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The pendulum's swing: Cause and effect relationship

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The pendulum's swing: Cause and effect relationship
Mauricio Goihman-Yahr MD PhD
Dermatology Online Journal 16 (2): 18

Professor(E) of Dermatology and Immunology, Vargas School of Medicine, Central University of Venezuela, Caracas, Venezuela.

Disclaimer: Opinions expressed in this paper are the author's. They do not represent nor pretend to represent those of Central University of Venezuela nor those of Dermatology Online Journal.

If conditions are set up for something to happen; it is very likely that it will.

Dermatology and Medicine became extremely interested in the basic sciences and research during the XXth Century. In the US, the acme of this interest was reached in the fifties and sixties. Dermatologists (as well as other physicians) became very involved in research. It became evident that not only aptitude and interest, but also special training was necessary. Many medical schools developed strong research departments with full time faculty devoted to research and teaching. Physicians became involved. Being an MD, PhD, turned from an oddity to a worthy goal achieved by a number of capable individuals. Dermatology was fully engaged in this program. The Society for Investigative Dermatology and its Journal were started and grew. The goal was that as many specialists as possible would become engaged in the pursuit of knowledge and the rest would become fully conversant with the language and philosophy of science. Departments of Dermatology and training programs were the means to achieve this goal. An academic career was deemed to be highly desirable. In truth, some went into it without the needed gifts and will. There was some pedestrian science; but there was also highly productive research that created an overall elevation in scientific intelligibility and its advancement by dermatologists.

The tide turned; funds dried up. Academicians received lesser salaries. Academic life became very embroiled. Departments closed or shifted emphasis to engage increasingly in the most lucrative aspects of Dermatology. The emphasis turned to efficiency, legality, and fund raising, not creativity. Clinical trials were no longer initiated by clinicians but by pharmaceutical houses. Medical care became the fief of for-profit organizations. Results were as should have been expected. Dermatology and Medicine survived. Physicians became acceptable bureaucrats. Techniques and procedures grew as a function of the market and so did medications. There was improvement in some areas. Indeed, administration became, perhaps, more efficient. Ivory Towers stopped being built and significant progress occurred disproportionately in areas deemed profitable to those funding the projects.

Today there is a renewed cry for creativity. There is a new term, “Translational Medicine.” The Editorial of the November issue of the Journal of Investigative Dermatology advocates for clinician-educators, investigators and, yes, patients.

I do certainly hope that the spigot of Academia, personalized patient care, education, and training can be turned on again despite economic woes. Wouldn’t it be better if instead of cutting down the tree of Academic dermatology over the last couple of decades, only some prudent pruning had been performed? Wouldn’t it be more efficient to make changes smoothly instead of the typical sudden braking and abrupt starting?

© 2010 Dermatology Online Journal