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So what's the deal with masks? Nobody asked me to wear one. Shouldn't they be called mtells?
NIH funding cuts
- Thread starter Lamount
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I'm not sure that 'what did people expect' is a rational argument. I can tell you that most voters probably didn't expect another wanton firing of air traffic regulators just a week or two after the first fatal crash in over a decade. Just one such example. At any rate, even if people 'expected' this cut it doesn't mean we can't question the means and the ends.
I think you're missing the general concern that cutting infrastructure is not just going to get rid of 'fat' but will severely handicap the ability for institutions to support research. That's a huge missing variable in your 62.5 -->86.9 math. I don't think anyone believes that will happen, so I'm surprised to see you put forth that argument.
It doesn't surprise me that Trump cut NIH funding... he's cutting everything that won't make him or his buddies money
What surprised (if only a little bit) was how many folks here are willing to carry his water on that decision. Would hope that the PP vs. Academia thing here was like a sibling rivalry... sure it can get nasty, but no one should tolerate someone outside the family attacking their brother or sister.
...when the current administration is proposing cutting cancer research funding by 12.5% ($4 billion off a $32 Billion), we have a bunch of cancer doctors saying "well, I guess those greedy academics will have to be more efficient".
Honestly, it is a little disappointing to see a bunch of folks here taking the side of a bully over their colleagues'. Given the lack concern for genuine wasteful government spending elsewhere in the budget, I have to imagine the only reason for the dog piling on cancer research by posters here is just a bit of schattenfreude -never a great look.
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Yeah, as someone in community cancer care, it's tempting to crap on academia, and I have of course questioned the pricing of academic medicine, the corporate culture of academia, the negative aspects of academic careerism, the cost of consolidation under academic umbrellas and things like the proton boondoggle over the years.
But let's face it...we are all elites.
I can't see how this sudden cut helps our future or the trajectory of cancer care, and I believe it was targeted to inflict pain on academia in general and elite academic research institutions in particular. While imperfect, these institutions are IMO one of the great accomplishments of the liberal consensus. They also provide a competitive advantage for the US and function as a powerful nidus for international collaboration, which is itself a bulwark against international conflict.
I want my children to grow up in peace and to be ambitious regarding skill and competency but not regarding position or wealth. Ideally, they will have opportunities to do good through expertise while doing well enough.
It's an elitist ambition I guess, but one rooted in some version of virtue. In principle, its why people become doctors. It is dependent on academic institutions.
How Trump’s Medical Research Cuts Would Hit Colleges and Hospitals in Every State
Changes to a key funding formula will reduce research grants at hospitals and universities by billions — and may discourage future research.
This is a good article calculating the costs per major institution. The Fed has been using a complicated formula for infrastructural funding since the 1960s and incorporates things like COL. Presumably, scope of research also matters....the fed has been using complicated formulas to reimburse clinical radiation oncology services as well. Lets be cautious. It's easy to figure out who will feel the most pain.
There are many things the fed could do, leverage wise, to make higher education more affordable for students and thus more equitable. Lets see if any of that gets done. This admin is certainly interested in using leverage to make higher education behave culturally in ways commensurate to it's own values.
Do we really think the private sector will more ethically pursue research...do you think Musk has read the Belmont Report?
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🤦♂️
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PP vs academicia acrimony is next level in the specialty of radiation oncology in a way I've never seen in any other specialty. And it's sadly deserved IMHO
You seem like a great guy and professor and you could easily be one of the nicest and most accomplished mentors I had in training if I had to guess identity. I don’t have a good answer for your kindness and generosity. It just seems like the powerful people in rad onc, and let’s face it that equals powerful rad onc chairs mostly, don’t care that much about trainees or the specialty as a whole, at least over the last decade I’ve been in rad onc. I don’t know, maybe the wrong people got promoted way back when. Maybe it’s wrong to cast blame across all academics when it’s a small inner circle making most decisions, but I also don’t want every city’s cancer care to be dominated by an MDA satellite and for every PGY5 graduate to have to kowtow to a small number of decision makers to live in a decent city.
