I enjoyed reading your musings on European travel in the February TR [“Medical Renaissance”], particularly when reflecting on my own experiences as a rheumatologist in Europe, wearing two very distinctive hats. It was a rare treat to be invited to lecture at the ACR during fellowship (twice when in Mannik’s lab as a research fellow, not at all during my clinical year at The University of California, San Francisco), yet the occasions were more numerous (limited by clinic duties, attending requirements, and administrative obligation) in my years as a clinician, primarily in small group sessions with colleagues sharing clinical observations.
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By contrast, the world has expanded mightily during my brief tenure as clinical investigator in biotech—trips to Nottingham and Edinburgh (phase I dosage titration study of a candidate molecule for rheumatoid arthritis), upcoming EULAR meetings followed by a trip to Moscow to meet with a potential study sponsor for a parallel phase II program, investigators’ meetings this summer in Dubrovnic—to name but a few. The point has less to do with the attractions of European travel—an experience of complex aesthetic and culinary reward—than the difference of focus when attending to the goals of biotech. In distinction to academic medicine and pure patient care, I have become a project coordinator, attending to every detail of protocol construction, drug formulation, regulatory requirements for agency registration, and eventual commercial implication—none of which approached the radar screen when I ran a service in an academic hospital setting.
In Massachusetts, the relationship between church and state has become polarized to the point where academicians risk “outing” on Internet pages should they accept financial support for meetings, lectures, or even lunches from pharma. There are efforts to ameliorate this disaffected relationship, with the realization that many fellowship programs accept industry support for their operations, and might not, based on real revenue projections, be able to sustain their teaching mission were it not for such financial help. I would only say that knowing the experience of rheumatology from both sides has expanded my view of the complex universe we cohabit as peers, and my desire would be to humanize the relationship between parties, knowing that the clinical enterprise requires the efforts of biotech/pharma as much as industry in this arena requires the voice of physician advocates.
Perhaps a glass of Haut Brion with a view of Parliament over the Thames is in order.
Jonathan Krant, MD
Vice President, Clinical Research