Guest Post: The brightest and the most insightful people in the country?

Mar 08 2014 Published by under Academics, Careerism, NIH, NIH Careerism, Public Health

bluebirdhappinessThis is a guest appearance of the bluebird of Twitter happiness known as My T Chondria. I am almost positive the bird does some sort of science at some sort of US institution of scientific research. The bird is normally exhausted by typing messages 140 characters at a time so I was skeptical but....well, see for yourself.


MDs and PhDs are considered to be some of the brightest and the most insightful people in the country. Indeed, look no further than the nearest MD or PhD and ask them; they will attest at great length to their exceptional smarts and individual importance in maintaining the sun orbiting the Earth. Yet for all the combined education there remains a fundamental lack of appreciation of how intertwined the fate of these two professions are - ranking right up there on the irony scale with Pakistan threatening to nuke India (they are geographic neighbors, so that’s ironic, you see).

For anyone who has ever worked at a major academic medical center, we are told ad nausea how important we are in understanding human health. Yet we do so almost exclusively in parallel universes. Asked what its like to try to work with an MD, a PhD will often tell you MDs are ‘erratic, ill informed and totally lacking in any understanding of what goes into doing real research’. Conversely, asked what PhDs do, MDs will likely reply ‘they like to present very complex diagrams, write grants and develop models of disease and pathology that have little to do with any case I’ve ever seen.

I get to surf between these groups; my primary appointment in a clinical department affords me a perspective that is unique in that I am able to pass as either an MD or a PhD on any given day. I spend the majority of my time running a research lab but I can scream “House! Put down the scalpel you jackass! All you have to do is order a chest x-ray and look for pulmonary infiltrates to know it’s not sarcoidosis!” with the best of interns.

Figure 1. “It’s a fan!” “It's a spear!” The hilarity of people in white coats looking at their own little microcosm of an elephant and being unable to appreciate it is actually a bloated endangered species that could kill them all. And by bloated endangered species, I mean academic medicine*.  *Author note: Am I going to have to explain all my jokes?

Figure 1. “It’s a fan!” “It's a spear!” The hilarity of people in white coats looking at their own little microcosm of an elephant and being unable to appreciate it is actually a bloated endangered species that could kill them all. And by bloated endangered species, I mean academic medicine*.
*Author note: Am I going to have to explain all my jokes?

In drifting between these lands, I noticed the rifts earlier between ‘researchers and doctors’ which seemed vaguely amusing not so much now as first but as the business of academic medical is getting the shitte kicked out of it and PhDs think it has little to do with them.

In previous faculty meetings, I would watch tenure track PhDs glaze over as our beloved leader discussed the ‘blah, blah’ of clinical revenue streams.

Conversely, the MDs would eagerly reengage a new level of Candy Crush Saga as our chair commiserated with PhDs about pay lines and sequestration. (So clueless were the MDs about the recent plight of scientists that the esteemed journal JAMA even had to run an article in their online edition earlier in the year explaining sequestration to the primarily MD audience.)

At our most recent faculty meeting, there seemed to be a moment of real illumination between both groups that everyone in the medical center was screwed and better start making more widgets faster. Our Fearless Leader informed faculty that our hospital budget shortfall was progressing more quickly than we had anticipated even three months ago and vacations were canceled for faculty, more clinical hours were going to need to be booked and the bergermeister was coming to take all our toys (only two of these three have happened so far).

Figure 2. Predoctoral kitten downed by lack of understand of the health care industry on academic medicine.

Figure 2. Predoctoral kitten downed by lack of understand of the health care industry on academic medicine.

Later that day, I took to on Twitter to vent and look for pictures of kittens doing cute things (see Fig 2 as evidence of my hard work). Many of my Twitter followers are porn bots, but at least 2 or 3 are PhD-types and aghast that my medical center was being so aggressive. There were many sad emoji’s sent my way and a flutter of ‘how could they’ and ‘oh, your poor little university’ that made me wonder what planet everyone is on and if donuts were as delicious there as they were here (see Storify by @mrhansaker here).

