To advocate or not to advocate?
Early in May, Congress voted to increase spending for the National Institutes of Health by $2 billion as part of an omnibus spending bill for fiscal year (FY) 2017. The boost–a product of bipartisan, bicameral negotiations–came on the heels of another $2 billion increase for NIH in FY 2016 after several years of flat or reduced funding for the agency. And in December, Congress offered near-unanimous support for the 21st Century Cures Act, which provides additional funding over the next 10 years for targeted NIH research initiatives.
Without the strong voice of the nation’s academic research institutions on Capitol Hill, it’s unlikely the outcome would be this affirmative for science, said Karen Fisher, AAMC chief public policy officer. “House and Senate appropriations leaders have become incredibly passionate champions for steady, sustainable growth in the NIH budget. It’s a direct response to their constituents, who are becoming increasingly vocal about the potential to improve health and strengthen local economies through a strong funding commitment to medical research.”
Congress has pushed back against the White House budget blueprint for next year in which the Trump administration proposed slashing the NIH budget to $25.9 billion–nearly $8 billion less than the final FY 2017 spending bill. But with federal budget pressures mounting, many in the science community are anxious about the long-term prospects for research funding.
Joseph A. Hill, MD, PhD, chief of cardiology and director of the Harry S. Moss Heart Center at the University of Texas Southwestern Medical Center, said the proposed cuts would be “cataclysmic.” And it’s not just funding cuts that are creating a challenge for scientific researchers. Evidence-based science, itself, is being questioned by some—from fears about vaccinations to skepticism about climate change, Hill added.
“Any scientist, any physician-investigator, must be able to justify why what you’re doing benefits society and why society should continue to invest in it.”
Joseph A. Hill, MD, PhD
University of Texas Southwestern Medical Center
Some scientists are deciding that the time has come to speak out—at the very least to advocate for scientific research as Hill and many others did in the nationwide March for Science on April 22. The rub, however, is that many researchers lack the communication know-how to sell the importance of what they’re doing to the media, public, or even their medical school deans. “I think many scientists do a very poor job of that,” Hill said.
Many scientists never figured communicating to the public was part of their job description, echoed Rich Eckert, PhD, chair of biochemistry and molecular biology at the University of Maryland School of Medicine. “I think there’s a tendency among some faculty to believe that their mission is doing the science and they shouldn’t have to worry about this other stuff. That’s a bit of an old-fashioned idea,” he said. “Nowadays you just can’t exist in that kind of vacuum. The younger faculty are changing. They recognize they need to do this.”
Ambassadors for science
From its $34 billion budget, the NIH awards nearly 50,000 competitive grants each year to more than 2,500 universities, medical schools, and other research institutions. Until FY 2016, the NIH budget had been declining in inflation-adjusted dollars for years. Success rates of grant applications have declined as well—down to 18%.
“Any scientist, any physician-investigator, must be able to justify why what you’re doing benefits society and why society should continue to invest in it,” said Hill. “We are already at risk of losing an entire generation of emerging, early-career investigators who are making the difficult and treacherous leap from training status to independent status.”
Communicating and engaging with the community is something academic medicine needs to learn how to do better, said Alex Ommaya, DSc, AAMC senior director of clinical effectiveness and implementation research. “I think researchers need to be engaged with the community that they’re working in and make sure that they’re talking about their research specifically and the importance of research generally.”
“In academia, we’re trained to talk a lot. We’re trained to write a lot. But that doesn’t mean we’re communicating. It doesn’t mean the other person is actually getting it.”
Christine O’Connell, PhD
Alan Alda Center for Communicating Science, Stony Brook University
When Eckert addresses nonscientists—a patient, a stranger, or a member of Congress—“I go with the theme I know is important,” said Eckert.
“One is that government financial support of the National Institutes of Health is necessary as a source of funds for investigators in universities and medical schools to support biomedical discovery science because the government is the only entity with enough resources to support this expensive work. And we have to do that for several reasons. One is patient care. We want to develop things that are going to treat disease and to help people live a more sustainable life. And we have to do it because it is an economic driver that creates new jobs, and it creates a group of people who are trained to do science. And if we don’t sustain that, we’re going to lose continuity and we’ll be behind the rest of the world.”
To start the conversation, Eckert wears a button, produced by the AAMC, that says “Ask me about my research.” “I wear the pin at airports, while shopping, and at dinner parties, and other places. The public will ask you if you give them a chance. I have a short little speech I give them so they get a little education about what we do and how it’s funded and what the need is,” he said.
“I always find that they are very supportive. I wish that I could reach more people that way. That’s why I think all scientists should be trained to do this, and they should have buttons that say, ‘Ask me about it.’”
Know your audience, know your goal
“In academia, we’re trained to talk a lot. We’re trained to write a lot. But that doesn’t mean we’re communicating. It doesn’t mean the other person is actually getting it,” said Christine O’Connell, PhD, the founding associate director of the Alan Alda Center for Communicating Science and assistant professor in the School of Journalism at Stony Brook University.
“I was finishing up my dissertation [marine and atmospheric sciences] when I worked with Alan Alda, before the Alda Center existed. I was trained in improvisational techniques to see if I could improve my communication skills,” O’Connell said.
“I had been trained to talk in a certain way [in graduate school], which was important for journals and science culture, but was detrimental in terms of actually communicating beyond that,” O’Connell recalled. “I was getting lost in the jargon. I was losing my passion, the reason I wanted to do this in the first place. I wasn’t letting myself show that or be personal. In so much of science you’re told to take the personal out of it. When you’re doing science that makes sense. When you’re actually talking about it, communicating about it, you have to learn to put the ‘I’ back into it.”
Today O’Connell coaches scientists, including medical researchers, at the Alda Center to help them discuss their work in more effective ways.
“Know your audience. What do they want? What do they care about? And how can you connect to them?” O’Connell tells them. “And then, know your goal. What are you trying to accomplish? What are you trying to get your audience to think, to feel, or to do after they read that article or after they’re done talking to you? Focus on those two things.”
Science needs better metrics
Researchers are trained to measure success in metrics such as grant funding received and publication in peer-reviewed journals, said Philip Alberti, PhD, AAMC senior director of health equity research and policy. These yardsticks are “very important for academic audiences. They’re not on anyone else’s radar.”
Alberti and colleagues undertook a collaboration with RAND Europe to identify “research stakeholders,” including patients and families, local legislators, philanthropic donors, and academic institutions to develop “metrics that matter,” he said. These metrics included the level of local spending and direct employment, the number of patent applications and innovations, new cures and improved quality of care, and the number of research projects engaging community partners.
“It’s crucial to bring more players to the table who can voice their support for the research enterprise,” said Alberti. “Through the RAND collaboration, we’re helping our institutions learn how to communicate the value and importance of research to a broader cross-section of society.”
Make the economic argument
NIH spending supports 380,000 jobs and $65 billion in economic activity. But that’s not even the main economic argument in its favor, said Hill. Looking at the bigger picture, funding cuts could irreparably harm the ability of researchers to develop cures and treatments.
“[Medical research] is a wonderful investment in the short term, in terms of jobs and products and knowledge that is learned and transferred into other industry,” said Hill. But, he added, “The argument that I have used [for funding research] is that the costs of health care are skyrocketing and will ultimately bankrupt our society if we don’t bend the cost curve.”
“The way that we’re going to bend the cost curve is at the front end, by discovering cures for chronic illnesses, like heart failure and Alzheimer’s disease,” Hill continued. “If we’re going to keep our society from being bankrupted by runaway health care expenditures, we need to start curing some of these diseases.”