In a recent correspondence, three young doctors from Changhai Hospital lamented the pressure on young physicians in “large hospitals in China” to publish research papers (Yuan et al. Young Chinese doctors and the pressure of publication. The Lancet, 2013;381(9864):e4.). They complained about the difficulty in doing research for young physicians, and argued that publication“is unreasonable and completely unnecessary”, and thus young doctors should pay“more attention to the accumulationof medical experience and improving their communication skills with patients”.

   However, these views, expressed by three budding physicians from a tertiary teaching hospital, are incredibly myopic, alarmingly insular and completely misguided, on several grounds. First and foremost, biomedical research is absolutely imperative to the advancement of medicine, a field that is constantly and rapidly evolving. Modern medicine comes a long way frombloodletting to now CT, PET, MRI, robotic surgery, whole-genome sequencing, and targeted therapy. Biomedical research, along with improved living standard, helped to substantially reduce infant mortality and prolong life expectancy. These remarkable and in some cases breathtaking achievements would not be possible without painstakingly hard work by countless dedicated scientists and clinicians, some of them even risked their lives inpursuit of scientific truth. Despite all these achievements, however, many, if not most, diseases, especially those chronic diseases that exert heavy economic burden on the society do not have effective treatment, let alone cure or effective ways of prevention. Only through continued and tireless research, there is hope that we can offer better patient care to the patients. Yet if all young physicians take the same as views as these authors, medicine would be doomed.

   Second, as the most populous nation that alsois the second largest economic entity in the world, it is incumbent on China to invest heavily on biomedical research and contribute its fair share of scientific discovery and the advancement of human knowledge to benefit all mankind. Unfortunately, for many reasons, known and yet to be delineated, China’s contribution to medicinein the past is wildly disproportional to its size, population, history, or its new-found economic prowess. In all medical fields, nearly all diagnostic tools, procedures, and instruments, drugs or biologicals, surgical methods and instruments, and even diagnostic and treatment principles that are proven to be efficacious or useful by evidence-based medicine, are first discovered or developed in the West, not in China. National pride aside, it is a moral obligation to contribute one’s own share to the advancement of human knowledge. If all doctors merely practiced medicine and no one did any research, how would medicine advance?

   Third, there is no ground to dichotomize doing research and being a fine doctor. In fact, since the very essence of science is to question everything, a good training in scientific research would cultivate an inquisitive and critical mind, a habit of logical thinking, andadequate skills of problem-solving---all the hallmarks of a fine clinician. Indeed, without any research training, a physician may be completely at loss when first confronted with a SARS patient. It is no wonder that, in stark contrast to primary and secondary hospitals in China, tertiary teaching hospitals, which value research and publication, are inundated almost daily by innumerable patients all wishing to get the best care.

   Of course, not all practicing physicians should devote a sizable portion of their time doing research. However, for atertiary teaching hospital, doing  research, publishing, and thus advancing medical knowledge is arguably one of its core missions.

   Granted, there are many problems inperformance review, funding, grant review, and even medical education and training in China, and the current environment is not entirely conducive to scientific inquisition. However, doing medical research is not only a necessity for economic and commercial reasons but also a moral imperative to advance medical knowledge along with Western peers. It is also the source for national pride. Above all, it is a vehicle to bring tangible benefits to patients and their loved ones, and the best way to win public support for sustained and heavy government investment on scientific research.

   There is little doubt that the pressure that Yuan and his fellow young doctors experienced is genuine, and they may well have vented their frustration and despair. Indeed, as lower echelons in a highly hierarchical institution, these young doctors may bear the brunt of inordinately heavy work load and the strained or, in some cases, even mistrustful and tense physician-patient relationship that permeated into almost all tertiary hospitals. They may also be overburdened by insanely high housing prices, distressed by artificially and ridiculously low salary that often forced them to supplement their income by taking monetary awards from patients and/or kickbacks from vendors of drugs and/or medical devices for the generous and preferential prescription and/or usage of their merchandises. They may also be disillusioned by rampant scientific misconducts and innumerable national, provincial and municipal prizes and awards bestowed to clinical investigators for discoveries that turned out to have questionable or even dubious scientific values. Life is not very kind to them.

    But they should not despair. For a country that is aspiring to be the world’s  superpower, rampant corruption, inefficiency, waste, mismanagement, scientific misconduct and all the other ills are simply incongruent with the country’s ambition. The young doctors should take a long-term view. Just forty years ago, listening to the BBC or VOA was a crime punishable with incarceration or labor camp, but now CNN is almost ubiquitous in China.  For a vast country such as China, there will always be an inexhaustible demand for first-class clinicians who not only have the best clinical skills but also are well-versed in clinical research so that they are on top of their profession. When opportunity knocks at their door, these young doctors should better be fully prepared. And this preparation will, inescapably, include some solid research training and publication.