Respectful Insolence

Justify my existence?

Our Seed overlords demand a response:

Since they’re funded by taxpayer dollars (through the NIH, NSF, and so on), should scientists have to justify their research agendas to the public, rather than just grant-making bodies?

Ooh, boy. That’s a loaded question that depends a lot on how you interpret it.

My first reaction was similar to that of Razib, PZ, Dave, John, and GrrlScientist; i.e., no way, because the public doesn’t have a clue what constitutes good scientific research. Ah, heck, my second reaction was the same, too, and it led me to ramble on way longer than the 300 words that our Seed overlords wish us to limit ourselves to. (How typical of me, eh?)

In any case, we as scientists already do have to justify our existence to the public, only not directly. Instead we do it through intermediaries, specifically our elected officials. We are entrusted with public money, and in return we are expected to do high quality research on topics of scientific and public interest. Indeed, I see this as not unlike the way this republic was originally formulated. We are a Constitutional Republic, not a direct democracy. Indeed, the Founding Fathers intentionally made certain branches of government (the Senate, for instance, where before the 17th Amendment it was the state legislatures, not direct election, that chose Senators).

Our system for funding science is, in effect, similar. The Federal government, under direction from Congress, sets up a system for peer reviewing research proposals submitted by individual scientists. Congress determines how much money is devoted to different broad areas of research as embodied by different agencies (NIH, NSF, the military), which then disperse the money. Although not without its flaws, it is, by and large, a good system to determine what sorts of science receive funds, allowing public input through their elected officials, but (usually) not so much that it distorts the scientific process, although certainly powerful Senators, Representatives, and successive administrations have tried. Like Razib, I fear that if there were more direct involvement of the public in deciding what science gets funded, we’d have more government-funded research proposals studying the mind of God in astronomy or more studies of prayer on mortality.

Besides, politics already has a large effect on what gets studied. If you want to look at a cautionary tale of what happens when politics affects science, look no further than the National Center for Complementary and Alternative Medicine (NCCAM), originally started by Senator Tom Harkens (D-Iowa) in 1992 as the Office of Unconventional Medicine (later renamed the Office of Alternative Medicine, or OAM). What happened after its creation is described by Dr. Wallace Sampson:

The first OAM director resigned under Sen. Harkin’s pressure, having objected to Harkin’s OAM Council nominees who represented cancer scams such as Laetrile and Tijuana cancer clinics. One influential Harkin collaborator and constituent was a travel agent for a Bahamas cancer clinic. And the Federal Trade Commission fined Harkin’s bee pollen distributor, $200,000 for false claims.

In 1998, Dr. Edward Halperin, President of the North Carolina Medical Association called for disbanding OAM. Responding to objections from the scientific medical community, NIH Director Harold Varmus placed OAM under more scientific NIH control. But Sen. Harkin countered, elevating OAM to an independent Center. By 2001, the annual budget rocketed to nearly $90 million per year and by 2002, over $100 million per year. Congress, believing erroneously that public demand for unscientific services had increased, passed appropriations without a dissenting vote.

If you do the numbers, you’ll find that, since 1992, NCCAM has spent $842.1 million ($671.4 million since 2001) and has not a single real positive study to show for it. It has a couple of famous negative studies, such as the one showing that echinicea doesn’t work for common colds, but never quite seems to believe them, promising “more study.” In the meantime, NCCAM continues to fund dubious studies of distance healing for AIDS or Reiki therapy for prostate cancer–even homeopathy. (I’ve joked in the past that I have to find a way to relate my research to alternative medicine, so that I can find a way to get on this gravy train.) As a result, for the nearly $1 billion spent, we have precious little idea now of what alternative medicines might be useful than we did in 1992.

I used to be a supporter of NCCAM, thinking that a scientifically rigorous examination of altie claims would do some good and might actually allow the identification of modalities that worked that could be integrated into standard medical care and, more importantly, modalities that didn’t work and could therefore be discarded. However, I now see NCCAM as a cautionary lesson of what happens when politics influences too closely what sorts of science get funded. Another cautionary example is William Proxmire’s old Golden Fleece Award. While he often did make fun of wasteful government spending that deserved ridicule, all too often Proxmire would pick legitimate scientific studies that could be made to sound ridiculous and castigate them as “wasteful spending.” When it came to science, Proxmire often didn’t have a clue and instead used esoteric studies funded by the government as an excuse to engage in demagoguery. The NSF became a frequent (and usually undeserving) target of his ridicule.