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Literally just posted the same thing before you. Jinx
Have not seen this in heme/onc, gu, ENT, etc
Would be lying if I said I understood it completely, as I am sure I have lucked out in my personal interactions -got smacked around in residency in a traditionally "tough" program, but nothing that left a permanent mark. These days, for the most part, I am lucky enough to get to do my own thing at a mothership, and do enough research/see enough patients that no one bugs me too much. As for PP, my only interactions have been positive
...from reading comments here, I get the sense that there are some deep, personal wounds that go beyond the superficial silliness of the verbose academic twitteratti.
Would just remind the other posters here that most of us in academics are not your former chairs, the ones who scooped your research, or the ones who blamed all of the residents for a bad physics board exam -just nameless, faceless grunts like me, trying to see patients and run a few clinical trials here and there.
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This has been discussed ad nauseam. Big vs little rad onc Simuls monologue, chirag shahs 2013 "bloodbath" editorial in red journal etc
PP didn't expand residencies or engage in hypocritical "choosing wisely " campaigns or make ridiculous direct supervision arguments to CMS, or try to prevent physician ownership of linacs through the Astro pac etc
I'm sure you're aware of all of this. I just haven't seen this kind of thing between academia and PP in other specialties
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I think we can all agree if those 2018 kids just studied more things would have been a lot less confrontational in RadOnc. (ducks tomatoes, just kidding).
That is still one of the worst ways I've heard any leadership handling things.
That is still one of the worst ways I've heard any leadership handling things.
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Honestly, Im surprised that it took so many days for someone to make the academic versus community accusation 🤣
I am sure you just place a high value on fiscal responsibility, and have a specific passion for assuring that cancer research -above all other forms of spending- is conducted with the utmost efficiency. Better a discovery missed than a dollar wasted, right NMS? Perhaps Musk can use your help!🤣
lol, common buddy. This isn't just you having an ax to grind? You can admit it -you're among friends.
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Certainly not re-litigating... and I am well aware that I have been spared the worst of academics and that many in PP were directly hurt by academic policies. Would just reiterate that point made much more eloquently by @communitydoc13: de-prioritizing cancer research does not bode well for either side of the divide.
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If I have to pick between being a noble academic trying to cure cancer or an angry community practitioner with an axe to grind, I guessssss I pick the former. I hope Im not making a mistake.
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Unfortunately, many people who are willing to endure the incessant nonsense of leadership are those least morally equipped to wield its power… this isn’t unique to rad onc, but we are heavily afflicted.
I like my job in academics because I run my own service line, have a couple of clinical trials and -for the most part- get to make my own rules. I know I am incredibly lucky to have this setup and may lose it at any time… and know that far smarter people than me have been chewed up and spit out by my institution
When a leadership opportunity presents itself, I hide under the table. I’ve advanced as far as I need to do what makes me happy. I am not alone … we just aren’t that loud (unless basking in the warmth of anonymity 😎)
Glad I can count you as a noble colleague 🙂
All joking aside, if we cross paths in real life, would love to buy you a drink and hear your perspective
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The rate of fraud/non-reproducibility of biomedical research seems to match the administrative overhead >60%. At what point, do we have consensus that the system needs to be rebuilt. 60,70,80,90% ? Should it be left alone to creep higher.
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I'm sorry that you feel so personally attacked by others on this forum that we can't even have a discussion about this topic without it offending your sensibilities.
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Hesitant to reply as this seems so obviously trollish.
There is no evidence that I am aware of that NIH funded researchers or researchers at large institutions or academic researchers in general are more prone to bad science than any other group of scientists.
Excellent article above. I even suspect that our esteemed academics on this board would probably agree that a couple (1-3) quality publications a year (particularly if doing hard stuff like basic or translational work) is more in line with what a really bright and conscientious scientist should be aiming for than the insane productivity numbers that have become standard in some fields...again, not relatable to NIH infrastructure funding.
