Do Market Forces Steer Money Away from Basic Research at Academic Medical Centers?

Abstract

We always wonder whether a single case study has the requisite depth of penetration of the subject to serve as the basis for extrapolation. In his treatise, The Golden Bough (1), the Scottish anthropologist Sir James Frazer erected nothing less than an explanation for all religion (and much of civilization in the modern era) based on a single vignette in Greek mythology (the myth of Aeneas and Sibyl, who brought a golden bough to the gates of Hades to procure their entrance) having to do with a celebration of the harvest and an imperative for royal succession by unpleasant means (Fig. 1). Frazer's book catalyzed polar views. Some felt he had committed an act of blasphemy against Christianity (apparently the only religion that took offense), whereas others thought he was onto something. Genius may be the ability to perceive analogies, but in some cases, creating a sweeping generalization from a limited perspective can be folly. In this issue, we have a perfect case of this dialectic in the form of a Perspective that presents a case study of how, in the opinion of the authors, funding for basic research became encumbered at one of America's elite academic medical centers (2). In publishing this article (after peer review and extensive give-and-take between the authors and the editor-in-chief), I am of the view that it makes a point, but. As readers will see, this Perspective makes three main points. One is that reduced state support to the authors' institution, starting about 20 years ago, occurred when the clinical enterprise was expanding. Second, and related, they convey that the overall culture at their institution has been powerfully skewed toward clinical departments. Third, they argue that their and all other academic medical centers of ambition should seek major funds that are unrestricted as to use and deployed by an overarching research leadership office to support the best science on campus. As to their first point, they present comprehensive data to support their contention, but as my Golden Bough metaphor conveys, the issue here is extrapolation. To paraphrase Tolstoy's famous opening line in Anna Karenina: “Happy U.S. academic medical centers are all alike; every unhappy one is unhappy in its own way.” A major parameter in all of what the authors present is whether a given academic medical center does or does not own and operate its allied clinical system. Theirs does, mine does not, and having served on the Board of Trustees of my clinical system, separate from the University of Massachusetts legally but yet in common purpose as to mission, this can make a difference. As to the authors' second point, they present data that underscore the preferential growth of NIH translational and clinical research grants at their institution relative to basic research R01s. To me, this is a case of “it is what it is.” The authors' third point is that academic medical centers should have unrestricted money to support basic research. They make the valid point that most philanthropic gifts to their institution and most other academic medical centers are restricted-use donations. They can spot fund some labs or perhaps cover, from earned income, some or all of a faculty member's salary. But, for the most part, these gifts don't reach down to drive basic research at the hands of junior faculty in the basic science departments, especially as many go to clinical faculty (anent the authors' second point above). Although many institutions now confer named professorships upon junior faculty, what the authors argue for is a different sector of philanthropy that creates a fund that can be used with no restrictions to support basic research campus-wide on an internally peer-reviewed basis. They also argue for a specific research leadership structure, just one level below the top campus executive office, with this position responsible for the deployment of such funds. I read this part of the authors' Perspective with particular interest, because I was surprised to learn that their institution doesn't have this structure. So, let us read this Perspective with an open mind and ponder how the authors' case relates to our own institutions. The authors do not assert that what they have claimed to have found at their institution translates to comparable institutions but ask us to consider the possibility that it may. Frazer dared to advance a major thesis from a single vignette. An extrapolation from n = 1 to beyond should not be faulted on that basis alone.