Tuesday, January 13, 2009



As we approach a new presidential inauguration, a look back to 1961 is instructive for those concerned with the interface between academic medicine and industry. Here are the words of President Dwight D. Eisenhower, as he left the office of the presidency. He warned of the military-industrial complex:

In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes.

Eisenhower’s basic insight was that national security is paradoxically threatened by an unchecked military-industrial complex because both partners commit to flawed paradigms out of misguided self-interest and perverse incentives.

Eisenhower went on to critique the academic-government complex in similar terms:

… research has become … more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.

… the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity…

The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.

President Eisenhower’s prescience in 1961 has been confirmed. The dependence of universities and academic medical centers on federal funding is now a fact of life. In 2009 we see another variant on Eisenhower’s theme – the entry of for-profit corporations into academic medicine – with much the same dangers. Today the danger is that innovation is paradoxically retarded because both partners commit to flawed paradigms out of misguided self-interest and perverse incentives. As with federal funding, there has been no shortage of academic physicians to embrace the new stream of money from industry.

So, the dramas that have played out lately involving academic key opinion leaders compromised by their coziness with industry have good precedents. We could do worse than to remember President Eisenhower’s insights and warnings: human nature has not changed – only the players are different. Across at our neighbor ClinPsych is a fine summary of specific examples of these principles.

Bernard Carroll

1 comment:

Anonymous said...

I found it interesting that yesterday I saw three articles that address this issue. The first was a reprint of a Washington Post article Obama's headache: A health-care system gone haywire that basically covers a McKinsey report. The highlights being there is no one singe scapegoat and no silver bullet to solving our medical crisis. Other important points were that medicine consumes 25% of our national budget and is only continuing to grow.

The second article was a reprint of a New York Times article Probe finds oversight by FDA lax. No news to HCR readers, but this quote is telling : "Karen Riley, a spokeswoman for the FDA, said the agency opposed reviewing doctors' financial conflicts before trials because they represent just one possible source of bias."

The third article from the Jan. 12th WSJ titled Medical Journal Criticized Over Lack of Disclosure on Authors takes to task the NEJM for not disclosing financial conflicts of authors submitting articles. The WSJ then takes credit for changing the disclosure policies of the NEJM.

One common theme of these articles is that medicine has become a great machine and maintaining the machine has become the overriding goal of those involved. I see this machine extending into the academic world where, in both systems, we see terms such as "profit center" or "cost center." The very use of these terms places a positive or negative connotation on the services provided.

One troubling aspect of the articles is that transparency and accountability has been defaulted to the business community. Medicine and academic science should be above reproach and to allow business to become the standard is tragic.

I am old enough to remember being taught that not everything is a "business." While we may apply business like controls, and use business like terms, some organizations operate for the common good. It seems medicine and the academic world has lost this concept.

Steve Lucas