This is a companion piece for my previous post on philanthropists in risky research funding. Private donors can be a blessing for research, but if you’re interested in the sorry state of money in biomedical research, here’s a more in-depth dive.
Where does all the money go?
As I mentioned in my last post, federal agencies contribute about $40 billion per year to scientific research. Accessing that money, however, can be a soul-crushing process that looms over the heads of academic scientists.
The National Institutes of Health (NIH) channels most of its energy to “groundbreaking” research, leaving very little for the truly experimental stuff. This means that most financial support goes to already well-established areas of research. Scientists are driven to ask safer questions with surer outcomes. Well-studied areas continue to make strides while murkier and less well-studied areas are left behind, stuck in a vicious cycle: they can’t get funding because they don’t know enough, but they can’t learn more because they can’t get the funding. This is a big problem, because without basic research, more advanced, clinical research and development couldn’t exist.
Alarmingly, NIH funding has been in steady decline in research years, and the Trump administration has only increased cuts to its budget. The budget for 2019 was adjusted at the last minute, seemingly to save biomedical research from cuts. Yet considering it also entails absorbing three other agencies into the NIH, it is still a de facto cut because the money is spread even thinner.
Cuts, combined with poorly-prioritized allocation of funds, make scientific research stagnate – and ultimately, patients are the ones who suffer the consequences.
Is disease funding a popularity contest?
According to the WHO, heart disease accounted for a whopping 31.3% of total global deaths in 2015 – approximately 17.7 million people. Cancer accounted for 15.5% – about 8.8 million people. And yet, that year, cancer received nearly $5.4 billion in NIH funding, while less than half that amount – about $1.3 billion – went to heart disease.
Even more striking, chronic obstructive pulmonary disease (COPD), the third leading cause of death in America and fourth in the world, kills about 3.1 million people per year – 5.6% of deaths in 2015. And yet, COPD received just $97 million, down from $107 million in 2014. That’s over 20 times more funding per capita for cancer research than for COPD.
Why are some diseases left in the dust? For heart disease, at least, we’ve reached a complacent standstill. Many effective generic drugs exist, and new research is expensive. Heart disease is sometimes preventable by improving lifestyle habits, and prevention and control is not the NIH’s strong point. This is why progress in the fight against cancer has been disappointingly slow, despite the NIH continuously throwing money at it. The majority of cancer funding is directed towards treatment and basic research into its mechanisms, while prevention and control – arguably the most important area of all – receives comparatively little.
As a result, we know a ton about how to treat cancer and how it functions within the cell, but we know precious little about how to keep people from getting it.
The development of antibiotics has gone off the rails.
Now we come to infectious diseases. For better or worse, research is driven by capitalism. In the world of drug R&D, “economically viable” is a careful way of saying “quantity over quality”. Historically, in the race to develop antibiotics faster than diseases could develop resistance, pharmaceutical researchers were actually incentivized to churn out as many chemicals as possible in the search for infection-fighting drugs. Rather than increase successful drug output, this contributed to a massive overload of cheap, easy-to-produce, low-quality synthetic compounds, instead of higher-quality, often naturally-derived molecules, which are harder to tease apart but ultimately far more reliable. Click the link for an in-depth article I wrote for The Conversation earlier this year on the problems in antibiotic discovery.
Of all the successful antibiotics out there, over half are derived from natural sources, and yet the vast majority of chemicals screened are still these huge quantities of low-quality synthetic small molecules. Improved methods in synthetic biology are being harnessed to increase the quality of these molecules, often by mimicking natural products, but much of the damage has already been done.
It’s estimated that if antibiotic-resistant superbugs are left unchecked, resulting deaths per year will increase more than 10-fold; numbers are expected to reach 10 million by 2050, outpacing cancer.
Wealthy philanthropists give scientists hope, but are they enough?
Some wealthy philanthropists have made big names for themselves in disease research. In addition to their support for the universal flu vaccine, Bill & Melinda Gates have awarded billions in grant money to Seattle’s Infectious Disease Research Institute (IDRI) for the study of malaria, tuberculosis, and other vaccine adjuvants. And Seattle doesn’t stop at infectious diseases; in 2015, the Allen Institute for Cell Science was opened with the help of $100 million from Paul Allen. These donors have turned Seattle into a major hub for global health.
The idea of concerned philanthropists stepping up to fund scientific research is a comforting one, especially for young scientists and riskier researchers that are rejected by government funding bodies. But with dwindling federal money, are wealthy donors enough to pick up the slack? As I said in my previous post, according to the Science Philanthropy Alliance, philanthropic donations reach around $4 billion per year. This formidable chunk of change cannot hope to match the $40+ billion provided by federal agencies. Instead, private funding sources are excellent for identifying gaps and channeling support to the areas of research that most desperately need it.
With the dearth of government funding, more researchers must turn to private sources for support. And as corporations enter the ring, a new complication arises: conflicts of interest.
Corporate funding can muddy the waters with ulterior motives.
As private funding sources become a bigger player, their motivations must bear up to greater scrutiny. A quick Google search turns up plenty of examples of corporate conflicts of interest.
It’s a poorly-kept secret, for example, that nutrition science is largely funded by the food industry. Welch Foods Inc. reported that drinking Concord grape juice boosts brain activity and conveniently failed to mention the adverse health effects of drinking excess sugar. In 2015, the University of Maryland came under fire for issuing a press release stating that chocolate milk – specifically, Fifth Quarter Fresh chocolate milk – could help people recover from concussions. Turns out, the professor leading the study, Jae Kun Shim, conveniently forgot to disclose that he’d been receiving money from the company. The sugar industry has infamously paid scientists to push pro-corn-syrup narratives, which have almost certainly contributed to the world’s growing obesity epidemic, not to mention heart disease.
