While the role of research in advancing the state of medical care is well established there must be another important factor. While we are waiting for the final research results crucial to the implementation of a new therapy such as surfactant replacement, medical care continues to improve. Our patients do better. Complications decrease and survival increases. Extrapolating from Richard Foster's ideas in Innovation: The Attacker's Advantage,1 the other important factor is probably innovation. By that I mean the introduction of new technology or improvement in existing or old methods by frontline people who believe that better care will be provided. This is in contrast to hypothesis-driven research, which is either systematically performed away from the clinical setting or with the primary care givers blinded to the treatment in question and with the goal of establishing a fact or principle.
Who is involved in this innovation and what are they doing?