And if you want another present day example, don’t even get me started on stem cell research.

Does any of this mean that the public shouldn’t be involved in deciding what science is funded? Of course not. Believe it or not, one model that involves the public intimately in the grant-awarding process that seems to work quite well is the Army’s biomedical research programs. For example, the Breast Cancer Research Program includes lay people from breast cancer support groups in the peer review process and requires researchers to write a detailed lay abstract specifically for these reviewers. (Let me tell you, writing such an abstract is very difficult to do well without lapsing into jargon–you scientists out there, try it sometime if you don’t believe me.) Indeed, last year at the Army’s Era of Hope Meeting that I attended, several of the speakers were interested lay people involved in helping the Army decide which projects should be funded. The generally high quality of the projects funded by the Army (in breast cancer research, at least) demonstrate that such a model could easily be adapted to, for example, the NIH review process without compromising scientific integrity.

ADDENDUM: I may very well have more to write about NCCAM in the near future, based on some literature I picked up about it at the AACR Meeting last month. As a skeptic who was formerly sympathetic to the idea embodied in NCCAM, I found what I read to be disillusioning.

Comments

  1. #1 Abel PharmBoy
    May 31, 2006

    I couldn’t agree more with your political characterization of NCCAM. I’d argue further, as I did in this post that the political pressure to get a high-profile, positive result led the agency to emphasize support of expensive, phase II/III trials of botanicals while giving short shrift to the basic science studies necessary to get to that point.

    I’ll be very interested to hear what you learned at AACR. But I, for one, have been very impressed with the quiet progress made by NCI’s Office for Cancer Complementary and Alternative Medicine (OCCAM), dedicated specifically to issues of cancer patients, those most likely to be preyed upon by hucksters selling hope. OCCAM was instead established by the senior leadership of NCI (i.e., scientists, physicians, physician/scientists) and seems to be taking a far more measured, thoughtful, and scientific approach toward building a research portfolio that addresses key mechanistic questions before jumping to large clinical trials. Led by an outstanding MD medical oncologist and former intramural NIH scientist with an emphasis in nutrition, OCCAM is avoiding the high-profile mistakes of NCCAM and including well-qualified scientists, physicians, and public health professionals in its decision-making processes.

    In my mind, NCCAM was set up for failure by being charged to take on too large and too contentious an area. I predict that OCCAM will serve as a model for the rest of NIH: for each Institute to have its own office under the larger banner of NIAID, NIDDK, NHLBI, etc. to address specific CAM issues in each disease/disease prevention area, keep the good and call it medicine, and discard the practices that fail to stand up to scientific scrutiny.

  2. #2 Hank Barnes
    May 31, 2006

    Since they’re funded by taxpayer dollars (through the NIH, NSF, and so on), should scientists have to justify their research agendas to the public, rather than just grant-making bodies?

    Absolutely. Much of the scientific research is redundant and unecessary, a self-perpetuating society, research for the sake of research.

    Of course, some of it is great and worthwhile. So, there should be some mechanism to discern between the valuable and the worthless.

    Hank Barnes

  3. #3 Bronze Dog
    May 31, 2006

    I don’t think the public would qualify for such a mechanism. A lot of people out there would cut research into vital fields because some centuries old book disagrees with the findings.

  4. #4 Joe
    May 31, 2006

    Popular and political support has brought us the biggest waste of scientific funding- the astronaut program. Not that it is scientific; but the funds come from the “science” budget. And it dwarfs the NCCAM budget.

    It is also notable that scientists did not initiate the call for the NCCAM. While I hate to disagree with Dr. Sampson, I think the public was clamoring for unscientific programs. Although, many people did not realize they were unscientific.

    Bottom line, Orac’s first and second inclinations are right.

    As for Mr. Barnes, I suspect if he gets enough rope he’ll accidentally hang himself. With all due respect.

  5. #5 DDS
    May 31, 2006

    Many NIH Institutes (especially NIAID and NCI) use interested lay people/activists on certain clinical research study sections. They are especially useful in helping to discern whether a grant proposal has the necessary mechanisms to reach out to the community for clinical trial volunteers.

    As for Hank’s comment “..a self-perpetuating society, research for the sake of research.” That is absolutely true about basic research. His mistake is that thinking that this is a bad thing. Because we are searching the unknown we can’t know what is redundant, worthless or great until after we look. I think few people would have guessed that studies of an obscure family of snails would lead to a new FDA approved painkiller (http://en.wikipedia.org/wiki/Cone_snail).

