Balancing the Ethical with the Financial in Medical Research Funding

By Philip A. Cola

The United States government allocates billions of dollars annually to training physician scientists and funding medical research. But what are the ethical and motivational considerations of the scientific knowledge transfer necessary to advance the clinical practice of medicine, known as translational medicine? Naturally, when we or a family member gets sick, we want the best-trained physician scientists and the most advanced treatments available. Indeed, there is a greater need for health care services and dissemination of scientific discovery than ever before. Unfortunately, the outcomes of these studies come at an unusually heavy societal cost.

Improved science and advanced technologies increase treatment demand—but results don’t come quickly: It takes 17 years to translate 14 percent of research findings into clinical practice. Although partially due to government-mandated regulatory processes to protect human and animal subjects, the vast majority of studies end up on the cutting-room floor, unable to be replicated or not as novel as originally thought.

Even after medical advances are incorporated into patient care, many patients don’t benefit because of high initial costs. This poses a moral challenge for academic medical centers: Medical advances move so slowly down the pipeline that those who might benefit most can’t afford them. Although the current economic climate in AMCs elevates business interests to meet rising health care costs, this approach challenges physician scientists by emphasizing clinical revenue generation over patient care innovation. It is our ethical obligation to find ways to help physician scientists be more efficient and improve health care for society.

We must keep in mind that physician scientists are people too. Despite extensive training and highly technical skill sets, my research shows that they rely strongly on mentorship, collaboration, and support to consider themselves “successful.” Stressors such as work–life balance, demands for increased productivity, and reduced funding can cause the physician scientists working in your academic medical center to feel that they lack organizational support. My research also shows that this feeling causes them to be more cynical, and to forget that their earlier definitions of success were based on genuine care and concern for others.

It’s crucial that AMC leaders understand and acknowledge the importance of “relational capacity” for physician scientists: their personal relationships that reinforce caring and concern for others. This capacity is essential to reframing the translational medicine process so that the greatest good can be achieved for the greatest number of people. We must reframe success so that scientific and medical advances are based on actions—treating the greatest number of people with the most advanced technologies and treatments—and not on institutional motives—revenue for AMCs or profits for insurance and drug companies.

The physician scientists themselves are the true drivers of this proposed paradigm shift. They are uniquely positioned to translate scientific knowledge for the advancement of the community practice of medicine without answering to corporate shareholders, business strategies, or market utility.

AMCs and physician scientists must partner to generate beneficial consequences to patients and society. With proper institutional support, coaching, and education in navigating regulatory hurdles, physician scientists can conduct work that will benefit patient care; and which can lead to added economic benefits for the AMC. It also should result in advanced health care options for “no-option patients” through effective translational medicine.

It’s simple, really: The more satisfied physician scientists feel in their role, the more likely they are to advance the practice of medicine to benefit their communities and society as a whole.

Philip-ColaPhilip A. Cola is vice president for research and technology at University Hospitals Case Medical Center and an Adjunct Assistant Professor in the School of Medicine at Case Western Reserve University in Cleveland, Ohio. He is also a doctoral candidate in the Weatherhead School of Management at Case Western Reserve University, where he is a non-profit research fellow. He can be reached at philip.cola@uhhospitals.org.

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