Leaders past and present reflect on a department that helped shape modern rheumatology through research, training and a pioneering focus on pain and patient care.
A landmark 50-year reunion at St Vincent’s Hospital Sydney’s Rheumatology Department has brought into focus not only the department’s distinguished past, but the voices of the leaders who built it and the vision guiding its future.
Uniting generations of clinicians, researchers and trainees, the event highlighted a rare continuity of leadership across five decades, from founder Professor David Champion to long-serving head Professor Milton Cohen, to current department head, Associate Professor Laila Girgis.
For Professor Girgis, the reunion was not simply celebratory, but also the beginning of a broader effort to preserve and understand the department’s history.
“I got the idea and inspiration (for the reunion) from David Champion’s interest in the department and writing up the department history,” she said.
She described Professor Champion as an enduring presence.
“We are very lucky to still have him around … coming to visit the department from time to time and express interest in the younger members of the department and the future work of the department,” she said.
Recognising the urgency of capturing institutional memory, Professor Girgis began identifying past members and gathering their recollections, with strong support from colleagues including Dr Christopher Browne and Professor Cohen.
“It appeared to be a very good opportunity to get everyone’s recollections at this time,” she told Rheumatology Republic.
Professor Girgis’ own journey mirrors the department’s evolution. She first joined in 1993 as a trainee, returning in 2004 after completing a PhD and postdoctoral research, and later becoming head of department in 2016.
“I found it to be a highly academic environment… with subspecialty interests and active clinical and laboratory research in many fields. This was certainly a stimulating environment for a first-year trainee,” she said.
She said the St Vincent’s Sydney Rheumatology Department had always been a standout, not only for its academic strength, but for its ethos.
“There is a unique atmosphere at St Vincent’s of excellence in care … with a unique interest and respect for the Sisters of Charity and the Catholic ethos of the hospital,” she said.
She recalled working alongside the Sisters of Charity early in her career and the strong sense of mission they brought to patient care.
This culture continues to shape the department’s philosophy today.
“At St Vincent’s every patient has a special story… we do hope to treat every patient as unique and special with their own story,” said Professor Girgis.
Over time, she has been part of and led significant transitions in the specialty.
“I recognised that I would be leading a transition… from the strong biologic treatment and research era to a newer way of practice and new research interests including precision medicine,” she said.
The department’s development had been driven by an unusual concentration of leading clinicians across multiple disciplines. Today its research strengths include:
- Osteoporosis and bone biology
- Clinical pharmacology and pharmacokinetics
- Rheumatoid arthritis clinical trials
- Pain and nociception research
- Strong collaboration with immunology and the Garvan Institute
This multidisciplinary approach has helped produce a substantial body of research recognised nationally and internationally.
Professor Girgis also highlighted the department’s early commitment to clinical trials.
“Every patient who came to the hospital should have the opportunity to participate in a clinical trial,” she recalled Professor Peter Brooks advocating, well before it became standard practice.
For her, the emotional highlight of the reunion was the response from attendees.
“Perhaps the greatest highlight was to see how much everyone enjoyed being together,” she said.
She was also deeply touched by the feedback she received from those who had attended the event.
“Dr Christopher Browne mentioned that this will be an evening that they will remember for the rest of their lives,” she said.
Professor Champion, widely regarded as the architect of the modern department, used the reunion to reflect on the extraordinary transformation of rheumatology over his career.
“When I began, the main treatments for rheumatoid arthritis included high-dose aspirin and gold,” he told RR.
“These were serendipitous treatments, whereas now we’re relying increasingly on science.”
He believes this shift from empiricism to mechanism-based medicine has defined the past 50 years of the specialty.
Professor Champion also highlighted how clinical gaps drove innovation at St Vincent’s, particularly in the area of pain.
“We could not explain some of the pain conditions such as fibromyalgia using rheumatology knowledge. So we felt compelled to take on pain medicine to understand these things,” he said.
Working closely with Professor Cohen and colleagues led to the department’s early and sometimes controversial expansion into pain medicine, an area that would become central to its identity.
Despite limited institutional support, Professor Champion emphasised the department’s remarkable academic output and national recognition.
“Our little department produced 11 professors, including three associate professors, and four Members of the Order of Australia and one Medal,” he said.
He suggested that this level of achievement was unusual for a unit of its size, attributing it in part to a distinctive training philosophy.
Professor Champion himself trained across multiple disciplines, helping establish a culture that valued breadth as well as depth.
He acknowledged that the department’s move into pain medicine was not universally embraced, but he remained convinced that this broader perspective was essential.
