Transcription:
OMS Research – The Future of the Specialty Depends on It

Bill Klaproth (host): This is an AAOMS On the Go Podcast. I'm Bill Klaproth. And with me is Dr. Simon Young, who is here to discuss OMS research and how the future of the specialty depends on it. Dr. Young, thanks for being here today.

Dr. Simon Young: Hey, Bill. Thanks so much for inviting me on here. I'm very excited to be here.

Bill Klaproth (host): Yeah, absolutely. This is going to be a great topic to discuss. So first off, can you tell us what is your background and what made you interested in research.

Dr. Simon Young: Let's see. I finished dental school in Toronto in 2003. So, I did my undergrad in human biology. And then, I came down here to Texas right after dental school to do a combined residency in Oral and maxillofacial surgery combined with a medical degree, which is a six-year track typically. And then, I also combined that with a PhD in bioengineering at Rice University. So, it started in 2003 and it ended in 2013. And when I finished that sort of combined route, I went to Harvard for a couple years at the School of Engineering there to do a research postdoc for two years in the lab of Dr. David Mooney for immunoengineering. And then, I came back to my faculty job here in Houston at the University of Texas Health Science Center in 2015.

Bill Klaproth (host): Oh my, Lord. Did you have any fun through those college years? Man, nose to the grindstone, Dr. Young. Geez.

Dr. Simon Young: Yeah. It was good. I mean, I think sometimes it's hard when you start, and people who started after you are graduating ahead of you. So, you know, you go to these graduations every year and you're like, "Wow, that person was like in high school when I started." But it was actually a great time. I really enjoyed my education.

Bill Klaproth (host): So, you're the perfect person to ask this. Why is research important to the future of OMS?

Dr. Simon Young: I think it really boils down to innovation. If you look at other medical specialties, I guess because our lab does a lot of cancer research, I'll go to cancer meetings and you listen to oncologists speak. And I think one thing in general that most clinicians, pretty much all clinicians and students learning healthcare can agree on is that evidence is really important.

So decades ago, there was a joke that, instead of evidence-based care, it was eminence-based care. So, you would have, you know, a very gray, respected figure. And they told you how it was, not because there was any data behind it, but because based on their life experience, it was so, and you had to just accept that.

And of course as time goes on, you know, I think we realize that there's many research questions out there. We're trying to sort of push the envelope. And so when we offer a new sort of diagnostic modality to our patients or a new treatment, hopefully, you can look that patient in the eye and say, "The reason we're offering you this treatment option is because the data shows X, Y, Z. You know, we've done studies and we've compared it to other previous modalities, and the data shows that you get better outcomes with this" instead of, "Well, I've been doing this for 50 years and it just works in my hands, so this is what we're doing". And so, research really plays into that because it's sort of a systematic way of collecting data and assessing it, evaluating it. And if it's no good, then great, we know it's no good and we shouldn't offer it to our patients. And if it's better, then we should be offering those things.

Bill Klaproth (host): Yeah. We don't want eminence-based care, right? But you're right, research is a way to evolve the specialty. So, can you share examples of promising current research projects?

Dr. Simon Young: Yeah. So, I would kind of split it into things that are very far away and then things that are closer by. And what I mean by that, and I was sort of introduced to that concept when I did my research postdoc. Because my boss at the time, Dr. Mooney, he said to me, he said, "Simon, what sort of research do you want to do?" And I said, "I don't understand what that question means, Dave." And he goes, "You can either do research where it's so cutting edge that a human being won't see it for 30 years because it's going to take forever for the FDA to approve it or you can be doing clinical research where the things you discover go into patients in a year."

And examples of things that are very potentially easy to implement in programs are clinical things or even educational things. So for example, I'm here in Houston and we have one of the largest oral surgery departments in the country. And an educational question, for example, is when we have all these residency candidates coming to us from dental schools, how do you evaluate these people best? Because we use something called the CBSE. And so what it is, it's almost like a practice test for medical licensure. And our entire profession uses that to sort of evaluate one aspect of our candidates. But there's no data to actually show right now whether having a high CBSE score makes you a so-called better resident.

