The Future Rests on our Past
"Under my administration the days of science taking back seat to ideology are over. Our progress as a nation - and our values as a nation - are rooted in free and open inquire. To undermine scientific integrity is to undermine our democracy. It is contrary to our way of life."
(President Barack Obama)
Extraordinary progress has been made in perinatal care during the last half century, something for which we can all rejoice and be proud. But there is still much to do.
The future rests on our past.
With the rapid development of information and communications technologies, industrial nations are transforming into societies in which knowledge is the most contested and valuable good.
Since time immemorial, science has been competing for the best minds and the best conditions for them to work in. In our great enthusiasm we should not forget important fact of life! A fact of life is that close to 1.5 billion people in the world live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live.
Poverty has a woman’s face; of the world’s 1.3 billion poorest, only 30% are male.
Furthermore, for 90% of the pregnancies and deliveries in our world, the reality is very different.
As perinatologists, we should know that for 90% of the pregnancies and deliveries in our world, the reality is very different. A young woman in Ethiopia, for example, goes into the reproductive phase of her life with a one-in-ten chance that she will die as a result of pregnancy or delivery. That is not only shocking – it is totally unacceptable.
While medicine is international law is not! The laws in different countries differ significantly. The controversial issues of genetic engineering, stem cell research, and therapeutic cloning in particular show how wide the international gap is regarding what is permitted and prohibited. In Asia, and particularly in Europe and Great Britain, researchers are given great freedom in these areas.
People may believe that science has little to do with the main preoccupations of humanity (e.g. family, work, personal expression etc). They assume that the social sciences and humanities are independent of natural sciences, and that they are more relevant to humanity. I propose, however, that science is not marginal. Like art, it is a universal possession of humanity, one of its vital potentials. It comprises what we know of the material world with reasonable certainty. For example, if the natural sciences can be successfully united with the social sciences and humanities, we believe that the liberal arts in higher education will be revitalized.
We firmly believe that the globalized world will be run by those who know how to synthesize; i.e. people able to put together the right information at the right time, think critically about it, and make important choices wisely.
At the time of fast globalization it is clear that no human endeavor is more adapted to the globalized world than science, for its very nature is global. The brotherhood of scientists is truly international. This is an immense privilege, but equally so an immense responsibility for the development of humanity.
What is the basis on which we can and must rethink values, society, individually, and maybe even our concept of the human being?
Scientific and clinical research in the field of developmental biology, embryology and perinatal medicine will grant the human embryo and fetus, both as a subject of inquiry and a patient, the respect and treatment that is due to a child, even if still unborn.
Knowledge itself ought not to be limited and, therefore, the function of bioethics is not to ban upfront research into new technologies but to define the limits within which, if at all, these new scientific means may be applied and for what purpose.
Every advancement of science and technology raises a new the question of what are we to do with our increased power over nature. A task of the ethics of science is to take care not to „demonize“ science, presenting its power as a danger to human cultural values, as a demon that wants to take control over human free choice of action or as a Promerhean revolt. Science alone does not answer the question of what to do with the knowledge it generates – it is not in itself a moral value. Rather, the human cultural values in their ethical, legal, philosophical and often religious dimensions are the tools which help determine how to use knowledge for good purposes. The biblical image of the „Tree of Knowledge of Good and Evil“ (Genesis chap. 2) is already a warning to mankind that knowledge (science) may be used for good as well as for evil, and because science is morally neutral it should not be consummated without the „Tree of Life“ (Zohar Bereshir, Folio 33b), which is the symbol of all higher moral values sustaining human life (as they are expounded in the biblical message, Torah).
Our species has produced a remarkable array of individuals, ranging from Mozart to Michael Jordan to Marie Curie to Genghis Khan himself, who have shown a huge range of abilities. These remarkable people have appeared at every time period, in every racial group. But, because of the anatomical similarities of all our brains, it is clear that the differences between the brains of these remarkable individuals and the brains of the rest of us must have been second-order differences that could only have been detected at the cellular or the biochemical levels.
We will be able to make these remarkable advances because of a growing understanding at the molecular level of how brains work, and a new understanding of the evolutionary relationships between ourselves and our closest relatives.
The advances in care of preterm neonates in the last decades has improved survival dramatically in developed and in developing countries, so that the definition of viability has been reframed.
The success of neonatal medicine in treating the consequences of preterm birth has not been matched by the prevention of spontaneous or indicated preterm birth.
The identification of known (in other disciplines) and unknown mechanisms of diseases responsible for preterm birth represent the major challenge of perinatal medicine. Our discipline must commit itself to the use of the tools of “discovery science” and computational biology to meet this urgent need. This needs to be followed by rigorous translational science and ethically designed clinical trials.
Governments, scientific societies, funding bodies and charitable organizations which fund clinical and basic research need to realize the importance for society of the consequences of preterm birth. We believe that the prevention of preterm birth is possible if perinatal medicine, science and society give the necessary priority to this most urgent problem of maternal, fetal and neonatal patients.
Over the course of the last 60 years, Obstetrics, which had remained virtually unchanged for centuries, has progressively emerged from the past to become a scientific discipline, and „Perinatal Medicine“ has been born. It has evolved from the cultivation of an art to a science.
Without scientific method, there is no science, and, without science, there is no real progress. Without sufficient knowledge of the aforementioned methodology, it is not possible to conduct any serious research, and it is even less possible to adequately interpret the work of others.
Research is to see what others have seen, but thinking what others have not thought. In the scientific field, what separates the view of thinking is the ability to conceptualize the facts and their unknowns, and have enough preparation to lounch investigation to clear the latter.
IAPM is an independent, non-profit institution with 30 permanent fellows from all over the world and owes its existence to the preparatory work done by the World Association for Perinatal Medicine.
