March 3, 2023

Read the full article of the entire interview:

 Interviewer: Professor Masayuki Amagai, President of JDA 

Thank you very much for joining us, Prof. Röcken. JDA started this Leadership Dialogue series to provide a chance to talk with leaders in dermatology around the world. You are the current president of the European Academy of Dermatology and Venereology (EADV), and I have been looking forward to speaking with you. Could you begin by introducing yourself?

My name is Martin Röcken. I am originally from Germany, my wife is Swiss, and our three children are now spread across Europe, so we see ourselves as Europeans. I started as a clinician only and after five years moved to science. We, Prof. Amagai and I, met first when we were working at the National Institutes of Health (NIH) in the US. You were a floor above me. We both worked on autoimmune diseases from different approaches. Your work changed the understanding of blistering autoimmune diseases. At this time, I was working on the T cell side to explore the influence of T cell cytokines on the development of diseases. We focused on the role of cytokines in autoimmune diseases. We mainly analyzed the T helper cells. We showed that we do not need to delete the T-cells to efficiently treat autoimmune diseases (a dogma at that time), but that we rather have to educate the autoreactive T helper cells to become less aggressive or even protective by changing their cytokine pattern in vivo.

After my experience in research, I joined the medical faculty at the Munich university for nine years, and about 20 years ago I became the chair of the department of dermatology here at the Tübingen University. My personal view on dermatology is that we have to care on the large spectrum of the potentially severe diseases, and that our goal is to broadly understand these diseases and our patients. Academic dermatology has changed our understanding of many diseases and allowed us to develop most the novel treatments. Clinician-scientists paved the way for new therapeutic concepts further developed by the industry, especially in the past 20 years.

I vividly remember first meeting you at the NIH. I was at the Dermatology Branch, NCI, NIH from 1989 to 1992, and you were there from 1991 to the beginning of 1993. You were working with Ethan Shevach, mainly focused on T-cells and cytokine T-cell mediated diseases. At that time, I was working on pemphigus, an antibody-mediated disease. Dealing with antibodies was relatively easy. But you were studying T-cells, which are much more complicated, so I was really impressed. From the Zoom video, the audience probably cannot tell, but you are very tall. So, I have been quite literally looking up to you since we first met, and that impression has lasted over 30 years. Now, you are a huge figure in dermatology and are leading scientists in both basic immunology and clinical dermatology.

As a T-cell person, I admire the B-cell people. I think we both think that the other side is more complicated than ours.

It was hopeless for me to understand T-cells well. But it was a good time.

Yes, it was a fantastic time. At that time, no one believed that we would change thinking and therapy, in medicine and dermatology.

In the late 80's and early 90's, the main focus of dermatology was diagnosis, not treatment, because there was so little variety in treatment. But now, it is amazing the approaches we have for skin diseases. We witnessed the fantastic progress of the field over the last 30 years.

You mentioned Ethan Shevach, who was a big star in immunology in the US in the late 90's. At that time, he still said there was no evidence that immunology could help us with therapy, but things have changed significantly since then.

Next, can you tell us about EADV? It was founded in 1987, but what is its mission, and what are its major activities?

EADV was started by clinicians and a few clinician-scientists, who wanted to establish Europe-wide training, akin to the American Academy of Dermatology (AAD). The main focus was dermatology training. Beginning around 2000, the EADV started to be mainly chaired by important clinician-scientists from throughout Europe, who were experienced in translational dermatology. They turned the EADV into a more academic-clinical training including the different European schools. Japan is very universal, but in Europe the different countries have each special focuses. It is at the EADV, where we learn from each other about the various aspects of dermatology. Some areas of dermatology are best covered in France. e.g., the large studies on novel therapies, others in the northern countries, like large genetic studies, others in southern countries, or in central Europe, where there are many departments especially strong in immunology.

We have different experiences, and the beauty of going to the International Investigative Dermatology (IID) was learning about the different focuses in other areas of the world, which enrich one another through these congresses. To strengthen this, the EADV Congress was changed 10 years ago to be more structured with symposia starting from clinics, epidemiology, and pathophysiology to classical and more advanced therapies. This allowed us for each disease to unify the different experiences from Europe in one symposium over one day, and to exchange our different experiences on, for example, melanoma: surgery, pathophysiology, immunotherapy, side effects, targeted therapies.

This is the beauty and significant advantage of EADV and the training it provides. We now seek to include more practitioners again. Dermatology has changed dramatically in recent years, so a primary goal of the EADV is to educate practitioners throughout Europe who do not have much insight on the biology and the "why" behind the drugs.

Another significant activity of the EADV is training our young colleagues, including on leadership and soft skills. Also, we have been working to unify our efforts together with the European Society for Dermatological Research (ESDR). There were major communication problems in the past, but now we see each other as a sibling organization, and we make common courses for our young fellows. We also unify patient advocacy. There is less visibility on severe dermatological diseases compared to a field like cardiology, so we have to teach the public about the severe impacts skin diseases have on the life of the affected patients.

