On Friday, I expressed my irritation at the misunderstanding of science by NEWSWEEK’s science columnist Sharon Begley, in which she opines that it is those nasty basic scientists who insist on learning new science and new physiological mechanisms of disease that are devaluing translational and clinical research, in effect ghettoizing them in low impact journals, and, as I sarcastically put it, “keeping teh curez from sick babiez!!!!!”
I also thought of another thing regarding Begley’s rant. She complains how medical science’s emphasis on the novel is supposedly inhibiting the search for cures of various diseases and how the desire of scientists to publish in top journals may lead them to take more time to “get all their ducks in a row,” as Steve Novella put it, by having a mechanism for an observed effect worked out. Often, top journals won’t publish papers that don’t have evidence for a molecular, genetic, or physiological mechanism.
Castigating “the same old incremental research that has produced too few cures” and praising “risk-taking, innovative studies,” her proposal is to find a new Director of the NIH who will strongly emphasize translational research and fund riskier but potentially higher payoff research. Yet not too long ago this same Sharon Begley ripped into physicians for opposing comparative effectiveness research, which is nothing more than comparing one existing treatment against another. Now don’t get me wrong. Comparative effectiveness research (CER) could be potentially very important. There are lots of conditions for which multiple treatments exist, the relative effectiveness of each being not entirely clear. However, if there’s one form of clinical research that is about as far from “risk-taking” and “innovative,” it’s CER. Indeed, CER is about as plain and white bread as it gets, because all it does is to compare two or more treatments that are already FDA approved in order to see which one is more effective. Important information, yes, but it’s about as far from what Begley thinks we should be doing as far as translational research as it gets. Worse, given how long it does to do a typical clinical trial, it’s not hard to imagine situations in which both treatments being compared in CER have been supplanted by new therapies, making the results of the research no longer relevant by the time it’s published.
In any case, Begley is going to have a hard time having it both ways. There are only limited resources, even if the Obama administration greatly ramps up the funding for medical research. CER has a huge number of potential therapies to be compared to each other. Given the many permutations that could be tested, CER could easily expand to fill up the entire health research budget. Obviously, doing CER leads to no new treatments. Too much CER, in other words, would cause medical progress to grind to a halt (and, if Begley thinks clinical research is ghettoized in low impact factor journals now, wait until she sees the collective yawn from the top journals that would greet the results of lots of CER). On the other extreme, “risky” translational research fails far more often than it succeeds, meaning that too much of an investment in such research is likely to produce a lot of failures. After all, major breakthroughs aren’t common, and they can’t be conjured at will. Finally, as I have said many times before, translational research will grind to a halt without a steady stream of new basic science results to exploit in the pipeline. Thus, an effective medical research effort will require a careful balance between hard core basic science research, both of the careful, incremental variety and the more risky, innovative kind; translational research, both incremental and risky; and the very safe, very dull CER. Unfortunately, Begley doesn’t seem to understand that. Indeed, her view seems to shift according to whatever is politically expedient (she appears to be a big Obama supporter) or what makes for her a provocative column, even if, as in her last column, she ends up relying solely on anecdotes of disgruntled researchers who feel they were treated unfairly by the NIH and pharmaceutical companies.
It’s a good thing Sharon Begley isn’t in charge of figuring out what kind of research is funded.