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DCRI, Peds Epidemiology join for care The following article was edited and reformatted from the November issue of the Children’s Hospital newsletter, Kids Connection. Blazing a new trail is nothing new to the MUSC Children’s Hospital and certainly, the Darby Children’s Research Institute (DCRI) embodies that same spirit. These two entities are working together for optimal patient care through research and have a unique component that aids them in that quest.   Quite rare in the United States, the MUSC Department of Pediatrics encompasses the Division of Pediatric Epidemiology. This division, one of only two in the country known to Thomas C. Hulsey, Sc.D., pediatric epidemiology director, studies populations and looks for trends that provide insight into the underlying mechanisms of disease. In more detail, this means that the epidemiologists within this department employ a population-based view to unveil nuances in disease distribution specific to children that other types of investigations overlook.   “By having such a unique division, the department of pediatrics is acknowledging that improving child health goes beyond that of the traditional physician-patient relationship,” Hulsey said. “It’s a recognition that the discovery of the relationship between risk factors and disease does not come solely from the laboratory.”   South Carolina often ranks poorly in health statistics when compared to other states. Several demographics are taken into account when looking at the health of populations, including social, economic and educational components that affect the health of a society. South Carolina embodies a large rural population disproportionately affected by said components.   Based on the 2000 census, one-third of South Carolina’s 3.9 million residents belong to a minority group, with African-Americans representing the largest group at almost 30 percent, and Hispanics at two percent. However, between 1990 and 2000, the Hispanic population more than doubled, and African-Americans increased by 14 percent.   The focus of many academic medical centers across the country are in health disparities, meaning that minorities experience poorer health outcomes and more premature deaths than whites. Because of pediatric epidemiology and the DCRI, MUSC stands poised to make a real difference not just in the treatment of disease for all children, but also for those faced with health disparities.   While most see the marriage of research and patient care as a good thing, designating children as research subjects might seem, on the surface, a shaky idea.   “At first glance, one might think that the last place to ‘experiment’ with new therapies is with the care of children hospitalized for serious illnesses. However, there are a few misconceptions in this way of thinking,” said J. Philip Saul, M.D., Children’s Hospital medical director and Pediatric Cardiology director. “When discussing clinical research, we like to use the term ‘investigational’ rather than ‘experimental’ because the therapies being evaluated have already undergone rigorous testing in animals and adult volunteers before reaching the bedside of children. Furthermore, many trials are designed to compare two existing alternate therapies which may have been used for many years but are without actual data supporting which one was best.”   To illustrate Saul’s comment, he said that when most new surgical techniques are developed by innovative individual surgeons, they are rarely if ever formally evaluated against other surgical techniques or medical therapies.   “Appropriate concerns over the protection of children in research studies, combined with the relatively small number of children compared to adults with any particular condition, have also hampered our ability to objectively compare one therapy against another, or even a lack of therapy for most conditions in children,” Saul said. “Moving the care of our children to the stage where our evaluations and therapies are based on evidence, rather than intuition, will require that we continue to bring clinical investigations to the pediatric population.   “It is also important to note that, for many serious diseases, only the very latest ‘investigational’ therapies offer hope for long-term survival. The presence of clinical research in the hospital is critically important to our primary mission of delivering the best care possible to the children who come to us.”   Pediatric epidemiology collaborates with faculty involved in clinical research and provides an infrastructure, shared resources, data base management and statistical analysis.   Support continues for those involved in clinical research through division services like teaching research methods and assisting colleagues in developing testable research questions, designing clinical trials, analyzing data, and writing grants and articles for publication.   In the spirit of investigational therapies then, basic scientists in the DCRI and pediatric epidemiologists must work together as part of providing the best care for children. To that end, pediatric epidemiology broadened its focus in recent years and remains the scientific structure often responsible for new discoveries.   “We might know, for instance, that 20 percent of children are going to get sick with a particular disease, but which 20 percent?” Husley asked. “Epidemiology provides the tools that allow us to understand which differences are important in disease occurrence and which are not. Pediatric epidemiology brings in the added resource of studying how the health of populations of children differ and how characteristics of those populations are associated with those differences.”   In addition, Hulsey and his colleagues are enthusiastic about a newly acquired geographic information systems capability. “We can determine if certain childhood diseases tend to cluster in different places around the area, giving us new information into the incidence of birth defects or the prevalence of other persistent conditions,” he said.   The division team sees collaboration as the future of their field and important to their own growth.    “We’re looking forward to seeing the division grow, to forming a tighter association with our basic science colleagues, and to a greater collaboration with translational researchers,” Hulsey said. “It’s critical that modern, contemporary epidemiologists embrace the contributions of biomarkers and other new discoveries to determine how they can be applied to the population and back again. It’s exciting for us to forge collaborative relationships with new multidisciplinary teams in the scientific and medical community.” The role of the National Institutes of Health (NIH) in enhancing clinical and translational sciences   As one of the most sought after and competitive sources of federal scientific research funding, the NIH states that the discipline of clinical and translational sciences must develop further to bridge gaps between basic science discoveries and clinical applications. Many challenges exist for this endeavor.   Difficulty recruiting and retaining clinical researchers, increasing regulatory burdens and overhead costs, and the absence of a true academic home for young clinical faculty denote a few of these obstacles.   In recent months however, the National Center for Research Resources (NCRR) released a request for applications for Clinical and Translational Sciences Awards (CTSAs) to establish centers/institutes/departments to oversee enhancement of the discipline of clinical and translational sciences.   They envision funding 60 centers nationally, and phasing out the 78 General Clinical Research Centers (GCRCs) through 2012. Each of the CTSAs would have career development programs to develop future clinical and translational scientists, and grow clinical research enterprise and catalyze translation of “bench top” discoveries to “bedside” applications, including best practices.   On Oct. 26, Kathleen Brady, M.D., Ph.D., Psychiatry professor and MUSC GCRC director, and Bernard Maria, M.D., DCRI executive director, met with NCRR director Barbara Alving, M.D., to explore opportunities for MUSC.   “We believe that the MUSC Children’s Hospital and DCRI are breaking down programmatic and disciplinary silos and creating new bridges across scientific fields, stimulating change at all levels,” Maria said. “The Children’s Hospital and the Department of Pediatrics have a strong track record in multidisciplinary care, education and research. One recent example of success is the recent award of a T32 Roadmap training grant to co-principal investigator Dr. Tom Hulsey. Within our world of children’s research at MUSC, we have luminaries in pre-clinical, clinical, and community translational approaches that NIH is seeking for CTSAs.” Friday, Nov. 25, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.