Commentary: Sir James Mackenzie (1853-1925): an ambiguous pioneer for research in primary care.

Sir James Mackenzie is generally accepted as the founder of research by general practitioners in Great Britain, studying their own patients where and how they actually live. His pioneering work on arrhythmias was a foundation for modern cardiology, consolidated by his pupil Thomas Lewis, Britain's first full-time clinical researcher for the Medical Research Council. Mackenzie became a dominant figure in public imagination, more widely celebrated than any later generalist. At the clinical research institute he founded at St Andrews in 1919, he hoped to set in train a permanent and growing body of longitudinal clinical research outside hospitals, by community generalists studying their own patients. This article tries to explain the failure of this project: how it influenced later research by general practitioners and others in primary care after creation of the National Health Service (NHS) in 1948 and its relevance today to primary care research policy. Such research is now becoming an urgent necessity, for the British National Health Service to survive as a public service and as a foundation for democratic development of biosciences.