© 2004 American Thoracic Society
Rebuttal from Dr. Lenfant"Suddenly I found that a lot of very important people—Presidents of the United States (guided by their budget analysts), Congressmen, Nobel Laureates, heads of foundations—knew for sure how to get the most for the medical research dollar and how to plan and generate medical breakthroughs. Since I didn't know (because I hadn't done any honest-to-goodness research on research—research on the process of discovery—and I couldn't find reports of objective studies done by others), I thought it was time to learn something for sure."I am withholding the reference for that statement until the end of this rebuttal, but in the meantime I would urge Dr. Macklem to refresh his memory. As people grow older, one hopes that they become wiser, that is, they know better ... and surely, that they have more patience. Research is an investment and this investment, like all others, has it ups and downs—but the long-run trend is definitely up. The Hurd and Lenfant editorial of 1987 did not mention a time scale, but it said that biomedical research must take advantage of all the tools. Cell and molecular biology are tools that must be used, and we must pay for them. The basic issue, I believe, is whether the pursuit of the knowledge derived from cell and molecular biology detracts from better care, or even slows patients' access to readily available gain. So far, there is no evidence to support this fear. Physiology has been, and remains, a unique discipline from which respiratory medicine has gained and patients have benefited. But how fast has this happened? Inspiratory volume and residual capacity were first measured in 1680 (1), and in 1846 an article was published titled "On the Capacity of the Lungs and on the Respiratory Functions, with a View of Detecting Disease by the Spirometer" (2). Yet in 2003, pulmonary disease experts are lamenting that many airway impairments (especially COPD) go undetected because spirometry is not used routinely even when functional symptoms make it imperative to do so. The point is that the introduction of new disciplines into the practice of medicine is a very slow process. The statement cited at the beginning of this document comes from the introduction of a wonderful little book that was written by Julius Comroe, Retrospectoscope (3). It should be required reading for all scientists, especially those who are impatient. I rest my case. FOOTNOTES This article should be required reading for all biologists: it appears to do for biology what Gödel's theorem did for mathematics. REFERENCES
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