A Political Strategy for Biomedical Research During and After Trump

Current United States administration policies are degrading the nation’s biomedical research system, and the damage is likely to grow. Those valuing research face the dual challenge of limiting damage and charting a path to eventually rebuild. There is an urgent need for an organized effort to promote these goals. Such an organization could also provide valuable functions beyond the Trump years, such as evaluating procedures and policies and guarding against new destructive initiatives. With federal funding for this type of project currently unlikely, a philanthropic foundation is needed to take the lead.

An Urgent Need to Oppose Damaging Policies to Research

There is an urgent need to oppose policies that are damaging biomedical research. In its first year, the administration canceled several thousand National Institutes of Health (NIH) grants, reduced the number of new grants, and compressed their duration. The administration has also demonstrated a hostility that suggests more damage to come. This has included attacks on vaccine research, efforts to severely cut the NIH budget, among many other actions. Biomedical research could also suffer from general administration policies, such as refusing to spend congressionally appropriated funds, increasing its authority to fire federal employees, and discouraging foreign workers.

There is no organizational voice dedicated to resisting these policies. A new organization could monitor and mitigate damage and help develop a vision for rebuilding. In developing such a vision, we should recognize that it is not desirable to simply recreate an earlier status quo. There have been widespread concerns: a risk averse NIH, overwhelming bureaucracy at home institutions, a cumbersome and flawed NIH grants process, obstacles slowing young researchers, and the increase in fraudulent publications and retractions.^1-6 Despite many concerns, the system has proved resistant to change.

A Conceptual Framework for Rebuilding

How then can we build an organization whose mission is to limit damage and use the ongoing tragedy as an opportunity to address these problems? We suggest a process organized around five thematic questions.

Questions for Near-term Efforts to Limit Damage:

• How is the system being damaged, now and in the future? To date, numerous grants related to research on health disparities, vaccines, and other fields have been canceled. The associated loss of indirect costs will have downstream effects. Discretionary funds, critical to launching new initiatives, may be needed for more routine maintenance. Institutes have become more cautious about faculty hiring, and many promising researchers are examining other career options. The current environment seems certain to deter foreign PhD students and postdoctoral researchers.
• How can such data be used to influence sympathetic policymakers in Congress and elsewhere? There have been two hopeful signs: Congress’ refusal to slash the NIH budget by 40 percent and an appellate court blocking the proposed 15 percent limit on NIH indirect cost recovery. While current administration policymakers may be unpersuadable, Congress, the courts, business leaders, state policymakers, and wealthy donors could play a positive role. Reaching such policymakers will require transforming a description of how the system has been damaged into a compelling narrative. One that provides a strategic view of the problem, identifies specific research consequences, and describes impacts to the nation’s health.

Questions Related to Rebuilding:

• How should concerns about the current system help shape a future vision? While many concerns are subjective, retractions are a quantifiable and compelling starting point. While most scientists have not been directly affected, the factors leading to erroneous publications affect everyone. The review system and pressures to publish are two obvious upstream sources. A focused effort to solve this problem can open a wedge into a broader examination of troublesome issues.
  Another wedge issue is the system’s rigidity. At the simplest level, it represents a failure of scientific leadership. The pressures to raise money, monitor budgets, and deal with administrative matters have left little time for leaders to solve substantive problems. A focus on system responsiveness will uncover a range of leadership gaps that touch other problems.
• What will be the biggest obstacles? This obviously depends on the status when rebuilding can occur. Attracting foreign scientists will probably be a lingering problem. We can also expect vexing career development problems as talented young scientists flee academia and if the pipeline of trainees suffers. Restoring capabilities to damaged subfields, such as health disparities research, will be a significant challenge. There could be a counter-productive competition, as institutions compete for identical scarce resources.

A Question Connecting Near- and Long-term Issues:

• How should a vision of a more flexible and effective system affect ongoing priorities for damage limitation? Understanding long-term needs will help establish priorities for damage limitation efforts. It will help a budget constrained community understand which capabilities to preserve.

How to Setup This Organization

The process to form an organization to deal with these problems should begin promptly. It will require sponsorship and funding from a large philanthropic foundation. Funding will be needed to maintain a staff that organizes meetings and roundtables, gathers data, and fulfills administrative requirements. Scientists must take the lead, but issues related to organizational behavior, communication, and politics will play an important role.

This implies a multidisciplinary approach and fresh perspectives. In addition to established scientific leaders, the planning process should include input from diverse sources such as upcoming biomedical researchers, retired scientists no longer competing for recognition, experts in organizational behavior and change management, science journalists, and even lobbyists.

To the extent possible, activities and recommendations should be supported by quantifiable data. A team of analysts will need to track numerous organizational metrics. To ensure maximum credibility, this activity should be subcontracted to a prestigious non-partisan research institute known for objectivity and skills in data gathering and analysis. Examples included Brookings, RAND, Mathematica, among others.

There will come a time when rigorous biomedical research is again appreciated by leaders in the federal government. Until that time, an organized approach is needed to resist damage and prepare for rebuilding. Over the long run, such an organization could also help ensure against repeated destructive initiatives and provide a capability to evaluate the policies, procedures, and traditions that govern biomedical research.

Editor’s note: During the editorial process, coauthor of this opinion piece Paul Salvaterra, PhD, passed away unexpectedly. David Rubenson, MS, MBA worked with the editorial team to revise and finalize this piece.