Too much benchmarking – Authors' reply

Abstract

If the Comment by Hutan Ashrafi an and colleagues (Sept 26, p 1045) is an example of current surgical thinking, then surgical research is indeed in big trouble. Ashrafi an and colleagues seem to believe that creative thinking is best encouraged by a frenzy of peer assessment, audit, and metrics, rather than nurturing those who have the courage and imagination to think diff erently. They are confusing two very diff erent activities: the need to do more clinical trials, and the need for original thinking. Essential though they are, most trials are logistical rather than intellectual problems. Fundamental questions can of course be asked about appropriate statistical analysis and outcome measures, but such issues aside, most trials require little imagination but a high degree of professionalism and coordination. Such skills are in ample supply in our society, although usually not in the best academic laboratories. Just look at the logistical skills of a modern supermarket or a major online retailer. Indeed the medical community would do well to contract most randomised trials to such organisations. As for nurturing real innovation, we know much more than people pretend. Bell Laboratories in the physical sciences, or the Medical Research Council Laboratory of Molecular Biology in the biological sciences, or perhaps most daringly of all, Tim Berners Lee’s majestic invention of the worldwide web, all provide examples of game-changing science that benefi ted from keeping accountants away from men with the imagination to think diff erently. Ironically, one of the problems for surgery has been the dead hand of convention on minds such as those of Patrick Steptoe and Kurt Semm. It is those at the centre of so many academic surgical centres who are themselves part of the problem.