So, a simple sort of research project would be to literally say, "Well, you know, we have five years of data on this. And here's this entire cohort of residents over the past five years with CBSE scores that were dah, dah, dah, dah, dah. Were the people with the higher scores actually better residents or not?" That's sort of an easier, simpler question to maybe look at that you could answer more quickly.

A more difficult question is, let's say, something we work with in our lab. So, we do NIH funded research in our lab. So, the NIH is sort of the federal, it's the National Institutes of Health. And they have many institutes, that's why it's institutes, plural. And so, we are funded by something called the NIDCR, which is the National Institute of Dental and Craniofacial Research. And they fund a lot of sort of dental-based research and oral maxillofacial research. And so, one thing our lab does is we look at biomaterials to try to enhance cancer therapies or tissue regeneration therapies. But some of the materials we use are so sort of early stage that you have to do a lot of sort of stuff in the dish first and stuff in preclinical models, and then, you eventually get into clinical trials in people. So, that's like 15 years away. But at the same time, you have to sort of look at these innovations now with an eye to the future. So, that's kind of giving you an illustration of the extremes of research.

Bill Klaproth (host): Yeah, absolutely. So, that makes total sense what you're saying. So, it sounds like having the support of the OMS Foundation is critical to advances in oral and maxillofacial surgery and this type of research having their backing or support is really important. Is that fair to say?

Dr. Simon Young: Absolutely. And the reason, and I'll have to say that I'm very fortunate to have been funded by the OMS Foundation, so shout out to them and AAOMS, of course. But the reason is because, when you're starting out, depending on where you go and what university you're at, for example, you get varying amounts of what they call startup money, right? And so, you have some sort of startup capital, almost like starting a company, you know, mom or dad or an angel investor, whoever it is gives you a lump sum of money and you start up your little lab, which is almost like starting a business. You have to hire people, you have to buy equipment, right? All those kind of things. And once you spend all your money on that, you still need money to do experiments, right? If you go to a fancy place where you get a million dollars of startup, sure, you have some money to do all sorts of experiments. But most of us have to write grants, let's say, and get the money competitively.

The difficulty with the NIH is that, if you want to get a sizable grant, you need to have a lot of preliminary data. And so if you don't have preliminary data, you go for smaller grants or you go for foundation grants. And that's where things like the OMS Foundation are so important because the OMS Foundation is literally geared to help oral surgeons with their research. And so, one of the first things I did when I started my lab was take very early ideas where we didn't actually have preliminary data, because we actually hadn't done the experiments yet, but we pitched the idea to OMS Foundation. They said, "Okay, you know, this sounds promising. We'll give you some money for it." We used that funding to start up our early experiments and gather that data, and that data was what we put into our larger grants at the NIH. So when I applied for NIH grants, I actually had preliminary data because it was funded by OMS Foundation. So, you really need to have that sort of stepping stone, right? Like if you want to reach to the top shelf for your money, you can't get there by just jumping. You got to have like, you know, the step first.

Bill Klaproth (host): Right. No, that's really good. So, let me ask you this. What are some tips you would give to residents looking to receive funding for their research or working on grant applications?

Dr. Simon Young: Yeah. I think what's really important is something that's clinically relevant. So, we have various kinds of folks who are applying for programs. And so, you have one stream of folks, for example, that are, let's say, DDS, PhD students or students who are going to seriously, let's say, go into a career where research will be a large component of their career, right? And maybe they're going to start a lab, right? So for those people, they're looking long term. They may be thinking of projects that are more basic science or join a lab that is doing basic science. Not necessarily to convert it into a paper in a patient like next year, but to slowly, let's say, get themselves one step at a time up to larger amounts of funding, right? Or you may have someone who said, you know, "I'm not interested in bench research, but I want to do outcomes research," right? And so, they may do something where, let's say they're here, they work at a large hospital, they're a resident and they say, "Hey, you know what? This is Houston. There are like 300 infection patients a year that are being seen." And what is the common denominator about all these infection patients? You know, are they doing better? Are they doing worse? Is there something about their underlying medical problems, right? And so, that is a research question that they could answer by combing through the database and that would have sort of shorter time horizon to completing it, right? And so, they could also write an OMS Foundation grant for that, and it would be very clinically relevant.

