Clinical research key in advance to prospective health care

February 17, 2004

DURHAM, N.C. -- The vast potential of the U.S. health-care system to improve health, minimize disease and increase the value of each dollar spent cannot be realized without a greater emphasis on clinical research, says a Duke University Health System leader.

In an editorial in the Feb. 18, 2004, issue of The Journal of the American Medical Association, Ralph Snyderman, M.D., chancellor for health affairs at Duke University and president and CEO of the Duke University Health System, says scientific evidence is critical to physicians' ability to assess a patient's risk for disease and to offer the most effective treatments to minimize or prevent illness; these are the key elements in a prospective approach to health care. He argues that health care today suffers from a "lack of a robust clinical research enterprise mobilized to translate basic scientific discoveries into clinical relevance," and calls on the medical community to more fully support clinical research and clinical researchers.

The editorial complements a report by researchers at the National Institutes of Health's Center for Scientific Review examining the role of the NIH as a potential barrier to clinical investigation. The study found that although physicians compete favorably for grants in the peer-review process, funding rates for clinical research lagged behind those for non-clinical research.

"Clinical research -- including the translation of basic scientific findings into medical treatments and the evaluation of patient outcomes -- is the critical element needed to define and monitor effective health strategies," Snyderman said. "Without clinical research, the rational application of research discoveries to the development of prospective care and personalized health planning cannot occur."

In the "prospective health care" model advocated by Duke Health System leadership, physicians would use rapidly evolving tools to determine an individual's specific risk for developing particular diseases. That information would then allow for personal health planning and medical interventions designed to prevent or detect disease in its earliest stages, when treatments can generally provide the maximum benefit. Such a model requires that medical treatment rely on solid evidence stemming from rigorous clinical investigation.

Despite the critical role for clinical research in advancing health care, several obstacles have prevented its expansion. "The 'parity gap' in peer-review funding is only a symptom of a larger, more complex problem," Snyderman said. The pool of well-trained clinical researchers remains inadequate as the medical community and the public at large continue to undervalue the role of clinical investigation in the advancement of health care, he continued.

Snyderman calls for academic medical leaders to "jump-start" support for clinical research by fostering clinical research centers within their institutions and by advocating the application of new discoveries and technologies to medical practice.

"The wave of the future for improving health care through evidence-based medicine depends on the capability of conducting large clinical trials," said Snyderman. "Clinical research is the way to translate the huge body of knowledge stemming from research into clinical practice. It is the way we will learn which medical interventions work and which do not in large patient populations over time."

Some medical centers have begun to focus on clinical investigation, Snyderman said. For example, the mission of the Duke Clinical Research Institute (DCRI) is to develop and share knowledge that improves the care of patients through clinical research. The DCRI has nearly 900 employees and has enrolled more than 450,000 participants worldwide in its clinical trials.
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Duke University Medical Center

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