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EditorialMedical Research: Its Curse and BlessingsNiranjan Kissoon, M.D., Editor |
| In this issue of Jacksonville Medicine Resident
research endeavors in Jacksonville are published. These abstracts represent the sanitized,
succinct summary of many painstaking hours of toil from the embryonic idea through periods
of doubt, despair, exhilaration and finally relief and a sense of accomplishment. We
should therefore be cognizant of the time, dedication and dogged effort that is the
currency for the offerings in this issue. Research, unlike clinical medicine, has different challenges, rewards and disappointments. In clinical medicine our competence, dedication, empathy and good clinical care usually leads to respect from our colleagues, nurses and other professionals. In addition, patients and families are grateful for our efforts and show it in a variety of ways. On many occasions, instant gratification is the reward for our efforts. On the other hand, our journey in research is one of frustration and rejection at many junctures. For instance, as a trainee our research ideas are rejected by our supervisors. Even when the ideas are endorsed by funding agencies, the request for funding may be denied since the competition is fierce and of high caliber. Even when funding is obtained, potential subjects may reject our request to participate in clinical trials. In addition, abstracts and manuscripts may be rejected many times. Finally if we are dogged, the manuscript is finally published, but the journey has left us spent and relieved rather than ecstatic. Therefore, why do we do research? We do it because it is of value to us. As research supervisors we need to define value for our trainees since a wrong concept of value may lead to frustration, failures and ultimately publish and or perish. Dr. Douglas Altman in the British Medical Journal (January 1994) makes a very strong plea that there is a scandal in medical research. He states: "We need less research, better research, and research done for the right reasons." He also contends that many errors are made in research because researchers "use the wrong technique, use the right techniques wrongly, misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions." While his contention for better quality is based to a large extent on the poor use of statistics, there are other compelling reasons to evaluate why we do research. Dr. Michael Kramer, in acceptance of the research award of the Ambulatory Pediatric Association (January 1995), put it in simple and elegant terms. He stated there are five reasons to do clinical research. The lowest level is improving one's curriculum vitae. Unfortunately, this is a very common case scenario and should not be supported. People who are doing research because they have to should be doing something else and hence should not be supported by academic departments. Level two is doing research solely to derive personal satisfaction. This in itself is an insufficient goal to justify the time, effort and money involved. Besides, researchers who reach one of the higher levels can gain additional satisfaction above and beyond that gain by doing the research itself. Level three involves the use of research as a means of increasing knowledge. This may be true for mathematics and theoretical physicists, but those who are responsible for expenditures on medical research should expect more than that. The increased knowledge should lead to the higher levels rather than be an end in itself. A much worthier goal is level four, which entails changing of other researcher's behavior. Research that improves the way other investigators conduct their research may eventually lead to the highest level. Level five, the highest level, should be the ultimate goal of research: to improve health. Dr. Kramer pointed out that "very few of us can point to direct links between our own research and improved health, but one thing is sure: if improving health is not our goal, we will never get there." It is this goal that we should all aspire to and our trainees should adopt. Finally, trainees should be cognizant of the myths and realities of their role as clinicians and clinical researchers. As Dr. Ward stated in 1996: "Researchers must strive to abolish uncertainty, to be unwaveringly committed to truth, and to rid themselves of all bias. Clinicians, in contrast, must frequently manage patients in the absence of certainty, handle truth creatively and be willing to be biased on their patient's behalf as part of their professional obligation. These differences constitute powerful selection pressures for individuals for particular skills, personalities and sources of job satisfaction. Clinical practice and research are intrinsically different activities and it is probably unreasonable to expect an individual talented one to be similarly expert in the other." I would like to congratulate all of the trainees for their research efforts and trust that some at least will find great rewards and satisfaction in their research career. Moreover, I sincerely hope that every one will come to the realization as to what is best for them. While a few lucky ones will be able to have a fulfilling research and clinical career, most will face the proverbial two roads diverging in the woods. I sincerely hope that some will choose the road less traveled, as it may be the path to their Holy Grail. July 2000 / Jacksonville Medicine What's New
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