“I am a bit worried that they tend, these days, to contract to inflammatory rheumatology and I don’t think that that should occur,” he said.
Instead, he argued that musculoskeletal pain should remain integral to the discipline.
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Professor Champion’s clinical career has spanned a remarkable range of patients and settings.
“From prime ministers to paupers, if you like,” he said, reflecting on decades in both private practice and hospital medicine.
He has produced more than 150 publications from private practice, underscoring his commitment to research outside traditional academic pathways. He has also been passionate about his work in paediatric rheumatology and pain research at Sydney Children’s Hospital.
“That’s a really important part of my life and continues to the present,” he said.
Even in retirement, Professor Champion remains active in research and advocacy, currently focusing on the links between iron deficiency and chronic pain.
“About 35% of women have had iron deficiency at some stage and since iron deficiency affects pain this is something that’s got to be prevented,” he said.
He is now advocating for a national prevention strategy, reflecting his ongoing engagement with public health.
He paid tribute to his wife Caroline, affectionately known as Tommie.
“My contributions to St Vincent’s Rheumatology were enormously facilitated by the love, patience and support of my long-suffering wife,” he told the reunion gathering.
Professor Cohen, who succeeded Professor Champion and led the department for three decades, said rheumatology had undergone nothing short of a revolution.
“We were still in the dark ages and then the biologics revolution really did change rheumatology,” he said.
“Rheumatology has always been a bit of a Cinderella specialty for some reason, because very few of our patients ended up in hospital, so it was mainly an outpatient specialty, and then it turned out to be the one of the last bastions of general medicine.
“So with increasing specialisation, rheumatologists still had to retain a lot of general medical skills which other specialties have lost.”
He emphasised that biologic therapies transformed previously disabling diseases into manageable conditions.
“Diseases became not only treatable, but potentially curable,” he said.
He also reinforced the department’s commitment to understanding pain.
“I went even further into the pain realm than David, who maintained a bit of rheumatology,” Professor Cohen told RR.
“I kind of moved away from conventional rheumatology, especially after the biologicals came in, because it all became very straightforward, and I got more and more into the pain work.
“And so the point I’d like to make here is that we thought that pain, chronic musculoskeletal pain, should be the natural professional ground of rheumatology.
“It’s not all just inflammatory disease or other diseases, but this phenomenon of pain. It fell, as it were, naturally, into the realm of rheumatology.
“But it has to be said that the vast majority of rheumatologists elsewhere did not agree with us.”
Professor Cohen said there was much more understanding today about the nature of chronic pain in general and chronic musculoskeletal pain in particular than there was in those early days. But there was still a long way to go in effective treatment of pain, he said.
“At the moment, we haven’t had the biological moment, we are still waiting for that biological moment,” he said.
“What substances, what techniques, what molecules are going to be developed that will switch off nociception without damaging the rest of the person? That’s what we are really waiting for.”
Looking forward, Professor Champion offered clear guidance for emerging rheumatologists, urging them to remain engaged with research and to broaden their expertise.
“Even private practitioners can benefit from being involved in research, and secondly, do consider training in another related field,” he said.
Professor Girgis sees a rapidly evolving future for rheumatology.
“We are in a uniquely privileged position to have worked through this period and witnessed such tremendous change,” she said.
She pointed to advances in genomics, molecular science and emerging therapies as key drivers of the next era.
“This has led to the concept of personalised and precision medicine, which did not exist when I started training,” she said.
New treatments, including cellular therapies such as CAR T-cell approaches, are already reshaping expectations, raising the possibility of long-term remission or cure for autoimmune diseases.
Professor Girgis reflected on the significance of the department’s five-decade milestone and the responsibility it carried.
“I have a strong vision for the future of the department and hope that I will be able to see this come to fruition in the years ahead,” she said.
She also hinted at future celebrations.
“It is a great idea to have a 60th reunion and other celebrations going forward,” she said.
Attendees at the reunion included Raj Anand, Christopher Browne, Peter Brooks AM, David Champion AM, Philip Conaghan, Milton Cohen AM, Pei Dai, Ric Day AM, Jonathan Emerson, Etienne Farquhar, Ann Fuller, Laila Girgis, Kara Goon, Stewart Graham, Malcolm Handel, Mitchel Hurlbert, John Moore, Paul Preisz, Kieran Scott, Leslie Schreiber, Christina Seow, Daniel Suan, Tien Tay, Isabelle Traini, Natasha Ung and Laurel Young.