EVERY medical center in the US is getting carpet bombed into financial oblivion by the economy, Medicare reimbursements and Obamacare. And yes, I assured my Tweeps, the amount of our gross national product that goes to health care is stoopidly high. But, a startling number of my PhD buddies were taken aback by the idea that those pesky ‘high health are cost’ they glaze over in faculty meeting or when listening to NPR is also covering their academic PhD arses.

So, for my PhD pals, whom I shall refer to as ‘People who are doctors only when they book hotel rooms’ (I’m kidding, I’m a kidder!), I wanted to run this down a bit further. If you have a medical center as part of your university, you have been riding clinician’s financial coat tails for a long friggin time. The indirect rate charged to granting organizations in no way covers operating costs for research. That takes an endowment or an additional revenue stream. Endowments usually come from long dead old rich doods. These endowments don't just sit in Scrooge McDucks cave. They get invested in things like the stock market. And the stock market got the shitte kicked out of not too long ago. Billions in endowment money were lost in the economic collapse - most Universities took 25-50% hits on their Scrooge McDuck funds. So, if you’re a PhD, you can take endowments out of the equation as what’s been filling in those pesky financial gaps between costs and expenses. No worries, you’re at a medical center so you have a revenue stream- your clinical enterprise. Sick people. America is ALWAYS good for some damn unhealthy and foolish folks who will make the worst choices possible and rack up a small fortune in insured and uninsured care.

Thank God for stoopid and unhealthy people, amirite?? This is even better because our Commander-in-Chief got an electoral mandate to insure everyone’s (ish) stoopid arse. More money for medical centers has got to be a win, yes? Not so much. Show me a medical center meeting its financial goals, hell even one that isn’t heading for a hundreds of millions of dollars of deficit for 2014, and I will show you a for profit medical center (read here: “not academic, so no jobs for you PhDs”).

The proverbial sky has been falling for research scientists for some time now as well documented by my kind host Drug Monkey and others with inferior blogs and better shoes. And indeed, MDs have been hounded into appreciating the genius that is the bench scientist. So valued are the basic researchers that they are sought after to heap more prestige on the medical center and an even better training environment which increases numbers of trainees, blah, blah.
Unlike clinicians, scientists have known the economic sky was falling for some time and have been zealously advocating the importance of science research bracing for impact. To the outside world, that looks a lot like holding your collective sphincters together as tightly as humanly possible and waiting for things to improve. Well-done people. Actually, you sort of sucked at advocating for yourselves as evidenced by the two of you who actually sent @nparmalee letters to hand deliver to your Congress Critters a few weeks ago, but I will need another bottle of wine for that.

The first warning to those PhD types in the 35+-age bracket would have been when Scamp-in-Chief Bill Clinton never quite delivered on his ‘peace dividend’. The one where all those pesky defense dollars would go to building a bigger, better, smarter American work force with futures in STEM (Dumber Bombs! Smarter People!). We would turn in our tanks and churn out better-educated versions of ourselves with outstanding oral hygiene to lead us forth into the new millennium free of disease and with cats with laser vision. Not only did we forget to provide sustainable growth mechanisms for STEM, we also neglected to maintain world peace and not screw the interns. Bill, you lovable rascal, at least you didn’t shoot anyone in the face. Just in the foot. Or both feet.

Metaphorically.

In the parallel world of MDs, who kindly request you simply refer to them as ‘real doctors’ for the rest of this diatribe, the pesky business of health care in academia has always been a house of cards. About 7% of MDs practice in the rare air that is academic medicine. This affords prestige, time for clinical research, collegiality, security and none of the business hassles of private practice, but about half the salary. Which, to be honest, is still a metric shitte ton of money especially if you do a bit of consulting. But now, there’s no research time, Medicaid is squeezing out every reimbursable dime and you are keeping the same hours as your hapless residents.

