From oranges and lemons to glucosamine and chondroitin sulfate: clinical observations stimulate basic research.

Abstract

Over the long history of the medical profession, physicians seeking answers to questions raised by their clinical observations have had a central role in stimulating research that has improved the prevention and treatment of disease1. In the last fifty years, the increasing cost and complexity of scientific investigation have helped to make basic biomedical research an enterprise of its own, increasingly separated from physicians who are skilled and experienced in medical practice. This change has occurred to the extent that expert clinicians who participate in basic scientific investigations have become scarce2. Some outstanding scientists currently believe that biomedical science has advanced to the point that there is little need for investing in basic research that is stimulated or guided by clinical observations or for testing the value of basic research against clinical experience. At the same time, some prominent clinicians believe that asking fundamental questions about their clinical practice accomplishes little and that they can rely on pharmaceutical, medical-implant, and technology companies to provide the information and innovations that improve patient care. Should these views go unchallenged? A little more than 250 years ago, James Lind (1716-1794), a British naval surgeon, designed and conducted the first controlled, prospective clinical experiment1,3,4. Like other naval surgeons, he observed that debilitating and often fatal scurvy occurred only during long voyages. Eighteenth-century physicians used a variety of methods to prevent and treat the disease, but Lind, on the basis of his clinical experience, believed that eating oranges and lemons produced the best results. On May 20, 1747, while serving as the HMS Salisbury’s senior surgeon, Lind selected twelve sailors suffering from advanced scurvy, choosing them so that “their cases were as similar as I could …