Why ignore those icebergs? (I)

Instead, let’s first ask where they come from. We begin with institutional addiction to expansion

BiomedWatch began by comparing the US biomedical research enterprise to the RMS Titanic 100 years ago, heedlessly steaming into dark night, where icebergs loom (1). Why do so many scientists—in academic corridors and labs, in research societies, NIH, and Congress—persist in ignoring icebergs?

One simple, obvious answer: jostled daily by the same old icebergs, we avoid thinking about them because the underlying problems of our biomedical juggernaut are too overwhelmingly big, too complicated and numerous, or just too sadly familiar. Every-day icebergs would be scary if we hadn’t already gotten used to them. Examples:

  • The near-impossibility of publishing in a journal glitzy enough for the first author to get a job interview.
  • The growing fraction of soft money in faculty researchers’ salaries.
  • Shrinking academic budgets in public institutions, and many private ones.
  • Arbitrary peer review, increasingly onerous for both grantees and reviewers.
  • Apparently inexorable graying of biomedical researchers (2).
  • Competing (for funds, papers, trainees) steals time from thinking and experiments.
  • Conflicting goals: training young scientists vs. getting exciting results.

The same icebergs plagued us in the late 20th century, but we managed somehow to ignore them. Now we are trying hard to ignore an even scarier iceberg: no one wants to think about Washington’s terrifying political gridlock, which has produced flat-line NIH budgets for the past nine years and (if it continues through January) will trigger “sequestration” of federal funds, removing more billions from the NIH budget (3). Instead, many of us revile evil gnomes for instigating the icebergs. Do such gnomes populate teeming covens of our colleagues, peer reviewers, journal editors, deans, NIH administrators, or politicians? Not likely—evil gnomes are too few, even in Congress.

The obvious alternative is to figure out what is happening, and why. To do so, we need a conceptual framework to help us pose questions and devise strategies to shape the future. Here I lay out a brief, schematic version of one such framework. For fuller description and more facts, consult the framework’s most thoughtful architects: Paula Stephan, an economist (4), and Michael Teitelbaum, a demographer (5).

The framework, as we shall see, suggests that many forces driving our present troubles originated in choices that were rational at the time. The key choice-makers include stakeholders (no gnomes) throughout the biomedical research community, among scientists and in universities, medical schools, research institutes, NIH and other federal agencies, and Congress. Each set of stakeholders interacts with the others, via positive and negative feedback loops. Perhaps useful at one time, the feedbacks can become genuinely dangerous later. Today BiomedWatch will focus mainly on feedbacks that underlie rampant expansion of the academic research enterprise (see diagram). The following blog will connect this expansionism to training of young scientists.

Historically, biomedical research in the US began to expand soon after World War II, in keeping with: (i) transformation of many colleges and universities from venues for training privileged youths to take their fathers’ place in society into “multiversities” capable of creating new knowledge (6); (ii) rapid increases in federal research funding, via the NIH; and (iii) Medicare, which by paying for care of indigent patients produced an unintended consequence: new funds for faculty salaries in medical schools. Medical schools and universities quickly learned to expand their research faculties, lab facilities, and commitment to research and patient care. NIH funding for extramural biomedical research continued to increase, by 8-9% per year from 1970 to 1998 (7)—a rate faster than GNP, inflation, or the two combined. Yearly increases from 1999 to 2003, the period when Congress doubled the NIH budget, rose even higher.

By itself, increased NIH funding would certainly have supported a substantial size increase in the US biomedical enterprise, but two additional developments further accelerated that increase. One was a gradual shift, beginning in the 1960s, toward paying larger fractions of research faculty salaries from grant funds (“soft money”), rather than from university coffers (“hard money”) (8). Reducing academia’s contribution to such salaries allowed faculty members to teach less and thus to devote more time to the lab. Simultaneously, it relieved institutions from part of their obligation to pay faculty researchers’ increasing salaries. Soft-money salaries gradually began to prevail in medical schools and research institutes, where teaching obligations were lighter (even in the 1960s) than in universities. The shift toward soft-money lifted a heavy financial foot from a potential brake on institutional expansionism. No longer obliged to invest scarce funds in researchers’ salaries, institutions could use those funds to construct new research labs and pay start-up costs for beginning labs. In comparison, I imagine, institutions see salary support for a tenured scientist as a riskier and more expensive long-term investment.

In the latter half of the 20th century, the federal government was more directly responsible for a second accelerant to expansion of academic biomedical research, in the form of rules governing indirect cost payments on research grants. Federal grant costs are direct (incurred by performing the work proposed, including salaries and necessary equipment or supplies) or indirect (incurred by the institution in providing adequate conditions for performing the work). Indirect cost payments typically account for approximately one third of NIH’s total investment in any individual research grant. Rules determined by the Office of Management and Budget (OMB, in the federal executive branch) specify that indirect costs be negotiated by each institution as a percentage (often 50%, or more) of direct costs incurred by the investigator. Institutions can use such indirect costs to pay for heat, light, security, and research administration, plus interest on money borrowed for lab construction.