My take home from today friends is that the party seems to be winding down. Rather than recognizing that our fates are intertwined, MDs and PhDs frantically see more patients and write more grants and wonder when the sun will shine on us once again and society will appreciate our true worth. I have yet to see any evidence that for all the brain power and letters after peoples names, PhDs are even aware of that medicine money is research money. So you go put your blinders on and find that spear, and I’ll put mine on and grab this rope and no one will call it an elephant.

34 responses so far

  • So, for my PhD pals, whom I shall refer to as ‘People who are doctors only when they book hotel rooms’

    Hey, we PhDs are *also* doctors on our frequent flyer miles! Don't forget that!

    But seriously, besides the valid C.P. Snowish style "two cultures" between MDs and PhDs, another reason for the animosity might be that the PhDs have to deal with the larval stage of MDs -- premeds. Who are, on average, terrible people, always bursting into office hours trying to wheedle a point here and a point there on exams, because you know, that's what matters, not actually learning or anything -- just getting the 'A' needed to go to med school.

  • The Other Dave says:

    Interesting. Our very large medical school and hospital is going broke, and has been subsidized by the rest of the university for years.

  • Pinko Punko says:

    I think we would want a lot more information about general trends in teaching hospital/research med school combos and those for specific hospitals and exactly why money is being lost and what historical trends are. I think I could take something away from this.

  • Odyssey says:

    The number of people in academia who have absolutely no idea who's paying for what just boggles my mind. It's not so hard to figure out. Talk to your chair, dean and/or VPR. Pay attention to what's going on around you. Indirects don't cover all the costs of supporting research. You can argue ad infinitum about whether or not indirects are being used correctly and whether they should cover all the costs of research infrastructure, but that won't change the fact that they just don't. Others are making up the shortfall. And when those others, be they clinicians or students paying tuition, can no longer make up the shortfall, basic research is screwed. Period.

  • Eli Rabett says:

    The ACA has the potential to save the hospitals by covering all those uncovered costs. This is being played out in the red states, where rural hospitals are closing because they are not reaping the benefit of Medicaid expansion.

    Still, for a university president, the only thing worse than having a medical school with a hospital on campus is having two medical schools with hospitals.

  • gerty-z says:

    It's hard for me, as I try to scrap my way up through the tenure process, to spend a lot of time figuring out the budget structure of MRU. I know that faculty on the undergrad campus do a lot more teaching than the PhD-basic-science faculty at the med school. And I know the MD and MD/PhD in the clinical dept. have to see patients. But that is it. It's really pretty shameful, TBH

    It seems like the source of the rants that MyT and DM are having is that the gov't expects to get more than what they pay for. Sort of how there are some citizens that are incensed at having to pay taxes and will bitch about every pot-hole/cut in USPS service/etc. The incentives at NIH are fucked up. The incentives for clinical research are totally fucked. But...what would fix it? Lobbying and calling congress critters is a good start, but you have to know what you want as the outcome. Otherwise you are just calling and complaining, not actually changing anything.

  • AcademicLurker says:

    "Basic research loses money" is something I've heard for a while now. I've heard it from enough sources that I suppose it's true, but it raises one very puzzling question:

    Why the stampede to expand basic research at so many institutions from the late 90s until recently?

    If basic science is a money loser even when it brings in federal funding, this means that administrators - well known for being penny pinchers in general - have consistently jumped at the opportunity to lose more money. That's odd.

  • The Other Dave says:

    @AcademicLurker:

    Basic research loses money, but the products of that research don't. It's still a good game, if you play it right.

    http://www.forbes.com/2008/09/12/google-general-electric-ent-tech-cx_mf_0912universitypatent.html

    It was never about the ICR. It was always about developing something marketable. Universities basically became startup biotechs, with the benefit that their main investor -- NIH -- didn't actually expect any share of the profits. Sweet deal, no?

    When you look at it this way, everything else makes sense. Why did certain types of institutions and departments expand? They were most likely to produce marketable biomedical products. Why the shift toward soft money? It wasn't about sustaining research; it was about screening for people who could hit something big while employed there.

    If you are a biomedical researcher, your job is to produce marketable products. Just as if you were in a company. Because, in a sense, you do.

