COMMENTARY ON:        Issues and Perspectives: Can NIH Renovate the Biomedical Workforce?
FROM:                            sciencecareers.sciencemag.org [1]
A MODEST PROPOSAL

This recent article in Science summarizes an NIH Advisory Committee draft report [2] calling for the diversion of funding from research grants to training grants for graduate students and post-docs in the biomedical sciences. The proposal is one  that needs to be taken seriously because it represents a paradigmatic shift in science education and training policy. It could open the way to making science a profession rather than a technical craft for current and future generations of researchers. The report also recommends better pay and benefits for post-docs and staff scientists—resulting in all likelihood in fewer but better-paid positions.

Some members of the Advisory group argued that the current state of affairs is “dysfunctional and unsustainable” and that most graduate students do not receive the training they need to work in other roles in industry, government, policy and science writing. I agree. Nor, I would add, do they get adequate training to teach science in primary or secondary schools, community colleges and four-year colleges—the very places where early instruction in the sciences is so critical for the future of the United States in technology, biomedical research and a host of other areas of strategic interest to this nation. 
PUSHBACK

Faculty and administrations in research universities all know this to be true, so why do we need a special advisory panel to tell us what is so clear to all? Because the status quo serves senior administration through increased indirect cost returns on awarded grants and those faculty who want to sustain and advance their careers by using graduate students, post-docs and non-tenure track staff scientists as cheap-labor laboratory drones. The pushback has already started, as Price reports, with establishment scientists from within and outside the advisory committee weighing in on behalf of the status quo.

As Price notes, this situation has been going on for a very long time. Keeping students and post-docs narrowly focused on their “mentor’s” research can lock them into  student/fellow/staff scientist positions for 7-11 years or more at a low cost in salary and benefits. Putting more students on training grants instead of research grants could mean that some serious attention in graduate programs will have to be given to actually training students beyond the confines of an individual’s laboratory. This could mean a real shift in effort and a distraction from grant writing and getting out those publications we need for promotion and tenure (and more grants) (and more grants) (and still more grants).

Given these conditions is it any surprise that so many laboratories are filled with students and post-docs from overseas, mostly from China and India? We all know this but we turn a blind eye to the reality of the situation. We rejoice in our openness to the global science community and congratulate ourselves on attracting cheap highly skilled labor, while we ignore the crisis represented by our failure to maintain human capital to forward our larger national science agenda.
DEJA VU

When I came to Emory as Dean of the Graduate School, my staff and I proposed a then-new program to train graduate students in all fields across the university to be more effective teachers and communicators. The students would get stipends to take required training, which would then allow them to participate in the teaching of at least one course as they advanced through their graduate curriculum. The students were enthusiastic about the program and the President, Board of Trustees and department chairs all approved it. As a new dean at the time, I was invited to lunch by several department chairs in the biomedical sciences to discuss the teaching-training program. After a few pleasantries, I was told that if I expected the faculty in the departments to honor what they had agreed to do, they, the Chairs, would “make my life a living hell.” They argued that even  this limited training opportunity would detract from the students’ research and impair the productivity of the mentor’s laboratory and his/her ability to get grants.

This happened over 15 years ago. Just as Shirley Tilghman, President of Princeton University and chair of the Advisory Committee noted, the issue of how to properly train and mentor graduate students and post-docs is still with us today.


YOU GET WHAT YOU PAY FOR


In fairness to my faculty colleagues, I realize that the issue is complex and compounded by a host of other unpleasant factors that are not of their making. The problems we face are pervasive. The May 9th issue of The Scientist [3] has an interesting “Opinion” article by Fred Southwick, a professor of medicine and Chief of Infectious Diseases at the University of Florida: “Academia Suppresses Creativity—By discouraging change universities are stunting scientific innovation, leadership and growth.” Southwick argues that “in the academic world—where much of today’s scientific innovation takes place—researchers are encouraged to maintain the status quo and not ‘rock the boat.’ This mentality is pervasive, affecting all aspects of scientific research from idea generation to funding to the training of the next generation of scientists.”