    As for his last comment “So, there should be some mechanism to discern between the valuable and the worthless.” That mechanism is called peer review.

    I am curious though exactly which great projects HB would pick to fund? No fair picking things like, Cure for Cancer or Abolish Poverty or HIV vaccine. They have to be a specific project that can be completed in a 5 year time span.

    D

  6. #6 Hank Barnes
    May 31, 2006

    The Dentist asks:

    I am curious though exactly which great projects HB would pick to fund? No fair picking things like, Cure for Cancer or Abolish Poverty or HIV vaccine. They have to be a specific project that can be completed in a 5 year time span.

    I think funding the Physicists in the Manhattan Project to develop the A-Bomb was a damn good idea.

    You have a good point about open-ended basic research — I would devote mebbe 20% of the NIH Budget to this.

    The private sector and industy and philanthropic organizations should fund the bulk of scientific inquiry.

    I would cut much of everything else, including the Cure for Cancer and HIV vaccine programs, which have been milked endlessly by money-grubbing research scientists. These are boondoggles writ large.

    “Abolish poverty?” — is this a scientific program? I am for raising people from poverty to middle class, and support most private and public sector efforts to do this.

    That is why I would redirect wasteful spending on scientific crap to the above endeavor.

    HB

  7. #7 Opiwan
    May 31, 2006

    Um, would it be possible to “get you started” on stem cell research? I’d be interested to hear a medical researcher’s opinion on the topic instead of the talking-head bullshit I usually have to slog through when reading about it.

  8. #8 Roman Werpachowski
    May 31, 2006

    I think funding the Physicists in the Manhattan Project to develop the A-Bomb was a damn good idea.

    There would be no A-bomb without a “research for the sake of research” done much earlier. For God’s sake, do you think that Einstein was motivated by commercial applications when he worked on theory of relativity??

    In my opinion, the biggest scams happen in applied science, not in basic research. At least in my country.

  9. #9 Nat
    May 31, 2006

    money-grubbing research scientists?

    I spend about half my time grubbing/begging/scrambling for money Hank. I don’t think that any profession anywhere spends as much time justifying their existance as scientists do. The grant writing process is inordinantly inefficient. When scientists are given sufficient resources to get something done they often come through (Manhatten, Apollo, Human Genome etc etc). Many times the spinoffs are completely unforseeable and this is why scientists support the curiosity driven approach (MRI perhaps?). The ‘cancer’ problem you bring up as if it were a single disease entity hasn’t been solved because it’s far far more complicated than was thought. The spending on individual projects is very difficult to justify because the outcomes are not foreseeable but the spending on science as a whole has not been without it’s merits during your lifetime alone.

    Back to money grubbing- My salary doesn’t quite cover the repayments on my student loan after spending ten years in post-high school training (i.e. University). If I were money grubbing I’d go work in the commercial/finance sector as I’m additionally qualified to do.

    We spend years working on projects that produce information that we essentially give away at the end. I enjoy doing it but I refuse to be called greedy for the privilege.

  10. #10 Orac
    May 31, 2006

    I spend about half my time grubbing/begging/scrambling for money Hank. I don’t think that any profession anywhere spends as much time justifying their existance as scientists do. The grant writing process is inordinantly inefficient.

    Amen.

    I just spent the last month working on multiple grants due last week. I now have to turn right around and do a final report on a grant that expired last month, in essence, proving to the granting agency that I spent its money wisely.

    As for money-grubbing, hell, if I were that I would have skipped the Ph.D., the lab years during residency, and the fellowship and gone straight into private practice in a part of the country with low managed care penetration. Come to think of it, if I were truly that “money-grubbing,” I would have skipped the M.D. altogether and gone into investment banking or business.

  11. #11 Bronze Dog
    May 31, 2006

    Come to think of it, if I were truly that “money-grubbing,” I would have skipped the M.D. altogether and gone into investment banking or business.

    Or, even better, if you were completely amoral, “alternative” medicine.

  12. #12 Hank Barnes
    May 31, 2006

    As for money-grubbing, well, you two ain’t doing it right. You gotta patent some drug and license it, or start a bio-tech company on the side.

    Come to think of it, if I were truly that “money-grubbing,” I would have skipped the M.D. altogether and gone into investment banking or business.

    Well, at least your patients would be better off;)

    Barnes

  13. #13 Orac
    May 31, 2006

    Well, at least your patients would be better off;)

    Really, Hank. That rated maybe a 0.2/10 on the Troll-O-Meter.

    Maybe–if I’m generous.

