In the palace of the sultan
Authors: Barbara L. Weber
Journal: Journal of Clinical Investigation (2007)

It is a rare privilege to stand in front of this group of distinguished physician-scientists today. I admit to feeling more than a little awed by this privilege for several reasons. First, as has been noted by many previous Presidents quaking in their boots up here, this podium has been host to legends — including some of my own personal heroes. I am deeply humbled to stand in the place of people like John Merrill, Eugene Braunwald, Stu Orkin, Rick Klausner, David Ginsburg, Ed Benz, Joe Goldstein, Bill Kelley, and many others who have been true leaders of American medicine. Secondly, I believe this privilege confers on me a responsibility to use this time to say something original, meaningful, and hopeful. Finally, who am I to be here at all? When I was elected, I was a Professor of Medicine at the University of Pennsylvania, an academic clinical investigator. But now, I work for a drug company. Not wanting to rehash the rancor around this topic that erupted at last year’s Joint Meeting, I will only say that wherever my paycheck comes from, I am physician-scientist to the core. I am single-mindedly committed to doing clinical research with the potential for clear and immediate impact on patients and their families, guided only by the needs of those people. This is what I did when I was at Penn, and this is what I do now at GlaxoSmithKline. My laboratory group at GSK works to identify the patients most likely to benefit from new targeted cancer therapies in development, and my clinical group designs and executes the clinical trials to evaluate those drugs. It’s one of the coolest clinical investigation jobs in the world. 

To point two, the topic of my presidential address, I found to my dismay that many of the themes I had in mind had not only been raised before, but in fact had been discussed so many times that I began to wonder what happened to the imaginative spirit of some of the world’s greatest clinician scientists when they became Presidents of the ASCI. In fact, David Ginsburg, on the occasion of his ASCI Presidential Address (1), graphed the topics covered, and, not unexpectedly, the “Big Five” are 1) The Future of the Physician Scientist (said to be in dire need of rescue to avoid immediate extinction in most Addresses since the society was chartered in 1908), 2) Defining Clinical Science (hotly debated annually by every ASCI Council in the history of the society during review of membership nominations), 3) The State of the ASCI (said to be on the verge of collapse since just shortly after its formation ninety-nine years ago), 4) Education and Mentoring, and 5) Research Funding (an unavoidable topic when two or more physician-scientists are in the same room for more than five minutes). So I gave up on original, and I strive only for meaningful and hopeful. 

Today I would like to discuss three issues in academic medicine that I believe are having a serious negative effect on the pace and quality of academic clinical investigation. Some may seem minor on the surface, some are more obviously substantial, but all three are things that I believe ASCI members can help to change, individually and collectively, and in so doing can make a real difference in our ability to do what we do: find new ways to help patients through our research. These three issues are 1) the cost to creative time of “feeding the beast” of the academic bureaucracy; 2) the innovation-squelching nature of the current peer-review system, and 3) the loss of physicians with a passion for clinical investigation as the leaders of academic medical centers. The tasks and energy required for investigators to survive, to say nothing of flourish, in the face of these problems leave everyone spending far too much time doing things that contribute very little to important, clinically relevant research.