The Attack on Biomedical Research - Part 4, Morale in Science

Slight break in my series due to both a family and personal health issue that had me a bit sidelined for a while.  But, I'm now back online and moving forward with the series.

The progress of science is, like many things, tied to the morale of those who are doing the work.  I have been doing biomedical research for over forty years (sure doesn't seem that long).  During that time, I have seen both highs and lows both personally, but also as experienced by the industry as a whole.  There were exciting times where one could see new avenues of insight and research direction opening new discoveries and directions.  There were other times where significant roadblocks were thrown in front of us, resulting in scientific progress crawling along at a snail's pace.  The one thing I learned over the years of highs and lows, is that keeping my head down, focusing on my science, writing my grants and papers, and thinking of the next step regardless of what was going on around me, would get me through the tough times.  

However, this new political environment we face continues to dramatically change science, primarily not in a positive direction, has me and others questioning not just our personal futures, but that of scientific research in general.  Some of the issues that have contributed to this massive shift in science I briefly touch on below.

Public Trust in Science

There has been a number of major shifts in society over the past couple of decades.  One of them being the lack of public trust in science.  This shift in how the public perceives and understands (or doesn't understand in many cases) science has changed how many of us in the field operate.  Part of this shift can be blamed on scientists themselves.  The broad model had always been that the scientist would do the research, write up the results for publication in a scientific journal, and then move on to the next question to be answered.  The publication of our results would be considered the dissemination of our findings, but that audience was generally the scientific community.  How many in the general public actually reads the scientific literature?  Thus, dissemination of our findings to the broader public was usually left up to others. 

Typically, your institution's press operation takes on the responsibility of marketing your findings out to the general public, which means the media becomes the vehicle by which information is disseminated to the public.  Unfortunately, the media gets is wrong too many times, hypes up results, report contradicting findings from different studies as if they were all equally valid, and sometimes get the facts just totally wrong.  John Oliver did a really nice piece on this on his show Last Week Tonight.  The lack of integrity in how the media disseminates scientific information only contributes to the lack of understanding of science and the distrust of science.  Science is not perfect, is many times inefficient, and as I teach my students, no single study proves anything.  Not all scientific studies examining the same question are equal and each needs to be carefully evaluated.  Thus, it's not surprising when the public sees the media reporting contradictory conclusions and get the impression that scientists "can't make up their minds" about a given problem.

Scientists have never been trained to move beyond the scientific publication to help educate the public.  A minority of scientists have embraced social media to do this, but frankly too few have done so and unfortunately a large number of those who do, seem to be doing it more for the "fame and fortune" aspect, rather than the educational aspect.  Scientific journals have also made attempts to make what they publish more publicly accessible, with mixed results.

In this new digital age, the lack of engagement by scientists, the poor reporting by the media, and the variety of digital outlets has allowed those who have a personal agenda to fill the apparent void with pseudoscience, conspiracy theories, and political agendas.  These individual viewpoints have gained more traction thanks to automated algorithms that feed individuals with only things they want to hear, rather than feeding them correct information.  Traction is gained even more so by the invocation of "First Amendment Rights" rather than whether information is factual or not.  We have seen this most prominently with the recent pandemic where sound science was ignored and even vilified in favor of anecdotal information or even wives' tales.  The situation was further exacerbated by people attacking and ignoring scientific experts who have studied such problems for decades, in favor of political hacks or so-called "online influencers" with zero to less-than-zero scientific knowledge or expertise.  Even our President claims to rely on "common sense and gut instincts" rather than scientific expertise.

The increased lack of public trust in science has extracted an immeasurable toll on morale in science.  Students come in with a level of skepticism that has to be overcome that we have never previously encountered.  This requires time and energy we have never had to include in previous teaching or training of students.  The public questions everything we do to try and improve health and quality of life as if it was tied to some giant pharma-conspiracy to keep everyone sick and tied to profit making on medications.  It's as if The Flat Earth Society suddenly captured the national conscience and everyone now believes the earth is flat.  Society is moving in a very dangerous direction that has a direct impact on the morale of science.

This lack of trust in science has widespread implications, particularly in terms of public health.  Vaccines are an excellent example where trust has eroded to the point where diseases we have not seen in decades are appearing across the country.  The hard work that was put into developing vaccines, implementing their deployment, and ensuring their levels to protect the public has degraded primarily due to lack of trust in science. There needs to be a concerted effort to correct this shift in the public perception, as it has implications for future science and the training of scientists.

Political Leadership and Politicization of Science

I have recently been expressing to colleagues that we seem to be undergoing our own version of China's Cultural Revolution, where politics dictate everything.  This is the first time in my career where political leadership have directly interjected themselves into scientific decisions, particularly what research will or will be funded.  The initial purge of research grants based on the 197 verboten words sent shock waves throughout biomedical science, but was just the beginning.  Much like how this administration implemented many of their changes, the claw back of grants based on these words was accomplished by simply doing a simple word search.  If any given word appeared more that 6 times in a grant (including titles of citations from the literature), the grant was flagged.  How bad was this implementation?  Just as a minor example, the word "trans" was part of the list, obviously in reference to this administration's dislike of "transsexual."  However, the term "trans" is used in other scientific contexts, like transgenic mice (genetically altered mice), translocation (movement of something from one location to another), cis vs. trans genetic regulation (regulatory elements on the same DNA stand vs. the opposite DNA strand), and other similar examples.  All these grants were initially frozen and tagged before someone finally figured out they had nothing to do with trans-sexuality.  

However, things did not stop at a mere set of words.  Research perceived to be motivated by Diversity, Equity, and Inclusion (DEI) has been pretty much terminated.  DEI will be a separate topic in this series, but let me just say at this point that the administration's definition of DEI has had extremely negative effects on scientific research, the careers of individual scientists, the training of new scientists, and eventually will have negative effects on public health.  

The Department of Health and Human Services (HHS) is currently led by an individual who has ZERO training or experience in science.  While some of the things he says are broadly true and need addressing, much of the details and justification he provides is just outright wrong, not based in any science, and based on his own perceptions rather than facts.  Such an individual is a huge danger to the overall biomedical enterprise of the U.S.  You can immediately see the negative effects he has had in the short handful of months he has led HHS.  He has removed scientific experts and replaced many of them with charlatans or non-scientists.  He has interjected his own opinions into the scientific process to push for outcomes he prefers to see, rather than letting the science determine the outcomes.  None of of us do science based on a political viewpoint or agenda.  Why?  Because many of the problems we study don't give a flying fuck about your political affiliation, sexual orientation, religious preference, or any of the other social factors that separate us as a society.  Cancer cells only care about replicating.  Viruses only care about reproducing.  For those who think chronic diseases are new problems created by the pharmaceutical industry know nothing about this history or challenges in studying these diseases.  Most have existed way before the pharmaceutical industry was established.  

The degradation of scientific leadership, the layoff of thousands of skilled workers by DOGE, the realignment and restructuring of institutions like the CDC and FDA to align with political views continues to degrade our scientific industry, our leadership in science, and most importantly is leading to a erosion of the health of our nation.  Superimpose upon that changes to Medicare/Medicaid, Federal support for food safety programs, the extinction of USAID, and other changes to our government can only push us in one very negative direction.

Restructuring of the National Institutes of Health

There are many negative changes going on at the National Institutes of Health (NIH).  These are too numerous to delineate here, but I will briefly touch on five items that have directly affected morale within science.

