Index
A
Academic health centers
career path of researchers in, 5, 13-14
clinical care component in, 21, 28, 53
in clinical research oversight, 6
cost of graduate medical education, 21, 28
definition, 13
disincentives for clinical research in, 53-55
faculty demographics, 45-50
faculty growth in, 43-44
faculty tracks in, 55-57
funding for research in, 20-21
growth of, 28
in health care plan benefit design, 21
health research spending by, 63
historical development, 43-44
patient access, 21
recognition for researchers in, 13-14, 28-29, 50-55, 60
research infrastructure, 14-15, 60-61
research involvement of faculty, 50
technology assessment in, 21
See also Medical school(s)
Academic-industry linkages, 110
benefits for academic institutions, 209
commercialization of research findings, 205-206
conflict of commitment in, 214-215
conflict of interest in, 20, 213-214
current context, 199-200, 216-217
exclusivity of research findings, 212-213
history of, 197-199
industry benefits, 207-209
management of, 215
objections to, 200
prevalence, 206-207
proprietary rights issues in, 210-212
recommendations, 20
research culture in, 201-202
research goals and, 211
types of, 202-205
Accreditation/certification
agencies, 16
in clinical psychology, 277-278
as disincentive to research, 18, 57, 166-167
of medical schools, 167
problems in, 4
recommendations, 16-18
residency review committees, 17, 164-165
specialty board certification, 18, 166-167
Accreditation Committee for Graduate Medical Education, 16, 17
Agency for Health Care Policy and Research, 27
outcomes research, 100-101
role of, 99
AIDS Research Debt Relief Program, 12, 190
Alcohol, Drug Abuse and Mental Health Administration (ADAMHA), 64, 69, 73-76, 136
Alliance for Aging Research, 19, 119
American Academy of Orthopaedic Surgeons, 284-285, 300
American Association for the Advancement of Science, 137
American Association of Physicians, 56
American Board of Internal Medicine, 166
American Board of Medical Specialties, 16, 18, 166
American Cancer Society, 107, 189
American College of Surgeons, 294-295
American Federation of Clinical Research, 56
American Heart Association, 107, 189
American Lung Association, 107
American Society for Clinical Investigation, 24, 56
Anesthesiology, 166
Armed Services Health Professional Scholarship, 157-159
Association of American Medical Colleges, 147, 214
Atherogenesis, 26
Autologous bone marrow transplantation, 114
B
Basic science research
clinical research and, 27, 28-29, 35, 55-57
disease-related, 34
in medical schools, 28-29, 55-57
medical student interest in, 147
NIH grants, 93-94
Biomedical and Behavioral Research Scientists: Their Training and Supply, 30
Biomedical Research and Development Price Index, 76
Biotechnology research, 110-111, 199
Breast cancer, 26
autologous bone marrow transplantation for, 114
C
California Institute of Technology, 133
Carnegie Mellon University, 133
Centers for Disease Control and Prevention, 12, 67
research spending, 98-99
research training in, 187-188
role of, 98
Clinical Associate Physician program, 12, 186
Clinical research
background papers for evaluation of, 38
classification of activities in, 7, 32-34, 88
cost of, 79
data collection/analysis for evaluation of, 7, 29, 44
definition, 3, 30-31, 32, 34-35, 87-88, 92-93
evaluation strategy, 29-31, 36-40
future challenges to, 4-6, 41-42
future needs in, 3-4, 6, 25-27, 35, 41, 216-217
historical development, 24-29
institutional obstacles to, 5
researcher demographics, 44-50
supply of researchers, 2, 4, 6, 27, 29
See also Human research;
Training for research
Clinical Scholars Program, 190
Clinical trials, 5
consortia for conduct of, 204
historical development, 25
third-party payers and, 115-116
Compensation for researchers, 12
in academic-industry collaboration, 203, 204, 213
in academic settings, 13-14
as career path disincentive, 59-60
in clinical psychology, 272-273
in Department of Veterans Affairs, 103
educational debt burden and, 160, 190
Conflict of interest issues, 20, 213-214
Consulting, 203
Cost of training
in academic health centers, 21-22
as disincentive to research career, 4, 42, 60, 156, 159-160
recommendations, 12-13
tuition debt relief program, 12-13, 189
See also Funding/funding issues
Cystic fibrosis, 26
D
clinical research in, 239-251
curriculum, 124
human research training, 11
recommendations, 240, 243-244, 245-247, 249-250
schools, 248-250
Department of Agriculture, 12, 67
Department of Defense, 12, 67, 105, 131, 286-287, 296
Department of Education, 12, 67, 105
Department of Health and Human Services, 12, 73
health research spending, 67
Department of Veterans Affairs, 12, 67, 282
organizational structure, 101
