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sections of special pleading, and I hope that we will encourage a general perception that we are in the earliest infancy of trying to determine the answers to the questions that the public can readily formulate for us. The Independent Researcher GEORGE E. SCHREINER* Dr. Beeson's quotation of William Harvey (1651) bears repeating. "Nature is nowhere accustomed more openly to display her secret mysteries than in cases where she shows traces of her workings apart from the beaten path; nor is there any better way to advance the proper practice of medicine than to give our minds to the discovery of the usual law of nature, by careful investigation of cases of rarer forms of disease. For it has been found, in almost all things, that what they contain of useful or applicable is hardly perceived unless we are deprived of them or they become deranged in some way." This is where most physicians' sense of curiosity begins—by being exposed to a derangement and asking the question as deeply as they can from their training and facilities. William Castle used to say that the role of a clinical investigator is to ask the question at the bedside and then go as far from the bedside as his curiosity, legs, money, and facilities will take him. Some people take one step, some take 10, and some may be able to take 100 steps; but the important thing for the clinical investigator is the direction he walks, not the number ofsteps he takes. We often judge him more by how far he gets from the bedside than from where he came—the bedside. As I listened to Dr. Whedon I realized I was on the blackened silver edge of his slide, not in the illuminated part. Our clinical group at Georgetown in the last academic year had 104 publications. For that we had one NIH grant of about $30,000. The point is that things are happening in clinical research that are not in the NIH statistics. This fact needs to be emphasized for those people who think the world is HEWgocentric . One thing that has happened is that some of the clinical or practice money that Beeson refers to has in fact been turned back into clinical investigation. Like the recipe for rabbit stew that reads, "First you *Division of Nephrology, Department of Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, D.C. 20007. S52 Edward H. Kass ¦ Funding ofBiomedical Research catch the rabbit . . . ," young people who want to try a research project for the first time have found that first of all you have to catch the money. If you test your wings on money derived from clinical practice you find out that this money is very efficient and time saving. Because we all ask for a controlled series, I urge investigators to do a sham grant—to figure out the time it takes to fill out the forms, write a proposal, proofread it, get it through the local institution and the various committees, defend it at the site visit, reply to the critiques, and comply with the accounting requirements. Then the investigator should spend the same time writing a protocol and doing a piece of research without any of that red tape which is now so taken for granted. He is likely to discover that the two activities take about the same amount of time. That is, to get the license to do the research takes about as much time as to do an average small research project. Does that mean the system is bad? Not necessarily, but it does show a reason why many senior people are peeling off the upper end of the grant system after 10 years or so. Perhaps a system which achieves this result is good because with tight entry the investigators are competing for limited dollars, and as it becomes more and more uncomfortable to go through the process some look for alternative sources. In this way we increase our sources of support, at least for small grants. A member of the Federal Reserve Board told me recently that one of their biggest problems is the inability of any...


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pp. S52-S54
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