Full shelves... This is the image that comes to mind when I think about the Brazilian medical literature. Shelves full of well prepared theses, which took time, money and availability of dedicated researchers, many of them with little previous technical education, which had to work hard to gather the necessary training to prepare a research study within the post-graduation period, since they had not had a period of scientific preliminary learning during medical school. Despite all personal, public and private investments, the results are almost always forgotten in some hospital library or occasionally cited in other publications that will probably be equally forgotten.

We would like to discuss the relationship between teaching and research and its final purpose to society. Teaching-research integration is considered by most as useful and necessary, and, however it has been quite difficult to reach it. From a historical perspective, Brazilian universities are very new - they date from 1830. The first higher education institutions were created by Dom Joao VI - the Military Academy in Rio de Janeiro, the Medical School in Rio de Janeiro and Bahia, and the Law School in Sao Paulo and Recife. From then on, higher education institutions have had as their main purpose to train professionals to the marketplace. The comparison with other countries show that the role of training professionals - people capable of having a specific legally acknowledged qualification - is not always the core activity of universities, which also have a research and cultural role to play.

In Brazil, however, the terms "university" and "higher education institutions" are synonyms and the correlation between professional teaching and science has historically been very problematic. It happens in some countries and maybe Germany, since the beginning of the 19th century, is the only case of effective combination between professional teaching and scientific research in the university. The United States currently has high level scientific research in the universities, but it is primarily connected with training of professional scientists and not professional workers - physicians, engineers, etc., such as in Brazil. Other developed countries have tended to maintain a scientific research system that is apart from the universities and the most well known examples are France, with the Centre Nationale de Recherche Scientifique, and Russia, with the Academy of Sciences, both maintaining very few interrelations with their respective educational and professional systems.

Regardless of this relation, one of the characteristics of modern science is the institutionalization of scientific research as a professional activity, well compensated and requiring full time dedication.

The scientific work is based on talented and trained people that are attracted to this type of activity not only to be free to exhaust their curiosity and face intellectual challenges that are part of their fields of knowledge, but also to be economically and psychologically rewarded for their achievements. This fact, in turn, requires agencies and institutions that support and compensate such activities. Since only scientists can intellectually assess the quality of their own work, they require professional institutions and entities to define contacts and exchange programs, through which the values of scientific excellence can be encouraged. It makes most of the researchers willing to be part of the academic world to perform their functions.

However, we have to be careful about the balance between useful and necessary. A society that considers that only an academic position is relevant may be led to intellectual futility, whereas a society that compensates only research technological products rather than the research per se will discourage scientific careers in favor of purely commercial enterprises.

In a way, the traditional system of Brazilin universities has privileged academic careers and little has been done to transfer the knowledge acquired in private companies. Conversely, the academy, in rare opportunities, has tried to get together with the private initiative to find current and public utility common topics. Under such perspective, if we investigate the demand for high level research and training in underdeveloped countries, we will see that the traditionally low standards of large universities in underdeveloped countries are in general appropriate to the little qualified demand for their respective marketplaces.

In the absence of a more aggressive policy of technological independence, the occasional scientific research studies tend to be transformed into simple academic exercises.

This is a typical case of circular negation cycle, in which stagnated societies demand little from universities, which discourage the emergency of better professional, technical and scientific work standards, which reduces the motivation of talented people to be attracted to scientific and technical areas, which contributes to general stagnation of the society and so and so forth.

This vicious cycle could be broken with hybrid institutions that would deal with the university system and its bureaucratic, administrative and political institutions and reach productive chains and their flows of financing lines. Independent institutions could provide high quality professional training in research, in addition to gathering professionals coming from the universities that would have a scientific bias despite the clinical-oriented training. When such institutions move ahead, thus, and try to reach in addition to technical and professional state-of-the-art teaching, the development of scientific activities, their potential of social transformation can be quite significant. In such case, they work as centers with a creative way of thinking and working, comprising alternative and innovative concepts about the reality surrounding them and the nature of university activity. Therefore, the purpose is to intensify the cooperation between companies and universities by adopting initiatives such as the organization of workshops, intellectual property programs, increment to company incubation projects and the search for sector funds to sponsor research projects.

Even though there are research sponsoring agencies in which the researchers can individually apply for financial support, as well as others that respond only to teaching institutions applications, we can look for financing lines within a shared perspective.

Training, Financing, Intelligence, Need and Demand - perhaps these are the five pillars that can support an alternative concept in which medical curiosity together with the difficulties perceived in the performance of clinical functions will generate original and innovative ideas to be applied in clinical practice by professionals that are trained in problem solving, providing viable and feasible solutions so that the private initiative can produce and commercialize them.

This concept could be the core of a self-sustained solution for Brazilian medical science, creating research institutes associated with the academy and the industry, forming hybrid professionals aware of their professional and social attributions. That would define the autonomy and intellectual independency of Brazilian medicine and the whole country.


Henrique Olival Costa