Academic medical centers face challenging research future

Sustaining financial support depends on managing public expectations and maintaining public trust.

Academic medical centers face many critical challenges to their ability to effectively conduct research, including balancing rising research costs with constrained funding, notes an article in the Journal of the American Medical Association.

Lead author Jordan J. Cohen, MD, president and chief executive officer of the Association of American Medical Colleges (AAMC) and coauthor Elisa K. Siegel, a senior vice president at the AAMC, examined the state of medical research at academic medical centers.

“The present era offers more promise for progress ... than ever before. Contemporary science has deciphered the human genome, discovered some of the potential of stem cells, and unleashed the power of information technologies. Any one of these three historic scientific achievements would have the potential to effect a fundamental transformation in medicine; their confluence has created unprecedented opportunity for spectacular breakthroughs in human health,” the authors said.

Despite this potential, the academic research community faces many challenges. According to a press release from the AAMC, these challenges include the following:

managing high, often unreasonable public expectations for discoveries;
maintaining public trust despite suspicions aroused by financial conflicts of interest;
sustaining cultural norms of academe while partnering with industry to promote technology transfer;
recruiting and retaining physician-scientists to pursue translational research;
managing the widening gap between research costs and available funding;
complying with unfunded mandates inherent in conducting research; and
transforming the academic reward structure to encourage collaboration between teams of scientists to pursue greater projects.

Public understanding

Past research advances have raised the public’s expectations for research breakthroughs. As a result, the research community must help the public understand the research process, particularly the “often uneven and incremental pace of progress that characterizes most medical discoveries,” the authors said.

“Academic medical centers, as sources of much of the advances in medicine, have a special role to play in managing the public's expectations and can do so by ensuring that public communications about their research developments are tempered with realistic assessments of their practical impact,” they said.

Financial conflicts of interest, for investigators or their institutions, also can undermine the integrity of the scientific process and compromise safe human research, they noted.

A 2004 AAMC survey showed academic medicine has made substantial progress in addressing possible conflicts of interest, with many institutions surpassing minimum federal requirements. However, the survey also showed that more work remains. In particular, the academic medicine community needs to establish uniform policies. “Sustaining public trust in the medical research enterprise will, at minimum, require continued efforts to identify and address ways to improve the protection of human research subjects and to buttress the management of financial conflicts of interest,” the authors said.

“Academic medical centers and their industry partners must be willing to adopt more uniform, more robust and more transparent standards governing their relationships if the mutual benefits of those relationships are to be sustained,” they said.

Research funding

In recent years, growth of federal research funding has decreased, with the National Institute of Health’s budget increasing by less than the rate of inflation. Increasing costs of modern regulatory compliance compounds the problem, according to the press release.

Federal agencies have begun a cross-agency initiative to streamline federally sponsored research requirements. But without some relief, “some institutions may find it impossible to sustain their sponsored research programs,” the authors said.

“The ability to nurture and sustain a vibrant clinical research workforce in the future is heavily dependent on the ability to shift the academic culture and reward system away from the traditional paradigm focused on the individual investigator in favor of one that is more collaborative, team-based and interdisciplinary,” they added.

“The ability to sustain financial support for medical research in the face of constrained federal and state budgets is heavily dependent on managing unrealistic public expectations and on maintaining public trust. The ability to benefit optimally from the growing relationships with industry is heavily dependent on remaining true to fundamental academic values, including the safety of human subjects research, the integrity of the scientific process, and the free exchange of research results. The degree to which medical schools and teaching hospitals are successful in meeting these challenges will determine the degree to which the historic promise of modern medical science will be realized,” the authors noted.

For more information:
Cohen JJ, Siegel EK. Academic medical centers and medical research. JAMA. 2005;294:1367-1372.