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"Two Challenges to Negative Prophecy: 'Clinical Applications Units' and 'The Cloister Project'" [HHMI President's Report to Trustees]

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President’s Report Two Challenges to Negative Prophecy: “Clinicd Appliczztions Units” and TWO CHALLENGES TO NEGATIVE PROPHECY “Clinical Applications Units” and “The Cloister Project” BY Donald S. Fredrickson, M.D. From the President j Rrport to the Trustw of the Howard Hughes Medic-al Institute. July 21. 1984 PRESIDENT’S REPORT T HE SUMMER issue of The Ameviun Scholar contains a thoughtful article entitled “The End of the Pb~~ician-Scientist?“’ The author, Gordon Gill, predicts that in America - as he says happened in England and on the European continent ten years ago -a schism between basic science and clinical medicine will soon be complete. The gist of his message is that the clinician- scientist is now the “clinician-applier of basic science” and is not likely to keep pace, much less surpass the basic research specialist. By Dr. Gill’s reckoning, the revolution in biology has bypassed the medical profession, and the academic practitioners will have to be content with simply improving the quality ofcare. The dizzying acceleration of molecular biology is thus viewed as threaten- ing the extinction of a never-too-abundant species: those physicians who have managed to be both prime movers in solving fundamental problems in the laboratories and pioneers in applying what they learned on the hospital ward. Especially from the early 1950s to the ‘7Os, the intramural program of the National Institutes of Health was a rich breeding ground of such hybrids, and their migrations to and fro between Bethesda and Academe transformed medical education. Today it would appear that Cal Tech and MIT and Cold Spring Harbor are the preserves of the new biology and that physicians who winter there may never return to the clinic. There is legitimate concern here - one of profound importance to many, including the Howard Hughes Medical Institute. The HHMI was chartered to promote “human knowledge within the field of the basic sciences (princip

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