Career dilemma

[mercaptovizadeh]

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I'm in the midst of the PhD portion of the MD/PhD and I'm just not enjoying it too much. It's not so much mentor or research topic issues but rather a general sense of malaise on the prospects of a career in science. I've come to the realization that, while I find nature and biology specifically fascinating, I find a great many other things fascinating as well, like theology and philosophy and art and literature and music and physics and chemistry and history .... not to mention spending time with family, traveling, etc. To me, the appeal of biological research does not lie in the expansion of human knowledge (if I was interested in that, I'd pursue a career in physics, the more fundamental science), but rather in the potential for alleviating/curing disease.

Which brings me to the next point: of all the research that goes on now in biomedical science, only a miniscule fraction, say 0.01%, is going to have a substantial impact on alleviating/curing disease/improving patient outcomes. And, ironically, those discoveries that may lead directly to advances in medicine seem to be more closely concentrated in clinical and epidemiological research than basic science research (which, I suppose, makes sense). And when I think of what I believe to be a worthy "basic science" career, one worth pursuing at the expense of clinical medicine, I think of Salk, of Semmelweis, of Thomas (bone marrow transplant), of Fleming, of Hilleman (if you don't know about him: http://en.wikipedia.org/wiki/Maurice_Hilleman). And many of these achievements were purely accidental or the result of slow incremental effort over decades or just a simple observation not requiring huge intellectual effort.

So, if the basic biomedical science that really transforms medicine happens exceedingly rarely and frequently accidentally, is it wise to "gamble" on making a substantial discovery in basic science that directly impacts the patient, and forfeit the known rewards of seeing and treating patients? If I *know* that I can make some difference in someone's life through clinical medicine, is it sensible to waste years and decades on basic science research which has a very small chance of producing a comparable or greater impact?

Is anyone else in this position?

 

[gbwillner]

I'm in the midst of the PhD portion of the MD/PhD and I'm just not enjoying it too much. It's not so much mentor or research topic issues but rather a general sense of malaise on the prospects of a career in science. I've come to the realization that, while I find nature and biology specifically fascinating, I find a great many other things fascinating as well, like theology and philosophy and art and literature and music and physics and chemistry and history .... not to mention spending time with family, traveling, etc. To me, the appeal of biological research does not lie in the expansion of human knowledge (if I was interested in that, I'd pursue a career in physics, the more fundamental science), but rather in the potential for alleviating/curing disease.

Which brings me to the next point: of all the research that goes on now in biomedical science, only a miniscule fraction, say 0.01%, is going to have a substantial impact on alleviating/curing disease/improving patient outcomes. And, ironically, those discoveries that may lead directly to advances in medicine seem to be more closely concentrated in clinical and epidemiological research than basic science research (which, I suppose, makes sense). And when I think of what I believe to be a worthy "basic science" career, one worth pursuing at the expense of clinical medicine, I think of Salk, of Semmelweis, of Thomas (bone marrow transplant), of Fleming, of Hilleman (if you don't know about him: http://en.wikipedia.org/wiki/Maurice_Hilleman). And many of these achievements were purely accidental or the result of slow incremental effort over decades or just a simple observation not requiring huge intellectual effort.

So, if the basic biomedical science that really transforms medicine happens exceedingly rarely and frequently accidentally, is it wise to "gamble" on making a substantial discovery in basic science that directly impacts the patient, and forfeit the known rewards of seeing and treating patients? If I *know* that I can make some difference in someone's life through clinical medicine, is it sensible to waste years and decades on basic science research which has a very small chance of producing a comparable or greater impact?

Is anyone else in this position?

For me... my response to your comment is the proverb:
"Give a man a fish, he eats for a day. Teach a man to fish he eats for a lifetime".

While being a good clinician can make "some difference in someone's life", being a good scientist can make a difference in everyone's life. We all do our part, little by little, to understand the way things work and hopefully, someone will use all that to figure out how to use that info to help people. It happens every day. You just may not be in a position to see it just now.

 

[Jorje286]

Very interesting topic, and it's something I've thought about quite a lot.

To me, the appeal of biological research does not lie in the expansion of human knowledge (if I was interested in that, I'd pursue a career in physics, the more fundamental science),

I don't think that's strictly completely true. There are areas in biomedical science that quite strongly intersect with another fundamental objective of science, which is to expand knowledge and (at the risk of sounding cheasy) simply advance our understanding of fundamental processes in the world. Probably the most obvious example is research in neuroscience, especially at the intersection of psychiatry and neurology. Which is why I chose this field anyway. Consciousness, working of the mind..etc are still some of the concepts least scientifically understood, and approaching them from a clinical perspect would definitely help us in understanding what they are.

