Written by Deirdre R. Bland, MD in 2001 – Still true today

The realm of academia and medical research has evolved in a way that none of us would have predicted. In the "good old days", medical research was in the purview of the physicians and scientists associated with academic medical centers. The physician-scientist devoted time to all aspects of the academic triangle; research, clinical care and education. The founding fathers of our specialty were known as excellent clinicians, and they used those skills to both train the next generation of physicians and to provide lasting contributions to medical care. Now research comes from many different venues, including individual clinicians, contract research organizations, governmental support, and industry. The increasing industrialization of medicine has changed the landscape of medical care, bringing with it time constraints, financial issues, and previously unrealized ethical challenges.

Urogynecology has seen exponential growth as a specialty. As recently as 10 years ago, fellowships were uncommon, and those that were available had vastly differing training experiences, depending on the emphasis of the mentor. Programs could vary in length from a year to 2 years, which may or may not include structured research training.

With growth also comes growing pains. We are not only in an era of expanding knowledge in Urogynecology, but also in the midst of the drive towards evidence based medicine. The majority of abstracts submitted for the AUGS meeting are now reports of clinical trials rather than case series. Data is more commonly collected in a prospective manner, with specific outcomes measures such as urodynamic testing, quality of life and structured questionnaires. We are seeing more basic research looking at the mechanisms of pelvic organ prolapse, detrusor instability and stress incontinence. No longer is the lower urinary tract examined in isolation without attention to prolapse, bowel and sexual function. However, quality research takes time and attention to details. From inception, to Institutional Review Board approval, to obtaining finances and, then finally initiating the study is a frustratingly slow process.

Time is becoming a precious commodity to the clinician-researcher. We are all experiencing decreases in clinical revenues that demand increases in time spent in clinical care to cover expenses. Truly achieving 'protected time' is difficult, especially for our junior members. In order to continue to support the high level of research conducted by our membership, we must be innovative in finding ways for those interested in research to buy protected time.

Medical research is leaning more and more heavily on industrial support. As the level of NIH funding dropped in recent years, and the availability of industrial moneys increased the entire practice of medicine has undergone an industrial revolution. Financial support is now available in many guises, from unrestricted educational grants, exhibitors fees, sponsored symposia, research awards and research contracts. Within AUGS we now have an obvious industrial presence at our annual meetings. In reality, without industry support, we would not be able to provide as high a quality meeting. We rely on our industrial partners not only for financial support but also to stimulate and expose our members to new ideas. Kimberly-Clark and the June Allyson Foundation have spearheaded the drive to garner endowments for research and education. The establishment of The AUGS Foundation will provide opportunities for AUGS members, private benefactors and industry sponsors to establish more awards to further the mission of research within our organization. A capital campaign for both of these Foundations will provide the financial support needed to foster new and innovative research in Urogynecology.

Industrial partnership brings with it many ethical concerns from our members. The fine line between support and influence is becoming more and more difficult to draw. The Siren's call of financial support is well known but often disregarded. We all believe that we are personally above the influences of outside support, yet publically voice concern about the effects of industrialization on the practice of medicine and research. Indeed it is human nature to be influenced by those who are generous to us and vigilance is ever needed to maintain our integrity as a society. Each of us must carefully examine our own activities and those of our organization for undue influence. An increasing number of our scientific presentations are sponsored by industry who are, de facto, conducting post market research. The requirement to disclose conflicts of interest when at the podium or microphone is more important now than ever. Most of these presentations bring valuable information to our meetings, provided they are conducted with insight, clarity and complete honesty.  We must present the drawbacks, negative findings and complications of our studies/operations with the same emphasis we give our successes.

Urogynecology is indeed moving forward. We are making unforeseen strides in medical research but are also encountering unexpected challenges. We must continue to lobby for increased support from the NIH and to work towards developing the Foundation resources within AUGS. As we continue to improve medical knowledge and find better ways to care for our patients, we must be ever vigilant that our quest for scientific truth is not unduly influenced by our need to obtain support and resources.