ACADEMIC EMERGENCY MEDICINE • December 1999, Volume 6, Number 12 1187 COMMENTARIES Taking the Lead Vision: the art of seeing things invis- ible. Jonathan Swift Things come to those who wait, but only the things left over by those who hustle. Abraham Lincoln T he articles included in this end-of-the-year and end-of- the-century issue of Academic Emergency Medicine are power- ful illustrations of the solid and significant contributions, accom- plishments, philosophies, and controversies of our young spe- cialty of emergency medicine (EM). Many represent very hard- fought and -won battles for the common good, or for our unique needs to be recognized. Almost all remind us that these battles are never really over and rarely stay won, that the peace a vic- tory affords is tenuous at best and needs vigilant, painstaking, and thoughtful maintenance. Who better to do this than emer- gency physicians (EPs)? This year marked the 20th anniversary of the American Board of Emergency Medicine (ABEM). In future issues of AEM we will hear from those most in- volved in the early development of the specialty, who will share their insights with those of us who have directly benefited from their dedication to an idea that provides for us demanding, yet rewarding, careers. In this issue, we present articles that demon- strate the scope of our practice and our academic endeavors. We include research on the emer- gency care of elders and of others and present clinical path- ways and practice guidelines. We discuss the usefulness of comput- ers in the ED and the develop- ment of systematic reviews rele- vant to emergency medical practice. We illustrate retrospec- tive, prospective, and other re- search study designs authored by EPs who are principal inves- tigators of large, multicentered clinical trials that cross medical disciplines, as well as by individ- ual investigators working at a single site. We see studies with large amounts of external fund- ing, and studies funded by clini- cal revenues of a single depart- ment. We can identify EPs with powerful oversight responsibili- ties and authority as chairs and members of data and safety mon- itoring committees for large clin- ical trials. We acknowledge the service provided to us by our peer reviewers, who represent varied excellence within our spe- cialty, and whose generous gift of time is compensated by an in- creasingly sophisticated EM lit- erature. Using the solid ground- work provided by those early visionaries in EM, we have taken their lead and have developed credible, respected, and irre- placeable clinical and academic expertise. Looking at the accom- plishments reflected in this sin- gle issue of AEM, I cannot help but believe our early leaders would be proud of (and perhaps a little amazed by) such incredi- ble growth in such a relatively short time. This issue also carries with it some grim reminders of the re- alities and consequences of our academic and clinical develop- ment. Dr. Goldfrank, in his re- marks on receiving the SAEM Leadership Award, 1 recounts our progress as a specialty, but also reminds us that we have much more to do, and that we are pub- lic defenders in the true (and not the legal) sense of the word. The articles on domestic violence 2 and toxicologic emergencies 3 remind us that by default, our specialty serves as both a clinical and a so- cial safety net, and in all likeli- hood will continue to do so. The articles presented on waiver of informed consent in certain emergency research circum- stances 4–7 are direct results of re- search regulations developed with the assistance and at the persistence of EPs so that our re- suscitation researchers can con- tinue to search for the best pos- sible treatments for the worst possible conditions that occur to our most vulnerable patients. Al- though other medical disciplines are also stakeholders in this is- sue, EM took the lead, and rec- ognized the regulatory problem first, poured countless resources into fixing it, and has main- tained close contact with those empowered to make or break this effort. The successful devel- opment of the Final Rule is an important achievement and one that we should be proud of; equally important is its appro- priate implementation. It is easy, however, to forget that these reg- ulations were not developed for the convenience of researchers; they exist for the protection of patients—both as research sub- jects and as potential sufferers of catastrophic injury or illness for which current treatment is in- adequate. We need to take the lead and keep this simple truth in focus for ourselves and our re- search colleagues. It is also easy to forget how difficult resuscita- tion research would be without these current regulations, in spite of their shortcomings, and how easy it would be for federal regulatory agencies to rescind them if they were inappropri- ately applied or inadequately fol- lowed. Emergency researchers must again take the lead, to en- sure that these fragile rules re- main available to us, while we continue to assist the regulators on improving them as we gain more experience with them and discover their strengths and shortcomings. Our field will undoubtedly continue to rapidly develop as we continue to define, redefine,