But I think the most thing that most surgeons really hope for is that you have to pitch your idea that it actually makes a difference to the specialty and makes a difference to patients, right? If I said, "Well, hey, you know, I have this interest where I'm kind of interested in the soil on Mars, because if 80 years from now someone's doing oral surgery, and the soil from Mars gets into an extraction socket, what's going to happen?" Like, seriously, what are you talking about, right? So, relevance is key. And also, the ability to complete the project is key. You can't pitch an idea that you tell the foundation's going to cost you $75,000, when in reality would cost hundreds of thousands of dollars. So, relevance and sort of economics play into it.

Bill Klaproth (host): Okay. So, let's back up a step then, talking about relevance. For some, what advice do you have for someone who might be considering embarking on a research project? I mean, what makes a good idea to research? What is a good research project? How does somebody know, "Hey, this is a valuable thing I want to research," instead of like, "What are you researching that for? It doesn't make any sense." How does somebody know what's good to research?

Dr. Simon Young: That's a great question. Thinking back to the start of my residency, you know, in my career, I would say the vast majority of people graduating from dental school don't necessarily have a really solid idea of what the sort of the clinically relevant ideas or questions are in oral surgery because they're not oral surgeons yet. And I think that's why residency training programs are so important. And not just residency training programs in general, but the people, the faculty who work in these training programs, they need to understand that, yes, obviously the goal of a residency program is to graduate competent oral and maxillofacial surgeons who are going to go out into the community, into the hospitals, into our academic institutions and practice competently, safely and ethically,

However, I think we all recognize now, especially with our training standards, that research is actually a component of that. Because even if you don't want to step foot into a lab for the rest of your life, you have to be able to evaluate research, right? So, the truth of the matter is not all research is the same. Some research is higher quality than others. And you may be working in your office and some person from a company comes over and tries to sell you a new product. "Hey, Dr. So-and-so, this is the greatest product ever. It's going to make your bone grafting so much better." "Oh, really? How is that?" "Well, here's this study." "Okay. Well, how is this study designed? What kind of patients did you do it on? You know, how similar were they to my patients? You know, did you have adequate control?" So if you have an appreciation for research and understand to ask the right questions, it'll even help you in your sort of day-to-day doing surgery, evaluating techniques and products.

Bill Klaproth (host): So for someone who is embarking on a research project, are there certain pitfalls to avoid when performing research? "I've got the idea, I've got the funding." Now, make sure you don't make this mistake.

Dr. Simon Young: Number one, in oral surgery, there aren't too many ways to get funding. So in general, we have the OMS Foundation. We have also something called the Osteo Science Foundation. But most of the time, if you're going to do funded research, it means you are writing a grant proposal and it's going to be reviewed by folks who understand research.

So as a first pass, any resident who's interested in research, they should talk to their attendings, they should talk to their faculty and get a sense for what projects are ongoing and are they feasible. For example, if you want to look at the effectiveness of a certain medication for a certain population that would require 500 patients of that type, let's say you wanted to say, "Oh, I'm very interested in this new way to treat cancer patients." And if your department doesn't see cancer patients, that might be an interesting question. It's not feasible because your department doesn't see cancer patients. So, part of it is feasibility. Part of it is, you know, the things that your faculty are interested in. And it's always important I say as a faculty person to engage faculty and things that they are interested in because interested people are going to help you out more because they like the topic, right? If you try to pick something way out on left field that no one is interested and they don't think it's relevant, you might not get the help you're looking for. So, that can be a consideration.

