Research in Kaiser Permanente: A Historical Commitment and A Future Imperative
By Robert Pearl, MD

At Kaiser Permanente, research means applying the scientific method to solving the problems and challenges we face as physicians. Through clinical, epidemiological and basic scientific research, we are continually finding ways to improve both quality and service for our members. Moreover, for more than half a century, our research and publications have helped to define both the newest clinical approaches and the standard for medical care.

Throughout my career, I have enjoyed the challenge of identifying a problem, developing hypotheses, devising approaches to explore the validity of each theory, and reaching a conclusion. Clinical research is best done in conjunction with colleagues committed to openness and honesty. This is why Kaiser Permanente is the ideal environment to pursue these research efforts regardless of whether the problems are medical or administrative, and it has stimulated me to publish or present more than 100 articles and talks.

Outside of a university setting, two organizations have been able to embed the scientific method into their daily activities--the Mayo Clinic and Kaiser Permanente. This is no accident but reflects the commitment of each organization's founders to research and teaching. Next year, we will celebrate 60 years of Permanente research. When Permanente Hospital, the predecessor of the Oakland Medical Center in California, was opened by the founders of The Permanente Medical Group in 1942, the keynote speaker at the dedication was William F Knowland, later long-time United States Senator from California. He reminded the dignitaries who were gathered that research and teaching would be among the cornerstones of the then-new medical care program created by Sidney R Garfield, MD, and Henry J Kaiser. Within that year, these principles also were embedded into the medical care program at Kaiser's World War II shipyards in the Pacific Northwest and at the hospital opened at Fontana in Southern California. Today, our clinicians and researchers continue that tradition in every KP region across the country.

The first person to publicly link Kaiser Permanente with the Mayo Clinic was Paul De Kruif, the 20th Century medical writer best known for his landmark book Microbe Hunters. After observing the work of Dr Garfield and his colleagues firsthand, along with hearing Henry Kaiser describe his vision for spreading their ideas to medical centers across the nation, De Kruif was impressed by the fact that these physicians "can be scientifically independent and can plan and do their own research. Here they can begin a new assault upon those great diseases that yet remain inscrutable and enigmatic."¹ Now, 60 years later, the power of Kaiser Permanente research across America is enormous. Jeffrey Harris, MD, Director of the Division of Prevention Research at the Centers for Disease Control, has observed that among health care organizations working to improve medical care, Kaiser Permanente "is clearly at the top of that list."²

At present, we are attracting the caliber of physicians who in the past might have selected an academic setting for a career. They are attracted to our medical groups because we provide a collaborative, multispecialty environment in which they have the opportunity both to teach and pursue research interests. At a time when some research findings are being questioned because of pharmaceutical industry funding, it is even more important that we assure that research expertise is embedded in Kaiser Permanente. Our research efforts allow us to examine questions and reach independent conclusions through a more systematic approach and with greater confidence in the outcomes rather than solely depending on others.

One of the most exciting opportunities a physician has at Kaiser Permanente is the ability to participate in research projects that can have a national, even international, impact on medical practice. Research is time-consuming and requires intense personal commitment. For many, the work is harder than the reward. But for those who are driven by a love to pursue the unknown, the thrill of solving a problem that has vexed them makes the many hours worthwhile. And that reward is enhanced so much more when we see our hard work improve the care and save the lives of our patients.

Throughout our history, we have valued research as a core principle of Kaiser Permanente's very existence. As the market leader in quality outcomes, it is imperative for our future that we continue to support research as part of the core of Permanente Medicine. As medicine becomes more complex, it will be essential to nurture that ideal as we move into the 21st Century. Through publications and presentations, we can shape both present clinical standards and future possibilities.

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