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Five Futures for Academic Medicine

  • Shally Awasthi,
  • Jil Beardmore,
  • Jocalyn Clark mail,

    To whom correspondence should be addressed. E-mail: jclark@bmj.com

    X
  • Philip Hadridge,
  • Hardi Madani,
  • Ana Marusic,
  • Gretchen Purcell,
  • Margaret Rhoads,
  • Karen Sliwa-Hähnle,
  • Richard Smith,
  • Tessa Tan-Torres Edejer,
  • Peter Tugwell,
  • Tim Underwood,
  • Robyn Ward on behalf of the International Campaign to Revitalise Academic Medicine
  • Published: July 05, 2005
  • DOI: 10.1371/journal.pmed.0020207

Reader Comments (3)

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The need for a new specialist professional research system of 'pure' medical science

Posted by plosmedicine on 30 Mar 2009 at 23:44 GMT

Author: Bruce Charlton
Position: Editor-in-Chief Medical Hypotheses
Institution: University of Newcastle upon Tyne, UK
E-mail: bruce.charlton@ncl.ac.uk
Additional Authors: Peter Andras
Submitted Date: July 13, 2005
Published Date: July 13, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Awasthi et al's discussion of the future of academic medicine [1] is stimulating, but the primary focus of policy should be enhancing scientific progress in medicine. Science policy should address the decline in major, clinically-relevant 'breakthroughs' over recent decades [2].

Medical research has become mostly an 'applied' science which implicitly aims at steady progress by an accumulation of small improvements, each increment having a high probability of validity. Applied medical science is therefore a social system of communications for generating pre-publication peer-reviewed knowledge ready for implementation [3]. However, the need for predictability dictated by peer reviewing of research funding and the need for a high probability of validity in published research makes modern medical science risk-averse. This has led to a decline in major therapeutic breakthroughs where new treatments for new diseases are required [2].

There is need for the evolution of a specialized professional research system of pure medial science where the major evaluation of validity occurs (in the manner of classic sciences) post-publication and by peer-usage, rather than peer review [3,4]. The role of pure medical science would be to generate and critically-evaluate radically novel and potentially important theories, techniques, therapies and technologies.

Pure science ideas typically have a lower probability of being valid, but the possibility of much greater benefit if they turn out to be true [5]. The domination of medical research by 'applied' criteria means that even good ideas from pure medical science are typically ignored or rejected as being too speculative. It is possible to publish radical and potentially important ideas in medical science, but at present there is no formal mechanism by which pure science publications may be received, critiqued, evaluated and extended to become suitable for 'application'.

Pure medical science needs to evolve to constitute a typical specialized scientific system of formal communications among a professional community with close research groupings, journals, meetings, electronic and web communications - like any other science. However, the pure medical science system would have its own separate aims, procedures for scientific evaluation, institutional organization, funding and support arrangements; and a separate higher-professional career path with distinctive selection criteria. For instance, leaders of pure medical science institutions would need different qualities from many of the current leaders of medical science; being selected on the basis of their specialized cognitive aptitudes and their record of having generated science-transforming ideas.

The main 'market' for pure medical science would be 'applied'medical scientists who need radical strategies to solve important clinical problems which are not yielding to established methods. Pure medical science units might then arise as elite grouping linked to existing world-class applied medical research institutions. The direct financial stimulus to create elite pure medical science institutions might come from the leadership of academic 'entrepreneurs' and imaginative patrons in the major funding foundations.

References

1. Awasthi S, Beardmore J, Clark J, Hadridge P, Madani H, et al. (2005) Five Futures for Academic Medicine. PLoS Med 2(7): e207

2. Charlton BG, Andras P. Medical research funding may have over-expanded and be due for collapse. QJM. 2005; 98:53-5.

3. Charlton BG. Conflicts of interest in medical science: peer usage, peer review and 'CoI consultancy'. Medical Hypotheses. 2004; 63:181-6.

4. Charlton BG, Andras P. The future of 'pure' medical science: the need for a new specialist professional research system. Medical Hypotheses. 2005; 65: 419-425.

5. Charlton BG. Inaugural editorial. Medical Hypotheses. 2004; 62: 1-2.

No competing interests declared.