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Despite declining numbers of PhD and MD investigators at hospitals and stagnant federal funding, experts are cautiously optimistic about the future of innovative research at teaching hospitals.
"There is a need for people who understand both the research and clinical worlds, and that will continue through the year 2010," said Dr. John A. Parrish, MD, a professor in the Harvard-MIT Division of Health Sciences and Technology (HST) and professor and chairman of the dermatology department at Harvard Medical School. "Innovation will be a necessary survival criteria for academic health care centers."
Dr. Parrish spoke at a March 12 panel discussion entitled "The Roles of MD and PhD Investigators in the Teaching Hospital of 2010." The panel was part of the 1997 HST Forum of the Harvard-MIT Division of Health Sciences and Technology. The Harvard/MIT program has about 300 graduate students and about 150 core and affiliated faculty members.
The other two panelists were Dr. Richard Johns, professor of medicine at Johns Hopkins University and distinguished service professor of biomedical engineering, and Dr. Arnold Relman, editor emeritus of the New England Journal of Medicine and professor of medicine and social medicine emeritus at the Harvard Medical School.
The number of research MDs in research-intensive departments of hospitals, such as the department of medicine, has declined from 3,000 in 1986 to 2,000 in 1993, according to Dr. Joseph Bonventre, associate director of HST and the panel's moderator.
"There has been a significant dropoff in research MDs in departments of medicine, and a parallel trend can be drawn with research PhDs in hospitals," he said. "The question is, will the students in our programs in 2010 find positions in hospital medical departments?"
Dr. Parrish attributed the decline in the number of hospital-based researchers to two factors.It is harder to do science because research procedures have become more rigorous. And second, it is harder for people to work in both the research and clinical worlds, he said.
Dr. Parrish, who also is director of the Massachusetts General Hospital-Harvard Cutaneous Biology Research Center, said that when the center first started about eight years ago, six of the seven principal researchers were MDs. But years later, when the lab had grown to 10 researchers, only two were MDs.
"They couldn't keep up with their clinical duties and do the work for peer-reviewed funding," he said. "We miss the MDs. Technology must be driven by the people who understand the problems."
Dr. Parrish sees new opportunities for hospital-based biological researchers emerging, especially in the areas of minimally invasive techniques and lower cost technologies.
"High technology (to date) has enabled us to take better care of fewer people for more money. So there's something we're not doing right," he said. "People who understand technology and medicine, like those in HST, will guide health care to make it less expensive and available to far more people."
Dr. Relman agreed, adding that clinical health care became so expensive that funds for research simply ran dry. "Things are going to get worse before they get better because of the lack of funding," he said.
Dr. Johns said industry will not be able to make up for the shortfall in federal funding. "It's not doom and gloom, but it will be increasingly competitive to get funding."
A version of this article appeared in MIT Tech Talk on March 19, 1997.