The new NIH wish list

I just returned from the NIH where I was invited to lecture on translating science into therapies. I had presented my science there before and I was not quite sure how interesting they might find my broader perspective, which I had entitled: “The long course from ‘the Aha!’ to cures: can we do better – together?“

The standing room only audience provided a first clue that emphasis is evolving at the NIH… During the Q&A and in talking individually to several people, I could sense their intense interest and excitement regarding the many challenges – and opportunities – created by the translation of basic science into positive health outcomes. Several independently pointed out that Francis Collins, M.D., Ph.D., took no break from being confirmed to making his first appearance as the new NIH chief where he announced what he hoped to accomplish during his term. The overall underlying message was clear: no time to spare!

For those relying mainly on the funding that comes from the NIH to carry on science, it is very important to understand what the change at the NIH helm might mean for its future directions and priorities to increase chances of successful funding. In the bigger picture, all of us will be affected as the NIH-sponsored research is a major – if not the major – source for the new ideas that become one day life saving treatments. I dare to say that the success of these ideas is in no small measure due to the fact that the NIH, throughout various administrations (maybe in spite of?), has been one of the original and perennial implementers of innovation models, yet not even themselves might think of it that way. For instance, the NIH has a signature initiative called an “RFA” (requests for applications), where they invite independent researchers to submit proposals related to specific scientific and health questions, and they fund the winners. Isn’t this a classic case of “crowd-sourcing”, implemented way before the term was coined? The NIH also has an “RFP” (request for proposals) mechanism by which they contract projects with the various independent winners and create the network needed to sustain the project – isn’t that what is called elsewhere “out-sourcing” and “open innovation”?

I could not find a script of Collins’ speech, but I watched it for you! Here is a short run down of what he announced as his top 5 priorities for the NIH during his term:

1. Apply new high throughput (“comprehensive”) technologies (e.g., nanotechnologies, genome wide-scans, proteomics) to understand fundamental biology questions as well as causes for different diseases.
2. Emphasize translation of basic sciences into treatments, making “discoveries amenable for public benefit”
3. Put science to work for the benefit of the heath care reform: “inform the conversation based on scientific evidence not on prejudice” by performing comparative effectiveness studies (e.g., study effect of life style changes vs. therapies for treatment of diabetes)
4. Put greater focus on global health, including AIDS, malaria, tuberculosis and other major diseases in developing countries, by working with them in research and helping them develop their own capabilities
5. Reinvigorate the biomedical research enterprise by making sure that funds are available to support younger investigators, increase work force diversity, encourage risk taking and innovation.  

I for one, cannot but applaud and embrace all these goals. Even as an academic researcher, I have always sought to “begin with the end in mind”, or how I like to refer to it “going back to the future”. In my case, this means starting with examining the real life case (the patient) to formulate the questions to take back to the lab for study in detail, increasing the chance that the answers from our research would be used to alter for the better the patient’s health in future…

Some of the more hard core basic researchers might not entirely feel comfortable with the emphasis on translation. I agree that there is a fundamental need for fundamental research: the pursuit of questions that are so “out there” that no one can really tell where they might lead us or what they might connect with. Yet, after putting a lot of bright dots on… the blue sky, some need to concentrate on seeing patterns and be able to connect them, yet others will need to start figuring out how we might touch upon the new dots and patterns. I see the issue of translating science not as an imposition on fundamental research, but as an invitation to an open intellectual dialogue between basic, applied and clinical scientists, as well as product developers, regulators, and the public, where all can contribute with their own proficiency: the “constructive interference” effect. It is still not easy most of the times, as many places still operate based on narrow definitions of expertise and make make others feel as strangers in a stranger land. Thus, making scientific innovation happen for the benefit of humankind will require skilled, open-minded, and maybe fearless translators who can make sense of various intellectual languages and lands…

Here is a list of related links:

Francis Collins, M.D., Ph.D., inaugural address to the NIH

About Translational research

The NIH Overview

In Wikipedia

Nature Medicine: In the land of the monolingual

NIH Funding opportunities for translational research

NIH-RAID (Rapid Access to Interventional Development 

NIH Translational research meetings

The NIH Roadmap

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Out of the box choices and the educational journey

Our educational journeys, when and where (in its most general sense) did we start them and where through these have taken us, have a lot to do with “where we are coming from” (i.e., our current perspective and approach to things). Multiple personal and cultural anthropological factors influence our formation as individuals. To keep on my previous post’s train of thought, I will refer specifically to issue regarding the exam type choices.