First is the overall effect of the various changes that has many scientists questioning their futures.  This is particularly true for young investigators just starting their careers or those trying to decide whether to apply to graduate programs.  The overall attitude, perceived or real, is that America doesn't want them and that their contributions to society will not be appreciated.  This could be the start of a brain drain for the U.S. as foreign countries see opportunities to attract students and scientists to their countries.  Many Ph.D. programs have announced no new incoming classes as support for students have disappeared.  Seeing this, many foreign countries are actively cherry picking young Americans to start their training or careers in foreign lands.  This is not a good thing for America.

Second, the injection of politics and political views into the funding of science has many of us extremely disturbed and concerned.  This approach aligns with how Chairman Mao implemented the Cultural Revolution in China.  Sure, you can do science, just so long as it aligned with how the Central Committee defined things, which was political fealty to Mao-ism.  That's essentially what is starting to happen within the NIH.  Freedom of speech and freedom to choose your scientific question is being replaced by political fealty to whatever ideology the current administration and leadership espouses.  Furthermore, the expert leadership that has guided the NIH research programs, both intramural and extramural, are being replaced by charlatans and political hacks who only have personal or political agendas.

Third, the proposed changes to the NIH budget and overhead will have devastating effects on science in America.  I previously covered the overhead issue in my first post in this series.  However, more recent proposed changes will have additional devastating effects on science.  First, the proposed reduction of the overall NIH budget by 40% will basically gut the American research enterprise.  Coupled with the change to overhead, the loss in research projects, loss in research talent, the inability to train future scientists, and the impact on American health will be immeasurably bad.  

Additionally, the administration has changed the way funds for grants will be awarded.  Traditionally, when one was awarded a multi-year grant, you were required to submit a progress report at the end of each year before the next year's funds would be awarded.  This was a mechanism to ensure that each project was meeting its goals and making appropriate progress.  This also allowed NIH to spread the funding of a given grant across a number of budget years, without having to immediately fund the entirety of the project.  This meant that more projects could be funded across a number of years.  

However, this administration is now requiring that grants be fully funded the year they are awarded.  That means there will be less funds for a given budget year and less projects funded.  This recent change has forced changes to the "payline" (the rate at which grant applications are funded).  The National Cancer Institutes recently announced their payline for grants will now be the 4th percentile.  Other institutes are moving to single-digit levels of funding, although I have not heard what those exact numbers will be.  My guess is most will probably fall around 6-8 %-tile..  So what does this mean?  It means that for a given funding cycle, your cancer research grant application must score in the top 4% nationwide, in order to be funded.  Think about what that means.  Given the thousands of scientists writing thousands of grant applications each cycle, you basically have to be better than the best in order to get funded.  I have been fortunate to have been fairly successful in getting my grants funded and my scores have usually fallen in the 10-15 %-tile range....twice I scored in the single digits....an achievement I am quite proud of.  But, under the new paylines, even at my best, the chances of my grants getting funded have significantly fallen.  This drop in the paylines will probably have the greatest effect on morale in science as funding begins to fall outside of the reach of the majority of scientists.

 Fourth, the NIH is realigning the grant review process and centralizing it into the Center for Scientific Research (CSR).  Previously, CSR handled the administrative parts of grant applications, but then would assign them to the different institutes and the institutes would operate grant review panels, identifying expertise appropriate for a given grant application review.  The final decisions would then be sent back to CSR for final processing.  Now, the entire process is to be handled by CSR and the institutes will no longer be involved in the grant review process.  While in the long run, this change may prove to be an improvement (I have no a priori evidence to suggest it won't), short term, this is a disaster.  Primarily because NIH and CSR have not been transparent in how the new process would work and who might be involved.  Anecdotal evidence suggests individuals who are not familiar with your research area may be handling your grant and its review.  It does not help that NIH will simultaneously be realigning the institutes with some being eliminated and others merged into new entities.  None of us can foresee what our scientific futures will look like in this newly re-vamped NIH.

Fifth, is the discussion of requiring NIH-funded scientists to only publish in some new NIH-based publication system that RFK, Jr. has envisioned.  Again his lack of scientific background and vague perception that scientific journals are all controlled by the pharmaceutical industry and rife with corruption, graft, and bias has resulted in an idea that is not necessary and problematic in its own right.  While the current publication system is not perfect and does need some much needed overhaul, it is definitely not as RFK, Jr. describes.  Furthermore, given the direct injection of politics into science by the current secretary and his minions, I would have no confidence that any publication operated by the current administration would be to the benefit of science.

So, in closing, morale in science is probably at an all-time low.  Surveys like the Biorender State of U.S. Science Funding: 2025 Report bear this out.  My own conversations with friends and colleagues across the nation also bear this out.  Too many bad things have been happening all at once.  I have seen senior colleagues choosing retirement over having to deal with what it going on.  People my age struggle with that option....while appealing on one end, I still have things I'd like to accomplish before I retire.  It's the thing that has driven my entire career; making my tiny contributions to improving the health of Americans and people across the globe.

But you can also see what is happening based on active protest to what the current administration is doing.  NIH scientists and staff issued the Bethesda Declaration raising their concerns regarding the staff cuts and other changes at the NIH.  Their declaration was publicly hosted by the group Stand Up for Science, who has taken stances on other issues such as changes at the National Science Foundation, National Aeronautics and Space Administration, Food and Drug Administration, Center for Disease Control, and others.

At the end of the day, even if everything that has happened is reversed and returned to "normal," the damage has already been done.  We will not recover from these past 6 months for at least a decade.  That's not to say everything before the Trump Administration came to power was perfect.  There were very clear improvements and changes that were necessary.  However, the sledgehammer this administration has wildly wielded within the glass house of scientific research has had only predictable outcomes. 

 

The Attack on Biomedical Research - Part 3, Student Visas

I thought it made sense to next talk about the student visa issue, since the last segment focused on education.  For the purpose of this series, I will discuss the student visa issue in three general parts, although I will probably keep it relatively high level without digging too much into the weeds.

Why Foreign Students?

Educational opportunity should not be restricted to specific subsets of the population.  This is particularly true with respect to higher education.  Talented individuals come from all segments of society across the globe and any talented individual who desires an advanced education to pursue their dreams, should be afforded that opportunity.  This is only one of many reasons for taking foreign students into U.S. academic programs.  So why is the current administration targeting foreign students?  Many currently enrolled students have received notice that their student visas revoked or threatened with revocation.  U.S. embassies across the globe had been instructed to either more closely scrutinize visa applications, slow walk their processing, or reduce the number of student visas for review (although this one apparently has been recently temporarily rescinded).  Universities are being threatened with loss of access to SEVIS (Student and Exchange Visitor Information System), which is necessary for them to process and track student visas at their institution.  Why this sudden attack on foreign students?

Too many times I have heard the argument that the playing field should be level, that no special considerations be given to specific groups of individuals, and acceptance into degree programs at institutions of higher education should be based on merit.  Well, then thanks to the relatively poor educational system in the U.S., many foreign students significantly outperform domestic students.  That's not to say we don't have skilled and talented American students.  But, if you compare standard academic metrics, coupled with the fact that grade inflation is rampant within the American educational system, it's no wonder foreign students look better on paper.  This is one reason why a holistic approach to reviewing applications and candidates for degree programs is necessary.  Being a successful student isn't just about how you look on paper. 

However, associated with the fact that foreign students tend to "look better" on paper, there is a myth that foreign students get their education in the U.S. then return to their home countries taking all the "secrets" they learned back with them.  This is far from the truth and a myth perpetuated primarily by politicians with specific agendas (briefly discussed below).  There are two important components to consider when talking about the fate of foreign students.  

