Dear Editor,
I have read Dr. Manual Praga1 Terente’s article about independent clinical research in Spain with great respect and admiration. I share many of his ideas, especially when he claims that quality research in hospitals will not be possible until there is real material recognition rather than mere moral support of the activity carried out. Unfortunately, the politically influenced persons who make the decisions regarding the management of personnel in the hospital environment systematically forget this premise, making the development of any type of quality research in this area very difficult.
Nonetheless, in spite of my respect and admiration for Dr. Praga, I would like to put a different point of view, not necessarily to the contrary of his about some of the topics that he covers. In particular, I would like to make a few brief references about the evaluation process, the role of Official Agencies concerning Clinical Research and the systematically evoked dichotomy between clinical and basic research.
The evaluation of a research project is a complex process. In general, it is based on a combined analysis of the scientific quality of the applicant group and of the project. At the same time, the research groups are usually evaluated with mixed criteria, depending on their capacity to obtain competitive funding and on their level of scientific productivity. It is true, as Dr. Praga notes, that certain programmes, or certain assessors, attribute excessive relative importance to some of these areas, creating a biased evaluation. The examples given make reference to highly productive groups without competitive funding and to groups with great amounts of competitive funding and low productivity that can be evaluated as “bad” and “good” respectively in some of these evaluation processes. Although it is true that this happens at times, the managers of the evaluation process as well as the very assessors themselves are absolutely convinced that a quality research group is defined by a reasonable balance between planning capacity, including obtaining resources, and scientific productivity. This is what normally happens bearing in mind that there are always exceptions. Although in reality, in the last few years, groups with abundant funding and little scientific production are evaluated, almost automatically, in a negative manner, while those with high scientific productivity, although they have no funding, are usually evaluated in a positive manner.
I would like to note here that as pointed out in the last cited hypothetical figure: it is the groups with high scientific productivity without funding in the hospital setting. It is true that these groups exist, as Dr. Praga clearly is aware but it is also completely true that they are an exception. Some of these groups have even been systematically funded by private companies with commercial interests leading to a scientific productivity that is not always based on their own ideas.
While even considering this possibility, there are still certain totally independent research groups of high quality, without funding, in the hospital setting. These groups, with an effort and dedication, could have obtained economic support from the Public Research Agencies which would have helped their research efforts.
The Public Agencies that evaluate and fund research have made huge efforts in the last few years to give proper attention to clinical research in the hospital setting. Three examples are enough. The ANEP, the Spanish Agencia Nacional de Evaluación y Prospectiva has remodelled its evaluation areas, creating a specific area of Clinical Medicine where not only the Coordinator but also the workers are hospital doctors. The Carlos III Health Institute, in its general project funding programme, includes a specific area of Epidemiology and an area of the Evaluation of Health-related Technologies in order to foster specific hospital research of a strong clinical character.
These areas, which group together a large number of projects are as successful as others in obtaining funding, are funded with success rates that are similar to others.
Finally, many research projects allow for the inclusion of atypical funding concepts which are very different from the classic “laboratory reagents” in order to meet the needs of groups that carry out clinical research. There are many more examples of this concern for clinical research in the hospital setting but presenting an exhaustive list does not seem necessary.
Abrief final reference to the dichotomy of clinical and basic investigation: we have to forget about it. We must stop systematically talking about this antagonism. Those researchers who identify themselves as basic researchers should start interiorizing a profound and convinced feeling of respect for clinical research. Clinical researchers should understand that some of their future activities are going to be conditioned by the work of basic researchers.
They should speak amongst themselves in order to understand each other and, despite the difficulty, speak less and less about this antagonism thus making it disappear.
