One of the definitions of Academic is the following: Not of practical relevance; of only theoretical interest.
When we look at the term Academic Medicine, sadly the descriptor “Academic” increasingly falls under this definition.
To be fair there have been some wonderful scholars in the field of medicine: Semmelweis, Fleming, Salk, Sabine, Starzl, and Marshall to name a few. And these few were not readily embraced by their peers in Medicine. Barry Marshall was ridiculed for the idea that peptic ulcer disease results from a bacterial infection of the stomach. Tom Starzl was driven out of Colorado for the audacity of attempting to transplant a liver in a human. Yes, the few have suffered greatly at the hands of the many. But that is not the focus of this piece.
Academic Medicine is losing its practical relevance and becoming of only theoretical interest because it has failed to become a system that continuously and sustainably seeks to self-improve at the one thing it should do better than anything…take care of patients.
The numbers are staggering. An estimated 440,000 lives lost per year due to medical errors and an estimated $800 Billion in waste every year.
Yet what do our medical universities do? They press young faculty to become gene Jockeys, and nano-technology experts. They compel them to pursue “sexy” basic science research for the sake of discovery and theoretical interest. And these pursuits often lack a clear translational endpoint or concrete timeline for that endpoint.
Without those endpoints, physician-scientists focus on getting a federal grant. And if they get one grant, then the next objective is to get a second grant. Productivity thus is not based on demonstrating relevance by solving a problem, but rather by how many papers you publish and grants you receive. If you publish a lot of papers then you have a high likelihood of getting another grant. If this sound analogous to an election cycle, it is. Is it any wonder that the public has soured on supporting this kind of research when they see no tangible results for where taxpayer monies are going?
So, what does Academic Medicine need to do in order to be of more than theoretical interest?
First, it needs to stop asking the question: “How can I get grant money for this project.”
Instead it needs to ask: “Am I solving a problem?” and “If I solve that problem, will it be of value to society?”
Next, Academic Medicine needs to focus on problems of which it has a deep knowledge and expertise, that are solvable and will have a major and immediate impact.
So, trying to clone a gene from a cancer cell line in the hopes of someday finding a cure for the disease fails because there is no timeline for this overly ambitious and imprecise translational endpoint.
Instead Academic Medicine should focus on problems it can solve. For example, minimizing the cost and improving the outcomes for the most common surgical procedure we do: the appendectomy. There 280,000 appendectomies per year in the United States. Disposable operating room costs alone average close to $3000/case or $840 million/year. This could easily be reduced to $80 million/year ($300/case) if we would just widely disseminate the information on cost containment measure that some surgeons are already practicing. That’s $760 Million in savings or about 1% of all the estimated annual waste in healthcare. In fact, if we did this for every surgical case the savings would be staggering.
Finally, Academic Medicine should also focus on precision medicine. In other words, determine what therapies are ineffective in which patient populations and then eliminate those therapies to minimize risks and cost.
This is what evidence-based medicine should look like.
Don’t get me wrong. There are some tremendous discoveries being made by full-time scientist at medical universities. But physicians are not full-time scientists and if they become part-time physicians for the sake of pursuing science, they will fail at the one thing that they should be an expert at: taking care of patients.
PETER F. NICHOL MD/PHD
Associate Professor of Surgery
University of Wisconsin School of Medicine and Public Health