Myths and realities in clinical research.

It is often argued that clinicians should be more actively involved in research and that this inactivity is due to shortage of time and funds. This may be so, but more important and less obvious constraints are the differences in the philosophical foundations of clinical practice and research. Researchers must strive to abolish uncertainty, to be unwaveringly committed to truth and to rid themselves of all bias. Clinicians, in contrast, must frequently manage patients in the absence of certainty, handle truth creatively and be willing to be biased on their patients' behalf as part of a professional obligation. These differences constitute powerful selection pressures for individuals with particular skills, personalities and sources of job satisfaction. Clinical practice and research are instrinsically different activities and it is probably unreasonable to expect an individual talented in one to be similarly expert in the other.