    So quit fucking around pretending C/N/S papers matter and get your ass over to the tech transfer office, pronto!

  • @Gerty-

    The incentives have been screwed up in the USA for so long we don't even know what a working research system looks like anymore.

    The first step might be to get the Public to understand why we need "basic" research (I call it "discovery or essential or foundational" research). The next step is to persuade them to pay for it; which may be tricky at this point.

    Ya gotta discover Natural Laws before ya can work them into applications like drugs, or faster car engines, or a Tricorder-like scanner that will diagnose disease without even needing a biopsy. But first you need to know the molecular basis for phenotypes; or the laws of thermodynamics (well OK and a few others for the metallurgy stuff).

    The ROI for "research" is applications, and the USA has forgotten this because it's way way cheaper to to just jump in at the applications phase, swoop up a patent, and make serious profit off a technological product for miniscule investment or risk. (You can tell I've been talking to patent lawyers lately, sigh....) I feel this attitude is particularly despicable in the health sciences- the ROI for biomedical research is not dying quite so quickly; not "money".

    Research is not cheap (esp health research, as this blog regularly points out), but no other nation on the planet has the infrastructure for it like the USA (yet). It won't be cheap, fast, or easy, but if we started re-investing now we may just be able to slowly and painfully turn this situation around. Maybe. (Everyone's talking about the "collapse of the NIH" where I'm at in the same tone as "the sky is falling". I'm glad I'm with the physicists for right now; it looks really, really rough out there in health.)

  • @The Other Dave
    There have been successful university tech-transfer offices, but the majority of ones don't even come close to breaking even when all the high-powered lawyer time is taken into account.
    (see for example the analysis, http://www.bu.edu/entrepreneurship/files/2010/09/Abrams-Leung-and-Stevens.pdf -- the article tries to defend tech transfer by claiming that it isn't about the money, but that seems more like a desperate rationalization)

    Tech transfer offices are like football teams -- yes in *theory* they are supposed to make money for the university, and that's generally their primary justification for existence, but when you do the math, you find that they generally don't

  • AcademicLurker says:

    @TheOtherDave

    Fair enough. But, honestly, it sounds like a bit of cognitive dissonance to me.

    "We want to make a bunch of money from patents and marketable products."
    "How do you plan to do that?"
    "I know! We'll start a bunch of basic research departments!"

    Think it through, folks...

  • DrugMonkey says:

    GertyZ-

    I'd say you can't ever really understand it. Uni accounting uses the principle of money fungibility to prove that all aspects are a loss leader. All that is left that isn't shown to be a cost drain is the parking department or something.

  • DJMH says:

    No, the parking department is ALWAYS running in the red, hence the yearly increase in rates.

    It's football that brings in money, of course.

  • The Other Dave says:

    @Jonathan: I am not disagreeing. In fact, the cost/benefit analysis might be useful for more high admin to read. But it's also human nature. Provost/Chancellor: "They're making how much from that drug? We should be doing that! Build some labs and hire biomedical researchers pronto!"

    As for the importance of basic research... Hey, I'm with y'all. I do basic research. But look at it from the other side. Why should U.S. taxpayers pay billions of dollars for knowledge that is often of arguably questionable value, and which in any case is typically given away to other countries free? Why not just give more R&D tax breaks to biotech companies? Or more money for defense research initiatives? Or just keep in place the tax breaks for charitable giving to private research organizations, so people can pay for esoteric stuff if they want, or not if they don't want.

    Higher education isn't subsidized because it makes people feel good. It's subsidized because an educated population makes our economy more competitive and society (theoretically) work better. Cheap state universities encouraged more people to go to college. But now that more and more people go to college, the subsidies are decreasing. it's not a conspiracy or mistake. It's perfectly logical.

    So how do we get more money for basic research? Training. I think our best argument is training. Even though plenty of people go to college in the U.S., we still have a shortage of good STEM-trained graduates. The best way to teach science is to have people do science, right? We can't provide opportunities for people to do science without having a solid research enterprise. Instead of contracting research in the U.S., we need to EXPAND it -- to more schools, smaller schools, lower levels of education. Active research labs should not be restricted to elite research institutions.

