Article Text

Altruism under fire
  1. T J DAVID
  1. University Department of Child Health
  2. Booth Hall Children’s Hospital
  3. Charlestown Road, Blackley
  4. Manchester M9 7AA

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    Editor,—When, somewhere between the Devonian and pre-Cambrian layers on the desk, I come across at a late hour a questionnaire, I do not always oblige. It falls into the category of the discretionary rather than the obligatory, and the obligatory now consumes all our physical, moral, mental, and spiritual resources.

    When I was a student, cystic fibrosis and leukaemia were both incurable. Since then, the patterns have diverged. Thanks to a series of carefully designed multicentre Medical Research Council (MRC) trials, we have treatments for leukaemia that are based on firm evidence. In contrast, much of the current treatment of cystic fibrosis is based on dogma, masquerading as science.1 Resentment for filling in the MRC forms unless one’s efforts are publicly acknowledged represents the death of altruism, yet almost all the work we do as clinicians goes without acknowledgment or thanks, and it is hard to see why one should single out for acknowledgment activity in supporting national non-profit making trials that are by their very design virtually guaranteed to help future sick children. The trouble is that we are all so besotted with throughput, productivity, personal indicators of research, teaching, and clinical performance that we don’t want to allocate any time to things that don’t count in the sense of being counted. This frenzy of Brownie-philia is deeply corrupting as it eats into the commitment to the common good.

    Moncrieff raises the type of motivation for supporting research.2 ‘What’s in it for me?’ seems to be the question; what a lamentable response to requests for cooperation. Most students who enter medicine do so with higher ideals, and it is a grim reflection on current medical education that these ideals are so rapidly lost and replaced by the need for external motivators.3

    It is naive to equate filling in surveys with doing research. However what is as yet undiscovered is a mechanism for a researcher, for example a hospital doctor in training, to participate in the design and execution of a really useful large multicentre national or international study. There probably is no mechanism, and the shift from small single centre to large multicentre studies will have an impact on the type of project that is suitable for trainee specialists who wish to do some research. Maybe the solution is to alter the emphasis from ‘research’ to ‘research training’, and offer suitable MSc courses. We need to rethink the social psychology of research when most of the data will need to be generated by people who will be somewhere in a limbo between ‘et al’ and ‘anon’.

    To question that a clinician can make a significant contribution to 10–20 publications a year was unhelpful. It certainly is possible, though it is enormously hard work. My own obsessional traits usually lead to a complete rewriting of the works of colleagues, and then helping them through the 10 to 12 versions of a manuscript that are essential if the article is to ever to be worth publication. The reason that publications are important is that these are the principle means we have for conveying new information, and it is no surprise that publication quality should be used as a measure of research quality. Until one can find better forms of communication or research quality assessment, we are stuck with research papers. For heads of department to insist on authorship of all departmental papers is plainly wrong, and Moncrieff’s insinuations of impropriety are well directed.

    Open any medical journal and it will be clear that much research is supported by unsung heroes. Altruism is not quite dead; it is simply under fire.


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