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Clinical vs basic science research

Discussion in 'Physician Scientists' started by MacGyver, Jul 28, 2006.

  1. MacGyver

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    I'm going to be a bad boy and offend some people here, but I need to rant:

    clinical research is not the same intellectual rigor that basic science is. Yes, its important; yes its necessary.

    But the bottom line is that hte vast majority of clinical researhc is cookie cutter mold methods and analysis that a mediocre undergrad student could do, or even an advanced high school student.

    The LOGISTICS of running clinical research is challenging (i.e. gathering all the medical records of kids < 5 admitted for meningitis at a hospital over hte past year), but he actual science and intellectual capacity needed to write a clinical research paper is vastly inferior to a basic science paper.

    The reason I bring this up is because I think when you cite someone's publication record you have to keep in mind what kind of researcher they are.

    Clinical research MDs can easily put out 7 first author papers per year (I'm not talking peripheral PI involvement either, I'm talking first author papers)

    Basic science researchers would never have that kind of output unless they are listed as PI and not the first author (which doesnt count IMHO because PIs generally have very peripheral involvement)

    IMHO, 1 basic science paper is worth at least 4 clinical research papers. You can easily run 10 different clinical investigations at the same time and hire some undergrad or RN to do the dirty logistical work for stuff like retrospective case controls.

    To publish a basic science paper requires major intellectual reasoning that takes much longer than clinical research. You are basically starting from scratch.

    On the other hand, clinical research is based on the cookie cutter molds of cohort, case control, or RCT. There's very little actual thinking involved. Even the results/analysis section on clinical papers does not require nearly the same fortitude to interpret as a basic science paper.

    Again, I'm not saying that basic science is superior to clinical research. We obviously need both. But what I am saying is that publishign a basic science paper is much more difficult (from a science perspective, of course clinical research often has lots of logistical hurdles) and much more intellectually challenging than publishing a clinical paper.

    End rant.

    Flame away
     
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  3. Faebinder

    Faebinder Slow Wave Smurf
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    You are kidding me right? Do you know how horrible it is to track down 100 patients to make them answer questions for a study for you after they have finished a procedure like 3 years ago...

    Your brain might feel mighty supreme about some basic science invention but let me tell you something... after calling patient number 20 and them yelling at you how much they hate your guts cause you didn't pay attention to them enough as they think they want you to or because his boss yelled at him this morning.... you start to wonder why you are doing all this. Oh ya, so you can actually improve someone's life...

    "Mister XXX, how are you doing? Ya I'm calling from YYY and I know you had an LNF with DR ZZZZ.... oh you are not Mister XXX... you have no idea who mister XXX... this is not VVVV in Florida? IT is....okay he must have moved, thank you."

    You dont think 100 is bad? Try 700 or 1000 or my favorite.... a 50 in a multi-center clinical trial, where the data is EVERYWHERE.

    Come on, stop comparing apples to oranges.. when dealing with actual humans... it's a nightmare getting things together. IT takes a lot of effort and years to build those patient databases such that they are publishable... Not to mention that SOOO MUCH clinical research does not result with funding unlike basic science..
     
  4. Nuel

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    but i thought macgyver explicitly said the logistics of clinical research was challenging, but that basic science research needed much more intellectual rigor and effort in execution? i agree as much, so you are arguing with yourself here, it seems to me.
     
  5. Frank Hardy

    Frank Hardy Member
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    Exactly.
     
  6. RxnMan

    RxnMan Who, me? A doctor?
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    It occured to me that a lot of clinical research is like quality control - did patient X get better, or worse, after procedure Y?

    I'll agree that clinical research doesn't require the brain power it takes to come up with the average basic science project. But getting patients, and particularly IRB (ethical review board) approval is a pain.

    Faebinder - I'd think drug companies would give out the bucks to fund clinical research.

    At my lab we've got a huge database of patients we've been working with - we've got pre- and post- op data, a hunge number of procedures, and a patient population of 1000+. All you have to do is think up of a procedure and query the database to see the pre- and post-op effects and viola! a paper. It infuriated me that one of the research assistants just hired a month ago is writing a paper when I've been working here on a different project for 1.5 years to get my first paper. But when I realized it took 6 years to get that database, I didn't feel so bad.

