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Director’s Blog: Culture Clash

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In a previous post I described the growing contrast between the patient community for whom “time = lives” and the academic community for whom “success = papers and grant funding.” This apparent clash of cultures is important for NIMH. Each year, we spend roughly $1B of taxpayer funds to support research in academia. In effect, we are tasked by taxpayers to hire scientists to fix the problems of the patient community. In the end, if research in academia does not align with the needs of patients and families, we’ve got a problem.

Actually, we’ve got two problems. One is helping taxpayers to understand the importance of both long-term and short-term investments. Yes, we need short-term investments that inform policies and improve services. The needs are urgent. But we need better diagnostics and better therapeutics as well. And these require longer-term investments. Better services will ultimately require better science, including basic science, and a deeper understanding of brain development and brain plasticity.1 The need for a long-term strategy for mental disorders is no different than the need in other areas of biomedical research. And the promise, with new tools from genomics and imaging and cognitive science, has never been greater. My sense is that most families, whether they are grappling with Type 1 diabetes, Alzheimer’s disease, or schizophrenia, understand the need for both short-term and long-term research.

The bigger problem is changing the culture of academia. Researchers in universities wear many hats. Most are hired and paid to teach or provide clinical care; few are paid to do research full time. Faculty who want to do research are expected to raise the funds through research grants. As a result, many spend more time writing grants than doing experiments. In a recent survey  of 3,600 academic scientists, 80 percent reported spending more time writing grants now than they did in 2010, yet most receive less federal support. In research-intensive universities, promotion is contingent on the numbers of papers, grants, and patents, as well as university service. The culture is competitive, with success measured in terms of individual achievement, usually assessed by (a) the number of first or last authorships on publications in high-ranking journals and (b) the grant dollars brought into the university.

Very little in this culture comports with the goals of the public. The public wants research that goes from bench to bedside, not bench to bookshelf. I learned this in my first weeks transitioning from academia to NIH a decade ago. As part of my new job, I met with the chair of the House-Labor-DHHS Appropriations Subcommittee, then a congressman from Ohio. He greeted me by asking, “What’s exciting at NIMH?” When I responded that we had just published two papers in Nature, he looked at me like I was from another planet. His next and final question was one of the most important I heard in my first years at NIH. “How does that matter to people in Ohio?” Over the past decade, although the public demands for impact have increased and public funding of biomedical research has decreased (NIH has lost 25 percent of its purchasing power), academic culture has remained remarkably unchanged. Consider these three examples.

Team science has become a necessity for tackling tough problems. The recent report of over 100 genetic associations in schizophrenia came from the Psychiatric Genetics Consortium, a team of 400 scientists in 30 countries. When this paper is published, there may deservedly be over 100 authors. How will the 98 authors who are not first or last receive appropriate recognition in the current academic system? Or, more to the point, if the public needs academic scientists to tackle tough problems, does the current culture discourage team science?

Crowd sourcing has become one of the fastest ways to solve analytic problems, from protein folding to the need for new technologies for diagnostics. Large data sets from genomics, imaging, and clinical trials are ideal resources for crowd sourcing innovative solutions. But such a resource requires that data be standardized and shared. For academic scientists who often lack the funds or time to analyze fully their own data, sharing seems more like a threat or a burden, not a solution. A culture built on individual promotion rewards the scientist who is first to publish, not first to share.

Clinical trials have been one of the greatest sources of conflict between public expectations and academic culture. For NIMH this begins with the simple observation that people with our most prevalent disorders seem to be everywhere—homebound, homeless, in prison, schools, primary care—except the academic health center. As a result, recruitment into clinical trials may be slow. At NIMH, the average time to complete clinical trial recruitment extends beyond 4 years. Many trials fail to recruit, and those that complete recruitment may be very slow to publish, meaning that a typical clinical trial will report results more than 7 years after a funding decision. We are not unique. A paper from the National Heart, Lung, and Blood Institute last week reported on 244 trials completed between 2000 and 2011.2 More than one third remain unpublished and, for those published, the median time to publication was more than 2 years. If time = lives, it’s no wonder that taxpayers have their doubts.

Scientists in academia are not the problem. Most go into science driven by a desire to have an impact on a disease or fueled by curiosity to solve some important puzzle. Scientists learn quickly that the culture is competitive and that the average age of a scientist receiving his or her first NIH R01 grant is over 40. They work long hours, accept low salaries compared to what they could earn in the commercial market, and delay all kinds of gratification to pursue this career. The problem is that they are in an ecosystem that is not aligned with public expectations. Scientists can complain about public expectations, but we should remember who is paying the bills. This culture clash would not matter except that most academic research depends on public funding. Public funding is now lower than it has been in a decade. If we want our best and brightest to continue in science, we need to provide the right incentives and the right environment for them to have the greatest impact. Increasing public support for research requires a commitment to deliver value for the public.

References

1 Insel TR, Landis SC. Twenty-five years of progress: the view from NIMH and NINDS.  Neuron. 2013 Oct 30;80(3):561-7. doi: 10.1016/j.neuron.2013.09.041.

2 Gordon D et al. Publication of trials funded by the National Heart, Lung, and Blood Institute.  N Engl J Med.  2013 Nov 14;369(20):1926-34. doi: 10.1056/NEJMsa1300237.