The Role of Academic Research in Medical Developments

1
The Role of Academic Research in Medical
Developments George P. Chrousos, Athens
University Medical School, Athens, Greece
2
Oh let me lead an academicke life B Hall,
Ad Virginem 1599IV 83
3
Academic Medicine A Faltering Engine BMJ
2002 Clinical Academic Medicine in Jeopardy
The Academy of Med Sciences Academic Medicine
in Crisis Med Educ 2004 Academic Medicine
Resuscitation in Progress Can MAJ 2004 The
Problem with Academic Medicine Engineering our
Way into and out of the Mess PLOS Medicine
2005
4
The Role of Academic Research in Medical
Developments
Definitions Current status Changing
priorities Instability Reformation
5
Give your assistance to all.. for the love of
mankind and for the love of the art
Hippocrates
6
The purpose of any scientific inquiry is to find
the truth
7
Clinical medicine employs Aristotelian logic and
is, in fact, patient-oriented scientific
inquiry
8

Medical research has become biomedical research.
Discovery flows from bench to bedside and vice
versa.
9
Biomedical Research
Basic Clinical (face-to-face)
-Opportunistic or Planned
-Translational Epidemiologic
10
The University Medical School
Clinical Practice Teaching Research
11
The Role of Academic Research in Medical
Developments
Definitions Current status Changing
priorities Instability Reformation
12
Share of Total RD Spending 1990-1992
EU 15 36.4 USA 44.2
Japan 17.6
13
Share of Pharmaceutical Patent Grants 1969-1994
EU15 24 USA
54.6 Japan 14.7
14
RD Expenditures at US Universities 2005
Federal Government 29.0 billion State
Governments 2.9 billion Industry
2.3
billion Institutional 8.2
billion Other sources 3.0
billion
15
Federally Financed RD at US Universities 2005
Johns Hopkins U 1.277.000.000 Columbia
U 453.000.000 Harvard U 395.000.000 U
Maryland 129.000.000
16
RD Expenditures at US Universities 2005
Johns Hopkins U 1.440.000.000 Columbia
U 535.000.000 Harvard U 447.000.000 U
Maryland 304.000.000
17
Global Pharmaceutical Sales(320 Billion in 2000)
US in Billions
12 Annual Growth
Source IMS Health
18
RD INVESTMENTS BY 15 PHARMACEUTICAL
COMPANIES1996-2000
Wood McKenzie 2001, Pharmaceutical company reviews
19
Pyramid of Progress
Therapeutic AgentWorks
Clinical Trial
Clinical RelevantPreclinical Trials
Phase I Animal Trials
Focused In Vitro/In Vivo Studies
Basic Sciences
20
Top 10 US Granting Foundations 2003
Gates 235.000.000 Reynold
s 54.000.000 Starr
31.800.000 Whitaker
25.400.000 Dana
18.800.000 Burroughs Wellcome
17.900.000 Avon
17.000.000 Moore
15.000.000 Finn
15.000.000 Abrahamson
15.000.000 JAMA2005
21
Biomedical Research Productivity EU vs. USA
1994-2004
EU15 USA Population
375 278 GDP 9374 8930 GDP
RD 1.9 2.7 Citations 1.394.000
2.380.000 Papers/1000 3.7 4.9 Papers/bil
RD 764
563 Citations /bil RD 1723
2665 BMJ 2005
22
Researchers
EU 5 per 1000 USA 9 per 1000
Japan 10 per 1000
23
The Role of Academic Research in Medical
Developments
Definitions Current status Changing
priorities Instability Reformation
24
(No Transcript)
25
The Role of Academic Research in Medical
Developments
Definitions Current status Changing
priorities Instability Reformation
26

Current instabilities in academic
medicine Drivers of change in academic
medicine
27
..ep?st?µ? ??????µ??? a?et?? pa??????a ?? s?f?a
..

• ..science without virtue is evil
• ???t??, 5cent BCE
• ?e???e??? 247a

28
The Role of Academic Research in Medical
Developments
Definitions Current status Changing
priorities Instability Reformation
29
The improvement of childrens health depends on
research and provision of health care demands a
culture that constantly questions and revises
A. Aynsley-Green, Arch. Dis. Child. 78 101, 1998
30
91 Successful Inventions
Inventions are made every day, but not all of
them meet with the same sweeping success as the
following

• 1931Alkaseltzer
• 1931 hair colour to use at home
• 1931 electric shaver
• 1931 stereo amplifier
• 1931 tampons
• 1931tape record ( invented by AEG, Germany)
• 1931LP record
• 1933laundry powder
• 1935colour film
• 1935 garbage disposal
• 1937 electric blender
• 1938 Teflon
• 1938 photocopier
• 1939 nylon stockings
• 1937 jet-propelled aircraft
• 1940 electric kettle
• 1941 elastic
• 1941 wrinkle-free textiles
• 1942cake mixes

• 1900 portable camera
• 1900 paper clip
• 1902 dog biscuits
• 1902 teddy bear
• 1902 vacuum cleaner
• 1903 safety razor
• 1907 baking powder
• 1908 model T ford,(first mass-produced car)
• 1910 electric stove
• 1910 washing machine (with crank)
• 1912 luminous advertising
• 1912vitamins discovered
• 1913zipper
• 1914 bra
• 1916 tennis shoes
• 1916loudspeaker
• 1919electric toaster
• 1920 paper handkerchiefs
• 1920 sliced bead

• 1954 Domestic dishwasher
• 1954 Frozen food
• 1955 Vaccine for polio
• 1955 Transistor radio
• 1956 Correction fluid
• 1957 Frisbee
• 1958 Hula Hoop
• 1959 Barbie doll
• 1960 Pantyhose
• 1960 Tylenol (painkiller)
• 1960 The Pill
• 1961 Soft contact lenses
• 1963 Cassette recorder
• 1963 Canned Coca-Cola
• 1963 Touch-dial telephone
• 1963 Metal tennis racket
• 1964 Fax machine
• 1969 Quartz wristwatch
• 1970 Skateboard

Sources "Bild Zeitung"/" The people's Almanac
Presents the 20th Century"
31
Life Expectancy (1998)
  75-80
  70-75
  65-70
  60-65
  55-60
  under 55
  NA
32
(No Transcript)
33
Age adjusted death rates for CAD by country and
sex, age 35-74 (British Heart Foundation,
Statistics Database 2003)
34

• It is good to take care of the sick for the sake
  of their health. It is even better to take care
  of the healthy for them not to become sick.
  
• Hippocrates

35
Academic Research and Medical Developments-Conclu
sions
-Has almost single handedly led to the success
and growth of the health sciences -Has palliated
human pain and increased human longevity, but
also the morbidity of abundance and old age -Has
increased health-related expenditures -Has
allowed globalization to occur -Is threatened by
the products of its own success -It must be
supported for the good of mankind