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Strengthening Research in Academic OB/GYN Departments
STRENGTHENING RESEARCH IN ACADEMIC OB/GYN DEPARTMENTS
Jessica Townsend, Editor
Committee on Research Capabilities of Academic Departments of Obstetrics and Gynecology
Division of Health Sciences Policy
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
1992
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Strengthening Research in Academic OB/GYN Departments
NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education.
This project was supported in part by funds from the National Institutes of Health, National Institute of Child Health and Human Development, Contract Number NO1-HD-0-2905. The Johnson and Johnson Foundation, the Burroughs Wellcome Fund, Syntex (U.S.A.), Inc., the Institute of Medicine, the Andrew W. Mellon Foundation, and the Richard King Mellon Foundation also supported this project.
Library of Congress Catalog Card No. 92-70987
International Standard Book Number 0-309-04697-1
Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue, N.W. Washington, D.C. 20418
S557
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held at the Staatlichemuseen in Berlin.
First Printing, April 1992
Second Printing, June 1992
Third Printing, December 1992
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Strengthening Research in Academic OB/GYN Departments
COMMITTEE ON THE RESEARCH CAPABILITIES OF ACADEMIC DEPARTMENTS OF OBSTETRICS AND GYNECOLOGY
RICHARD E. BEHRMAN (Chairman),* Executive Director,
Packard Foundation—Center for the Future of Children, Los Altos, California
EVERETT ANDERSON,** Professor of Anatomy and Cellular Biology, and Associate Director,
Laboratory of Human Reproduction and Reproductive Biology, Harvard School of Medicine, Boston, Massachusetts
C. WAYNE BARDIN,* Vice President, The Population Council, and Director,
Center for Biomedical Research, New York, New York
GERARD N. BURROW,* Dean,
School of Medicine, University of California, San Diego, La Jolla, California
SHIRLEY S. CHATER,* President,
Texas Woman's University, Denton
ARTHUR L. HERBST, Professor and Chairman,
Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
ERNST KNOBIL,** Director,
Laboratory for Neuroendocrinology, University of Texas Medical School, Houston
PAUL C. MACDONALD,* Professor, Department of Obstetrics-Gynecology and Biochemistry, and Director,
Cecil H. and Ida Green Center for Reproductive Biology Sciences, University of Texas, Southwestern Medical Center, Dallas
DORIS H. MERRITT, Associate Dean,
Indiana University Medical Center, Indianapolis
RODRIGUE MORTEL, Professor and Chairman,
Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey
MARY LAKE POLAN, Professor and Chairman,
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California
GLORIA E. SARTO, Professor and Chairman,
Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque
PAUL D. STOLLEY,* Professor and Chairman,
Department of Epidemiology and Preventive Medicine, University of Maryland Medical School, Baltimore
JOSEPH B. WARSHAW, Chairman,
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
*
Member, Institute of Medicine
**
Member, National Academy of Sciences
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Strengthening Research in Academic OB/GYN Departments
Institute of Medicine Staff
RUTH ELLEN BULGER, Director,
Division of Health Sciences Policy
JESSICA TOWNSEND, Study Director
DEE SUTTON, Administrative Assistant
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Strengthening Research in Academic OB/GYN Departments
PREFACE
The work of this committee could not have been accomplished without the contributions of many people and organizations who provided assistance and information. The staff of the National Institutes of Health were especially generous with their time and expertise. Many individuals contributed, including Duane F. Alexander, Sumner J. Yaffe, Charlotte Catz, Michael E. McClure, Donald McNellis, Darlene D. Levenson, George E. Lewerenz, and many others at the National Institute of Child Health and Human Development who spent considerable time with us. A particular debt is also owed to Jerome G. Green and his staff at the Division of Research Grants who provided data that were crucial to the work of the committee. Our project officers were Pamela Wolf and Jeffrey A. Perlman.
Important help with data was also provided by Paul J. Friedman of the University of California, San Diego, who supplied special analyses of data on physician age distribution, and Warren H. Pearse of the American College of Obstetricians and Gynecologists (ACOG), who kindly allowed us to participate in a survey sponsored by ACOG and the Association of Professors of Gynecology and Obstetrics.
Individuals who participated at meetings of the committee include Florence Haseltine (who provided the inspiration for this study), Daniel R. Mishell, Lawrence D. Longo (who also contributed a background paper), Harold Pincus, and Frederick Naftolin.
