University Maryland School of Medicine, Baltimore VA GRECC
Geriatric Medicine has provided me broad clinical experience and a diverse research history. This has exposed me to many clinical subjects in many settings, and to many vexing ethical and regulatory issues. Recent work in rehabilitation, strength training and fall prevention in older adults continues to challenge me to examine how best to balance risk vs. benefit on multiple levels --for the individual participants, for the specific study, and for the research enterprise more broadly. Often a risk that a patient and I may deem worthwhile for the hope of clinical benefit is simply not appropriate for a research setting; this can be difficult to understand for volunteers who are turned away, and for young investigators struggling to recruit. More difficult for senior research colleagues and regulators is that often the “high risk subject” will indeed have adverse outcomes while enrolled in research, but that the research itself may have minimally impacted the specific outcome, much less the overall risk for the individual.
My most important roles for interdisciplinary projects, as it was for the CAPMP project, are to help my colleagues to determine appropriate recruitment and screening protocols, to provide medical screening of potential volunteers, and then to adjudicate the safe enrollment and participation of individual participants. I am curious about, and able to contribute thoughtfully to, how muscle biology and neuromotor control impact ability to maintain and regain balance to prevent falls. However, I am ever mindful of my role as clinician-scientist and my obligation first to protect the safety of our participants and remain grateful CAPMP went well in this regard. It is quite rewarding now to evaluate the results, discuss their implications and share them widely.