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Public and private money needed to stop ‘physician brain drain’
Mailbox The Clinical Investigator Award – promoting patient-related research Your August 1 editorial (Lancet Oncol 2001; 2: 459) on the declining numbers of clinical investigators refers to educational debt as one of the reasons why medical school graduates are not entering the research arena. I agree. According to the Association of American Medical Colleges, 81% of medical students graduating in 2000 had educational debt, and the average debt was a shocking US$ 95 000. With this enormous burden, it is not surprising that these graduates are choosing more lucrative careers in clinical practice, rather than dedicating themselves to research. In response to this serious problem, David Livingston, Samuel
Silverstein, and I together with other scientists on the Board of Directors of the Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation designed an award to encourage promising young physicians to conduct patientoriented research. With support from Eli Lilly & Company, we established a Clinical Investigator Award that targets young clinical investigators conducting patient-related research. In addition to funds for the junior faculty investigator, the project, and partial support for a faculty mentor, the award includes medical school debt repayment of up to US$ 100 000 per awardee. This scheme has served as a model for
other grant-making organisations. Our efforts are not enough, however. Several months ago, Congress gave the National Institutes of Health (NIH) authority permission to provide loan repayment for clinical investigators. We urge the NIH to move rapidly to implement a substantial programme to help ensure that greater numbers of physicians will be available to translate scientific breakthroughs into new treatments for all diseases. Richard J O’Reilly Chairman, Department of Pediatrics Chief, Marrow Transplantation Service Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York NY 10021, USA.
Public and private money needed to stop ‘physician brain drain’ Your recent editorial on the unresolved crisis in clinical research shed needed light on why fewer and fewer physicians – particularly recently trained physician scientists – are pursuing clinical research. As someone who has committed the better part of his professional life to new cancer drug discovery and development, this ‘physician brain drain’ is of serious concern. I fear that it is a worrisome prognostic marker for the future of medical science and for our efforts to find new treatments. In calling for large-scale and longterm policy changes, you say that
current grant programmes and awards are important, but are not enough to reverse the downward trend. I agree, but with the caveat that neither the public nor private sectors can reverse the decline in the number of clinical investigators by their independent action. We need the active involvement of both. Earlier this year, Eli Lilly & Company made the second installment of a US$ 15 million grant to the Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation to give outstanding young physicians the time and resources they need to perform
clinical research. Will this grant by itself solve the physician brain drain? No. Is it a positive and important step? Yes. But, in order to reverse this dangerous trend, the private and public sectors need to work together to address the issues that are preventing outstanding young physician scientists from pursuing careers in clinical research. Ultimately, this is an issue that affects the global community of cancer research. Homer Pearce Vice President, Cancer Research and Clinical Investigation, Eli Lilly & Company, USA.
Euthanasia: to kill or not to kill? In the Forum debate on assisted suicide and cancer in the March issue of The Lancet Oncology,1 Dr Gunning condemned the Dutch euthanasia law. Among other arguments, he focused on the role of doctors and the potentially dangerous consequences of legally allowing doctors to kill people. Yes, doctors are powerful people – they have the power to affect life and death. In this respect I agree with THE LANCET Oncology Vol 2 September 2001
Gunning. But equating euthanasia with murder as a means of population control, either supported by economic arguments or with the aim of creating a ‘healthy society’, is a demagogic trick to discredit the debate on this difficult issue. The key point separating the Dutch rationale for euthanasia from this type of argument is that the patient must voluntarily request physician-assisted suicide and permission must be sought.
In addition, Gunning supports his arguments with a misleading interpretation of the results from two unique research projects in the Netherlands, carried out during 19902 and 1995.3 Both these studies showed that medical decisions (like pain-relieving treatment and refraining from further treatment) accounted for some 45% of all deaths, but only 2.3% could actually be described as euthanasia.2,3 The 531
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Silverstein, and I together with other scientists on the Board of Directors of the Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation designed an award to encourage promising young physicians to conduct patientoriented research. With support from Eli Lilly & Company, we established a Clinical Investigator Award that targets young clinical investigators conducting patient-related research. In addition to funds for the junior faculty investigator, the project, and partial support for a faculty mentor, the award includes medical school debt repayment of up to US$ 100 000 per awardee. This scheme has served as a model for
other grant-making organisations. Our efforts are not enough, however. Several months ago, Congress gave the National Institutes of Health (NIH) authority permission to provide loan repayment for clinical investigators. We urge the NIH to move rapidly to implement a substantial programme to help ensure that greater numbers of physicians will be available to translate scientific breakthroughs into new treatments for all diseases. Richard J O’Reilly Chairman, Department of Pediatrics Chief, Marrow Transplantation Service Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York NY 10021, USA.
Public and private money needed to stop ‘physician brain drain’ Your recent editorial on the unresolved crisis in clinical research shed needed light on why fewer and fewer physicians – particularly recently trained physician scientists – are pursuing clinical research. As someone who has committed the better part of his professional life to new cancer drug discovery and development, this ‘physician brain drain’ is of serious concern. I fear that it is a worrisome prognostic marker for the future of medical science and for our efforts to find new treatments. In calling for large-scale and longterm policy changes, you say that
current grant programmes and awards are important, but are not enough to reverse the downward trend. I agree, but with the caveat that neither the public nor private sectors can reverse the decline in the number of clinical investigators by their independent action. We need the active involvement of both. Earlier this year, Eli Lilly & Company made the second installment of a US$ 15 million grant to the Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation to give outstanding young physicians the time and resources they need to perform
clinical research. Will this grant by itself solve the physician brain drain? No. Is it a positive and important step? Yes. But, in order to reverse this dangerous trend, the private and public sectors need to work together to address the issues that are preventing outstanding young physician scientists from pursuing careers in clinical research. Ultimately, this is an issue that affects the global community of cancer research. Homer Pearce Vice President, Cancer Research and Clinical Investigation, Eli Lilly & Company, USA.
Euthanasia: to kill or not to kill? In the Forum debate on assisted suicide and cancer in the March issue of The Lancet Oncology,1 Dr Gunning condemned the Dutch euthanasia law. Among other arguments, he focused on the role of doctors and the potentially dangerous consequences of legally allowing doctors to kill people. Yes, doctors are powerful people – they have the power to affect life and death. In this respect I agree with THE LANCET Oncology Vol 2 September 2001
Gunning. But equating euthanasia with murder as a means of population control, either supported by economic arguments or with the aim of creating a ‘healthy society’, is a demagogic trick to discredit the debate on this difficult issue. The key point separating the Dutch rationale for euthanasia from this type of argument is that the patient must voluntarily request physician-assisted suicide and permission must be sought.
In addition, Gunning supports his arguments with a misleading interpretation of the results from two unique research projects in the Netherlands, carried out during 19902 and 1995.3 Both these studies showed that medical decisions (like pain-relieving treatment and refraining from further treatment) accounted for some 45% of all deaths, but only 2.3% could actually be described as euthanasia.2,3 The 531
For personal use. Only reproduce with permission from The Lancet Publishing Group.