Broadcast on 29-08-16 on Today with Sean O’Rourke
The evidence shows that the best hospitals – the ones where patients have the best medical outcomes – are those that are most actively engaged in medical research.
This is the kind of practical hospital based research that saves people’s lives and it is often led by doctors or nurses seeking better ways of doing things, with no commercial motivation.
People at the frontline may have an idea of how a tried and tested way of doing things with certain patients can be improved upon. Then trials or tests are setup to test the new idea.
If the idea works, and an improvement in patient medical outcomes is proven, then changes are made in medical practice to ensure that patients fully benefit from the new knowledge.
It is called ‘bench to bedside’ research where doctors or nurses use science to test out their ideas, and if they work, then the new ways are translated from lab bench to patient bedside.
The evidence shows, from decades of work all around the world, that hospitals are safer and generally better where the doctors, nurses and medical professionals are ‘research active’.
Medical practice doesn’t stand still, or it shouldn’t, and there are always ways of making improvements in patient care. Sometimes there is a big leap forward, with a dramatic new advance, while lots of other times, it’s a case of steady, gradual incremental gains.
The important thing is that medical professionals are in a mindset where they are constantly challenging how they do things, and never believe that existing methods can’t be improved.
The research that we are talking about here could be as simple as a better, or more, timely way of delivering a medicine, or a radical new method of performing difficult surgery.
One of the great advantages that hospital researchers have over laboratory scientists is that they can carry out tests and trials on humans, who have agreed to take part in such trials.
The individual patient can be asked to sign up for a ‘clinical trial’ to advance the state of knowledge in a particular field, such as cancer research or cardiovascular disease.
Taking part in such trials offers patients, sometimes very sick patients, the chance to help their fellow man (and woman) that come behind them, who may have the same illness.
But, as well as helping to improve the prognosis for future patients, there is plenty of evidence that an individual has a long to personally gain by taking part in a clinical trial.
The evidence suggests that people on clinical trials in hospitals have better long-term health outcomes that those that aren’t, and have earlier access to new drugs and treatments.
The people on clinical trials are watched very closely by medical staff, and they get the very best of care and attention, so that any issues that arise are picked up quickly and addressed.
There are more and more clinical trials taking place in Irish hospitals and this is a very good thing for our patients there, young or old, as the more trials, the better the health outcomes.
All of the major Irish hospitals have significant research programmes going on at this stage, and many people will have been offered the opportunity to take part in a clinical trial.
It was long recognised that Ireland needed to be done more hospital based research, and in 2006 the Irish Clinical Research Infrastructure Network was setup to facilitate this.
Clinical trials, and studies are best done across a number of hospitals, at home and abroad, to increase the numbers that take part, and make the results more meaningful. The Network is now supported by the Health Research Board, the HRB, and the HSE.
There is also a lot more paediatric research taking place in Irish paediatric hospitals such as Our Lady’s Children’s Hospital Crumlin, and around the country, than ever before.
There is also a paediatric research network being set up between medical researchers at Irish paediatric hospitals, and this is very good news for sick children in Ireland.
Generally speaking then, there is a lot more hospital based research taking place in Ireland than there was say, 20 years ago, but we have a long way to go to catch up with the best.
Many people may have the impression that a lot of research done in hospitals is being by pharmaceutical companies who want to test our new drugs and products on patients.
That kind of industry led research does happen, and, in fairness, it can occasionally lead to the development of a wonderful new drug, or to the different use of an already existing drug.
However, the kind of research that is having a more sustained impact on patients’ health is the type of research that is called ‘investigator led’ research with no commercial motivation.
The genesis of this type of research is a doctor, or nurse, physiotherapist, spotting a potentially better way of doing things in their daily work, and setting up a trial to test this out.
This requires a culture to be established in Irish hospitals, where new ideas, or ways of doing things are encouraged, and they don’t always have to come from the consultant.
The important point is that it is not the pharmaceutical industry calling the shots here, it is the medical professionals on the ground, who have no axe to grind but trying to help patients.
The one issue that we have in Ireland, however, compared to the leaders in hospital research is that not enough time is freed up for consultants and others do do research.
In the US, clinical researchers might spend half their time working with patients and the rest of the time doing research. That kind of freedom is not the norm, here in Ireland.
I visited the UCD Clinical Research Centre last week to talk to some medical researchers about their work. This is just one of many research centres attached to Irish hospitals.
Dr Alistair Nichol, a consultant anesthestist told me about a research project called TRANSFUSE. The goal here is to test out whether using new blood to transfuse patients leads to better outcomes than older blood.
Irish blood products can be 35 to 42 days old by the time they are used for a transfusion, and there is some evidence emerging that ‘using fresh blood is better.
Dr Nichol is testing this out in a study on 5,000 people that receive fresh blood against blood that is ‘standard’ (older). They have gone through 4,000 patients so far.
They plan to publish the results in about one year, and whether the fresh blood is found to be better, or not, the information that is obtained from this trial will change clinical practice.
Dr Nichol is also involved in a study that aims to get Ireland better prepared for the next major flu outbreak, as we weren’t ready for the H1N9 outbreak in 2009 he said.
The idea is to be ready to move fast when the next major flu outbreak happens here, and we are due one he said, by having everything in place to capture information on the flu.
The idea is that the doctors, nurses, and paperwork are all in place so that when people come in with a dangerous flu that UCD is ready to start a trial to capture information on it.
UCD is linked with researchers in Australia and New Zealand, in this major effort to prepare for the next flu outbreak so that information on its first appearance is properly captured.
A flu pandemic hits in waves, so that when the first wave comes through Ireland, the UCD trial will capture the information needed so that it can be tackled on the second wave.
I also met Professor Carel Le Roux, a South African doctor and researcher now based in Ireland who is doing important work on obesity and diabetes.
The work of Professor Le Roux, and colleagues around the world, has found that there is a gene in some people which means they are always hungry, even soon after a meal.
This genetic link to obesity shows that obesity, and related conditions such as diabetes Type 2 are not due to some moral weakness, but due to measurable genetic differences.
This finding means that for some, it may be better for doctors to try and maintain people’s health at their current weight, as trying to get big weight reductions might not be effective.
It also means that for some, said Prof Le Roux, the best option may be to have gastric bypass surgery, which is a proven method of reducing people’s appetite in the long run.
There is also important research into children’s diseases – paediatric research – happening in Ireland, in areas such as leukaemia, eczema, controlling pain and childhood diabetes.
What Irish paediatric researchers are doing is identifying the very earliest signs of diabetes, or allergies, for example, and this means treatment can also begin much earlier.
The goal in the future is to be able to identify children or infants that are at risk from a condition, or that have a condition, even in the womb and then prevent or treat it.
This preventive approach to medicine which is investigator led is far different from a world where the pharmaceutical industry wants to simply test drugs and products on already sick people.