Crossing the line

Psychologists are employed by fast food chains to do market research to develop better advertising tools to convince children to eat hamburgers and french fries. In the course of their research, they discover much about children, about psychology, about fast food, about business, marketing and advertising. And they get paid pretty well. Is that research? Is it science? Is it a good thing? Doctors are employed by the health care industry to develop new products, bring them to market and then convince other doctors and patients to use those products. In the course of their research, they help to discover better treatments and they learn much about basic science, about diseases, research methodology and outcomes research. They also learn about business, marketing and advertising. And they get paid pretty well. Is that a good thing? The research process is an important one. It requires a creative, questioning, innovative mind. It begins with an idea, a hypothesis, an observation, a discovery. Animal and human studies are completed and the results are analyzed. Then back to the drawing board with more ideas and hypotheses and more studies. Progress is made incrementally. Research is a process in evolution. Not so with pharmaceutical research. Once a drug is approved by the regulators, the company that developed it is stuck with it until its patent expires or a better drug comes along (because to improve it would require going through the onerous and expensive regulatory process again). So the focus of the research changes. The new research is designed not to make improvements to the drug but to sell it, to make the drug look better than the competition’s drug. ‘‘This one is slightly more e⁄cacious than that one; ours has fewer side e¡ects than yours. ’’ That’s where the next generation of doctor/researchers come in. They actually do the clinical trials comparing this drug to that one. Inevitably, the company sponsoring the research ¢nds something about their drug that is better than the other drug. And vice-versa. The doctor/researchers actually write the papers that say this drug is better than that one. And vice-versa.The doctor/researchers are not doing independent research; they are doing contract research. The oncebright minds that focused all of their energies on the creative process of original research have crossed the line. They have become part of marketing and sales. Is that a good thing? Is that research? Is it science? It’s a good thing for science, but a mixed blessing for doctor-researchers. Its good for science because industry has the resources (and brains) to devise and execute focused research in a way that the individual researcher does not. Industry has been driving force behind the development of extracorporeal lithotripsy, minimally invasive surgery, synthetic and allograft reconstructive surgery and neuromodulation. Industry popularized and rede¢ned the term overactive bladder and fostered research that developed a better generation of anticholinergic agents and a better understanding of the ¢ve types of muscarinic receptors. Since the beginning of industry’s advertising assault, the number of patients seeking care for this condition has increase by about twenty-fold. All of these are good things. It’s good for doctor/researchers because the interaction with industry and other doctor researchers creates a positive intellectual environment, an exchange of ideas, and a mutually bene¢cial learning process. And they get paid pretty well. But, it is also bad for the doctor/researchers because their energies are diverted from the creative process to a mechanical one of doing contract research. Even when they do original research, they are prodded by their involvement with industry to do those kinds of things that ultimately lead to economic gain. Pure research, the passionate kind whose genesis is the muse of the scientist, is relegated to a secondary status. Finally, their involvement with industry (rightly or wrongly) taints both their sceinti¢c and professional credibility. Somewhere in the transition from pure science to contract research to industry salesmen, the doctor/researcher crosses the line. But where is the line?