The Academic Emperor

The economics of academic medicine are THE "third rail" topic. It leads to a lot of hidden costs to and hiding of costs by academic physicians and their families. To publicly ask about it during, for example, contract negotiations, leads quickly to the pregnant pause that implicitly asks the question "are you sure you're really in this for the right reason?" Obviously a nice "out" for the department chair. And yet, fundamentally, bills need to be paid. Hidden "moonlighting" is common among junior (and senior) faculty members, who do it under a sort of "don't ask, don't tell" policy. The moonlighting morphs as faculty move up to become extensive medico-legal, pharmaceutical, or investment "consulting" - all done in addition to the ever-spiraling and time-consuming "pro-bono" work (study sections, manuscript reviews, society work, etc) that further erases an academician's time for free-thinking, creative scientific inquiry. This is a MAJOR issue which, though not to be spoken of "in polite company," leads to an erosive hypocrisy which flies in the face of nominal academic honesty and integrity. This issue should be taken seriously by academic leaders, but will only be so when honesty prevails over wishful thinking and averted eyes.

See www.jci.org/cgi/content/full/117/6/1727 for a very interesting discussion on some of these issues. It is the 2007 American Society for Clinical Investigation Presidential address, by Barbara Weber, a prominent oncology clinical trialist who recently moved from U Penn to GSK where she is VP of Oncology Discovery and Translational Medicine. One is left wondering if the "sultan," like the emperor, may be a bit less well-dressed than he (or she) would like to think.