A post many weeks ago by Andrew Leonard in his blog “How the World Works” mused about the significance of the declining number of publications from “top” academic economists. It was July 26, so the original post is in the archives here. (a day pass to Salon is free after viewing an ad.. ) The paper he cites by Ellison and colleagues here is interesting reading, as is one from last year by Kim and colleagues here on a similar topic. There are many interesting parallels to changes we’ve seen in health care.


The hand wringing titles of these papers (“Is Peer Review in Decline?” and “Are Elite Universities Losing Their Competitive Edge?”) belie the positive trends that are described by the research. In a nutshell, the argument is made that within academic economics and research the so-called “elite” universities are losing their prominence. The reasons given are that first, the Internet makes it possible for academic collaboration to occur between individuals in a variety of settings, not just between those physically located at an elite university. Secondly, the professional societies and the large publishing houses are no longer the controller as of the peer review process and have begun to lose their power. It’s nice to see a careful analysis of both of these trends but both are pretty obvious to anyone who has spent much time using the Internet. Clearly, geography has become almost meaningless when it comes to exchanging ideas and communicating with others. Secondly, its also pretty obvious that the rich conversation, critical thought and “peer review” that takes place in any discussion group could supplement or even replace the present formal review process.

While both these papers discuss changes within academic research in economics, they both also recognized that these trends have implications for other areas. Any knowledge -based industry is bound to be affected. A large amount of activity within the health care sector is clearly “knowledge management”and so I suspect, over time, the forces described in these papers will have a dramatic impact in academic medicine. For example,in the second paper that height linked to above (Kim and colleagues) the authors state-

“industries that rely heavily on human capital and expertise, such as financial services and entertainment, may find centralizing their production in core locations, such as New York and Hollywood, to be increasingly less important. What we have documented for universities has also been happening in other industries. Back office operations are increasingly outsourced overseas. Industries that can provide service over the internet (e.g., real estate brokering) are breaking out of traditional modes of operation. Our results suggest that these breakdowns are only the tip of the iceberg; in the not-so-distant future, many industries may find little need for locational anchors at all.”

I would argue that much of what we do in medicine is even more likely to detached from specific locations associated with prestigious hospitals. Instead, the services offered by high-quality clinician’s and hospitals can be made available much more widely than in the past. Additionally, not only will individuals at every university or hospital be able to take part in research, the discussion of results and criticism of findings; everyone, everywhere, will begin to take part in the management of this knowledge.

This is, after all, exactly what we have been talking about and promoting through this blog at e-Patients.net. However, it is nice to see convergent and evidence from other fields that further bolster our arguments.

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