Clinical Research: Where is the "laboratory" and what are the methods? - [abstract]

ABSTRACT

Clinical research is obviously necessary if medical care for patients is to improve. Over the last several decades, however, there has been a tendency to marginalize this branch of science. The reasons for this trend are obvious enough - lack of scientific training of investigators, pressure of clinical responsibilities, substitution of product testing (eg drugs, devices) for sciences, etc - but the solution is not. Clinican scientist control two unique resources - access to patients and an understanding of clinical problems - that should translate into control, if not a monopoly, over the clinical research enterprise. Unfortunately, this resource if squandered. In this presentation, a perspective on clinical research at the present time, at least from the North American perspective, will be offered. It will be argued that medicine has responded very ineffectively to changes in the academic environment. As a result, clinicans are deeply confused about where the appropriate "laboratory" is situated and what constitutes the method of enquiry for clinical research. In conclusion, a view on what might constitute the elements of a programme to restore that balance will also be presented.(Au)