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 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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