“Science and knowledge transform society. It is our moral obligation to contribute, support and defend the advancement of science against disease to improve human condition”.

The obesity epidemic has driven many scientists, epidemiologists and researchers to investigate the root cause of obesity. Our knowledge about weight gain, exercise, healthy lifestyle, hunger, satiety, metabolism and many other factors that contribute to obesity has exploded over the past few years. New paradigm shifts in clinical practice have opened the way for many obese patients to receive more effective, reliable and durable treatments. Diabetes is no longer considered a chronic progressive disease in the face of metabolic procedures like gastric bypass and gastric sleeve surgery. The concept “eat less and move more” has been replaced with “eat well and choose wisely” the calories you ingest. Exercise daily but don’t starve yourself. Neuro-hormones rather than will power control satiety, appetite, energy metabolism and body weight. The framework for future development of effective therapies for obesity has been set. New effective therapies, however, are not on the horizon.
Indeed, there has been not a single breakthrough in the treatment of GERD over the past 70 years ever since Dr. Nissen introduced his Nissen Fundoplication. Our understanding of GERD pathophysiology is still limited. Proton pump inhibitors have been mistakenly accepted as the gold standard of acid reflux treatment. Pharmaceuticals companies were happy with a steady supply of GERD patients getting dependent on daily proton pump inhibitors while acid reflux disease continued to progress. Endoscopic devices, like Stretta and TIF, for lower esophageal sphincter augmentation have limited efficacy. Recently, EndoStim, an electrical stimulation device of the lower esophageal sphincter, has been introduced. Clinical trials are currently being conducted.
Similarly, except for gastric sleeve surgery, we haven’t witnessed any breakthrough in the treatment of morbid obesity ever since Dr. Mason has introduced the gastric bypass more than 50 years ago. Many weight loss surgeons still talk about restriction and malabsorption as mechanisms for weight loss surgery. SOARD, the official journal of the American Society for Metabolic and bariatric Surgery still publishes articles debating the efficacy of gastric banding; we exalt the merits of gastric balloons and usher with great excitement the era of endoscopic sleeve gastroplasty. We have introduced procedures like gastric plication with great enthusiasm and hope. We watched in awe banded gastric plications being taught to community bariatric surgeons as the next best thing since sliced bread. Last but not least, a gastric pump has been recently approved to purge the stomach empty and some how cure the obesity epidemic. When is this trend going to stop?
“Medical research in a way is in crisis,” reports Dr. Ole Frobert, a cardiologist at Orebro University in Sweden. “We do a lot of research and publish a lot of papers, but there are very few breakthrough,” Frobert explains. Original research in the field of bariatric, metabolic reflux surgery must be guided by knowledge we gained from prior studies and observations. Shrinking the gastric volume and narrowing the lower esophageal sphincter should no longer be accepted as a guiding principle for device development for obesity or GERD treatment. Indeed, research purely driven by device creation to make a profit does not seem to improve our medical care nor does it transform our society. I am still hopeful that the current state of medical research in my field of expertise will change in the near future. We need to solve problems, resolve conflicts and improve care with innovative approaches that are yet to come.