First, our immigration policies have significant hurdles making it difficult for graduates to stay in the U.S.  The transition from a student visa to a work visa is not easy, made even more difficult if the job market tightens.  This is part of what needs to be addressed with immigration reform.  Many students go back to their home countries, because they basically have to; it's not by choice.  Yes, there are students who choose to return to their home countries (a handful of the students I've trained chose to do so).  Yes, there are students who work for their governments and take "secrets" back with them.  Anyone who denies the latter is ignoring reality.  However, these two categories make up a small proportion of the total foreign student population.  Many foreign students realize their best opportunity to build a scientific career is to remain in the U.S.  Although, the dramatic and detrimental changes in biomedical research being implemented by the current administration may change that.  This is also why countries like China have programs to woo students back home by offering positions with significant resources, large salaries, and/or high prestige.  Again, the current changes now provide other foreign countries the opportunity to poach American talent as students are seeing lesser opportunities for their future if they stay in the U.S.  In some sense, the current administration is creating a "brain drain" with their policies.

Second is that foreign students who train in the U.S. and remain have made (and continue to make) innumerable contributions to society.  The National Foundation for American Policy in 2022 estimated that immigrants founded more than half of the U.S.'s privately-held billion dollar startups.  The intellectual contributions of foreign students to the success of biomedical research in the U.S. is equally significant.  One cannot and should not discount their contributions. 

So Why Revoke Student Visas?

In their attempt to show "strength" and "resolve" to "solve" the immigration "problem," the current administration has targeted immigrants of all types.  The rhetoric used is they are going after the "criminals," but their definition of "crimes" is very loose and their approach, much like their approach to other issues they've tackled, has been haphazard, racially based, and implemented without clear rules.  The current administration has created the narrative that all immigrants, legal or not, are criminals of the worst kind who need to be deported.  Yet, the majority of individuals they have apprehended and deported or are trying to deport do not fit that description.  In fact, according to many news reports, many apprehended individuals were done so without knowing their criminal records.  At least in Los Angeles, the empirical evidence is that ICE is using racial profiling to target and arrest individuals regardless of their "criminal" records.  This has resulted (as I had predicted in other social media posts) in U.S. citizens being arrested and detained for deportation.  

Earlier this year, foreign students across the nation actively enrolled in academic programs started to receive notices their student visas were being immediately revoked and they were to immediately return to their home countries.  The reason provided in many of the notices was evidence of criminal activity that was a violation of their visa.  So what were those crimes?  In many cases, things most of us would dismiss as minor, like a parking ticket.  In many instances, the student had properly resolved their "crime" by paying the fine, going to court, or some other legally accepted process.  Yet, just the fact they had this minor infraction resulted in their visa cancellation.  These students are not drug lords, gang members, murderers, or any of the other adjectives the current administration has used in their public declarations to described both legal and illegal immigrants.  These are smart kids who are working towards some advanced degree in an attempt to build a career and a life.  

I am aware of two students at my institution who received such notices and had to deal with them.  One went so far as to retain legal representation to handle their case.  But, then the national injection was issued and the student, at least for a moment, did not have to return home.  However, they had spent a significant amount of money for their legal representation and now find themselves short of money to pay for tuition for the coming school year.  I don't know how that student is currently dealing with that situation.  However, none of these students are out of the woods....the recent Supreme Court decisions that resulted in greater latitude for the Executive Branch now puts these students at risk again.

The additional reason for targeting foreign students has to do with the "extortion-based" approach to governance that has been the model this administration has been using with respect to many of its policies.  Foreign students make up significant proportions of student populations at many academic institutions and many of them pay full tuition, since they are not eligible for various forms of financial aid, particularly Federally-based programs.  It's an easy target to hit the pocketbooks of universities to pressure them into accepting changes the administration wants to implement at American universities (this will be another segment in this series). 

Should a Country's Politics Penalize the Individual Student?

This administration has significantly politicized many aspects of this nation that should be non-partisan.  They are faithfully following the overall political strategy outlined in Project 2025 and politicizing every aspect of government and even the public.  However, many aspects of Project 2025 had already taken root even before the project was publicly released.

Finding its roots in the first Trump administration the House of Representatives created the House Select Committee on the CCP.  Copied directly from the committee's website: "The Select Committee on the Chinese Communist Party is committed to working on a bipartisan basis to build consensus on the threat posed by the Chinese Communist Party and develop a plan of action to defend the American people, our economy, and our values."  While this sounds noble and just, many of the committee's activities have been rooted in racist views, animosity towards the Chinese Communist government, and extended to Chinese civilians, foreign, legal resident, or U.S. citizen.  One can only naturally look back to the McCarthy era and note many similarities.

The Select Committee recently sent to a number of universities across the country a letter with a list of 20 questions regarding Chinese nationals enrolled in their degree programs.  The letter cites the threat to national security, how universities have become dependent on foreign tuition monies, and the need to address this threat to national security.  However, personally, I am not aware there is a true "threat" to national security.  Yes, there have been individual cases of either espionage or loss of intellectual knowledge, but not at the level that these letters and the Select Committee's Press Release hints at.  In fact, historically the "national security" argument as been repetitively used as an excuse to work around laws, norms, and even the U.S. Constitution.  Furthermore, there have been a number of prominent cases where the Justice Department (not just this administration) had targeted academics of Chinese ancestry, only to find no evidence of wrongdoing.  Sadly, the zeal with which these individuals were targeted was not matched with an equally zealous apology once they were exonerated.  A basic flaw in our justice system.  Many of these victims found their careers forever damaged, their reputations irreparably tarnished, and some unable to cope with these stresses even committing suicide.

The Chinese government has traditionally flaunted many norms of international relations to move their agenda forward.  No different than any other nation, but they clearly are on the fringe of acceptable behavior.  Nobody is saying China is a saint among nations.  But to take out our poor relations with another government on individuals is not holding to our principles as a democratic nation.  Why punish all Chinese students?  Why create excuses to cancel their visas, when they have essentially held up their end of the visa agreement?  Why disrupt our biomedical and scientific research by yanking out individuals actively working on projects who have done no wrong?

Like the damage caused by clawing back research grants and reshaping research priorities to meet a political agenda (again, a future topic), casting a dark cloud over current foreign students has already damaged the American research enterprise and who knows how much additional damage will be caused if this direction continues.   

 

The Attack on Biomedical Research - Part 2, Education

Biomedical research does not move forward without the talented and creative individuals who generate the scientific questions and do the research.  While the Principle Investigator (PI; the head of the lab) typically generates the scientific question, the studies to address these questions are not successful without the research team the PI assembles.  For example, my own team includes a study coordinator, a programmer/analyst, students, and other support staff.  Each one of these individuals has gone through their own educational process and training and make their own unique contributions to the overall success of research conducted in the U.S.  While the PI might get the bulk of the fame and notoriety associated with the work, no PI is successful without their research team.  It is, indeed, a team effort.

Reflecting on my own education, I completed a bachelor's degree in biological science that included work-study as part of my financial aid.  Work-study allowed me to work in a lab and start to learn more about how research is done.  My first job was to measure glucose in plasma samples using a YSI Model 23A glucose auto-analyzer (this will mean nothing to most of you, but maybe generate a chuckle in those who know).  Some of the measurements I made contributed to publications in which my minor contribution was noted in the acknowledgements section of the papers.  Progressing to a master's degree in applied biometry (basically biostatistics), I was involved in the design and execution of a clinical study that led to one of my first publications.  This study was supported by a grant from the National Institutes of Health (NIH) and partly supported my salary.  My training as a Ph.D. student was partly supported by an NIH grant awarded to my mentor, but I was also supported on an NIH T-32 training grant.  The T-32 is a grant that supports training of students and post-docs in specialized areas of research and provides additional training beyond the standard curriculum.  These grants are written by the faculty of different Ph.D. programs and are used to support Ph.D. students throughout their training.  As I completed my Ph.D. and transitioned into my post-doctoral training, I was supported in my first year on another T-32 grant, but then was awarded my own F-32 fellowship from the NIH.  The F series of fellowships are designed to support the research and training of individuals students and post-docs.  I wrote my own F-32 research proposal that was reviewed and scored high enough to be funded.  These all led to my first independent research grant from the American Diabetes Association that formed the basis of my future research program.