Pressure to publish, secondary gain and conflicts of interest all seem to influence scientists. Pressure to publish is probably the biggest culprit regarding fraudulent and poor-quality publication IMO. I don't see any of this being relatable to NIH infrastructure funding. Of course, industry scientists (who have done fabulous work over the years) are often associated with blatant cover-ups and sequestration of important data for public health when it is incompatible with corporate goals.
Maybe securely employed federal scientists with limited opportunity to cash in on intellectual property, reduced pressure to publish and very low COI are the best practitioners of science, or at least the most reliable?
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Too much to address briefly but one thing worth mentioning is journal policies play a huge role in addressing non-reproducibility. Pre-clinical cancer models are inherently unstable. You can't and shouldn't do something once in a single model and publish the results. Most quality journals now require showing something novel in 3-5 lines in vitro and 2+ in vivo to publish.
And many academic centers (in the US at least) are trying to de-incentivize publishing in junk journals by having impact factor cutoffs for promotion. Publishing somewhere with an impact factor less than 2.5-3 does you no good at a growing number of centers.
I'm sorry that you feel so personally attacked by others on this forum that we can't even have a discussion about this topic without it offending your sensibilities.
lol personally attacked? you don't know who I am, so why would I feel personally attacked?
The lady doth protest too much, methinks.
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AI is coming hard for these types of human misbehavior, AI's current version is actually a great fit to weed out publishing fraud
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Nothing says intelligence like blanket cuts at large entities by managers who have yet to understand what they do.
The new administration in a few days is aware of all USAID or NIH does to the point they are comfortable drastically reducing expenditures and staff? And this is being defended, through the microcosm of the overhead system?
The NIH cuts will significantly impact research funding, staffing, cancer center budgets, research, and academic employment at levels far beyond but still directly impacting our field. It’s not a good change for patients, science, or us.
The new administration in a few days is aware of all USAID or NIH does to the point they are comfortable drastically reducing expenditures and staff? And this is being defended, through the microcosm of the overhead system?
The NIH cuts will significantly impact research funding, staffing, cancer center budgets, research, and academic employment at levels far beyond but still directly impacting our field. It’s not a good change for patients, science, or us.
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I sure hope they don't cut the budget for more proton research. I heard Duke was gonna treat arthritis with protons. It's just common sense to do so.
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it is my understanding that there is a cap on overhead% not cuts to the grants. Maybe 15% is too low, but the system is in need of reform. Universities have become hedge funds w/nonsensical endowments. Cambrigdge and Oxford have endowments of around 2 bill vs 50 for Harvard.
A cut to facilites and administration fees (aka "overhead") is functionally a cut to research - those costs - particularly the facilites will be passed onto the "direct" budget - thus our $ won't go as far and for any given grant we will be able to do less work.
I think it is worth noting that the "standard" NIH grant amount for an R01 (the majority of grants) hasn't changed in 25 years (250K/yr). You can request more, but only up to 500K/yr. Meanwhile we have tried our best to keep salaries of research staff increasing at the rate of inflation. It's not hard to see this leaves less $ for everything else... In our group, i estimate costs of supplies has nearly doubled in the last 7 years. Those are not going down.
Regarding endowments - universities are often limited in how they can spend these funds. They can't be drawn down, they often can't be used for facilities. Major donors often have the right to recoup their donation if it is no longer being directed in the way they intended. so while the amounts seem huge, and at many places they are, the ability to use these to pay for F&A is somewhat limited.
I'm all for supporting research, but the fact we are supposed to allow the universities to say "we have a ton of money in our endowment but can't spend it" is complete nonsense. Rules about endowments weren't etched in stone via lightning from The Heavens.
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I don't agree with Ricky or Prasad all of the time. But let's talk about this stuff. The rate of non-reproducibility is way too high. Hiding data points can make the difference between a big thumbs up or not. The rates of fraud are way too high, bar none, for everyone. A lot of countries have issues with research, not just the US. Even if it's not just complete "fraud", there are huge issues in research.
