What’s Important: Disruption in Research

With the exception of the current COVID-19 crisis, injury and disease of the musculoskeletal system have represented the greatest health-care-related socioeconomic burden and the most frequent reason for sick leave and loss of quality of life in working populations1,2. History has proven that “paradigm-changing” progress in health care is almost exclusively achieved by methods that either prevent or cure disease. However, current research, as reflected in the peer-reviewed literature, is heavily oriented toward technical improvements in known diagnostic and treatment methods. Increasingly sophisticated technology has been developed and promoted to do much of what we have been doing for at least 20 years, with more precision or repeatability and greater ease and comfort for the surgeon, but with relatively limited gain in patient well-being, despite the spectacular growth of infrastructure and cost. This is in contrast to truly disruptive advancements. For poliomyelitis, for instance, tendon transfers and bracing were the orthopaedic standards of care for that terrible disease. Gifted surgeons continuously refined the respective techniques to the point that they knew much more about tendon transfers than any one of us currently. Had Salk3 and later Sabin4 not developed the poliomyelitis vaccine, we might still be bickering with one another about whether transfer A is better than transfer B. The disruptive research approach of Salk and Sabin ridiculed such discussions; their work resulted in a vaccine that prevented poliomyelitis, thereby opening the door to its eradication. An entire generation of physicians had been looking in the wrong direction, pursuing improvements in palliative care, when meaningful advancement required disruption. If prevention is not yet possible, cure appears to be the solution for which our research must strive. In the first half of the last century, tuberculosis was a plague that led to the construction of multiple sanatoriums where people were treated with bed rest, fresh air, and sunlight. Tuberculous joints were fused if they had failed to undergo spontaneous fusion, and abscesses were drained. Vaccination helped to prevent the most catastrophic complications but was not effective enough to prevent the disease. It was the discovery of streptomycin by Waksman5, the person who coined the term “antibiotics,” that paved the way to our ability to cure tuberculosis. The impact of this discovery was a cure for patients and the redundancy of treatment institutions, some of which were transformed into ski resort hotels for the enjoyment of good health. It is incontestable that orthopaedic giants have created “disruptive” innovations, be it Ilizarov with distraction osteogenesis; Buncke with new, universally accessible microsurgical repair and reconstructive techniques; Charnley with successful total joint replacement; Müller, Küntscher, and others revolutionizing fracture care; or Dandy and Jackson transferring arthroscopic surgery into daily routine. Such paradigm-shifting efforts, however, seem to be scarce and are not the predominant focus or priority of research. Why, for instance, are we still putting screws into vertebrae to fuse them without comprehending the etiology and pathogenesis of back pain or scoliosis, and why are we still treating joint pain with metal and plastic? Research leadership must drive us to a fundamental understanding of back pain, scoliosis, osteoarthritis, and soft-tissue degeneration, and focus its efforts on the prevention and cure of these challenges. To be of value, we must forswear “me-too” research and ask “so what?” before (and not wait until after) the research effort. Those who are able to do this kind of research must be identified and fostered, and those who have created extraordinary patient value should be duly honored. It is for these latter individuals that the Meyer Award was created, and it will be presented for the first time in 2021 to one extraordinary individual, or a team, who has changed the destiny of musculoskeletal patients. Recognizing “discovery, innovation, and disruption in orthopaedics,” the award is named in memory of Dominik C. Meyer, MD, Deputy Chair of Shoulder and Elbow Surgery at the Department of Orthopaedics at Balgrist University Hospital in Zürich, Switzerland. He was an extraordinary talent with all of the prerequisites to become a game-changer, but he died at the age of 49 years due to ALS (amyotrophic lateral sclerosis), for which the discovery of a cure has yet to be achieved. The recipient of the Meyer Award will be selected by a jury that is composed of members that have been appointed by the American Academy of Orthopaedic Surgeons (AAOS), the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), the Japanese Orthopaedic Association (JOA), the Australian Orthopaedic Association (AOA), Swiss Orthopaedics, and the sponsoring body, the ResOrtho Foundation. Additional information about the award and the nomination and application process can be found at meyeraward.org.