WASHINGTON _ The transformation of the U.S. health caremarket by managed care may claim among its victims many academicmedical centers and the biomedical research efforts nurtured there.The relationship between those centers and the biotech industry as aconsequence will undergo fundamental change, according to DavidBlumenthal, vice president of Brigham and Women's Hospital, ofBoston.

"Academic medical centers may be either victims of health careoligopolies _ huge integrated health care networks _ or masters ofthem," Blumenthal said. He predicted that fewer than 10 academicmedical centers possess the necessary resources to remain intact in ahealth care system increasingly influenced by managed careorganizations.

Blumenthal has written extensively on the relationship betweenacademic medical centers and the biotech industry. Recently hereleased findings of a survey documenting this relationship whichwas supported by a grant from the National Center for HumanGenome Research at the National Institutes of Health. The article,"Relationships between academic institutions and industry in the lifesciences _ an industry survey," appeared in the Feb. 2, 1996, NewEngland Journal of Medicine.

"Academic medical centers have the potential to become dominantregional players in their markets. However, most will find themselvesequal partners or junior partners in alliances with providers designedto assure market share. The power that academic medical centerswield within those alliances will depend on their market strength,assets, reputation and leadership," he said.

One upshot may be a dramatically diminished role for biomedicalresearch. "Academicians will become less important to academicmedical centers because the organizations will become so large. Itwill be a bit like taking Bell Labs and adding AT&T to it. Bell Labsmay stay but it won't be as important as revenues from longdistance," Blumenthal said, adding that academic research could getdiluted.

"Some academic medical centers may use some net revenues forteaching and research but they won't do that without federal andgovernment support. Research is not a sustainable mission in thecurrent health care business market. If enough money falls to thebottom line, it may be diverted to teaching and research but it will bevery carefully done," he stated.

Blumenthal speculated that biomedical research will not decline aslong as federal support through the National Institutes of Health(NIH) remains stable. But he has already seen signs that the federaldollar is shrinking. "The NIH no longer pays for secretaries nor doesit fully cover the cost of animal labs. The relative value of the NIHdollar is not as high as it used to be," he said.

He made it clear that these federal biomedical research dollarsindirectly subsidize the dollars drug companies spend to supportresearch at academic centers. "Drug companies do well sending theirbasic research to universities. They do not have to carry the overheadand can get the research out quickly. In most labs the drug company'smoney is mixed up with two to three federal dollars. In other words,drug companies are leveraging federal dollars. They are gaining entryto the work of scientists for whom most research support comes fromanother source. The commercial benefits of that federal money can beharvested by the commercial drug companies," Blumenthal said.

"Drug companies rely on academic medical centers to continue to dothe fundamental research that produces new findings that often resultin quantum leaps in knowledge about how human organisms workand life functions. Without them, the possibility for dramatic newbreakthroughs wont be there," he predicted.

He urged the biotech drug industry to stop giving lip service tosupport for NIH research. "It is important that we continue to remindthem how dependent they are on academic researchers," Blumenthalsaid. "There is no reason why academic medical centers in theircurrent form will be preserved especially if they are training toomany physicians." n

-- Michele L. Robinson Washington Editor

(c) 1997 American Health Consultants. All rights reserved.