The state of primary-care research

In March, 2003, the editor of The Lancet attended an international conference in Kingston, Ontario, Canada, on primary-care research, subsequently running a rather dyspeptic editorial entitled “Is primary-care research a lost cause?”1 This article highlighted the unacceptable weakness of primary-care research worldwide. A particular concern of the conference was the shortage of primary care research in less economically developed countries to inform the clinical and public health management of malnutrition, malaria, AIDS, water-borne infection, and other illnesses of poverty.2 However, problems exist even in economically developed countries. In Australia, for example, a crude measure of research productivity with practising physicians as the denominator suggests that primary care is only 1% as productive as internal medicine, 0·5% as productive as public health and 1·6% as productive as surgery.3 But for The Lancet to characterise primary-care research as a “lost cause” is unhelpful. This notion implies either that the field is so weak that it cannot be resuscitated or that it is irrelevant anyway. Both are wrong.