The transcendental scientist

Abstract

‘Le savant n'est pas l'homme qui fournit de vraies réponses; c'est celui qui pose les vraies questions.’The scientist is not a person who gives the right answers, he poses the right questions.Claude Lévi‐Strauss (1908–2009) Research is performed to obtain answers to questions that can be answered. For the life sciences, according to Karl Popper, hypotheses that can be falsified are interrogated. If falsification is not even theoretically conceivable, the question is not a scientific one. So, ‘God exists’ is not a scientific question, whereas ‘Praying cures disease’ is, because, for the latter, a simple randomized trial could be designed. In fact, the earliest negative report on this hypothesis dates from 1872, when Francis Galton published his Statistical Enquiries into the Effectiveness of Prayer, in which he tabulated the life expectancy of those who prayed a lot (priests) and those for whom a lot of public prayer was performed (monarchs); he found no benefit relative to the less blessed. Biomedical research is often divided into basic and clinical, or laboratory and human, and further categorized in finer subclasses, such as meta‐analyses and crystallography, to name two different ends of the spectrum. Perpendicular to this classification by method is the division by content, e.g. thrombosis and hemostasis, or oncology, and obviously, fields may overlap. In the current issue of the Journal of Thrombosis and Haemostasis, Joshua Muia and Catarina Casari reflect on interactions between basic researchers and clinicians. They define different attitudes towards scientific questions as the ‘What’, ‘Why’ or ‘How’ questions of a basic researcher versus the matter of utility for patient care that will preoccupy a clinician. Indeed, when the Editors evaluate manuscripts submitted for publication, these are exactly the questions we ask ourselves: does this report further our insight into coagulation, and is it likely to affect patient care, either now or in the future? If the answer to both questions is no, the manuscript will be rejected. It is, however, quite possible that only one question will be answered affirmatively: understanding the spatial structure of antithrombin has no application in patient care, whereas investigating whether 3 or 6 months of anticoagulant treatment yields the optimal outcome in patients with thrombosis has direct implications for patient care, but offers no new insights into coagulation. A general observation is that the more fundamental a discovery, the more scientific fields it affects, but the less relevance it has to daily life. For instance, Einstein's insight that Newtonian laws of gravity do not suffice to describe the behavior of stars and galaxies has permeated many aspects of theoretical physics, but bears little relevance to daily life. Likewise, Darwin's theory of evolution is an essential part of any first‐year genetics course in any field in the life sciences, but does not affect the experiments performed in coagulation research. When we look at it this way, the difference between fundamental and clinical research is not as clear‐cut as it often seems. Besides their tasks in patient care, clinicians may be involved in both fundamental and clinical research. Moreover, laboratory research is not synonymous with fundamental research, and studies involving humans are not invariably clinical in the sense that they provide answers to clinical questions. Laboratory studies that strive towards uniformity of standards in assays are directly relevant to diagnosis and patient care, but do not necessarily offer insights into the biology. Epidemiologic studies that focus on the identification of new risk factors for disease answer a fundamental question, but testing for these factors may be clinically useless. Nevertheless, standardization of assays is hardly possible without understanding the biology of hemostasis, and epidemiologic methodology is also required for a randomized trial of 3 versus 6 weeks of anticoagulation. So, although the distinction between clinical care and research is clear‐cut, the subdivions of research are not. Specialization is crucial in order to become an expert and to contribute, for, without knowledge of the tools of the trade, success is impossible. However, progress often requires looking beyond the boundaries of a single field: knowledge of the symptoms of a certain disease may assist in designing the optimal laboratory test, and a clinical researcher who understands the possibilities of animal models will know when to enter that arena. It is neither possible nor desirable for a researcher to master all tricks of all trades, but a general knowledge of the methods of other fields is both possible and desirable, and every scientist should therefore strive to mentally transcend boundaries.