Medicine - Physician-scientists - Endangered and essential
Medicine - Physician-scientists - Endangered and essential
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DOI：
10.1126/science.283.5400.331
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发表时间：
1999-01-15
期刊：
影响因子：
56.9
通讯作者：
Rosenberg, LE
中科院分区：
文献类型：
--
作者：
Rosenberg, LE
随着下一个千年的临近，美国的医学研究事业似乎准备为人类的健康和福祉做出更大的贡献，从而为国家和国际利益做出更大的贡献。然而，国家医学研究大厦的结构存在缺陷，必须加以修复。这一缺陷就是内科科学家数量的日益危险的减少。“内科科学家”一词代表了将全部或大部分专业精力用于通过研究寻求有关健康和疾病的新知识的所有医学博士。这是一个包容性的名称，包括基础调查、疾病调查、患者调查、人群调查和预防调查。这种下降并不是一个新问题。20年前，美国国立卫生研究院（NIH）前院长詹姆斯·温加登（James Wyngaarden）在题为《作为濒危物种的临床研究者》的论文中首次呼吁人们关注这一问题。1984年，戈登·吉尔（Gordon Gill）写道：“医生兼科学家的终结？”随后，这个问题一再引起我们的注意(3)，但重点从从事科学研究的人转向正在进行的科学研究，即以患者为导向的研究(4)。尽管进行了所有这些活动，但由于一些原因，必须重新解决这个问题。首先，整个医学科学家都处于危险之中——不仅仅是那些以病人为导向的研究。就像保护生物学家一样：我们最近一直把注意力集中在斑点猫头鹰上（也就是那些以病人为中心进行研究的医生），而没有注意到所有的猫头鹰都有危险（也就是所有的医生和科学家）。第二，危及医师科学家也危及与医学研究有关的每一个人。第三，迄今采取的行动无法解决问题。最后，只有国家医学研究事业的所有参与者采取大胆、协调一致的行动，才能避免这种威胁。
As the next millennium nears, the medical research enterprise of the United States seems poised to make ever greater contributions to humanity's health and well being—and, hence, to both the national and international interest. However, there is a defect in the structure of the country's medical research edifice, which must be repaired. This defect is the progressive, dangerous decline in the number of physician-scientists. The term “physician-scientist” represents the entire species of MD's who devote all or a majority of their professional effort to seeking new knowledge about health and disease through research. This is meant to be an inclusive designation, covering basic, disease-oriented, patient-oriented, population-oriented, and prevention-oriented investigations.This decline is not a new problem. Former National Institutes of Health (NIH) director James Wyngaarden first called attention to it 20 years ago in his paper entitled,“The clinical investigator as an endangered species”(1). In 1984 Gordon Gill wrote,“The end of the physician-scientist?”(2). Subsequently, the problem has been called to our attention repeatedly (3), but with an important shift of emphasis away from those doing the science and toward the kind of science being done, namely, patient-oriented investigation (4). Despite all this activity, the problem must be readdressed for a number of reasons. First, the entire species of physician-scientist is at risk—not only those doing patient-oriented research. Think of it as conservation biologists would: we've been so focused recently on the spotted owl (that is, physicians who do patient-oriented research) that we haven't noticed that all owls are at risk (that is, all physician-scientists). Second, endangering physician-scientists endangers everyone concerned with medical research. Third, the actions taken to date cannot solve the problem. Finally, this threat can be averted only by bold, concerted action on the part of all of the participants in the country's medical research enterprise.