Perspectives in Biology and Medicine

THE PHYSICIAN-SCIENTISTS ROLE IN MEDICAL RESEARCH AND THE MYTHOLOGY OF INTELLECTUAL TRADITION FRED D. LEDLEY* Introduction The diminishing role of the physician in medical research is a paradox . Never before have the tools for meaningful analysis of disease and its therapy been more accessible, never before has the potential for understanding and interceding in the course of disease been so great, and never before has society been more expectant and demanding of medical science. At the same time, medical research is becoming less focused on disease; fewer physicians are entering careers in research; and fewer grants are given for clinically related research. These circumstances reflect fundamental concerns about the ability of physician-scientists to participate in contemporary biological research. These concerns fall into two classes. First there are practical concerns: that molecular biology is too abstruse and absorbing to be mastered by physicians; that physicians torn between clinical work and research cannot expect to contribute on the same level as full-time Ph.D. researchers; and that physicians are simply not trained to do research. Second, and perhaps more important, there is a subjective sense that the questions physicians ask, the approach to science predicated on investigation of homeostasis and pathology, and the discipline that physicians bring to the laboratory are not competitive with the approach and orientation of Ph.D. scientists. The physician-scientist who addresses problems of disease seems out of synchrony with the image of the scientific researcher who freely seeks the boundaries of scientific knowledge as an intellectual enterprise in and of itself. The perception that the Work was supported in part by the ACTA Foundation. *Howard Hughes Medical Institute, Departments of Cell Biology and Pediatrics, Baylor College of Medicine, Houston, Texas 77030.© 1991 by The University of Chicago. AU rights reserved. 0031-5982/91/3403-0726$01.00 410 Fred D. Ledley ¦ Physician-Scientüts in Research physician-scientist does not engage in science purely out of intellectual curiosity may be central to the dilemma facing physician science since research is intended to be essentially an intellectual enterprise. The Mythology of the Intellectual Tradition The impression that the physician's approach to science may be less intrinsically intellectual than others' reflects a fundamental conflict within the intellectual tradition, one that is evident in art as well as science. This conflict is epitomized by the tensions between abstract and representational art, between atonal and chromatic music, and between deconstructivist and modern architecture. It embodies a distinction between the pursuit of ideas and the application of method, between license and purpose, and between individuals who pursue the intellectual enterprise without regard for cultural constraints and individuals who pursue a more directed course. The distinction is not between intellectual and anti-intellectual (though "anti-intellectual" is a common invective). While there is generally considered to be a distinction between essentially intellectual and technical domains in art as well as science, it is impossible to define an objective boundary. The legacy of Andy Warhol and others has been to question the very concept of whether such a boundary exists. An idiomatic definition of the intellectual tradition can be recognized in the mythology that describes the history and process of the intellectual enterprise. This mythology portrays the intellectual enterprise as a medium apart from the mainstream of culture. It describes conflicts between "town" and "gown," audiences rioting after innovative musical scores, and the desecration of creative art and literature that are perceived to be threatening or offensive. Students of the intellectual tradition are indoctrinated with the stories of Michelangelo struggling against the Pope for artistic creativity, Stravinsky insulting audiences with his harmonics, and Frank Lloyd Wright searching for pure architectural form. These images, and many others, have been ingrained in popular mythology through Irving Stone's The Agony and theEcstasy, Ayn Rand's Fountainhead, and countless other fictional works. Scientists are indoctrinated with similar mythologies. Science students are weaned on the legends of Copernicus and Galileo spurning the church with their astronomical theory, evolutionists offending Victorian society with the descent of man, and James Watson and Francis Crick recognizing the double helix in a race to discover the structure of DNA. These images have also assumed the status of...