Screening: the inadequacy of population registers.

seems to have paid little attention to research when framing the manpower proposals, and similarly the NHS review devotes only a non-committal paragraph to research.6 Yet the opting out of teaching hospitals, the high costs of providing treatment in research oriented hospitals, and the possibility of paying doctors at local rates may all undermine clinical research. It is also unfortunate that the government has not replied to the important report from the House of Lords on medical research despite its publication a year ago., But the issue that neither the House of Lords nor the Academic Medicine Group has considered adequately is the problem of concentration of medical research in Britain. The group has accepted the principles ofconcentration, selectivity, priority setting, and better management of the resources needed for research but has not perhaps accepted the consequences. Thus the group says: "Internationally com- petitive academic clinical departments will need a broad range of skills including top class clinical investigation combined with advanced basic science. There is little sign that many departments can meet these demands." It says too: "The size of most British academic departments now is often inadequate to meet the demands of modern clinical education and research." Yet the group rejects the three tier system of universities put forward by the Advisory Board for the Research Councils (type R universities doing internationally competitive research across the board, type X doing it in selected subjects, and type T doing only a small amount of research needed to support teaching)2; and the group's first recommendation is that "teaching must take place in schools where high quality research is in progress."