Progress in medicine is based on continuous research.
The main drive in medical research is improvement of treatment and cure of diseases, which translates into improvement on life expectancy and / or on quality of life. The results of medical progress over the last 20 years are impressive. Mortality from various severe diseases has dropped dramatically (e.g. various forms of cancer, infectious and cardiovascular diseases), life expectancy and quality of life improved significantly.
What is “medical research” anyway?
For someone not involved in this sector it can indeed be difficult to see clearly and understand the multiple forms and dimensions of medical research.
Research can be focused on
clinical outcomes, e.g. how do patients do after an operation / treatment – immediately after, in the short-, mid- or long-term or comparing results and outcomes between different treatments (applied clinical & epidemiological research)
progress of current or development of new medical techniques based on experiments on models & animals (pre-clinical and applied clinical research)
understanding of basic physiologic functions usually at cellular or subcellular level (basic research)
- pharmacological research for development of new drugs, based partially on the results of basic research
iterative feedback loops between the basic and clinical research domains to accelerate knowledge translation from bedside to bench, and back again (translational research)
Translational research was born from the need to focus and connect promising basic research to the end-result, i.e. towards the patient’s benefit. The focus on the end-result helps putting together mixed research groups and streamlining research projects. Crucial to success, however, is a strong leadership and mental approaches across traditional boundaries.
Is research important in daily practice?
It is important! Even if not everyone feels the urge to do research, staying up-to-date is nowadays easier than ever (internet, connected mobile devices, easy travelling etc). Applying results from cutting edge research in patient care should not be an issue today.
There is, however, another option: pursuing research and participating in research projects while being active in patient care.
Is this possible? Yes, it is!
There are some restrictions, though. Time is the most important one. Research activities have to be cleverly inserted in the busy agenda of patient care (interventions, surgery, contact and talks to families, outpatient consultations, reporting, keeping up-to-date). Time management and good team work are essential.
An appropriate infrastructure is “mission-critical”. There is much more to research than ideas and motivation: laboratory spaces and equipment, experienced technical and administrative staff, a research promoting culture and an efficient network are some of the requirements for serious research.
Last but not least is money. Classic, traditional general research budgeting only exists in university departments. Even there, it just covers basic needs. For anything more than this, applications with specific and detailed project proposals have to be submitted to various public (state controlled) or private (on national or international level) organisations, that allocate funds to selected projects. Preparing research proposals is very time and energy consuming and needs a specific expertise.
When the above mentioned requirements are met, good research can also be conducted outside the university, e.g. by privately held organizations, such foundations or private companies. Research teams are ideally mixed ones, partly pure researchers, partly clinically active physicians.
Being involved in research as a clinically active physician is a balancing act, but can be very rewarding in terms of intellectual improvement, as well as in terms of general motivation, which normally also reflects to patient care. Research-prone people love to challenge their brain, love the creative process of finding solutions to difficult problems, love generating and sharing knowledge. Their minds become critical, they know how results are generated and how they should be understood, they learn the power of statistics, they can better interpret and challenge what is being published, they adopt innovation mindfully.
In my personal perception, research should be an integral part of the professional life for a physician who wants to operate at the edge of medical knowledge and innovation and wants to offer the best available care to his patients.
Where does cardiac surgery find itself in this framework?
From its very beginning cardiac surgery has almost been a synonym for pre-clinical and clinically applied research. It was crucial to develop a deep understanding of the physiologic responses to extracorporeal circulation, as well as of the complex physiology of ischemia and reperfusion associated injuries. From the late forties to the early fifties (i.e. invention and introduction of the heart-lung-machine by J. H. Gibbon) a huge amount of wisdom was generated by this new and rapidly developing specialty. Novel surgical techniques were developed and rigorously evaluated in experimental settings. Heart and lung transplantation became another very prolific and productive research field. The tight integration of pre-clinical and clinically applicable research exposed the majority of contemporary cardiac surgeons to a significant experience in experimental surgery on various animal models.
After more than half a century, however, research in cardiac surgery is now being redefined. “Feasibility” is being gradually replaced by “change” and “evolution” as principal driving forces. Adaptation to new realities is requested. To name a few:
Organ donation is declining – engineering technology is advancing steadily: the role of ventricular assist devices is being redefined, from temporary short- to mid-term assistance as bridge to transplant towards a permanent solution in advanced heart failure (see also here). A broad and thrilling research field in which cardiac surgeons and engineers are working close together.
Patients, cardiologists and the society in general call for miniaturization of surgical access and trauma to obtain (if possible) the same good and long lasting result as with “big” surgery. Minimal invasiveness, catheter-based interventions and innovative robotic approaches are requested (see this post of the blog)
Aging of the (patient) population is a matter of fact. Traditional age limits towards interventions are falling one after the other due to innovative more “gentle” techniques. Cerebral complications of cardiovascular disease and interventions are a burden, which increase with age. Good collaborative research is ongoing, aiming to a better understanding of the mechanisms of brain defense and injury.
Regenerative medicine based on the huge and unexplored potential of stem cells and other forms of cellular and molecular therapy can change completely the way we think, treat and manage cardiovascular disease. We are still at the very beginning of this new era.
These are some of the new fields of thriving research in which cardiac surgeons can contribute significantly. New skills are needed to succeed in these new settings, both hard and soft skills. Knowledge in engineering, biochemistry, cellular biology, as well as the capacity to interact and communicate efficiently in the challenging environment of mixed research teams are crucial elements for fruitful contemporary research. The ones among us who understand this will evolve. Continuous improvement and learning as well as adaptation to environmental challenges are the keys for a successful evolution.