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nteractions between academic medical centers and industry have increased substantially during the past two decades, spurring medical innovations and new types of research collaborations. Consumers benefit with new medical devices and drugs that improve health care. Scientists gain by having access to technology and ideas outside their respective academic and industrial milieus.

But some suggest these relationships are blurring the lines between the so-called "pure research" of academia and the commercial activities of business. As a result, critics charge, the academic mission of disinterested inquiry and an objective search for truth is being transformed into one in which the quest for knowledge is tainted by bias due to the profit motive.

In the Jan. 2 issue of the Journal of the American Medical Association, Dr. Annetine Gelijns, director of the Columbia University International Center for Health Outcomes and Innovation Research, associate professor of health policy and management in the Mailman School of Public Health, and associate professor of surgical science (in surgery) at the College of Physicians & Surgeons, and Dr. Samuel Thier, president and CEO of Partners Healthcare System in Boston, Mass., analyze the nature of academic-industrial relationships.

While acknowledging the potential downsides of academic-industrial collaborations, Drs. Gelijns and Thier also believe society's view of the research activities in the two arenas needs revision and that the interactions could be maximized to foster the rapid development of important medical innovations.

Robin Eisner, editor of In Vivo, asked Dr. Gelijns to describe the issues raised in the JAMA article.

In Vivo: Why did you write the article?

Annetine Gelijns: Some recent publications have focused on the negative aspects of academic-industrial relationships. An Atlantic Monthly article addressed how industrial grant support was compromising academia's charge for objective inquiry. Dr. Marcia Angell, former editor of the New England Journal of Medicine, also wrote that the need for academia-industry relationships for technology transfer is "overrated." By the time a technology reaches clinical trials, she said, academic researchers' role is minimal.

While we agree there are downsides to these collaborations--such as less openness in scientific communication, a partiality in reporting research results, and a potential shift from basic to applied research--that need monitoring, we believe these interactions actually could be improved to enhance research and development. Crucial to thinking about these improvements, however, is better understanding of the roles that universities and industry play in the various stages of the medical innovation process. We wanted to clarify these complex ties that surprisingly are seldom studied and are often misunderstood.

What is the prevailing notion of academic-industrial ties and what is your view?

Most people believe scientists at universities and academic medical centers are single-mindedly devoted to the advancement of fundamental knowledge and that industrial firms merely apply academic research to develop products. But reality is more interesting. Many university faculty members create new technologies, such as medical devices, and industry performs basic research. The flow of information between academia and industry is quite dynamic, in the form of licensing arrangements, personnel movements, company start-ups, and clinical and contract research, with people and ideas moving back and forth between the two environments.

What are some of the most significant examples of the overlapping roles of academia and industry in fostering medical advances?

An academic medical center is a major source of translational research, routinely taking discoveries from the laboratory into the clinic. An academic medical center can apply research findings by drawing on its infrastructure of animal laboratories and its specialized patient base, which is critical for identifying genetic abnormalities and their varied expression patterns in sub-populations of patients. Industry is also a major locus of such research. These overlapping assets make collaborations very fruitful.

The value of such collaborations does not end, however, with the introduction of a new diagnostic or therapeutic intervention or, say, the licensing of a basic research finding. Many new interventions, and results, may find totally new and unexpected uses after their first applications. It is hard to predict these new uses because complementary technology may still need to be developed. The use of lasers for medicine was not appreciated when they were first invented at Bell Labs. The benefits of drugs for other indications than the initial research focus can take time and back-and-forth interactions between academia and industry. Alpha blockers, for example, were approved for hypertension, but doctors 20 years later realized these drugs could also treat problem urination associated with benign prostate enlargement.

What do you think needs to be done to enhance the industrial-academic relationship?

While universities and government are addressing the potential conflicts of interest in academic-industrial ties, bettering the relationship has been less of a focus. Most academic-industry collaborations, such as licensing, clinical research, and grant agreements, currently are done on an ad hoc basis and not as part of a strategic plan.

Such strategic thinking might require newer models of collaboration or internal organization changes. An initiative started in 1994 at MIT, Draper Laboratories, and two Boston hospitals called the Center for Integration and Innovative Technology (CIMIT) brought basic scientists, physicians, and engineers from different departments to collaborate on the development of the next generation of minimally invasive diagnostics and therapeutics. Such a project aims to prevent what happened with laparoscopy. Although laparoscopy had been used in gynecological surgery in the 1960s, its application in general surgery was not realized until 25 years later.

We don't know how successful CIMIT or other similar, but rare, efforts are. More research should be done to evaluate which academic-industry interactions are the most effective. To analyze their success, though, a new view of these interactions must be put forth. Academic-industrial ties are complex and dynamic. The age-old paradigm of academia doing pure research and industry applying findings is too simplistic.

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