alternating with periods of putting that gained knowledge to practical uses, although maybe I'm wrong.
Actually his point was excessive funding results in focus on the what he termed "big science" such as molecular biology (the lesions project or the genome etc--science he calls "basic") at the expense of other methods of scientific inquiry.
Essentially there is an erroneous assumption that by looking harder and deeper at the basic you will eventually have a breakthrough for disease.
He says that microbiology successes early in the 20th century resulted in excessive excitement, investment and bloated funding that has resulted in the research bubble we are in today. The results of this bloated system are disappointingly poor, the system is inefficient and results are dwindling, yet claims about how great the findings are and their usefulness are vastly exaggerated compared to their real value.
When he talks about using other lines of inquiry like patient oriented research he is talking about shelving "big science" (I'll use the term too for clarity) and looking at the PATIENT to see what can be seen. He in fact says we will be forced into this as the bubble bursts and funding dries up making other ways of doing research financially attractive. He says this will be good for us as the dominance of big science has stifled innovation that would be meaningful for patient oucomes.
That was the point.
Here are some examples of what MS big science has brought us:
1. there are 4 lesions types according to one group
---but some other groups dispute that and did not reproduce 4 types,no body knows what type anyone has and no drugs are targeted to a patient based on type.
2. there is some increase in DRb1 0602
---but not all patients have that, it just appears more commonly in MS, furthermore, most people with that genetic don't have MS at all
3. there is a latitude gradient and some vitamin D issues
----but not every patient has these specific issues it is just a tendency and trend overall. For example no one is told they don't have MS if their d levels are fine or of they are born in fall in the south to an outdoorsy woman.
This is what I mean in that this information has not made the jump to clinical practice. These big science facts are essentially useless in the clinical setting....they are useless in other words to the patient or the doctor treating the patient.
It is another model of research altogether to take a patient look at them and try to treat what you see in patient oriented research.
In the case of CCSVI, what is seen and provable is stenosis with collateral circulation; that can be changed with an intervention that returns the circulation to normal.
Treating that stenosis is based on known physiological principles, for example that collateral circulation is a well known parameter that indicates that normal circulatory capacity is overloaded and intervention is justified. Add to that physical fact the knowledge that stenosis in a femoral vein causes lesions and tissue changes in the foot to further justify the approach as reasonable.
Now you have treating a patient based on what is physically there in the individual with a goal to return normal physiological function.
The point of the article to me was that constantly insisting that only
"big science" qualifies as good science or indeed even is
a science is a mistake. There are many ways to make scientific inquiry.
The author offered the 12 acknowledged greatest medical achievements of the last century and few of them used any of what he was calling big science, most were patient oriented research (trying something to see if it worked because it made medical sense) or serendipitous accidents (like Fleming leaving a petri dish of germs out open overnight accidentally and discovering penicillin).
He was suggesting that we ought to broaden our scope if we want to be successful to include other avenues of exploration. I think the NIH could help by looking at other models for how we address disease.