Surgical Research and Clinical Routine in the New Century

Abstract

The German Research Foundation (DFG) has recentlydenounced the poor state of clinical research in Germany[2]. It is therefore worthwhile to contemplate the currentstate of surgical research with special focus on the futurepossibilities to combine research and clinical routine inuniversity hospitals.Current StateReading the daily newspaper one may get the impres-sion that German universities and clinical research in par-ticular are in a deep crisis, and that German professors areto be blamed for it. In medicine, additional insufficienciesof the system are obvious, with corruption cases broughtup against clinicians and conflicts of interest due to thefact that clinical professors in addition to research andteaching devote much of their time to the special care ofprivate patients. These headlines in the news tend to let usforget that during the last decade grant moneys forresearch projects stagnated whereas the number of grantapplications has increased out of proportion. In Germanystate governments are primarily obliged to finance theuniversities, and in 1996 spent some 5 billion Germanmarks for clinical research and teaching. Most of thatmoney, however, is used to balance the deficits arisingfrom patient care not paid by insurances, outpatient carein particular. Only recently university hospitals have be-gun to redefine their legal status enabling them to betterillustrate money flow within the system. In the recentmemorandum on clinical research the Deutsche For-schungsgemeinschaft (DFG, German research founda-tion) states that patient-oriented research – although im-proved during the last 20 years – is still unsatisfactory [2].As one possible explanation the memorandum states alack of institutionalization of clinical research. Such aninstitutionalization includes not only the creation of de-fined independent units which under the chairmanship ofcompetent researchers supply know-how and technicaladvice to interested colleagues. Institutionalization alsoimplies that universities define their research profiles,which may mean that certain research topics in the futurewill not be funded at all 36 university hospitals but only inthose centers which can prove their expertise in the topic.It is argued that increasing costs and decreased fundingwill make such a segregation between clinical routine andhighly specialized clinical research mandatory. Actuallyan incentive by the BMBF in 1995 has already led to thecreation of eight interdisciplinary clinical research centerscoordinated by the ‘Association of Clinical Research Cen-ters of German Universities’ (Interdisziplinare Zentrenfur klinische Forschung, IZKF).For all those reasons a segregation between researchand clinical routine is certainly the imminent scenario for