This is how nutrition myths are born. If you’ve ever heard that drinking cranberry juice can decrease your risk of urinary tract infections, you’re not alone; turns out that “game-changing” study was both funded and co-authored by Ocean Spray. A 2007 study in PLOS Medicine found that in 206 papers studying the effects of milk, soda, and juice, industry-funded papers were four to eight times likelier to find that their drink produced positive results.
Conflicts of interest legally have to be divulged, but they are often shoved into the fine print. This practice has come under closer scrutiny; PubMed, for instance, started putting conflict of interest statements right under the abstracts. But we’re not always looking at blatant data manipulation; rather, industries are naturally more likely to pick and choose potential positive effects of their products, and to fund studies that support those effects. If someone finds evidence that organic food gives people cancer, it’s not likely that O Organics will jump at the chance to prove it.
In dealing with conflicts of interest, scientists may be forced to reject precious funding from questionable sources; the American Geophysical Union, for example, was pressured to cut ties with ExxonMobil in 2016 due to the company’s rhetoric of climate change denial. Scientists who wish to benefit from highly sought-after industry funding often find themselves in the awkward position of pushing their research to reflect the industry’s goals; those labs unwilling to align with their sponsors’ views are left in the dust. Industry funding is so product-oriented that basic research is highly overlooked; the AAAS cites that 80% of industry R&D goes to development and only 20% goes to the research itself.
These problems leave a bad taste in everyone’s mouth. People have learned, for instance, not to trust anything funded by the tobacco industry, and researchers often reject their sponsorship. But it’s not always easy for the public to distinguish industry- vs. non-industry-funded research, and with these lines blurred, even good science loses its credibility.
Industry funding is not always a bad thing. Sponsor control is not always the same as simple bankrolling. But readers and other investors must be extra vigilant in scrutinizing those studies. How do the research methods hold up? How do the findings compare with the general consensus of the scientific community? Where is the conflict of interest statement displayed? Asking critical questions is key.
The problem is, while other scientists may know what questions to ask, the public often doesn’t.
Public access to science is a major concern.
Affordable access to research papers is difficult. A single article PDF, from Springer for example, may easily cost the reader $40. Subscriptions for universities and libraries are in the tens of thousands. For-profit publishing companies often take advantage of scientists by selling research paper access back to their home institutions at a huge profit – Elsevier, for example, boasts annual revenues around $3 billion, and a profit margin of around 40% – more than Apple, Google, or Amazon. The most high-impact, career-advancing publications like Science and Nature are often not open access, and even open access journals have to get money from somewhere; currently, that means already strapped-for-cash scientists, who pay to submit manuscripts.
With some notable exceptions, there is simply no incentive for scientists to participate in good communication with the public; with so much on their plates, scientific literacy is not a high enough priority. Some scientists will gladly send you their original paper for free if you request it, but this is not common knowledge. And what happens when you do get your hands on a paper? They are so jargon-filled, even many scientists can’t fluently read papers from other specialties.
Furthermore, quantity is often prioritized over quality. Fake or low-quality scientific journals are preying on desperate young scientists, especially in developing countries, where academics are judged on their number of papers, not the rigor of their research methods. These predatory journals bombard scientists with tantalizing invitations to publish quickly and with minimal, if any, peer review for a nominal fee. That means open access journals – that is, papers accessible for free by non-scientists – are being diluted with crappy research, and the public can’t always tell the difference.
With research papers so inaccessible, the public has to rely heavily on science communicators for their understanding of research-based issues. Particularly now, in the age of “fake news” and social media, gotcha journalism reigns supreme. That, combined with over-saturated editors and a broken peer-review process, means only the sexiest research, rather than the highest quality, gains traction in the public eye.
Life behind the laboratory bench isn’t easy.
Scientists suffer greatly at the hands of these systemic issues. The words “publish or perish” are engraved on the inside of every scientist’s skull. Researchers trying to survive in an extremely competitive environment are pressured to produce hurried, poorly-designed studies. Experiments aren’t replicated, findings are hyperbolized, and scientists are driven to manipulate data (see p-hacking, which can be used for good and for evil) to make their results more flashy and publishable. An estimated $200 billion – 85% of global research spending – is wasted on low-quality studies in a single year.
Researchers often learn best through failure, but publications do not favor negative results. Scientists can’t afford to take risks, so research becomes ever more gruelingly slow and incremental. Some publications are taking steps to correct this problem; for instance, the Journal of Negative Results in Biomedicine hopes to bring the beauty of failure back into research.
When it comes to funding, it’s often about who you know and what funding you’ve already secured, not the quality of your work. Young scientists suffer disproportionately for this. Early-career researchers work long hours, make peanuts, and still struggle to get published. Because research is so poorly funded, the system promotes the indentured servitude of postdocs and PhDs for the bulk of the work force.
Scientists have to spend a tremendous amount of time churning out grants instead of focusing on their research – grants that often provide over 75% of academics’ salaries, but which carry their own sets of problems. Often they’re too short-term, spanning only a few years when a research project can take a decade or more. On the flipside, the specific requirements of grants may prevent a research group from cutting their losses if they reach a dead end early on. Either the group has to live out the remainder of the grant fishing for data they know is worthless, or they are forced to quietly misappropriate grant funds to other projects and hope they don’t get caught. To help combat this systemic problem, the Howard Hughes Medical Institute (HHMI) has changed their grant structure, awarding funding to researchers and labs themselves rather than individual projects; this allows scientists to choose how to allocate the money where it’s needed.
The overarching solution to every one of these problems revolves around the same basic concept, and it’s a doozy: publication and funding should be awarded to studies with the most rigorous research methods, not the flashiest results. It’s time for a scientific culture shift, and it can’t come too soon.