    Both have their place, especially in medicine.
     
  7. Hard24Get

    Hard24Get The black sleepymed
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    Yeah, you're totally arguing with yourself. But, logically... since translational medicine (what we're being paid for) involves clinical research in combination with basic science (human tissues, etc), it is the best of all (assuming you have the foundations of clinical and basic research to work with) because it is more likely to yield new treatments). Right?
     
  8. rishi

    rishi Junior Member
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    I'm all for the disease-oriented basic science camp.
     
  9. MacGyver

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    You didnt read my post. The stuff you are talking about is LOGISTICAL HURDLES THAT REQUIRE ZERO SCIENTIFIC KNOWLEDGE OR TRAINING TO DEAL WITH. A high school student could be hired to deal with all that stuff.
     
  10. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    I'm admittedly much less well-versed in clinical research versus basic science research, but in my limited experience, one of the hardest things about clinical research is to make sense of the data. You get a ton of data, and you have to choose the right statistical tests, figure out what the data mean (if they mean anything at all), and design your studies so that they will protect patients' rights and pass IRB muster. There are people who do entire PhDs in biostatistics and have expertise in this area. You also have to make sure that your research subjects can make an informed consent to participate in the experiment, which is not something we ever have to worry about in basic science. :p

    I thought it was plenty hard participating as a clinical research volunteer during grad school; I sure don't agree that a high school student could figure out how to set up a clinical experiment! But at the same time, it's definitely true that the publishing requirements are different for basic versus clinical science experiments. You don't hear of experimental chemists with hundreds of first-author papers, either. ;)
     
  11. Faebinder

    Faebinder Slow Wave Smurf
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    I think you all didn't read my post... i agreed basic science research is much more intellectual but the fact is... clinical is more work. Heck you can say that about MDs in general.. they don't need to be geniuses... they just need to have great memory and be able to remember the stereotypes, diagnostic steps and treatment. In life, people do get paid for working hard.. intellectually/physically/what-ever-form hard.

    What makes it look easy is the fact that the principle investigator is usually an MD/DO and knows about the disease... It requires way more background to do clinical research than basic science research. A PhD in the science field can do basic science research but would have a hard time with clinical research because he is simply not trained in that area of medical science. *It took me 30 min to explain to MPH students who were pre-meds on what is cholangiocarcinoma and how to pin point it in the charts*

    And I am sure you didn't read my part where I said.. stop comparing apples to oranges. It's like comparing an MD to a PhD... completely different.

    Bah, I have a lot of respect to clinical research... I've done both... and BTW... the pharm companies don't fund the majority of clinical research.. you are wrong.. The clinical trials is mainly where they aim.... Clinical trials are only a section of clinical research.
     
  12. BozoSparky

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    Well, I have another question. Why the competitive rift between clinical and basic research? Is it due to funding differences? Like the OP said, both are very important...in fact I love to imagine that old Reese's peanut butter cup commercial...when the dude with the peanut butter runs into the guy with the chocolate candy bar. What a powerful combination! :) Sorry for dorking out. Anyway, I remember sitting in my M1 Clinical Epidemiology course and hearing the instructor remark how unimportant basic science is...I couldn't believe it!!! :scared:


    "You got peanut butter on my chocolate!" "No, you got chocolate in my peanut butter!"
     
  13. relentless11

    relentless11 Going broke and loving it
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    I agree with Faebinder, comparing basic science research and clinical research is like comparing apples and oranges. I'm now a second year PhD student who has done both bench and clinical research over the past 6 years (including undergrad), with a more clinical oriented thesis project. The intellectual rigors can't be compared.

    Although I do agree that clinical researchers have the ability to publish more, not all clinical research papers/projects are as you describe. Try inventing a new assay and now trying to get it FDA-approved. My thesis project did start from scratch, and being new and unique assay, there are no "gold standards" to compare to. You are now in the grey zone of medicine, where patients are never homogeneous, and at least for my ICU and ED patients, they have like 4-10 other co-morbidities that can effect outcome.
    To reason why, in terms of pathophysiology, molecular biology, statistically, patient A did better than patient B while taking into account they had several other diseases that could make it easier or harder to treat is quite challenging, especially when nobody has used this assay before.