All these mechanisms, work-study, individual research grants, T-32s, F-type fellowships, and various other grants are critical in supporting the education and training of future scientists.  Without them, we don't have the next generation of talent and we don't have the workforce necessary to move biomedical science forward.  I'm not sure I would be where I'm at today, without these various support mechanisms.  Yet, the current administration has been clawing back grants using a plethora of false narratives, which has resulted in current students losing their funding, losing their training opportunities, and casting a dark cloud over their futures.

The loss of individual research grants has been catastrophic for Ph.D. programs and in particular, current Ph.D. students whose training is dependent on those grants.  What many do not realize is that these grants provide support for individual trainees, providing not just financial support, but also invaluable training opportunities as they learn from their mentors and research teams.  This goes a long way in establishing research skills in students.  The loss of individual research grants means students are losing their livelihoods and training opportunities.  The loss of their stipend means not being able to pay the rent, buy food, and pay for all the other day-to-day necessities of living.  The current administration has essentially taken their futures away from them overnight.

The clawing back of grants and the ambiguity of future of research funding due to the rash behavior of the current administration means Ph.D. programs across the nation have accepted smaller incoming classes for Fall '25.  Some have even retracted offers initially extended prior to the implementation of the these new policies.  So, a large number of students who thought they were starting a Ph.D. program this fall, abruptly learned their opportunity was gone and with the deadline for acceptance long past, have no program to start in the fall.  The additional review and restructuring of student visas has added additional unnecessary chaos that has huge negative impact on the future of the U.S. research enterprise (a topic for a separate segment in this series).  

The current administration's positions have been short-sighted, but also unnecessarily hastily implemented.  It is very clear little to no thought has been given to what the actual consequences of their actions are.  The approach of, "Oh, you've got a blister on your toe, we're gonna have to amputate your leg" approach to everything has clearly not worked, as they keep learning what their actions really mean for America.  How many times have you heard after they've removed whole parts or fired staff of entire segments of the government, "Oh, we didn't mean to get rid of THAT office" or "Oh, we didn't mean to fire THOSE people."  These are real people with lives, families to support, and futures to build.  They aren't abstract items you tick off a list.  Long term damage to America's research enterprise has already been done.  We have already created a long-term shortage of well-trained research professionals by having to shrink our educational programs.  Recovery from this will take decades.  In the meantime, if this administration continues these policies, the damage will extend beyond decades and will have profound effects on peoples' health as research cutbacks result in slower progress on critical question.

Not a year ago, I could robustly make an argument to a young person to consider a career in science.  Particularly those students who wanted to make a difference in society.  Biomedical science is one area where "making a difference" comes in many different forms and has a special sense of personal satisfaction that cannot be found in other professions.  We ARE making a difference.  However, given the current situation, I am finding it more and more difficult to tell young people they should consider a career in science.

The Attack on Biomedical Research - Part 1, Overhead

I know I have not posted on this blog since 2018.  This was due to a number of things, including the pandemic, but primarily it was because too much was going on and finding time to write was a bit challenging.  However, given events so far this year, I thought I would start posting again starting with what I am thinking will be a short series highlighting various aspects of the recent attack on biomedical research.

You can see long rows of pain medications, decongestants, treatments for athlete's feet, cough medicines, and other over the counter medications or devices when you enter a drugstore or even in your local grocery.  You grab what you need, pay, and leave without thinking too much about where all these options came from.  Many times you're just thankful you can deal with your issue by going to the local drugstore, rather than having to make an appointment to see your doctor or to go to urgent care.  But, sometimes you have to go see your doc or urgent care.  While you might have blood draws, testing of some kind, 
receive prescriptions for drugs or physical therapy, you again walk away without a thought about how these things are part of the arsenal to aid in your health.  In less fortunate cases, you might need surgery or other major life-saving efforts and while you may be thankful for these interventions to allay your malaise or even save your life, again, you might not give much thought to how these miracle procedures came to be.  Well, you have biomedical research to thank for it all.

The U.S. has been THE leader in biomedical research on planet earth.  This is not disputable.  America has invested money, talent, and effort into countless medical breakthroughs, expansion of biologic knowledge, and translation into medical care.  These efforts came about thanks to public funding of research through the National Institutes of Health (NIH), National Science Foundation, and other government agencies.  The improvement in human health over decades can be directly attributed to the knowledge gained through research. YOU have been a partner in all these discoveries through the taxes we all pay.  However, you're getting a pretty good return on your investment.  In its most recent annual assessment, United for Medical Research estimated that each $1 NIH spent on research generated $2.56 in economic activity.  Leadership in biomedical research has been one of the many things that has made and continues to make America great!  However, today modern biomedical research is under attack.

The current administration seems to believe science is rife with bias, wasteful spending, pushes specific political ideology or agendas, and does not serve the public good.  While I would never say things is scientific research are perfect (who can say that of anything?) the general description this administration paints is far from the truth.  Who am I to say this?  I have spent over forty years working in science starting as a student worker and working my way up to being faculty at a major university.  I'm not the best scientist in the world nor am I the worst (at least I hope not!).  I've made my contributions over the years working in the area of diabetes and obesity and hope my small contributions move us that much closer to finding cures for these conditions.  But, our march towards those cures has now been significantly impeded by what's going on today.

My various comments in the coming posts will be done from the perspective of working with the NIH, because NIH-based funding forms the bulk of my research support and is what I am most familiar with.  However, much of what will get discussed pretty much applies to other funding entities within the U.S. government.  Private funders can be using totally different models from what I'm describing here.  

Our first topic will be "overhead."  This refers to costs related to supporting scientific research at various academic and non-academic institutions.  Each institution negotiates an overhead rate with the NIH to help support research activities at their institution.  These rates vary from institution to institution, because of various factors and the final negotiated rates have a very wide range.  An example of why rates might vary include whether an institution gets support from state government that might support the same activity.  Private universities typically do not receive state support and therefore may negotiate a higher overhead rate.  Overhead is critical to the performance of research, because it funds the necessary scaffolding that supports research.  Some of that framework is sometimes mandated, but not directly funded, by NIH and other funding agencies.

When I write a grant, the funds I receive are to support the actual research.  My grant funds salaries for myself, my staff, and my students, the actual research, purchasing of necessary equipment, and ancillary things like costs related to publishing our work and travel to scientific conferences.  But what about all the other things I need to do my research that are not directly covered by my grant?  I need the following things specifically to do my research, some of which are mandated by the NIH and others are basic needs (other researchers may have different needs):

• I need physical space for me, my staff, and my students.  That space needs water, lighting, electricity, heating/cooling, sanitation, and phone/internet.
• The university needs staff to maintain the space; clean and take out the trash, perform maintenance, etc.
• I need administrative support to help generate and submit my grant, but also manage the grant if I am lucky to receive one.  The latter includes budget management, ordering of supplies, and other administrative activities
• My proposed research needs to be reviewed and approved by my institution's Institutional Review Board (IRB), a committee of scientists and non-scientists that reviews all research protocols for safety and ethics.  Approval from the IRB is necessary in order to receive funding.  If you want to learn more about the importance of the IRB, Wikipedia has a good description.  
• My proposed research needs to be performed in a clinically-approved research space.  Since I'm doing clinical research (research on humans), the space we use to perform our studies needs to have appropriate staffing, e.g., nurses, pharmacists, along with adequate equipment and support in case of emergencies. 
• I perform DXA scans (you probably know this as a bone density scan) in our research, which involve X-rays.  So my research protocol has to be approved by the Radiation Safety Office to ensure the safety of our study participants.
• I need space for the freezers that will store the biological samples we collect for our research.  That space needs electricity, internet (for the freezer alarm system), and climate control.

