Pediatric Health is a new journal that targets a wide range of individuals who provide care to children, and the launch of this journal comes at a unique crossroads in the history of clinical practice. For many years, pediatric journals have generally been considered as either ‘academic’ journals, where those individuals who work in an academic environment (typically medical schools and universities) report new research, or ‘practical’ journals, where review articles focus on topics of interest to the general pediatrician. As an individual who has practiced in both kinds of settings, I can attest to the fact that it is only too infrequent that an article or paper that appeals to one audience will simultaneously hold the interest of the other. This is not a criticism of either group, but simply an observation borne by experience: the concerns of the general pediatrician and the academic physician–scientist have historically seldom overlapped. Nonetheless, pediatricians have continued to provide outstanding care to our children, and academicians have generated new knowledge that has advanced that care, often in dramatic ways.
So what is changing today? Are we truly at a historical crossroad in the way we deliver clinical care? Increasingly, it has been recognized that the translation of basic laboratory and clinical research into clinical practice has not been as seamless or straightforward as might be hoped. Out of this concern grew the NIH Roadmap Initiative Citation[1]. The basic tenet of this initiative is that efforts must be made to catalyze changes in the way that we transform our new scientific knowledge into tangible benefits for patients. Developed with input from key leaders in academia, industry, government and the public, the NIH Roadmap provides a framework of priorities which must be met in order to optimize not only the NIH research portfolio, but, by extension, other biomedical research as well. The NIH Roadmap lays out a vision for a more efficient and productive system of medical research, emphasizing opportunities in three main areas: new pathways to discovery, research teams of the future, and re-engineering the clinical research enterprise. As the NIH Roadmap has continually evolved over the past 5 years, we have seen major reorganization in the way biomedical research is structured and administered, with a new initiative to pursue a Clinical and Translational Science Award (CTSA) funding mechanism that is intended to transform clinical research, training of future researchers, and integration of community resources Citation[2]. By transforming how clinical and translational research is conducted, ultimately researchers should be better poised to provide new treatments more efficiently and quickly to patients.
What are the implications of these Roadmap initiatives for those involved in the care of children? There are many important issues that must be carefully considered for the practice of pediatrics in the context of the NIH Roadmap and CTSA programs. First of all, it is becoming more and more evident that the clinical practice of pediatrics is increasingly consumed by the anticipatory management of the early antecedents of adult diseases. Health issues such as obesity, diabetes and hypertension are now becoming common pediatric concerns. In the setting of the NIH Roadmap, the opportunity to interface more earnestly with colleagues in internal medicine, public health and epidemiological research is compelling. New strategies focusing on behavioral and pharmacological interventions must be pursued and quickly translated into the clinic. Team-building with colleagues across many disciplines will be critical to meet the health needs of our children in the light of the complex and changing epidemiology of pediatric diseases. As the Roadmap emphasizes, research partnerships will be of major importance for child health.
A second area of focus that must be strongly emphasized is the retention of pediatricians in key leadership roles in CTSA and Roadmap programs. Pediatric representation on NIH study sections and on expert review panels will be essential in ensuring that the biomedical complexities unique to child health are considered in the grant review process. A corollary to this goal is the continued need for a ‘pipeline’ of pediatrician-investigators in basic, clinical and translational research. The training programs of CTSA and other NIH programs must continue to place, nurture and protect the time of all those broadly engaged in child health research, including pediatricians, basic scientists, PhD investigators, public health researchers and educators. At the same time that team-building in research is rightly anticipated to be increasingly valued and emphasized, advocates for Children’s health research must be included in key leadership positions during this period of increased emphasis on translational research.
A third major focus of the Roadmap initiative that will be critical for child health is the need to establish research partnerships between academicians and community-based providers. It is in this arena that this new journal Pediatric Health can fill a unique niche. By providing an outlet for reporting cutting-edge research findings that have immediate clinical relevance, Pediatric Health aims to bridge the gap between ‘academic’ and ‘practical’ journals, and provide those involved in the care of children with information that has immediate translational implications for practice. It is hoped that those individuals in primary care pediatrics will be energized with a sense of excitement about how their practices can partner with clinical and translational researchers to promote new knowledge generation. Such partnerships are particularly urgent in the developing world, where research opportunities abound and the need for improved care is immense. Academicians, in turn, will need to develop a greater sense of urgency in understanding and helping to solve unmet needs in pediatric health, both locally and globally, in the years ahead. As such partnerships are forged in the near future, the creation of the Pediatric Health journal can serve as an example of the kinds of new possibilities the Roadmap creates. An exciting implication of the Roadmap initiative is that clinicians and investigators might be able to share a common journal and learn to speak each others ‘language’, unified by a shared mission in streamlining the flow of new findings from bench to bedside.
The nature of pediatric care has changed in many ways in recent years. There is an urgent need to tackle problems such as obesity, diabetes and autism at multiple levels, including basic discovery, health services and public policy. This is a time of great opportunity: the increased emphasis on immediately translating new findings to clinically relevant approaches to care is occurring at the very time that we face these urgent new problems in Children’s health. Although the face of child-health practice has evolved in many ways, the fundamental commitment of pediatricians to the health and well-being of children has not changed. As a member of the Editorial Board of Pediatric Health, I hope we are successful in capturing the balance between basic research and clinical practice in a manner that meets the needs and piques the interest of both academicians and clinicians. The Roadmap initiative stresses that the barriers and separation between these constituents is artificial and unnecessary, and that by working together we can enhance each other‘s professional activities and, above all, help kids. We hope that Pediatric Health can be a bridge that helps meet this goal. By providing up-to-date information about emerging topics of importance in child health, this new journal can remind us all of the importance of intra- and interdisciplinary collaborations and interactions that promote new discovery and improve the health of our children.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, royalties
No writing assistance was utilized in the production of this manuscript.
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Bibliography
- National Institutes of Health Roadmap initiative www.nihroadmap.nih.gov
- National Center for Research Resources: Clinical and Translational Science Awards www.ncrr.nih.gov/clinical_research_resources/clinical_and_translational_science_awards/