I have just returned from Balikpapan in Indonesia, where I was speaking at the 14th Annual Scientific Meeting of the Indonesian Association of Plastic Surgeons. Indonesia is an amazing country having over 240 million people. There are just 100 plastic surgeons and two burns centres in this vast and extremely diverse country. On the flight I was catching up on some papers, one of which was an invited article on burns research present and future. There is no doubt that there is some fascinating research being undertaken in many parts of the world related to various aspects of burns care but whilst musing on the future trends I had an epiphany. What if we stopped all burns related research in Europe and America tomorrow and diverted all the time money and effort into implementing what we already know but on a global scale. If we look at the best centres in the world, the best practices, are the results not good enough?
Three things come to mind. The first is the current joke that seems to be circulating in the cartoon world that says: “We have taken 20 years to discover that eating too much, drinking too much and smoking are bad for the health.” “Why 20 years?” is the question and the answer is: “Because we couldn’t get funding for 21 years.” The second thought that came into my mind was tobacco. The Tobacco-Related Disease Research Program has awarded $393,423,971 in 1,260 grants. That is a lot of money. Why not just ban tobacco? And the third? Well as a newly qualified doctor I went to Guatemala to work at INCAP, the Institute of Nutrition of Central America and Panama. This was set up in 1947 to look at the nutritional status of the Central American countries. Within two years the answer was apparent. There was plenty enough land to produce consumption crops to feed, and feed well, all of the people in all of the Central American countries, but… But what? The vast majority of the land was owned by a rich minority who wanted money and so grew cash crops instead of consumption crops. So what was the option for the scientists in INCAP? Suffice to say INCAP is still flourishing in 2010.
So back to burns. In the best centres of the world outcomes are already most impressive. What research is needed to allow all patients with burns to achieve such results? It is not laboratory research, nor clinical research. It is research related to global planning, resource allocation, training, and implementation. I am not even sure which journal to look at to find that type of research. But I am going to find out and report back.
Conflict of Interest. None declared. Of course if someone wanted to donate a large sum of money to investigate some aspect of burns care I might reconsider my position but then I am not in the “West.”
Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.