EADV provides a strong and crucial platform for educating the next generation. EADV is a European community, but are there any conflicts with the individual countries' dermatological meetings? How do you unify-or is the mission different?

At one time there was some conflict, but now the national societies understand the necessity of inter-European education. We are a sort of mother organization, closely collaborating with national societies. We are working closer and closer with them. Each country has one or two of their representatives in EADV board, depending on the number of members.

I see you have built EADV maintaining respect to each of the countries' societies.

We cannot try to overrule each other-we need us as a unity for our patients. It is at the EADV where we exchange and from where the messages are brought to the countries, where they distribute the knowledge and carry out the training. Especially with our young doctors, they are using anti-cytokine antibodies, anti-PD1s, immunoglobulins, and they frequently have no idea why! Our mission is to make people understand what they are doing.

You also mentioned that the ESDR and EADV used to be in conflict, but now they are cooperating well?

In the early times, the clinicians who created EADV did have a weaker connection to academic dermatology. It was when strong clinician-scientists from throughout Europe started to have a big impact on EADV and that the ESDR and EAVD both understood we have the same goal of helping patients. The one is more basic, and the other is more clinically oriented, but when our shared goal was understood, it became a very fruitful interaction and collaboration.

As chair of the EADV Scientific Program Committee from 2014, you have had a significant influence on bringing EADV towards a more scientific approach. Little by little, through the contributions of many science-minded dermatologists, EADV and the ESDR have reached their current status.

EADV would not be what it is today without the ESDR and those trained in the ESDR. I was trained in a department of clinical dermatology, with excellent dermatologist trainers. Once I had done academics, I learned that you need both to be an excellent clinician. Knowing the academics gives an important advantage because you understand the pathophysiology of the diseases and treatments.

What are the future challenges of the EADV in your view?

There are two major challenges. One is making the best congress, with the quality to not only translate academics into practice but also to motivate practitioners to make them want to understand and learn. This will help our patients. Another big problem-if you read Nature or Science, most of the articles are now about the environment. Congresses and fairs worldwide in aggregate produce as much CO₂ as 1 to 10% of the world population would be allowed to produce in one year. We want to work strongly on sustainability since we all share this one planet.

With an international congress, about two-thirds of participants are traveling in, so we are pushing for sustainable options for traveling, and are working together with local organizing congress societies. Secondly, we met with the ESDR and are considering reducing travel for congresses, perhaps in two or three years. Third, we are working on concepts to compensate our CO₂ output. It is still difficult to find the right way and measurement for this. But if the calculations from publications like Science, PNAS, and Nature are correct, a sea level rise could endanger many harbor cities, if we exceed a warming of two degrees C. The next 10-20 years seem to be of critical importance, so we have a responsibility.

It is amazing that EADV is also thinking about CO₂ output and reducing travel. That is very impressive.

Looking at Science and Nature from last year was a wake-up call.

We live on a single planet and must pass on a good environment to our children.

Yes, you and I, we both have children, but it is also a general responsibility for humanity. Until recently, I did not imagine the tremendous impact we have on the environment with all the congresses.

Whatever our specialty is, we each have to think about our CO₂ output, I completely agree. I would now like to turn the conversation to potential areas of collaboration between EADV and JDA. What ideas do you have in this regard?

Japan and Europe have complementary experience in many diseases and experimental approaches, so two ideas come to my mind. It would be great to have colleagues from Japan coming to give lectures in Europe, and vice versa. Another idea is having exchange programs between trainees, potentially beginning through virtual means. What ideas do you have in mind?

We have plenary lectures and symposiums, so it would be easy to implement an EADV guest lectureship. We aim to always have some English-speaking sessions at our annual plenary symposium, so it can benefit participants from other Asian countries as well. JDA is also trying to provide an important platform for Asian communities including Korea, Taiwan, and others. We would like to increase international exchanges, especially after the last three years of COVID-19. It would be wonderful if EADV could provide a core program for our JDA event.

Yes, I agree.

It may also be good to have a JDA representative or JDA-related Asian representative hold a session at EADV's annual meeting as well.

At our EADV meeting, we have symposia in the morning and afternoon, but also plenary sessions with major talks from prominent speakers from other groups like ESDR. It would be great to have speakers from Japan also. If we have the right focus that is clinically relevant to participants, the talks can have a great impact.

JDA appreciates the EADV's support offered to our young fellows with registration and travel grants, and this is something we would like to reciprocate for EADV for our 2024 annual meeting in Kyoto.

Thank you very much Prof. Röcken for your time and the wonderful Leadership Dialogue today. Do you have any parting words for the audience?

Thank you so much, it was a real pleasure seeing you again. When you asked me about this, I felt a lot of pressure because I hold you and your colleagues in great esteem. When I was the first time in Kyoto for the IID, Japanese culture impressed me so much. The few days I spent there left a lifelong impression, and I have a deep respect for the experimental and clinical dermatology in Japan. The only pity is that we are so far away one from one another. Thank you so much for opening this interaction between JDA and EADV.

Thank you!