I'm sure I'm missing one or two other items, but you should get the sense of the immense support structure that surrounds the kind of research I do.  The support structure varies by research type, so most institutions need to maintain a wide spectrum of services to maintain excellent research programs.  Thus, our institution provides a wide range of support for biomedical research, all of which are covered, in part, by the overhead charged on grants....not the actual research grant.  You'll see the distinction below.

The proposal to cap the overhead rate on all NIH grants to 15% is extremely misguided.  The negotiated overhead rate at my institution is 65%, which means the institution would be losing a very significant chunk of change that helps pay for the various services I described above (and more).  I know overhead rates at other institutions can run as low as 30% and as high as 90%, so the hit each institution would take would vary.  These funds cannot be easily replaced and therefore will force cutbacks in these services.  This means a significant deterioration in our country's biomedical research enterprise.

I have heard several Department of Government Efficiency (DOGE) functionaries give the same explanation as to why the cap of 15% would be good for research (same argument is pushed by the Heritage Foundation, authors of Project 2025).  The example goes like this.  Let's say an investigator gets a grant for $100 and let's say the overhead rate at their institution is 40%.  That means the investigator gets $60 and the institution gets $40.  However, under the new proposal, the institution would only get $15 and the investigator would get $85 and therefore more money is going to the actual research.  Sounds pretty good, doesn't it?  But, this ignores two major issues.  First, under their scenario, there is now less money to support all those services I described above.  How are all of those services going to be paid?  Second, their description is not how NIH overhead works.  Using their same scenario, if an investigator writes a grant for $100, $100 goes to the research.  The overhead of $40 is added on top of the research funds, such that the total grant award is $140.  So, under their proposal to cap overhead to 15%, the investigator still gets $100, but the institution now only get $15.  There is not one extra penny going to the research! 

The other aspect of this DOGE fairy tale is where all the savings are actually going.  If overhead is capped at 15%, that means the NIH budget will now have a chunk of uncommitted funds.  I have not heard a single word about where that money will be directed.  Nobody has said that the overhead savings would be diverted to increasing the number of research grants or to seed new research initiatives.  In fact, the overall proposal is to cut the NIH budget by 40%.  Therefore, there will be less funding for research, which makes the DOGE explanation an even greater fairy tale.

The other argument put forth by DOGE is that private funders typically have overhead rates that are around 15% and if those groups can fund at 15%, so should everyone else.  Unfortunately, this ignores the fact that the funding base for private funders is very low (because it's mostly donation driven) and if they applied a regular overhead rate, their ability to fund research projects would be severely limited.  Additionally, given their funding base is so low, they would not be able to sustain the levels of funding needed to maintain the research support structure.  This DOGE argument is akin to saying that small countries are able to maintain armed forces at a fraction of what the U.S. spends, therefore the U.S. should cap defense spending at some average similar to what smaller countries spend.  

The reality is that biomedical research we have done and continue to do has many intangible positives that cannot be directly put into dollars on a ledger.  The significant strides in health and medical care have made significant improvement to quality of life for everyone across the globe, not just Americans.  However, taking away those dollar and cents will significantly deteriorate our progress and will likely degrade livelihoods and quality of life.  A real discussion regarding overhead rates might be appropriate, given the desire for efficiency and the ever increasing cost of doing research.  However, capping overhead rates to a uniform arbitrary figure that has no basis in reality, is not a solution to what may not be a problem.

 

#DrWattAtUSC  #LetsMakeAmericaBuenoAgain 

Some random thoughts...

Haven't posted in an eon and thought, given the Thanksgiving Holiday, I'd post some random thoughts.  There is much going on in the world and too many things to talk about, so I'm just gonna post a bunch of disjointed things.

• There was a recent opinion piece by Mark Penn and Andrew Stein (WSJ Article) that raised the possibility that Hillary Clinton would be a candidate for President in 2020. Mrs. Clinton herself has not confirmed nor denied whether she would actually be a candidate, but did state that she would like to be President.  Now, I know there are millions of Hillary fans and others out there who believe the 2016 election was robbed from her, because she won the popular vote, but lost the Electoral College.  Well, I'm sorry to all you fans out there, but having her run would be a huge mistake.  I've noted before in a previous post (See here) that even though lots of things worked against Clinton, the bottom line was that she ran a poor campaign and much like her loss to Obama, she and her campaign totally misunderstood how the election worked and what to pay attention to.  My views on this are somewhat reinforced by parts of Bob Woodward's "Fear" in which some in Trump's circle clearly believed he could win, because they understood where Clinton was failing.  I'm sorry folks....if the Democratic Party wants to win the next Presidential election, they need to find a new standard bearer.  Sadly, the current crop of candidates don't seem up to the task.

• The Fourth National Climate Assessment was released on Black Friday this year (Click here to see the report).  The strategic release during a major national holiday weekend and a day where Americans hack and slash at each other to get a 50% discounted toaster actually didn't do much to obscure the fact that the report was full of bad news.  However, I was more amused that among the various discussions about what to do in the face of this report, the idea of blocking the sun's rays was once again raised.  If you want a good description of how this would work, or not as the case may be, click here. But, the one thing that came to mind as I heard this idea banted about pundits...isn't this pretty much how the Matrix started?  Sounds like a bad idea to me...

• The recent Supreme Court confirmation hearings of now Justice Brent Cavanaugh was yet another illustration of how much our politics have degenerated to partisan bickering.  While this began way before Trump was elected President, I have to say that in my opinion, President Trump has taken politicization to a new level we have not seen in at least my lifetime.  He has put political labels on everything, especially when things are not going the way he would like.  It is amazing to me how he uses "Clinton," "Obama," or "Democrat" as adjectives to describe a multitude of things, whether it's appropriate or not.  Both political parties used to go out of their way to ensure that certain parts of the government and their operations remained as bipartisan or politically neutral as possible.  Yes, you can never take away one's political leanings, but generally-speaking, I think until recently our government has done a decent job of making sure things like national intelligence, the Justice Department, and other key agencies and committees remained as neutral as possible.  But this President has been politicizing every aspect of government and, even worse, there are members of his party that feel it's now OK to also politicize them as well.  The political light-weight Rep. Devin Nunez is a good example.  I'm not totally blaming the Republican party, because the Democratic party has taken to doing almost the same thing, just because the Republicans are.  These are very dangerous trends that people have to wake up to and push back on.  Americans are definitely better than this.

• Which leads me to another point.   Our politicians, especially those in Congress, seem to have forgotten that our form of democracy is based on a "checks and balances" system where the Congress is one of three equal branches of government.  While it's OK for Congress to work with the Executive branch, Congress needs to push back when it is necessary.  Yes, there is partisan cooperation between Congress and the Executive branches when a single party controls both, but we've seen in the past how both branches can cooperate and work together even when either branch is controlled by the other party.  I've been extremely disappointed and distressed by the fact that the current Congress seems to be missing their huevos and can't seem to criticize the President when necessary.  There has been a deafening silence from Congress on a number of things where they should be pushing back.  I'm sorry, but when you need to criticize the President and restrain him on certain issues, you need to be doing that.  Not cowtowing to him because you're afraid of the consequences.  That's part of your responsibility and risk as an elected representative.  While I can comment on many issues where Congress should be speaking out, the one that concerns me the most is the racially-toned messages emanating from the White House and its staff.  I've previously commented on the fact that this line of messaging has emboldened fringe groups and has resulted in increased racist activities ("Out of the Shadows...").  It's only gotten worse since I made that original post.

