He is not hesitant about sharing the reason why he decided to study medicine because it has an actual name: Rosario Romero, his maternal grandmother, whom he “loved very much.”
“I used to say I was going to study medicine so I could help my grandmother,” according to Argentinian doctor Bernardo A. Pons-Estel. That was my incentive to become a rheumatologist.
Fotografía de Rosario Romero. / Cortesía del Dr. Bernardo A. Pons-Estel
Suffering from rheumatoid arthritis, “she became someone who was very much disabled,” he recalls. Her hands were particularly affected, the same hands that used to prepare the rice pudding he enjoyed so much as a kid, and that now he remembers fondly.
That is how it all started.
“I always liked the idea of being there for people, of serving others,” he confesses. For him, it was about something truly connected to family values: “one must start helping and supporting those who need it the most.”
But his grandmother was not the only reason behind his decision to choose this kind of life. There was someone else, a doctor who, through actions, guided him into the medical path. A man in his hometown, San Justo, in the Santa Fe region, whom, he states, he “admired very much”: a man called Dr. Macera.
He was the town’s doctor who, “when called, would always be there, at any house, regardless of their economic status. I remember vividly because, at the time, I was suffering from fake croup, a condition that surfaces around midnight hours, and Dr. Macera would come and help me breathe again. He was my savior,” he recalls. And that was it. He's been a physician ever since 1978, but he is no doctor Macera, he is doctor Pons-Estel.
Those are what he calls anecdotes that remain throughout history.
Born to Guillermo Pons-Estel and Rosario Ruiz, husband to Adriana Silvestre, whom he refers to as “Nursing bachelor and master, and partner in crime,” and father to, also rheumatologist, Guillermo J. Pons-Estel. He is also a grandfather to 3-year-old grandson Alejandro, and a father-in-law to Rosa Serrano, who is natural from Almería, Spain, and who is also a physician, specialized in autoimmune diseases, currently living in Rosario, Argentina.
At first, he tried going into Immunology. He was in between that major and Rheumatology. “After all, it came down to both since I ended up developing research for the first one,” he adds.
During his bachelor, there were two truly important professors whom he remembers dearly: Carlos Battagliotti y Norberto Quagliato. “They made me grow fond of the specialization, and of the lupus disease in particular, and they were also of great mentoring help when I was in the middle of deciding whether to go or not into rheumatology, along with the motivation behind my grandmother’s story,” he highlights.
From that moment on, researching became a part of his life. “I have plenty to be amused with,” he tells us while laughing.
He graduated as a medical doctor from the National University of Rosario, and obtained his specializations from the University of Columbia, Missouri, and the New York University, both in the United States, where he learned how to do research.
When he is not in the consultation room, it means he is in the middle of a research project. “I spend six or seven hours a day at my medical practice. I wake up at 5 in the morning in order to start consultations at 9, so I can concentrate, for those 4 hours, on doing epidemiological research.”
“This is something I love,” he adds.
-The question is: How do you find time for it all?
We have to take time away from other areas like family, for example… sometimes I take too much time from it. Weekends spent enclosed or postponed outings and plans.
“My son is a doctor, my daughter-in-law is a doctor and my wife is a nurse. What was smart about this was making the whole family become passionate about the same thing,” he says bursting into laughs after this statement. He does not leave family love behind, and having it intertwined with his passion to serve others through medicine makes his home even more special.
Many years ago, he developed a project with a group of friends. Each one of them was coming back from having done their studies abroad and their thirst for research united them. That is how this chapter of his life began.
“We all met when we came back to the country and we started working together. Back then, everything was done by pen and paper, drawing sticks one by one into a square, until you reached the fifth one, which was a crossed one. That is how we would add up patients.” That was around 1985.
They went from sticks to technology. Computer science began to bloom and, together, they developed a program called Arthros.
He recalls having been selected among the top papers at a congress, and therefore, having presented what their paper was about. Developing epidemiological studies was the goal of that program. Donato Alarcón-Segovia, a professor who had just arrived from Mexico, became interested in our work and wanted to interview us, so we made him a proposition to work together.” That is when GLADEL took off.
GLADEL is the Latin American Group for the Study of Lupus, created in 1997 alongside doctor Donato Alarcón-Segovia, from Mexico. Pons-Estel is the founder and general coordinator, overseeing 34 centers in 9 countries.
That is how the first epidemiological study took place. “It was one of the most highlighted works about lupus in Latin America, where, at the time, there was little research done. A collaboration never seen before for something that big,” he notes with notable pride.
After GLADEL came GLADAR, the Latin American Group for the Study of Rheumatoid Arthritis, where he is also the founder and general coordinator. This group is composed of 43 centers in 14 countries.
Another one of his projects is GLADERPO, the Latin American Group for the Study of Rheumatoid Diseases in Native Populations. “We study more than 10 different indigenous ethnicities from Argentina, Mexico and Venezuela, and more recently, from Ecuador and Colombia.”
For this project, Pons-Estel is once again the founder and general coordinator, together with doctors Ingris Peláez from Mexico, Ysabel Granados from Venezuela and Romana Quintana from Argentina.
