This document discusses the history and importance of clinical research. It notes that while medical research has only recently emerged as a formal discipline, epidemiological practices date back centuries to figures like Hippocrates, James Lind, Edward Jenner, John Snow, Ignaz Semmelweis, and Joseph Goldberger. Their studies helped establish strong methodologies in the 1940s-1950s. The document outlines reasons for conducting research, including fulfilling degree requirements, advancing medical knowledge as the field continues expanding, and contributing to the art and science of medicine. It argues doctors should be trained in research to apply findings wisely, produce research that helps colleagues, and consume research accurately to treat patients. Finally, it describes seven key reasons related to

1. Clinical Research
Dr Naveen Phuyal
MBBS. MD

2. History
Medical research as an organized scientific
discipline has just surfaced in last few decades.
The practice of this art however can be traced
to almost 400 years back when Hippocrates
related human disease to the environment on
his treatise “ Airs, Waters and Places”.

4. James Lind and Scurvy (1747)

6. Edward Jenner vaccinating for
prevention of Smallpox (1796)

7. John Snow and Cholera (1850)

8. Semmelweis’ hand hygiene study

9. Goldberger relating pellagra to
maize diet (1915)

10. History
Fletcher relating beriberi to polished rice (1905)
They all were practicing epidemiology
Strong methodologies were developed later on in
1940s and 1950s
Community trials of fluoridation of water supplies
Cigarette smoking and lung cancer by Doll and Hill

11. Why research at all ?
To submit thesis/ dissertation
Publish or Perish syndrome
Medicine is still practiced and so many things yet
to be known
Medicine is expanding we need more knowledge
As qualified doctor we have obligation to art and
science of medicine and we also have to
contribute to this advancement.

12. Why should a doctor be trained to do
medical research?
Clinical epidemiology is nothing but an extension of wise
clinician’s intuitively explorative faculties.
However such extension of this faculty does not occur with
learning and practicing medicine.
History of medicine is replete with instances in where the
results based on unscientifically conducted research have
been applied to the patients eg. Blood letting, Gastric
freezing.

13. Why should a doctor be trained to
do medical research?
Doctors are consumers of research done by others,
applying their research to treat their own patients.
Our own research will be used by our colleagues
who read our publications, in their clinical practice.

14. 7 reasons
These 7 reasons act in sequence and make a working
knowledge of ‘ medical research’ necessary for every
doctors:
1. Variability
2. Generalisability/ Loss of external variablity
3. Precision/ Sampling error
4. Internal validity/ Bias/ Measurement Errors
5. Indirect Associations/ Confounding
6. Statistical significance / Clinical significance
7. Selecting the correct research “Design”
8. Reading and asking questions

15. Variability
All humans, healthy or sick, and their characteristics are
different from each other.
Hence our clinical observations based on few subjects of
our own practice may not be enough to be applied to all
patients all over the world.

16. Generalisability
We cannot study the whole lot of subjects , we have
to study samples.
Samples should be representative: if not results can
not be generalized to the total population.
This is called as loss of external validity or loss of
generalisability.

17. Precision/ Random or Sampling Error
 Samples should be of adequate size to obviate the play of chance.
 The role of chance has to be evaluated statistically.

18. Internal validity/Bias/Measurement
Errors
Entire research is based on making correct
measurements.
We should be able to accurately measure what we
really intend to measure.
We need to be aware of places where such
‘measurement errors’ may come up.

19. Indirect association/ Confounding
 We have to demonstrate that association in our research is
not explained by ‘ indirect association’ due to a third factor.

20. Statistical and clinical significance
 We must consider primarily the clinical and public health
significance of our result and not go by “ statistical
significance’

21. Design of the study
The design of our research work should be
such that it is appropriate to answer the
clinical/ public health question at hand.

22. Reading and asking
Research does not stop after our particular
study has been done.
Every research opens up many more question,
which need to be further answered.

25. Thank You