During the last decades, research in Belgium benefited so much from the superb leadership of Paul Levaux and Marie-José Simoen, the chiefs executive officers of the Fonds National de la Recherche Scientifique [FNRS], of the Fonds de la Recherche Scientifique Médicale [FRSM], and of the FRIA [Fonds pour la Recherche dans l'Industrie et dans l'Agriculture] , three important " public " research structures in Belgium. They gave me unique opportunities to participate in the planning of biomedical research in our fields of expertise ; it has been for me a great privilege and experience to serve Research under Paul Levaux and Marie-José Simoen. In Paris, Pierre Gressens and myself, we pursue collaborative programs with the FNRS organized by the INSERM (" accord de collaboration internationale INSERM/CFB ").

André Flahaut, Pierre Huvelle, Marie-José Laloy, Danièle Lecleir, Fernand Geubelle, and Françoise Goossens are or were (several left for other responsabilities) superb leaders of the " ONE " (" Office de la Naissance et de l'Enfance ", the Belgian public institution for Mothers and Children). They revolutionized this derelict institution and transformed it in a tool for the future. I have been delighted to be with them in this task during the decade I served as President of the Scientific Committee of this governmental agency for Mothers and Children.

When I was Chief of Clinical Service and Director of Research Unit in Belgium, I benefited from the constant friendship and support of President Gaston Deurinck, of Professor André Molitor, of F. Valentin Nelissen, of Mrs. Albert Froehlich, of Ms. Marie-Pia Froehlich (who enjoyed the competent help of Mr. Christian de Pauw), and of the Hon. Charles Everaerts de Velp, important national figures, who supported so efficiently our research and development programs in pediatric neurology and developmental neurosciences. I wish also to acknowledge the support granted by Mr. Philippe Busquin, who was at that time the Federal Minister of Health and Social Affairs of Belgium: he approved my proposal and recognized pediatric neurology as a " Board certification ", a " subspecialty " (in French, we use the term " surspécialité ", which is more elegant) given in addition to the main board certification in Pediatrics or in Neurology, and enjoying an official status with positive consequences for practice of pediatrics in our field. I had also a staff of superb administrative assistants, created by Mrs. Jo Serneels, who worked with me during 28 years, and later Mrs. Patricia Debluts, Mrs. Caty Defat, Mrs. Chantal Vynckier, and Françoise Barras. Contributions of Ms. Anne-Marie Rona as technician-in-chief and as " chief of staff " for the financial support of research has been quite remarkable, as her contributions to modern art.

In 1969 and during the following years, Rector Edouard Massaux, Prorector (and CEO of the Hospital) Pierre Lacroix, Dean Jacques Berthet, Professor Christian Laterre, Professor Roger De Meyer, Professor Georges Cornélis, and a bit later Professor Jean-Jacques Haxhe, the new CEO, and Professor Michel Meulders, accepted most of my proposals of investments in personnel and funding. The investment of UCL (in its academic hospitals, starting in 1969 at the Hôpital Universitaire Saint-Raphaël when we were in Louvain, continuing at the Hôpital Universitaire Saint-Luc after our moving to Brussels in 1976 ; and in its mediical school), of FNRS / FRSM (see above), and of the Belgian Social Security has been very conspicuous in pediatric neurology, pediatric rehabilitation, and developmental neurosciences on our UCL campus. I estimate that the average budget for our 28 acute beds, our 83 beds of pediatric rehabilitation, and for our research and teaching programs has been around 10 millions US $ per year (in dollars of 1985) during the decade 1980-1990, including, of course, the Social Security payments for the patients using our facilities.

For such an amount, what did we produce during the almost three decades we were in charge at UCL-Belgium in terms of care for the sick children, in terms of prevention of diseases interfering with brain development, in term of teaching, in term of applied and basic research, in term of the national Belgian interest, in term of cooperation with other countries of the Western World, in term of cooperation with developing countries, in term of achievements for pediatric neurologists and pediatricians ? This historical note is not the place to answer these crucial questions and my answers could be considered unreliable, because I would be " juge et partie ". Before leaving the key issue, raised in this paragraph, of the ratio.