A personal story:
In my early college days trying to do research there would be times I was asked to try to replicate an assay by reading through some published articles and finding whats necessary within the lab I was in (while fumbling through different technologies and chemicals), because I did chemistry and physics. This should be easy for me (?). Following protocols and things not working out, little guidance (maybe a "lets see what (s)he can do" type thing?). But I was trying to do the protocol with what may have been at best truncated or at worst, something that just didn't work. Or maybe I'm just not very good at basic research. Frustrating right?
Now a friend of mine joins a lab, gets put on a few publications just because, "I don't know why, they're putting me on it though..".
If we stop there and submit applications, my friend will automatically be seen as better than me. I am washed, a failure. This doesn't even have to do with the complete fraud that happens, just how terrible the research meritocracy actually is in this country. Publish to publish, put people on the publications who did nothing.
Most of the time research is more about who you know than how good or smart you are.
Another anecdote: I know more MDs that fell into research as residents that got labs than I do MDPhDs that got labs.
A personal story:
In my early college days trying to do research there would be times I was asked to try to replicate an assay by reading through some published articles and finding whats necessary within the lab I was in (while fumbling through different technologies and chemicals), because I did chemistry and physics. This should be easy for me (?). Following protocols and things not working out, little guidance (maybe a "lets see what (s)he can do" type thing?). But I was trying to do the protocol with what may have been at best truncated or at worst, something that just didn't work. Or maybe I'm just not very good at basic research. Frustrating right?
Now a friend of mine joins a lab, gets put on a few publications just because, "I don't know why, they're putting me on it though..".
If we stop there and submit applications, my friend will automatically be seen as better than me. I am washed, a failure. This doesn't even have to do with the complete fraud that happens, just how terrible the research meritocracy actually is in this country. Publish to publish, put people on the publications who did nothing.
Most of the time research is more about who you know than how good or smart you are.
Another anecdote: I know more MDs that fell into research as residents that got labs than I do MDPhDs that got labs.
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Easy answer: set significance levels to 0.005 instead of 0.05, and reproducibility would go up… significantly.
Publish or perish sucks… and probably does lead to some bad science.
The more senior I get, the easier publishing gets. I am now frequently included “just because” -usually for legit reasons (data gathered from my patients, or needed my opinion on XRT section, or I put a bunch of patients on a trial)… but a few years ago, when I was junior faculty, trying like hell to get a few more pubs for promotion, nothing came easy. Publication opportunities are wasted on the folks who don’t need them, and those who do can get desperate
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Id argue the present system seems to be working. Prasads tweet has more to do with fixing human nature than the nih.
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I'm personally not that impressed with Prasad's thinking. Admittedly, I am uniformly skeptical of anyone who builds a personal brand on contrarianism. It's not that a contrarian won't be right some of the time, it's that they will almost uniformly be wrong most of the time as only contrarian positions feed their brand. In this way, a professional contrarian typically corners themselves into bad thinking.
This is different than the person who occasionally takes an unpopular opinion.
We have an entire cohort of popular contrarians getting confirmed to top governmental positions in the health sector. It will be interesting.
Reform should be a constant process. I have no doubt NIH could do better...also, it has done amazingly well. Not sure if there is even another entity globally that is appropriate for comparison? Please let me know if there is such an entity and if there is a published comparison regarding value/fraud etc.
It is not clear to me that the NIH is engendering bad science more than any other funding/governmental agency. Please let me know if there is evidence to this. Is Prasad really saying that the NIH needs reform or is he saying that contemporary science over all needs reform?
I suspect that the percentage of fraudulent or at least sloppy publications actually goes up with intense competitiveness (meritocracy). It is also true IMO that science is in fact suffering from an "excess" of meritocracy.
