Do We Need the Basic Scientists?

DO WE NEED THE BASIC SCIENTISTS? ROBERTH. GLEW* After publication of the Flexner Report in 1910, basic scientists were recruited to the faculties of American medical schools and it was recognized by educators of physicians that the study of medicine would best achieve scholarly excellence if schools of medicine were incorporated into the university. The achievements and progress realized over the last 70 years support the wisdom of the decision to integrate basic science programs into our medical schools, yet in recent years many secure, tenured biochemists, physiologists, microbiologists, and other basic scientists in American medical schools who were hired in the 1950s and 1960s when money for research and faculty appointments were plentiful seem no longer to appreciate or understand the responsibilities of their positions as members of a medical school faculty. Too often, Ph.D.-basic scientists have set themselves apart from their M.D. colleagues and the clinical activities of the health center and acted more or less as isolated research institutes, to the extent that the question is now often raised, Do we indeed need the basic scientists? In many instances the community of basic scientists has developed into a separate estate within the walls ofour medical schools. Chairpersons of basic science departments are often individuals who assumed their positions a decade ago or more when seemingly infinite funding from the federal government permitted Ph.D.-medical school faculty members to pursue their research interests with little concern for the clinical research and teaching activities and health-related programs of the medical school. Unfortunately, too many of these chairpersons have not heeded William Osier's advice against remaining in the same position for more than 10 years. With their unsupportive and nonsympathetic attitudes toward clinical research and M.D.'s, they have often actively discouraged members of their departments—too frequently the more vulnerable junior faculty members—from participating in the activities of ?Department of Biochemistry, School of Medicine, University of Pittsburgh, Pennsylvania 15261.© 1981 by The University of Chicago. All rights reserved 003 1 -5982/82/250 1-0248$0 1 .00 Perspectives in Biology andMedicine ¦ Autumn 1981 | 149 clinical departments. I would estimate that not more than 10 percent of the Ph.D.-basic scientists in any medical school could tell you the time and place of the weekly clinical grand rounds. I am certain that even fewer have attended one clinical pathologic conference in the last 5 years. What an unfortunate lost opportunity! The few Ph.D. graduate students who attend these worthwhile health center activities often express astonishment at how frequently significant questions arise during the various weekly clinical conferences that bear directly on the principles , concepts, and methodologies of biochemistry, physiology, molecular biology, or some other basic discipline. Unfortunately, these questions usually go unanswered or are inadequately developed because of the absence of colleagues from the basic science community with expertise in the relevant areas. For example, a recent grand rounds involving a discussion of the pathology of the trigeminal nerve caused by Herpes simplex virus would have been enriched by contributions from a microbiologist knowledgeable on the subject of interferon. In another instance where a clinical pathology conference concerned a patient with amyloidosis, the internist and pathologist presenting the case carefully avoided any reference to the chemical nature of the green-fluorescent, proteinaceous material stored in the tissue of the patient. As a result of this evasion, the question of the etiology of the disease was developed in a most incomplete and unsatisfactory manner. When asked why the biochemistry of the amyloid storage substance had not been discussed, the pathologist responded by acknowledging that he had consulted the literature on the subject but after finding himself incapable of dealing with the newer concepts of immunology, immunoglobulin structure, and /3-pleated sheets, he opted to ignore the problem. It is unreasonable to expect these clinicians to be competent and confident in all areas of modern molecular biology. Instead, it should be the responsibility of the basic science community to provide such expertise. Various pressures have been mounting over the past decade that are forcing an evaluation of the extent of support of basic science departments for the short and long-term...