    My view is a populist point of view, because obviously the most education bang for the buck is achieved by spending it on a new previously unfunded lab rather than a rich lab (that is probably run by a bunch of foreign postdocs anyway).

    The trouble with my argument is that it doesn't have the same emotional punch as "We're going to cure cancer. Or Alzheimers." NIH has a long history of being successful with those types of arguments. NSF traditionally makes arguments more similar to the one I'm making. But that might be why NSF has a quarter of the budget NIH does, while funding many many more types of science and technology, in many more contexts.

    So, what's the magic bullet? I don't know. Maybe develop an undergraduate lab class where the students will screen potential anti-cancer drugs and get extra credit for landing a job in a big U.S. pharmaceutical company before the end of the semester? Hmmmmmmm....

  • Eli Rabett says:

    The football analogy isn't so bad. The thing about research is that there are a lot of fixed costs, libraries, computer networks, research offices, etc. That means that above a certain level, yes, research can make money for a university. Think Notre Dame or Alabama.

  • Comradde PhysioProffe says:

    The medical center affiliated with our medical school has been swallowing up private practice groups left and right, and then we have been giving the physicians clinical faculty appointments. This is a collaborative effort to monopolize the provision of medical care in our State. At least so far, clinical income to our medical school--comprising both direct payment of physician fees and payments from the medical center--has been soaring.

    However, the academic medical center model of clinical practice combined with research and teaching--and most importantly, clinical training of residents--will only survive if the Federal Government and insurance companies explicitly agree to pay for both the training of new doctors and the provision of medical care to the indigent. As it stands now, for-profit hospitals externalize those costs to academia by not training residents and refusing indigent patients.

  • […] not suggesting we know every little detail. Sometimes that's well nigh impossible. But at least make the effort to know enough to make informed […]

  • mytchondria says:

    The football analogy is horrible, because football.
    The other side of this that got highlighted further in the Twitts, was 'haven't the markets recovered'. And the answer is that regardless of the current state of the market, our donors are scared to give $$ because of the pounding they took (Development is WAY off from 1997 numbers in 18/20 Top Med Schools) and Chancellors don't want to break into their Scrooge McDuck funds.
    As for CPP*, The Harvard model of swallowing up private practices has indeed been spreading to both CPPs esteemed instution as well as ours. I would argue that clinical revenue 'soaring' is HIGHLY variable and not reflective of what happens in urban Level 1 trauma centers on the inpatient care side . Many inpatient emergency services (OB/Gyn, NeuroStroke, Psych, Trauma) that must take patients or they will crump on on our doorsteps. Many of these folks are uninsured/underinsured in our area.
    The NYT has a handy map for folks that want to see where the shitte will hit the fan because they haven't bought into Obamacare, don't have insurance and have high poverty http://www.nytimes.com/interactive/2013/10/02/us/uninsured-americans-map.html?ref=health
    And CPP is dead on. You can add salt to the wound of losing money with residents and fellows. We get paid nadda for training those folks.

    *I'm totes fangirling that he commented on my blog BTW but haz sad at lack of swearing.

  • Ola says:

    So to put some real numbers on things, at my AMC/Univ., the hospital is about a $1b/yr. enterprise, and a while back was churning out almost double digit profits, so there was easily $80-100m in surplus cash to subsidize research. Now that number is closer to $20m and there's no indication where the difference will come from. The big schools are making it up from endowment draw-down, but that's not an option here (endowment mismanaged in the 80s and too small now).

    The major issue is that the other branches of the school became addicted to the "cash cow" that the hospital was. The board of governors of the university (of which the med center is a branch) has 9 members, but only 2 are from the med center. Undergrad tuition is about 6% of the total operating budget for the hospital/university/AMC combined, and yet the undergrad campus represents the bulk of expenditures.

