Addressing the leaders of the nation’s medical schools and teaching hospitals at the 128th annual meeting of the AAMC, Marsha D. Rappley, MD, chair of the AAMC board of directors, and Darrell G. Kirch, MD, AAMC president and CEO, urged the academic medicine community to reduce costs to ensure access to medical education, research, and care for all, and to use a combination of evidence and ethics to enable the power of truth and science.
“I would like to ask you to think with me about some very important questions,” Rappley said to the more than 4,500 attendees in Boston during her address, “The Most Important Question We Can Ask.” “What are the essential experiences that can only be achieved in medical school? What experiences are necessary to demonstrate competency and readiness to move to the next level of training? How do the experiences of residency extend from medical school into the practice of medicine?”
These are the most important questions members of the academic medicine community can ask themselves as they provide a path to reducing the costs of medical education and health care, noted Rappley, vice president for health sciences at Virginia Commonwealth University (VCU) and CEO of the VCU Health System.
“But I am also a patient. My perspective is deeply rooted in the compelling need for us to respect the trust that our patients and our learners place in us at the most vulnerable times in their lives. The reality is that our cost is hampering our ability to deliver on this trust.”
Marsha D. Rappley, MD
Virginia Commonwealth University Health System
“I believe that the cost of what we do in education and in service is undermining our ability to improve the health of the nation,” she said. “Our cost is compromising our ability to prepare a diverse and inclusive physician workforce. This is something we believe is absolutely necessary to attaining a truly healthy nation. And our cost is impinging on our ability to sustain the world’s leading research enterprise, which is essential to the discoveries that save lives.”
Rappley reflected on the earliest experiences in her career. Starting out as a nurse’s aide scrubbing bathrooms and setting up breakfast trays, her journey continued through medical school and residency into academic medicine, to today, where she serves as CEO of a large academic medical center.
“But I am also a patient,” she told attendees. “My perspective is deeply rooted in the compelling need for us to respect the trust that our patients and our learners place in us at the most vulnerable times in their lives. The reality is that our cost is hampering our ability to deliver on this trust.”
There are three trends in health care costs that pose a threat to the nation’s health, Rappley noted. The first trend is a decreased confidence in the value of higher education and the cost of education to the individual student. In addition, the cost of health care for the individual patient is increasing, climbing by 72% between 2004 and 2014. Finally, health care systems are experiencing falling margins, which may fall most heavily on research and medical education.
“We are the stewards of our nation’s health care,” Rappley concluded. “And addressing our costs…is critical to achieving our mission to improve the health of all.”
Speaking about “Truth, Science, and the American Dream” in his 12th address as AAMC president and CEO, Kirch discussed how the current landscape where opinion and fake news can be mistaken for fact could affect the science and academic medicine communities. “The more challenges our nation faces, the more we feel a need to come together as a community,” Kirch said. “For us, this threat to truth represents a fundamental challenge to science—the science we depend on to reveal truth in medicine.”
The history of diabetes demonstrates the power of science in action, Kirch said, sharing how the disease meant an early death until medicine found the scientific basis for the disease. This led to the discovery of therapeutic insulin in the early 1920s. “In just a few decades, the truth revealed by science has enabled people with diabetes to live their own personal lifelong dreams.”
“The challenge to truth has been building for some time. It transcends political party affiliation and our current political leadership. But it is an issue that undermines what we as a community believe and the role we in academic medicine can and should play in society.”
Darrell G. Kirch, MD
In another example of the power of science and of hope in medical research, Kirch reflected on his own experiences as a young physician fellow studying schizophrenia at the National Institute of Mental Health. “I vividly remember the patients and their families who volunteered for our studies,” he recalled. “They knew they might never directly benefit from our research. But, like us, they believed that someday research could finally reveal the truth behind the mysterious, devastating illness that had taken such a toll on them.”
In the early 1950s, researchers discovered that chlorpromazine could effectively calm and clear the thoughts of some psychotic patients, opening the door to the psychopharmacology advances of the last six decades. Schizophrenia was once considered a hopeless disease, but a growing number of patients are now receiving effective treatment.
“But building scientific evidence isn’t enough. We need to match our science with an ethical commitment to ensure that all patients benefit from that research,” Kirch said. “Sadly, the treatment of patients with schizophrenia shows what the failure by society to fulfill that ethical commitment looks like.”
“Scientific understanding of disease desperately needs to push forward,” Kirch implored. “Which is why we should all be concerned when we see proposals to cut investment in scientific and medical research. And why it is so important that we consistently push Congress to block those cuts and build our investment.”
Kirch outlined how the AAMC and its policy positions are guided by the critical balance of evidence and ethical principles, including key issues that the association has supported and continues to support:
- Expanding access to health insurance, because the evidence shows improved access leads to better health status and longer life;
- Improving access to health care for everyone, regardless of their background, beliefs, race, sexual orientation, gender identity, or geography;
- Preserving a clear immigration pathway for physicians and researchers from around the world, because the evidence shows that they contribute to innovation and the nation’s health security; and
- Continuing the Deferred Action for Childhood Arrivals (DACA) program, because the evidence shows that a diverse health care workforce, including these “Dreamers,” can help narrow health disparities.
“The challenge to truth has been building for some time. It transcends political party affiliation and our current political leadership,” Kirch said. “But it is an issue that undermines what we as a community believe and the role we in academic medicine can and should play in society.”
Kirch urged attendees to take a stand for science and truth when they encounter misinformation and misunderstanding, noting the passionate defense of science millions of advocates demonstrated earlier this year during the March for Science and the Rally for Medical Research Hill Day.
“Think how far we have come in medicine, and think of how much farther we can go,” he concluded. “Someday soon, someone with diabetes could receive their 100-year Joslin Medal. Someday soon, schizophrenia might not only be treatable, it might be preventable. It all depends on how relentless we are in our commitment to science and truth.”