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We Need More Doctors Who Are

Scientists
It’s in everyone’s benefit if physicians participate in research.

(New York Times, September 23, 2019)

By Mukesh K. Jain, Tadataka Yamada and Robert Lefkowitz

Drs. Jain, Yamada and Lefkowitz are board members of the Physician-Scientist Support
Foundation.

Physician-scientists have often changed the history of medicine by identifying a problem in the
clinic and taking to the lab to address it.

About a decade from now, public health statistics will begin to show a substantial decrease in
cervical cancer in the United States and other developed countries. That’s because in 2006,
young people began receiving vaccines against a sexually transmitted virus, HPV, that causes
cervical cancer. By preventing HPV infections today, those vaccines have the potential to avert
hundreds of thousands of cervical cancer cases.

The HPV vaccine exists because Dr. Douglas Lowy, a physician, and his research collaborator
Dr. John Schiller recognized the potential for it after more than a decade studying the family
of infectious agents to which HPV belongs.

Unfortunately, Dr. Lowy’s career transition from stethoscope to microscope might not be as
feasible today as it was a few decades ago. The number of physicians able to engage in
scientific research either alongside a medical career or after medical training has waned greatly.
Physician education in medical school has shifted away from basic science. In addition, federal
funding has declined. After adjusting for inflation, the 2013 N.I.H. budget was 21.9 percent
below its 2003 level. These and other trends have driven the proportion of medical doctors
engaged in scientific research to a paltry 1.5 percent of the physician work force.

Time and again, physician-scientists have changed the history of medicine by identifying a
problem in the clinic and taking to the lab to address it. Alexander Fleming watched men die
of sepsis during World War I while serving in the Royal Army Medical Corps, then returned
home to create penicillin. Sidney Farber, a young physician at Children’s Hospital in Boston,
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committed himself to finding treatments for childhood leukemia, and laid the foundation for
modern cancer chemotherapy.

In the 1970s, the physicians Michael Brown and Joseph Goldstein set out to understand how a
young child’s arteries could be as clogged as those of an overweight septuagenarian. This
patient-inspired research led to the discovery of LDL-cholesterol receptors, and paved the way
for the statin drugs that are taken by millions of people every year in the United States alone.

And more recently, the research efforts of two physicians, Brian Kobilka and one of us, Dr.
Lefkowitz, seeking to understand how hormones conferred their biological effects, led to the
discovery of a large family of receptors that have formed the basis for the development of
hundreds of F.D.A.-approved medications.

The biomedical research establishment has long recognized the importance of clinical
experience to medical research. In the 1950s and 1960s, during the Korean and Vietnam Wars,
physicians were conscripted within a few years of their medical school graduation. Of those
young physicians commissioned as officers in the United States Public Health Service, a small
fraction was posted to the N.I.H., where they cared for patients and also learned to perform
laboratory research.

This program essentially trained an entire generation of medical professors, and its graduates
went on to engage in research that has produced major insights into cancer, infections and heart
disease, forming the basis for lifesaving therapies. Indeed, physician-scientists account for 37
percent of Nobel Prizes in Physiology or Medicine.

Of course, medical doctors are not the only people who can make great medical discoveries.
The discoverers of the structure of DNA and the developers of CT scans had no medical
background. But there could not be a worse moment than now to allow the vital role of
physician-scientists to disappear. Trends like an aging global population and the resurgence of
infectious disease have increased the need for medical advances.

Meanwhile, science is becoming more relevant to medical practice with the emergence of
innovations like precision medicine, which requires a detailed understanding of disease
mechanisms and genetic data in order to determine the best treatment for each individual
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patient. More than ever, we need doctors who are competent at both the lab bench and the
hospital bedside.

Unfortunately, the career path of the physician-scientist has become longer and a lot less
appealing. In the United States, about 20,000 graduates emerge from medical school each year,
many with significant debt. Many physicians are well into their 30s by the time they complete
their clinical training. Doctors who decide to take the research path face the daunting prospect
of many more years struggling to win grants and establish a lab. According to N.I.H. statistics,
researchers with medical degrees on average receive their first major N.I.H. grant only at age
45.

Recognizing the problem, the National Institutes of Health’s Physician-Scientist Workforce

report, published in 2014, laid out a road map to address it. Nonetheless, the number of young
doctors pursuing research continues to wane.

In response, six physician-scientists from across the country have formed a nonprofit
organization, the Physician-Scientist Support Foundation, to raise funds to support the research
efforts of talented young medical students and physicians. The foundation aims to mentor and
inspire new doctors to undertake research programs to solve unmet medical needs.

Physician-scientists are among the most highly trained investigators in the research enterprise.
Their efforts will be crucial to improving health care. Our world needs a growing, corps of
professionals who bring a human understanding of patients to medical research, and a
researcher’s expertise to improving patients’ lives.

We need to ensure that the brightest young doctors can contribute to further advancements in
their field, or we risk stalling the engine that consistently delivers better medicine, longer lives
and a stronger economy for Americans and people around the world.

