French medical research: the risk of 'demedicalization'

French medical research is at present financed almost entirely by INSERM (Institut National de la Santé et de la Recherceh Médicale). The INSERM budget (286 million francs in 1975) supports research in laboratoreis in university hospitals by doctors who have both clinical and teaching commitments and, especially, by more than a thousand 'statutory research workers' employed by INSERM. Research in INSERM laboratories now tends to be fundamental biological research rather than directed towards pathological problems. Among the reasons for this are (i) the mode of recruitment of staturtory research workers; (ii) the difficulties of clinical investigation, which are due mainly to the way the hospitals function and to lack of interest by the hospital administration in medical research; (iii) the small number of university doctors actively involved in research. Research on fundamental biological problems in INSERM laboratories is making excellent progress, due to the quality of the research workers, and it may pay in the long run. But medical research is now tending to become an 'ivory tower' for the victorious researchers, who sometimes scorn the clinicians. Medical research will, if no measures are taken, 'demedicalize.' Institutes of pure biological research could soon be isolated within the medical faculties and doctors may become even less scientific and investigative than they are today. This situation could be modified by: (i) re-evaluating the role of research in a university hospital career, making it impossible for a doctor to attain high levels of promotion unless he does some research (this could be done by asking doctors interested in such a career to work for several years in an INSERM laboratory after their training and before they take up clinical responsibilities); (ii) awarding clinicians, exceptionally, the status of research worker; (iii) increasing considerably the participation of the universities in financing medical research, a participation which at present is absurdly low and is every decreasing.