    Statistically we have used numerous multivariate analyses including logistic regression and poisson regression, and are even now inventing our own statistics to deal with the new challenges. With all that in mind, try to publish that in JAMA, NEJM, or CCM. For these journals they want the part where you started from scratch in terms of the clinical sciences, not neccessarily the assay.

    To even deal with this project, I have essentially had to learn the usual grad level basic sciences, and combine that with the 1st and 2nd year med school curriculum, and be trained by our attendings on the finer points of clinical medicine to even deal with this project. Although I must admit that I've only scratched the surface of clinical sciences, I don't think any of the scientific knowledge or training for my clinical research can be done by a high school student, or by some hired hand. If it was any easier, it wouldn't be a PhD-worthy project anyways, and University of California would laugh at me :oops:.

    However I must digress, clinical and basic science research are apples and oranges, the logistical and intellectual rigors are there but in different forms. I have found both to be challenging and stimulating, but I prefer clinical over basic science since I like to be out there with the patients. Ultimately, as MacGuyver pointed out, there is a need for both, and thus a reason why there's been a move towards integrating medicine into biological sciences. Physicians will benefit from more basic science research, and conversely scientists will benefit from clinical training. However I found it naive to make a claim that clinical research's challenges are due to logistics, rather than intellect. Most of our MD/PhDs here, including my PI, did a basic sciences PhD and currently do clinical research and say both can't be compared, both are hard to do if its anything worthwhile;).
     
  14. MacGyver

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    I would not put that research into the "clinical" category I would call it translational

    I'm referring specifically to clinical research, not a combo of basic + clinical

    Clinical = retrospective case controls, cohort studies, case series reports, etc

    Basic = bench work involving assays, proteins, DNA, virus, cells, etc.

    Translational = modifying an assay for use in clinical screening, adopting an MRI pulse sequence for a new clinical intervention, etc
     
  15. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    So would you call clinical trials translational? Just wondering how those fit into your neat little categories here.
     
  16. fantasty

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    I'm curious about the definition of "translational" anyhow. I've tried to have this defined and every time it is different.

    Most people wouldn't consider case reports or case series to be research at all - this is more just to raise hypotheses and alert colleagues to potential problems.

    As an epidemiologist, I consider my research to fall into clinical or translational (depending on the project and the hypotheses). But, translational should be the middle ground, correct? Clinical research (and broader epidemiology) may give us associations that are observable in human samples and populations, and are most directly related to understanding the most appropriate medical care. However, the translational research could be used to inform either direction.

    For instance, my dissertation research is in pharmacoepidemiology, and I'm taking some information that has only been conducted in lab sciences to see if it plays out in existing patient populations, although it might not actually influence patient care until we further understand the complexities of this drug. However, I also just did an analysis from a clinical trial that was looking at a secondary outcome for hormone therapy. Although the findings suggested a protective effect for this drug, this will *never* influence patient care directly because the harms outweigh the risks But we hope that basic science researchers will be able to use our findings to explore new ways to influence disease progression.
     
  17. Faebinder

    Faebinder Slow Wave Smurf
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    You are taking all pharm/instrument clinical trials and separating them from clinical research? In that case, you should be able to take all those wonderful enzyme experiments and mechanisms of cell processes from basic science and put them into translational..

    The definitions should be dead solid... Clinical: On humans... Basic: In The Lab. Complicating the inbetween is un-necessary..
     
  18. fantasty

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    Well, even in the "clinical" realm, there are lots of shades of gray. I was taught that anything "on humans" was considered patient-oriented research. But even though this just may be semantics, MacGyver's groups are not very accurate. He is just describing clinical epidemiology. Clinical *research* would also include things like imaging and diagnostic studies, physiologic studies (in whole humans), clinical trials (as QofQuimica mentioned, and which would be consider the gold standard and "true experiments" of clinical research), as well as a host of other topics, like cost studies, outcomes research, etc.

