American Academic Medicine Research Articles

What's new in academic International medicine? The evolving terrain of American academic medicine

What's new in academic International medicine? The evolving terrain of American academic medicine

Evolution of American Academic Medicine: A View of Its Contributions to World Medicine and Reflections Influenced by Personal Role Models

The changes in American academic medicine in the last 6 decades has been a success. During these years, I participated in this development through patients care, research, editorship of major Journals and as a member of governing boards of several professional organizations. This discussion will describe some of the developments of medicine and will recount my own professional career and my mentors who help me to achieve my goals.

Blood Picture: L. W. Diggs, Sickle Cell Anemia, and the South's First Blood Bank by Richard H. Nollan

Reviewed by: Blood Picture: L. W. Diggs, Sickle Cell Anemia, and the South's First Blood Bank by Richard H. Nollan Steven Noll Blood Picture: L. W. Diggs, Sickle Cell Anemia, and the South's First Blood Bank. By Richard H. Nollan. ( Knoxville: University of Tennessee Press, 2016. Pp. xii, 187. $45.00, ISBN 978-1-62190-221-8.) Long a staple of popular history, the biography is often a throwback to the "great man" genre of historical writing, where authors use breezy prose to write about the lives of important people in minute detail. By providing a lens to examine the period in which the subject lived and worked, biographies that examine larger questions can appeal to an academic audience as well. Blood Picture: L. W. Diggs, Sickle Cell Anemia, and the South's First Blood Bank shows the promises and pitfalls of using biography as a form of historical analysis, as it examines the life of Lemuel Whitley Diggs, a Memphis physician and medical researcher whose life spanned much of the twentieth century. Richard H. Nollan chronicles the life of L. W. Diggs from his birth in Hampton, Virginia, at the turn of the twentieth century to his death in 1995. While examining Diggs's family and personal life in some detail, Nollan focuses most of his attention on Diggs's more than fifty-year career at the University of Tennessee Medical Units (now the University of Tennessee Health Science Center) in Memphis. More than simply an academic physician, medical scholar, and teacher, Diggs was instrumental in the dissemination of knowledge about sickle-cell disease (SCD) and established the first major center for the study of the disorder. His long career included significant research and publications on SCD, public outreach, and intense personal work with patients (almost all of whom were African American) and their families on living better with the disease. Tied in with his work on SCD and hematology, Diggs marshaled community and university resources to create the first blood bank in the South in 1938. Finally, Nollan examines Diggs's role in the founding of St. Jude Children's Research Hospital in Memphis, a hospital that treated catastrophic childhood illnesses free of charge to patients. This book works best when Nollan discusses Diggs's relationship with both the city of Memphis and his fellow physicians and researchers. Diggs was not simply another doctor, but also an important figure in this emerging New South city. Nollan concludes that "Diggs's stature in the community and his [End Page 742] reputation as a physician grew because of his sickle cell research and his interest in medical technology, especially his commitment to blood banking" (p. 80). Diggs's research, patient care, and commitment to teaching reflected the larger changes taking place in American academic medicine throughout the middle of the twentieth century. Using increased federal resources and grant monies, Diggs continued his work on sickle-cell disease and its relationship to the African American community. In recognition of his contributions to this field, the Southern Christian Leadership Conference awarded Diggs the Martin Luther King Medical Achievement Award in 1972, highlighting a life dedicated to service and a "doctor-patient relationship … based on trust and mutual respect" (p. 156). While Nollan succeeds in allowing the reader to understand Diggs as a doctor, a family man, and an individual, he does less well in placing Diggs in the context of the Jim Crow South. Nollan tangentially examines issues of race throughout the book. Given that Diggs was engaged in a long-term longitudinal study of a disease and its effects on the black community, Nollan should certainly have given more attention to the infamous Tuskegee syphilis study taking place at the same time. There also is little mention of black doctors during this period. The reader is left wondering how Diggs related to these physicians and what they thought of him and his research. As a layman with little medical knowledge of SCD, I would also have liked Nollan to have better explained the disease and its various permutations. These concerns, however, do not negate the value of this book. Though at times a bit hagiographic in his approach, Nollan...