“We knew about developments with Caucasian people in Europe and North America, Asians and Afro-Americans, but we knew nothing about our own population. Nowadays, we have over more than 75 published papers worldwide regarding this topic, including works from GLADEL and other collaborations,” he states.
Most importantly, he adds, is that “we found mestizos tend to develop disease in a more severe way than caucasians, behaving very similarly to African-Americans. Our population is different, and therefore, it needs to be regarded with a different approach.”
Lastly, for researching groups, we have GLA-GENLES and GLA-GENAR, both Latin American Groups for the Study of Genomes in Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis, respectively. Pons-Estel is the coordinator for this group, with doctor Marta Alarcón-Riquelme, from Mexico/Spain.
An added bonus comes with GLADEL 2.0, created four years ago. “This means being able to incorporate new generations: those under 40, passionate about lupus.”
“My son is one of them,” he says proudly.
They are the ones continuing all of this, “and it still does not have any expiration date, at least.”
What moves him is the passion for producing knowledge designed for our own population, our own ethnicities, our own cultures and our own people. For him, it is not about importing content from abroad, the key is to be able to create it here, for his own people, people that he has been keen to help ever since he was a little boy, people that make his desire for helping become even more intense. “This is a passion that brings us together,” he asserts.
White coats and studies aside
Besides the consulting room, researching, conferences and medical endeavors, he’s passionate about other things.
Although medicine clearly comes first, reading, films and sports follow suit.
He was Chairman for the Argentine Association for Rheumatology (2011-2013), the 10th International Congress on SLE (2013) and the 2018 Pan-American Congress of Rheumatology, and he is currently a member of PANLAR’s Science and Education Committee, but aside from that, he enjoys films like Roma because “testimonial and traditional” movies are the ones who catch his eye. His book selection takes on the same tone. His favorite writers are Gabriel García Márquez, Pablo Neruda and Eduardo Galeano. And when it comes to music, he is into Mercedes Sosa, León Gieco, Pink Floyd and The Beatles.
-What about food?
-Everything… except for cucumber.
-And when it comes to football?
-Big Boca Juniors enthusiast here, as well as a fan of the Barcelona team, which has Rosario native Leo Messi playing for them. I also like tennis, basketball and rugby.
The rheumatology research launching platform in Latin America is significantly improving, says the specialist. “This isn’t, by far, a coincidence or a random accomplishment, it accounts for a growing interest within scientific communities such as PANLAR and National Rheumatology Associations that are responding to a new paradigm and encouraging their participants, while forming them to become the leaders of this challenging scenario.”
All of this, he adds, takes place in our countries with an epidemiological transition environment, “where the challenge continues to be tending to health issues deeply connected to poverty, while, at the same time, having to face the difficulties of the conditions that are common to development, including chronic degenerative conditions such as autoimmune and rheumatoid diseases.”
The much heterogeneous ethnic compound in Latin America comes into play here, while being tied to a geographical, economic and social setting with great inequalities and challenges.
For him, “this alchemy makes us as different as we are unique, a reason that needs to be acknowledge so we can help new generations of rheumatologists gain awareness on how producing knowledge on their own is, therefore, a must.”
In his opinion, evidence shows that Latin American scientific production is taking a qualitative and quantum leap. “We are observing the phenomenon, following its progress, convinced about its exponential growth,” and he is so certain about this rise that he would like to “answer this question again in 5 years.”
GLADEL’s creation in 1997 has seen the inclusion of a new generation of experts, in order to continue generating research and methods that will allow the region to be up-to-date and to also be recognized worldwide.
Through continuous dedication for over 20 years and numerous publications, he has proved that lupus behaves differently in Latin America, “and for that reason, we need to be trained to tackle that situation”.
In November 2014, during the ACR Conference in Boston, they held a meeting with a strategic goal in mind: boosting a generational change and developing a collaboration network. That is how GLADEL 2.0 was created, a project that engages with a new coming generation of young rheumatologists, what he calls “seedbed.”
“The GLADEL community was already in progress, thus, laying the ground for an easy yet encouraging task. Many young people joined it and today we are on the verge of another big leap: the creation of a new Latin American cohort for the study of patients with lupus nephritis, where 43 centers from 10 Latin American countries are participating,” he states.
Based on what has been previously mentioned and the shared commitment between both GLADEL generations (senior and junior 2.0), “the future looks incredibly encouraging,” he says.
A family passion
His collection includes more than 10 books published within the specialization and more than 120 indexed journal publications on PubMed. His life is devoted to researching so he can bring knowledge to the service of others, and he gets even more excited when it involves local issues. Something he also does with his family.
He takes part, along with his mentees which include his son and his daughter-in-law, in the Regional Center for Autoimmune and Rheumatoid Diseases (CREAR, by its Spanish initials), in Rosario, Argentine, and with his wife in the study of native populations (GLADERPO).
-A family mission?
-“It is a privilege,” he replies clearly excited.
Now, he says nostalgically, every time he obtains an important achievement, he remembers his grandmother, his father, professors and “people who helped me a lot.” That is why being surrounded by that family, from which he has been “stealing” a little time in order to contribute his knowledge and help others, is his life’s engine day by day.
-Best takeaway from Medicine?
-Passion, service and being able to provide knowledge of my own, he concludes.