|
July
2004
Leave No Scientist Behind
Investing
in clinical research is an investment in hope — hope
for a cure for oneself, a relative or a friend and for future generations.
If health research doesn’t produce better health, the public’s
faith in science will falter.
The trick
is how to shape publicly funded clinical research to respond
to current
and future health threats in a highly political
environment with many public, private and non-profit stake-holders
vying for resources. Doing so means setting priorities — saying
some topics are more important than others — and directing
research, thus violating some of the strongest taboos of American
science. It will take leadership from all the stakeholders that
make up the clinical research enterprise to accomplish this.
But aligning the clinical research enterprise with actual health
needs is only one strategy to use scarce public resources more
wisely. Another is to improve the effectiveness of the clinical
research enterprise itself.
We rarely systematically subject the way we fund, conduct, train
for or communicate clinical research to the scrutiny of its own
methodological and analytical tools. Could it be that a perfect
system of supporting and conducting research to achieve optimal
benefit has evolved on its own? That would be a first!
If we can agree that it is not perfect, why would we resist investing
in the systematic investigation of what kinds of training, grant
mechanisms, public-private partnerships would help us do it better?
It is ironic that such a bastion of scientific knowledge as the
U.S. Department of Education is using scientific methods to evaluate
different means of producing positive student outcomes, while the
clinical research establishment is generally resistant to any such
scrutiny.
Well, I say
let no scientist be left behind! Especially not when the NIH
budget is going to
remain level in the near term. Let’s
apply the scientific method to the question of how to better capture
the value of health research.
Do we know, for example, what works and what does not in training
researchers to cross disciplinary boundaries? What is the best
composition of study sections to ensure flexibility in funding
innovation? Do we know the career trajectory for M.D.-Ph.D.s? What
do we know about the relative effectiveness of RFAs, Program Announcements
and RFPs in addressing different levels of research questions?
It seems that
most changes in the federal biomedical research enterprise take
place in response
to problems or criticism that
something isn’t working and that the solutions are chosen
by their face validity. Why are scientists, who are trained to
reject face validity out of hand, so willing to depend on common
sense alone to ensure the best outcomes?
Applying the tools of scientific analysis to the operation of
the entire clinical research enterprise means being willing to
do things differently, adapting to shifting demands and building
the capacity of health systems and professionals to absorb new
information and practices.
PDF
version
|
