A FEE for SOSORT

Dear members of SOSORT, dear colleagues,

Manuel Rigo, Theodoros B Grivas, Tomasz Kotwicki, Toru Maruyama: you can imagine what an honour it is for me to become President of this new, but already most distinguished Society, after these amazing doctors and, most of all, wonderful men. They created, as Founders (together with JP O’Brien, HR Weiss, and myself), the Society; they served as Presidents and Board members; they remain in the Consulting Board to help, and audit SOSORT, our international Society On Scoliosis Orthopedic and Rehabilitation Treatment. But, primarily, while directly driving their own patients through the path of disease to find the best possible solutions for them, they have been able to find a way to indirectly help many, many more patients through SOSORT, and the scientific strength the Society is finally giving, after many years of absence, to the Scoliosis Orthopedic and Rehabilitation Treatment. My biggest privilege and task is to try following these efforts, and maintain high the vital flame of our Society.

The Society is steadily growing. Like a baby, after the first, cautious steps, SOSORT is now strengthening and new, fresh blood, is arriving. Hopefully, it will not pass too much time before these new friends will give much more scientific strength to research in the field than what the Founders have ever been able to do: but this is what we hope, and one of the main reasons why the Society has been founded: to coagulate these forces, to create the fertile basic ground from which a new and better knowledge can grow in this underdeveloped, and for a long time almost ignored area of research on scoliosis treatment.

And now, it is time to find straight, and good paths towards the future. The last Meeting in Barcelona clearly showed some of the old, as well of the new challenges we are going to face, and I will try to focus my Presidency on three key words, synthesized in an acronym, FEE: I list them in the order of the acronym, not of the priority:

• Fair-play: we are definitively different. We grew up in a world that was gradually forgetting research on conservative treatment, and where consequently a forum to compare each other, did not exist; we developed somehow isolated, in a few mainly (but not only) European groups; as a consequence, we are in many respects very different one from the other, either for braces used or for exercises proposed. But we also have a lot of commonalities, as we discovered and enlightened in these years: the treatment tools (but not how they are applied and developed), the team approach, the care of patients, the total commitment to their health, and to reduce their impairment and disability due to disease and/or therapy. While we began to contaminate each other, being also strong believers in what we do, we obviously continued to fight for our ideas. And this is correct, because new and better treatments for our patients can grow only from a good and strong comparison of theories and techniques. But, like in any other game, fair-play is the key: let’s fight “for” what we do, and not “against” what others do. This is a challenge SOSORT is already facing. And the Board has to be the referee to avoid unfair players to contaminate and disperse the good we are doing.

• Evidence: SOSORT is born to develop and strengthen evidence on scoliosis conservative treatment, either in favor or against our practices. After some years, we can say today that we have at least some evidence to rely on, but we have also to admit that a long way has still to be run. First of all, we need to find the means to reach the best possible evidence. In bracing, the partial failure of the well-financed and well-organized US randomized controlled trial (RCT) – it has been converted into an observational controlled trial – joined with the total failure of the Dutch one, as well presumably of others previously attempted we are not aware of, clearly tells something: RCTs are really difficult in a field where parents want the best treatment (or, at least, a treatment) for their kids. An RCT has been produced on SpineCor, but on very few patients with low degree curves; perhaps RCTs will be started on exercises, since it could easily be done in countries where exercises are not used at all, due to the so-called “exercise-dogma” that continues to be claimed against their usefulness. But, evidence can be gathered also through other designs, such as good observational prospective studies, mainly if coming from clinical databases and/or registries. We have to find our way towards evidence; but in any case we have to deeply fight for evidence, strong evidence, because this is the only road to the future. This is a task to be continuously maintained, and SOSORT will do, while trying to find the best methodological approach to evidence in our field.
• Ethics: while the pendulum apparently is coming back, and conservative treatment for scoliosis seems to gain some more strength, it is also time to be very careful. We must be ethical in the approach to patients, in the selection of patients to be treated, in the conduction of treatments. We have to fight for teams, including all the interested people: surgeons, conservative physicians, orthotists, physiotherapists, patients and families. Without a team, we loose the battle: and we cannot sustain the approaches based on single professionals. Moreover, there are people around the world that are making money with caricatures of conservative treatments: insoles or dental treatments to correct scoliosis, therapies sold through Internet without even knowing the patient, non-sense exercises and non-sense braces. This is not ethical: while remaining open to new ideas if developed through formal (and ethical) researches, SOSORT has to start fiercely fighting for ethics in the approach to patients. In our field, first of all; but not only. We will, and the Board is already trying to tackle this issue.

The term FEE underlines another concept. We must pay, in the sense that we must serve our Society, to make it grow even more, because our patients and the conservative world of scoliosis treatment deserve it. Let’s pay making research, let’s pay remaining members, let’s pay participating in the Meetings, let’s pay serving the Society in the various Committees, in the Board, and eventually becoming Presidents. And we will receive back much more: knowledge, science, advocacy (through the “policy of research”, that is the only one valid in front of the world), but also wisdom for our patients. And friendship. At least, this is my own experience; and I will fight to maintain this unique atmosphere of respect and alliance that now exists in the Society.

We are going to Milan for the next SOSORT Meeting, and you will soon have some news on that. Chicago 2013 and Wiesbaden 2014 are exciting venues we are already waiting for. Scoliosis Journal is growing, our Newsletter is a strength, the Web Site is developing very well. The new Guidelines will soon be published, and other Consensuses are on the way. The relationships with the other Scientific Societies of the field, SRS (Scoliosis Research Society) and IRSSD (International Research Society on Spinal Deformities), are steadily growing. The Presidential Line will continue, going to France and Lyon, with Jean Claude de Mauroy ready to face at best our future from next year. SOSORT is slowly, but constantly growing.

Dear members, dear colleagues, we gradually showed ourselves to the world in these years, and we will be looked at even more in the next future; we have one way only, the way of any scientific society: Fair and Ethical research for Evidence (FEE).

Stefano Negrini
President of SOSORT