Academic medicine: time for reinvention

Editor—Clark and Smith announce a crisis in academic medicine and call for an international campaign to re-establish its credentials.¹ This assertive policy marks a turning point for a discipline that has to date adopted a defensive posture in the developing healthcare environment.²

Unlike healthcare research, where the impact on service delivery has been minimal, research in academic medicine has delivered many important innovations. But, unfortunately, academic research still reflects a store in which researchers are busy filling shelves with a comprehensive set of all possible relevant studies that a decision maker might some day drop by to purchase.³ The endeavour is characterised by a voluminous literature, invariably driven by the dictates of funding spirals and accreditation exercises and, in many cases, irrelevant to the efficient production of health against a background of limited public resources.

Figure 1.

Credit: ST BARTHOLOMEW'S/SPL

This retail perspective on research overlooks two important economic insights.

Firstly, life is lived on an exponential curve. The law of diminishing marginal returns means that increments in benefit become smaller with additional increments of resource allocation. As the pharmaceutical sector is beginning to discover, the flat portion of the curve may have been reached in medical research.

Secondly, the principle of opportunity costs means that an investment should be valued in terms of its next best opportunity forgone. Although medical science has had many spectacular successes, its contribution is secondary when compared with behavioural and environmental factors.⁴,⁵

The resources that Smith and Clark argue for so passionately may produce greater health gain if diverted into areas other than health care. We need to start winding down investment in academic medicine, not talking it up.