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Experiment Perilous: Forty-Five Years As a Participant Observer of Patient-Oriented Clinical Research

����� The invitation to deliver the 1995 Foundation of Medical Sciences Lecture led me to review the almost 45-year-long relationship that I have had as a sociologist of medicine with what is presently termed patient-oriented clinical research. (By patient-oriented research I mean the sort of investigation that entails moving back and forth between the clinical bedside and the laboratory bench; that involves patients as subjects; and that is directed toward finding more effective modes of diagnosing, treating, and preventing the diseases and disorders from which its patient-subjects suffer.) My long relationship to this type of research encompasses my participant observation-based sociological studies of a metabolic research ward; of the education and socialization of medical students; of organ transplantation, the artificial kidney and dialysis, and the artificial heart; of young European physicians' postWorld War II struggles to pursue careers as clinical researchers; and of the genesis, evolution, and significance of bioethics. Reflecting on what I have learned from these firsthand inquiries turned my thoughts toward some of the worries about this type of research that are currently being expressed in medical circles and in the public sphere. Paramount among these are concerns about the intellectual demise of patient-oriented research; the dearth ofyoung physicians willing to commit themselves to this sort of research career partly because, in the words of Harold Varmus, Director of the U.S. National