Clifton Leaf, deputy editor at Fortune magazine, called for a cultural makeover of academic medicine as he spoke on campus as part of the Dean's Lecture Series this week.
Leaf, who is a noted critic of the cancer research system as well as an award-winning journalist, illustrated the challenges facing the field of cancer research by way of a story: a story that begins in Africa in the late 1950s and involves an enterprising missionary doctor named Denis Parsons Burkitt, MD. While working in a hospital in Uganda, Burkitt began seeing cases of children with disfiguring facial tumors. The cases were tragic and mysterious, spurring Burkitt to try to figure out what was going on.
In an effort that involved sending out 1,200 fliers to fellow doctors in Africa, creating a large map dotted with colored pins — each representing cases of the disease — and a 10,000 mile road trip with two colleagues to document cases, as well as some assistance from researchers in England, Burkitt was able to link the cancer to areas were malaria was prevalent.
Between 1957 and 1966, a period of nine years, Burkitt was able to progress from having no idea what was causing the tumors to finding a few chemotherapeutic therapies that were effective for the condition now known as Burkitt lymphoma, Leaf said.
But now, Leaf challenged the audience, consider how Burkitt — a resourceful, bright investigator — would fare in today's research climate.
He'd need a grant, and to secure a grant, he'd need publications, Leaf explained. And not just any publications would work: only papers in high-impact journals where he was the first author would do. To get those publications, Burkitt would have to specialize, picking a small sliver of one of cancer's many biological pathways to analyze. Even with publications, his odds of obtaining a career-sustaining R01 grant are about one in 10, Leaf said. And, he noted, despite thousands of papers on each of these cancer pathways each year, hundreds of thousands of people are still dying from cancer.
"What we really need is to change the way we spend the money and do the research and with that I think we can save some more lives," Leaf said.
First, rather than discussing the need to share data, researchers need to actually start sharing their data and create incentives to work together, he said. The "frenzy of grants and publications" isn't producing meaningful, speedy progress, he added. In addition, it would help to change the system of financing research.
"We are funding projects but now we need to fund people," Leaf said. "Let smart people do what they do."
Dean Lloyd Minor, MD, who introduced Leaf, said Stanford Medicine is working to catalyze changes called for by critics like Leaf.
"When we move forward with our biomedical revolution in precision health, we look to people like Cliff to achieve the audacious goals that we know are in our grasp," he told the audience.
Previously: Clinical research's flaws highlighted by Stanford's John Ioannidis, Summer's child: Stanford researchers use season of birth to estimate cancer risk and "We need a breakthrough: Cancer researchers call for more effective, lower cost therapies
Photo by Stanford Video