Magazine article Issues in Science and Technology

Opening the Books: Follow the Money: Funding Research in a Large Academic Health Center

Magazine article Issues in Science and Technology

Opening the Books: Follow the Money: Funding Research in a Large Academic Health Center

Article excerpt

Opening the Books Follow the Money: Funding Research in a Large Academic Health Center by Henry R. Bourne and Eric B. Vermillion. San Francisco, CA: University of California Medical Humanities Press, 2016, 232 pp.

Academic health centers are complex ecosystems. They typically have a medical school at the core and one or more major teaching hospitals, often complemented by a Veterans Administration medical center and community hospitals and clinics. Other health professions schools are also often affiliated or included. The centers' missions of education, research, technology innovation, and clinical care are often viewed as trade-offs, but should be viewed, I believe, as synergies.

The University of California, San Francisco (UCSF), the subject of Follow the Money: Funding Research in a Large Academic Health Center, has become one of the nation's leading academic health centers. Its medical, nursing, dental, and pharmacy schools are among the most highly ranked and highest-funded research-oriented institutions in each category. UCSF is unique among campuses of the University of California system in being limited to these schools; all of the other components of a comprehensive research university (including the School of Public Health) are across San Francisco Bay at the venerable University of California, Berkeley, campus. Berkeley has none of the UCSF schools, although the university system does have additional medical schools at the Los Angeles, San Diego, Irvine, Davis, and Riverside campuses.

Two UCSF veterans, Henry Bourne, a professor emeritus of cell and molecular pharmacology, and Eric Vermilion, a retired vice chancellor of finance, collaborated on this book. Bourne previously authored Paths to Innovation: Discovering Recombinant DNA, Oncogenes, and Prions, In One Medical School, Over One Decade, published in 2011, which celebrates the UCSF's faculty and its academic environment. The current book explores the university's financial structures, investigating the sources of revenue, nature of expenditures, and especially funds transfers between units. This analysis is a tried-and-true approach to understanding the priorities, decision-making processes, resources, and financial risks of an institution. Hence Follow the Money is an appropriate title for this book.

Longitudinal analyses are commonly performed over a few years or even over decades, as in this case. Always, the choice of the base year and the recognition of major external stressors are critical. This book is focused primarily on funding for biomedical research, including research training for PhDs and MDs, with minimal attention to the many reimbursement issues affecting the now-vast clinical enterprise. The metrics of success for an academic health center such as UCSF involve long-term vision, investments, and scientific and health impacts.

The authors clearly state their concerns in the introduction, as they refer to "the extreme fragility of academic biomedical research," "sharp cuts in state government support," and stagnant federal research funding. The book's overall tone is quite pessimistic, despite the status, strengths, and resilience of UCSE The authors long for the time several decades ago when the state paid the faculty salaries and the construction costs of a much, much smaller institution. They also claim that medical schools at private universities and other state universities may have more secure funding from endowments or appropriations, which is dubious.

The authors have three aims. First, they present a primer for people, especially those working within UCSF or sister institutions, who want to learn how and where research dollars flow in such complex enterprises and may be bewildered by the hybrid of academic research and education tied to a huge clinical enterprise. Second, they examine how the internal distribution of resources guides and constrains investigators' goals and training of young scientists in basic science units and clinical departments. …

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