The Crisis in Clinical Research: Overcoming Institutional Obstacles - Hardcover

This book describes the changing scene of American medicine over the past 40 years and charts the vast growth in the number of MDs and PhDs engaged in biomedical research. The book's main theme is the changing pattern of clinical research - that is, research addressed to scientific questions that have their origins in observations of human health and disease. Ahrens meticulously analyses seven very different kinds of research activity that are included under the term `clinical research'. He shows that there has been a devastating decline in the type of research that poses fundamental questions of why and how people become ill by studying the `whole patient' at the bedside rather than just their `bits and pieces' at the laboratory bench. He examines the medical school environment in which the research is carried out and the main funding source, the National Institutes of Health. The system of awarding grants and its impact on the careers of today's young investigators is discussed. The root of the problem lies in the structure of US medical schools, many of which have been overpowered by the large size and impersonality of the biomedical centres that surround them. Research is only one essential part of a medical school's mission. Today's environment has caused a misalignment of these priorities, with teaching and whole patient research having dropped in esteem and rewards. The author, with over 40 years of clinical research experience, argues that changes must be made in the special training of truly clinical investigators and in their funding requirements, and that new working partnerships between clinically skilled MDs and technically trained PhDs are urgently needed in order to restore patient-oriented research to full productivity.