Why should this book about the commercialization of higher education, written by a former president of Harvard University, be reviewed in a medical journal? And what relevance does his thoughtful analysis of the corrosive effects of big-time athletics and profit-oriented education and research in our leading universities have for the medical profession? The answer should be obvious. Medical schools and teaching hospitals resemble the major research universities in being not-for-profit institutions that are entrusted with essential public responsibilities and that are now endangered by commercial incentives. As part of this carefully balanced yet compelling description of how financial rewards are increasingly tempting universities to compromise their educational and scholarly standards, Derek Bok also exposes the ethical crisis now facing academic medicine and the U.S. medical profession at large. Whether describing the scandals in the athletics programs at major colleges, the consequences of universities' pursuit of profits from the licensing of patented discoveries, or the conflicts of interest among faculty scientists who have financial ties to industry, Bok shows that he knows his subject well and that he has done his homework. Moreover, he marshals the relevant facts with an even hand and unsparing candor. He seems as familiar with the medical academy as with the rest of the university scene. Unlike many university presidents, he fully understands the risks inherent in the growing liaison between medical schools and the pharmaceutical and biotechnology industries. Although he acknowledges the social usefulness of the enhanced collaboration between academic and corporate research that followed the passage of the Bayh-Dole Act in 1980, he also is clear about the risks to the integrity and independence of research in medical schools that results from industry sponsorship and about the need for stronger policies to protect these values. Bok says that corporate influence on research involving human subjects needs particular attention because of the threat to the welfare of patients, but he also says that the involvement of businesses in the education of practitioners is no less problematic, since the practitioners' education will determine how they treat their patients. He is right on both counts. Bok is also correct to emphasize the growing danger of the corporate subsidization of continuing medical education. By allowing pharmaceutical companies to support and thereby influence programs for the continuing education of practitioners, medical schools and teaching hospitals are surrendering their own professional responsibility for education. In so doing, they risk losing the public's trust in the objectivity and reliability of medical teaching and in the professional advice that is based on this teaching. He fears that this trend may no longer be reversible because medical schools and teaching hospitals already depend on corporate support, but I think he is too pessimistic. Continuing medical education does not need to be nearly as costly as it is, and it could be financed without corporate handouts. Professional medical educators could easily regain full control if they were determined to do so and if they worried less about the loss of their corporate subsidies. Despite similar concerns about the reversibility of much of the current commercial tide in higher education, Bok thinks that university leaders still have the power to develop policies that could effect change. He urges collective action by the trustees and presidents of our universities and hopes that senior faculty can be persuaded to join the effort. I believe the same should be said about our medical academic leadership. If a handful of the most prestigious and influential medical schools were to adopt new guidelines that drew clear and reasonable limits to protect research and education from the worst effects of corporate influence, we would be well on our way to a solution. Without such action, it is hard to see how the values of most medical professionals can be sustained in a climate that is now so heavily dominated by investor-owned corporations. The medical profession, like the rest of higher education, is too important to society to allow its future to be determined by market forces. One can only hope that this book will help the public understand what is at stake and will generate support for the needed reforms. Derek Bok has sounded a warning that ought to be heeded. I suspect his book has already become required reading for college presidents and trustees and other leaders in higher education. It deserves just as careful attention from the deans of medical schools and their faculty -- and indeed from all physicians who care about the soul of their profession. Arnold S. Relman, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
--This text refers to an out of print or unavailable edition of this title.
Winner of the 2003 "Silver" Frandson Award for Literature in Higher EducationWinner of the Alice L. Beeman Research Award in Communications for Educational Advancement
"Provocative and original. . . . Bok is one of the premier elder statesman of American higher education."--Stephen B. Sample and Warren Bennis, Los Angeles Times
"Astute and fair-minded. . . . Derek Bok, a sensible man, has written a sensible book about the commercialization of the American university."--Jonathan Yardley, Washington Post Book World
"Contending that the trend toward excessive commercialization is not yet irreversible, Bok offers cogent, urgent arguments for reorienting universities toward fulfilling their unique purpose uncorrupted by the insidious influence of money."--USA Today
"Derek Bok begins his new book with [a] nightmare of university avarice and moral decay. Some of the moneymaking schemes are imaginary, but, as Mr. Bok warns, the dangers inherent in the insatiable demands for revenue are not. . . . It is increasingly difficult . . . to meet higher education's insatiable financial demands through conventional means. . . . Mr. Bok notes that commercialization has seeped even into the core educational mission. . . . Having a Derek Bok to remind us of our higher calling and the present dangers may, if his words are heeded, be more consequential than we can imagine."--Anthony W. Marx, New York Times
"Raises lots of big, disquieting questions. . . . Universities that blur the lines between their own culture and that of the corporate world endanger their values without substantially raising the value of their endowments. It is, in short, shortsighted. With the publication of this book, the nation's universities can't say they weren't warned."--David M. Shribman, Chicago Tribune
"Derek Bok, the former president of Harvard, argues that institutions have, perhaps unwittingly, made Faustian bargains. . . . Athletics provides a cautionary tale. . . . The dangers of corporate-sponsored research are even greater."--Glenn C. Altschuler, Barron's
"Bok realizes that there are times when allowing a business to provide funding for research or clothing for an athletic team is critical to a particular college's survival, but the trend of marketing various aspects of higher education is becoming more prevalent. This book is Bok's way of sounding the alarm for universities to analyze their practices critically."--Library Journal
"A humane and beautifully crafted book. Bok believes that the intrusion of the marketplace into the university is eroding fundamental academic values, and that we must act now to halt this decline. . . . [A] thoughtful and thought-provoking book."--Jeremy Gunawardena, Nature
"This is a good and needed book. . . . Bok strives for balance. He tries to puncture both the dangers to academe raised by its purists and the promises of easy money made by mortarboard Babbitts. He calls for new scrutiny of financial relationships between university researchers and companies. He [worries that] . . . corporate cash, fed slowly but in rising and addictive doses, will become the force behind what is discovered and what is ignored and even suppressed."--Ned Barnett, Raleigh News & Observer
"Bok shows that he knows his subject well and that he has done his homework. Moreover, he marshals the relevant facts with an even hand and unsparing candor. . . . One can only hope that his book will help the public understand what is at stake and will generate support for the needed reforms. Derek Bok has sounded a warning that ought to be heeded."--Arnold S. Relman, New England Journal of Medicine
"Bok is sensibly, judiciously and presidentially concerned. He puts the commercialization of the university into the same frame as big-time intercollegiate sport: both are unambiguous distractions from what universities are properly supposed to be about."--Steven Shapin, London Review of Books
"A thoughtful, clear-eyed inquiry into the impact of commercialization on the university's fundamental missions of education and research."--Daniel J. Kevles, American Scientist
"Bok is a retired President of Harvard, who was Dean of Harvard Law School before becoming President, and has been a distinguished professor in the Kennedy School of Government in his retirement. Harvard's endowment is worth something around $20 billion, so Professor Bok's views on money in higher education carry a certain weight. Bok provides a measured account of what goes wrong when too much of what a university does is seen to be up for sale--but not so measured that the point is lost or the lesson muffled. . . . Bok's patient attention to useful policies that each university can institute on its own--forbidding coaches to lean on professors for better grades, putting gin place policies about disclosure that commercial sponsors must sign up to--is the sort of thing that is needed."--Alan Ryan, Times Literary Supplement
"[An] excellent and beautifully written book."--Gordon Johnson, Times Higher Education Supplement
"Informed, concise, readable, temperate yet sounding necessary alarms."--Change