Writer Deborah Gesensway described several problems related to sustaining a career in academic clinical research. ("Is there a crisis looming in clinical research?" May ACP Observer.) Another underlying crisis that was not highlighted enough in the article involves the education of medical students.
The article pointed out that an assistant professor of medicine and pediatrics at Harvard Medical School receives only 20% of his salary from the institution and thus must generate the other 80% from "outside grant funding." His successful NIH grant will provide an additional 25% for the next three years, making up a total of 45% of his salary.
Medical schools are caught in an irrational conundrum in which economic pressures affect and distort the goal of medical education.
—Lawrence R. Freedman, FACP
Where will the rest come from? Wherever the remaining funds are found, that financial pressure will inevitably leave him precious little time to teach medical students. Yet clinical investigators are the backbone of medical student clinical teaching, while clinical learning is rooted in spending time and making rounds with clinical investigators. The absence of such a crucial exchange is a lamentable omission in medical education.
Medical schools are caught in an irrational conundrum in which economic pressures—necessary to engage faculty—affect and distort the accomplishment of their primary goal, which is to teach medicine. I believe it is time we focus much more attention on this crisis.
Lawrence R. Freedman, FACP
Drug safety reporting
I was surprised to find that the recent article regarding drug safety failed to mention the responsibility physicians have to report suspected adverse drug reactions either to the manufacturer or to FDA's MedWatch. ("Drug-safety issues spur debate over monitoring," March ACP Observer.)
Our responsibilities are not restricted to reporting only events associated with prescription drugs. Adverse events can also be associated with the use of a biological product or a medical device—and all such events can be reported to MedWatch. Drug, biologic and device manufacturers also have telephone contact numbers physicians can use to report events associated with using their products.
It is important for all physicians to consider an adverse event when assessing unexpected clinical events in the course of patient care, especially if their patient has recently started using a new product. The FDA receives about 15% of its adverse event reports directly, mainly from physicians. Having worked in the FDA's post-marketing review group, I know firsthand that safety reviewers give careful attention to physician reports.
Janet Arrowsmith-Lowe, FACP
Ruidoso, N. M.
The FDA adverse event reporting forms are available online and in the Physicians' Desk Reference. Physicians can also report an adverse event by calling the FDA at 800-332-1088 or faxing reports to 800-332-0178.
The recent President's column and "Washington Perspective" address the broad issues of access to health care in the United States. ("Balancing individual care with our social obligations" and "The president—and the College—address U.S. health care," March ACP Observer.)
Of the major issues detailed as policy directions for the College, the need to "[i]ncrease health care coverage" deserves special emphasis. It is increasingly clear that the approach that will most efficiently result in adequate health care for all Americans and reduce inefficiencies in the health care system would be some version of a streamlined single-payer system.
The College should continue to foster debate on the merits of various means to achieving that desired end. Anyone with a moral interest in health care should be working with Physicians For A National Health Program.
J. Julian Haywood, FACP
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