M.O. You are always publishing; how do you feel about the supremacy of the English language in the medical literature?
R.T. I am, of course, very concerned about the declining use of French world-wide. What can we do about it? When I was running the Annales de Chirurgie de la Main, I tried a number of solutions. First, we published French articles with long abstracts in English and in Spanish. Then we brought out a bilingual journal in English and in French, in which each article was translated into the other language, which used a lot of paper and cost a lot of money. Finally, I tried the solution of a French journal and an English journal published independently of each other. That was equally expensive, and the English version of the journal did not sell well abroad. In fact, the Revue de l'Orthopédie had a similar experience. Should we go back to a bilingual solution? I think not, because the great majority of foreign surgeons are now used to reading English. Should we stop publishing a French journal? Surely not. We must maintain a French-language journal. Of course, it will only have a relatively small readership, although there are still French-speaking communities here and there, who must not be neglected. The journal will be read if the articles are good, because, at the end of the day, the only thing that matters is quality. That is also true of books.
M.O. The problem of English is actually a problem of American supremacy, because even the English complain that the Americans don't read their papers ...
R.T. This is a difficult subject and a very sensitive one, because it is one of the central preoccupations of the French: How do we preserve our identity while becoming part of a world order in which we are no longer the decision-makers? There is no simple answer, particularly as the whole matter is complicated by politics, by national sensibility, and by misunderstandings. Of course, now and then one may be very irritated by the way American culture dominates everything; and it is galling to find that the Americans will not cite papers that were not published in English. But isn't it also possible that the Americans themselves are just as irritated by a certain intellectual smugness of the French - a smugness which unfortunately is usually because of what we once were rather than because of what we are doing now. And could not the Americans be annoyed by our endless criticism, which they see as ingratitude, after their crucial role alongside us in both World Wars? Obviously we should not slavishly accept everything that comes out of America; we should stand up for our values and defend the French language. But our cause will not be best served by routine opposition to everything American. We should accept from them what we find useful, and reject things we have no use for. Let's not be too unfair to the Americans: When all is said and done, they have made a major contribution in the area of medicine; they have given us new techniques; they have taught us how to write scientific papers; and, most of all, they have made a very substantial contribution to the field of research. Also, they are very receptive whenever we have something interesting to offer them. I am against any knee-jerk anti-Americanism, which is too convenient a way of masking our own weaknesses. It is at the commercial level that American dominance is most dangerous: Almost all the French instrument-makers and medical publishers are now under American control. I feel that other European countries have made a better job of standing up for themselves.
M.O. How do you see the future of orthopaedics, and especially of hand surgery, within Europe?
R.T. I think that teaching in Europe will gradually be harmonised. The conditions under which the various disciplines are practised will depend on the internal politics of each country for a long time yet. But what concerns me most is the question of seeing that French research is published more widely abroad. It is a very serious problem. We have excellent congresses: SOFCOT and Hand Study Group meetings are still the most brilliant in their field in Europe; but they now attract fewer visitors from abroad. In addition, our studies are not sufficiently widely published. It is not the quality of the surgery which is in question - some of the best surgery in the world is done in France. We have to look elsewhere for the cause of this paradox. Certainly, the use of French has declined. There is no two ways about it. When I think of the tours I used to do in Latin America or the Middle East, only 25 years ago, when everybody spoke French ... Now, you have to translate your French into English in order to be understood, even in the Latin countries. But it is not good enough just to blame the declining use of the French language, because there is another, more serious, reason why French studies are not being published more widely, and that is our lackadaisical attitude to research. Any scientific paper that wants to be taken seriously has to have a research content - and yet, French surgeons have not had the right kind of education to give them the scientific approach that is needed for research. Of course, there is a group of professional researchers at the French Science and Medical Research Councils, but they have no real concept of clinical practice, and they are only concerned with laboratory studies. That is a terrible handicap, because the liaison with the clinical world should be provided by physicians and surgeons who work in the clinical arena. It must be said that professional researchers sometimes display the condescending attitude so typical of French civil servants, which is hardly conducive to cooperation. Also, it is true that in France it is very difficult for a surgeon to spend some time in a laboratory. However, and I must repeat this, it will increasingly be necessary for surgeons to have acquired a "research-mindedness" during their training, so that they will be able to collaborate effectively with basic researchers, computer scientists, and engineers.
Some surgeons will go further and become true researchers, which is what is happening now in America or Sweden.
M.O. How can you promote research?
R.T. Neither the academics nor the orthopaedic surgeons have been in any great hurry to develop research, except perhaps in the traditional French domain of anatomy. The excuse is that we haven't got the money or the premises. This is not strictly true: There are laboratories, but they are underused. As regards funding, there are sources, particularly European ones, which the French make very little use of. I have to say it yet again, what we really need is to develop a research-mindedness. In addition, the surgeon researchers who do exist need to be given some official status and be paid for their research activities. In other words, the national education system should create a number of permanent Academic Surgery posts with a career structure. I also think that senior registrars and perhaps even the more junior surgeons should be made to spend time in a laboratory, as part of their specialty training.