Academic health centers are trying to overcome stiff competition for lucrative clinical-trial contracts from drug companies and other vendors.
These university-based medical schools and teaching hospitals known for their expertise in clinical trials research must shed their stodgy image to compete against community hospitals, private physicians and for-profit research centers, all of which have been making forays into the market.
Academic health centers have been portrayed by many vendors as out of touch with their needs.
"Vendors have been saying, `we get all of the arrogance of the academic medical center and not the substance,"' said Peter Vlasses, associate director of the University Hospital Consortium's Technology Advancement Center.
Mr. Vlasses has been working with many of the Oak Brook, Ill.-based UHC's 67 member academic health centers to keep them competitive in the market for clinical research dollars.
"Vendors aren't saying we academic health centers don't do good research," Mr. Vlasses said. "We were the action in the 1970s, we got away from it in the 1980s, and we're back playing hard in the 1990s."
Changing business needs.The competitors that emerged in the 1980s promised and delivered quicker turnarounds of clinical trials.
In the 1980s of Reaganomics and leveraged buyouts, the importance of deadlines and speedy clinical trials were stressed by big businesses striving to stay competitive.
Meanwhile, academic health centers, more accustomed to meticulous science than the demands of the new marketplace, couldn't keep pace, Mr. Vlasses said.
"There have been case studies where a company found a doctor at a community hospital to do the research, and that business literally walked across the street," Mr. Vlasses said.
Losing that business is no academic matter. With federal dollars for research from the National Institutes of Health becoming more scarce, analysts say academic health centers have no choice but to go after more contracts from private industry.
Member companies from the Pharmaceutical Research and Manufacturers of America were expected to spend $3.5 billion more on research and development this year than the NIH (See chart).
PhRMA member companies began outspending the NIH in 1988 when they spent $6.5 billion compared with the government's $6.3 billion. Now, this year's projections show private industry spending $13.8 billion compared with the NIH's $10.3 billion, according to PhRMA's annual survey and NIH figures.
The competition.One competitor to academic centers that emerged in 1987 was the Chicago Center for Clinical Research, which saw its revenues grow to $5 million last year. Revenues are projected to be more than $6 million this year.
"Academic centers' goal is to fill hospital beds and not to deal with the pharmaceutical industry," said Kathleen Drennan, CCCR's president and chief operating officer.
CCCR has conducted some 250 clinical trials for an array of biotechnology, pharmaceutical and food companies across the country. Among its clients are Abbott Laboratories, McDonald's Corp. and Parke-Davis' pharmaceutical research division.
"Academic centers don't have the staffing, the funding and the expertise to recruit patients for clinical research," Ms. Drennan said.
With two satellite centers in Chicago, CCCR expanded its main downtown headquarters to 22,000 square feet this year from 10,000 square feet and plans to open a dozen more satellite clinical research centers in the next two years throughout the Chicago area and in other Midwestern states.
"We at clinical research centers cater to the needs of industry, but we're just not a drug industry puppet," Ms. Drennan said. "We publish and write our own protocols."
Admitting errors.Some academic health centers admit their research components have earned a reputation as being slow and arrogant when it comes to dealing with industry on clinical trials. But academic health centers are working to correct their poor business practices.
Academic health centers typically include a medical school, other health professions' schools or programs, and one or more teaching hospitals. In many cases, the medical school controls the research function, but some of the more successful research institutions and the UHC encourage academic health centers to have a central office that oversees clinical research.
At Philadelphia's Jefferson Medical College, an affiliate of 707-bed Thomas Jefferson University Hospital, efforts were made to prevent clinical research organizations from chipping away at the medical college's $12 million in annual clinical research revenue from industry.
"Given the pressures that academic centers are under to begin with, we thought we were going to lose market share," said Joseph Sherwin, associate dean of scientific affairs, who is responsible for contracting for clinical research.
Thomas Jefferson created an internal infrastructure for vendors to work within, Mr. Sherwin said. Marketing efforts also were expanded and improved.
"We haven't been beating on doors and looking for work," Mr. Sherwin said, but efforts are being made to maintain contact with other vendors.
Of Thomas Jefferson's $64 million in research revenues, $47 million is from the federal government, $12 million comes from industry and the remaining $5 million is from foundations and private grants.
Increased market share.The improved links between Thomas Jefferson and vendors have helped the academic health center keep its clinical research market share and increase revenues 4% to 5% annually. "If we wouldn't have done some of the things we did, we would have lost ground," Mr. Sherwin said.
Nationally, the UHC is working on getting other academic health centers to become more competitive in the race for clinical research dollars.
Academic medical centers are being urged by the UHC to "re-engineer" their clinical research departments. UHC will release a model case study in hopes of helping academic medical centers change their ways.
The document includes analyses and expert insight from a spectrum of people involved in clinical trials research, from various vendors to the internal people at the academic medical center, such as the medical school dean and the hospital administrator.
Still, CCCR's Ms. Drennan, who has consulted with academic health centers on their clinical trials' research programs, said academic centers need to do more.
"There's enough research money from industry to go around," Ms. Drennan said. "Hospitals will always be needed for inpatient clinical research."
Ms. Drennan said academic health centers may consider an affiliation such as CCCR's link with 812-bed Rush-Presbyterian-St. Luke's Medical Center in Chicago. CCCR does inpatient studies with Rush and contracts with Rush physicians for studies such as one on HIV that is now under way.
Academic medical centers may want to consider forming an affiliation with a clinical research center or even developing a for-profit arm of their institutions that would deal with clinical research, Ms. Drennan said.
"They need to share the patients and share their knowledge," Ms. Drennan said of academic health centers. "They have created fiefdoms, and they are protecting their own."