Leveraging Diversity in American Academic Medicine. The Harold Amos Medical Faculty Development Program

Leveraging Diversity in American Academic Medicine. The Harold Amos Medical Faculty Development Program

A tribute to Helen M. Ranney

A tribute to Helen M. Ranney

Atlantic City memories

Fifty years ago, the Atlantic City meetings, held the first week in May of every year, were attended by all the elite of American academic medicine and all who wanted to join that group. Part of the magic of those meetings was that professors and neophytes took each other seriously and talked to each other.

Lost in a dark wood

Organizations are defined by their missions. When they lose sight of them, they risk losing their identity and purpose. Developments in American academic medicine over the last several years point to a loss of focus on the long-term objectives and the big picture. This nearsightedness is a major threat to our enterprise.

ASCI Presidential Address: Mentoring and teaching clinical investigation.

A man walking along a road comes across three bricklayers. When asked what he is doing, the first bricklayer replies, “I am laying bricks.” When asked the same question, the second bricklayer answers, “I am making my living.” When asked what he is doing, the third bricklayer steps back, looks around, and responds, “I am building a cathedral.” It is my great privilege and pleasure to address the ninety-sixth annual meeting of the American Society for Clinical Investigation. I will begin with many thanks: to the council members who provide sage advice and a critical eye; to our staff, who provide dedicated direction and a keen sense of corporate memory; to the members of the ASCI in 2001, who felt it appropriate that I serve on the ASCI Council; and to the Presidents who have come before for providing the insights and precepts that have helped shape our Society into an organization of extremely dedicated men and women that continues as the leading advocate for scholarship in medicine. I will also try to follow the advice of the seventeenth-century Catalan philosopher Baltasar Gracian, who stated, “What is good, is doubly so if it be short; and in like manner, what is bad, is less so if there be little of it.” Most recent Presidential Addresses have begun with a palpable angst, prompted by one of the major challenges of ASCI leadership — preparation of the Address itself. Although I cannot speak for others, my apprehension was due to the sense of awe that developed while carrying out the unwritten oath of office requiring each President to read the prior Addresses in the months prior to the annual meeting. The angst of writing the Address comes from considering the accomplishments and panache of the individuals who have previously held the ASCI gavel and used this pulpit to espouse acute wisdom and uncommon insight and to create new professional diagnoses and level outstanding wit — the Clem Finches, Joe Goldsteins, Holly Smiths, Gene Braunwalds, and Don Seldins. We have a distinguished history and an outstanding cause, and I applaud the members of the ASCI. In reading over prior Addresses, I was struck by the many recurring themes that our past presidents chose to highlight: the spirit of science, the imbalance between MD and PhD biomedical researchers, financial support for clinical investigation and the favorable economics of investing in biomedical research, and diversity in the ranks of American academic medicine. But of all the challenges facing us as a Society within our broader society, I am most concerned about our ability to mentor and teach our learners, and am frequently reminded of the pure joy that endeavor can bring to the physician-scientist. Rather than being intimidated by the prospect of having my remarks compared to those of Presidents past — such as Joe Goldstein’s insightful 1986 talk formulating the malady of insufficient technical training and consequent lack of courage in junior faculty which I paraphrased to a group of junior faculty members just last week, or Tom Stossel’s witty and wise apocalyptic fable in 1987’s Brave New Medicine, or Ed Benz’s 1992 celebratory Presidential remarks — I relish the chance to convince you that perhaps our greatest challenge as advocates for the physician-scientist is the issue of teaching. We must teach, teach often, and teach widely. We must teach medical students the rewards of marrying scientific inquiry and clinical medicine; we must teach residents that the singular discovery of new knowledge can sometimes impact tens of thousands of patients; we must nurture our fellows and junior faculty members, providing them the tools of the trade and instilling in them the tremendous excitement that comes from solving the mystery of an idiopathic disorder or bringing effective therapy to patients. And because teaching can impact these constituencies, we must teach the public about the values and processes and power of biomedical science, replacing the fear of things unknown with a renewed enthusiasm for the reward and potential made possible by strong support for clinical investigation. To reiterate: it is clear that we must teach, teach often, and teach widely. And we must teach the grand landscape — the larger context of clinical investigation — to demonstrate to each of these groups how the act of asking scientific questions with a clinician’s intuition can build “cathedrals.”