OMB’s indirect cost rules foster addictive institutional expansionism in two ways (9): (i) by paying interest on lab construction loans, the government encourages institutions to borrow and over-build research capacity even when their funds are stretched; (ii) soft money salaries, charged to an NIH research grant as a direct cost, bring the institution the extra bonus of a larger indirect cost payment on that grant. Thus returns on previous years’ investments begets further investment. By rewarding research centers for failing to commit their own funds (to paying off debts or to faculty salaries), the indirect cost rules encourage expansion and discourage constraints on bricks-and-mortar investment and hiring more researchers. It should be no wonder that academic institutions increased biomedical research space by 62% in 1998-2009 (10), or that medical schools and institutes pay an ever-decreasing proportion of research faculty salaries.

Back in the 20th century, rampant expansion produced extraordinary discoveries and clinical advances that benefitted scientists, universities, physicians, and patients while creating jobs and fueling economic growth (11). In addition to these intended consequences, others were not anticipated. In fact, expansion also created a research behemoth with new properties, including tightly-wound adaptations, such as soft-money salaries and indirect cost rules, that fostered dangerous addiction to ever-continuing growth. One unintended result, among others: a growing chasm between faculty that teach and those that do research. The latter occupy large labs and work hard to keep them going, but as grant funds dwindle they become increasingly aware that the institution values them primarily as earners of indirect costs, rather than as integral members of a common polity with shared broad institutional goals.

Separate BiomedWatch posts will focus on an additional set of adaptations to expansionism, the feedback loops that connect expansion to using research trainees as the source of cheap labor in labs—and vice versa.

NOTES

1. As described in BiomedWatch, Why blog? Why this blog?

2. The average NIH grantee is now 51 years old—that is, 13 years older than the average in 1980. N Ruiz-Bravo, Conversation with NIH: The Health of the Scientific Workforce, presentation 4 December 2007. Web 29 November 2011.

3. The Budget Control Act of 2011 required caps on discretionary programs, beginning in 2013, which will amount to more than $1 trillion over the ten years from 2012 to 2021. If Congress does not agree on a way to do this, in early 2013 across-the-board mandatory cuts in discretionary funding will “sequester” about $109 billion from the next year’s budget (and from subsequent budgets, until the total budget reduction has been accomplished). The Federation of American Societies for Experimental Biology recently estimated (FASEB analysis demonstrates devastating impact of sequestration on medical research, FASEB Washington Update) that such sequestration would in its first year reduce extramural NIH funding by 11.1%.

4. PE Stephan, How Economics Shapes Science, Harvard University Press, Cambridge, MA (2011).

5. M Teitelbaum, Structural disequilibria in biomedical research, Science 321, 644 (2008). In addition, I recommend a careful reading of the tour de force summary of feedback loops, recently published as appendix D (pages 72-80) of the Tilghman-Rockey report on the Biomedical Workforce. Although not billed specifically as Teitelbaum’s work, he was a member of the panel responsible for this appendix and (I guess) its principal author.

6. C Kerr, The Uses of the University , Cambridge, Massachusetts, Harvard University Press (1963).

7. D Korn, et al., The NIH Budget in the “Postdoubling” Era, Science 296, 1401 (2002).

8. Early on, most of a faculty researcher’s salary was paid by the academic institution (i.e., hard money) or (in medical schools) by fees from patients. Then grants paid small portions of such salaries—called “soft” because money from the parent institution was considered more predictable and reliable—but such soft-money contributions to faculty researcher salaries gradually increased over the years, especially after 1980. Now a part of the salary of almost every researcher is charged to a research grant (or often, to several such grants).

9. B Alberts, Overbuilding Research Capacity, Science 329, 1257 (2010).

10. National Science Foundation: National Center for Science and Engineering Statistics, Research Facilities, Data Tables 3 and 8. Web 28 November 2011.

11. RA Atkinson, SJ Ezell, LV Giddings, LA Stewart, SM Andes, Leadership in Decline: Assessing US international competitiveness in biomedical research, Web 20 May 2012[].

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About biomedwatch
Professor Emeritus of Cellular and Molecular Pharmacology, University of California, San Francisco

6 Responses to Why ignore those icebergs? (I)

  1. Morgan says:

    Dr. Bourne,
    Thank you for contributing this article and this viewpoint to the biomedical research community. As a current postdoctoral trainee, the issues you raise couldn’t be more important to my future and the future of the NIH. I hope people take these issues seriously and begin implementing the changes we need to sustain our academic and scientific endeavor.

  2. Sheila McCormick says:

    Hi Henry. Many of these points are also applicable to Plant Research, which is underfunded, relative to what China (for example) is doing. You might be interested in this article
    http://the-scientist.com/2012/06/01/food-for-thought/#disqus_thread

    Sheila

  3. Bill says:

    Hi Henry. Thanks for the interesting perspective, and for providing historical details as to how we got to this point.

    I often wonder how private donations fit into this network of feedback loops? It seems the desire to have private donations contribute to brick and mortar structures inadvertently feeds this expansionism.

    • biomedwatch says:

      I don’t really know. Donors surely like to see physical monuments to themselves, just as the pharaohs used to. But I wonder how hard universities try to sell monuments of similar cost, like a raft of 30 or so VIP-named professorships (at, say, a total cost of $300M?).

  4. art tart says:

    Fascinating. Incredibly important. Highly depressing. Many thanks for your engagement.

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