The pediatrics department has long been a centre of evidenced-based medicine, being
able to demonstrate not only what works, clinically, but also why it works.
In his practice as a pediatric nephrologist, Dr. Keith Lau follows many children with chronic kidney diseases and, without a doubt, they are some of the sickest patients that come through the department. They are also some of the patients that form the greatest personal attachment to it, since they come in three times a week for dialysis, without which they would go into kidney failure.
Even with the weekly treatments, the trend among these children is toward greater dysfunction, leading, ultimately, to kidney failure. But Lau and others have noticed that the rate of kidney degeneration isn’t consistent across patients; in some, kidney function deteriorates very quickly while, in others, the process is slower. The obvious question, then, is, “Why?”
“We have a hypothesis,” says Lau. “If you do more exercise, you will have less inflammation [a factor that is an indicator of kidney function].” If that hypothesis were true, then it’s possible that you could slow the rate of inflammation, which, in turn, would slow the progress of kidney disease. And there’s another aspect to Lau’s hypothesis: He suggests that exercise can have an immediate effect, rather than a cumulative, delayed one.
That is, a child spending an hour exercising will have a marked reduction in inflammation at the end of that hour as compared to the beginning. If that were true, it’s something a parent of a child with kidney disease, let alone the physician treating that child, would like to know.
In a study being led by Lau in collaboration with Dr. Brian Timmons, Lau hopes to be able to provide an answer to that question: Can exercise reduce inflammation in patients with chronic kidney disease? He believes that, very probably, it can.
“I hope my hypothesis is correct,” says Lau, with a chuckle. “But it takes some time…. If you come back next year, we may have some results for you.” Of course, that kind of curiosity, as well as that sense of uncertainty, is something that all researchers share. “Hopefully all our hypotheses are right,” says Lau. “But, of course, there is no guarantee. Sometimes we have a marvellous hypothesis, and everything [in the study] runs smoothly; but, sometimes it’s the wrong hypothesis and, well, we have to start all over again…. But you don’t know what you get until you see the results.”
The advent of evidence-based medicine
Something else that Lau, and indeed all researchers know, is that whatever is found — that the hypothesis is right, partially right, or entirely incorrect — there will be something learned, a new piece of knowledge gained, another piece of the puzzle found. If Lau’s study finds that exercise can reduce inflammation, both in the short and the long term, great. That’s information doctors all over the world will be interested in knowing. His research can also provide a point of entry for further studies in this area of inquiry. Conversely, if Lau’s hypothesis is not correct, well, that’s also good to know.
Whatever the outcome, Lau is demonstrating the essence of evidence- based medicine: the desire to be able to support clinical practice with hard evidence of its efficacy. Indeed, it’s that kind of approach to clinical practice that has defined McMaster’s medical program from even its very early days. “It started here,” says Dr. Anne Klassen, adding that the term “evidence-based medicine” was coined at McMaster by Dr. Gordon Guyatt in 1990. It’s now used commonly around the globe.
“Even when I was at Oxford doing my doctorate,” says Klassen, “McMaster people were coming, and evidence-based medicine was spreading around the world…. It’s very relevant in clinical practice, making sure that your treatments are based on the best evidence.”
That’s even more evident within the department today as it continues to grow as an academic setting. The need to know, to find out and to learn is shared throughout the department, often entirely irrespective of any of the divisional boundaries that, in some settings, are prevalent. Timmons, who is also a co-investigator with Dr. Gabriel Ronen on an epilepsy study, has said, “Whenever I’ve asked someone to work with me, no one has ever said ‘no.’” It’s precisely that character that continues to make the department an international centre of unique, cutting-edge research.