An intriguing article was recently published in the Proceedings of the National Academy of Sciences — one of the most prestigious (more on “prestige” later) journals around — with the provocative title, “Rescuing U.S. Biomedical Research from Its Systemic Flaws.” That this was written by some of our country’s most well-respected scientists provides credibility to this challenging and thought-provoking critique. The piece also provides fodder for significant soul-searching in our academic community.
I found the authors’ comments and suggestions largely on point. But there was one paragraph in particular that seemed to me an ill-conceived and gratuitous dismissal of applied, “translational” research. In a section focused on the problems of “hypercompetition,” the authors write:
One manifestation of this shift to short-term thinking is the inflated value that is now accorded to studies that claim a close link to medical practice. Human biology has always been a central part of the U.S. biomedical effort. However, only recently has the term “translational research” been widely, if unofficially, used as a criterion for evaluation. Overvaluing translational research is detracting from an equivalent appreciation of fundamental research of broad applicability, without obvious connections to medicine. Many surprising discoveries, powerful research tools, and important medical benefits have arisen from efforts to decipher complex biological phenomena in model organisms. In a climate that discourages such work by emphasizing short-term goals, scientific progress will inevitably be slowed, and revolutionary findings will be deferred.
In one sense, it is understandable that as our unsustainably growing academic infrastructure struggles under the weight of flat or declining funding, armed camps will emerge, making the case that people should spend money on what I do, not what they do. So throughout the fairly recent (as the authors point out) focus on the National Institutes of Health funding research with direct applicability to human health and disease — so-called translational research — the laboratory-based, curiosity-driven researchers in academia have cried, “Hold, enough!”
Such an attitude — valuing unencumbered scholarship over research with direct applicability to real-world problems — is actually hard-wired into the hallowed halls of academia. Indeed, just Google the word “academic”: After a definition relating to educational institutions, the second definition is “not of practical relevance; of only theoretical interest.”
Most of us overeducated folks have experienced an academic hierarchy that values, say, physics over engineering, pure math over applied math, philosophy over ethics. In the biomedical sciences, the late Dr. Alvan Feinstein, considered by many the father of the field of clinical epidemiology, famously remarked on “the ideologic belief that scientific importance is inversely proportional to the size of the investigated entities.” Thus, there is greater academic prestige accorded to the study of genes and cells than of organs, or intact human beings, or (heaven help us) populations.
There’s another problem in the mix, besides the zero-sum game of research dollars and the hierarchy of prestige: That the bigger (and more complex) the thing is that you’re studying, and the more “real world” the setting of your research, the harder it is to make precise measurements. Those of us who work in the messy settings of clinical practices or communities recognize that the methods and models we use are imperfect. But should we avoid the challenging and important questions simply because they’re hard to answer? Indeed, isn’t the pursuit of the elusive truth a cornerstone of academia?
There is some good news on the horizon: the formation of the Patient-Centered Outcomes Research Institute (PCORI). This entity, created under the Affordable Care Act, brings some new research dollars into the equation, specifically focused on research that leads to actionable improvements in the delivery of health care, so it’s not entirely a zero-sum game. And PCORI has addressed the big-picture challenges head-on, beginning its existence by creating new methodology standards, and more recently developing an entirely new infrastructure to support practice-based research.
There is no question that without public financing, scientific inquiry in the U.S. would not be so robust as it is, and we need continued and growing research funding to secure a bright future. But we should also remember that people trust us with their tax dollars because they want research to translate into improved health. As Senator Tom Harkin said, “There’s a reason it’s the ‘National Institutes of Health’ and not the ‘National Institutes of Science.’” Yes, science informs health and medicine, but academia has an obligation to ensure that our publicly financed research isn’t entirely “academic.”
Paul Marantz is associate dean, clinical research education and director, Center for Public Health Sciences, Albert Einstein College of Medicine, Bronx, NY. He blogs at The Doctor’s Tablet.