In Reply: Mr Andreopoulos is incorrect in asserting that we favor expanding ties between universities and industry. Our article neither advocates nor admonishes against this. Rather, the options we proposed for isolating and managing those ties reflect the current reality that many universities and investigators are expanding their links to for-profit companies. A variety of pressures more laudable than simple avarice encourage enhanced commercial relationships. These may include the constrained ability to subsidize research from clinical income, the appropriate ambitions of investigators to seek new outlets to rapidly apply their innovations, and the recognition of companies of the quality and importance of academic talent, institutions, and the patients who seek care in them. Therefore, academic medicine will grow more dependent on nontraditional sources of support. Whether this is desirable or not is arguable.
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