The Idea

The idea of inhaled antibiotic therapy for treatment of pulmonary tuberculosis is about to "tip" into mainstream thinking in the field, or at least I hope that it does. This idea has been hanging in the periphery of the scientific literature since the late 1940s. It seems to gain and lose momentum, but never become accepted or rejected based on evidence. Nevertheless, there is a continuous thread of case reports, predominantly in English, French, Russian, German and Japanese, which support the use of administering antibiotics by the inhaled rout to treat tuberculosis. 

Since about 2000 there has been a renewed interest in the strategy of treating tuberculosis with inhaled antibiotics. That is evident in the publications of pre-clinical studies conducted to identify ideal drug formulation and delivery devices. As one would expect, there is abundant pre-clinical data and little to no clinical data (the time it takes to bring a new treatment strategy to standard clinical practice will be the subject of another post). In writing a proposal to secure funding to produce clinical phase 1 trail data in this field, I did something counter-intuitive: I broadened my search of the literature in Google Scholar from specific drugs and devices to "inhaled therapy for tuberculosis," and that in itself is not unusual in my literature research techniques, but what I did next was. Instead of starting with the most current review, I went to the last of about 26,000 search results. This is not normal behavior for someone who wants the most current and cutting-edge information. But I struck gold. I found an abundance of clinical case reports in the archives of medical journals from the time when the drugs I proposed to study were first discovered.

I have been working on this project for several years, and never came across these articles. Similarly, the most recent "expert reviews" in the field state that the idea of inhaled therapy for pulmonary tuberculosis arose in Russia in the 1950s. But this is not true. Nevertheless, I thought it excusable.  Who has time to look through 26,000 odd Google search results? However, I've become increasingly irritated that the expert reviews I was previously relying on were false, for lack of better terms. Maybe I should say they are incomplete. How is it that in an age when so much information is so easily accessible that crucial facts are going unnoticed? It might be that the experts opinions are so expensive, and funding so competitive, that they don't have time to be thorough. So, how do we take collective responsibility for the correct dissemination of information? 

I think the "wiki" format is a component of the answer.  The eventual goal of this blog is to diary my progress in figuring-out how to create an international, translatable forum for clinical researchers, physicians and scientists to share their work in real time without the cost and time barriers associated with peer reviewed publication: to set up an international online community of peer publication and review. Of course, I do not think that the current system of peer reviewed publication should be replaced, nor should institutional oversight and human subject protection be undermined. The forum that I imagine may also already exist and I just don't know about it yet. I just think that information deemed "not worthy" by experts should be accessible to a larger audience who may find the missing link to their discovery in a random, web-published observation. We should rely on group intelligence rather than the expert opinion of a few.

In other words, I think that our current infrastructure for innovation in medical science is putting the cart in front of the ox. In a time when "translational research," interdisciplinary collaboration" and "evidence based medicine" are all the rage, the institutions that are set up to support this work might be strangling true innovation. These institutions think linearly e.g. from bench to bedside. The regulatory guidelines are clear in their articulation of what milestones must be met and what data must be collected before a project can graduate to the next tier. Overall, this may be good, but translation from basic to clinical science has actually slowed down, interdisciplinary refers to collaboration between sub-specialist and the definition of evidence has narrowed. 

This blog is going to chronicle my investigation into an ironic trend: stated support and functional weakening of innovation in medical science. It is not going to be linear; direct (including speling-grammer corrections!) , loosely associated feedback and new ideas are all welcome. My hope is to develop the idea behind this blog into something that is beyond the limits of my education, skill and curiosity into a platform for scientific communication that is not yet imagined. So please, take this idea, share and or run with it.