[Summary] Preparing Physician-Scientists for an Evolving Research Ecosystem (Hirschtritt, Heaton, Insel 2018)
TLDR; Growing research opportunities funded by private companies can help physicians/scientists develop new diagnostics and therapeutics.
https://jamanetwork.com/journals/jama/fullarticle/2681496
TLDR; Growing research opportunities funded by private companies can help us develop new diagnostics and therapeutics. Many physicians gravitate away from research due to financial barriers, but private company support of research may help increase research opportunities and have it applied toward tech-enabled new therapeutics.
“Science needs physician-scientists who understand how to take foundational knowledge and apply it to develop novel therapeutics or policy decisions. Increasingly, their research, especially high-risk research in academia, may be supported by private sources, including philanthropy. Although positions in industry may be less stable and more subject to market forces than academic medical center–based research careers, physician-scientists in the private sector may explore diverse projects in multiple roles (including product development, regulatory affairs, bioassay design, marketing strategy, and policy drafting), particularly in larger organizations. The technology industry, a significant new entrant in the biomedical research ecosystem, offers biomedical researchers massive data sets with an opportunity to explore new diagnostics and therapeutics at a scale that is usually not approachable by academia.”
Because of the financial and structural challenges for a physician to pursue research, most pursue full-time clinical careers
“Aside from the research funding challenge, young physicians still must surmount multiple hurdles to pursue a research-predominant career, including prolonged training requirements with substantial undergraduate and medical education debt, challenges in finding and maintaining mentors, difficulty achieving work-life balance (particularly for dual-career households), and obligations to engage significant time in revenue-generating activities such as direct clinical care.4 Confronted with these challenges, many physicians with an interest in research choose instead to pursue full-time clinical careers with greater job stability and higher incomes than research grant–dependent positions.”
As private funding in research has increased, private companies should help facilitate research training of clinicians as well (for instance via rotations or fellowships).
“While NIH funding has not kept up with inflation over the past decade, investment from diverse private sources has increased substantially, notably, from biotechnology and pharmaceutical companies, technology companies, philanthropy, and foundations.5 From 1994 to 2012, as a proportion of the total research funding, private sources for US medical research increased from 46% to 58% (approximately $15.2 billion to $67.9 billion).5 Likewise, between 2011 and 2017, total venture funding for digital health ventures increased from $1.1 billion to $5.8 billion.6 Technology companies, both large and small, have entered into biomedical research, further expanding the role of the private sector.7”
“Should this increasing private sector role in research funding be matched by a commitment to research training, or should the NIH and academic medical centers serve as the only funding sources for preparing the next generation? Could a commitment from private entities to research training, from medical school through residency, help sustain, and even expand, the physician-scientist workforce? Such efforts could begin with research experiences (“rotations”) in private industry during (or perhaps even before) medical school. Later in their training, residents could engage in site-based internships. Examples include internships through the design and consulting firm IDEO in which residents engage in clinically relevant design projects, as well as summer or year-long research internships offered by industry sponsors such as Merck and Janssen, and foundations, such as the Allen Institute and the Howard Hughes Medical Institute’s Janelia Research Campus. Furthermore, the Icahn School of Medicine at Mount Sinai and Verily (Alphabet Inc’s life science research division) have formed a partnership in which a limited number of medical students spend 2 years engaged in a research fellowship at Verily, and MD-PhD students can choose to complete their thesis work at Verily.”
Private sector partnerships may improve biomedical research.
“Incorporating private-sector opportunities and experience into physician-scientist training may enrich and expand the scope of biomedical research. “
Although private sector careers are stigmatized as the “dark side”, physician-scientists may be able to apply their knowledge to develop new diagnostics and therapeutics in the private industry.
“Within this changing research ecosystem, prospective and early-career physician-scientists may perceive 2 distinct career paths: a publicly funded academic institution–based track or a track funded exclusively by the private sector, which some academics have stigmatized as the “dark side.” Biomedical advances depend on the strengths of both tracks. There are still significant gains to be made in basic science; compared with a career in the private sector, physician-scientists in academia may be more likely to explore topics that advance scientific foundational knowledge, to have more control over the direction and focus of their work, and to mentor the next generation of scientists. However, science needs physician-scientists who understand how to take foundational knowledge and apply it to develop novel therapeutics or policy decisions. Increasingly, their research, especially high-risk research in academia, may be supported by private sources, including philanthropy. Although positions in industry may be less stable and more subject to market forces than academic medical center–based research careers, physician-scientists in the private sector may explore diverse projects in multiple roles (including product development, regulatory affairs, bioassay design, marketing strategy, and policy drafting), particularly in larger organizations. The technology industry, a significant new entrant in the biomedical research ecosystem, offers biomedical researchers massive data sets with an opportunity to explore new diagnostics and therapeutics at a scale that is usually not approachable by academia.”
Public and private sector science can be symbiotic, but we have to watch out for financial conflicts of interest.
“Public sector and private sector science can (and perhaps should) be symbiotic. In an ideal system, biomedical science trainees would be offered meaningful exposure to both systems as well as career paths that blend funding mechanisms. However, impediments to the integration of privately funded career paths into physician-scientist training include introducing financial conflicts of interest between publicly funded training programs and for-profit companies, potential weakening or distracting from current physician-scientist curricula, complicating trainee funding mechanisms, and raising real or theoretical ethical issues regarding the goals of research endeavors (eg, financial gain vs improvements in human health).”