research activities, 101-103
research training in, 188
Dermatology, 166
Disabilities, students with, 137
Disincentives for research career, 42-43
career compensation as, 12, 59-60
clinical care responsibilities as, 170
in clinical psychology, 272-278
duration of training as, 4, 12, 42, 55, 150, 162
educational costs as, 4, 12, 42, 60, 156, 159-160, 190
evaluation of, 29-31
lack of exposure to research practice as, 167-168
lack of role models or mentors as, 4, 29, 58-59
lifestyle factors, 29, 42, 59-60
in medical education, 53-55, 144-145, 167-170
for newly independent investigators, 8, 53
professional status of research as, 4, 12, 28-29, 42, 55, 194
recertification requirements, 18, 57, 166-167
timing of training and, 169
Doctor-patient relationship, 113, 203
Duke University, 151
E
F
F32 awards, 170, 171, 173-175, 178
Federal Coordinating Council on Science, Engineering and Technology , 128, 130, 131
Federal government
in clinical research oversight, 6, 18-19
commercial use of research funded by, 212-213
departmental support for human research, 12, 67, 101-105
in development of academic medical centers, 44
health research support, 9-10, 63, 65, 67, 120, 197, 198-199, 202
in improvement of research training, 194-195
legislative encouragement of research, 198-199
medical school scholarships, 158
postdoctoral training funded by, 170
in precollege science preparation, 131
training program outcomes, 188-189
undergraduate science programs, 134-136
See also specific agency or department
First Investigator Research Support and Transition, 8
Food and Drug Administration, 115, 188, 200
Foundations, 106-107, 189, 190
Four Schools Physician-Scientist Program in Internal Medicine, 151
Funding/funding issues
academic health centers, 20-21
academic-industry collaborations, 203, 204, 205
average cost of research grant, 102
basic research, clinical research vs., 28-29
in Centers for Disease Control and Prevention, 98-99
central management of, 19
clinical psychology, 270-271
comparative cost of human research, 79
in cooperative model of research management, 118-121
cost of medical education, 156-160
Department of Defense research spending, 105
Department of Education research spending, 105
in Department of Veterans Affairs, 102, 103-104
faculty, support for, 193-194
in General Clinical Research Centers, 97
government support, 9-10, 64-67, 197, 198-199
grant size, 76
grant writing skills, 10
health research spending, 63
historical development, 27-28, 64-65, 197
human research programs, 58
industry-sponsored research, 109-111, 197, 198
Medical Scientist Training Program, 11, 12, 152
minority access to science careers, 134-136
NIH extramural research, 72-77
NIH human research, 81-95
NIH research centers, 95-96
nonprofit organizations, research spending in, 106, 107, 108
postdoctoral research training, 171-178
precollege science preparation, 130-131
privately supported research training, 189
research career development awards, 184-185
research training programs, 11, 151, 192
social context, 202
support of newly independent investigators, 8, 53
in surgical career, 291-292
third-party payers in clinical research, 112-118
training in, 192
training related to subsequent grant success, 178, 182-184, 186
tuition debt relief, 12-13, 189
undergraduate science preparation, 134-136
Funding Health Sciences Research: A Strategy to Restore Balance, 31
G
General Clinical Research Centers
evaluation of, 194
funding, 97
future of, 97
historical development, 96, 97
number of, 9
organizational structure, 96
research activities in, 97
role of, 96
training of researchers in, 97, 186
Government-University-Industry Research Roundtable, 119
Grant preparation, 10
as distraction from research, 74-76
training in, 192
H
Harvard Clinical Effectiveness Program, 189, 191
Health care reform, 23-24
clinical research and, 2, 5, 8, 18, 41-42
medical innovation and, 110
support for clinical research and, 118
Howard Hughes Medical Center, 108-109, 151
Human immunodeficiency virus, 2, 24, 97, 98, 99
Human research
cost of, 79
data needs, 7
diversity of, 3
in F32 awards, 173-175
in K awards, 185
in NIH, 81-95
recommendations for NIH in, 6-7, 8, 9-11, 12-13
resources assessment, 29-30
See also Clinical research
I
Imaging technology, 23
Incentives for research career
in development of research infrastructure, 14-15, 28
need for, 6
professional recognition, 13-14
recommendations, 12-13
tuition debt relief, 12-13, 190
See also Disincentives for research career
Intellectual property rights, 199, 204, 207
in academic-industry linkages, 210-212
corporations owned by academic institutions, 206
Internal medicine, 166
J
