The changing health care landscape, accelerated by the Affordable Care Act, has signaled a move of the federal government, as well as private insurers, from fee-for-service to value-based reimbursements. To ramp up for this change, academic health centers are creating larger, integrated care delivery systems through mergers and acquisitions of hospitals, physician practices, and potentially of digital health companies. Continue reading Health Care Mergers and Acquisitions: A Promising New Environment for Medical Research?
Reproducibility has emerged as a touchstone controversy within the scientific community, the public and the Congress over the past few years. In the wake of recent reports and headlines, science has come under intense scrutiny. But revelations about failure to reproduce experiments, alone, should not shake our trust in the legitimacy of the medical research enterprise. In fact, the attention may be a good thing. As scientists, we understand the complexities of science, but understanding among ourselves will not reassure the public and Congress. If we truly want to engender the public trust and enhance our own learning, let’s welcome this opportunity to address limitations and uncertainties and improve our processes and communication in science rather than overlooking, ignoring, suppressing or railing against the topic.
The term itself, “reproducibility,” can provoke an array of reactions – from immediate confidence (the results were reproducible and so are credible!) – to consideration of the context of the results (differences due to biological variables and applicability of the model, e.g. Were the results obtained in male humans, animals, and cells not generalizable to female species? Was the animal model simply not applicable to humans? Are there discrete differences in the population studied that masked important differences?) – to unfortunate misperceptions (science is fickle. The results must be fraudulent).
Perceptions in the public and in Congress shape policies. To that end, the NIH has just taken a big step toward ensuring reproducibility by increasing the requirements for rigor and transparency in the research that it funds.
At the 2015 GREAT Group and GRAND Professional Development Meeting, prior to the release of the new policy, NIH principal deputy director, Larry Tabak described the NIH’s proposed solutions within the policies to enhance reproducibility: 1) being accountable for adequately describing the methods or materials; 2) noting limitations in the study design; 3) considering all relevant biological variables in the scope of the research (the NIH specifically called out that sex is a biological variable and focusing studies on male animals and cells may obscure the importance of sex on biological processes and responses to interventions); 4) authenticating key biological and chemical resources; and 5) bearing in mind implicit biases in how the results are interpreted or disseminated. Thankfully, from the evidence available, fraud or misrepresentation of findings accounts for only a small percentage of the problems identified, and the scientific community and federal sponsors have effective means to address misconduct.
Navigating the reproducibility rapids goes beyond this policy. There are additional steps the entire research community can take to advance rigor and transparency; and that is by promoting and sharing negative findings as a rule. Beyond enhancing a sense of openness, there may be vital scientific knowledge residing in those negative findings – a legitimate source of “irreproducibility” that could help dissect when and for whom certain interventions may be promising and when and for whom they may not. And, isn’t that a clear signpost for building public trust?
This will take all of us. Sharing data (both negative and positive) would need to be a consideration in merits and promotions, welcomed for publication in respected journals, and established in trusted infrastructures and venues where data sharing is not a prohibitive time and resource burden for the scientists who do the work, or a concern for not protecting privacy in human studies.
In the end, navigating the reproducibility rapids may lead us not only to public confidence and supportive policies, but also to a “learning research system.”
This post originally appeared on aamc.org
Ann Bonham, PhD, is chief scientific officer at the Association of American Medical Colleges. She can be reached at firstname.lastname@example.org.
By Ann Bonham, PhD
As Congress heads into summer recess, we will continue to see some heady days for medical research. The 21st Century Cures Act has provided a light at the end of a long tunnel of stagnant growth in NIH funding. While not a miracle “cure,” the bill is a good start to reversing the trend of stagnant federal support for medical research — setting aside $1.75 billion a year, for five years, for an NIH innovation fund. (See bill’s text here.) Continue reading Investing in Medical Research: Resource-Intensive, Long-Term, and Worth It
By Samantha Ngooi, MPP, and Vineet Arora, MD, MAPP
When we got an NIH grant last year to ascertain how teens could get their peers interested in research careers, we did not anticipate turning to Jimmy Kimmel for inspiration.
Kimmel’s “Lie Witness News” segment is notorious for asking unsuspecting pedestrians to share their opinions about ridiculous topics from a new “scented” iPhone to the “appointment” of Judge Judy to the U.S. Supreme Court. While the interviews are purely for amusement, at times they reveal an embarrassing lack of knowledge among members of the public, adding weight to the saying, “Don’t ask questions you don’t really want the answer to.” Continue reading Making Research Careers Sound Cool, Jimmy Kimmel-Style
By Ann C. Bonham, PhD and Diana Lautenberger, MA
The recent Science article on stereotypes about innate genius and the impact it has for women in science fields is the latest in a series of discouraging reports. It brings to mind the 2012 Yale study published in PNAS, which concluded that both male and female scientists regard female undergraduates as less competent than male students with the same accomplishments and skills. Why are we still grappling with the differential assignment of competence by gender? What will it take to upend the stereotypes about the capacities of women that remain in our cultural subconscious? It’s not that women don’t have an innate talent for science: Women working on important discoveries challenge this notion every day. One answer may be that our cultural blinders inhibit us from seeing women as authorities, and this lack of visibility for women in science fields perpetuates a cycle of cultural stereotypes.
By Jennifer Kesselheim, MD, MEd & Ayres Heller, MEd
One of the most exciting developments in medical education happened last summer when the Institute of Medicine (IOM) released a new report, “Graduate Medical Education That Meets the Nation’s Health Needs.” The report was requested in 2012 by the Josiah Macy Jr. Foundation and supported by 11 other private foundations as well as 11 United States Senators. The Report Brief outlines the IOM’s intriguing conclusions about the governance and financing of Graduate Medical Education (GME). The recommendations highlight the immense need for innovation in the way Graduate Medical Education is structured, distributed, designed, and implemented. The report suggests that a portion of the Medicare GME fund be designated as a “Transformation Fund,” intended to finance innovation and experimentation in GME.
By Rachel K. Wolfson, MD, and Vineet M. Arora, MD, MAPP
When we were in medical school, medical students could opt to participate in traditional research at some point, generally the summer between the first two years of medical school, or during the fourth year. There were no required scholarly projects, semi-annual progress reports, or specific concentrations or tracks for students to choose. Some of our classmates took an extra year to do research, but there was no year-off forum, quarterly newsletter announcing student dissemination of scholarly work, or faculty with protected time to promote student research.
Times have changed. We co-direct the University of Chicago Pritzker School of Medicine Scholarship and Discovery program, in which students can pursue scholarly work in a broad array of areas, including non-traditional research such as global health, medical education, community health, and quality and safety. We are not alone…
By Michael J. Friedlander, PhD
The article in the most recent issue of the AAMC’s Analysis in Brief, “Interprofessional Educational Opportunities and Medical Students’ Understanding of the Collaborative Care of Patients,” by Drs. Grbic, Caulfield, and Matthew, provides an interesting and informative look at interprofessional education for medical students interacting with many health professions.