My own early educational experiences (I was initially trained as a physicist) did not include multiple choice questions exams. Quite frankly, it was probably the main factor that allowed me to survive the rather arduous process to emerge with scientific credentials. I became familiar with the multiple choice exams afterward during my North American education in the life sciences and medicine. As I concentrated on unraveling the intricacies of the human body I thought  the years I had spent resolving differential equations modeling inanimate matter behavior might have been a huge waste. Yet, I finally realized the real value of a training gained through examinations of abilities based on a combination of writing essay, solving new problems, and oral (“free style”) exams, requiring us to understand fundamental principles and to use them to continuously deduct or construct solutions on the spot. These had armed us with a system for thinking through any kind of problem. We also had to develop the ability to clearly (and efficiently) explain in words our thinking process and interact live with our examiners, which further encourages (forces?) cultivation of our creative side. I now credit my initial training for the ease of doing well later on my multiple choice tests. On the other hand, I am pretty convinced that, personally, I would have had trouble passing as successfully through a reversed sequence of exam styles.

One instance when the realization of the likely impact of differences in educational and selection systems finally struck home not too long ago. While attending a professional session aimed at assessing personality profiles, I turned out to be the only “creative” out of a group of 20+ scientifically trained people. The most surprising to me was my colleagues’ reaction: “How can you possibly be creative? You are a scientist!” (?!?) Furthermore, corporate HR guidelines recommend that people with my profile work in the sales or marketing divisions rather than in R&D. One cannot but wonder: are the current education and selection systems working to most efficiently filter out all the creatives from the scientific and technical fields?!? Likely! Furthermore, is the common work environment placing people into boxes, force fitting or even rejecting the ones who are different or refuse to fill predefined boxes? Would this be expected to have an impact on our overall ability to innovate? I would love to hear other opinions…

My hypothesis, that not only the field of education but also the place of education plays an important role in our predisposition to innovation, has been confirmed by many conversations with other foreign-trained individuals. Besides the many obvious ethnical differences that influence our formation in general, many of the foreign-trained individuals are the product of different educational systems where the multiple choice selection does not reign supreme, thus were not filtered out tightly by its use. Other differences are likely to put their mark. For instance, individuals might have also been trained to think more broadly.

Times also put their mark on the issue. The younger generations, currently using mostly keyboards to communicate, are likely to erode the domination of either side, allowing an increased use of both sides of our brains: the end of the lopsided – or maybe lobe-sided – “left brain-right hand” era”? We all, regardless of age, are increasingly using new learning, communication, and cooperation channels, a phenomenon which I think is majorly responsible for the definite surge in the interest toward understanding global issues and wide open cooperation. Take for instance the “crowd-sourcing” phenomenon, which allows a wide variety of people to jump at the chance to solve problems, including some that normally would not be presented to them, because they do not have the credentials normally qualifying them as “specialists”. Due to the broad availability of knowledge on the Internet, what one needs to be able to do is not to remember information, but be able to use it in a constructive way. Technically speaking, the only relevant product of the educational system should be developing reasoning skills and knowledge management skills, finally releasing us from our current hang-up on possessing factual domain knowledge, and the definition of ability based on narrowly classified specialties or specific degrees. We could then step into the brave new era of creative problem solving.

 

Addendum. As I was writing this entry, the following joke was landing into my e-mail box… (seemed to hit too close to let it drop).

“During a physics lecture to the pre-med class, the professor was explaining a particularly complicated concept. A student interrupted him:

‘Why do we have to learn this physics stuff?’

The professor responded: ‘To save lives!’ and he continued his lecture.

After just a few moments the student interrupted again. ‘So how does physics save lives?’

The professor intently stared at the student. After a long silence, he said: ‘Physics saves lives because it prevents certain people from getting into the medical school.'”

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Embracing a well-meaning stranger – The case for the alter-specialist

We all probably have recollections of this kind of movie snippets: a dark saloon or tavern filled with smoke and locals. Doors open, enter the stranger. The silence and tension that follows can be cut with a knife… everybody is reaching for their gun… In contrast, in his book The Medici Effect, Johansson describes the convivial atmosphere in a tavern at the intersection of waterways bringing travelers from all over the world. They all share a common thing, they are all “strangers” eager to learn from the others’ and reveal their own diverse knowledge about new ways of doing things in distant lands. This reciprocal mental stimulation works as a great idea exchange. New ideas are afterward disseminated for implementation in faraway places.  What is different in the two settings and how do these examples relate to innovation?  

