Why Research?

The mandate of a medical school is the triple mandate of education, research and clinical care, all supported by adequate resources, engaged partners and effective administration. Still, occasionally, I hear that we are a small medical school and we cannot be expected to do it all, so why should we be trying to do (or grow) research?

Simple explanations—like our curriculum needs to be supported by biomedical scientists whose entire careers are devoted to research; or that UGME and PGME accreditation require that education be in an environment where research takes place; and learners must have the opportunity to participate in research—are not always convincing to politicians, hospital administrators running a deficit, or even some of our clinical colleagues.

Researchers I have known are motivated by an insatiable curiosity, a passion for research itself and a huge ambition to make that discovery that changes everything (or at least, saves lives or improves the lives of many)! Learners want to participate in research to maybe one day become a researcher or to enhance their CV in ways that will open other doors.  Deans and university leaders want to see rankings improve and reputations grow. Unfortunately, not all are swayed by these arguments for growing biomedical, clinical and population health research.

In medical schools there is a widespread belief that both education and research improve the quality of care and, thus, health outcomes. At the macro level, that is obvious. Though the greatest reductions in mortality over the last 150 years have been from population interventions like sanitation, clean water, improved nutrition and vaccines, all of these were due to research.

However, in the last 30 years our country has seen a steady decline in the national rate of avoidable mortality from 373/100,000 in 1979 to 185/100,000 in 2008. These improvements have been attributed equally to high-tech invasive treatment, pharmaceutical innovation and behavior change (e.g., smoking cessation), all of which are due to research.

Unfortunately, these national reductions in avoidable mortality are not evenly distributed across our country. We can all speculate on many reasons why that may be so.

One argument goes like this: “Fine—research saves lives; we will simply adopt others’ research.” Again, because “we are too small, or too busy clinically, or too resource-challenged to play in that game.”

What if you knew that the volume and quality of biomedical, clinical, and population health research done locally had a direct impact on the quality of care delivered to you, your children or your parents?

Zwicker and Emery from the School of Public Policy at the University of Calgary explain exactly that in their discussion paper, How is Funding Medical Research Better for Patients?, from August 2015. They compare provinces that have substantially invested in medical research (Alberta, British Columbia, Ontario and Quebec) with provinces that have not (Manitoba and Saskatchewan) and correlate that with reduction trends in mortality from potentially avoidable causes (MPAC).

The results are disturbing. At one point they argue that in 2011 Alberta had 62.2 fewer deaths per 100,000 people from potentially avoidable causes than Saskatchewan. And they are able to correlate these variations in the trends for reduction of MPAC with the provincial investment in research across six provinces. They appropriately point out the limitations to their study and concede that rates such as MPAC are multifactorial.

Much of the last 10-20 years in the world of health research has been preoccupied with the challenges of “translational research” and “implementation science.” These authors make an eloquent argument that local investment in research is an essential ingredient to the local adoption of health innovation and, in this case, reduction in mortality from potentially avoidable causes.

I highly recommend you read it. And the next time you have a great health system outcome, also thank a researcher!

As always, I welcome discussion and feedback.

7 thoughts on “Why Research?

  1. Research was undervalued and in some ways penalised in this college in the past.
    We are seeing the consequenses of that shortsightedness. I am glad that we are now waking up to the reality. The excuse that we are “small ” can only go so far. If we are that small ,why should we have a medical college?Since we have a college we have to meet the national standards in all major academic aspects. If we have pride, are innovative , are willing to work hard and the institution gives proper recognition to research. we can be successful.
    I have been able to do that and will be happy to share the related “simple secrets “.

  2. Well said Dean Smith, and a refreshing change in attitude that is central to the new College of Medicine as it will emerge over the next decade.

  3. I have a comment. I recall reading research about prazosin for nightmares, originally done in Seattle, Washington state. The further away geographically from the State, the less
    Likelihood of trying the therapy. This might help in your argument.

    Sincerely,
    Dennis Lawson MD FRCPC

  4. HERE – HERE !!!!

    Yes we need to know what we are doing / what needs to be done and who we are treating.

    It is high time that we moved forward on these issues – look forward to some faculty development around these topics.
    Keep up the good work and challenges – we can change.

  5. I agree with your points. Budgets are a reality and unfortunately they are often partisan. Wouldn’t it be nice if health care was considered too important to be a partisan issue. How can one plan for the next 25 years or more by making crucial investments,when governments have such a short mandate? Health care planning should be a nonpartisan standing committee with a 10,20,30 year horizon.

    The argument of spreading resources too thin has some merit. Research is expensive and it takes many years to build strong teams where knowledge can be honed to make meaning contributions to a field. Instead of trying to do research in all fields in a mediocre way, why not partner with other cash-strapped universities and create centres of excellence. That way be build on each other’s strength, and achieve the mutual goal of doing meaningful research that budgets can sustain.

    I think the other thing is that the divide between researcher and clinician needs some healing. I am a family doctor , but my undergraduate degree was in biochemistry from the u of s and I did an honours project in research because I had an interest. When I started medicine I was keen to do research, but when I started residency I found it just a game. The research projects are often make work projects, and usually not part of anything meaningful. Residents are often isolated in their projects, are told they can not conduct research on certain topics of significance (like alcoholism, drugs or homelessness in ER patients) because they will never get published or they are too socially charged. Residents become discouraged because they can not pursue their interests. They move on to their clinical careers and develop a distaste for the esoteric, pedantic and politically correct practices of research at the U of S. Research becomes a pawn used to advance careers, not to get at the heart of any real passionate cause or question.
    If you want a passionate research community you need to foster insatiable curiosity. I know I am not the only resident that has had a discouraging experience with research at the U of S.

  6. Great post Preston. It’s easy to say ‘we’ll just let everyone else do the research and we’ll read it and implement’. The reality is that implementation just does not happen at the same level or with the same enthusiasm as if you did the research itself.

    The size of our provinces 2 ‘big cities’ does pose a problem for some forms of clinical research, however joining a national research collaborative provides the numbers and peer mentorship required to be successful.

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