    I will concede that a clinical paper is probably easier to get out the door than a basic science paper. But, this may partially be due to differences in quality between clinical journals. Even epidemiologists are upset about the quality of the research in some clinical journals. But, as far as time commitment and rigor for clinical papers, they *can* be fairly high quality. Even in my secondary analysis of existing data (collected over 10 years, well before I became involved in the project), it took 18 months from the idea to the publication (you have to do literature reviews, proposals, collaboration with investigators and statisticians, interpret the findings, etc).

    As for intellectual rigor, clinical investigators are much more likely to have to worry about applying the most appropriate statistical analyses and study designs. Our design issues are less likely going to involve appropriate positive & negative controls or learning new lab techniques. But I think these are parallel tasks (like others said before, it's comparing apples and oranges). Our "control" issues revolve around our design and statistics, and our "lab work" revolves around the business of actual data acquisition (whether it's enrolling new subjects and getting clinical measurements, or working with lab data or large databases to extract the information that we need).

    Also, I realize your point here. But, there really is a lot to know about statistics and clinical study design. Sure, you can hire and train a student to conduct standardized interviews or manage your paperwork (just as you can hire them to run a bunch of gels and clean your glassware). But, the knowledge required to become a PI or even collaborator is pretty extensive. My PhD will have a LOT more coursework than a bioscience PhD required.
     
  19. relentless11

    relentless11 Going broke and loving it
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    Let me ask you this, have you done PhD-level clinical research? The comparisons that you make, make it sound like you've done a full PhD thesis in some kind of clinical setting.

    NIH defines human clinical research as: (1) Patient-oriented research. Research conducted with human subjects (or on material of human origin such as tissues, specimens and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects. Excluded from this definition are in vitro studies that utilize human tissues that cannot be linked to a living individual. Patient-oriented research includes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, or (d) development of new technologies. (2) Epidemiologic and behavioral studies. (3) Outcomes research and health services research. (http://grants.nih.gov/grants/funding/phs398/instructions2/p2_human_subjects_definitions.htm):)

    Regardless if you agree with this or not, its where the money is, and thus we go by it. Where does my thesis fall? It falls into this NIH definition, and in fact I am funded by NIH. Now if you like, you can talk to NIH and perhaps they can add in another catagory called translational research, but in the end, I am doing research with human subjects with the new technology that we developed in this clinical trial.

    To reiterate, both basic and clinical research are challenging in their own way, and one cannot quantify how one type of research paper is better than the other. My friend works on x-ray crystallography to try to characterize and eventually identify the purpose of several proteins found in eukaryotic cells. Hard to do! I can't imagine what it was like for scientists to map out the various biochemical pathways found in our body when using animal models. A drug that was tested on an animal model may work great, but when it goes into clinical trials, there may be confounding variables which may result in an adverse event. There is minimal room for error, there may be unknowns such as a persons pO2 levels interfering with the enzymes in your biosensor, or perhaps the antibiotics that they are on are attenuating the microorganisms that you are looking for. Drugs can compartmentalize in different tissues, while patient age/gender may cause unexplained results. The point I'm getting at is, BOTH basic research, and clinical research have their own problems that need to be solved intellectually. We can talk about this all day, and describe by our OWN interpretations what research is what, but ultimately research will fall into two catagories: (1) Basic, and (2) Applied. Both are important, both overlap, but both are also apples and oranges.
     
  20. basha

    basha Senior Member
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    What would the best type of research be for someone in my position, a med student taking a year out to do research in anesthesiology. Would it be basic, clinical or translational?

    I also want to add that Ive already gotten acceptance for basic science research in anesth at the mayo clinic but im having my doubts about it after speaking to my anesthesia advisor, who has along with a few others suggested that clinical research will have better implications for my future, as in more opportunity to get published and having my work recognized. Im not sure if that also means that come interview time, residency programs will be more thrilled that i did clinical vs basic science research, although that sounds very unlikely. If you have any advice or knowledge to share concerning this, please let me know.

    I should perhaps also mention my reason for the year off for research - basically wanted to go into anesth but had OK comlex scores so wanted to take the usmle step 1 as well as step 2 to increase my chances as well as do research to show my interest in the field.
     
