Natural kinds, natural history and the clinician-researcher

Recent medical research has been based on a flawed rationale of clinicalinnovation (here termed the 'basic-to-mega model') which neglects the humanorganism as a vital focus of clinical scientific study. The consequentover-concentration upon cellular and population levels of analysis hasprobably damaged the rate of therapeutic progress. The key role in medicalresearch should be acknowledged to lie with clinician-researchers whose'experimental animal' is the patient and whose 'end-points' are health anddisease. The distinctive strength of the clinician-researcher derives froman ability to combine understanding of the 'natural kinds' (i.e. truebiological categories) relevant to human disease, with experience of the'natural history' of disease (i.e. its longitudinal pattern, including theresponse to interventions). Such knowledge is explicitly formalized by theactivities of clinical science and clinical epidemiology. A sufficientsupply of active clinician-researchers is the catalyst of innovation, andan insufficient supply is currently a rate-limiting factor in therapeuticprogress.