NIHA recent op-ed in the New York Times makes a few interesting points– partly through what is said, and partly through what was not said. Let’s start with the obvious:

1) It is increasingly challenging to receive NIH funding for research. It is highly competitive, and you must craft a compelling story on a solid foundation to have any hope of realizing your dreams. Basically, you need the support of some pilot work, previous research, logic for your project, institutional support, and the right partners. And, you need a damn good idea that is both novel and has significant public health impact.  Yes, I more or less agree that “risk” is something NIH minimizes, but as a taxpayer, I’m pretty much okay with that.

2) Young researchers aren’t getting a whole lot of money. Yes. Do you know how long it takes to get a PhD these days? If you’re going to have contact with actual humans (like, say, research volunteers), it’s a good idea to get some “real world” experience, and many PhD programs also like to see graduate school. So, 22 + 2 years work experience + 2 years MS + 1 year job/school searching + 5 yrs PhD + 2 years post-doc = age 35 BEFORE you are even at the Big Institution that will provide that infrastructure you need to get the grant. Say it takes two or three rounds, and suddenly you are 37 and getting your first grant (and you wanted a kid? sorry).

Age is somewhat of an artifact of our training system and somewhat a consequence of who is successful in a limited-funding environment (those with the institutional support and the networks to conduct their proposed projects).  Decreased age will merely shift funding towards fields where the training process is shorter. When the baby boomers retire, age will decrease naturally.

Fast-track them from high school, you suggest? A recent trend does appear to be towards accepting more undergrads directly after graduation, but there are distinct disadvantages for non-bench scientists. Working, living, and thinking in communities provides fodder for ideas and perspectives on etiologies of problems impairing the adoption of “best practices” or “evidence-based guides”.  (Those at the bench probably do better, given they don’t have time to forget which electrons belong in which…oh well. Want me to draw you a pretty model of the socio-ecological model?)

3) Most concerning, the good Mr. Harris seems to have forgotten that eating your vegetables will promote health, and even brain health. Perhaps he might find it helpful to review some of the advances in nutrition science since he attended (hopefully) a few lectures about it in medical school. A factor contributing to ovarian cancer, for example, is obesity.  Lifestyle changes can prevent and help manage obesity but physicians have consistently failed to provide successful weight management counseling for their patients.  Why?  Good qualitative research followed by an intervention grounded in social and behavioral theory are the best way to truly answer this question, but I suspect Mr. Harris’s focus on biomedical research would prevent this project from being funded.  A singular foci would kill novel and practical ideas.  Let’s not allow the NIH to follow become more trend-driven than it already is.

The most concerning unspoken assumption underlying this Op-Ed was that bench science, fMRIs, genomics, proteomics, novel medications, and fun devices are the future.  Don’t dis non-bench science because you worship the alter of the p-value. Knowing molecular pathways only helps if you can then translate and disseminate them.  While the technology treadmill will unquestionably produce some excellent products, they are close to meaningless without the community and socially-based work that, for example, make it socially acceptable to have a mammogram or a colonoscopy or that make it possible to follow your MD’s care plan in your neighborhood.  Social science research that leads to good theory and successful public health interventions is the glue between bench science, clinical work, and community-wide efforts.R esearch needs to be multifaceted, and incorporate a variety of modalities.

So, I return your challenge: figure out how to fund the full spectrum of research needed to improve population health– not just the sexy technology. Consider the problems of bed sores, constipation, and poor access to dental care as compelling as the mysteries of Alzheimer’s and cardiomyopathy.  Cover bench to bedside to behaviors at home/work to designs of street corners to analyzing federal policy. Do not overvalue the petri dish or randomized control trial– there are powerful quasi-experimental designs that allow community-based research to both advance science and serve the people we entered science to help.

P.S. Can you do something about misogyny and racism in science while you’re at it, too? Yeah, thanks.  And maybe issues of student debt?  Great, glad to hear you want to support students.

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