J. David Gladstone Foundation Laboratories for Cardiovascular Disease , 108
Johns Hopkins University, 56, 151, 192
Joint Commission for Accreditation of Health Care Organizations, 16
K
L
Legal issues
in academic-industry linkages, 212
antitrust law and cooperative research, 119
intellectual property rights, 199, 204, 207, 210-212
reimbursement issues, 113-114
M
Managed care, 110
Managed competition, 5
March of Dimes-Birth Defects Foundation, 107
Mayo Clinic, 191
McMaster University, 192
M.D.s
dual-degree program, 151-152
laboratory-research training, 150
medical school faculty, 44-46, 50
in Medical Scientist Training Program, 154
as NIH grant recipients, 28, 77-79, 85, 172, 173, 175-176, 178
in NIH peer review groups, 82
number of, 44-45
postdoctoral training, 182-184
research training after medical school, 163
See also Postgraduate medical education
Medicaid, 112
Medical research organizations, 108-109
Medical school(s)
accreditation, 167
dual-degree programs, 151-152
faculty, clinical or preclinical distribution of, 45-46
faculty degrees, 45
faculty demographics, 46-48
faculty research activity, 50
historical development, 42-43, 142-143
laboratory training in, 146
Medical Scientist Training Program in, 152-155
model training programs, 189-192
postgraduate research training, 160-170
in promoting research careers, 144-145
research training programs in, 151
student demographics, 143-144
student exposure to research, 15, 148-150
student interest in research, 145, 147-148
time demands in, and research, 150
tuition debt relief, 12-13, 189
See also Academic health centers
Medical Scientist Training Program, 11, 12, 152-155
Minorities
in clinical psychology, 270, 276
in medical school, 143-144
on medical school faculty, 49-50
in medicine, 127
in surgical science, 289-290, 297-298
in undergraduate science, 134, 136, 137
Multidisciplinary research, 8, 61
Muscular Dystrophy Association, 107
N
National Center for Health Statistics, 99
National Center for Nursing Research, 3
National Easter Seal Society, 107
National Health Service Corps, 157-159
National Institute of Mental Health, 271
National Institute of Occupational Safety and Health, 98-99
National Institute on Disability and Rehabilitation Research, 104
National Institutes of Health (NIH), 131
appropriations to, 9-10
biotechnology research, 111
Computerized Retrieval of Information on Research Projects, 88-90
degrees of grant recipients, 77-79, 85
General Clinical Research Centers, 96-97
grant applications received by, 78, 84-85
human research funding, 81-95
intramural research, 67, 69-72
Medical Scientist Training Program, 152-155
Minority Access to Research Careers program, 134
Minority Biomedical Research Support, 136
multidisciplinary research in, 8
Office of Medical Applications of Research data, 87-88
oversight role, 7
peer review process, 77, 79-82, 282, 285-286, 295-296
postdoctoral research training in, 170, 171-176, 180-184
recommendations for, 6-7, 8, 9-11, 12-13
research career development awards, 10, 184-185
Research Supplements for Underrepresented Minorities, 136
study sections, 7, 81-82, 282, 285-286, 295-296
surgical research in, 285-286, 290, 298-299
in training of researchers, 71, 178-180
National Oceanic and Atmospheric Administration, 131
National Research Service Awards, 30, 170
National Science Foundation, 12, 67, 131, 136, 137
Research Experiences for Undergraduates, 134-136
Nonprofit organizations, 106-109
Nursing
clinical research in, 3, 253-264
doctoral programs, 124
training, 142
O
Outcomes research
in Agency for Health Care Policy and Research, 100-101
in dentistry, 250
General Clinical Research Centers for, 9
in human research, 81
status of, 41
third-party payers in, 116
Oversight
of academic-industry linkages, 20, 215
interorganizational interdisciplinary group for, 117
model of, 118-121
of NIH study sections, 7
P
Patent & Trademarks Act, 199
Patient-oriented clinical research. See Human research
Peer Evaluation of Extramural Research, 7
Peer review, NIH, 7, 77, 79-82, 282, 285-286, 295-296
Pharmaceutical industry
corporations owned by academic institutions, 206
new drug development, 109, 110
reimbursement concerns, 115
research spending, 109, 110, 197, 209
Ph.D.s
dual-degree programs, 151
educational debt, 189
on medical school faculty, 45-46, 50, 55
as NIH grant recipients, 28, 77-79, 85, 172-176, 178, 182
in nursing, 257-259
training, 150, 161-162, 182-184
Positional cloning, 1
Postgraduate medical education
design of research programs in, 161-163
mentoring in, 168-169
quality of research training in, 167-168
recommendations, 16
residency review committees in, 164-165
role of research training in, 160-161
