The Zerhouni Challenge: Defining the Fundamental Hypothesis of Emergency Care Research

What is your hypothesis? This is almost always the first question I ask graduate students when they enter my office to propose a new research project. It is also the first thing I look for when reviewing a research grant or original research manuscript. The hypothesis is fundamental to modern scientific inquiry. Without one, it is impossible to judge the potential impact of a proposed line of investigation. Why, then, was I surprised, and somewhat unprepared, when the same question was asked by the director of the National Institutes of Health (NIH), Dr. Elias Zerhouni? What makes Dr. Zerhouni’s question compelling is that it wasn’t directed at a specific research grant or manuscript: it was directed at an entire field of investigation, the field of emergency care research. On January 25, 2007, a group of Emergency Medicine investigators, including Chuck Cairns, Jim Hoekstra, Judd Hollander, Roger Lewis, Sandy Schneider, and me, met with Dr. Zerhouni at the NIH to discuss the future of emergency care research. After numerous conference calls and e-mail exchanges, we were prepared to highlight the synergy between the recent reports of the Institute of Medicine (IOM) Committee on the Future of Emergency Care in the United States Health System and the NIH roadmap initiative to “reengineer the clinical research enterprise” in the United States. Dr. Zerhouni listened attentively to a wellorchestrated proposal that was primarily focused on integrating emergency care research and research training into the new Clinical Translational Science Award program. 7,8 Although he acknowledged the importance of building our research infrastructure, he asked us to consider the “why” as much as the “how.” He challenged us to define and prioritize emergency care research. What areas of scientific investigation are unique to emergency care, best studied by emergency care investigators, and inadequately explored by other groups of scientists? He asked us to state the unique fundamental hypothesis of emergency care research. Before he even finished articulating the question, my mind was racing to recall the text of the IOM reports, 1-3 the American College of Emergency Physicians (ACEP) Research Committee report submitted to the IOM, 9 and even the original 1995