From Biomedical Discovery to Society
Restoring Public Trust
The idea for a future book began with a simple exercise. I tried to trace the path a health claim travels from the place it is born to the person who acts on it.
Every claim has an origin. It may start as a laboratory finding, a small clinical trial, a press release, or a remark on a podcast. From there it moves. It passes through journals, newsrooms, marketing departments, clinics, and social media feeds. At each stop someone can test the claim, sharpen it, or correct it. At each stop someone can also inflate it, strip away its cautions, or sell it. By the time the claim reaches a patient at a kitchen table, its original evidence may be unrecognizable. A weak claim can arrive with the confidence of real science.
I came to think of this route as a highway. It runs from bench to bedside to population to the commons. Along the way, data become information, information becomes knowledge, and knowledge becomes power. That power shapes what people eat, which treatments they accept or refuse, and whom they trust. Valid claims and false ones travel the highway in the same traffic.
Tracing the route led me to a harder question about the people who stand along it. Physicians, nurses, pharmacists, scientists, educators, and public health officials hold a particular place on this highway. Society licenses them, invests in their training, and grants them its trust. That trust carries a duty. Health professionals owe the commons information that is valid, honest, and usable.
I have written on this subject before. My 2025 book, In the Pursuit of Real Science in a Modern-Day Society, drew on Karl Popper and Thomas Kuhn to separate real science from pseudoscience and faith-based claims. Empirical evidence, reproducibility, and skepticism mark the difference. The book examined failure and fraud, the reproducibility crisis, and the growing influence of corporate funding on research. Its warning was plain. When profit or ideology shapes research, science loses the credibility that makes it a reliable guide. That book defended the integrity of science. This post asks who must protect that integrity on the road to the public. Each time I return to this subject, I come back to two organizing questions. They are simple to state and difficult to answer.
Where does society get valid and trustworthy biomedical information?
Who bears primary responsibility for policing the biomedical information highway?
The first question is about sources. A generation ago, most people got their health information from a physician, a reference book, or the evening news. Today they get it from search engines, influencers, advertisers, and, more and more, artificial intelligence. Few of these sources answer to a professional standard. Some answer to no standard at all.
The second question is about transparency and accountability. The candidates include government regulators, journal editors, universities, professional societies, technology platforms, and individual clinicians. Each holds part of the responsibility. None holds all of it. When responsibility is spread this thin, everyone can assume someone else is watching the road.
Misinformation now poses an existential threat to the public’s health and well-being. It erodes trust in vaccines, delays care, wastes limited resources, and turns clinical encounters into arguments. It also corrupts the learning health system, which depends on reliable data to improve. A society that cannot tell good evidence from bad cannot make sound decisions about its own health.
Biomedical research and clinical medicine stand at the head of this highway. Together they form the academic medical enterprise. Most biomedical claims are born in its laboratories and clinics. Its faculty train the professionals who carry those claims to patients. The first miles of the highway belong to this enterprise, and so does the first duty to keep them clean. Restoring public trust must begin there. That conviction sent me back to a paper that asks what the enterprise owes the society that sustains it. Its answer is demanding.
A Mission Built for Another Century
For most of the last century, the academic medical enterprise had a three-part job. It cared for patients with complex problems. It conducted biomedical research. It trained the next generation of clinicians and scientists. That mission saved millions of lives. It produced better treatments for heart disease, stroke, and diabetes. It made organ and stem-cell transplants and minimally invasive surgery routine.
That mission is no longer enough. An aging population and the spread of chronic disease keep pushing demand upward. Care remains fragmented, and problems of access, cost, and equity persist. Public trust in science has weakened, and misinformation now outruns correction. Then COVID-19 struck patient care, research, and education all at once. Many institutions worldwide were unprepared.
In a 2021 Viewpoint in The Lancet, Victor Dzau, president of the National Academy of Medicine, and his colleagues Celynne Balatbat and William Ellaissi called on the academic medical enterprise to rethink its purpose. Their argument deserves a wider audience. It reaches every part of the university, well beyond the medical school.
From Bench to Bedside to Population to Society
Dzau, Balatbat, and Ellaissi have built this argument over a decade. In 2010 they proposed moving academic medicine past the Oslerian model of bench to bedside. They called for a continuum that ran from laboratory to clinic to population. In 2013 they urged academic health centers to plan as integrated biomedical research and clinical enterprises and to seek partners outside their walls.
The 2021 paper takes the final step. The continuum now runs from discovery to health to population to society. It has four stages:
Discovery and translation. Genomics, gene therapy, synthetic biology, engineering, and digital technology.
Adoption and implementation. Implementation science, health services research, and workforce training.
Population and global health. Social determinants, cross-sector partnerships, public health, and globalization.
Society. Ethics, economics, security, trust, environment, and climate.
Three threads run through every stage: data science, convergence science, and equity. The model asks academic medical enterprises to measure success by the health of communities they serve. Publications and patient volumes still count. They are no longer the whole ledger.
