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Interview of Prof. Elaheh Malakan Rad, EBM of the month, October 2021

Edited by Dr Anna Melidoni, Senior Editor

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AM: Tell us a bit about yourself and your current focus of research.

EMR: I am a tenured, full-time Professor of Pediatric Interventional Cardiology at Children’s Medical Center (Pediatric Center of Excellence) affiliated to Tehran University of Medical Sciences with 25 years of experience as a Pediatric Cardiologist. I have also been very active in Medical Education for about two decades. Cardiology is a technology-dependent discipline and obviously, limitations of technological resources such as advanced echocardiographic machines equipped with advanced softwares can limit the range of research activities of researchers in this field. My current research focus is congenital heart disease but it could be different if there were no technological resource limitations.

AM: What do you think is the most fascinating recent development in cardiovascular research/Cardiology?

EMR: There are several captivating developments in the field of cardiovascular medicine. These include percutaneous approaches to treating various cardiac diseases from the fetus to the elderly, advancement of molecular genetics of cardiac diseases and translational knowledge. Furthermore, integrating computer science and programming with medicine such as progressive use of artificial intelligence in cardiovascular medicine and cardiac telemedicine, as well as remarkable progress in non-invasive cardiac imaging by echocardiography and MRI, are very attractive. 

AM: Is there an area of Cardiovascular biology/Cardiology that you think is currently under-explored?

EMR: Yes, I think biphasic cardiomyopathy in Alström syndrome is not yet clearly understood. Furthermore, more multidisciplinary investigations can be done on the improvement of Fontan circulation. The problem demands collaboration between engineers of fluid and geometry mechanics, cardiologists, cardiac surgeons and more. I also believe there is a lot in nature that we can learn from and test apply to the Fontan circulation. I wonder whether we can apply any part of the physiology of xylems in the redwood tree (the tallest tree in the world) that allows transport of water against the gravity upward to an altitude of more than 100 meters, to Fontan circulation. For instance, I wonder whether we can devise a smart Fontan Jacket to exert an externally-generated suction effect on the blood from the vena cave by producing negative pressure through the smart expanding of the thorax at regular intervals in a smartly planned manner? Alternatively, perhaps to change the wall of the conduits that connect the IVC to the right pulmonary artery, by using smart material in their walls, or a lot more ideas that may warrant testing in the laboratory. These all need a multidisciplinary collaboration of medical and non-medical researchers and scientists about this topic.

AM: Where do you see (or where would you like to see) the cardiovascular/Cardiology research field 10 years from now?

EMR: Several changes seem expectable, including the prominent role of artificial intelligence in the diagnosis and treatment of cardiovascular diseases, breakthrough advances in non-invasive imaging modalities and percutaneous treatments, advancement of translational science and finally, increasingly more multidisciplinary research. 

AM: Can you think of any collective initiatives that could support/speed up ‘bench to bedside’ research?

EMR: I believe any subject should be studied from the molecular level to the patient’s bed level. To achieve an in-depth understanding of health and disease processes, integrating basic and clinical science in medical research is as crucial as is in medical education. For example, many years ago, we were saying that patients with long QT syndrome might present with seizures, now we know these are cardiocerebral channelopathies; this is a step forward towards better understanding of this disease.

The second crucial point is the multidisciplinary perspective to research to get the big picture of the facts. Molana (Rumi) in his poem of an elephant in the dark, has brilliantly described the importance of a holistic approach. The poem is about an elephant in a dark room. People entered the room to find out what is in the room. Since they could not see because of darkness, they tried to find out by touching it. Those who felt the feet of the elephant said this is a column. Those who palpated the back of the animal said this is a bed. The ones who touched the ears thought this is a fan. Others who touched the trunk believed this is a drain pipe, and so on. Accordingly, mono-disciplinary research confines our perception of the scientific facts because of a tunnel vision.

Regarding the cardiovascular system, the involvement of scientists in fluid and geometry mechanics and related fields would be beneficial. Since so many mechanical, mathematical and physical rules are embedded in the heart.

AM: What does it mean to you to be an Editorial Board Member for BMC Cardiovascular Disorders?

EMR: I am honored to be privileged to serve as an Editorial Board Member for the prestigious journal of BMC Cardiovascular Disorders. I am zealous in promoting BMC Cardiovascular Disorders and intend to cultivate the journal among my main commitments. Furthermore, I feel committed to keeping myself updated in the relevant competencies as an Editor and remaining open to constructive feedback. 

AM: What is one piece of advice you would give to reviewers as an EBM overseeing peer review ?

EMR: All reviewers, including me, are expected to abide by the  Ethical guidelines for peer reviewers published by the Committee on Publication Ethics (COPE). They are expected to spend adequate time to avoid missing anything. The history of medicine cannot forget the rejection of Sir Hans Adolf Krebs’ article by a prestigious journal in 1937, where he described the discovery which led him to obtain the Noble prize. We should not let such egregious or even minor errors at lower scales be repeated.

AM: What is one piece of advice you would give to prospective authors ?

EMR: Every author, including me, should be committed and adhered to principles of ethics and integrity in research. The authors should avoid misconduct in research in any form.

AM: What would you change in scientific publishing if you could?

EMR: A good change to me would be the addition of a journal for the publication of novel ideas worthy of testing and researching, JUST THE IDEAS and no more.

Brilliant and new hypotheses need resources to be tested and after that, they can be published. Even journals that publish hypotheses at present demand some work before accepting the manuscript. However, these two critical elements, i.e., ideas and resources, are not necessarily co-existent simultaneously, at the same place and for the same person. This results in a delay in scientific progress and unfairness regarding the first one who thought of that innovation. Publishing worthy new ideas as they are born, without any need to be tested, has two advantages: gives credit to the first one who introduced the concept in a fair manner and accelerates testing the idea by those who have the resources. 

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