approaches that use the new science of gene therapy. The opportunities for translation of information gained from molecular biology to health care delivery have never been greater, and they can be expected to increase at a dramatic rate, creating unique societal pressures on the ability of science, medicine, and other health professional groups to respond.

Tremendous advances in biology are opening doors to new therapies, creating numerous clinical research opportunities for evaluating the effectiveness of current or standard therapies. When numerous treatment regimens are possible for some conditions, the outcomes of treatment are often variable and dependent on the diverse social and behavioral attributes of patients. As more and more therapies are added to the medical armamentarium, prospective and retrospective studies of standard therapies also need to be performed. These types of questions have spawned an emerging area of clinical investigation often referred to as outcomes research. Such health services research will be needed to guide the nation's struggles to reorganize health care to expand coverage and improve quality while simultaneously holding down costs.

There continues to be debate on whether the current supply of individuals appropriately trained as clinical investigators is seriously deficient. Nevertheless, the explosion of the new knowledge in molecular biology, medicine, and health care, as well as in medical informatics will create the need for substantially more expertise—particularly for more fully trained physicians and other health professionals in academia, government service, and industry—to transform these discoveries into cost-effective diagnoses and treatments for human disease. Since most of these clinical investigators are trained in academia, it is important to recognize the crucial roles that academic health centers (AHCs) have in the career paths of clinical investigators and that there are many external factors that have an impact on the AHC environment.

The escalating costs of health care and the large number of uninsured and underinsured people in the United States have thrown health issues into the policy arena at all levels of government. In medicine, highly subspecialized medical training, a declining interest by U.S. medical students in primary care training, and shortages of physicians willing to practice in rural or inner-city areas are all cited as symptoms of a worsening problem. The spontaneous rise of human immunodeficiency virus infection and the rapid transmission of HIV infection to all segments of society has demonstrated that new diseases can arise at any time, and that a multifaceted approach spanning a variety of fields of research and a range of professional research scientists is needed to develop fundamental knowledge about a disease process, develop and test new diagnostic and therapeutic approaches, design prevention strategies, and assess the subsequent outcomes of health care practices. This can only be accomplished with a sufficient supply of highly talented and well-trained researchers in all areas of research.

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