Returns for the citizens / Investments of the public service

I wish to make a few additional comments concerning my rather long experience with responsabilities of " CEO " in a clinical service and in a research unit. (a) Many parameters used by institutional CEOs in our public or non-profit organizations do not take in consideration on non-profit organization the concept of a " cash flow " parameter. It is for me the most difficult aspect of our responsabilities as chiefs of service when we have daily to adapt our services to new expertises and new tools to help patients (to cure or to care them) and to help communities (to prevent diseases among them). Even superb and inspiring authors, like Baudouin Meunier (see his book " Le management du non-marchand ") did not touch this problem, perhaps because they did not know or understand it, perhaps because they prefered to ignore it in order to protect respectable social and political interests. I am almost sure that the problems faced by our Social Security systems will not be solved without taking this aspect in due consideration. (b) Handicapped people in Belgium benefited immensely since almost three decades from TV fund-raising. Belgian public TV networks were almost forbidden to support fund-raising for research and were very much encouraged to support fund-raising for building and operating institutions for handicapped, and the Belgian State decided to add ~ 300 % of the funds raised for the handicapped people by the TV. It transformed the panorama of institutions for handicapped people in Belgium and it has been a crucial element in the action we had in pediatric neurology.

* * *

After a long meditation, I made the decision to take the position opened at Robert-Debré Hospital / Xavier-Bichat Medical School / Paris VII Denis-Diderot University. The first reason was the rich number of excellent " agrégés " I had " produced " in Belgium, being sure that I was not " leaving the bridge ". A crucial factor has been the leadership and enthusiasm of Professor Henri Mathieu, who created the Hôpital Robert-Debré, of Dean François de Paillerets, of Director General Philippe Lazar, of Director Anne-Marie de Saxcé, of President Claude Amiel, who were in charge of Robert-Debré Hospital, of Bichat Medical School, and of the INSERM at that time. Another essential factor was the exceptional sanity of the project in term of public health : as explained by Professor Henri Mathieu, there is an urgent and immense need of clinical pediatric neurology and research in developmental neuroscience in the Northern and Northeastern sector of Paris 75 and of the " Grande Couronne ". Professor Jean Navarro, President of the Comité Médical Consultatif of Hôpital Robert-Debré, Dean Jean-Marie Desmonts, Professor Claude Griscelli, Directeur Général of the INSERM, Director Bruno Soudan, Director Marie-Christine Grenouilleau, and, cited by alphabetical order, Professor François Beaufils, Professor Philippe Blot, Professor Jean-Pierre Changeux, Professor Pierre Chatelain, Professor Michel Dehan, Professor Jean de Kervasdoué, Professor Jacques Epelbaum, Professor Michel Fardeau, Professor Jean-Claude Gabilan, Professor Claude Gaultier, Professor Jean-Claude Job, Professor Jean Laugier, Professor Alexandre Minkowski, Professor Jean-Pierre Muh, Professor Bernard Salle, Professor Constantino Sotelo, among others, accompanied me with much sollicitude in this rather exceptional European exchange. I quote only a few colleagues with official duties ; all other colleagues welcomed me so warmly also.

A dozen of excellent colleagues were candidates or considered to be candidates or " potential candidates " (sometimes without formal application but wishing to be invited) for the position I had created and I left at the University of Louvain Medical School / Hôpital Universitaire Saint-Luc. The search committee and the chiefs of the institution decided to appoint a well trained colleague, full of competence and dynamism, Professor Guillaume Sébire. As an honorary professor, I remain very close with the University of Louvain, even if I resigned completely all my active positions there. I am extremely scrupulous not to interfere with the responsabilities of my successor, despite many warm requests and sollicitations for interferences !

In this note, I did not try at all to make a " bilan " based on a personal account. Furthermore, our " C.E.Os. " at the Hospital, Research, and Teaching levels, have now standardized tools to evaluate us and do not need our reports anymore. Among their tools, I shall quote the hospital reports (quantitative indicators and parameters for " quality of care ") ; the " PubMed " and the impact factors ; the number of " Board certified " and " PhDs " produced by clinical and research facilities; quality and volume of teaching impact when appropriately assessed. Personal accounts become more trivial in comparison with these more objective and targeted parameters.

I had four mean reasons to write these few paragraphs. The first one is to answer the question so often asked to me: " Was your decision to move to Paris due to the " Belgian problems " ? The second reason is another frequent question : " Is it really possible to move in academic medicine in Europe ? ". More than that, during the last decades, networks of national and international collaborations and exchanges became, in every respect, one the important features of our global academic community ; to keep alive the links and the roots is a so powerful catalyst of the networks. And on top of that, the main reason why I wrote these few paragraphs is to honor and thank so many colleagues who enthusiastically decided to come with us, and made us the exigent " gift " of very precious years of their life, especially the numerous young colleagues who were in the embryonic clinical and scientific epoch of their life when they joined us.

Philippe Evrard 

Paris, August 15, 1998

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