The Trajectory of Discovery
What Determines the Rate and Direction of Medical Progress?

Explores the forces determining the trajectory of medical progress, bringing together scientific policy, economics, sociology and innovation.

Mark P. Khurana (Author)

9781009354431, Cambridge University Press

Paperback, published 13 April 2023

192 pages
23.4 x 15.5 x 1 cm, 0.27 kg

'A compelling route into the contemporary world of science. With plenty of illuminating examples from biomedical research, Khurana gives us an insider's view into how prizes, important discoveries, easily-accessible tools, funding bubbles, temporary emergencies and crises have long-term effect on what scientists study, and contribute to determine whether science will ultimately progress or sluggish. It shows how patients' groups, philanthropic institutions, corporate lobbies and governments can have a say into what gets prioritized and discusses how some of the current obsessions of science, such as having positive findings, publishing first and cumulate citations pose additional frictions. The final portrait is a world where little room, if any, is left to academic freedom.' Chiara Franzoni, Professor of Applied Economics, School of Management, Polytechnic University of Milan

Medical research works in trajectories. Scientists and researchers must choose to pursue certain scientific pathways and omit others, limited by resources, attention, and time. The trajectory of medical progress is therefore characterized by two crucial characteristics: rate and direction. These two components form the foundation for this book - what are the forces that determine the rate and direction of progress in medicine? This book brings together the worlds of scientific policy, economics, sociology, philosophy, and innovation to describe why the world of medical research looks the way it does. The book also addresses fundamental contemporary issues in medicine, how they influence progress, and how we might improve medical research going forward. The contemporary issues discussed include: flawed incentive structures, a concentration of power and resources among few actors and disease groups, the potential distortionary effects of lobbying by different scientific actors, and missing novelty in drug development.

Part I. Incentives, Context and Capital: 1. Citations as currency
2. Hacking statistics
3. The allure of prizes
4. Streetlight effects
5. Patented and regulated progress
6. Teams and diversity
Part II. The Financial Determinants of Discovery: 7. The research marketplace
8. Winners take all
9. Public service
10. The medici model
11. The goldilocks zone
12. Kindling creativity
Part III. Bending the Arc: 13. Lobbying for change
14. Scientific elasticity
15. Death of a star // new kids on the block
16. Great emergencies
17. Fraudulent findings
18. Serendipity
19. Converging paths
Part IV. Reflecting on the Trajectory: 20. Civic engagement
21. Uncertainty
22. Commercialization and power
23. Morality and progress.

Subject Areas: Medicine: general issues [MB]