Abstract
Should we concentrate our efforts on the most common ailments or indulge our fascination for the obscure? The answer, I guess, rests on whether we are talking about our professional or private lives. A reasonable assumption is that in our professional lives we focus on where we can have the biggest impact. In private, take your pick.
Medical research is an enterprise that by rights should address the big questions facing humanity. But there is a clear mismatch between the risk factors that are responsible for the greatest global burden of disease and research expenditure. Journal editors are just as culpable as researchers and funding bodies in seeking out answers to questions that do not really matter. The questions that matter go unanswered.
This month's issue highlights two particular challenges. Norovirus is possibly the most common enteric pathogen and a major cause of short-term illness. There is wide media coverage of outbreaks and its economic burden on the NHS is around £100 million each year. Globally, diarrhoeal diseases are responsible for the fourth greatest burden of disease. It makes sense that research funding should follow? Michael Head and colleagues analyse funding awarded for norovirus research to institutions in the United Kingdom and find that it is unacceptably low given the burden of disease and disability. 1
Separately, Clive Bowman and Julienne Meyer examine the purpose and the clinical practice of care for the frail. 2 An analysis of life trajectories to death of a large group of US Medicare beneficiaries discovered that 20% of deaths follow a clear clinical transition from treatable to unrelenting progression (e.g. cancer), 20% of deaths are related to progressive long-term conditions (e.g. chronic obstructive pulmonary disease), 20% of deaths are sudden (e.g. myocardial infarction) and the final 40% of deaths follow a period of ‘progressive dwindling'. The authors argue that, with our ageing population, progressive dwindling is rising in importance and it is difficult to study using standard research methodologies.
In both these situations, the arguments for more attention seem compelling and demand a passion for research as exemplified by clinical trials pioneer Nasarwanji Hormusji Choksy, who urged the Indian Government in 1923 to create a special sanitary preventive and curative service. 3 Even if the masses are not ready for an intensive campaign of sanitary education, he argued, they need concrete demonstrations of the benefits that sanitary reform promises. To reinterpret Choksy, even if the masses are not ready for an intensive campaign on progressive dwindling, they need concrete demonstrations of the benefits of limiting its effects.