Bill Klaproth (host): Right. So, engaging, attendings, et cetera, is really important to do. So, don't just silo yourself alone, try to bring other people in is a good idea to do. So, are all types of research important, lab versus clinical?

Dr. Simon Young: Yeah, absolutely. And I think just going back to my original comment about the spectrum of research. In general, some people may think that research is this thing that people do in their ivory towers, and they don't like disseminate that information to anyone else, but that's really not true.

I think really, to put it succinctly, research is really the scientific process, right? It's looking at things you're doing or having some sort of question you want answered and investigating it properly. And then, evaluating your results and thinking, "Can I do better?" Right? So, I think the easiest way to describe that is, let's you have a private practice person who's very busy and they put in, you know, 1000 to 1500 dental implants a year, right? And let's say they are trying one technique. Let's say they started with one technique in January. And then, sometime in October, they say, "Eh, I'm going to start trying a different technique." And they switch techniques, but they never really look back on the results, right? That's not going to really give them a good sense if their new technique was actually helping their patients. But if they systematically said, "You know what, of the 1500 implants I'm going to do this year, I'm going to do half of them one way, I'm going to do half of them the other way. And then at the end of the year, I will, as objectively as possible, look at the outcomes between technique A and technique B, see which one worked out." That's a little more scientific, right? It's even more scientific if you get a person who is completely unbiased and is not you, let's say a partner, to look at those since it's not affected, you know, by the person doing it. They're just looking at the outcomes and that would be even better. It would be even better if you blinded it and didn't say, "Well, I'm going to do technique A in all the young healthy people with lots of bone. I'm going to do technique B on people who are like terrible, right?" So if you mixed it up and randomize it, even better.

So, I think thinking about things scientifically, evaluating yourself and looking at your outcomes is sort of like-- I mean, that is research. Some people might not call it that, but it's sort of the scientific process and being objective about how you go about doing your daily surgical practice.

Bill Klaproth (host): Right. So, let's talk about that. What is the breakdown of your clinical time and research time? How do you do that?

Dr. Simon Young: Yeah. That's like the million-dollar question in a way, right? Because I would say the vast majority of people in, whether it's academia or in the community, are doing, you know, their clinical practice day in, day out, right? They're clinicians 100% of the time, whether that means they're in clinics seeing their patients, they're doing procedures in clinic, or they're operating the operating room.

I was very fortunate, and this is where it really speaks to mentorship, that our chairman, Dr. Mark Wong, he recruited me from the very beginning, you know, sort of as a research-focused person. Like when I was doing my residency, I was kind of known around here as a research guy because I did my PhD. And even the first day that I stepped into his office, when he was asking me about this, he had already put into my mind sort of long-term career goals, right? And it was very clear to me when he said to me, "Listen, you're not doing a PhD just to get a degree and then just get out of here, right? You're going to use this degree for something. "And so, always keeping that in my head, my entire career was sort of based around that.

So when I finished all my training and started looking at jobs in the academia, I made sure that I had protected research time. So, what that meant was I wasn't going to go to a place that's like "Okay, Simon, you can operate five days a week. And for that time at night when after your kids are in bed from 10 o'clock at night until 12, you can think about research and maybe like do some research then," that just doesn't work, right?

So if you look at other specialties in medicine, people who are so-called clinician scientists, they have what we call dedicated protected research time. So for me, on my contract, I have dedicated protected 75% research time. So, I operate on Tuesdays at the hospital with the residents. I actually do private practice on Friday mornings. But the rest of my time is actually here in the lab, running the lab. And I have a research scientist, research associates. I have three PhD students and we're doing basic science here, in this school along with infrastructure, which is really important, right? Because it's another thing for the boss to say, "Well, great, you go do research and just go in that corner over there and good for you," right? So when I came here, they gave me lab space, equipment, startup funds, and all those things for me to be able to achieve a successful sort of career as a surgeon scientist.

Bill Klaproth (host): Right. Dedicated, protected research time. That definitely sounds like a tip. You want to go into an organization that values your research and wants to allow you the time to properly do that research, right?

