The Crisis in Clinical Research

To the Editor: I take exception to the definition of clinical research offered by Dr Nathan¹ as "patient-oriented research." This misnomer fails to acknowledge the significant conflict inherent in clinical research between a physician-scientist's devotion to the promotion of health for the individual patient and allegiance to the outcome of human research.

A luncheon discussion last year with a well-known researcher illustrates my point. The researcher was commenting on the differences between the mindsets of military brass and those of noncommissioned field officers who are in the trenches, directly leading their troops. He pointed out that war may at times require a strategic loss of life in 1 sector to win the war or protect more life in another sector. Thus, a general may draw battle plans with "acceptable" troop casualty projections. However, it is the field officer's goal to reach the objective while protecting individual troops. These differences in emphasis may at times become critical. I pointed out that the distinction between the generals and the "non-coms" was parallel to the difference between researchers who conduct clinical trials focused on the scientific outcome vs clinicians who concentrate on the individual subject's medical needs.