Jonathan Grant, Liz Green, Barbara Mason "From Bedside to Bench: Comroe and Dripps Revisited" HERG Research Report No. 30 August 2003

[Eugene Garfield]

TITLE       From Bedside to Bench: Comroe and Dripps Revisited

AUTHORS     Jonathan Grant, Liz Green, Barbara Mason

SOURCE      HERG Research Report No. 30 August 2003

Health Economics Research Group,
Brunel University, Uxbridge, Middlesex UB8 3PH, UK



ISBN 1-902316-34-7

This report is available as a pdf file from:
http://www.brunel.ac.uk/depts/herg/pubs/internal.html

Details of pre 2003 HERG reports can also be found at the above web address.
Copies of reports can be obtained by writing to:
Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8
3PH, UK.
Tel: +44 (0) 1895 203196; Fax: +44 (0) 1895 203330


EXECUTIVE SUMMARY
Twenty-five years ago a paper published in Science by Julius Comroe and
Robert Dripps purported to demonstrate that 41 per cent of all articles
judged to be essential for later clinical advances were not clinically
oriented at the time of the study and 62 per cent of key articles were the
result of basic research.

Since that analysis, support for basic research has increased in the G7
countries. In the UK,

Research Council expenditure on basic research has increased from a low of
£444 million (or 42 per cent of total civil R&D) in 1991/92 to £769 million
(or 61 per cent of total civil R&D) in 1998/99. Although it would be
difficult to argue that Comroe and Dripps were directly responsible for a
strategic shift (or drift) in the type of science supported by research
funders, their arguments are often cited (albeit at times implicitly) in
support of the increased funding for basic biomedical research.

In 1987 Richard Smith wrote a critical paper reassessing Comroe and Dripps.
His main argument was that the original study was in itself ‘unscientific’
and that it should be “followed by bigger and better studies”. This study
is, in part, an answer to that challenge.

Given the increased support for basic research, and the apparent importance
based on the work of Comroe and Dripps, we felt it was important to
investigate Smith’s comments by replicating Comroe and Dripps’s study and at
the same time try to improve upon the methodology. The current project had
two objectives:

1. To see if the original Comroe and Dripps’s methodology was ‘replicable’.

2. To validate the key findings of Comroe and Dripps.

By looking at neonatal intensive care (NIC), we concluded that Comroe and
Dripps’ study – as reported – is not repeatable, reliable or valid, and thus
is an insufficient evidence base for increased expenditure on basic
biomedical research. We did, however, develop an alternative methodology
which used bibliographic databases and bibliometric techniques to describe
the research underpinning five of the most important clinical advances in
NIC, as identified through a Delphi survey.

Using the revised bibliometric protocol, we demonstrated that after a
time-lag of about 17

years, between 2 and 21 per cent of research underpinning the clinical
advances could be

described as basic. This observation is at odds with Comroe and Dripps’s
finding that 62 per cent of key research articles judged to be essential for
latter clinical advance were the result of basic research.

In reaching this conclusion we are acutely aware of the significant
limitations to the revised methodology and, therefore, we caution against
the over-interpretation of our results.

However, we would argue that there needs to be a greater understanding of
how basic research supports healthcare and hope this report will inform part
of this wider debate.


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__________________________________________________
Eugene Garfield, PhD. email:  garfield at codex.cis.upenn.edu
home page: http://www.eugenegarfield.org/
Tel: 215-243-2205 Fax 215-387-1266
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