Constraints in federal funding, compounded by declining clinical revenue, jeopardize more than the nation's research enterprise.
These twin pressures have created a "hostile working environment" that erodes time to conduct research, "discourages innovative high-risk science" and threatens to drive established and early-career scientists out of the field. And this, in turn, undermines patient care, proclaimed deans of leading academic medical centers from across the U.S. The group commentary was published in Science Translational Medicine on Wednesday.
"For university medical centers to continue to make the enormous strides in advancing research and helping people prevent and combat disease, the nation needs to invest in research," said co-author, Vivian S. Lee, M.D., Ph.D., MBA, dean of the University of Utah's School of Medicine and senior vice president of health sciences. "As it stands already, university medical centers subsidize federally funded research. Moreover, universities have increasing administrative and bureaucratic burdens, and our clinical reimbursements, which have been used to help support research and teaching, are diminishing."
In it, the deans acknowledge the work of policy leaders who are looking for ways to streamline discovery and development of new therapies and medical devices through mechanisms like the 21st Century Cure Act now before Congress. They call for predictable and sustainable funding indexed to inflation, which they say is needed to strategically plan and adequately manage expenses.
"Due to extraordinary advances in the biomedical sciences, the medical research community has never been in a better position to advance the health of our patients," said co-author Robert J. Alpern, M.D., dean of the Yale School of Medicine. "Academic medical centers have invested extensively in research, in partnership with funding agencies such as the NIH. However diminished federal financing of research is preventing us from accomplishing the research and is creating an environment that will discourage the next generation from pursuing careers in biomedical research."
On average, universities contribute 53 cents for every dollar they receive in research support, and their share of the costs has grown faster than any other funding source (state governments, technology transfer, and philanthropy). Much of that money comes from clinical margins, which are shrinking under efforts to control health spending.
Proliferating federal regulations have added to the cost of research. Seventy member institutions of the Association of American Academic Medical Colleges spent $22.6 million just to comply with rules governing potential financial conflicts of interest.
"The frightening truth is that America will soon forfeit its preeminence in biomedical science. As a country, we have already fallen to tenth in the world in our investment in research and development, and we are slipping further behind. Our academic medical centers have led the way in finding treatments and cures for disease and there is much more work to be done. But we can't make progress if the federal government disinvests," said Nancy C. Andrews, M.D., Ph.D., dean of Duke University's School of Medicine.
Research funding needs to be a national priority, said Karen Antman, M.D., dean of Boston University School of Medicine and provost of Boston University Medical Campus.
"We cannot stand idly by and see our patients negatively affected by reductions in research funding. We need to act now, not only for our patients, but for our current and future physician-scientists whose research will ultimately benefit us all."
The commentary will appear as "Research in academic medical centers: Two threats to sustainable support" in Science Translational Medicine online on May 27, 2015
The lead author is Arthur S. Levine, M.D., at the University of Pittsburgh. Contributing co-authors are from University of Utah, Yale University, Duke University, Princeton University, Vanderbilt University, Case Western Reserve University, Albert Einstein, UT Southwestern, University Wisconsin-Madison, Columbia University, University of Pennsylvania, University of Chicago, Michigan State University, University of Maryland, University of Iowa, Washington University, and Johns Hopkins University.