In a thought-provoking JAMA commentary out today, Stanford’s John Ioannidis, MD, DSc, and two colleagues call for biomedical researchers — and funding institutions — to “sunset underperforming initiatives.” Nothing controversial there, until you go on to read that some of those initiatives are in the popular fields of gene therapy, stem cell therapy or precision medicine. And, they write, perhaps some less-successful projects have been pursued simply because they fall within a top research field.
None of these popular topics has had any measurable effect on population mortality, morbidity, or life expectancy in the United States. The improvements of the past decades in these outcomes, which have been substantial but are now stalling, have largely reflected improvement in nonmedical aspects of everyday life and the operation of broad-based public health and classic prevention efforts, such as curtailing smoking, that are undervalued as outmoded and old-fashioned by the narrative.
The answer, they write, is to consider funding unconventional ideas that don’t fit neatly into current research trends. For preclinical work, standards should be tightened to ensure the projects have a “public health benefit.” The National Institutes of Health should change how it decides which projects to fund, they write:
Criteria such as number of publications, citations, prizes, and recognition are irrelevant as these are simply self-rewarding artifacts of the system. After several decades of substantial investment, the fundamental question is whether these big ideas have improved quality of life and life expectancy, by how much, for how many, and for whom. These are public dollars that should benefit the many, not the few.
It’s an interesting read, sure to prompt some lab bench discussions.
Previously: Clinical research’s flaws highlighted by Stanford’s John Ioannidis, On communicating science and uncertainty: A podcast with John Ioannidis and A conversation with John Ioannidis, “the superhero poised to save” medical research
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