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  • Letters to the Editor
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Clinical research, or classical clinical research?

Nature Medicine volume 5, pages 714–715 (1999)Cite this article

To the editor—In the May issue, Bell emphasized the enormous potential of molecular medicine1. Iterating the view that classical, clinical investigations have had their day, the author were enthusiastic that the new molecular medicine will unravel "the nature of disease." However, knowledge of disease based on physiology, pharmacology and histopathology can still be gravely inadequate. Even with the most common and severe chronic diseases, such as bronchial asthma, central aspects remain undetermined. Asthma can be described as an eosinophilic, exudative airway disease with epithelial shedding, airway remodeling and hyperresponsiveness to many inhaled factors. But what about the cellular and organismal physiology/pathology beyond these general terms?

Bell's idea that the classical observation-based techniques that characterize classical clinical research have nothing more to offer the medical investigator, does not stand up to scrutiny. For example, many classical issues remain unstudied, conjectural or, at best, controversial: the shapes of eosinophil degranulation and disappearance in vivo in the blood-perfused bronchial mucosa; the appearance of pluripotent plasma-derived proteins/peptides in the diseased tissue milieu; the epithelial shedding–restitution processes in vivo and their inflammatory/remodeling sequelae; the particular tissue remodeling that contributes to the non-specific bronchial hyperresponsiveness; and so on. Admittedly, this is a subjective effort at making a list, but rather than being parried easily, I think it can be expanded into a substantial enumeration of disease aspects that require innovative but classical medical research.

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  1. Department of Clinical Pharmacology, Institute of Laboratory Medicine Lund Univ. Hospital, LUND, SE-221 85, Sweden

    Carl Persson

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  1. Carl Persson
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Persson, C. Clinical research, or classical clinical research?. Nat Med 5, 714–715 (1999). https://doi.org/10.1038/10419

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