It wasn't always this way, and in our country this excess has to some degree been built on demography, immigration, and an emphasis of growth within scientific fields without a commensurate growth of mature career opportunities or funding. The result is an insane pressure to publish early and often for young scientists, with a much smaller cadre of mature scientists accumulating enormous publication lists without doing much of the work.
Please look at the CVs of some of the most esteemed scientists aged 70 or older. Many of them will have had only a few publications (1-3) from graduate school and a modest number of important publications early in their post-graduate career. They often spent the greater part of a decade building working on a particular problem. In this way, they were able to get deep and meaningful work done.
In our own field, I remember the insane pressure to publish as a resident in the early 2010s. Meanwhile, chairs often had 0-1 publications during residency (which is actually fine). The publication becomes a false currency.
Yeah... I already wrote the above screed...you nailed it in one sentence.
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Hear me out on this spitball. Maybe delete this later:
Do we diminish our field by focusing on research early? By making it such a huge part of our field that it is a year of our training (unneeded, but I digress).
(In competitive years) We force the smartest people who don't want do be researchers (maybe not even radoncs) into gaming the system to try to show they are researchers.
Introducing an overly competitive group into a habitat that requires people to just be super nerdy and love the specific topics.
Ultimately these very smart people end up out competing others because of a competitive nature, not because of true love of the field.
They end up going into the type of career they want to go into, private, community, california, new york, or maybe a few of them take that one science focused job in the middle of America.
We stifle the number of people that would actually provide benefit to the field through sheer interest in the field, by weeding them out from predators looking for a cush over paid field.
tl;dr Ralph was right @medgator
Do we diminish our field by focusing on research early? By making it such a huge part of our field that it is a year of our training (unneeded, but I digress).
(In competitive years) We force the smartest people who don't want do be researchers (maybe not even radoncs) into gaming the system to try to show they are researchers.
Introducing an overly competitive group into a habitat that requires people to just be super nerdy and love the specific topics.
Ultimately these very smart people end up out competing others because of a competitive nature, not because of true love of the field.
They end up going into the type of career they want to go into, private, community, california, new york, or maybe a few of them take that one science focused job in the middle of America.
We stifle the number of people that would actually provide benefit to the field through sheer interest in the field, by weeding them out from predators looking for a cush over paid field.
tl;dr Ralph was right @medgator
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I agree...that happened
The last time a deep dive was done, at least that I'm aware of, rad onc represented 1.6% of NIH cancer research funding. Doubt it has changed much since then. Deep bench fighting over scraps. And from what I understand the RTB study section is brutal.
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This is only somewhat related, but am I the only one who thinks making USMLE step 1 P/F May end up being a bad thing for people going into competitive fields? I get it, the pressure sucked but at least it put emphasis on something you had to do. Now folks still have to study for it to pass AND engage in something else just to stand out. I suspect that something else will more often than not end up being research they only kinda care about. This feels like a well intended idea that will end up creating more work for a lot of folks in my opinion.
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Love this type of information, would love if someone could do it again over years?
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RTB gets a worse rep than they deserve. All study sections have turn over and they have had some pretty tough groups, but it’s not unique to them. I will say, I had a good friend get a 13th percentile on their last A1 only to have their next submission get triaged. It’s hard to not feel like something is broken when you see that kind of thing happen.
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I do think that, but at this point I don't think there is a reason for it, at least for RadOnc. I am convinced (read: suspicious) that there are strong forces in some big academic centers and collaborative community docs that want to kill the field. Some of them are here.
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Nothing I said applies to rad onc anymore. At this point, our something else is limiting your wrap sheet to misdemeanors or not getting caught forging recommendation letters for your application.
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The alternative is a field from the 70-90s that no one cared to go into and matched from the bottom of classes
Not sure either option really helps patients or the specialty
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This is hardly a deep dive but according to NIH RePORTER, there are currently 4,553 active NCI R01s, of which 147 originated from RTB. This isn't a dollar-for-dollar accounting but this suggests 3% to me.
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