Dr. Simon Young: Absolutely. I think that's really important, and that comes from the top, Bill. So, that comes from the chair level, the dean's. Because all these people have to make room for you, right? I mean, someone has to find that space for you, give you the space, give you the time. And to be honest with you, you have to go to a department, let's say, where you have enough colleagues that are also making clinical revenue, right?

If you go to an oral surgery department that has two people total, and you tell them, "Well, we're going to bring in Simon. He's going to do research, but he's going to be operating one day a week. You know, the other people are going to be like, "Well, wait a second. Like, how are we gonna support his salary then if the guy only works one day a week, right?" That's very hard to do. But when you're in large organizations like ours, we have 15 full-time people, you know, there's enough sort of give in the system that they can afford to have someone like me. And not to say that I'm a money drain because I don't want to like leave that impression. But clearly, my role isn't to have a warm body in the operating room every day, right? I'm there like day and a half basically making clinical revenue and the rest of the time I'm making revenue through grants for the university.

Bill Klaproth (host): But this research is important for the future of the specialty. What you're discovering and learning now will help propel future potential services and efficiencies down the road. So, it is important what you're doing to the specialty overall.

Dr. Simon Young: Yeah, I'd like to say so. And aside from the things I do, for example, we do buy material. So maybe, hey, if we're lucky and we get through our clinical milestones, maybe 10 years from now, you know, an oral surgeon out in the community would be using some of the technologies that we're working on in the lab.

But I think a very salient example is, you know, when I was a resident, one of our faculty was working on something called virtual surgical planning. And so, this is sort of around 2003, 2004, where they would take these CAT scans of patients and do these movements of jaws all simulated into computers, so they could sort of plan out these orthognathic surgeries later. And at the time, it was very sort of pie in the sky. You know, no one was really doing it because everyone was doing model surgery with plaster and glue and wax, which was super painful to do as a resident, because I went through that.

But fast forward 20 years, that technology is now in the hands of everyone. I mean, everybody in our specialty now does it virtually, right? And they have all these like splints that are 3D printed. So, that's an example where at that time, it seemed like kind of pie in the sky. But now, like no one even blinks when they think about virtual surgical planning. It's just part of our workflow.

Bill Klaproth (host): Good example. So as we wrap up, Dr. Young, thank you so much for your time as we talk about OMS research and how the future of the specialty depends on it. Any final thoughts or things you want to add?

Dr. Simon Young: I just want to make a pitch for the younger generation. I think it's very important and I think this is great to sort of explain to our oral surgery community what it is that surgeon scientists do and how they can sort of contribute to the profession. But I think what's most important is actually to get the message out to our young folks, you know, the folks who are even in undergrad who are thinking of dental school, to capture these people early and get them interested, so you can put the thought on their minds, so there's more people coming up through the ranks who are going to look at people like me and say, "Hey, you know, that's another job choice. I mean, yes, I may want to become a full-time oral surgeon in a clinical practice. But hey, it's actually possible to do science too." And I think that's really important.

You know, they say nowadays if you show little kids like people that look like them, or you see little kids that something is possible, it's in their head. So when I grew up there, I didn't really know any surgeon scientists. But now, hopefully, we're putting these messages out, so undergrads and dental students can see this is a viable career choice and, hopefully, that'll play into more surgeon scientists down the road.

Bill Klaproth (host): Yeah. Well, you're leading the way and a living example of that. So, thank you so much for that. Dr. Young, this has been really informative. Thank you so much for your time. We appreciate it.

Dr. Simon Young: Oh, it's been a pleasure so much. I really appreciate the time, Bill. And thank you to AAOMS as well.

Bill Klaproth (host): You bet. And once again, that is Dr. Simon Young. And for more information and the full podcast library, please visit AAOMS.org. That's A-A-O-M-S.org. And if you enjoyed this podcast, please share it on your social channels and be sure to subscribe so you don't miss an episode. Thanks for listening.