Research Advocate: Through the Looking Glass to the Future

Preempting Disease before Symptoms and Damage Occur

New tools enabling the preemption or early treatment of common diseases encountered by otolaryngologists-head and neck surgeons are in development. Specific vaccines targeting otitis media and rhinosinusitis may one day be used with the same frequency and effectiveness as the pneumococcal vaccines, saving the health care system billions of dollars in direct and indirect costs. Monoclonal antibodies have the potential to neutralize common pathogenic bacteria such as P. aeruginosa, preempting the development of difficult primary and secondary infections, with the possibility of postoperative prophylactic use. In the future, drugs may be delivered by viral vectors or by nanoparticles able to cross the cell wall when properly configured. If the condition is known or suspected to be genetic rather than acquired, genetic engineering could make it possible to prevent and preempt syndromic deafness and craniofacial defects. The more widespread application of stem cell research will play a significant role in these goals. There would be, of course, serious moral, ethical, social, and legal issues associated with application of these approaches in more than theory for some time.

Partnering with Clinicians to Translate Research into Practice

The second translational block-and potentially the most difficult to overcome-depends on the ability to add the community-based practicing clinician to the research team, and to involve the community as well. One of the most effective ways to accomplish this goal is by designing, developing, and supporting national clinical research networks. Well-established clinical research networks are used to address clinically significant questions by the American Academy of Family Physicians (National Research Network) and the American Academy of Pediatrics (Pediatric Research in Office Settings Network). The American Academy of Otolaryngology-Head and Neck Surgery has made several forays into research networks with COG*ENT, BEST ENT, OCTCG, and the newest network now in development, CHEER. Effective studies on otitis media, rhinosinusitis, tonsillectomy, nasal obstruction, and obstructive sleep apnea were completed through these networks, raising the level of evidence to support treatment effectiveness for several common conditions.

Translating research into practice requires neither that the clinician read about the research and decide how to implement it clinically, nor that its essentials are viewed in a slide presentation. Rather, the clinician participates in identifying, shaping, and conducting research relevant to clinical practice. In this way, he or she generates the data to evaluate firsthand how research, applied to daily practice, can affect patients in his or her practice-i.e., the effectiveness of the principle can be tested on a broad range of patients. Clearly, some projects would most appropriately be conducted in a tertiary referral practice, but many others could easily involve both academic and community-based practitioners and facilitate acceptance by both groups. As one practical clinician observed, If we want more evidence-based practice, we need more practice-based evidence.6