To the Editor: I am amazed by your assertion in your recent column in the Journal that many clinicians fail to equate advances in basic research to advances in clinical medicine. 1 I would therefore like to make some small contribution to your understanding of the work of Richard Axel and Linda Buck, 2004 Nobel laureates in Physiology or Medicine, 2 and why this was considered worthy of the Nobel Prize.

Our understanding of the nervous system is still very primitive, and their almost complete description of the functioning of the odorant system — a small part of the nervous system — has laid down many of the principles pertinent to the more complex fundamentals for understanding neuronal signalling and signal processing. This is essential to an understanding of neurological and psychiatric diseases. The odorant receptors are also G-coupled protein kinases, and this is one of the most frequently targeted groups of compounds for novel small-molecular therapies.

If anyone still believes that Nobel Prize-winning science, such as understanding neuronal circuitry, is irrelevant to clinical medicine, they might look at the 2003 recipients for the Nobel Prize in Physiology or Medicine, Paul Lauterbur and Peter Mansfield. They received the award for the discovery of magnetic resonance imaging, which clearly plays a role in “mainstream” medicine.

In reply: I welcome Foote’s comments, but, to the contrary, I find it entirely credible that many clinicians “fail to equate advances in basic research to advances in clinical medicine.” The reasons are many, but include not only the tortuous language of research,1,2 but also the scepticism that inevitably follows research announcements of “cures” and “breakthroughs”, which prove to be patently premature or just peter out.3

However, I am amazed that Foote appears to have missed the point of my column — the “narrowness of the Nobel awards for physiology or medicine” with their recent predominance of basic research.4

While it must be admitted that the Nobel Prize is increasingly awarded for what is undoubtedly outstanding basic research that has the potential to be of “greatest benefit for mankind”, much of this potential remains unrealised. Indeed, it was the need for recognition of clinical and epidemiological research in the Nobel awards that moved the Lancet, in its Paper of the year 2004, to seek sponsorship for the clinical equivalent of the Lasker and Nobel awards.5

In summary, it is research’s exclusivity, the rise of its false prophets, and the irrelevance of most recent Nobel Awards to everyday practice that fuel disinterest among clinicians.