Research and the quality of medical at The Hospital for Sick Children The 100 years of existence of The Hos¬ pital for Sick Children in Toronto spans the period of the evolution of modern medicine. During this time a virtual explosion of biomedical knowledge has occurred, so perhaps evolution is too mild a term and revolution is more ap¬ propriate. The results for society have been substantial improvement in gen¬ eral health and expectation of a longer life. Although much of the progress can be attributed to the collective clin¬ ical observations of physicians, the ad¬ vances could not have occurred with¬ out the highly organized and complex activities we call research. The importance of research was rec¬ ognized at an early stage at The Hos¬ pital for Sick Children, and in 1918 a clinical research laboratory, later known as the nutritional research lab¬ oratory, was established. This small operation was eminently successful in the field of child nutrition, developing diet foods such as Pablum and Sunwheat Biscuits. Expansion of research efforts led to the formation in 1953 of the Research Institute, which grew into one of the largest and most important biomedical research facilities in Can¬ ada, with activities closely related to almost all the teaching and service functions of the hospital, but with its
immunology and infectious disease, and cell growth and differentiation. These programs include research activities ranging from basic laboratory studies to applied studies, and their organiza¬ tion ensures close communication be¬ tween basic scientists (largely knowl¬ edge producers) and applied or clinical scientists (largely knowledge users). Al¬ though the basic scientists are free to carry out their own research, their awareness of practical problems through contacts with the clinical scien¬ tists in the program has a strong in¬ fluence on the direction of their studies. At the same time, the total pool of basic knowledge is immediately avail¬ able to the clinical scientists for pos¬ sible application. Through this close association it becomes possible to study "experiments of nature" patients with unique and unusual disturbances that, once defined, may help clarify the mechanisms of fundamental bio¬ logic processes. Why does The Hospital for Sick Children maintain such a large and expensive research establishment within its walls? Why is the research not left to colleagues in the medical schools, or to the extensive establishments south of the border, or to scientists in other countries? It is true that useful results of research are eventually published and available to all, but there are cogent reasons why the research should be done within the hospital and not be left to others.
care
proach to problems that is attractive to the creative physician. In a researchoriented hospital the clinical staff tend to be especially competent, particularly in handling difficult or rare cases. 4. Physicians who primarily care for
patients
are
exceptionally busy. They
hard put to find time to keep up with the clinical journals and cannot keep abreast of the new knowledge re¬ ported in the many specialized research journals. Thus, useful knowledge does not come to their attention until some¬ one else has noted its relevance to a clinical situation and tried to apply it. At The Hospital for Sick Children the many full-time investigators are in the forefront of their research fields and are quickly aware of the work of others in the same field. They can immedi¬ ately bring to the attention of the clin¬ ical staff any relevant information or concepts. The hospital can develop im¬ proved procedures for diagnosis and cure rather than wait for others to do the job. 5. The Hospital for Sick Children is one of the primary training centres in Canada for pediatric specialists, teach¬ ers and research workers. It is essential, if the next generation of pediatricians is to provide improved service to the own administration. community, that they be trained in an The Research Institute today has a environment that not only offers them wide range of activities, from basic of the best of present-day knowledge studies in biochemistry and cell biology medicine but also emphasizes enquiry to many kinds of applied studies direct¬ and scientific methods of problem-solvly related to patients. The amount and The specific knowledge the stu¬ ing. 1. For some kinds of research The dents scope of current research is indicated acquire will, to some extent, be¬ by the following statistics: 120 funded Hospital for Sick Children is the most come out of date their years of research projects are being conducted, appropriate institution anywhere. As a practice, but theirduring habit of analytical 54 full-time and 53 part-time investig¬ large hospital receiving patients from thinking and their to integrate ability all of Ontario and from many parts of information and form ators are actively carrying out research will be concepts and 50 young scholars are in advanced Canada and the United States it pro¬ important in to new medical adapting vides more subjects for certain kinds of stages of research training. The re¬ It is for this reason the search activities range from develop¬ studies than any other institution. For knowledge. that have the highest teaching hospitals ment of theoretical computer models of some of the rarer diseases it is one of stature and are sought by trainees are active enzyme centres in proteins to the few institutions in which adequate those that are committed to re¬ heavily investigation of psychosocial problems numbers of patients are available for search. in children. study. In summary, outstanding hospitals Every major division and department are heavily committed to research and, of the hospital is involved to some de¬ 2. Because each member of the re¬ indeed, their excellence is directly re¬ gree in related research, and in selected search staff is a specialist and possibly lated to the extent of their research fields major interdepartmental research an authority in some field, a variety activities. The high of medical quality programs have been undertaken. Five of specialized information is directly care given at The Hospital for Sick such programs have been initiated in available to the clinical staff through Children attests to the importance of the last 3 years in respirology, person-to-person consultation. the work being done at its Research neurobiology, genetic-metabolic dis¬ Institute. 3. The Research Institute and its ac¬ eases, cystic fibrosis, and fetal and neo¬ A. ROTHSTEIN, PH D natal physiology and metabolism. Two tivities create an environment of enResearch Institute The Hospital for Sick Children additional programs to be initiated are quiry and encourage a rigorous ap¬ Toronto, Ont. 488 CMA JOURNAL/SEPTEMBER 20, 1975/VOL. 113 are