Given the tremendous pressure for scientists to obtain external grant funding, it is hardly surprising that anything that would rock the boat—like giving students a better-rounded educational experience or teaching opportunities, and helping them to learn real-world job survival skills (other than grant writing)—is considered by some to be a waste of time. Southwick also argues that grant pressures inhibit creative, high-risk, but potentially high-yield research. 


PART OF THE PROBLEM: STUDY SECTIONS AND THEIR LITTLE WAYS

I've lost count of the number of times younger faculty have told me they feel tremendous pressure “to go where the money is” rather than pursue novel ideas or follow their creative urges. There is an overwhelming emphasis on teaching and testing technical skills rather than critical and conceptual thinking that could lead to a lifetime of interesting research. The NIH is aware of this problem, but program officers are often overruled by study section members who simply cannot get beyond technical nitpicking to look at the broader issues of where their respective fields need to go. We end up practicing “safe science” to make sure we get that next round of grant funding.

It’s not surprising that the NIH has been called the “valley of death” when it comes to the development of new ideas [4]. 


THE UNIVERSITY OF OZYMANDIAS


Clearly, the pressure on the faculty to get grants relegates the teaching and training mission to the lowest possible priority because there is little, if any, reward for the faculty to put time into this very important endeavor. How many medical school faculty do we know who got tenure or support because they are excellent teachers and mentors?

Every time we turn around at Emory we see trees going down and new “research” buildings going up, but what about university support for faculty and student development? Where is the moral commitment on the part of the administration and department chairs to make the university whole? Our institution is closing  more than half a dozen departments in the college of liberal arts and freezing staff and faculty salaries across the campus while at the same time acquiring new hospitals and constructing many new research facilities, all presumably to be paid by indirect cost recuperation from Federal grants. Given the  state of US economy, some would argue that this is building a house of cards on a bed of quicksand. I'm just saying.

Fifteen years ago graduate students could count on at least five years of stipend support from the Graduate School. When they got training grants or other support, the departments were allowed to “bank” most of the released stipend funds to support their graduate programs and recruit top students. When was the last time that kind of investment in ”human resources” happened anywhere? As Southwick points out, “universities can take a clue from the business world, which has (finally) realized that investment in human resources and employee development—not brick-and-mortar structures—creates successful, competitive enterprises.”

I’ve said this before [5] and I’ll say it again: the concept of the University is not all about seven-figure salaries for administrators or throwing up new buildings in the hope of generating enough indirects to cover costs, or hiring a few stars who manage to pull in five or more NIH grants to help with this, or using the latest big ticket gadgets to generate another parametric study. It’s about the generation and imparting of new knowledge, and teaching students how to generate new ideas, create hypotheses, solve problems and develop a deep conceptual and theoretical understanding of their fields.


I HAVE SEEN THE ENEMY AND HE IS US


The faculty have themselves to blame for a lot of this. By letting ourselves, by default, be complicit in accepting the status quo, we fail our students and ourselves and sacrifice the long-term strategic interests of our country for short-term personal gain. This is not how it is supposed to be.



1. Michael Price. Can NIH Renovate the Biomedical Workforce? Science: Science Careers. June 22, 2012
http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2012_06_22/caredit.a1200069

2. A Working Group of the Advisory Committee to the Director National Institutes of Health. Biomedical Research Workforce Working Group Draft Report. June 14, 2012
http://acd.od.nih.gov/bmw_report.pdf

3. Fred Southwick. Opinion: Academia Suppresses Creativity. By discouraging change, universities are stunting scientific innovation, leadership, and growth. May 9, 2012
http://the-scientist.com/2012/05/09/opinion-academia-suppresses-creativity/

4. Sharon Begley. Where Are the Cures? Oct 31, 2008 8:00 PM EDT
http://www.thedailybeast.com/newsweek/2008/10/31/where-are-the-cures.html

“’It's called the valley of death,’ says Greg Simon, president of FasterCures, a center set up by the (Michael) Milken Institute in 2003 to achieve what its name says.”

