On the classification of research.

We need a new look at how we describe and classify research. The idea for this commentary grew out of a grant review session for a foundation with a declared clinical focus. The debate among the grant reviewers had a familiar theme—the failure to appreciate the nature of clinical research, as distinct from basic projects. It harkened back to three decades of debate during which the content has not changed. The reason for the repetitive nature of this debate is that this is not a trivial issue. Funds, lots of them, are often allocated or restricted according to certain categories of research, and this affects progress. Is basic research defined by being confined to a laboratory or, is it clinical if the problem addressed uses human tissue or is just relevant to the human condition? Is clinical research done by those holding an MD degree and confined to work involving whole humans or their blood and tissue specimens? And, what do we mean by translational research? And so it goes. There remains no generally agreed-upon classification. Clinicians, although appreciating the value of basic research, tend to support the need for more clinical research, and basic scientists, who have trouble seeing clinical studies as basic, want more basic research. Neither is quite sure what the other means. Part of the problem lies in using the words “basic” and “clinical” to describe a process, when these terms describe a place where research happens or the size of the particle. This semantic problem perpetually confuses us. The Pasteur quote cited here is often used to highlight the value of basic research. The process of research adopted by Pasteur was first outlined a few centuries ago by Francis Bacon. It involves a method of addressing fundamental questions in science in experiments designed to test alternative hypotheses through a series of disproofs. If the facts of an experiment do not fit a hypothesis, Bacon cautioned, keep the facts, throw away the hypothesis, and start the process all over again. This is the scientific method. Most of us recognize it, but surprisingly few of us practice it. Almost no one has emphasized that Bacons process applies to all types of research. Note that nowhere in Bacons process is the size of the particle under study mentioned. His use of the scientific method was what made Pasteur so successful in tackling important issues of his time, so that he could move every 2 years or so from field to field after quickly solving important problems that stumped people more expert in each field than he was. What would we call Pasteur's research achievements today, basic or clinical? There are all gradations of testable hypotheses, including those that test big questions and those that test subhypotheses derived from the big ones. In all cases where science has moved rapidly, however, the use of a series of disproofs testing alternative hypotheses is prevalent. In the context of Bacon's method of testing alternative hypotheses, beware of the individual with one method or one hypothesis. This characterizes research of a different quality, not necessarily fundamental in nature, both in the laboratory and in the clinic. There are plenty of laboratory researchers, for example, who have a hypothesis and design experiments to prove, not disprove it. In the clinic the situation is complicated further by the fact that most clinicians are trained to be men and women of one method, and quite naturally set out to prove their method is best. The model used in research projects affects our ability to approach the testing of hypotheses.