Quality and Quantity

I had a conversation with one of my attendings about physicians doing research. He argues that thirty years ago, physician scientists did much better research. Those who were interested in it were much better at basic science; they understood core biologic, chemical, and physical principles better than we do. It's evident in the textbooks from the day where the author of a chapter on cardiac output measured cardiac output in dogs and knew every detail and nuance. Now, authors are respected physicians who assimilate information from lots of sources but infrequently involve themselves in the nitty-gritty gathering of data. The researchers of yore had no institutional pressures; they didn't have to deal with the current "publish or perish" attitude of academic medicine. They studied science because they enjoyed it, and their research was better. Now, there is such a high volume of studies published that little is relevant, and very little is truly well done. It's a problem because as consumers of the literature, we have to sift through a lot to find the rare brilliant, innovative, or insightful study. And fewer of these are being produced by physician scientists, who have to contend with the rapidly changing clinical field in addition to the pressure to churn out papers when research ought to be a meticulous, time-consuming, and careful enterprise.