Academic medical centers and medical research: the challenges ahead.

Although the present era offers more promise for medical research progress than ever before, academic medical centers also face more daunting challenges for the conduct of medical research: high expectations by the public for a steady stream of lifesaving discoveries, news about financial conflicts of interest and scientific misconduct by researchers that threatens to erode public trust in academic institutions, tensions between the cultural norms of academe and industry that cloud their growing partnerships, obstacles to recruiting and retaining physician-scientists, constrained funding sources and increasing costs of research, and the need to transform the academic reward structure and culture to encourage collaboration and adapt to the new "team science." The interconnectedness of these challenges magnifies their difficulties and importance. Maintaining academic medicine's integrity and effectiveness in pursuing its vital research mission will be a crucial challenge for medical schools and teaching hospitals in the years ahead.