Wartime 'innovation' spurred revolution in rheumatology, surfing technology
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MAUI, Hawaii — Although traditionally marked by scant changes in treatment and diagnosis from its prehistoric roots, the field of rheumatology experienced a windfall of “disruptive innovation” following World War II — an unlikely catalyst that also revolutionized surfing technology, according to a unique “Hawaiian TED Talk” presented at the 2020 Rheumatology Winter Clinical Symposium.
“There have been some interesting parallels between the evolution of surfing and rheumatology over the millennia,” George Martin, MD, of Dr. George Martin Dermatology Associates in Hawaii, told attendees. “I wanted to base this talk on ‘innovation’ because that is what has driven rheumatology and surfing over the years to where they are today. However, that same innovation often creates a second problem — complexity — that we now have to deal with in medicine.”
First identified in ancient Egyptian medical texts, arthritis and joint pain have been long-time companions to humanity, Martin noted, and represent some of the earliest clinically recognized diseases.
“One of the first diseases in rheumatology to be diagnosed was gout, and we have prehistoric fossil remains of gout and osteoarthritis dating back to 2640 BC,” he said.
Similarly, the Greek physician Hippocrates of Kos would distinguish gout from other forms of arthritis in his medical writings in 300 BC, while a slightly later Ayurvedic medicine text — the Charaka Samhita — would reference a variety of different arthritides, and may provide the first description of rheumatoid arthritis.
However, despite awareness of these diseases across multiple cultures, Martin noted that therapies would remain largely unchanged and rooted in herbal remedies for much of its history.
Ancient Egyptian and Assyrian texts recommended using willow bark extract to reduce the redness and pain of inflamed joints; nearly two millennia later, in 1763, English physician Edward Stone would echo this use of ‘the bark of the willow’ for the treatment of inflammatory pain and fevers. Likewise, the use of colchicine for gout as prescribed by the Byzantine physician Alexander of Tralles in the sixth century was only rediscovered by Professor Baron Von Stoerk in 1763.
After centuries of stalled therapeutic progress for rheumatic diseases, “We had this incredible explosion of innovation right after World War II and leading right up to today,” Martin said.
Beyond the well-known advances in military technology spurred on by World War II, collaboration and sharing of information among Allied countries significantly contributed to medical advances that were still unknown in civilian practice. In 1948, Malcom M. Hargraves, MD, and colleagues would discover the LE cell phenomenon, which would lead to the development of the antinuclear factor.
First described by Norwegian professor, Dr. Erik Waaler in 1940, the discovery of the rheumatoid factor would be subsequently redescribed by Dr. Harry M. Rose in 1948 — a finding still known as the Waaler-Rose test. In that same year, the U.S. rheumatologist Dr. Phillip S. Hench would administer cortisone for the first time to a patient with RA, and discover the beneficial effects of glucocorticoids.
Lastly, the increased use of drugs to combat rampant malaria outbreaks in the South Pacific Theater during World War II would see the burgeoning familiarity with these drugs among rheumatologists as well as potential therapeutic applications. In 1951, quinacrine would be used for the treatment of lupus, with chloroquine used in 1957 for the treatment of several rheumatic diseases. Today, Martin noted, hydroxychloroquine is still used for rheumatic diseases due to its efficacy and safety profile.
As an avid surfer himself, Martin was quick to note that — much like the field rheumatology — the sport of surfing has been similarly unaltered for millennia-long periods, an unvarying trend only broken up by occasional “disruptive innovations”.
Estimated to have first originated in Hawaii around 300 AD with Polynesian migrants, surfing in the islands would use three basic styles of board: The small paipo, used by children; the mid-sized and maneuverable alaia; and the enormous 200-pound, 20-foot-long olo reserved for the ruling class. Carved from wiliwili, ula and koa trees, traditional surfboards would be laboriously smoothed with coral blocks, charred and scraped into their final shapes.
As these earlier surfboard designs lacked fins or a rocker, and therefore unable to be turned without extreme difficulty, they could only be surfed in a straight line to shore. Once establishing these basic tenets, surfboard construction would remain largely unchanged for hundreds of years.
“However, innovation had to take place, because these [surfboards] were just chunks of wood and, for years and years, there was really not much change,” Martin said. “These boards were blunt-nosed, flat-decked, rolled-bottomed, with no fin or much maneuverability.”
When the U.S. annexed Hawaii in 1898, American settlers to the islands were intrigued by the local sport and surfing experienced a resurgence in popularity, with a renewed focus on innovative surfboard designs. Martin noted that surfing enthusiasts experimented with surfboards built from imported California redwood over traditional local hardwoods, as well as imported balsa wood from South America.
“In the 1930s, balsa was a relatively cheap, lightweight wood,” Martin said. “Surfboards made of balsa were very lightweight especially compared to the heavy redwoods that surfers had been using earlier.”
Compared with the 90 to 100 pound redwood boards, surfboards made of balsa weighed in only at 30 to 40 pounds, which allowed for greater mobility and maneuverability; the addition of fins and the surf leash would also revolutionize the standard surfboard model. Later changes would include use of lightweight plywood, composite balsa/redwood designs for strength, and hollowed designs to create lighter, but still buoyant, surfboards.
However, similar to rheumatology, the end of World War II would open new possibilities for surfboard design and radically alter the sport.
“Surfing also benefitted from World War II,” George said. “Styrofoam, plastics and fiberglass came out following the war after all that military research and development.”
Radical advances in material technology during the war had trickled down to the consumer market, providing surfing enthusiasts with a wide array of new adhesives, plastics, plastic foam, polyurethane and fiberglass, which in turn fueled new experimentation in surfboard construction. In 1946, lifeguard and surfboard shaper Pete Peterson built the first fiberglass board, which would set a new precedent for surfboard design that would continue to reverberate through the sport to the modern day.
Even as surfing has continued its ‘innovative’ trend with the development of self-propelled electric surfboards, Martin challenged the audience to question, “What are the frontiers of innovation today and how are they being approached? And what are some of the future innovations [that you see coming] in rheumatology?” – by Robert Stott
Reference:
Martin G. Medicine and Sports: A Hawaiian TED Talk. Presented at RWCS Annual Meeting; Feb. 12-15, 2020; Maui, Hawaii.
Disclosure: Martin reports being on the scientific advisory boards of AbbVie, Celgene, Dusa/Sun, Galderma, Horizon, Janssen, Leo, Ortho/Bausch Health and Pfizer; consulting for Aqua, Celgene, Dusa/Sun, Lily, Ortho/Bausch and Pfizer; and being a speaker for Dusa/Sun, Ortho/Bausch and Pfizer.