While there is a lot of current agreement that large, diverse groups are innovative, I did not find much said about the “stranger in a strange land” situation in relation to innovation. Maybe less striking, but equally disengaging can be an attempt to venture into unfamiliar intellectual territory, an area outside the boundaries for which one can offer widely accepted educational or professional credentials. This is especially hard when the person is a “lone stranger” facing a homogenous congregation, which shares an unlike professional past, or even just a different way of thinking. For instance, a previously well-recognized and respected expert can expect to receive mockery or total dismissal when offering an opinion in a gathering of specialists trained in a different discipline. Some of these “strangers” may be enthusiastic but inexperienced, yet others might be already recognized specialists in another field or corporation making a dramatic mid or late career change to join a long-established group. Their fresh perspectives are likely to be greeted with similar unwelcoming receptions. No wonder many people prefer to avoid stepping out of their comfort zone and they refrain from offering fresh perspectives.

What do we, the “natives”, stand to lose by not welcoming inputs from neophytes, is there a benefit to listening to someone who “does not have a clue”? Many!!! People who had different training and different experiences did not have a chance to learn about the “accepted” rules, hence they do not have preconceived ideas of what’s “right” or why “this would never work”. These people stun the domain experts by asking the question which we should all ask all the time: “Why not?!?”  Personally I like to call these people “fearless” and feel they deserve the kind of respect pioneers get.

My high opinion has been forged during the many years in which I have had the good fortune to work with bright people who were novices and/or came from very different backgrounds. Particularly fascinating for me was working with young engineers when tackling life science/medical problems (see article). These were obviously smart, well-educated people, but many could not even remember if they actually took biology back during high school, much like the saying: “engineers speak Greek, doctors speak Latin”. Yet, when presented with the request to solve a life science or medical problem, engineers turned in the most innovative solutions by applying their own style of thinking and tools (e.g., models and calculations using… yes, Greek symbols!), and by interjecting into the solution their previous, supposedly unrelated, knowledge. Efforts to engage engineers in medical innovation have been springing up everywhere, one I recently witnessed was The Ohio State Innaugural Engineering and Medicine Translational Symposium.

I decided it may be fitting to call someone an “alter-specialist”, as in the other specialist, while s/he engages in solving a problem normally considered outside her/his area of training/expertise. The alter-specialist did not have the chance to chose sides in following a camp of thought or another in the area of the problem (as the great majority of specialists trained in that field), thus can maintain an objective attitude toward facts found to relate to the problem’s subject matter. Furthermore, the alter-specialist has the capacity to access knowledge and processes that would not be applied to the problem at hand by the domain specialist. As soon as I had reassured them that it was not only completely safe, but actually preferable for them to do so, my young engineer collaborators would challenge my assumptions everyday. I also discovered it was important to immediately preface my interactions with the firm statement that there was “no such thing as a stupid question”, i.e., if a question can be formulated, then it just cannot be stupid ( as in “cogito, ergo sum”!).

The environment offered to the alter-specialist(s) is an essential feature enabling innovative problem solving. From problem formulation, to being able to guide the alter-specialists without imposing preconceived rules and ideas, with a constant attention to the mind-openness allowing to entertain what a domain expert could easily consider outlandish suggestions.

Importantly, I found many evidences that the apparently amazing success of the alter-specialist in providing innovative solutions is a reproducible event. For instance, I was pleased to read the data emerging from analyzing the success stories of the Innocentive platform.  Dr. Lakhani, who conducted the study, was cited by the New York Times to say that: “the further the problem was from the solver’s expertise, the more likely they were to solve it.”  A fine example of constructive interference! One could conclude that the alter-specialists were able to solve these though problems by using alternative approaches, naturally sheltered from the potential scrutiny of the domain specialist while working solo until the solution was crafted. More and more web based platforms seek to harness the power of “crowd-sourcing” for innovative problem solving and design.

Clearly, breakthrough innovation is generated by “strangers” willing to dive into solving somebody else’s problems. This, of course challenges the status quo in many ways, including how we normally accept input or recognize potential capabilities, the widely spread practice of recruiting people based on narrowly defined and accepted credentials, and is in turn calling for the innovation of such cookie-cutter worn-out processes.

Please DO interfere!

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