Inherit the Wind

Inherit the Wind

By

Leonard Zwelling

         What is academic
medicine supposed to be anyway?

         For those of my
generation of academic physicians, the essence of academia was the belief that
science could be applied to the study of human disease in such a fashion so as
to alter the natural history of that disease and perhaps even cure it. Academic
medicine was about using our brains and our compassion to help people,
especially the sick.

         Today, this sounds
obvious, but it wasn’t when I started my career and it certainly wasn’t when my
father-in-law, the late, great pulmonary pathologist Jerome I. Kleinerman
started his. When he was an intern, the use of antibiotics were just beginning.
Cancer chemotherapy was virtually unheard of. No growth factors or anti-nausea
meds. Heart and brain surgery were in their infancy. The age of medical
treatment mattering had just begun.

         Today, doctor and
patient alike expect modern medicine to make a difference in the natural
history of disease, even chronic diseases like coronary artery disease, diabetes,
hypertension, chronic obstructive pulmonary disease and yes, even cancer. More
than ever we do matter as physicians and more than ever the world looks to the
academic centers to make the new discoveries that increase the potency of our
therapeutic sleight of hand. Furthermore, we really need the public to believe
in us for only with that belief will come the cures and only with that belief
will come the public support for the research grants to make the discoveries
that lead to the cures possible. We cannot compromise these delicate
relationships of trust by the public in the fiduciary nature of our role to put
patients first and money second.

         But are we doing
that? No, we are not.

         From coast to
coast including the Third Coast, academic leaders are pressing their faculties
to discover, patent and keep private, their discoveries as a mechanism to
facilitate additional and novel revenue streams for the academic center. MD
Anderson is not immune to this.

The Bayh-Dole Amendment of 1980 got
this started by allowing discoveries made under NIH grants to be commercialized
by universities and every dean was looking for the next Gatorade.
Unfortunately, in the rush to patent our findings, we lost our souls, our
purpose and our bearings.

         In this spirit, I
am going to argue that since we poisoned our house ourselves, we can clean it
up. The Proverbs 11:29 verse about “troubling our house and inheriting the
wind” is apt for we have done just that.

         A quote from
Thomas Huxley that dates back to the opening of Johns Hopkins University seems
particularly germane:

Huxley told his audience
that science has 2 deadly enemies: men of business and the clerics. The former
represent “the practical” and the latter “faith.” For those interested in
nurturing education in science he warned us not to expect any peace from those
two groups. He also emphasized that a university must be independent of nepotism
and reject corruption. Its fame will “rest upon the character of its teachers
and scholars and not on its number of buildings.”

         And here is a quote from Benjamin Disraeli recently sent to
me:

“The health of the people is really the foundation
upon which all their happiness and all their powers as a state depend”

         This is turn
harkens to the Preamble of that greatest of all documents the US Constitution:

We the People of the United States, in Order to form a more
perfect Union, establish Justice, insure domestic Tranquility, provide for the
common defence, promote the general Welfare, and
secure the Blessings of Liberty to ourselves and our Posterity, do ordain and
establish this Constitution for the United States of America.

         Supporting
scientific biomedical research and providing health care for all Americans is
clearly “promoting the general welfare.”

         Folks, we
need to get back to first principles. Academic medicine is not there to make
money and faculty shouldn’t have their own companies sponsoring their research.
They should also not be keeping the results of that research private until it
is patented. It should be published for all to see and review—and repeat if
necessary. And most certainly, faculty and academic institutions should not
hold stock of companies whose research the institution will perform, especially
if that is clinical research.

         That’s just
common sense, but the one thing about common sense is that it is so uncommon—especially
on the top floors of Pickens at 1515 Holcombe.