    The other big problem is the total failure of the nationwide subset of AMCs to negotiate different rules under the affordable care act. There are over 4000 hospitals but only about 120 AMCs, and it's arguable the latter have unique financial needs and should not be paid the same way as regular for-profit hospitals. The total failure of the AMCs to lobby this point to the government and the public, will be a big contributor to their downfall.

  • Chris says:

    The details of the situation at my institution are a bit different, but no less dire. My question is, WHAT CAN I DO ABOUT IT? Sure, I can trust that the powers that be are coming up with a brilliant plan, but is there a way that I, as an individual faculty member, can do anything to help (with the idea that if we all did a little something, the numbers might start to look better). The advice I've heard is to just "keep doing what you're already doing", i.e. applying for grants like crazy to bring in overhead. But isn't there anything else we can do? Increase our tuition income by offering a new class? Surely someone out there has some reasonable ideas...

  • mytchondria says:

    Chris...yes, you must continue to make widgets (ie grants) at break neck speeds. But you must also TALK to your clinical counterparts to make them aware of what you are doing and learn what they are doing. Far too many PhDs tune out when it comes to listening to discussions of hospital budgets. Offer to give Grand Rounds in clinical departments. And go to their Grand Rounds. Get an adjunct appointment. And don't think that discussions of Affordable Health Care aren't important for research. They are and deserve your advocacy. I shall tirade at another point about the church mouse phenomena that is academics advocating for research and medicine funding.

  • JD says:

    Yes, the business model described in this post is entirely accurate. So, I guess the moral of the story for PhDs in these situations (like myself) is "kiss the ring" or move on to something else. What could be better than an MD with an extra dose of arrogance thrown in?

    This is precisely the reason I'm looking to leave my medical center faculty position for one at a traditional state university. At least at a university the cash cow is teaching. If we have to listen to this sort of diatribe at least it is coming from other Ph.D.'s who have less of a sense of entitlement. Plus, research profs can support the mission of university by engaging in teaching/mentoring themselves. Here, I am constantly reminded how useless I am. Even if I bring in buku grant dollars I am still considered a financial liability.

    So, thanks for posting this crap. It could have easily been written by the powers that be at my own research institute. It only makes me more excited about the university interviews I have lined up later this month!

    BTW - This should serve as a warning to aspiring basic scientists who are now seeing jobs popping up at medical centers, hospitals, pharmacy schools, etc. Especially in a tough job market, these academic positions sure do glitter at first sight. Beware of what you're stepping into, though. If you dreamed of becoming a "professor" in the traditional sense of the word, you may be sorely disappointed.

  • AcademicLurker says:

    @JD

    I escaped from my soft money medical school position to a hard money position a few years ago and my tenure here was made official last summer. Honestly, sometimes I feel like I caught one of the last lifeboats off of the Titanic. Sure, there's a bit more teaching, but it's not that much more, and it's well worth to have gotten away. From what I've been hearing from my former colleagues, things are getting grim indeed...

  • odyssey says:

    This is precisely the reason I'm looking to leave my medical center faculty position for one at a traditional state university. At least at a university the cash cow is teaching.

    Good luck with that. You'll need it...

  • DJMH says:

    Uh, the football thing was a joke.

  • rxnm says:

    This is everything... not just academia, not just science. Health care, infrastructure, education... much of the economy. We all are just starting to get the baby boomers' credit card bills.

    In the mean time, I've been given a list of things to do to get tenure.

  • One additional thing that adds to the MD/PhD culture divide is salary. MD's, irrespective of how much clinical income they generate, get paid much more than PhD's (even if they are clinical and see patients, some of the time). Relative social arrogance is also a problem.
    OTH: in many of the less sexy clinical specialities (chronic diseases, peds, geriatrics, phys medicine, family medicne), I have met people who work harder than the most diligent and motivated grad student, day in and out. They also get paid less.

  • JD says:

    @ Academic lurker

    Great to hear. Gives me hope. My plan is to be out by next year. Two state schools seem really interested so far. I just hope I haven't missed the boat.