Help Secure the Future Of Psychiatric Research

Help Secure the Future Of Psychiatric Research

Academic Medicine Under Economic Stress: A Case Study of the Institutional Change Transforming American Health Care

American Academic medicine--the system of education and research that trains the coming generations of physicians, produces new basic and clinical bio-medical research and provides the medical safety net in many U.S. urban areas--is in a funding crisis. This essay lays out an historical and analytical account of the institutions, functions and funding mechanisms of this enterprise. The objective is to interpret the forces that led to the current impasse in which the medical education establishment now finds itself, and what the future is likely to hold as the forces of budgetary stringency and market competition continue to accelerate. A comprehensive review of the cross-subsidy system, its intricate relationship to the federal financing of health care and its origin in the Vannevar-Bush-inspired post-war research establishment is offered. The standpoint of economic theory is then taken to suggest that the intertwined functions of academic medicine be viewed from two perspectives. One, it can be viewed as a financially unnecessary mix of public and private goods. Two, it is an institutional framework for joint production that evolved under the post-Flexner, post-Bush era reforms of scientific medicine, but which now may be in need of modifications to its mission.

Battling quackery: attitudes about micronutrient supplements in American academic medicine.

T H R O U G H O U T T H E 20th century American academic medicine has resisted the concept that supplementation with micronutrients might have health benefits. This resistance is evident in several ways: (1) by the uncritical acceptance of news of toxicity, such as the belief that vitamin C supplements cause kidney stones; (2) by the angry, scornful tone used in discussions of micronutrient supplementation in the leading textbooks of medicine; and (3) by ignoring evidence for possible efficacy of a micronutrient supplement, such as the use of vitamin E for intermittent claudication. Part of the resistance stems from the fact that the potential benefits of micronutrients were advanced by outsiders, who took their message directly to the public, and part from the fact that the concept of a deficiency disease did not fit in well with prevailing biomedical paradigms, particularly the germ theory. Similar factors might be expected to color the response of academic medicine to any alternative treatment. In The Crime of Galileo, historian Giorgio de Santillana presents a revisionist view of the great scientist’s struggle with the Catholic church. According to de Santillana, Galileo’s crime was not his propounding a heliocentric universe; it was that he wrote in Italian; he communicated his revolutionary ideas about astronomy directly to the public. Previous scientists wrote in Latin, limiting their audience to other scholars. Within this small community, controversial ideas could be entertained. Copernicus’ proposal of a heliocentric universe 70 years before Galileo’s treatises had elicited no attempts at suppression by the church. The 17th-century church represented the intellectual establishment, and Galileo’s persecutors included some of the finest minds of his time. Galileo was punished not for writing heresy, not for threatening paradigms, but for bypassing the intellectual establishment and taking his exciting ideas directly to the people. The establishment, threatened not so much by his ideas as by his methods, did what it could to destroy his credibility. In addition, Galileo did not respect professional boundaries. He was a mathematician, and yet his writings dealt with phenomena considered within the purview of philosophers, a profession of considerably higher status than mathematics. Thus, he was considered a usurper as well as a popularizer. In what follows we argue that the reaction of academic medicine to the concept of micronutrient supplementation can best be understood in light of the foregoing description of Galileo. Our thesis is that throughout much of the 20th century, American academic medicine was resistant to the concept that micronutrient supplementation might prove beneficial, and that the cause of this resistance was similar to that which faced Galileo. This resistance is evident in several ways: (1) by uncritical acceptance of bad news about micronutrient supplements; reports of toxic effects were rarely questioned and widely quoted; (2) by the scornful, dismissive tone of the discussions about micronutrient supplementation in textbooks of medicine, a tone avoided in most medical controversies; and (3) by the skeptical reaction greeting any claim of efficacy of a micronutrient, relative to other therapies; indeed, most claims were simply ignored. Note that in each of the areas mentioned above we examine the reaction to micronutrients relative to other therapies. It is not proof of bias to be concerned about toxicity or to be skeptical of claims of efficacy. Bias occurs when concern and skepticism are applied selectively. Also note that we are not proposing to prove that any particular micronutrient supplement is indeed efficacious. Some readers of earlier drafts of this article have concluded that we are apologists for megavitamins. We are not. Rather, the vitamin controversy is one of a series of examples we have used to discuss the forces that influence medical practice other than those stemming directly from scientific discovery. Herein we rely on the multiple editions of 2 major American medical textbooks: A Textbook of Medicine and Principles of Internal Medicine. Each has been published in 12 different editions between 1950 and 1992. They can be presumed to represent established opinions and can be used to sample how medical opinion changes over time. From the Center on Aging, The University of Texas Medical Branch, Galveston. COMMENTARY