specialty certification, 166-167
timing of research training in, 169-170
Primary and secondary school science, 125, 126
classroom experience, 127-129
evaluation of, 132
federal programs, 131
role of, 127
science fairs, 129
special initiatives, 129-130
teacher preparation, 128
trends, 130-131
Private sector
in clinical research oversight, 6, 18-19
clinical researchers in, 42, 208-209
corporations owned by academic institutions, 206
in funding of evaluative science centers, 11
in funding of research training, 11
health research spending, 63, 65
industry-sponsored research, 63, 109-111, 197-198
medical research organizations, 108-109
medical school research programs funded by, 151
nonprofit organizations, 106-109
research culture in, 201-202
research training in, 170-171, 189-190
voluntary health agencies, 107
See also Academic-industry linkages
Prostate hypertrophy, 27
Psychology
clinical research in, 265-278
training, 142
R
R01 grants, 72
award size, 76
distribution of, 84-95
duration of, 74-76
evaluation of, 39
Research design
historical development, 25
human studies, unique features of, 79-81
obstacles in clinical studies, 55, 57
resource demands, 5
subject enrollment, 42
third-party payers in, 116
training in, 162-163, 167, 191-192
Research infrastructure
in academic settings, 14-15, 60-61
as career path incentive, 60
Residency review committees, 17, 164-165
Resources for Clinical Investigation, 30
Review of the National Institutes of Health Biomedical Research Training Programs, 176-177
Robert Wood Johnson Clinical Scholars Program, 189, 190
Role model or mentoring relationships, 4
faculty responsibility and, 193
good qualities in, 59
institutional recognition of, 14
postgraduate medical education, 168-169
role of, 58-59
Rush Medical College, 146
S
Science fairs and competitions, 129
Stanford University, 191
Surgical research
barriers to, 287-290
current status of, 281
Medical Scientist Training Program and, 154
resource base, 284-287
strategies for improving, 281-283, 293-299
types of, 283-284
T
T35 grants, 151
Technology assessment, 21, 114-115
Technology development, 1-2, 23, 123
academic health centers in, 21
in academic research culture, 201
clinical research and, 2
in commercial research culture, 201-202
commercialization of academic research, 205-206
health care reform and, 110
intellectual property rights, 199
regionalization of, 21
Technology transfer, 20
academic-industry collaboration, 20, 205
biotechnology, 199
federal initiatives, 198
Third-party payers
clinical research and, 64, 112-114, 117-118, 121
concerns of, 114-116
data collection by, 116-117
in research design and data analysis, 116-117
support for academic health centers, 20-21
Training for research
in clinical psychology, 265-266, 269-278
in Department of Veterans Affairs, 103
in dual-degree programs, 151-152
duration of, 4, 12, 42, 150, 161-163, 169-170, 183
effecting change in, 194-195
faculty needs, 193-194
federally supported non-NIH, 188-189
in General Clinical Research Centers, 97
goals of, 124-125
historical development, 43-44
importance of, 193-194
laboratory-based model, 57-58
laboratory experience, 150
in medical school, 123-124, 145-147, 151, 191-192
in Medical Scientist Training Program, 152-155
medical student interest in, 145, 147-148
model programs, 10-11, 188, 190-192
NIH intramural programs in, 71
in nursing, 257-264
obstacles to, 125-126, 168-170
postdoctoral, 161-163, 170-176, 180-184
primary and secondary school preparation, 125, 126, 127-132
in private sector, 170-171
privately funded, 189-190
program evaluation, 10-11, 12, 17, 18, 176-180, 194
recommendations, 10-11
recruitment for, 176-177
research methodology, 162-163, 191-192
residency review committee requirements, 264-265
scientific ethics as element of, 155, 192
social demographic context, 125, 126-127
specialty board certification and, 166-167
technology transfer as element of, 216
trends, 28-29
undergraduate student preparation, 132-142
Tufts University, 56
U
Undergraduate science preparation
criticisms of, 136-137
design of, 138-140
effectiveness of, 137-138
federal programs, 134-136
improvements in, 141-142
institutional efforts, 133
role of, 140-141
science majors, 132
University of California, 191
University of Kentucky, 133, 140
University of Michigan, 55, 190-191
University of Pennsylvania, 151
University of Puerto Rico, 140
V
Voluntary health agencies, 107
W
Washington University, 151
Women
in clinical psychology, 270, 275-276
in clinical research, 48-49
on medical school faculty, 46-48, 49-50
physicians, 44-45, 48-49, 127, 143
in surgical science, 282-283, 289, 297
in undergraduate science, 136-137