Mukesh K. Jain is a cardiologist at University Hospitals and a professor at Case Western

Reserve’s medical school. Tadataka Yamada formerly served as president of global health
programs at the Bill & Melinda Gates Foundation and oversaw research and development at
Takeda Pharmaceuticals. Robert Lefkowitz is a professor at Duke University’s medical school
who won the Nobel Prize in Chemistry in 2012. They are board members of the Physician-
Scientist Support Foundation.
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Summary Analysis of Article “We Need Doctors Who Are Scientists: It’s in
everyone’s benefit if physicians participate in research” by Mukesh K.
Jain, Tadataka Yamada, and Robert Lefkowitz

The article “We Need Doctors Who Are Scientists: It’s in everyone’s benefit if
physicians participate in research” by Mukesh K. Jain, Tadataka Yamada, and Robert
Lefkowitz, states that in this modern era, it is a compulsory to have more young doctors and
physician-scientists to contribute in research for medical advancements. It has been proved that
physicians have contributed to many discoveries related to medical purposes. For example, the
existence of HPV vaccine is because Dr. Douglas Low and Dr. John Schiller. Both of them are
physicians. Next, there was Alexander Flemming, also scientist, was the one who invented
penicillin (antibiotic). Physicians, Michael Brown and Joseph Goldstein, the inventors of statin
drugs which have been used for cardiovascular disease is another example. Diseases, viruses,
bacteria are growing and evolving to be more dangerous. Innovations in medicine and patient
therapy have to be more advance to avert and outgrow the diseases. I persona agree with
Mukesh K. Jain, Tadataka Yamada, and Robert Lefkowitz that physician-scientists and medical
doctors should participate in research for medical advancements.
In the article, Mukesh K. Jain, Tadataka Yamada, and Robert Lefkowitz mention
physician-scientists have often created innovation for medical purposes by identifying problem
in clinic and taking it to the lab for research. I agree with the authors of this article. Besides the
example that have been stated before, there are still a lot of inventions of medical advancements
by physician scientist. Medical thermometer was invented by a physician, Gabriel Fahrenheit.
Stethoscope was also invented by French physician René Laënnec. Then, there were also
cardiac pacemaker. This milestone invention was the fruit of two Australian scientists, Mark
C. Hill and physicist Edgar H. Booth in 1926 (Asian Scientist Newsroom, 2015). And there are
many more examples of how physician-scientists contribute in medical needs.
The authors, then state the transition from medical doctors who usually help patients to
medical researchers might not be as feasible today as it was decades ago. Unfortunately, this is
true and I agree with the authors’ statement. The problem is the funding. For examples, in
America after inflation, the National Institutes of Health lower the budget quite high. Same as
in England, the National Health Service (NHS) recently reduces the NHS funding and the strain
of a growing population on health services means that doctors are under increasing pressure.
Research by The Royal College of Physicians found that the key barriers to doctors undertaking
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research are a lack of time and funding, often due to the daily demands already placed on
doctors in a clinical environment (Ellie McLaughlin, 2018).
In this article, the authors think the medical advancements can not be achieved without
any clinical experience. The biomedical researcher must be supported by actual experience in
the medical field. I absolutely agree with this argument because to create a solution to a certain
disease, medicines or vaccines, the researchers must know everything about the disease. In
addition, how to have the knowledge is to directly involve with the patients. Clinical experience
involves patient interaction or getting your hands dirty doing patient care. Clinical
experience proves you actually like being around sick people. It helps to show that you’re
comfortable with the processes behind producing knowledge for evidence-based medicine
(Medical School Headquarters, 2019).
The authors give another statement. They say science is becoming more relevant to
medical practice. My opinion is the same as the author. I agree that right now science can
contribute to biomedical research. The innovations that have been discovered up until now are
all using complex science, Biology, Chemistry, and Physics all are used. The example is the
precision medicine. Precision medicine or personalized medicine is an approach to patient care
that allows doctors to select treatments that are most likely to help patients based on
a genetic understanding of their disease. Recent advances in science and technology have
helped speed up the pace of this area of research. The most common used of precision medicine
is for the cure of cancer. first, they will examine the cancer cell in the patient’s body and try to
identify the DNA and the cause of why the cancer cells keep growing (National Cancer
Institute, 2017).
Next, the authors point out an important statement, they say the career path of the
physician-scientist has become longer and a lot less appealing. I must say, this is true. Even
myself do not really interested in pure science. Most young people nowadays are interested in
applied science like engineering and other profession. Younger students also have opinion that
pure science can be stressful. Another cause why physician-scientist is not appealing is the job
available as scientist. If not become a researcher, fresh graduate from pure science usually work
as a teacher or lecturer. Most young people this day do not want to become a teacher.
The authors also state a powerful point about the importance of doctors or other medical
graduates to contribute in the research. The one who knows more about the medical
advancements should be the doctors themselves. I definitely agree with the authors. Doctors
have importance role in biomedical research, especially the bright young doctors. They usually
have the potential and youth spirit that helps them to keep move forward. Research in primary
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care is important because of three main reasons. Firstly, research is necessary for the doctors
to constantly question their practice and reduce complacency. Secondly, findings from research
allow to progress and improve patient care. And finally, doing research makes doctors become
a better translators of evidence. It is only with experience conducting research that we can
understand how difficult it is do carry out good quality research. We become better critics and
evidence based practitioners (SM Liew, 2017).
In summary, the arguments of the authors in article “We Need More Doctors Who Are
Scientists: Its’s in everyone’s benefit if physicians participate in research” and my personal
opinion are in the same page. I believe if more doctors, especially young doctors give more
contribution in biomedical research, medical advancements will be more developed. In results,
a lot of diseases will have the cure.