A Word From the President

Taking a Lesson From Today's Headlines

Over the past several months, media coverage of the business world has been dominated by the collapse of Enron, one of the seemingly indestructible darlings of Wall Street through much of the '90s. Although the jury - quite literally - is still out on the role that Arthur Andersen & Co. played in the Enron debacle, news accounts have emphasized the "unprofessional" behavior of the Andersen accountants who were involved in advising Enron's management and in auditing their financial statements.

The use of that word - unprofessional - served to remind me that accounting, like medicine, is indeed a profession, certainly insofar as the public expects it to exert discipline on its practitioners via self-regulation. Auditors are expected to operate not only within the confines of the law but also within the norms established by the accounting profession itself. The intent of those norms, promulgated as industry-wide standards, is to protect the public's interests. Being able to trust audited financial statements - to have confidence that they convey complete and accurate information about the fiscal status of an accountant's clients - is critical to the functioning of our capitalist economy.

It is the evident breach of that trust that is particularly distressing about the Andersen affair. The apparent failure of this one prominent company to honor the public's trust has plunged the entire accounting profession into a crisis of historic proportions. The upshot is likely to be new legislation that significantly restricts that profession's ability to regulate itself. And therein lies the lesson that academic medicine should heed from today's headlines.

Earning and maintaining public trust is a perennial responsibility for everyone in academic medicine, one that requires continued vigilance and careful attention to legitimate public expectations. Indeed, failure to maintain public trust in the conduct of our professional affairs could undermine the entire structure of our enterprise.

Let's remember that our professional activities benefit enormously from our ability to regulate our own affairs. We may complain loudly about the burdens of external regulations, and they are indeed burdensome. But consider the freedom we do have for setting our own standards for medical school admissions, for accrediting medical schools and residency programs, for licensure, for board certification, for promotion and tenure, for hospital privileges, and much more. Equally important to remember is that our professional activities are virtually totally dependent on public support, both financial and otherwise. I know we focus a lot on the shortfall of resources, and they do indeed fall short of our desires. But consider as well the recent doubling of the NIH budget, the billions of dollars of Medicare subvention for GME, the state support for undergraduate medical education, the federal guarantees for student loans, the private philanthropy that supports medical research, and so on.

We dare not take these tangible expressions of public trust for granted, especially now when the public and its representatives in Congress are justifiably exercised about two issues of vital concern with which the academic community has yet to deal effectively.

The first has to do with long-standing and mounting public concern about excessive duty hours in many of our graduate medical education programs. The time has long passed when we should have responded to legitimate public apprehension about the potential adverse effects of resident fatigue on patient safety and resident well-being. Several members of Congress are already on record as favoring federal legislation to restrict resident duty hours. Unless our profession comes to grips with this issue very soon by adopting and enforcing credible standards for itself, there is little doubt that our cherished professional prerogative to regulate our students' and residents' learning environments will be withdrawn by an act of Congress.

The second issue concerns the protection of human research subjects. Rare but riveting examples of lapses involving our administration of human subjects protection programs have convinced several members of Congress that legislation is necessary to ensure the safety of individuals who chose to participate in clinical research. Here again, swift action by the academic community is essential if we are to sustain public trust and preserve our ability to set our own standards in this vital area of our core mission.

One important step in this direction that all institutions engaged in human subjects research can take is to seek and acquire accreditation of their human subjects protection programs. The newly established Association for the Accreditation of Human Research Protection Programs (AAHRPP) is actively seeking applications for accreditation. The sooner all institutions meet AAHRPP's exacting standards, the less likely legislators and the public will perceive a need for federal intervention. Another important step that institutions can take to sustain public trust in the clinical research enterprise is to adopt the AAMC Guidelines for the Oversight of Individual Financial Interests in Human Subjects Research, available at www.aamc.org/coitf.

The turmoil currently besetting the accounting profession in the aftermath of Arthur Andersen's apparent deviation from professional norms is a vivid reminder of the fragility of public trust and of the toll exacted when mistrust supervenes. We may prefer to think that the medical profession is immune from a similar fate. It is not.

Jordan J. Cohen, M.D.
AAMC President

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