    @ Odyssey

    What exactly do you mean? Did you have trouble making a similar transition? Just wondering why I might need more luck than normal.

    Sometimes it does seem like many traditional universities are less and less interested in poaching people from Medical Research Centers. Almost as though the longer I stay in this environment, the more "typecast" I become. I already notice that teaching-intensive schools are not at all interested in my CV.

  • odyssey says:

    @ JD:
    Not that at all. More the idea that the grass is that much greener on the other side. It isn't.

  • Fe says:

    The problems come from an unsustainable economic system, so clinical and basic research personnel, which are also part of the people, or 99%, need to start looking into what the problem with the money system is and why it can no longer carry on fair civil and democratic society.
    Apparently the warnings on the ‘winding clock’ of the economy date back as far as 1970s. So by now all the skeptics about it must realize that it was true, though may not acknowledge it but rather do what it’s shown in the elephant drawing. And the fact that all the ‘palliative treatments’ partially carried that long a large and active society like the US, speaks on behalf of the people involved in the biomedical and basic research fields, that have a lengthy schooling and do not make a compensatory income. And on behalf of the general population that supported R&D as a form of true social and economic investment.
    There is good analysis on the subject all over the web, by economists and non economist, but so far no decisions, which is surprising and discouraging. The problem cannot be lack of productivity because you see it everywhere (overstock of food, medicines, drinks, school supplies, fashion items, housing, electronics, etc). Therefore, not enough money to purchase the produce and services (or the living basics), for many reasons built into the economic system, or due to the lack of jobs of any type, point into a direction: the economic system is out of balance relative to the current society. It has to be changed or adjusted.
    It is not sustainable and it is a huge waste of human capacity, nurtured and potential. It also indicates a strange business mind set, because low purchasing capacity would yield lower profits, and their consequences. ETC.

  • AcademicLurker says:

    Related to the OP, Nature is certainly bringing the cheer today:

    http://www.nature.com/news/don-t-hide-the-decline-1.14848

  • […] Guest Post: The brightest and the most insightful people in the country? Is Human Behavior Genetic Or Learned? (don’t forget the genotype by environment covariance…) Berg on the sequester: 1,000 fewer NIH funded investigators President Obama’s 2015 Budget for Health Research is a Disaster Up to 1000 NIH Investigators Dropped Out Last Year […]

  • GM says:

    The Other Dave March 9, 2014 at 10:33 am

    As for the importance of basic research... Hey, I'm with y'all. I do basic research. But look at it from the other side. Why should U.S. taxpayers pay billions of dollars for knowledge that is often of arguably questionable value, and which in any case is typically given away to other countries free? Why not just give more R&D tax breaks to biotech companies? Or more money for defense research initiatives? Or just keep in place the tax breaks for charitable giving to private research organizations, so people can pay for esoteric stuff if they want, or not if they don't want.

    Growing the economy is the worst argument in favor of or against anything. Because the imperative to grow the economy at all costs is in the not so long-term a guaranteed way to achieve collective suicide. Climate change, resource depletion, ecosystem collapse, etc,e etc., it is all the result of unsustainable population and economic growth.

    So what are all those PhDs doing about that? Instead of trying to fix the system by using their supposed knowledge and understanding of the natural world to educate the rest of the population about the problems, they argue back and forth about what would be the best way to convince people that what they do is going to help grow the economy... Why are there so few people who see the insanity in that?

    And let nobody come to me with the old "Research is expensive, can't expect people to pay for it if they don't find value in it" fallacy - people already pay orders of magnitude more for things that work directly against their self-interest,. Scientific funding is completely inconsequential in the grand scheme of the giant resource misallocation our societies are engaged in.

  • PalMD says:

    MDs are unlikely to figure out how to deal with the change in revenue streams until they default on their student loans half-way through the 40 year pay off period.

    Some are scrambling to be bought up by hospitals, who are in turn scrambling to get a hold of docs to form ACOs before said docs form their own ACOs robbing the hospitals of patients and money.

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