Convergence Over Silos
Reductionism built modern medicine. The method breaks a problem into its smallest parts, such as a gene, a cell, or a molecule, and studies each part on its own. It gave us antibiotics, vaccines, and targeted cancer drugs. It cannot solve problems rooted in housing, transportation, food, and work. Those problems arise from whole systems, and only a systems approach can address them. The authors call for exactly that. They push past team science toward convergence science. The National Science Foundation defines convergence research by two features: a specific and compelling problem, and deep integration across disciplines.
Convergence brings engineers, mathematicians, computer scientists, economists, lawyers, ethicists, and urban planners into the work of health. The Carle Illinois College of Medicine, the first engineering-based medical school, offers one model. Funding agencies organized around single organ systems or diseases will need new incentives. So will promotion and tenure committees.
Population health shows why this matters. Health outcomes are the product of medical care, public health, behavior, social conditions, and environment. Accountable care organizations are often mistaken for population health programs. Most ACOs manage care across a provider network. Few reach upstream to the conditions that produce disease. An academic medical enterprise that wants healthier communities must bring its schools of public policy, law, social science, and engineering to the same table.
The Anchor Institution
The academic medical enterprise is often the largest employer in its region. That economic weight carries a social obligation. Dzau and colleagues call on the enterprise to serve as an anchor institution. It should invest in housing, job creation, food security, and education in surrounding neighborhoods. It should direct its purchasing toward community-owned and minority-owned businesses.
Climate belongs to the same obligation. The authors treat climate change as a public health crisis. The NHS in England has committed to become the first national health system to reach net zero carbon. The National Academy of Medicine has launched a grand challenge on climate change and human health. The academic medical enterprise can lead through research, education, and changes in how it delivers care and manages its supply chains.
Preparedness belongs here as well. During COVID-19, academic medical centers supplied testing, sequencing, clinical trials, and vaccine distribution with little advance planning. The next public health emergency should find them ready. The authors want these centers working as a coordinated national network alongside public health agencies.
Trust, Governance, and Misinformation
Every scientific advance carries risk. Gene therapies priced in the millions of dollars raise questions of cost and access. Consumer genetic tests and health apps raise questions of privacy and security. Artificial intelligence raises all of these and adds another: who answers for its errors?
Researchers have long governed themselves through professional norms, but the authors judge self-governance insufficient for the technologies now arriving. They ask the academic medical enterprise to help build a multisectoral governance framework. It would follow a technology through every stage of its life, from conception and funding through research, publication, product development, and commercialization.
Trust is the currency of this work, and the past decade has spent much of it. Mistrust of biomedical science grew as misinformation spread, and vaccine hesitancy during the pandemic showed the cost. The enterprise will not win back public trust with journal articles behind paywalls. Its faculty must speak in public, in plain language, wherever people get their information.
Educating a New Kind of Professional
The authors call for a new type of clinician. The 2010 Lancet Commission on health professional education tied a set of competencies to clinical delivery. Dzau and colleagues extend those competencies to include social determinants of health and health systems science.
Three changes follow. Students should meet community and social issues early, in the preclinical years, before direct patient care begins. They should be fluent in data, because electronic records, genomics, and machine learning now shape clinical decisions. They should train alongside other professions, because teams deliver care. Clinicians already in practice need the same preparation through continuing education.
Every faculty member who teaches can apply one test. Knowledge, skills, and values earn a place in the curriculum when they improve the health of patients and populations.
Caring for the Workforce
No institution can serve society while it exhausts its own people. Too many health institutions are doing exactly that. Clinician burnout, depression, and suicide have risen sharply in recent years. These are the people society trusts to carry valid information to the bedside. A depleted clinician cannot do that work well.
The National Academy of Medicine’s 2019 consensus study named the three dimensions of burnout: emotional exhaustion, depersonalization, and a lost sense of professional efficacy. Each one harms clinicians. Each one degrades the quality of care. Burnout also drains organizations through turnover and staffing shortages, which put heavier loads on those who remain.
Electronic health records deserve particular scrutiny. They produced vast amounts of useful data. They also turned many clinicians into data gatherers and pulled them away from patients. The academic medical enterprise trains and employs these clinicians, and it must lead the repair. It must study what drives burnout, fix it, measure the results with rigor, and share what works. The enterprise cannot keep public trust while it neglects the people who earn it.
What the Enterprise Owes Society
Grants, rankings, and citations are easy to count. The better measure of the academic medical enterprise is what changes in the lives of the people it serves.
Dzau and his colleagues set out a clear agenda. Extend reductionist science with systems thinking and convergence science. Join molecular science to population health. Use data well. Partner with public health and communities. Act as an anchor institution. Protect the workforce. Few institutions will accomplish all of it. Each can adapt the principles to its own setting.
That agenda also answers my two questions. Society gets valid and trustworthy biomedical information when the institutions that produce it stay accountable to the communities that use it. Primary responsibility for policing the highway rests with those who stand at its head: the researchers, teachers, and clinicians of the academic medical enterprise. Regulators, editors, and platforms share the load. None of them can carry it without the enterprise.
I have spent five decades in clinical practice, health system leadership, and teaching. The institutions that earned public trust were the ones that showed up for their communities. Trust follows service. Discovery matters most when it reaches the people who need it, in a form they can believe.
