The premise that clinical research needs to be strengthened was placed
squarely on the medical agenda more than 2 decades ago. In his landmark paper
"The Clinical Investigator as an Endangered Species," Wyngaarden1
described a number of problems that he believed jeopardized the future of
clinical research. These included declining interest in biomedical research
and decreases in the number of postdoctoral training awards granted to young
clinicians. The solution he proposed, implementing a series of steps to encourage
young physicians to pursue biomedical research careers, has in many respects
been adopted. For example, the National Institutes of Health (NIH) has developed
a number of new grant mechanisms, such as the K23 and K24 awards, designed
to encourage clinical investigators to compete for peer-reviewed funding.
This measure and numerous others, implemented by funding agencies and by individual
academic health centers, have succeeded in the sense that today clinical investigators
are not extinct. To the contrary, by a number of objective measures, they
are thriving. For example, at the Johns Hopkins University School of Medicine,
the amount of support for sponsored projects that involve human subjects comprises
more than half the total amount awarded. This is not surprising, given the
greater number of clinical faculty compared with basic science faculty. However,
the clinical research would not pass peer review if it was of lower quality
than nonclinical research.
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