immunology and infectious disease, and cell growth and differentiation. These programs include research activities ranging from basic laboratory studies to applied studies, and their organiza¬ tion ensures close communication be¬ tween basic scientists (largely knowl¬ edge producers) and applied or clinical scientists (largely knowledge users). Al¬ though the basic scientists are free to carry out their own research, their awareness of practical problems through contacts with the clinical scien¬ tists in the program has a strong in¬ fluence on the direction of their studies. At the same time, the total pool of basic knowledge is immediately avail¬ able to the clinical scientists for pos¬ sible application. Through this close association it becomes possible to study "experiments of nature" patients with unique and unusual disturbances that, once defined, may help clarify the mechanisms of fundamental bio¬ logic processes. Why does The Hospital for Sick Children maintain such a large and expensive research establishment within its walls? Why is the research not left to colleagues in the medical schools, or to the extensive establishments south of the border, or to scientists in other countries? It is true that useful results of research are eventually published and available to all, but there are cogent reasons why the research should be done within the hospital and not be left to others.
care
proach to problems that is attractive to the creative physician. In a researchoriented hospital the clinical staff tend to be especially competent, particularly in handling difficult or rare cases. 4. Physicians who primarily care for
patients
are
exceptionally busy. They
hard put to find time to keep up with the clinical journals and cannot keep abreast of the new knowledge re¬ ported in the many specialized research journals. Thus, useful knowledge does not come to their attention until some¬ one else has noted its relevance to a clinical situation and tried to apply it. At The Hospital for Sick Children the many full-time investigators are in the forefront of their research fields and are quickly aware of the work of others in the same field. They can immedi¬ ately bring to the attention of the clin¬ ical staff any relevant information or concepts. The hospital can develop im¬ proved procedures for diagnosis and cure rather than wait for others to do the job. 5. The Hospital for Sick Children is one of the primary training centres in Canada for pediatric specialists, teach¬ ers and research workers. It is essential, if the next generation of pediatricians is to provide improved service to the own administration. community, that they be trained in an The Research Institute today has a environment that not only offers them wide range of activities, from basic of the best of present-day knowledge studies in biochemistry and cell biology medicine but also emphasizes enquiry to many kinds of applied studies direct¬ and scientific methods of problem-solvly related to patients. The amount and The specific knowledge the stu¬ ing. 1. For some kinds of research The dents scope of current research is indicated acquire will, to some extent, be¬ by the following statistics: 120 funded Hospital for Sick Children is the most come out of date their years of research projects are being conducted, appropriate institution anywhere. As a practice, but theirduring habit of analytical 54 full-time and 53 part-time investig¬ large hospital receiving patients from thinking and their to integrate ability all of Ontario and from many parts of information and form ators are actively carrying out research will be concepts and 50 young scholars are in advanced Canada and the United States it pro¬ important in to new medical adapting vides more subjects for certain kinds of stages of research training. The re¬ It is for this reason the search activities range from develop¬ studies than any other institution. For knowledge. that have the highest teaching hospitals ment of theoretical computer models of some of the rarer diseases it is one of stature and are sought by trainees are active enzyme centres in proteins to the few institutions in which adequate those that are committed to re¬ heavily investigation of psychosocial problems numbers of patients are available for search. in children. study. In summary, outstanding hospitals Every major division and department are heavily committed to research and, of the hospital is involved to some de¬ 2. Because each member of the re¬ indeed, their excellence is directly re¬ gree in related research, and in selected search staff is a specialist and possibly lated to the extent of their research fields major interdepartmental research an authority in some field, a variety activities. The high of medical quality programs have been undertaken. Five of specialized information is directly care given at The Hospital for Sick such programs have been initiated in available to the clinical staff through Children attests to the importance of the last 3 years in respirology, person-to-person consultation. the work being done at its Research neurobiology, genetic-metabolic dis¬ Institute. 3. The Research Institute and its ac¬ eases, cystic fibrosis, and fetal and neo¬ A. ROTHSTEIN, PH D natal physiology and metabolism. Two tivities create an environment of enResearch Institute The Hospital for Sick Children additional programs to be initiated are quiry and encourage a rigorous ap¬ Toronto, Ont. 488 CMA JOURNAL/SEPTEMBER 20, 1975/VOL. 113 are