HIV Screening for Healthcare Providers: Can We Provide Sense and Sensibility Without Pride or Prejudice?

The prosperous face of American medicine has changed more in the past decade than in any previous five decades combined. We are, as a country, witness to the greatest explosion in science and technology in our history. Medical science is able to accomplish today what would have been viewed, just 30 years ago, as too preposterous for competent science fiction. The pace at which new scientific information is being developed is mind boggling. A casual mid-July 1994 search of the National Library of Medicine's citation database for the subject acquired immunodeficiency syndrome elicited 12,342 citations in the Medline (1991-1994) file alone. Gene therapy, stem-cell harvests, molecular medicine, and cytokine immunomodulation all have become commonplace in American academic medicine. Unfortunately, the 1990s also present us with new and formidable fears and distastes, many of which represent virtually unexplored territory for American healthcare. Medicine is faced with new and remarkably dynamic scientific and economic realities: 1) the need to provide quality care to all Americans at a cost our economy can tolerate; 2) the need to develop effective strategies to decide when to use (and when not to use) the expensive new technologies that have changed the face of medicine; 3) the need to develop effective funding strategies and mechanisms to pay for these new and expensive technologies; 4) the need to develop effective strategies to manage the complex set of problems presented by relatively new diseases, such as the ongoing human immunodeficiency virus (HIV) epidemic; and 5) the need to bring healthcare institutions into compliance with the expanded standards and regulatory requirements that have become increasingly prevalent throughout all aspects of healthcare. In the 1990s, we also are observing dramatic changes in the manner in which healthcare is provided. Further, because of its relative expense, American medicine is receiving remarkably intense scrutiny both from the public at large and from our business and political leaders. Medicine is faced with the difficult necessity of engineering and initiating its own cost-cutting changes while maintaining or even increasing the quality of the services provided. The costeffectiveness of healthcare strategies and interventions has become a major concern. Most healthcare institutions have been forced to learn rapidly about business and economic concepts that heretofore have been almost entirely foreign, including competition, managed care, customer focus, quality improvement, and cost-effectiveness. Out of necessity, American medicine, long focused exclusively on the biological sciences, has discovered business and economic sci-

Remodeling the House of Academe

In this issue ofThe Journal, Schroeder and colleagues¹engage in a far-reaching review of American academic medicine. They shower the academic establishment with kudos for its performance in biomedical research, in the development and application of technology, and in progress against specific diseases, and also give us good marks for efforts in screening for preventable disease, in health services research, and in innovations in health care provision. On the other hand, the authors take us to task for our performance in matters of health status, health care costs, quality, manpower mix and distribution, and long-term care and disability and as a training ground for other countries. They argue that because the academic medical center has done well and has received its share of the public purse, it now behooves it to expand its horizons to encompass the problems of the public health; cost control; access for the poor,

Careers in Academic Medicine

American academic medicine faces a crisis as we move toward the 21st century. Some of our most talented young physicians are avoiding an academic career because of the perceived stressful nature of such positions. Competition for grant funding, long hours of patient care, administrative demands, and heavy teaching schedules have discouraged these potential academicians. In the 1960s, medical schools sought to fill faculty positions with so-called triple-threat men: individuals who were original and productive investigators, inspired teachers, and compassionate, practicing physicians. Since that time, medical school faculty have felt compelled to strive toward this ideal. The outcome, however, is often less than ideal. Physicians who are truly outstanding in one of these three areas feel compelled to excel in all three, but sometimes they end up excelling in none. Moreover, job and personal in academic medicine have declined as these faculty members realize that they are not achieving their desired