Basic biomedical science and the destruction of the pathophysiologic bridge from bench to bedside.

Although formerly a prime intellectual focus of medical practice, research, and education, the pathophysiology of organs and organ systems has become increasingly deemphasized. The field of clinical investigation is thereby left without a sturdy bridge to connect epidemiologic studies of patients with cellular and molecular studies. The decline of pathophysiology has led to major defects in diagnostic reasoning and clinico-pathophysiologic correlations, to isolated accomplishments in molecular research, and to the neglect of many prominent scientific questions that can be asked and answered only at the level of organs and organ systems. An important intellectual source of the problem is the ideologic belief that scientific importance is inversely proportional to the size of the investigated entities. With this belief, the title of "basic" is excluded from fundamental scientific questions in any research that does not occur at the level of cells and molecules. Although recent changes in National Institutes of Health policy may augment the decreasing number of physician-investigators, the more serious intellectual problems of constrained scientific creativity will continue until the current ideology is revised.