Clinical research: is the filling missing from the medical research sandwich?

Clinical research is essential for patients to benefit from the advances of medical science. Particularly needed are thorough and imaginative investigations into applied physiology, clinical observation, and patients' experience. This can help clinicians and their patients to distinguish between pathology and healthy variation, interpret diagnostic information, understand what patients want and gain from health care, and apply study results to individuals' problems. Clinical research has not grown as much as other forms of medical research, and is sometimes regarded as unscientific. Young academic clinicians are often persuaded that the only road to science leads through the laboratory. Clinical research, however, offers equal opportunities for original enquiry, rigour and excellence. The medical research sandwich will continue to provide an unbalanced diet unless research leaders and funders take the clinical setting more seriously.