Universities in the Marketplace: The Commercialization of Higher Education
Princeton University Press; 1 edition (March 3, 2003) | ISBN: 0691114129 | 538 pages | PDF | 1 MB
Why should this book about the commercialization of higher education, written by a former president of Harvard University, be reviewed in a medical journal? And what relevance does his thoughtful analysis of the corrosive effects of big-time athletics and profit-oriented education and research in our leading universities have for the medical profession? The answer should be obvious. Medical schools and teaching hospitals resemble the major research universities in being not-for-profit institutions that are entrusted with essential public responsibilities and that are now endangered by commercial incentives. As part of this carefully balanced yet compelling description of how financial rewards are increasingly tempting universities to compromise their educational and scholarly standards, Derek Bok also exposes the ethical crisis now facing academic medicine and the U.S. medical profession at large. Whether describing the scandals in the athletics programs at major colleges, the consequences of universities' pursuit of profits from the licensing of patented discoveries, or the conflicts of interest among faculty scientists who have financial ties to industry, Bok shows that he knows his subject well and that he has done his homework. Moreover, he marshals the relevant facts with an even hand and unsparing candor. He seems as familiar with the medical academy as with the rest of the university scene. Unlike many university presidents, he fully understands the risks inherent in the growing liaison between medical schools and the pharmaceutical and biotechnology industries. Although he acknowledges the social usefulness of the enhanced collaboration between academic and corporate research that followed the passage of the Bayh-Dole Act in 1980, he also is clear about the risks to the integrity and independence of research in medical schools that results from industry sponsorship and about the need for stronger policies to protect these values. Bok says that corporate influence on research involving human subjects needs particular attention because of the threat to the welfare of patients, but he also says that the involvement of businesses in the education of practitioners is no less problematic, since the practitioners' education will determine how they treat their patients. He is right on both counts. Bok is also correct to emphasize the growing danger of the corporate subsidization of continuing medical education. By allowing pharmaceutical companies to support and thereby influence programs for the continuing education of practitioners, medical schools and teaching hospitals are surrendering their own professional responsibility for education. In so doing, they risk losing the public's trust in the objectivity and reliability of medical teaching and in the professional advice that is based on this teaching. He fears that this trend may no longer be reversible because medical schools and teaching hospitals already depend on corporate support, but I think he is too pessimistic. Continuing medical education does not need to be nearly as costly as it is, and it could be financed without corporate handouts. Professional medical educators could easily regain full control if they were determined to do so and if they worried less about the loss of their corporate subsidies. Despite similar concerns about the reversibility of much of the current commercial tide in higher education, Bok thinks that university leaders still have the power to develop policies that could effect change. He urges collective action by the trustees and presidents of our universities and hopes that senior faculty can be persuaded to join the effort. I believe the same should be said about our medical academic leadership. If a handful of the most prestigious and influential medical schools were to adopt new guidelines that drew clear and reasonable limits to protect research and education from the worst effects of corporate influence, we would be well on our way to a solution. Without such action, it is hard to see how the values of most medical professionals can be sustained in a climate that is now so heavily dominated by investor-owned corporations. The medical profession, like the rest of higher education, is too important to society to allow its future to be determined by market forces. One can only hope that this book will help the public understand what is at stake and will generate support for the needed reforms. Derek Bok has sounded a warning that ought to be heeded. I suspect his book has already become required reading for college presidents and trustees and other leaders in higher education. It deserves just as careful attention from the deans of medical schools and their faculty -- and indeed from all physicians who care about the soul of their profession. Arnold S. Relman, M.D.
