Be more, do more, research more:The importance of developing local science

There were times when our ancestors lived in a dangerous environment. Indeed, primates including homo sapiens and its predecessors were neither strong nor particularly fast. They were an easy prey for predators: but they were smart and became eventually the dominant species. 
Why could this happen? First, they developed the concept of cause and effect, they learned to see events in causal terms, that one event followed another consistently and they used this to shape their environment – this made them the tool makers of the evolution. Then they discovered how to make fire and weapons and suddenly they were no longer a prey, but predators themselves. Finally, they learned to work together, to communicate, to talk to and inform each other about dangers and opportunities and to pursue them together. Working together was a key-success-factor of these social animals who alone would not have survived the struggle for survival. Thus, rational thinking, communicating with each other and working together made us the dominant species. 
What brought humans forward? The ambition to be more and to do more.

After the Second World War, an English epidemiologist with the name of Austin Bradford Hill performed a seminal experiment that changed clinical research. To prove that streptomycin was indeed superior to the then established therapy with bed rest, he recruited patients with acute progressive bilateral pulmonary tuberculosis of presumably recent origin, bacteriologically proved and unsuitable for collapse therapy. He then randomized them to either treatment.
As he reported in the British Medical Journal in 1948, 2 7% died in the streptomycin and 27% in the control group. He concluded "The difference between the two series is statistically significant; the probability of it occurring by chance is less than one in a hundred" 4 -and as such evidence-based medicine was born.
Hill's approach also stimulated cardiovascular medicine that became the major cause of morbidity and mortality after effective remedies against infectious disease became available. The first randomized cardiovascular trial was led by Edward Freis in patients with severe hypertension that showed in 1967 that blood pressure lowering with antihypertensive drugs reduced death, myocardial infarction and stroke. 5 And it continued with numerous trials thereafter showing that streptokinase reduced mortality in acute myocardial infarction, 6 that statins prevented major cardiovascular events, 7 that anticoagulation prevented strokes in atrial fibrillation 8 and eventually that percutaneous coronary intervention represents the treatment of choice in acute coronary syndromes. 9 Today evidence-based recommendations are available in prevention, 10 in intervention, 11 for the prevention of sudden cardiac death, 12 and valvular heart disease, 13 in thromboembolism 14 and heart failure 15 among other conditions -a true success story.

What remains to be discovered
But it does not end here: further research remains badly required, too many patients suffer from diseases that are untreatable, too many still die of conditions that are untreatable. For instance, although the history of the management of acute myocardial infarction is impressive (Figure 2), 16 mortality remains overall at around 10% for now due to our inability to manage cardiogenic shock appropriately.
Also, although neurohumoral blockade and cardiac resynchronization therapy markedly reduced mortality and hospitalizations for heart failure with reduced ejection fraction or HFrEF, we are far away from a cure of the condition.
Furthermore, heart failure with preserved ejection fraction or HFpEF remains an enigma without an effective treatment. 17 Finally, although the genetics of many forms of non-ischemic cardiomyopathies are now understood, 18 we lack effective means to correct the genetic mutation and its biological consequences in heart muscle -possibly genetic engineering will help. 19 Another example is valvular heart disease: Yes, we can replace stenotic aortic valves surgically and now even with transarterial valve implantation or TAVI, 20  Thus, there are many unanswered questions in cardiovascular medicine that wait for young scientists and cardiologists around the world that want to be more, do more and research more.

How to publish research
Only discoveries that are published do exist: Thus, any research needs to be finished, written up and submitted to a scientific journal. Only what can be read by others, will advance science and medicine. 21 Most journals, and in particular the best and most respected, work based on the peer review system, i.e. they ask expert in the field to evaluate the submitted work to make suggestions, to provide constructive cirticism, in an attempt to make good papers even better and to reject those who do not make the bar. What are the criteria editors use when assessing submitted work? (Table 1

Innovation
Research is about novelty either as a true discovery or as incremental innovation or more solid evidence with a larger cohort, longer follow-up or better mechanistic insight.

Precision
Measurements should be made with state-of-the-art equipment. If possible, mechanistic insight and causality should be provided.

Stringency
Data presentation should follow a logical stream in order and regards explanation of the findings.

Honesty
Science relies on proper and correct data reporting; anything else is not scientifically correct research.

Timeliness
Science is a global endeavor and hence there is a lot of competition. Being in time, means being first.

Reference
Give credit in you manuscript to those who work in your field, cite those who set the basis of your work -they may be your reviewers. visit and take part in congresses and courses of the highest quality to learn from and meet the best in your field. Networking is important. Finally, plan a stay abroad in an instiution of excellence in your field of interest -it will boost your professional and personal development.