5. Donald G. Stein. Hard Money/Soft Money: The two cultures. The Academic Exchange,  May 2007 Vol. 9 No. 6 
http://www.emory.edu/ACAD_EXCHANGE/2007/may/steinessay.html

 
I used to think that companies like Apple, Amazon, Google and Facebook were the masterminds of marketing, but an article in the May 31st  New York Times has changed my opinion. In “For some, exercise may increase heart risk” science writer Gina Kolata asks whether exercise could actually be bad for some people. She reports on data from six retrospective exercise studies involving over 1600 people showing that, for those who exercise regularly, about 10% become worse on measures related to heart disease—blood pressure, insulin resistance, and levels of HDL cholesterol and triglycerides. About 7% grow worse on two or more of these measures. What a, um, stroke of good fortune for cardiologists and what a fabulous marketing strategy for the field.

Most people who exercise a lot are young adults who usually don’t frequent a doctor’s office very much, and do not spend a lot of time and money being evaluated by cardiovascular and endocrinology specialists. Now, in this brave new world where exercise can be dangerous, unless you are properly evaluated, you won’t know which group you belong to—the fortunate 90% that will benefit from exercise, or the luckless 10% who would be harmed by it, or could be harmed by it over the, um, long run. So the active, healthy cardiologist avoiders will now be loping to the cardiologists as fast as their Nikes will carry them.

The folks who hate exercise will now use the report to stay away from activity or exercise even less, not knowing which group they belong to. But for anybody who wants to be sure, the only option is more visits to the cardiologist and more extensive checkups than the 3.7-5.0 minutes usually allowed for an office visit. Sorry, couch potatoes, you don’t get a free ride on this one.

With a stroke of a pen, the relative value units[1] of millions of people will dramatically increase. Can you imagine how General Motors would respond if it found a marketing strategy that could increase its sales by millions of customers just by issuing a report? I should’ve listened to my parents when they pleaded with me to become a “heart doctor."

With all the pressure to reduce health-care costs, the issues of maintaining physician income and increasing clinical revenue streams to safeguard the status quo are growing in urgency, so this report could not have appeared at a better time.

I now stand in awe of cardiology. With this marketing report they have struck the mother lode. Even if the studies prove to be flawed or downright wrong, their new revenue streams could be fantastic before any corrective actions can be taken.   

So congratulations, cardiologists--you are the new masters of the universe. At least until the new studies come along showing that sleeping and or sex shortens our lifespan.

 
[1] A relative value unit is an AMA copyrighted formula for figuring out what fees physicians can charge Medicare or other patients for their services. The more "resources" the doctors use (tests, time spent in the office with the patient, etc.), the higher the relative value of that unit. Old folks are typically worth far more in RVUs than a young and healthy patient. Today, most physician incomes are based on RVUs. The more RVUs he or she produces, the higher the salary.    
 
Why start a blog at this stage of life? 

I've done pretty well without having one up to now, but my students and colleagues in the lab thought it was a good idea to put some of my rants about what's going on in science and academia to better use (and maybe give them a little more peace and quiet). I've been in teaching and research since the early 1960's--some would say too long--but  during that time I've seen a lot and done a lot. 

Do my thoughts on higher education and scholarly research carry more weight than anyone else's? Not really, but there are a lot of things that worry me about the future of education, science and our country itself, so I'd like to get some discussion going.

When I hear presidential candidates trashing universities and colleges for political gain, I think there's real cause for concern. But  universities and the research establishment are by no means completely above reproach. I think academic values need to be re-considered. I don't think that teaching, research and scholarship are just commercial commodities to be sold like iPads or cars, but I see a lot of that going on these days. Are we losing our independence and objectivity by buying into the commercialization and commodification of academia? I think we are. I also think we need to fix some things and they won't get fixed unless people directly involved are willing to debate the issues and suggest some specific solutions.

So I want to try this Blog. 

I look at this from a number perspectives: as a college teacher and researcher in a small New England University for the first 22 years of my career, as a Dean of graduate studies and Vice Provost for research first at a large state university and then at well-regarded private university, for a total of almost 13 years in administration, and as a former Congressional and Fulbright Fellow who worked on Capitol Hill and spent a number of years working in European universities and research centers. So, maybe some of my perspectives might have value for colleagues and friends who have many more years of work ahead of them than I. 

I hope this Blog will lead to some discussions and maybe even open up some ideas for fixing difficult situations that are outside the box of current academic values and practice. So let's see what happens. My first one will appear in about a week. 


Scientific research, science, science education, brain research, academia, politics of science,