    Gee, you don’t think I’ve had alties or others who don’t like me make similar cracks about my patients or my skills as a doctor before, for, say, the last six years or so that I’ve been involved in providing a skeptical assessment of alternative medicine?

    Sorry, but, as much as it seems to have amused you, your crack wasn’t very original or clever at all. You’ll have to do better than that if you want to get a rise out of me.

  14. #14 Abel PharmBoy
    May 31, 2006

    As Nat and Orac have pointed out, we are far from “money-grubbing.” I know of very few careers where one is offered a “job” and is then charged with bringing in 60-80% of their own salaries, not to mention the usual 100% of salaries for lab personnel and supplies for conducting the research.

    State universities in particular have been riding high on the hog using this bait ‘em and switch. We largely are renters of lab space, then the institutions pockets the “overhead” dollars off the sweat of those of us foolish enough to be excited by science and the altruistic desire to devote our training and careers to helping our fellow citizens.

    If anyone wants to criticize anyone in this business as money-grubbing, have a chat with the administrators on the 24th floor of our state hospitals, the ones with the halls lined with original art and the suits or dresses we couldn’t afford on our best nights out.

  15. #15 Orac
    May 31, 2006

    I know of very few careers where one is offered a “job” and is then charged with bringing in 60-80% of their own salaries, not to mention the usual 100% of salaries for lab personnel and supplies for conducting the research.

    You know, I’ve been meaning for a while to write about how Universities take advantage of this whole setup and ruminate over whether this system makes sense anymore.

    Maybe next week, as the posts for Thursday and Friday are mostly set.

  16. #16 Nat
    June 1, 2006

    It’s more like 100-200% of your own salary and then the same ratio for everyone else you want to help.

  17. #17 Hank Barnes
    June 1, 2006

    Gee, you don’t think I’ve had alties or others who don’t like me make similar cracks about my patients or my skills as a doctor before, for, say, the last six years or so that I’ve been involved in providing a skeptical assessment of alternative medicine?

    Gee, methinks thou doth protest a bit much to a rather innocuous smart aleck remark.

    As for “skeptical assessment of alternative medicine” ie, the altie bashing that obsesses you — go right ahead. A lot of it deserves bashing.

    But, it would be more fruitful to grapple with the results from the Lazarou paper. Altie medicine may include some scams that offer false hope, but it ain’t killing 106,000 patients per year.

    Yes, Abel, the Universities are pimping out scientists, and the administrators should be fired. I agree.

  18. #18 Xerxes1729
    June 1, 2006

    Dow, GE, DuPont, AT&T, Merck, IBM, and other large corporations used to have extensive basic research programs. These programs have been significantly cut in recent years, mostly because they are not seen as cost-effective. Bell Labs physicists who started doing work on ultra-low temperature superconductors thirty years ago are now conducting “research” on what features customers want on their cellphones. Merck is still developing new drugs to target diseases, but it no longer conducts much research on identifying or characterizing the pathogens that cause disease.

    Basic research has become too financially risky for CEOs and stockholders. The likelihood that a new discovery will lead to a marketable product is quite low, and so research into simply improving current manufacturing processes and technologies is considered to be a better investment.

    Nevertheless, basic research is absolutely essential. I’m sure Barnes thinks things like television, MRI, and insulin for diabetes were all good uses of research money. I would agree. The trouble is that none of these wonderful and profitable applications would have been possible without mountains of basic research. When Maxwell was developing his equations for electromagnetism, they had no conceivable applications – research for research’s sake – but without them, there would be no television, radio, or Internet. When nuclear magnetic resonance was discovered in 1946, you could have reasonably asked why anyone should care that certain atomic nuclei absorb and emit specific radio frequencies when placed in a strong magnetic field. No one could have forseen that this discovery would lead to the ability to diagnosis injury and illness without surgery or exposure to radiation. The discovery of restriction enzymes in 1968 could have been greeted with similar dismissal – why should we care that there are compounds that will cut up DNA molecules in specific places? But this discovery made it possible for Genentech to develop bacteria that produce insulin.

    None of these discoveries were useful at first, but each of them has completely changed the world we live in. We can communicate almost instantly with almost anyone almost anywhere on the planet thanks to Maxwell’s “research for the sake of research”. We can look inside someone’s head and identify a tumor without touching him because of “research for the sake of research”. Treatment for diabetes is now readily available and saving millions of lives thanks to “research for the sake of research”.

    The importance of basic research, together with the unwillingness of the private sector to finance it, makes government funding of such research essential.

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!