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DURHAM, N.C. -- The vast potential of the U.S. health-care
system to improve health, minimize disease and increase the
value of each dollar spent cannot be realized without a greater
emphasis on clinical research, says a Duke University Health
System leader.

In an editorial in the Feb. 18, 2004, issue of The Journal of the American Medical
Association, Ralph Snyderman, M.D., chancellor for health
affairs at Duke University and president and CEO of the Duke
University Health System, says scientific evidence is critical
to physicians' ability to assess a patient's risk for disease
and to offer the most effective treatments to minimize or
prevent illness; these are the key elements in a prospective
approach to health care. He argues that health care today
suffers from a "lack of a robust clinical research enterprise
mobilized to translate basic scientific discoveries into
clinical relevance," and calls on the medical community to more
fully support clinical research and clinical researchers.

The editorial complements a report by researchers at the
National Institutes of Health's Center for Scientific Review
examining the role of the NIH as a potential barrier to
clinical investigation. The study found that although
physicians compete favorably for grants in the peer-review
process, funding rates for clinical research lagged behind
those for non-clinical research.

"Clinical research -- including the translation of basic
scientific findings into medical treatments and the evaluation
of patient outcomes -- is the critical element needed to define
and monitor effective health strategies," Snyderman said.
"Without clinical research, the rational application of
research discoveries to the development of prospective care and
personalized health planning cannot occur."

In the "prospective health care" model advocated by Duke
Health System leadership, physicians would use rapidly evolving
tools to determine an individual's specific risk for developing
particular diseases. That information would then allow for
personal health planning and medical interventions designed to
prevent or detect disease in its earliest stages, when
treatments can generally provide the maximum benefit. Such a
model requires that medical treatment rely on solid evidence
stemming from rigorous clinical investigation.

Despite the critical role for clinical research in advancing
health care, several obstacles have prevented its expansion.
"The 'parity gap' in peer-review funding is only a symptom of a
larger, more complex problem," Snyderman said. The pool of
well-trained clinical researchers remains inadequate as the
medical community and the public at large continue to
undervalue the role of clinical investigation in the
advancement of health care, he continued.

Snyderman calls for academic medical leaders to "jump-start"
support for clinical research by fostering clinical research
centers within their institutions and by advocating the
application of new discoveries and technologies to medical
practice.

"The wave of the future for improving health care through
evidence-based medicine depends on the capability of conducting
large clinical trials," said Snyderman. "Clinical research is
the way to translate the huge body of knowledge stemming from
research into clinical practice. It is the way we will learn
which medical interventions work and which do not in large
patient populations over time."

Some medical centers have begun to focus on clinical
investigation, Snyderman said. For example, the mission of the
Duke Clinical
Research Institute (DCRI) is to develop and share knowledge
that improves the care of patients through clinical research.
The DCRI has nearly 900 employees and has enrolled more than
450,000 participants worldwide in its clinical trials.