RESOURCES, RISK, & REWARD


Balancing Money and Biomedicine
An academic physician's ambivalence

By Samuel C. Dudley, Assistant Professor, School of Medicine


Join the discussion
What's your opinion of post-tenure review at Emory? Should internal resources such as University Research Committee grants be closed to senior faculty? Can Emory support its faculty without reducing the motivation to push the envelope?

Resources, Risk & Reward
Getting what you need as a faculty member

I could do some things here that I couldn't do at other established seats of power
Carol Worthman, Samuel Candler Dobbs Professor of Anthropology and director of the Laboratory for Comparative Human Biology

If Charles Darwin had wanted to be comfortable, he never would have taken the voyage on the HMS Beagle.
Kim Wallen, Samuel Candler Dobbs Professor of Psychology and Behavioral Neuroendocrinology

Keeping the Passion and Keeping a Job
Is post-tenure review a faculty development tool or a lurking threat?


Academic Exchange September 1999 Contents Page

Few companions accompany us on our attempts to climb our individual, intellectual Everests as scholars. The cherished diversity and depth of scholarship leave a vacuum of universally applicable benchmarks with which to measure our progress. Money fills that gap.

Monetary standards are easily codified, can be universally applied, give the impression of objectivity, evoke a sense of possession, and are transferred easily from source to user. The alternative measure, less stable and tangible, is trusting a necessarily subjective process of collegial evaluation.

What dangers can scholarship face from money? Have we become so inured to the benefits of money that we are ignoring potential pitfalls? Those of us in academic medicine and biomedical research daily face difficult choices concerning money, and these pressures are putting academic medical centers on the endangered species list.

One of those choices is how academic physicians use every minute of their day. Time is critical to inventive thought. Yet the opportunity costs are high for an academic physician who spends time in thought. Patients could be seen. Social utility could be increased. Bills could be sent. Assets could accrue.

I call this logic and its outcome "clinical creep." In the extreme, clinical creep has led some institutions to require that physicians "buy back" time for pursuits external to their service mission. These opportunity costs eat away at institutional support for academic creativity. Without a university commitment to fund part of their salaries in return for contribution to the academic endeavor, physicians cannot afford time for scholarship.

Other choices are more subtle. In part, the high turnover of assistant professors in academic medicine is due to commercial opportunities that generally offer considerably larger and more secure incomes for doing the same job. In addition to private practice, they often turn to similar pathways that universities inadvertently open--university-managed clinics and hospitals run in the private enterprise model. Assistant professors with weak links to the academic mission are usually the first to go.

The non-physician bioscientist cannot rest unperturbed, either. Because it addresses the basic, human, primal fear of mortality, bioscience has become flush with public money. This money has been put to creative and extraordinary use, but the achievements have hidden some controversial choices. The rapid proliferation of biomedical research has led to an equally rapid rise in soft-money positions and indirect costs. People in soft-money positions can contribute a great deal to the academic village, but embracing these positions can lead universities down the slippery slope of limited and overextended commitments.

Another potential flash point is indirect cost funds. These funds are paid by the granting agency to the institution to secure the researcher's basic requirements--work space, telephones, office supplies. Indirects are difficult to ascribe to a single investigator, and they are intended to further the scope and depth of scholarship. Nevertheless, if the institution metes them out without care, these funds can engender monumental battles that injure the communal sense of distributive justice, disturbing the concord necessary for scholarly thought.

The grant funding process brings constraints with its benefits. Writing grants means less time to do the work. Granting agencies demand that proposals specify in detail an investigator's intentions, methods, anticipated findings, and relevance to disease treatment. An investigator's prior efforts heavily influence the likelihood of obtaining a grant. This test of feasibility, funding for junior colleagues' salaries, and other obligations reduce an investigator's risk tolerance. But this fear of risk also lessens the possibility of revolutionary discoveries, which often come from taking on tasks perhaps thought to be nearly impossible.

On many levels, cooperation between industry and university serves the commonweal, but funds from industry necessarily come with encumbrances that can harm the academic enterprise if the goals are not closely aligned. Scholarly work is often less immediately profitable than more pragmatic goals. For all the good it might reveal for patient care, one company-designed clinical trial requiring limited intellectual commitment can be much more financially profitable than several hard-won grants. With attention so diverted, many worthy but less immediately fruitful lines of investigation will wither from neglect.

Of course, money powers the academic enterprise. The issue is balance. Have we arrived at the balance of money and scholarship, or have we made a Faustian compact to satiate our appetence for money? In Tennessee Williams's The Glass Menagerie, Jim offers one answer, saying, "Knowledge--Zzzzzp! Money--Zzzzzp! Power! That's the cycle democracy is built on!" The proper academic equation is the reverse of Jim's, where power and money serve knowledge or scholarship and where we are judged by these endpoints. Richer, bigger, and better are not necessary bedfellows, and we must not fear making scholarly choices about money.

Samuel Dudley is an assistant professor of medicine and physiology in the Division of Cardiology. He is also on the staff of The Atlanta Veterans Affairs Medical Center.