As with the Platonic Academy and the majority of those that followed during the Classical Era, one of the core objectives of the IAPM is to create a mechanism to promote dialogue, generate rational, free and unbiased thinking, and also produce ideas and agreements for the improvement of the future of human reproduction.
Perinatal Medicine is among the most challenging and beautiful areas of study and practice. It deals with events before birth, when the fetus is a patient and during the immediate neonatal period. Our IAPM is dedicated to the study of all aspects of perinatal biology, physiology, screening, diagnosis, management and ethics, with the goal of continuous quality improvement in the care of maternal, fetal and neonatal patients.
The permanent challenge is bias against those who cannot speak for themselves. Fetal patients and children have a stake in the allocation of healthcare resources but cannot speak for themselves in the political process. This is also true of women in some countries. If no one speaks for those who cannot speak for themselves, their interests may not be taken into account in healthcare allocation decisions. This violates procedural justice. The response of justice relies on the professional, fiduciary role of perinatologists. They are clinicians and scientists with expertise in the medical care of fetal, neonatal, and pregnant patients. As their fiduciaries, perinatologists should speak and advocate for the interests of fetal, neonatal, and pregnant patients in the process of making healthcare allocation decisions.
IAPM is the only scientific body within the world of perinatologists. It is therefore justifiable to believe that its international scientific visibility should be adequate. Most of the Academy members are leaders of international perinatal societies and should arrange that IAPM is actively included in their congresses and symposia. For example, the name and logo of IAPM should be printed either as co-organizer or sponsor. It could be recommendable that organizer would have one session with speakers from the members of Academy.
There is urgent need for improvements in Academy's website and we just elected our distinguished member Ivica Zalud who will permanently take care of its content. We are living in era of evidence based medicine and let me remind you that even Galileo Galilei used to say „measure whatever is measurable and make measurable what is not so“. Scientific productivity of an individual region institutions or learned society is nowadays measurable parameter. That analysis of scientific productivity of our members should be reviewed from time to time. This will be used as orientation without mentioning the names but in future election of new candidates this would be solid basis for correct election. It is fortunate that present and elective presidents of WAPM are fellows of Academy and might and should help that IAPM receive modest annual financial support because, as I already said, it is only scientific body close to WAPM. We will also form money-rising committee, and everyone of you is welcome to join this new body. Committee should look for modest donation from other sources.
During our annual IAPM meeting local host as a rule organize scientific meetings. We should offer series of annual meetings under the title Recent advances in perinatal medicine. That can bring some necessary money for regular activity of IAPM. Our official journal JPM is now highly prestigious. As you all know, quality of journals is now evaluated by Impact factor and journal reached its highest rating of impact factor of 1,949 in 2012. I think that each member of Academy must give personal even modest contribution to improving impact factor. Among us there are very active authors and among newly admitted members are some of the most productive perinatologists. It should be moral duty of all of them to publish their best paper and to quote papers published in JPM. This is the best way to increase impact factor.
As shown by topics to be discussed in Tirana, it is urgent to rejuvenate Academy with members younger than 50 years of age. My strong belief is that this is the best method to dynamize IAPM. It would be good to introduce Academy Prize, apart from presidential award Golden Amnioscope. This should be given to best paper of young scientist delivered at the World perinatal congress. And this should include diploma and modest financial part.
Finally, IAPM and WAPM should start evaluating and electing centers of excellence at the perinatal units all over the world. We will form in Tirana special committee to do that.
Distinguished members of Academy, some recent developments are, whether we like it or not, causing decreased rating of perinatal concept. There are some information that our colleagues neonatologists are not very happy with their involvement in the perinatal societies. The concept of maternal-fetal, not perinatal medicine, is used even by some of our leading members. If I were a neonatologist, I would really be irritated by the fact that it does eliminate neonatologists. Our distinguished member Ola Saugstad will discuss this issue in Tirana.
Human beings change continuously as the results of biological and cultural evolutions. Human beings do change the world they live in, indeed so much that it has been suggested that the current geological epoch be named Anthropocene epoch. Since knowledge now increases exponentially with a doubling time of 5-10 years, education cannot be time limited, but it has to be life-long. The Millennium Development Goals state that by the year 2015 everybody should be educated. Perinatal education is not ectopic part of global education, contrary it is its integral part. Indeed, contemporary education is education of a person that is changing and for the world that rapidly changes.
The Triangle of Knowledge in modern society is composed of education, research and patents. A country aspiring to a good longtime standing in international arena should perform well in all three corners of this triangle. Governments, universities and firms together spend around $1.4 trillion a year on R&D, more than ever before. World trends in knowledge and new ideas creation demonstrate that EU has overtaken US in idea creation but is still lagging behind in patents and applied ideas. Asian countries are closing the gap rapidly and the world knowledge scene is witnessing an extremely competitive and interdependent race.
The IAPM was founded in 2004 on the initiative of presidents of three scientific societies: the World Association of Perinatal Medicine (WAPM), the European Association of Perinatal Medicine (EAPM), the International Society “The Fetus as a Patient” (ISFAP), and Ian Donald School.
The IAPM members have met in various capital cities all over the world, held scientific panels, and published declarations on current topics of perinatal research and patient care from a global point of view.
The aim of the IAPM is to provide a place for study, reflection, dialog, and for the promotion of perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of the field.
The last 50 years have seen the founding of many national and international societies of perinatal medicine based on these principles, including the International Academy of Perinatal Medicine (IAPM), which was formed in 2005.
The IAPM should be responsible for research, education, standards. It has the potential of being a leading influence in the world of perinatal medicine.
We represent the best the World has to offer in Perinatal Medicine. Let us work together to make the World of Perinatal Medicine a better place.
Professor Asim Kurjak MD PhD