• While we're on the topic of government and civics, I've noticed posts regarding the composition of the Senate have been popping up on social media.  Comes in different forms, but the basic complaint is that states, regardless of their population size, each get two votes in the Senate and that this isn't fair, the argument being that states with larger populations should be more votes.  I think these folks need to go back and take civics again.  We have two houses of Congress, one based on population size and the other not, for a reason.  Go back and learn why.

• I've been very interested in seeing how President Trump's support has not wavered much since the 2016 election.  I'm guessing that unless he does something to truly piss-off his base, his approval rating will continue to hover in the forty-something percent range (FiveThrityEight Poll).  What's of greater interest is who makes up that group that approves of his job?  There is clearly the base that will support him no matter what he does.  This group it seems is made up of ultra conservatives, but also the fringe racists who like the President's immigration policies, but also like the tone of his pronouncements.  There are those Republicans who lean a bit more to the right, but may not fully support everything the President has been advocating.  These probably include folks who support the President's general agenda, but really don't like the manner in which he communicates things.  There are those Republicans who currently support the President, but are having second thoughts based on his communication style.  I keep wondering how long these people can keep holding their noses.  Finally, there are the Democrats who supported Trump.  I'm guessing the latter is becoming a smaller proportion of Trump's supporters.  Well, you might say I'm just pointing out the obvious.  However, it is interesting how many support the President despite his demeanor, lack of compassion, personal attacks, and racially-tinged language.  Two, maybe three, of the subsets I described I would have thought would be second-guessing their support of the President, but that's not turning out to be true.  So, the big question is, what does this mean for America?  Are we destined to become a nation who will support someone regardless of how they behave?  Does this mean that honesty, integrity, and compassion are no longer important characteristics of our nation's leader?  Inquiring minds would like to know...

• CNN changed the face of news.  It was said that Ted Turner created CNN and 24-hour news because he was upset he couldn't watch the news when it was on.  Sorry, I know there's an entire generation of people reading this that don't know that 24-hour news didn't exist and we could only watch the news at specified times, like regular programming.  Anyway, while the idea of 24-hour news was nice, sadly, there really isn't 24-hours worth of news all the time.  Hence, we now see news stories repeating ad naseum and, in order to fill the time, "analysis" and "commentary" have become blended into the news, blurring the lines.  Before, these were separate programs, which explains why we have the Sunday news shows like "Meet the Press" (btw, I really miss Tim Russert), "This Week," "Face the Nation," and others.  CNN and others have now started to run other news-related programs like "Anthony Bourdain:  Parts Unknown"....sorry, I liked Anthony Bourdain, but this program really isn't news per se.  The fact that all this stuff is now blended together is what contributes to the label of "liberal" vs. "conservative" news programs.  Also, many times you can't tell when the news ends and the commentary starts.  I have always argued that true television news programming ended when the networks figured out they could make money off the news.  The establishment of CNN just expanded this to a 24-hour cycle.  I've also argued that this format has led to the dumbing down of America, because nobody can tell where the news ends and where the commentary starts.  Viewers are essentially being told how to interpret the news, without giving them a chance to digest the news and form their own opinion.  This is a huge contributor to the "fake news" label that the President and his allies have used extremely successfully.  Personally, I can't watch the news anymore.  I get so little out of it and the "discussions" are simply people yelling and talking over each other, bending over backwards to distort information to support their own positions.  Again, I really miss Tim Russert....but I also miss the days of Walter Cronkite.  Heck, I even miss Bernie Shaw.  Anyway, it's really sad to see this chaos when it's really not necessary.  Yet another consequence of the all mighty dollar.

PhD Comics:  http://phdcomics.com/comics/archive.php?comicid=2028

OK, time to stop rambling.  Although, one last thing.  All the chaos surrounding our political chaos has a price on America.  A small example is that as an educator, I see this in how students are reacting to what is going on.  Many of them are distressed, concerned, and are therefore not focusing on what they need to focus on.  It's already stressful being a student and they really don't need these distractions.  However, many feel they need to do something and for some, it costs them dearly.  So, rather than both sides of the political spectrum pulling further and further to the extremes, it's really time for Americans to embrace "compromise" again as a viable and acceptable principle, for our politicians to start governing again, and for Americans to be American again.  Although I'm a registered Democrat, I consider myself to be a centrist.  There are some things I'm liberal about and other things I'm conservative about.  I'm always reminded of the song "Stuck in the Middle with You" by Stealers Wheel and the line "...clowns to the left of me, jokers to the right, here I am, stuck in the middle with you."  So why not join me and others in the middle.


#LetsMakeAmericaBuenoAgain

The First Year...

I had intended to write this after the end of the first year of the Trump administration, but so much has been happening, it got hard to find a good break point.  I finally decided to just write this, since waiting for a good point didn't seem reasonable.  At the onset, I want to say that this post isn't meant to convince people of one thing or another.  I understand I'm not going to change peoples' opinions on the left or the right and I'm not going to convince people they need to step out of their respective bubbles.  More importantly, I'm not sure I'm even going to convince people to keep an open mind and constructively consider opinions other than their own.  But, I wanted to get these thoughts down and share with everyone, in the hopes that maybe, just maybe, I can change a couple of minds.  Anyway, what follows are some random thoughts about the first year of the Trump presidency.

First, at some level, what we're seeing with this administration is what one might have expected.  Trump and his family are political amateurs.  Most of his appointees (and he still has a boatload of critical appointments to make) are political amateurs.  People criticize them as if they were just like any set of previous politicians.  However, these folks are mostly business people who've only dealt with business politics.  Now, they're mixing with the "big boys" and it's a whole different ballgame.  This is a whole different level of politics and their amateur status shows.  The ineptitude of a variety of things they've done clearly demonstrate they are playing a big game of catch-up and time is flying by quickly.  Yes, some of  you argue Trump is a smart guy and maybe he is.  But smart doesn't make up for experience.  Trump may be smart and a good businessman, but he'll never be a great surgeon or lawyer or seamstress.  Much in the same vein, he'll never be a great president, because he's not trained for it.  In fact, it may be his "smarts" that have prevented even greater dysfunction and disasters....who knows?  So, people need to give them a bit of slack.  However, at the same time the administration better get their sh*t together soon.


Second, this is probably the first president in modern history (well, at least in my lifetime) who is more concerned about himself and his image than doing the job he's supposed to do.  The level of narcissism and paranoia coupled with his brittle ego has given us a leader who is too self-absorbed to do anything truly productive for the country.  In fact, he seems to have forgotten, along with a large proportion of Congress, that they swore to uphold and protect the Constitution of the United States and that they serve The People....not their political party and a selected subset of the population.  Example, the Russian interference in our elections.  This is probably the gravest threat to our democracy since the Cold War.  Sorry to you folks fearing North Korean nuclear strikes....not gonna happen.  Yet, our President is more concerned about the allegations of collusion, the legitimacy of his election victory, false notions about illegal voters, and his bromance with Vladimir Putin, that he's done nothing to protect our election process.  While I understand his concern about the legitimacy of his victory, at this point nobody is going to ask him to step down as president, because we're not sure if everyone who voted for him, would have voted for him if Russia hadn't interfered with the process.  Frankly, the President needs to be forcefully working with Congress to figure out ways to protect our election process and our democratic institutions.  His actions clearly show he is more concerned about his own image, than he is about protecting the country.  Similarly, if the President isn't going to do anything, Congress should.  However, they seem to be more concerned about vilifying or protecting (depending upon party affiliation) the President. 