  21. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    Do you know any anesthesiologists with whom you'd like to work? I think if I were in your shoes and I knew I wanted to be an anesthesiologist (which I actually might, some day!), I'd find a respected anesthesiologist to do research with who publishes regularly and who could write me a good LOR for my residency apps, and I wouldn't worry too much about which category of research s/he does. As you can see, there's quite a bit of room for argument about what type of research fits into which category anyway. :)
     
  22. basha

    basha Senior Member
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    But Basic science research in anesthesiology has very little to do with anesthesia itself and more to do with molecular mechanisms of anesthetics and other such intricacies. I dont see myself becoming a more knowledgable anesthesiologist because of this. In fact, I dont see how this even translates to better patient care. Its kind of like doing research for the sake of research. What is the end for which the research is being done?
     
  23. Nuel

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    This is short-sighted thinking. Many of the developments in science weren't directed for such. Much of basic molecular biology could have been interpreted to be done for the sake of science at the time they were in infancy, but today they have significant relevance in human biology. Even many of the tools we have appropriated from chemistry and physics and, more recently, mathematics, are becoming relevant in biomedical science. You are putting forth a very dangerous idea.
     
  24. basha

    basha Senior Member
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    Anything that questions set paradigms with the right intentions is not dangerous thinking. I doubt anyone ever looks at how efficient our multibillion dollar medical research machine really is? Our healthcare system still ranks lowest among civilized nations. Well Im postulating that its partly because we lose focus and chase blindly after information. We have become obsessed with information and not the end. Yes, every bit of knowledge is helpful in the long run but cmon people dont have proper drinking water and are dying and all the while we are wasting our money and time on an inefficient system. Cmon dont you feel guilty?
     
  25. QofQuimica

    QofQuimica Seriously, dude, I think you're overreacting....
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    No, I don't. ;) But FWIW, I do think that you asked a fair question, and I agree with you that you should go about your research purposefully, and you should try to improve upon your methods, especially if your research entails causing humans or animals to suffer. I also think that it is proper to ask whether the ends of an experiment justify the means. There are certain data that we might like to have, but which would be completely unethical to obtain.

    Now, in regard to your specific dilemma, I don't agree that your learning about the molecular mechanisms of anesthesia won't make you a better anesthesiologist. There are at least two ways that you could benefit from doing this research: one is that you personally will learn more about how the drugs you are using work. The second is a serendipitous factor that cannot be predicted ahead of time. I think that is what Nuel is trying to get at. Serendipity plays a huge role in all of research; you never know when you will just blindly stumble onto something revolutionary. Maybe you will discover a new class of drugs, or figure out how a current class works. That is always a possibility.

    Anyway, all of this is neither here nor there. It sounds like you don't really want to do this research project. So in that case, if you'd rather do clinical research instead, then do clinical research instead. There's nothing wrong with that either. :)
     
  26. Ecthgar

    Ecthgar Evil Genius
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    EVIDENCE-BASED MEDICINE.......PERIOD. Without it we would still be cutting people to drain the "dangerous humours" from their blood. For you own sake, please don't voice these opinions on med school interviews.
     
  27. Nuel

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    First off, you can't blame the relatively poor state of healthcare on basic science research. Healthcare is very expensive in the US and not managed properly as most HMOs/PPOs are largely after undue profit, and this has to be solved by more investment in preventive medicine/regulation of insurance agencies.

    Can you tell us how scientific research/funding is inefficient?
     
  28. relentless11

    relentless11 Going broke and loving it
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    You are making naive comparisons here. Money and time are relative. Its easy to point out how we are wasting money away in research, but years from now one can say that we didn't put enough money in, or pat ourselves on the back for investing in such research. Plenty of researchers, governments, companies have gone on wild goose chases in the short-term only to find out in the longrun that it was indeed a wild goose chase or something more worthwhile than that.

