By: Phyllis A. Dennery, MD
How do physicians differ from basic scientists in their approach to diseases? The former provide insights into disease processes and their manifestations whereas, the latter delve deeply into mechanisms and look for potential therapeutic approaches. If we capitalize on these differences, this could lead to an ideal partnership between those who witness disease at the bedside and those who can adeptly use ever-evolving tools to elucidate the mechanistic underpinnings of human pathology.
Why is this partnership not always successful? Communication is often challenging due to limited understanding of each participants perspective. In fact, the gap is widening between the language spoken by biomedical scientists and clinicians/physician-scientists. With exponential advances in molecular biology and genetics, it has become difficult to incorporate these novel understandings into everyday medical practice. Philosophically, the two groups have different goals. Science for the sake of science is laudable and necessary to organically discover new insights. However, the pressures of finding a solution for diseases exist and are much more vivid for the physician-scientists who want solutions for their patients. Clinicians want to save lives and have immediate impact but are hampered by the fear of injury and/or bad outcomes. Scientists are encouraged to challenge paradigms and to develop new approaches which leads to a new found knowledge without the fear of such consequences. There needs to be a way to bridge the divide between the culture of basic scientists and that of physician-scientists.
Of course, the integration of newfound knowledge of basic science insights into clinical decision making is important to improve patient care. However, once a discovery is made, dissemination and adoption in clinical practice is another significant hurdle which requires community engagement and public health support. This path is riddled with pitfalls. Therefore, it is often difficult to see how certain basic concepts lead to therapeutic interventions and to clinical successes. This has been a big challenge for redox biology in that despite years of clear ascertainment that antioxidants are beneficial to prevent cytotoxicity in various model systems, the applications to large scale human trials have been extremely limited and discouraging. This is likely due to the fact that the human organism is much more complex than any other laboratory-based model and there are many more factors that come into play to alter outcomes, in particular, disparities in healthcare delivery and lack of cultural competence. Nevertheless, a partnership between physicians and scientists may overcome these hurdles by identifying ways to enhance a particular benefit without causing harm.
Recently, we have seen some encouraging success stories around treatment of disease using redox biology concepts. Hopefully, this is the beginning of a new era. The process from discovery to implementations is long and tortuous. A recent publication reviewed the literature and identified papers where a scientific discovery was made followed by its adaptation into healthcare. On the average, it took 17 years for this to happen (1). This means that we have to tolerate the uncertainty between basic discoveries and eventual adaptation into clinical practice for many years and not lose faith. This is not for the faint of heart and requires constant vigilance to continue to focus on the ultimate goal through partnership and collaboration.
Many will argue that we have to conduct science for the sake of science, rather than focus on finding an immediate solution to a disease process. I would say that we have to adopt both approaches. Families, patients, their families and communities rely on us to help improve their health. Without a goal towards therapeutic discoveries, we will extinguish their hopes and erode their faith in us.
How can we then work together as physician-scientists and basic scientists? We can be patient with each other in terms of understanding each other’s language. Oftentimes the physician rolls her eyes when PhD colleagues try to describe a disease process, smugly dismissing the limited understanding. In return, the basic scientist is exasperated by the approaches taken by the physician-scientist to solve a problem, and chastise him for his lack of rigor or his choice of vague assays. Working together and encouraging each other will go farther. Trying to formalize relationships between the most basic and most clinical investigators would make for an synergistic opportunity to accelerate discovery and implementation.
In the past 28 years, it has been my distinct pleasure to be engaged with SfRBM, known previously as the Society for Free Radical Biology and Medicine and The Oxygen Society. I have enjoyed every iteration of this Society and have felt compelled to be an active participant despite feeling inadequate in my lack of formal training in chemistry, biochemistry, molecular biology and genetics. I feel, nonetheless, that we physician-scientists can bring value to the Society in many ways.
As I approach the Presidency of the SfRBM as its first MD leader, I will look forward to working with you and learning from you to speak a common language that enhances scientific discovery and ultimately promotes health.
1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510-20.