Third, despite his self-proclaimed skill at negotiating, he has not demonstrated that skill in any of the legislation that has come forward during this first year.  In fact, his inability to stop tweeting has undermined many of his own initiatives and hampered many of his own negotiations.  I also think that he believes he's a great negotiator because as a businessman, he could always walk away from a bad deal.  In government, you don't always have the option to walk away.  Probably something that had never occurred to him.  Furthermore, my assessment been that Trump is a shallow thinker and doesn't consider how one decision might affect other things he's working on or purporting to be working on.  That type of shallow thinking gets politicians in trouble.

Fourth, I have never seen a president who has politicized everything he touches or mentions to the degree Trump and his followers have.  The degree to which the President and his followers have politicized things has started to degrade the legitimacy of key institutions that have, in the past, tried to remain non-partisan in order to provide balance in our government institutions.  Again, reflecting his own insecurities, Trump has made allegiance to himself the primary standard for anyone serving in any government office.  Thus, bureaucrats in agencies that have traditionally been non-partisan are now under attack if they show even the slightest hint they oppose any policy from the Trump administration or reveal their own political affiliations.  Those serving in government are not apolitical....they all have their political views and party affiliations.  However, as professionals, they have all chosen to take their jobs seriously and to serve to the best of their abilities the American people under whoever serves as president.  Yet, there are those who feel Trump needs to be protected at all costs, whether that means lying, perpetuating lies, attacking the free press, attacking non-partisan institutions within government, and vilifying anyone who opposes them.  Congressional representatives who defend the President even when he's lying or destabilizing our democratic institutions and, even more damning, those representative who remain silent, are all contributing to the demise of our democracy.  They all need to go back to their civics lessons are remind themselves that Congress does not serve at the pleasure of the President.  Congress is an equal partner in the governance of our country.  Furthermore, from the President on down, these individuals have all forgotten they serve to uphold and protect the Constitution and serve the people of the United States.   
Fifth, in parallel with the point above, these attempts to defend Trump at all costs has contributed to the general dumbing down of America.  I have never seen people bend over as backwards as some have to defend Trump regardless of how egregious the act or even if it violates their own beliefs.  By the same token, those on the other side are just as bad, attacking every act by Trump and his followers as if they were all impeachable or prosecutable offenses.  Facts used to be facts and the truth used to mean something.  Now, people believe only what they want to believe, whether true or not.  This has grave consequences for the future of our country and our ability to uphold our own form of democracy and governance.  The fact that our President and other officials are trying their best to demonize the news and more and more Americans get their information from social media, which can be manipulated by the Russians and others, is just crazy and frightening.  I have always argued that real news died when networks figured out they could make money off of news.  Today, news is seamlessly mixed with opinion with much of the latter slanted one way or another.  News discussions are not discussions at all.  In fact, most just degenerate into people yelling over each other and political commentators are chosen more for their looks and ability to generate revenue, rather than their ability to analyze and probe.  God I miss Chris Matthews!

Sixth, despite what those on the left want to fantasize, Trump has yet to do anything that is impeachable, despite what you might think or wish.  Just because he's doing stuff you don't agree with or he's doing things in a manner you disagree with, doesn't mean it's impeachable.  This talk of impeachment is a distraction and really should stop.  Talk about it, when there's something to impeach.  Similarly, those pushing for the possible invocation of the 25th amendment can relax.  Members of the Trump administration do not have the inclination nor the cojones to invoke the 25th amendment.  Again, while you might not agree with Trump, he's not done anything to warrant the 25th amendment.  Granted, he's nothing like any other previous president in projection, manner, or style.  But, those are not things that are impeachable or warrant the invocation of the 25th amendment.

Seventh, as I noted above a couple of times now, members of Congress need to remember what they are there for.  I realize the Republicans need to have Trump in place for him to sign off on any legislation they pass, but at the same time, should they be doing that at the expense of protecting the nation?  This President has done and said things that break social norms, degrade our democratic principles, and put people at risk.  Yet, very few in Congress on the right criticize those actions.  The handful that do, are not seeking re-election, which tells you something about motivations among congressional representatives.  Time to stop being selfish and to think of something more than yourselves.  You all claimed to have run for office to serve the people and the country.  Now is the time for all of you, on the left and the right, to be taking that oath seriously. 

I could continue, but I think I'll stop here.  Let me close by saying that while I'm concerned about the next three years of this presidency, I still have faith in our democracy.  However, our elected officials have to dispense with political expediency and show more political leadership.  Leadership is something sorely lacking in the US right now.  I have to admit, this past election cycle I had a hard time deciding among the two candidates.  They were both equally bad in different ways.  But, I can continue to hope that our democracy is strong enough to weather the current storm and make it out to the other side.

#LetsMakeAmericaBuenoAgain

Some thoughts on higher education...

I had originally intended my first post of 2018 to be a perspective on the first year of the Trump presidency.  However, recent events at work had me thinking about my job and generated some thoughts about higher education, the direction it's going, and the toll it's taking.  Apologies in advance as this post may end up being a bit more rambling than usual.

A little over five years ago, I took on the role of Vice Chair for Education for the Department of Preventive Medicine at the Keck School of Medicine of USC.  This job makes me responsible for our department's educational enterprise, which consists of undergraduate, masters, and Ph.D. degree programs with annual enrollments of over 700 students, in addition to some medical school teaching.  Ours is the only department in the medical school with this broad spectrum of degree programs and we operate more or less like a school within a school, which gives me a unique position to view higher education.

My job as Vice Chair has never been a walk in the park.  Like any job, it has its highs and its lows.  The lows include dismissing students from programs for various reasons with the highs obviously seeing our students graduate and succeed out there in the "real world."  I think the worst experience of my life as Vice Chair came just a few months after I took the position.  We had a student who was going to march in graduation, but was nowhere near degree completion.  The student thought they were close to being done and a sympathetic faculty member told the student they could participate in graduation; these things were extremely far from the truth.  Attempts to contact the student to let them know they could not march in the ceremony were unsuccessful and I was forced to have staff pull the student out of line at the graduation ceremony.  Needless to say, the student was not happy and neither was I.  However, there was no way we could allow the student to participate given their academic progress.  There were a multitude of procedural failures that allowed the student to think they could march in graduation, but also there was a complete failure of the faculty serving on the student's dissertation committee to provide appropriate oversight.  Sadly, in the end, despite various attempts by our faculty and myself to help the student make progress on their final dissertation, the student did not complete the degree.

Doonesbury - Garry Trudeau

So this gets to one of my first observations.  Many faculty are literally afraid of the students.  They fear poor evaluations that may affect promotion (see the Doonesbury cartoon), they fear the verbal threats of lawsuits made by students, and some just want to be liked regardless of what it means for the students.  Sadly, it's our job to be better educators, which is why we have evaluations to help make adjustments in our approach to teaching.  It's our job to make the tough decisions, but we also have to ensure we follow the rules and procedures in making those tough decisions.  We also have to explain to students why the tough decisions are in their best interests.  Having done so mitigates the consequences of lawsuits; a verbal threat made many times by students, but rarely followed through with.  I suspect many faculty do not follow protocol, which only elevates their fear of litigation.  It's not our job to be liked, although none of us wants to be hated either.  Part of our job is to try and help students find their way through their higher education and to steer them in the right direction.  Many times, that results in our having to tell students things they may not like to hear.  In the case of the student I had to pull from graduation, looking at the student's history it was clear faculty kept giving the student breaks along the way when they should have probably dismissed the student (at more than one point).  More importantly, the student showed zero skill in the field they were studying.  Another reason I was baffled the student had gotten as far as they had.  However, the student previously showed great skill in one of the laboratory-based sciences and really should have been pursuing a degree in a lab-based science.  The fact that no faculty member made that suggestion to the student was really a huge disservice.  Many times, students can't see what path they show promise in and instead choose a path based on other factors; parental pressure, perceived dreams, etc.  I think all faculty must pay closer attention to the student, rather than be overly worried about their evals or lawsuits.  The expedient path usually ends up being bad for all parties.

