Mad rantings about politics, evolution, and microbiology. Comment policy: say what you want, but back it up with an email address. I don't like anonymous trolls.
Recently, Newsweek published an article by Sharon Begley that claimed that the conflict between high-profile publication and quick release of medically-important data has led to delays in medical advancements (ScienceBlogling Orac takes down her particular example). But Begley is confusing a symptom, publication practices, with a much larger problem: incentives.
What do I mean by incentives?
Last week, I described how the data release policies of large and small sequencing centers differ due to distinct funding incentives: the larger centers are paid to rapidly produce lots of high quality data, while the smaller centers are paid to produce high-quality publications.
A similar dynamic is at work here. Regarding the specifics of publication, you do want to publish in a high-profile journal. That's not just due to careerism: if you want to keep your research going (and if you think your research could lead to medical treatments, that's a perfectly decent reason to do so), then you need high-profile publications. Until NIH (and other government agencies) change that reward scheme, this will keep happening.
But there's a larger picture too. Begley decries the dearth of translational research. Well, NIH doesn't really focus on translational (i.e., more applied) research: it focuses on basic research. It's not just NIH officials too--NIH relies on the expertise of outside reviewers who are, for the most part, oriented towards basic research*.
I've seen this phenomenon with antibiotic resistance. Most of the research on antibiotic research deals with the basic biology of antibiotic resistance and antibiotic resistant organisms. This is a good and important thing, since understanding this will, in the long term, lead to interventions. If you ask me, what, in the short term, would reduce the spread of resistance, it would be to implement rigorous, scientifically-validated infection control measures (WASH YOUR DAMN HANDS!!!).
But NIH doesn't do this sort of thing. This why AHRQ was created. Of course, the NIH budget for antibiotic resistance (~$800 million) is double the entire budget of AHRQ, but that's a separate issue.
This one example of a larger issue: if we want researchers to prioritize translational research, then that's where the money needs to be. Trust me, if the money is there, the high-profile journals will follow.
It's all about incentives.
*If NIH brought in lots of reviewers from industry, they would then be viewed as captive to industry, of course....
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The biggest reason translational and clinical projects are underrepresented in the NIH portfolio is the reviewers.
The study sections are dominated by basic scientists who try to hold patient studies to the same standards for preliminary data as basic studies. Run preliminary experiments with cultures or animals? Not a big problem. Recruit a pilot study of patients for your study? Ok, but then the reviewers want you to change something, and you have to exclude your pilot population, and pretty soon you can't recruit enought patients to do a study, so you give up and just practice medicine and make more money with fewer headaches....
Of course, until we get enough funded translational and clinical researchers to balance study sections, the problem will persist. Don't get me wrong; I'm an MD who does primarily basic science stuff. We need ALL types of biomedical research to advance healthcare and our understanding of the world.
There are investigators in Academia who would love to do more patient-centric research. The deck is stacked against them, and I'm not certain that the CTSA program is going to have a significant effect on the problem.
Posted by: Pascale | June 15, 2009 11:29 AM