The Agenda.

Few of my behaviors drive my family to distraction more quickly than my expectation that they will share my enthusiasm for my latest esoteric interest. The historical roots of words, the methods used to cure meats and cheeses, and, of course, details about the latest "techno-toys" hold me in rapt fascination. But when I begin to wax poetic about these things, my family would do anything for a talisman to ward off these bouts of what they view as near-fatal pedantry.

As a family, the Rothsteins often differ on what should be the focus of our attention. In the context of my esoteric interests, such disagreements are consequential only to the extent that they disrupt family dinners and make us eligible for an hour of glory as the "Dysfunctional Family of the Day" on the Sally Jessy Raphael show. On the other hand, I am in awe of our ability to set aside our differences in order to focus on vital issues of mutual importance. The cliche that there is a time and place for everything holds true.

Diversity and annoyance, vastly different expectations, and frank disagreements are all part of family, organizational, and societal lithe. There are occasions, however, when differences should be minimized in the interest of a common good. When the great muscle physiologist AV Hill abandoned his work on muscle function to participate in the British government's efforts to develop and enhance radar, he was demonstrating not only his brilliance and versatility, but his ability to understand and act on priorities. In the same way, the great thinkers who migrated to the laboratories at Los Alamos, Oak Ridge, and elsewhere understood that without a free world, no other physics but nuclear physics would matter.

Hill helped develop a defensive system. In their naivete, many of the physicists of the Manhattan Project thought that they too were developing a weapon so awful that it would have only a defensive application--and even then, primarily as a psychological impediment to war.

In the end, the Bomb was dropped, and its presence haunts us still. Regardless of our personal views on the Bomb and the scores of other inventions created to save the world from despotism, there is one overriding lesson. When people's existence is threatened, their ability to set aside personal differences and to act on what they believe is the common good can be nothing short of remarkable. We need to look no further than our own patients to be reminded of how adversity often elevates the human spirit and empowers people beyond what they believed was possible.

Unfortunately, it sometimes takes nothing less than the threat of annihilation to evoke such cooperative efforts. William James understood this when he admonished, "So long its the antimilitarists propose no substitute for war's disciplinary function, no moral equivalent of war, analogous, as one might say, to the mechanical equivalent of heat, so long they fail to realize the full inwardness of the situation."[1] James is often misunderstood. War is not moral, and during war much of human behavior is as base, vile, and immoral as can be imagined. James is not beseeching us to mimic the "morality" of wan He is beseeching us to mimic what happens on the positive side of the moral equation during times of war--that is, the elevation of human behavior. The lesson for us in physical therapy is clear.

After prolonged efforts and the involvement of disparate groups throughout the profession of physical therapy, a research agenda has been generated. The agenda is published in this issue, along with details about how it was painstakingly developed based on input from many sources and after exhaustive deliberations. Just as the Normative Model for Physical Therapy Education brought a cohesiveness never before seen in education, the Clinical Research Agenda can bring, for the first time in our history, a common vision of what we need to achieve in research in order to remain viable as a profession and vital as health care professionals.

In the past, efforts at developing a research agenda ended with ineffectual documents. Attempts to make these documents more meaningful were opposed by people with narrow interests, people who viewed an agenda as a threat to their own research. But a profession's priorities may not always be the same as an individual's priorities. For instance, I may be interested in how things work and in cellular mechanisms and theoretical assumptions. But the world, and our practice and our practitioners, need information now about what works and what does not work and about how to evaluate and prognosticate.

This new agenda is too important to be undermined by self-interests and the insistence that the profession support personal agendas. At the same time, the agenda's focus on more clinically relevant issues does not devalue other forms of research. It simply recognizes what is most essential here and now.

I would have respected any physicist who would have refused to rally around the banner of the Manhattan Project. (Actually, that is the course I hope I would have taken.) Likewise, I must respect anyone in the research community who does not view the Clinical Research Agenda as providing them with guidance for their own activities. However, as we face a frightening future for our patients and clients, I believe that the individual interests of researchers must take a backseat to efforts at improving the common good and that the focusing and unifying power of this agenda can be our "moral equivalent of war." Similarly, research priorities aimed solely at developing weapons in a war for reimbursement is not in our profession's long-term interests.

As proposed, the agenda is wide ranging and attempts to address the most critical issues of the day. For those who disagree with the priorities, there will be opportunities in the future to modify them. But now is the time to respond to the high-minded appeal suggested by James. Otherwise, we may irrevocably harm our profession by acting like a dysfunctional family that is incapable of placing individual interests into a broader context.

References

[1] James W. Memories and Studies. New York, NY: Folcroft Publishers; 1973.