We also wish to acknowledge the help of many members of departments of obstetrics and gynecology who welcomed staff and gave generously of their time and experience. Sites visited include the University of California at San Francisco, San Diego, and Irvine; the University of Pennsylvania; and Yale University.
The committee solicited input from chairs of departments of OB/GYN and others members of the profession. Their thoughtful responses gave us perspectives and information that provided important groundwork for our deliberations.
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Strengthening Research in Academic OB/GYN Departments
The research agenda, which constitutes Chapter 6, could not have been completed without the contributions of those who wrote background papers. Their names are listed in Appendix C, and our thanks go to each of them.
Finally I would like to thank my fellow committee members whose deliberations provided the basis for this report. On their behalf, I wish to express our gratitude to the Institute of Medicine staff. Jessica Townsend as study director managed all aspects of the study activities and report preparation. Dee Sutton provided secretarial support, and Paul B. Phelps edited the manuscript.
Richard E. Behrman
Chairman
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Strengthening Research in Academic OB/GYN Departments
Contents
EXECUTIVE SUMMARY
1
The Current Situation
3
Committee Findings
4
Committee Recommendations
9
A Research Agenda for OB/GYN
13
Oocyte and Follicular Development in the Ovary
15
Fertilization
16
Fetal Growth and Development
17
Preterm Labor
19
Contraception
20
Infertility
24
Premenstrual Syndrome
26
The Brain and Reproduction
26
Menopause
27
Oncology
27
Sexually Transmitted Diseases
30
1
INTRODUCTION
35
Origins of the Study
36
The Charge to the Committee
37
The Committee's Interpretation of Its Charge
38
Limits on the Scope of the Study
39
Conduct of the Study
41
General Concerns About Clinical Investigation
41
Beliefs About Research and Academic Departments of OB/GYN
47
References
48
2
IS THERE A PROBLEM?
51
Support of Research and Training in Departments of OB/GYN
51
Structural Characteristics of Departments of OB/GYN
69
A Research Agenda for Departments of OB/GYN
81
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Strengthening Research in Academic OB/GYN Departments
Conclusion
83
References
83
3
CAREER CHOICES
87
Career Pathways
88
Debt
89
Foregone Earnings
92
Duration of Training
95
Women and Research
101
Summary of Career Choice Factors
105
References
106
4
NIH POLICIES AND STRUCTURE
109
Absence of OB/GYN in the NIH Intramural Program
109
Absence of a Focal Point for OB/GYN Research at NIH
114
Study Sections
118
Restrictions on NIH Research Support
122
References
122
5
DEPARTMENTAL AND LEADERSHIP ISSUES
125
Departmental Issues in Expanding Research Capabilities
125
Leadership
132
References
139
6
A RESEARCH AGENDA FOR DEPARTMENTS OF OBSTETRICS AND GYNECOLOGY
141
Oocyte and Follicular Development in the Ovary
143
Fertilization
151
Fetal Growth and Development
155
Preterm Labor
160
Contraception
166
Infertility
178
Premenstrual Syndrome
186
The Brain and Reproduction
188
Menopause
192
Oncology
194
Sexually Transmitted Diseases
205
References
213
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Strengthening Research in Academic OB/GYN Departments
APPENDIX A -
PREPARING FOR THE TWENTY-FIRST CENTURY IN THE REPRODUCTIVE SCIENCES
229
Training Paths
231
Private Foundation Funding for Research Training: 1950 to 1985
231
Federal Support for Research Training
241
Obstetrics and Gynecology Research Training: 1985 to the Present
244
Other Foundations and Pharmaceutical Companies
248
Problems of Research Training
252
Manpower in Academic Obstetrics and Gynecology Current Status and Future Needs
253
Lessons Learned
255
Conclusion
261
Addendum: Results of Survey of Former Scholars, Macy Fellows, and RCDA Recipients
262
General Background
262
Scholarly Productivity
263
Research Training in Obstetrics and Gynecology
264
References
266
APPENDIX B -
NATIONAL INSTITUTES OF HEALTH SUPPORT OF RESEARCH IN DEPARTMENTS OF OBSTETRICS AND GYNECOLOGY
269
NIH Support for OB/GYN Research
276
NIH Support for OB/GYN Research Training
293
Summary of NIH Support of Departments of OB/GYN
300
NIH Administration and Structure
302
References
305
APPENDIX C -
BACKGROUND PAPERS FOR THE RESEARCH AGENDA
307
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