Walk into any major cancer center, and you will find doctors partnering with patients on hundreds of ongoing research studies. If you are looking for a medical setting farthest from the interwoven research and clinical care of oncology, go to any major medical center, and walk from the cancer center over to the emergency department.

In the Cancer Center, the place is just teeming with large-scale research studies, funded by more than 4.9 billion in National Institutes of Health dollars each year invested to achieve a better tomorrow for cancer patients. These studies are integrated into patient care and gain new understanding and/or test potential new treatments. Research is a core component of the culture and practice of oncology, across all major academic centers. It is no accident that improvements in cancer care, sometimes dramatic, continue to accrue and compound year after year.

In the Emergency Department, despite the fact that the number of individuals coming to US emergency departments with acute illness and injury continues to rapidly increase, with over 120 million individuals receiving care in 2015, research to improve the outcomes or to understand the maladies of individuals receiving emergency care is rare. In fact, in contrast to the billions spent on oncology care, Departments of Emergency Medicine received only 38 million dollars in NIH research support in 2014: far less than 1% of the funds spent on oncology, and only 5% of the funds spent on other medical disciplines such as psychiatry.

The consequence of this imbalance is that, for the vast majority of emergency care provided, no high quality studies are being conducted to improve the care of tomorrow. No studies are being done to ensure that individuals with acute illness, or suffering traumatic injury, will receive better care next year, or in 10 years, than they do today. This is a tragic situation for the public health, and for the hundreds of millions of individuals – ourselves, our children, and our grandchildren – who will be coming to emergency departments in the years and decades ahead.

The reason this is the case isn’t because the NIH has no funds available to support emergency medicine research. Rather, the reason is that emergency medicine, a young specialty, does not have a culture of research and has not yet developed a critical mass of professional researchers able to compete successfully for NIH funds and to perform the large-scale studies needed. A prototypical example of this is research to improve acute pain treatment and prevent the transition to chronic pain. Despite pain being the most common complaint for which individuals seek emergency care, few studies are being performed, and available treatments and interventions have improved little in decades.

With pain a ubiquitous crisis in emergency medicine, and so little funding, every dollar is impactful. Impactful in getting another young researchers’ career off of the ground. Impactful in producing studies in the literature to establish a nascent line of research. Impactful in helping a researcher advance successfully to NIH funding. Impactful in understanding pain.

We have a long way to go.


Samuel McLean, MD, MPH, Emergency Medicine | 29 April 2016