Dr. Berent Prakken delivered the esteemed Dunlop-Dottridge Lecture entitled "New Paradigms for Inflammatory Arthritis." Professor Prakken is at the University Medical Center Utrecht, The Netherlands. Aptly named with respect to this lecture, he is at the Eureka Institute for Translational Medicine.
Dr. Prakken started by having the audience guess how much research is irrelevant (sadly it's the vast majority; 85%). Using a framework in juvenile arthritis, he suggested that we change four common paradigms. The first is to think about autoimmunity as an immune deficiency. The old thinking is that T cells are the master regulators. He suggested a second paradigm change where we should get the big picture and critically make observations and follow the leads from nature. An excellent clinician and researcher is like a detective where they must observe and find the relevance, if any.
A third old way of thinking is to reset immune tolerance but this paradigm can be changed to: Think differently.
The final paradigm used to be that "Science will solve it all." Dr. Prakken challenged us to instead "Change the system." He offered insights into treatment-resistant systemic onset JIA and the relationship with IL-18. Vitamin B3 may be helpful as an adjuvant treatment due to its effects on the number and function of Treg cells. This hypothesis is currently in early phase studies.
Dr. Prakken's take home message was perhaps the most poignant for current and future researchers. We need to share our research, enhance collaboration and translate important findings into patient access. On average, one new drug costs $2.5 billion US and takes 17 years from idea to market! This is an unacceptable use of resources and time. According to Dr. Prakken, we need to share platforms, protocols, findings and change the system. He mentioned a platform in Canada which Dr. Rae Yeung has been instrumental in developing, the UCAN network, that espouses this concept.
There was a discussion during the question period about how the new paradigms -- especially with sharing of data and insights -- could impair promotion, publications and other ways that academics are evaluated.
What this means to me: We have to change the system and in order to appropriately advance medical science. We can share, collaborate and ask relevant questions, though science can also advance with keen observations and serendipity, so we have to keep our eyes open like a detective.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio