Physiologist Comroe had earlier criticized the first heart transplant surgeons for failing to explain to the public that the procedure had only been made possible through basic laboratory research.(45) These views were contradicted by the immunologist Robert Good, who explained that the key steps in developing heart transplantation, such as control of infection, development of anesthesiology, control of the immune system and more, were in fact triumphs of clinical investigation.(34)
Eleven years after Comroe and Dripps' claims were published, Dr Samuel Thier, then president of the Institute of Medicine, concluded that the balance of medical research in the United States was under threat because the importance of basic research was being overemphasized.(46) He explained how medical science is saddled with the myth that developments in clinical practice come from basic science. "The truth", he said, "is that the emperor has no clothes," innovations in clinical practice often coming first. For instance, Edward Jenner's discovery of vaccination against smallpox relied purely on clinical research (33) and preceded the basic sciences of virology and immunology by many years. Dr Thier also criticized the emphasis that had been placed on basic research into AIDS as opposed to public health research.
It is also disturbing that of the estimated 20,000 American physicians who are clinical investigators, about 5% discontinue their research careers every year.(47) Reasons commonly cited include difficulty obtaining funds and clinical responsibilities that do not permit sufficient time for research. More specifically, fewer young physicians are entering careers in clinical cancer research where the consensus is that grant proposals for work with human subjects are at a competitive disadvantage compared with those for laboratory research.(48) The problem is that scientists who review grant applications are frequently from disciplines other than clinical research. Nevertheless, even when reviewed by appropriate peers, clinical research applications fare badly compared with those for laboratory experiments.
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