, demanding increased allocation of healthcare resources and, ultimately, having a long term impact on the fabric of society itself. The chronic nature of endocrine diseases adds to the general burden on society.

 

The projections around the percentages of the population suffering from obesity, diabetes and the associated cardiovascular diseases and mortality are dramatic. Endocrine-related cancers are on the rise. Rates of fertility disorders and problems are increasing. The societal burden of rare diseases (including endocrine-related ones) is high on the agenda and continues to require new pathways to innovation and research resources. The challenge posed by environmental factors such as endocrine-disrupting chemicals may be accepted by some policymakers, but there’s a long way to go towards reducing exposure to these chemicals. And, very recently, the emergence of the pandemic has unveiled the huge impact of obesity and diabetes on mortality in individuals infected by the COVID-19 virus.

 

ENDOCRINOLOGY - WHAT?

This question is still a too frequent initial reaction when, as endocrine professionals, we want to draw attention to what our discipline means for the health of citizens around the world.

 

We need to recognise that, as a medical discipline, we are primarily present in secondary and tertiary healthcare structures. I would suggest that, too often, endocrinology remains distant and invisible from the mainstream discussions around healthcare – though some of the diseases we represent are very much part of the most pressing challenges our healthcare systems face right now.

 

Additionally, the number of healthcare providers engaged in our discipline is relatively small compared with the ‘bigger disciplines’ like cardiology or oncology (just to name two that most readily come to mind). A recent survey conducted by the European Society of Endocrinology (ESE) with national endocrine societies from 50 countries across Europe counted around 22,500 endocrine professionals. When recalculated, this equates to an average of 19 endocrinologists per million inhabitants (range 9–100 per million!). This survey also highlighted a number of the key issues we face, such as a general lack of understanding of endocrine health, under-funding of research, and a need to attract more people to endocrinology, amongst others.

 

A NEED FOR A EUROPEAN COLLABORATIVE EFFORT?

Yes, I am aware that there can be different perspectives around health and research policies and the national structures of healthcare, but I do believe that the things that unite us are stronger than the areas where we differ. And that definitely goes for a medical discipline like endocrinology.

 

I would postulate that every European country has the benefit of:

• access to research collaboration across borders and increased resources
• access to well-trained staff, with standards of education becoming more uniform across the continent
• staff who can move easily around Europe, so that opportunities for the individual and for the healthcare structures open up
• opportunities for patients to have access to across-the-border clinical care, primarily for those suffering from rare or ultra-rare diseases.

 

The suggestion that some countries would be reluctant to fully engage because they would expend more effort than the rewards they would reap is not new, and needs to be challenged. There’s something here for everyone. Just two areas where I can see a benefit for many countries are:

• the engagement in research without borders (including tapping into European funding mechanisms)
• hospitals’ need for skilled healthcare professionals with a good education, that may rely on mobility across Europe.

 

And for those countries where (due to size or economic considerations) healthcare structures, education and access to top-notch technologies and care are still problematic, the collaboration can and must offer a different perspective.

 

The solution can only be achieved within the framework of a collaborative European effort, much of which relies on a voluntary, engaged approach by all stakeholders. It is our aim that this should ultimately impact upon healthcare and research policies recognising the importance of endocrine health and disease.

 

ENTER ECAS

The collaborative effort in all its different dimensions and across national borders is one of the reasons for the existence of ESE. Our vision is to shape the future of endocrinology and we do so by uniting, representing and supporting the discipline.

 

Structures with the label ‘European’ can be perceived as challenging or competitive to national structures. The generally accepted principle of subsidiarity – the higher (European) level should only take action collectively when action at the lower (national) level is not effective (enough) – should also apply to the relationships between national and European medical societies, including ESE.

 

The ESE Council of Affiliated Societies (ECAS), a council with representation from 54 national endocrine societies from 44 countries in Europe, is at the heart of this principle and collaborative effort. Initiated in 2013, it has had an instrumental role in taking initiatives that address some of the challenges described above.

 

THE WHOLE IS GREATER THAN THE SUM OF ITS PARTS

The introduction in 2016 (with revision in 2019) of the European Curriculum on Diabetes, Endocrinology and Metabolism has set a common standard across Europe with regard to the expected knowledge and skills for endocrinology. It is reflected in the ESE European Postgraduate Course programme and the European Board Examination (organised for the first time in 2018, together with the Royal College of Physicians and the European Union of Medical Specialists). More than 200 endocrinologists have now taken this exam.

 

The development of the ESE Centres of Special Interest programme paves the path towards greater collaboration between European academic institutions in terms of joint research interests, staff exchange and educational exchange programmes. More is yet to come, with the valuable addition of initiatives from the ESE Young Endocrinologists and Scientists, in the form of their Clinical Observership Programme and the new Research Observership Programme.

 

The launch of the ESE White Paper in 2021, entitled Hormones in European Health Policies, addresses the priority areas for European endocrinology. It is here, as well, that ECAS and ESE’s National Affiliated Societies have played a major role in informing, prioritising and committing to the areas where endocrinology needs stronger policy engagement. In order to generate the ultimate benefit to patients around Europe, the efforts at the European level cannot be disconnected from a joined up effort at national level (most healthcare policies being the responsibility of national governments). ECAS will continue to have an important role to play here in the years ahead.

 

Members of the National Affiliated Societies represented in ECAS (which include the Society for Endocrinology) can sign up to ESE membership at reduced rates and enjoy a wide range of benefits, including substantial reductions in fees for registration for ESE events or for access to journals, as well as grant support. Through signing up to the ESE Advocacy Representative Scheme, societies and individual members can now build a stronger voice to be heard by policymakers, both at European and national levels.

 

A STRONG VOICE FOR ENDOCRINOLOGY - A SHARED RESPONSIBILITY

ESE, together with its partner societies with a national or specialist endocrinology interest, is fully committed to creating a better future for endocrinology. The collective aim must be to ensure that endocrinology remains an attractive and stimulating workplace for healthcare professionals, and an area for ongoing research and clinical investment. The goal is to secure better conditions around endocrine health and care for the increasing number of patients across Europe.

 

This, dear colleagues, is solely up to us, as endocrine societies, through the collaborations we foster, and also through the interest and engagement of every individual endocrine professional.

 

MARTIN REINCKE

President of the European Society of Endocrinology