    The ranking of our healthcare system can't be compared to healthcare research. In fact, our research machinary is one of the leading entities in the world. To postulate that its because we blindly chase after information is fool-hardy. The fact is, there are many facets to why our healthcare system isn't perfect (or near-perfect). One can argue its due to the direct costs of obese people in the US which costs >$100Bn a year. Should we be doing more research in helping obesity, curing diabetes, or just plain telling people to eat better? Even by curing diabetes, you will still have other problems. Thus this is just ONE aspect, and already it takes up a large chunk of our annual healthcare costs.

    One can postulate that NASA is wasting money too? Sending probes into the unknown with only the mindset of exploring Mars, or just space. Is that wasteful? Going into the unknown in search of whatever information we find, regardless of how relavent they may seem at the moment is the underlying foundation of research. Doing more research to find all the information possible is part of the process of research. It is not because we are obsessed with information and not the end, but the more informatio we have, the better the understanding, and evidence we gain to solve a larger problem.

    Your make a circular argument that we are obsessed with information and not the end. Without information, you can't get to the end, and in biomedical research, the more information you have, the better off you are at combating some disease. You treat the cause of the disease NOT the symptoms. Take for instance cancer, the vast majority of cancers have already run their course by the time we can detect it. Cancer must be treated before we can detect them (10^9 cells), but how do we do this without understanding all the details of cell proliferation, angiogenesis, cell signaling, etc? You'd be surprised how one finds something that was discovered 20 years ago, and was deemed insignifcant became of fundamental importance in some kind of research today. Hindsight is 20/20, but foresight is at times myopic.
     
  29. basha

    basha Senior Member
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    I dont think I said anything against basic science research, its like any other type of research in my opinion.

    I did mention that information, any information, will eventually lead to a good end, so Im in agreement with you there. And Im not against collecting information, Im against the culture of constantly wanting to know more information without having a clue what to do with it.

    Its interesting you brought up space travel. Even with space travel, we are just looking for information, we have no clue how we will apply it to anything productive, just the hope that we will DISCOVER. And I respect those discovery minded types but I respect equally those that want to actually do something with the information we already have.
     
  30. Faebinder

    Faebinder Slow Wave Smurf
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    I have to admit.. after my experience in the last year of research I understand basic science vs clinical research... and to add a comment on how I give sooo much respect to clinical research (after doing both clinical and basic science)... Here is what happened a couple of months ago...

    I am working with two department in the largest hospital in this city.. both do a lot of research... the attending I am with in the first department has been there for 30+ years and has databases on every single thing he does work on. The other attending I am working with is relatively a lot newer with 10 times smaller databases (and has less databases despite him working on more broad and more research oriented specialty.)

    It took the first attending years and years and so much work to get those databases from about his patients...... the second attending is like a past snap shot of the first attending, when he was collecting the databases still. Clinical research is a sign of prestige... and I don't blame the huge focus on basic science research... any new attending with a good head on his shoulders can do basic science research because it doesnt require the 30 years of clinical work..... but only an attending who spent years and years getting those patients lumped up can do the clinical research.

    I am not saying one is superior over the other... I am just saying... early in the MD career, basic science is soooo much easier to do because you don't need a large patient population which you are still establishing, you just need good knowledge in the subject which is attainable with extensive reading and asking around those who know.
     
  31. rishi

    rishi Junior Member
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    Is anyone else as amazed as me to STILL see this thread active?!? Are we really doing anything constructive by discussing this? I mean, don't we all have work to be doing?! Does this really matter??? One way or another we are all going to do research, right? What's the difference what kind we do? It's all the same. Nothing is easy. Enough. Done. End. Please....must....stop...... DISTRAActtiooooooonnn.
     
  32. Hard24Get

    Hard24Get The black sleepymed
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    But don't you see? You could have ignored that guy and it might have gone away, but by complaining that it WON'T go away, you open the door for masters of the obvious such as myself to point out that you, yourself, are contributing towards keeping this thread alive. By me posting, it will bump the thread, and others are more likely to notice it and get mad/have something terribly important to add. :p

    And yes, whatever research we do (basic vs clinical) should be useful. But as many of us are still deciding between a more basic and a more clinical research career, we keep being drawn to this thread like moths to a flame...

     
  33. Hard24Get

    Hard24Get The black sleepymed
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    Moreover, the above is the problem with SDN itself - the ultimate distraction!
     

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