http://jama.ama-assn.org/cgi/content/full/300/20/2435?etoc
"Research signifies effort directed toward the discovery of laws and
principles through the systematic collection of new and better
correlations of existing data. It means the utilization of hitherto
latent or wasted energy. The aims of research are not culture, not
miscellaneous information, not a mode of leisurely meditation on the
origin of things, but mainly utility and service to mankind."
These statements by Theobald Smith, while general, apply especially to
research in the field of medicine. Research is too often considered as
peculiarly difficult, requiring unusual and special qualifications and
only to be indulged in by a certain few whose sole ambition is to gain
fame by making some important discovery. This is by no means true. The
methods are straightforward, natural, simple, common-sense methods, but
complete, thorough, orderly and precise. Research is work in which
absolute honesty is demanded on every hand, for lacking this its very
purpose is defeated.
The great discoveries and generalizations in science and medicine have
been made usually after years of systematic and conscientious labor. As
a rule they evolve rather than flash into existence in a moment.
Twenty-three years elapsed from the time Darwin first published notes on
the evolutionary theory till it emerged in its complete form-"The Origin
of Species." It is said that Bacon delayed the appearance of the "Novum
Organum" for twelve years, and each year added something. Harvey
withheld the publication of his views on the circulation for twelve
years.
All research profits and is made possible by work that precedes it. This
work may be of little significance and of no practical value in itself,
but taken in relation with other facts it may help to solve the most
mysterious and difficult problems and be of the greatest practical
importance. It is never safe to predict in regard to the significance of
facts. There is only one safe method and that was used by Darwin,
namely, to note every detail carefully, feeling sure that in the final
causal interpretation of phenomena each and every one of these details
will find its place and there be of great significance. The question is
too often asked: Of what use is this or that piece of work? If the
practical side is not clearly evident the whole is considered a waste of
time and worthless. The important questions to ask are: Is it true? Are
these statements of facts? Are these true principles? If so, the work is
amply justified. Of course there is a scientific perspective. All facts
are not of equal importance. Some stand prominently in the foreground;
others are mere subsidiary detail; but in the final picture, in the
complete interpretation, all are essential.
At present many physicians look on the work in the laboratory as
scientific because certain phenomena are here more carefully analyzed
perhaps than seems possible in a clinic or at the bedside. But the
spirit of true practical medicine is scientific. Its aims are utility
and service to mankind. Facts are being observed and correlated and
their meaning determined. The apparatus may be different, but the
methods are fundamentally the same as those of the laboratory. Why
should an accurate physical examination of a patient be less scientific,
for instance, than the chemical analysis of the blood or observations on
the biology of the tubercle bacillus? The ultimate aim is the same, and
though the end in view in the former is more immediate than in the
latter the difference is not as to justify calling one scientific and
the other non-scientific. Scientific medical research must not be
confined altogether within the walls of the laboratory; a large part of
it must necessarily be done there, for medicine draws on the more
fundamental sciences for aid, and this requires more or less elaborate
laboratory facilities. What is desired is the greater use by physicians
at the beside of the general methods in vogue in scientific
laboratories, where are demanded careful observations, painstaking
analysis, logical reasoning, accurate and systematic records.
"No great discovery in science is ever without a corresponding influence
on medical thought, not always evident at first, and apt to be
characterized by the usual vagaries associated with human effort"
(Osler1). Laboratory workers and practicing physicians should come
nearer together and attempt to understand each other better. Often pure
scientists and experimenters are inclined to be radical, sometimes
impractical, and liable to be carried away by fanciful theories. And
sometimes they are justified in letting their imaginations soar to
heights which physicians perhaps dare not attain; this not infrequently
leads to valuable working hypotheses that may bring forth important
facts.
On the other hand, the scientific man, the laboratory worker, should
realize that physicians must have at least one foot on solid ground;
they must be conservative yet tolerant of new ideas, always willing to
consider and apply them in legitimate ways; they must be sympathetic
toward the new, knowing that in time the grain will be sifted from the
chaff and truth appear.
1. The Growth of Truth. Harveian Oration, London, 1906.
JAMA. 1908;51:1700
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