A researcher explains why he is optimistic about medical research-and why he thinks you should be too.
By William Bauman, MD
Have you ever appreciated medical care you received? If so, you know that medicine can make the difference between a good outcome and a bad one, and in the most dramatic instance, between life and death.
Did you ever feel that a physician could only do so much to treat a friend or loved one? When this happens, one feels hopeless, but concrete action can still be taken. A disease is like a puzzle, and it can be “solved.” Even if at times it may appear hopeless, it is often possible to study, eventually gain a fuller understanding of an illness, and treat it. Medical research routinely develops effective treatments for diseases or conditions where none previously existed.
How Research Improves Prognoses
When a person suffers an acute spinal cord injury (SCI), he or she will receive care that will inevitably lead to survival. The patient will obtain the benefit of research in neuroscience to reduce further damage to the nerves, research in bladder care to allow urination and prevent infection, research in pulmonary medicine to assist in breathing, and research to regain as much function to be as independent as possible.
Research is continuing to improve care in a variety of ways. The Lokomat® is a computerized suspended walking machine that may permit persons with SCI who were never expected to stand, let alone take a step, to learn to walk again. Research to adapt cars is permitting those with injuries to drive. Research to adapt homes is permitting persons with SCI to function in a more independent manner. Cutting edge technologies hold the promise and potential to continue to improve function over the next decade, such as brain-computer interfaces that implant electrodes in the brain to move limbs by electrical stimulation.
Research in the neurosciences has made tremendous advances in our understanding of nerves and how they grow and connect with each other. We know how to better protect them from injury and why they do not regenerate after injury. Someday, it will be possible to re-connect damaged nerves of the spinal cord so that a paralyzed person will be able to regain some, if not most, function. This is not a fairy tale. This is science and medical research in action.
Research Toward a “Cure”
If the “cure” occurs, a person with SCI will need to be well enough to walk again. Because of the possibility of a cure, it is important to keep the body’s muscles, bones, and other organ systems as healthy as possible. Also, until the neuroscientists learn how to “cure” the damaged spinal cord, individuals have to live with their condition and its associated problems. Some of the areas where medical research is needed to improve care for persons with SCI is discussed below.
If you are spinal cord injured, bowel care is often a dirty, labor-intensive, time- consuming activity. It may require stool softeners, laxatives, enemas, digital rectal manipulation, as well as other interventions. Recently, a combination of medications (neostigmine and glycopyrrolate) has been shown to safely and effectively cause rapid and complete stool evacuation in persons with SCI. In these studies, the medications were administered intravenously or intramuscularly, which make them unsuitable for home use. Investigators however, are developing an intranasal form of drug-delivery that should permit easy use for all persons facing difficulty with stool evacuation.
If you have a higher injury- that is, a high paraplegia or tetraplegia-you may have trouble breathing. This is for a couple of reasons: your breathing muscles may be weakened, and you may have an asthma-like condition. Research is being performed to try to strengthen these muscles. Also, we now recognize that if you have the asthma-like problem, then common medications used in persons with asthma may effectively relieve difficulty breathing. If you breathe better, you will be more comfortable and reduce your chances of lung infection.
Do you want to regain just a little more function? Do you want to breathe better? Move your bowels easier? Be healthier? All these needs will someday be partially or completely met. It is within the realm of possibility, but it will require time, dedication, hard work, and adequate resources.
One may question whether it is worthwhile to look for improved approaches to diseases or conditions like SCI. Why should we invest in what appear to be impossible problems? This should be a rhetorical question after the above discussion. Physicians and investigators have invested their entire lives in medicine and the related sciences. Doctor-investigators are poised to answer the most difficult clinical questions. Breakthroughs will occur, but we should not expect to answer all important questions in this generation, or even the next, but at least we will be moving in the right direction.
William Bauman, MD, is director of the Spinal Cord Damage Research Center at the James J. Peters Department of Veterans Affairs Medical Center in the Bronx, New York.
