The pursuit of knowledge and the business of science: The transition of research at United States academic health centers and economic implications for bioscience policy

U.S. academic health centers are entering the bioscience and technology industries in ways that are different from past notions of research activity by universities. With recent and projected declines in government funding for research, academic health centers have sought stronger alliances with industry. As a consequence of changing investment and research relationships, the organization of bioscience at leading research centers is characterized as more corporate than academic. For these centers, what was once the pursuit of knowledge has also become the business of science. Background. The sciences of medicine were widely introduced to the curriculum of medical education in 1910. With this introduction began the formation of the U.S. bioscience research infrastructure. Early close associations with universities attracted support from philanthropic sources. Through the 1930s, private and state support built basic research facilities at more than 100 schools of medicine. From the mid 1940\u27s, the federal government began to increase its interest in science research as a public investment, which it has sustained to the present. Industrial investments in bioscience research have supported some university efforts, mostly in applied ventures. Today, the bioscience research infrastructure has matured with new hybrid organizational forms at elite academic health centers. Methods. Case studies of three research-intensive academic health centers describe the evolution of bioscience research from government investment through corporate sponsorship to an emerging entrepreneurism. The role of institutions in bioscience research provides a context for economic policy implications. Findings. Academic health centers are organizing their research units as corporate entities and are pursuing science as a source of sustainable income. As a larger consequence of these changes, they are altering their relationships with government and industry. Academic health centers seek to invest in and to retain a measure of profit from the research enterprise that they create. Academic bioscience research activity is becoming more specialized and consolidated. Discussion. Reports of organizational changes at academic health centers are interesting stories that often overlook a larger question--why are these organizations behaving differently? Elite, academic health centers are responding to and creating changes in the science investment infrastructure. This research concludes with a discussion of policy problems associated with changing institutional incentives and organizational design: (1) the shift in investment from diffuse research efforts to a concentration of investment in elite centers, (2) consolidation of research efforts within the university setting, (3) proprietary information and its effects on peer review, (4) effects on faculty promotion, (5) the consequent relationship of science to medical education and (6) attraction of international investment sources. Conclusions. Changes in the organizational behavior of academic health centers are moving in a direction of greater consolidation and association with industrial goals. The future growth of academic research will depend increasingly on industrial support and an the ability of academic health centers to become self-sufficient. The need for improved policy models is considerable as the behavior of governmental, proprietary, and nonprofit organizations in the health care economy becomes increasingly interdependent. Institutional analysis derived from notions of institutional integration is a viable approach for the further development of bioscience research