Academic Medicine: The Heart and Soul of Health Care, Today and Tomorrow
It's easy to find fault with America's fragmented and bloated health system.
Chief among the parade of now-popular complaints is that it's too expensive. We're slipping behind other developed nations on measures of wellness. And though the Affordable Care Act has dramatically improved our uninsured rate, not everyone has access to quality care.
Those are formidable problems, to be sure, said Nancy Andrews, M.D., Ph.D., dean of the Duke University School of Medicine, delivering the annual Benning Society Public Lecture on Medicine at the University of Utah. But less appreciated is just how far medicine has come in the last half-century.
There have been more medical advances since World War II than in all of history – achievements driven by basic research at academic medical centers, which must rise again to solve the problems vexing health care today, Andrews said. “The goal is clear. We need to get better, less expensive care to more people. . . .I believe academic medicine should be leading the changes, and will be at least as important in its second century as it has been in the first.”
Prior to the development of academic medical centers, medicine was more art than science. That changed in 1910 with publication of the Flexner Report, which recommended “medicine and medical education be based on analytical thinking and science, something we now take for granted,” Andrews said.
Twenty years later, in 1930, the National Institutes of Health (NIH) was created to support medical research, primarily within its own walls at first. But with a major funding boost just after World War II, the NIH became a broader grant-making entity, giving rise to a national corps of academic biomedical researchers that today remains “the envy of the world,” Andrews said. “I believe Max Wintrobe [a hematologist and one of the founders of the U.'s medical school] received the first NIH research grant awarded.”
Academic centers were the genesis of modern health care and still provide a quarter of the country’s health care and majority of specialty care, though they account for just 6 percent of U.S. hospitals, Andrews said.
They were also the cradle of a half-century’s worth of medical advances. Among them, said Andrews, are vaccines that have safeguarded millions of children against diseases, such as polio, hepatitis A and B, measles, mumps and pneumococcal pneumonia. CT scans, MRIs and more than 5,000 new drugs were developed. It became possible to transplant hearts, lungs, limbs and hands. CPR was invented, along with surgical techniques and blood thinning drugs that preserve heart tissue in heart attack patients.
“Yes we have big problems in health care. But we also have good experience solving big problems,” Andrews said.
Only through research can data trump individual judgment, and guide providers in getting the right interventions to the right patients at the right time, and for the right price, she added. Getting there will take creativity. Today there are more researchers then there is NIH funding to support them, requiring medical centers to right-size labs, find faster, cheaper paths to discovery, and turn to private funding streams.
But increased government support must be part of the solution, said Andrews, bemoaning the 25 percent decline (after adjusting for inflation) in NIH funding over the last 12 years. “Basic science is the seed from which other types of research eventually grow. President Reagan called it one of the most practical things government does,” she said. “And there has never been a better time to be in biomedical research . . . . We can now peer into the inner workings of cells, and extract valuable information from genomes in ways that were unimaginable only a few decades ago.”
The next few years will be difficult, and no one has all the answers, she acknowledged. “In spite of these challenges I am very optimistic that we will end up in a much better place.”
When Andrews, M.D., Ph.D. joined Duke in 2007 she earned the distinction of being the first woman dean of a top 10 medical school. A pediatric hematologist/oncologist and prolific researcher, she led Duke’s medical school through the historically challenging financial crisis of 2009, and continues to adapt and advance its mission at a time of unprecedented change in health care.
Kirsten Stewart is a Senior Writer for University of Utah Health Sciences
