Prof. Daniel E. Singer's interview - http://sqlab.ru/index.php?option=com_content&view=article&id=6635:the-views-of-foreign-counterparts&catid=392:2010-10-23-20-21-25&Itemid=138

Cошников Сергей Сергеевич 24.10.2010 00:33

Six identical questions for six professors from different countries.

Daniel E. Singer, M.D.

Fellowship Co-Director
Professor of Medicine, Harvard Medical School
Professor of Epidemiology, Harvard School of Public Health
Chief, Clinical Epidemiology Unit, MGH

http://www.hms.harvard.edu/hfdfp/facmgh.htm

1. How did you choose the Public Health and Health Care as your main specialty?

Answer: These are difficult questions. For questions 2-6 I can only speculate. I always wanted to conduct scientific research that would reduce disease. I have always enjoyed pres enting research findigs and writing papers. I have also always been interested in politics and economics as well as biology. I found laboratory research too isolated. I gained great interest in merging the public health approach with clinical medicine. I was positively influenced by two great figures in epidemiology, Ole Miettinen, whose epidemiology course I took at Harvard School of Public Health, and Alvan Feinstein who started the field of clinical epidemiology. I enjoyed learning the epidemiologic and statistical methods and had some early success applying these approaches to predicting outcomes in intensive care and in using HbA1c as an epidemiologic risk factor in diabetes (HbA1c was a very new test when I first focused on it). That's how I started.

2. There is an annual growth in the number of defended dissertations in modern Russia, however, the number of scientific publications has a reverse trend. What do you think about this? Why it may happen? Could you please describe the situation with dissertations and research in your country?

Answer: I really know very little about the dissertation process in Russia. What you describe suggests that the quality of dissertations may not be high enough or that students do not persist in research after they get their doctorate degree. In the US very few medical students get PhDs in epidemiology or statistics. Trainees with MDs get their clinical training that takes 3 years or more after which they take fellowships where they learn specialty skills. During the fellowships, many trainees spend one or more years doing research. At Harvard, trainees who plan to conduct clinical research or more policy-related research will typically take our set of courses (Program in Clinical Effectiveness) at the Harvard School of Public Health (HSPH). They will pursue a research Masters in Public Health degree. Along the way they will conduct research and present it at seminars at HSPH and will often publish papers. Publishing high quality research is the main goal, not getting degrees beyond the masters degree. There are many career development granst they can then compete for that can provide 3-5 years further support for their research.

3. What are the most common ways to access information about new research used by practicing physicians in your country?

Answer: Traditionally, physicians read the leading journals either via paper or electronic copy. There are also many services that email research reports (e.g., theHeart.org), or research summaries (The Medical Letter). Resident physicans may use services that go to their handheld devices. Some physicians will search Medline or other bibliographic repositories. The busy clinician will frequently use UpToDate, an electronic service that serves as a frequently updated electronic medical text. Physicians in the US have to obtain Continuing Medical Education either by attending conferences or lectures or by internet-based learning.

4. How much time practicing doctors in your country spend seeking information about research findings?

Answer: I think that US practicing doctors have little time for seeking research findings. But they will use the various information sources I mentioned above when they are faced with patient problems where they are not sure how to proceed.

5. Do you think that Health Policy in your country is based on evidence derived from scientific research?

Answer: Health policy is based on a mix of research findings and politics. Approval of new drugs by our FDA is mostly based on scientific research.

6. How do you see the future of the evidence-based medicine in your country and around the world?

Answer: I think most thoughtful physicians and medical policy makers feel there is great merit in the evidence-based approach. So, it continues to gain influence around the world. Our new Health Care Reform legislation encourages evidence-based approaches to common clinical problems. One has to be careful to also encourage innovation and creativity. Sometimes, the evidence-based approach can be too conservative. In the end, we need the best use of current knowledge and aggressive pursuit of new knowledge.