Challenging Medical Science to Seek New Frontiers

Last week, I co-authored an article in Issues in Science and Technology with Sindy Escobar Alvarez , who leads Doris Duke Foundation ’s work in medical research to equitably improve human health.

In the piece, we argue that although the modern American medical research enterprise has been a genuine miracle machine, it has nonetheless begun to take too narrow a view of what constitutes desirable innovation.

The challenge as we see it is that, in some ways, the miracle machine has worked too well.

What has impelled the modern biomedical enterprise has been an enormous set of successive breakthroughs in understanding the molecular basis of disease. This so-called “reductive” medical science has produced generations of astounding treatments, cures and therapies that often manipulate our bodies at a sub-cellular level to prevent pathologies from taking hold—or to root them out, often permanently.  

Because this approach has been so successful, it has reshaped the culture of science—all the way down to the individual researcher. Today, an early-career medical researcher—who has already slogged through medical school, a PhD program, residencies and then research fellowships—has been groomed to focus almost exclusively on molecular medicine.

Institutional incentives invariably shape individual behavior. Whether material, psychic, or social, people will follow the rewards. In academic medicine, the key drivers of career advancement—and therefore professional prestige—are major research grants and publications. Today, both of these sources of validation overwhelmingly seek out molecular science that addresses the basic causes of disease.

This is great science and we need more of it. But it’s not all that medical research has to offer.

As we detail in the piece, we think medical science has the potential to deliver a revolution in the areas of prevention, care, and delivery. Think less “how do we tailor a cancer treatment to the genome of this specific tumor?” and more “how do we prevent childhood obesity in low-income communities?” or “how can we double the rate at which people take prescribed medications?” or “how can we shorten hospital stays?”

We think these are all important questions with the potential to improve the absolute level of health and well-being in our society and to ensure that positive health outcomes are more equitably distributed. And they are all questions that are begging for breakthrough innovation.

We make a range of suggestions in the article for how we can widen the medical research paradigm to include and valorize research on prevention, care and implementation.

But they all boil down to this: we get the science we ask for.

Prizes, funding, publications. These are all just so many ways of anointing knowledge as authoritative and important. 

American medical science is a civilizational achievement. But let’s ask it to stretch the frontier of human knowledge and insight just a bit further.