Without research, there is no medicine

Jerusalem’s 114-year-old Shaare Zedek Medical Center organized its first-ever staff research day and intends to hold them every two years.

The Shaare Zedek hospital's building (photo credit: SIR KISS/WIKIMEDIA COMMONS)
The Shaare Zedek hospital's building
Since Shaare Zedek Medical Center opened as a small hospital in 1902 – when horse-drawn carts rather than the Light Rail ruled Jerusalem’s Jaffa Road – it had never held a research day presenting studies by its doctors and nurses. That is, until the third week in May.
The long corridor reaching from one end to the other on the fifth floor of the medical center’s campus (to which it moved in 1979, opposite Mount Herzl) was wallpapered with large, colorful “poster sessions” describing 180 research projects, some of them published in medical journals, which were recently carried out at SZMC.
Now with 1,000 beds, offering many advanced treatments in a large variety of specialties, delivering more babies annually (22,020) than any other hospital in the world, it is considered one of the fastest-growing, most empathetic and best hospitals in the country.
So how is it possible that it never organized a research day before? The idea was recently suggested to Prof. Dan Turner, the deputy director-general for research and development and head of the Juliet Keidan Institute of pediatric gastroenterology and nutrition, by Prof. David Lichtstein, dean of the Hebrew University-Hadassah Medical School.
“Like every hospital, we set four missions before us: to save lives and cure diseases; reduce patients’ pain and suffering; train the next generation of medical professionals; and conduct basic and applied medical research,” Prof. Jonathan Halevy, who has been SZMC’s director-general since 1988, told the 400 doctors and nurses present at the Hedi Steinberg auditorium. SZMC staffers have always conducted research to benefit patients, but for years put the most stress on the first three functions.
In the past decade, the number of hospital beds grew with the opening of its Next Generation building and taking on responsibility at the state’s request for running the bankrupt Bikur Cholim Hospital; since 2005, the number of beds doubled from 500. Annual admissions, Halevy noted, jumped from 45,000 to 85,000; outpatient visits quintupled to 540,000; obstetrics deliveries doubled; emergency room visits more than doubled from 64,000 to 140,000. Public research papers rose from 173 in 2005 to 350. The medical center is also affiliated with the Hebrew University Medical Faculty, which is the first and main affiliate of the Hadassah Medical Organization’s two university hospitals.
So SZMC now feels “grown up” enough to hold research days, and it plans to organize them biennially from now on, Turner said.
TURNER, WHO received his medical degree from Ben-Gurion University of the Negev, has been at the hospital since 1999 but took time off for a pediatric gastro fellowship at Toronto’s Hospital for Sick Children and a doctorate at the University of Toronto. His institute has seen a 20 percent increase in clinic visits (most young patients coming from outside the capital) since it moved to the New Generation building a few months ago.
The institute’s 10 physicians treat, among other things, inflammatory bowel diseases (Crohn’s and colitis), liver diseases and eating disorders, and they wrote some of the poster sessions on their research project.
“Our credo is that doctors have to be available to patients and treat them with dignity, as they arethe focus of our work. We are here to serve them. If patients have to wait more than a few minutes, I apologize to them,” Turner told The Jerusalem Post after the research day. “Until we established our research and development authority, Madait, three years ago, SZMC didn’t have a single patent for a product or process developed at Shaare Zedek. Now, assisted by the Hebrew University’s R&D authority, Yissum, numerous contracts are being signed by the SZMC company, with a sharp increase every year.” Turner said.” Turner said.
“Suddenly, our doctors and nurses have started to present their ideas for development. We have an in-house engineer. We have also forged ties with the Jerusalem College of Technology [Machon Lev, Jerusalem’s Azrieli College of Engineering and Hebrew University (HU) researchers on exciting applied projects.”
A research day involves much more than asking colleagues to present their research orally or to print up poster sessions. Hundreds of hours were spent by Turner’s team on producing and printing a 200-page book of abstracts, each taking up a page, to summarize the background, methods, results and conclusions of the studies, as well as other organizational tasks (including providing food). Management also allocated money for NIS 10,000 and NIS 5,000 prizes for the best research.
It is ideal for senior doctors to conduct research in addition to their clinical and teaching duties, according to Turner.
“For some, it is part of their souls.
But some prefer to focus on treating patients rather than to be involved in medical trials, and this is also OK. You don’t have to publish in medical journals all the time to become a professor or to be a good physician.”
Some of the hospital’s women professors, including medical genetics head Prof. Ephrat Levy-Lahad, are known for their research around the world. Her institute’s staffers alone produced 33 poster sessions that were displayed in the corridors.
The nature of SZMC’s research is quite similar to that at the Hadassah medical centers – which is a “competitor” for patients. “But we do a little more clinical studies than basic science studies. We have fewer labs than at Hadassah, but this is not surprising, because Hadassah is the cradle of medical academization in Israel. We have a lot of cooperation with HU and Hadassah researchers.
“There is plenty of room for all, and there is no tension between us.
Cooperation was not harmed even during the labor unrest at Hadassah, when we had to pick up the slack. Our researchers and their share a love for research, and multidisciplinary collaboration is the mainstay of excellent research and breakthroughs. Some 20 percent of the faculty’s clinical teaching is at SZMC.
The hospital previously affiliated with BGU’s Health Sciences Faculty, teaching its medical students on the wards, “but today, there is no reason to go to Beersheba if they can just go across the road to the labs of the HU’s Medical Faculty.
