Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
APPENDIX D 50 to create this talent pool of behavioral and biomedical scientists. As we noted, postdoctoral support may be more applicable in more biomedically oriented subdisciplines, such as psychobiology and neuroscience, than in other areas such as developmental or social psychology. Moreover, it may be a very good use of resources to consider postdoctoral support for minorities as well. We recently added a postdoctoral component to our APA Neuroscience program and had 30 applicants from which to choose 6 postdoctoral recipients. In advertising opportunities for the Minority Research Supplements programs, there were many respondents who expressed interest in advancing their research skills and specific techniques at the postdoctoral level. It seems that the promise of the minority supplements as a training opportunity, is not fully realized. It is our belief that research careers in biomedical and behavioral science fields should show growth over the next decade, and the most important role of NRSA is to provide leadership and vision in providing training support to meet the supply of well trained and diverse scientists that are and will be needed. To this end, we feel that pipeline is probably the single most important issue to be addressed. We also recognize that the earlier you introduce programs, the less efficient they become in producing Ph.D.s at the other end. That is why a carefully balanced, efficient program is desirable. Perhaps the plans for evaluations of these programs will prove helpful in charting a reasonable course of action. Psychology has an important role to play in defining the needs and opportunities for training in the various fields of psychology. It has to take responsibility for increasing the rate with which new graduate students seek primarily research careers as well. Given the massive decline in predoctoral training support over the past decade, we feel that substantial assistance is needed to provide the funding base to support these efforts. We feel that training in psychological research is important and look forward to helping in any way we can. STATEMENT BY HOMAYOUN KAZEMI, M.D. I am Homayoun Kazemi, a Professor of Medicine at Harvard Medical School and Chief of the Pulmonary and Critical Care Unit at the Massachusetts General Hospital. I have directed a research training program in pulmonary pathophysiology for the past twenty five years. I very much appreciate the opportunity to present my views on the subject of the need for biomedical research personnel. Let me begin by stating that I am cognizant of the fact that biomedical research and medicine at large are undergoing major changes at the moment, and future trends in health care delivery and medical research are somewhat uncertain. However, regardless of the uncertainty, one thing that has been preeminent in American medical science has been the important contributions made to medicine at large by biomedical investigation. This has taken place primarily in medical schools and teaching hospitals and has through the years provided the basis for the excellence of medicine that is available in this country and, furthermore, underlies the prominence of American biomedical research in the world. This enterprise is now being threatened because of policies that bear directly on training of individuals in biomedical sciences, particularly those with an M.D. degree who enter research from a clinical perspective. If one were to point to major discoveries in medicine in the past five to six decades, one thing stands out: most discoveries were made at the time that the specific issue was not being investigated in the given laboratory, but came about by serendipity. It is the prepared mind that seizes the moment and, therefore, it is in this light that we need to address the necessity to continue to have a strong biomedical research community and to allow investigators to follow their lines of thought without being encumbered by too many restrictions in their research. To achieve our goals, it is important to have a continuing supply of young, energetic, and dedicated investigators who enter biomedical research for the rewards of discovery and for the contributions it makes to health care at large and to scholarship. Having interviewed a number of applicants to medical school, to residency programs, and to our fellowship training program, I am impressed by the caliber of individuals who are electing to go into biomedical research. They are an extremely dedicated group of individuals of high intellectual achievement and integrity who will inevitably contribute to the advancement of medicine. In order to continue to draw this pool of individuals into biomedical research and at the same time allow them enough latitude to pursue their research and also be adequately compensated financially, a number of issues need to be addressed. If we accept the premise that biomedical research is essential for the well-being of our medical system and
APPENDIX D 51 necessary the for advancement of knowledge, then the following suggestions seem relevant. 1. The most significant challenge that we face today in the United States for maintaining an adequate supply of qualified scientists relates to appropriate long-term funding. It is very discouraging for young investigators to realize that stable funding is hard to come by, the struggle for it is enormous and the rewards are relatively modest. It is essential for the nation to establish a stable biomedical research support system and training and not have it fluctuate from year to year. It is important to pay individuals entering biomedical research at levels that are commensurate with the cost of living and that their incomes compare favorably with incomes of those in the same age group who go into law or business. Research training takes anywhere from two to five years as a fellow. During that time, the message that the leaders have to impart to the trainees is that the future is bright, that discovery is rewarding in itself and that their work will be appreciated by the community at large. However, in this setting, we need to be cognizant of the financial needs of these individuals and their financial security. This is particularly true for those with an M.D. degree who finish medical school with significant debt and who do not look at biomedical research as an avenue where they can generate adequate funds to take care of their families as well as their debts. For example, at Harvard Medical School in the graduating class of 1992 last year, there were 107 students out of a total of 160 that had a mean debt of $51,438. Some 57 students were in debt in excess of $50,000 and 8 had debts of over $90,000. I believe we should pay them more and we should establish policies that allow better long-term funding than has been the case at the NIH in the past decade. If we do not do this, then we will lose the scientific primacy of the United States, and in the long run, our biomedical research endeavor will become totally commercialized, and science for the sake of science will no longer be performed by anyone. 2. As far as the National Research Service Awards (NRSA) are concerned, adequate pay for the young investigator is a major factor, particularly those with the M.D. degree who enter research careers, because of the debt that many of these individuals have. The current application for NRSA support as well as for research grant support is cumbersome; it occupies a great deal of time, and in many instances repeated applications are necessary before funding takes place. These are all discouraging for the young investigator. The peer review system has served a useful function through the years, but one wonders whether it continues to be as effective now as it has been in the past and whether more senior investigators should not be picked on the basis of their scientific achievements in the past and given a certain amount of financial support where they can continue with their work but also directly help with training of new investigators. 3. Recruiting women and minorities into scientific careers is of high priority, and NIH has taken steps to help. For it to work, minorities need to be introduced to science early. It is essential to strengthen and expand research training programs for college and high school students, to bring the students into research laboratories for a few months at a time to appreciate what biomedical research is, and then encourage their careers in sciences in college and medical school. The NRSA program could offer specific training to predoctoral students not only at the medical school level but also at the college and high school level, and thus increase the pool of minority candidates. One of the major drawbacks in not being able to bring investigators from minority groups into biomedical sciences is the lack of role models. Basically, we need better role models, more of them, and more money specifically put aside for the purpose of training women and minorities in biomedical sciences. 4. The NRSA training programs have by and large achieved their goals. For the training programs in clinical subspecialties, however, the problem that has arisen is that, on one side of the equation, the various specialty boards are requiring more and more time in clinical subspecialty training and documentation of specific technical expertise. At the same time the research training grants are suggesting that no clinical training be performed during research time. This inevitably creates conflicts for all programs. I believe it would be useful for the government to accept the fact that we need a number of sub-specialists who have both clinical expertise and research training, and that the two are complementary and not contradictory. The current guidelines from the NIH on NRSA programs and those put forth by the various subspecialty boards are in direct conflict. This causes a great deal of confusion amongst applicants and program directors.
