About two years ago, I hired my friend Danny Black, a talent agent for professional dwarf entertainers, to be my performance coach. Specifically, I wanted him to make me stop laughing at his jokes just long enough to teach me how to ask for more money for my speaking gigs.

This followed a secretary pulling me aside one day, at a university where I had been invited to speak, and telling me (while I filled out their reimbursement paperwork) that women get paid significantly less than men invited to speak, for no good reason. She asked me to start asking for a lot more money, because she thought I could help change the system and start getting pay equity for women speakers in academia. If nothing else, she said to me, I’d get paid what I was worth instead of getting the cutie discount.

Another time, I’ll tell the story of how Danny turned this part of my work life around, in just three coffee dates. I’ll just say here that, although he wouldn’t let me pay him more than one tall black coffee per meeting because we are good friends, within a year his coaching had earned me so much money that I wrote him a big check in thanks.

What’s relevant about that to today’s blog entry is that, in the process of having to explain to Danny how the weird culture of academia works, I had to explain to him that the coin of the realm is publications. He was fascinated by this, so fascinated that it gave me enough distance to realize how odd it really is. Danny was even more fascinated to hear that our universities make no direct profit from our publications, yet it is what they primarily value.

The more I thought about this, the more I realized that the value has been shifting over the course of my career, steadily, from publications to external funding. That made sense to Danny (the bosses want us to bring in money, as in any business), but it makes me grumpy. When I quit doing mortgage brokering and moved into academia, I thought I was moving out of sales. (The constant quest for external funding sure feels like a commission job.)

And the idea that publications are what is valued is not really a big revelation. In graduate school, reading Laboratory Life made that clear. But why do we value publications, Danny wanted to know? Why value that more than, say, teaching (which is, by contrast, often seen as a form of punishment for not publishing enough), or public service?

I think it’s obvious that, at one time, we valued publications because they were a sign of the production of new knowledge. And a lot of that knowledge had the potential to improve human life: more reason to value publications.

Over time, though, it seems as if we forgot about what publications represented and simply started valuing the publications themselves. Or at least individual academics have. This, in turn, has led to a system that, lately I fear, has started working against humanity rather than for it.

I’ve become especially aware of this as I’ve worked on the dex project. (You can read about that here.) It seems like so much of what I’m seeing, in terms of failure to protect patients from apparently being experimented upon in unprotected and unconsented ways, can only be explained by people being much more interested in publications than in taking care of others.

It isn’t as if all the people involved (both those directly responsible, and those who watched it and didn’t think to do anything to stop it) are uncaring souls. Not at all. But they seem to have become so focused on the next publication, the next grant, the next line on their c.v., that they had stopped valuing what publications were supposed to represent.

It’s worrisome. To be honest, it has made me think a lot about what my goal is with each project and each publication. I feel like I’m pretty clear about doing what I value; if I were doing the kinds of things academia valued that I don’t value, I wouldn’t be in the media mess I am right now. That said, I know my university values having my work show up in the press. . . . (I think of the media as the only way to do mass education and to push for reasonable change in problematic systems. It always feels like a deal with the devil, and this week has felt like no exception.)

I’m not sure what to say. I guess I just hope that, as the economy continues to be sick in bed, and taxpayers and donors are looking for more accountability out of universities and hospitals, maybe there’s an opportunity to do more than asking where we are wasting money. Maybe we could ask about where we are accidentally using money to hurt people in the service of our own careers. Work on considering, more consciously, where we are doing good.

When I was a mortgage broker in the 80’s, on Long Island, it was obvious to us all the system was broken and would crash. You see, we were all being paid to write mortgages. No one’s income depended on whether property owners could actually pay the mortgages back. Write ‘em up, write ‘em up, rah rah rah. Hence the first Savings and Loan crisis.

Now the reward system in medical academia looks frighteningly similar: people are rewarded for interesting results, not healthier outcomes. For sexier studies, not safer ones. And the rewards so outweigh the punishments, the only real risk seems to be in being too cautious when looking to write “it” up.

(Originally posted July 6, 2010)

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Wasn’t publishing supposed to be about new knowledge, or improving human existence, or something other than . . . publishing?