“Until lions write history,” says the African proverb, “the tale of the hunt will always glorify
the hunters.” Between the tale as it is written and the struggle on the ground, there may be more questions than answers. From whose vantage is history told and how do we read its lessons?
That was part of the challenge of the Office of NIH History’s recent 2-day conference at the Cloister, “The Role of the Research Physician: From Golden Past to Threatened Future?”
“Your conference raises a set of issues that goes to the very heart of the legacy and enduring identity of the National Institutes of Health,” said NIH acting director Dr. Raynard Kington.
History office director Dr. Robert Martensen noted that in contrast to the “golden past”—roughly 1950 to the mid-1970s—the number of research physicians is dropping nationwide.
History office director Dr. Robert Martensen
Ph.D.s now outnumber M.D.s, while M.D.s outnumber
“The number of M.D.s at NIH among total NIH staff is dropping,” he said, as is the number of M.D.s among new principal investigators in NIH extramural programs.
This workforce trend mirrors the division between fundamental and applied science. For Martensen, this is problematic.
“Was Pasteur doing clinical or basic research?” he asked.
Pasteur, in one of many breakthroughs, ran from his lab to the field and back again to create the first rabies vaccine.
“I’m arguing that [the line between basic and applied] is not that neat,” Martensen continued. “It’s never been that neat. Yet this hierarchy keeps being restated…and the tension over who is doing what is reflected in the division of dollars and embedded in research funding practices.”
How will physician-scientists sustain themselves and their research tradition? Fifteen speakers and commentators weighed in.
Kington traced NIH’s growth from a small Hygienic Laboratory in the U.S. Marine Hospital to a multi-billion-dollar agency, noting how “over nearly three decades, physicians and dual-degree holders have comprised about 30 percent of the PI pool on R01 equivalent grants.”
Meanwhile, as part of NIH’s continuing support
of the physician-investigator, the number
of mentored career development awards has increased nearly four-fold.
Yet concerns remain. “Proposals by M.D.s have lower success rates than M.D.-Ph.D.s or Ph.D.s,” Kington said. “M.D.s who propose clinical research are funded at lower rates than those who propose non-clinical projects. And M.D.s are less likely to have follow-on research grants.”
He cited the Clinical and Translational Science Awards (CTSAs) as robust opportunities for physician-
“CTSAs are flexible,” Kington said. “They encourage the development of local models, with results that improve local health and expand clinical research capacity. Moreover, they share and compare their results through a national CTSA network.”
The award adapts to an educational model, as in a CTSA-funded University of Pennsylvania undergraduate
training program. It also works as a community
model, as in the Mayo Clinic’s mobile clinical
Other opportunities for physician-investigators: the NIH Loan Repayment Programs, which encourage
promising researchers and scientists to pursue research careers by repaying up to $35,000 of their qualified student loan debt each year; awards such as Pioneer, New Innovator and EUREKA; and funding from the American Recovery and Reinvestment Act.
A conference participant objected that universities might be reluctant to take on 2 years of [ARRA-associated] funding “without a re-up.”
“I understand the dilemma,” said Kington. “We have to solicit, review and get the money out the door. But this is unique in the history of our funding
Dr. Michael Gottesman, NIH deputy director for intramural research, offered suggestions for the future.
A major challenge, both from the public and from Congress, is to fulfill demands to show payoffs for increased funding. Increasingly, Gottesman said, the pressure to produce [breakthroughs] results in specialization, which in turn leads to a loss of perspective.
“Clinical activity is creative activity,” he said, “and a lack of perspective can stifle it.”
He called for interdisciplinary “team science” and a new paradigm in the way research clinicians are recruited.
“We felt the need to rewrite the criteria for tenure,” he said. Moreover, “in order to do clinical research, there is an enormous administrative and paperwork
burden. It sucks the life out of clinical investigating…
intramural clinical researchers, in concert with the NIH steering committee, could develop
better ways to cycle from lab to bedside to lab. There are 11 institutional review boards embedded in the ICs. We could concentrate these into 6 or 7 service centers…with the goal of reviewing a protocol
within a few weeks.”
Mentorship is crucial, he said, and time spent with mentees “should be protected time.” In addition, making NIH more family-friendly would help to attract more women candidates.
Finally, he touted the Office of Science Education’s teacher modules, which include specific instruction
plans for elementary, middle and high school students.
“I’m enormously excited that our current President is interested in improving…science education,” said Gottesman, ending on a hopeful note.