The recent drops in preterm birth rates in the United States may reflect a new equilibrium, in which advances in prenatal diagnosis, obstetric care of high-risk pregnancies, and neonatal intensive care, along with a new steady state in the demographics of childbearing, and more careful use of assisted reproductive technologies all combine to lead to an optimum balance between reproductive freedom, obstetrical intervention, and perinatal outcomes. Acknowledgments This project was Inhibitors,research,lifescience,medical supported by a grant from the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research program (Prenatal

Care: Wise or Wasteful, grant #60470). Footnotes Conflict of interest: No potential conflict of interest relevant to this article was STAT activation reported.

The limits of the universe inhabited by the Inhibitors,research,lifescience,medical physician-scientist are defined largely by time and money. In a Journal of Clinical Investigation editorial, Andrew Marks stated:8 “Historically, physician-scientists have had dual roles in caring for patients and in performing investigative research that could potentially lead to new diagnostics and therapeutics. Physician-scientists conducted teaching rounds in

the hospital … and were often avidly pursued as the most important sources of new knowledge for trainees. “… Inhibitors,research,lifescience,medical Now physician-scientists are rarely seen in the hospital; they are most often spotted at their desks tapping Inhibitors,research,lifescience,medical out yet another grant application. Most struggle to find the time to mentor students and clinical trainees, let alone to care for patients, even though these interactions are often the motivating forces for scientific creativity.” These statements accompany a number of realities, as follows: Data collected by the American Medical Association from 1960 through 2005 show a major rise in the number of US physicians engaged in patient care while those involved in research and in teaching Inhibitors,research,lifescience,medical have been flat. Considering number of

faculty in medical school departments and National Institutes of Health (NIH) grants funded over roughly the same period, PhDs are increasing in number, MDs are decreasing, and the number of MD-PhDs is flat. Of interest below as well is that despite the efforts of NIH to fund young investigators, the trend over a 40-year period has been for the average age of research grant RO-1 recipients to increase, such that in 2005 approximately 35% of RO-1 principal investigators were over 50 years of age (as compared to about 22% 20 years earlier). Barbara Weber has summarized the time and money issues confounding the physician-scientist as follows:9 “Three [critical] issues in academic medicine [are] having a serious negative effect on the pace and quality of academic … investigation.