Another appeal in biomedical science (other than helping people and what I mentioned above) is the critical thinking, logic and the intellectual processes that have to go with it, as in any other science.

As an aside, probably one of the most inspiring stories for any physician-scientist is that of Huda Zoghbi. She started as an MD, a few cases of Rett Syndrome inspired her to get into science and then she was able to find the gene, figure out some of the molecular processes associated with the disease and now is even on the road of proposing therapies. So it's possible to acheive a lot during a life time.

 

[dl2dp2]

Being in a similar position as you are, I just want to add a couple of comments. I think first and foremost, the thing that sustains you in basic science isn't the desire to improve health and cure diseases. Rather, it's a curiosity of some part of biology, some deep passion for the day to day work/question that you are trying to address. Not everyone has that passion.

I would also argue that in fact MD/PhDs are not designed for people who go into basic, basic research, and if you are truly interested in that you would want to chuck residency.

Biology in this day and age is extremely narrow (especially experimental work). Experimentalists are busy body specialists who are rarely intellectuals. They neither have the desire nor have the luxury (time/money) to think about big, intellectual questions. This really gives you only two options.

(1) Do a lifestyle medical career, then do your intellectual pursuits as a leisure activity.
(2) Transitioning your research career into a more social science/translational type career.

I'm unsure which pathway I'll choose yet, and it'll depend on my clinical rotation experience. But the good thing is for MD/PhD the second pathway is not prohibitively difficult.


As far as epidemiology/clinical research not requiring "huge intellectual effort", etc. that's just poison those basic science faculty instilled into you. First off, that stuff isn't as easy as it looks. Secondly, having been interacting with quantitative types on a day to day basis, I am well-aware of the fact that if I were actually capable of doing string theory, I wouldn't be here. Your logic isn't quite right. What you are saying is that basic biology is neither here nor there: it can't cure diseases, and it's not intellectually challenging. Physics is too hard for most of us...and if you do experimental work (say at LHC), you'll still feel like you are doing some tiny tiny thing that has nothing to do with any big glorious problem.

Sorry for all the rambling but there's no perfect job. With MD/PhD you have probably the biggest amount of freedom to CHOOSE and BUILD a career that you want, and that's the advantage at the end of the day.

I'm in the midst of the PhD portion of the MD/PhD and I'm just not enjoying it too much.


So, if the basic biomedical science that really transforms medicine happens exceedingly rarely and frequently accidentally, is it wise to "gamble" on making a substantial discovery in basic science that directly impacts the patient, and forfeit the known rewards of seeing and treating patients? If I *know* that I can make some difference in someone's life through clinical medicine, is it sensible to waste years and decades on basic science research which has a very small chance of producing a comparable or greater impact?

Is anyone else in this position?

 

[pazan]

I don't think that's strictly completely true. There are areas in biomedical science that quite strongly intersect with another fundamental objective of science, which is to expand knowledge and (at the risk of sounding cheasy) simply advance our understanding of fundamental processes in the world. Probably the most obvious example is research in neuroscience, especially at the intersection of psychiatry and neurology. Which is why I chose this field anyway. Consciousness, working of the mind..etc are still some of the concepts least scientifically understood, and approaching them from a clinical perspect would definitely help us in understanding what they are.

I think that's a good point. I'm using MEG for my current project and the basis of communication between neuronal groups (what's thought of as "consciousness") is much more poorly understood than the synapse, which is definitely saying something considering the mechanism of vesicle release hasn't even been substantiated. Biophysics has a lot of good examples of using "pure knowledge" to develop clinical treatments and technologies.

To get back to the OP's point... both the yes and no arguments of whether devoting your life to research is more worthwhile than devoting it to treating patients have a lot of holes; you can't make a definitive case for either. I think the beauty of academic medicine was that it allowed you to do both, and, in the process, tailor your career to what interests you. Obviously, there are pressures (to publish, conform to a schedule, run a lab, become a full-fledged empiricist, etc.), but there are no requirements. I thought about the same issues a few months ago and concluded that having an MD/PhD would put me in the best position to make meaningful impacts on both society and individuals. Of course, I'm starting my MD/PhD next year, so I'm probably still pretty naive about the situation.