We also cooperate in research with most hospitals such as Tel Aviv Sourasky and the Rabin Medical Center.”
Turner predicts that in five years, research at SZMC will continue to increase dramatically and its researchers will publish some 500 articles an year. “There will be more commercialization of their discoveries and the establishment of biomedical labs,” he said.
But getting grants is very hard for all Israeli medical researchers.
“We have two grants from the US National Institutes of Health, but competition for them is fierce. Most money comes from the pharmaceutical industry, which naturally has vested interests, even though the research is mostly conducted independently of the companies.
But the money should come from the chief scientist,” he said, either of the Health Ministry or the Economics Ministry (which is much better endowed but does not fund medical research).
Greeting the research day participants, Health Minister Ya’acov Litzman stated that even though as a yeshiva student he had no secular education, he appreciated the importance of medical research, saying, “Without research, there is no medicine.”
He added that the NIS 8 million allocated by his ministry for medical research was only “a drop in the ocean. Isn’t it shameful? Maybe we can increase it.”
SZMC, established and owned by a voluntary organization, is permitted to offer private medical services (Sharap) by its most senior doctors.
“I don’t think Sharap hurts research efforts. In fact, it causes leading doctors to be in the hospital many more hours instead of pursuing a private practice outside,” Turner said.
Hearing from this writer that a senior Treasury official once told her that “hospitals here don’t have to do their own research, they can just import it from abroad,” Turner completely disagreed.
“Hospitals must conduct research. Findings are translated quickly from the lab to the bedside, and this benefits patients. It means better service and medicine and forces the physician to be at the forefront of medicine, think out of the box and be in touch with leading experts around the world.
And there are diseases and conditions, resulting from Israel’s unique mix of ethnic groups – Jewish and Arab – and its situation, that are not studied abroad.”
For instance, SZMC treats Arab children with kidney diseases that are caused only by consanguinity (first cousins who marry and have children). In addition, Crohn’s disease and colitis are somewhat different in Jewish and non-Jewish children, he pointed out.
MANY OF the studies presented at the research day or in the poster sessions alone were very technical and thus difficult for layman readers to understand. But here is a selection of the more intelligible ones.
Doctors in the hospital’s ophthalmology noticed that the inflation of heart-shaped balloons, as opposed to ordinary egg-shaped ones, is an exceptional hazard that can cause injury to the eyes. They not only documented eight cases but also conducted an experiment in which they inflated four ordinary ones and four heart-shaped ones until they burst, recording the process with high-cameras capturing 20,000 frames. The heartshaped balloons cause “backward whiplash,” splitting into two rubber parts that are more likely to harm the eyes. They advised that when inflating such balloons, eye protection must be worn.
Midwives found that the more the nurses encouraged breastfeeding (of colostrum) within the first hour of delivery, the more likely the women were to adopt longer-term breastfeeding, thus promoting the babies’ health.
Testing the grip strength of healthy adults, staff of the occupational therapy department found that Israeli men under the age of 30 were three percent weaker than their Australian counterparts, and Israeli women under 60 15% weaker.
They suggested that the difference could come from the higher rate of white-collar jobs in Israel compared to Australia.
SZMC psychiatrists studying IDF soldiers referred to emergency rooms for psychiatric assessment found them to have significantly more alcohol use disorder than students who already completed their military service. Even though alcohol consumption on duty is prohibited, the doctors found that 16% of the soldiers suffered from alcohol use disorder, and that the level of stress in the soldiers was significantly higher than in the students.
Emergency department nurses looked at psychological trauma suffered by cleaning, housekeeping and other non-medical staffers in the department who are routinely exposed to patients suffering from stabbings, gunshot wounds and accidents, and to blood and the transportation of corpses to the morgue. They found this group is significantly less equipped than medical staff to handle such experiences and would benefit from psychological sessions.
Siblings who undergo bariatric surgery for severe obesity have better success in permanent weight reduction than non-related patients, according to staff in the general surgery department. Other surgeons there, who studied breast surgery in elderly women, found that they suffer relatively low rates of complications and death, and thus that age alone should not disqualify patients older than 80 from breast cancer surgery.
Women who deliver their first babies in one hospital and subsequent children in others (“switchers”) are more likely to suffer complications in their second-baby experience than “stayers,” apparently due to the fact that switchers comprise a unique clinical group characterized by higher rates of cesarean section.
When women who previously gave birth by cesarean section are given epidural anesthesia before giving birth the next time, their chances of having a vaginal birth are higher, according to obstetricians and anesthesiologists.
Terminal patients are better able to cope emotionally if they are helped to produce a verbal and pictorial diary of their lives, said palliative medicine experts.
Many SZMC doctors were part of the IDF team that went to Nepal during the severe earthquake last year. The infectious disease unit and other doctors found that of the 137 members of the IDF team, including those from SZMC, who spent several weeks in the field hospital, 53% suffered from gastrointestinal complaints due to the difficult living conditions and shortage of running water.
Patients suffering from irritable bowel syndrome have a 38% higher risk of hearing loss (and 52% of those over the age of 40) compared to healthy people of the same age) – apparently due top sensorineural problems resulting from the autoimmune condition, according to gastro and ear-nose-and-throat specialists who studied this.
Finally, nurses who start their shift and are briefed by the nurses ending their shifts should be better trained on how to provide information on patients, because many of them do not absorb all they need to know about patients during the handover process.