Related to this is the fact that students are becoming more and more needy and faculty bend to that neediness.  I was appalled this past semester when two students in my undergraduate class complained to me about their overall homework grade, because they didn't get points for two assignments.  I told them they didn't get the points because they didn't turn in the assignment; seemed pretty straightforward to me.  At which point, I was informed that it wasn't their fault they forgot to turn the assignment in, because I neglected to remind the class that the assignments were due.  Really?!?!?  You can see why professor evals might be low....we don't coddle the students enough.  My colleagues and I have talked about the fact that we are noting an increased amount of neediness and entitlement among the students the past few years.  Each year, more and more students challenge me about their grading or the "fairness" of the course.  I don't know where this behavior comes from; a generational thing?  Is this what "millennials" are like?  If that's the case, I fear for the future of the world.  These kids seem to not understand that life doesn't just hand you what you want and you need to take responsibility and work for them.  I look back at what my parents endured after World War II and in their early days as parents and wonder how kids today are going to fare watching them have a meltdown when they don't have the latest iPhone.  Here again, faculty need not bend to these students and need to uphold a sense of responsibility and integrity.  I'd like to see one of these students pull off the "you didn't remind us" excuse out there in the real world.

Another observation are the crazy things undergraduates are doing to be "competitive" in the post-graduate marketplace.  Pre-med students are cramming every waking hour with study and activities, trying to make themselves stand out from the other pre-med students cramming every waking hour with study and activities.  Students obsess over grades and many feel like getting an 'A-' kills their dreams of graduate school.  These days it's not unusual to hear of students with double majors and one or more minors.  I recall one USC valedictorian at graduation being described as having completed two majors, both with dual minors, and several overseas experiences.  When do these people sleep?  Sadly, the vast majority of students cannot maintain that level of academic rigor and quite frankly, there's no need to be doing so.  Over the years, I've found myself encountering more and more students stressing out over their academic situation and their ability to "compete" with their peers to get into those precious med school or graduate school slots.  Quite frankly, it's not necessary and it's quite unhealthy.  More and more, I find myself telling students to ease off things, drop some of their courses or activities, and focus on doing well in a smaller realm of things.  I have a partial sense of where these students are getting these ideas from, but here again, faculty, mentors, counselors, and others have a responsibility to provide real guidance to these students.  Not everyone is cut out for post-graduate education.  Many times, students are again picking paths that do not fit their strengths.  I have to keep reminding students to think carefully about what they truly want to do in life, rather than what they think they should be doing in life.  I also have to remind them to think about how they're going to leverage their education to achieve their goals, rather than using their degree major to dictate their goals.

Finally, at least in my experience, we need to do more about students with disabilities.  I am among the first to advocate for access to education for students with disabilities, but there there are two things universities need to be doing to best serve these students.  First, if a student's disability directly contradicts their ability to perform in their area of study, students should not be provided accommodations to pursue those areas.  An extreme (and unrealistic) example would be if a quadriplegic wishes to become a microsurgeon, the university should not be giving the student accommodations to pursue medical school for that express purpose.  No issues if the student wanted to pursue another area in the medical field where their disability does not directly contradict what they wish to pursue.  Don't roll your eyes....I said it was unrealistic, but let me give a more realistic example that occurred at our university.  A student wishes to pursue a Ph.D. in a laboratory science and up to a point, the university has accommodated the student's disability, which requires a isolated and quiet environment.  The student now needs to pass their Ph.D. qualifying exam in which they propose some research project, must complete the experiments, analyze the data, and write up the results.  In order to do so, the student is asking for accommodation for their disability; an isolated and quiet lab space.  Unfortunately, no such lab space exists and the University does not have resources to build a person-specific lab to meet the requirements of the disability accommodation.  Furthermore, even if the University were to comply and allow the student to essentially have a private lab space to complete their degree, how will that student fair in the job market?  It is doubtful any other university would create a noise-free private laboratory (they might, but highly unlikely) and that definitely would not happen in the pharmaceutical or private biomedical industry.  So, once again, we have not done the student any favors.  Early on, the student should have been counseled on alternative paths that allow them to be within the biomedical research realm, but would accommodate their disability.

A secondary issue with disability accommodation is how that system has changed over time.  At least at my institution, the accommodation of disabilities was established to ensure those with disabilities had fair access to an education; mostly related to physical disabilities.  However, now it includes a wide spectrum of things and the number of students seeking accommodations has significantly increased.  While I have no specific data, my own anecdotal observation has been the following.  In the past I would, on rare occasion, have a student with a disability accommodation.  This typically was to accommodate a learning disability and typically consisted of extended time on assignments or exams; typically time-and-a-half.  However, the last couple of years, I have had multiple students coming in with disability accommodations and the accommodations have become more complex.  This past semester, I had six students with disability-related accommodations.  The most extensive one I have encountered to date was extended time (double-time) on assignments and exams, a personal note-taker, quiet space for exams (I had to schedule a separate room for the student), and flexibility on deadlines due to "possible flare-up" in the disability.  I didn't really fully understand that last one, but understood it to mean that if the student told me they had a "flare-up" in their disability, I had to accommodate that and change any deadlines for assignments or reschedule any exams.  I heard from other instructors of similar experiences.  Here again, while I support giving people with disabilities access to an education, there are limits. In fact, my own experience suggests some students have learned to game the disability angle to their advantage.  Sadly, in cases where students are clearly taking advantage of the system, faculty are fearful of calling their bluff, since the typical response is a threat of lawsuit.  Legitimate disabilities should be accommodated, but again there is a fine line between helping a student move forward and stringing them along.  Students with disabilities are no different than any other student.  If they show no mastery of the material and competency in the field, faculty should be helping them identify areas where they can succeed and make significant contributions.  We should not be discriminating against those with disabilities, but we also should not be blindly accommodating disabilities simply because of a threat of litigation.

I will be the first to admit that while I love my job overall, I never really enjoyed classroom teaching.  My having to do it, only makes me appreciate teachers even more, since it's many times a thankless job.  So for all you teachers out there, know that there are those of us who appreciate what you do, thank you for it, and encourage you to continue to serve the youth of America.  I do enjoy the mentoring of students in the research environment.  I get a lot of fulfillment out of that, although there are times when it's very taxing.  Over the years, students with various struggles I've tried to help have thanked me for my advice, which has been fulfilling, but those stories are few and far between.  Being in the Vice Chair position now for about six years, I have seen the best and the worst in education.  The primary thing that makes me sad is that many times, decisions regarding education are made only considering the fiscal or legal impact, not the educational impact.  The thing that makes me happy is seeing some of the best and brightest come through our programs and become successful professionals and academics making their unique contributions to society.  The issues I've noted above are just a small part of the education enterprise.  Somewhere, there's a happy middle-ground where we can make decisions that balance fiscal/legal impact with educational impact and move forward with the best interest of students in mind.