Building a Diverse and Equitable Biomedical Research Ecosystem

Image credit

Pawan Upadhyay and team

This piece received an honorable mention in the Reimagine Biomedical Research for a Healthier Future Essay Challenge, organized by the Health Research Alliance and PLOS.

Authors: 
Naira Abou-Ghali is pursuing a PhD in pharmacology at Weill Cornell Medicine in New York, New York. 
Jenny Bratburd, PhD, served as the Energy and Environmental Policy Fellow with the Missouri Science and Technology Policy Initiative in Jefferson City, Missouri.
Peter Myers, PhD, is a postdoctoral researcher at Washington University School of Medicine in St. Louis, Missouri. 
Megan Schroeder, PhD, is a postdoctoral researcher at the University of Colorado Boulder. 
Pawan Upadhyay, PhD, is a postdoctoral research associate at Washington University School of Medicine in St. Louis, Missouri, Director (Outreach) at Washington University Postdoc Society in St. Louis, and Founder & CEO of iSTEMCare. 

Summary: Decades of inequity and homogeneity in the world of biomedical research—which we call the biomedical research ecosystem—have reduced research quality and public trust worldwide. To address these inequities, we propose five critical actions: 1) foster equity between members of the biomedical research ecosystem workforce, 2) increase institutional transparency regarding work environments and equity, 3) reimagine admissions, 4) include the opinions of underrepresented voices in hiring and tenure practices, and 5) incentivize cultural changes by linking equity compliance to funding opportunities. We trust these recommendations would shape transformative actions towards greater equity, thereby empowering and nurturing diversity in the global biomedical research ecosystem.

---

Across the globe, inequity within the biomedical research ecosystem permeates institutional leadership, student admissions, faculty tenure, and grant funding. Overwhelming evidence shows that the inclusion of diverse individuals cultivates innovation, increases the breadth of biomedical research, and promotes novel approaches to complex problems. However, a recent survey of 13,000 researchers from 160 countries revealed that inequity manifests in hostile research environments, lack of financial equity for workforce members, and non-inclusive admissions or hiring practices.

Some initiatives already exist to address such issues, including the recent UNITE initiative by the National Institutes of Health (NIH) and the National Research Mentoring Network (NRMN). UNITE works to detect and solve systemic racism in the NIH-funded scientific community, as well as in the larger scientific community. Additionally, it aspires to build an equitable and civil culture within the biomedical research ecosystem and decrease barriers to racial equity in the workforce, with representation from across the NIH Institutes and Centers. Moreover, the NRMN aims to provide researchers across all career stages in the biomedical, behavioral, clinical, and social sciences with evidence-based mentorship and professional development programming that emphasizes the benefits and challenges of diversity, inclusivity, and culture.

Despite these efforts, diversity, equity, and inclusion issues persist because institutions lack transparency regarding their efforts to improve the current state of their research environments. To mirror the diversity of the population they serve, institutions across the globe must create and support networks that uplift talented individuals from all backgrounds, as well as establish equity, diversity, inclusion, and transparency initiatives to dismantle hierarchies at all organizational levels.

But how do we dismantle decades of discrimination and inequity in the biomedical research ecosystem? As Julie R. Posselt posed the question in her book Equity in Science, “How do you eat an elephant?” The answer is, “one bite at a time” (quote by Creighton Abrams, U.S. general).

Here, we propose five critical “bites” urgently needed to redesign a biomedical research ecosystem that harnesses gender, racial, ethnic, and experiential diversity to build a sustainable and thriving future for the field, worldwide.

1. Nurture healthy work relationships by fostering equity

Top-down power dynamics inherent to relationships within and between trainees (students, postdoctoral fellows, and junior faculty) and tenured faculty can create environments characterized by inequality, inequity, and discrimination. Widespread tolerance of power dynamics and incivility plays a role in promoting sexual or gender harassment, racism, sexism, or gender-phobic treatment and incivility—as evident from a recent CACTUS Foundation survey. Moreover, an NIH workplace climate survey showed that victims of sexual or gender harassment and incivility reported working in environments with low perceived equity between grantees (mentors) and trainees, and low perceived institutional support.

Attempts at addressing workplace harassment are hindered by limited investigations and lack of reports due to fear of retaliation. To overcome these limitations, we recommend that each research institution have 1) a group of dedicated Implementation Officers (IOs) trained in social services, conflict resolution, and emotional first aid, who will audit research environments for equitable practices; 2) a Diversity and Equity Implementation committee; and 3) a centralized incident reporting system that maximizes anonymity, minimizes retaliation risk, and generates cumulative, temporal data regarding incidents.

On a laboratory and department level, the IO will collect and synthesize trainees’ feedback regarding their perceived work environment to provide actionable plans for individual mentors and systemic plans for departments to implement. In turn, mentors and department leaders will relay their feedback regarding student interactions, and the IO will communicate with students in a similar fashion.

In an instance of harassment or discrimination, the IO may meet with all affected laboratory members, including the principal investigator, to assess underlying conflict, perceptions of the lab environment, and the perpetrator(s). The IO will notify the perpetrator’s superiors and work with the Diversity and Equity Implementation committee, which will be composed of trainees, department leaders, and at least one community member (i.e., not employed by the institution). The committee will either remove or actively retrain the perpetrator(s) and remediate affected relationships within the lab group.

In particular, the committee and IO will be trained in restorative and transformative justice practices so that root causes for actions can be discovered and addressed, and all parties can grow and learn from the mediation.

To minimize the risk of reporting mistreatment but increase accountability, all institutions must also implement a centralized, anonymous reporting system to track incidents over time and highlight cases requiring urgent attention by an IO. Systems like AllVoices provide a secure platform to report harassment, enable victims to chat with an IO in real-time, and should be configured to trigger an IO-led investigation if complaints about a specific individual reach an institution-defined threshold. The IO and Diversity and Equity Implementation committee will work together to determine an appropriate course of corrective action, depending on a given incident’s circumstances. While some institutions have implemented anonymous reporting, there is minimal tracking of incidents over time and little communication regarding actions taken as a result; thereby limiting the institution’s ability to learn and grow from incidents. 

2. Open and transparent reporting 

We recommend institutions make diversity and equity enforcement reports available to the public. Often institutions hide reports, fearing a negative reputation; however, the #MeToo and #BlackInTheIvory movements reveal that harassment and inequity are omnipresent. Enhanced transparency promotes a culture of accountability within the biomedical research ecosystem that can be further reinforced by public awareness. By releasing reports publicly, institutions can make a cultural shift to transparency and openness.

Such reporting can have a transformative impact, as evidenced by the House approval of H.R. 36 (Combating Sexual Harassment in Science Act of 2019). Federally funded research institutions should release aggregated data from anonymous reporting systems, IO reports, and Diversity and Equity Implementation committee reports as described previously. Ultimately, annual summaries of such reports must be analyzed for systemic issues and root causes to devise future diversity and equity plans. 

3. Reimagine admissions 

Racial bias pervades higher education admission programs, as enrollment of people of color at the undergraduate and graduate levels remains severely low. Barriers include standardized tests, recommendation letters, financial capacity, disability, and university transcripts. These metrics fail to consider the individual and cultural barriers students overcome to gain research experience. To make university attendance an equitable and diverse process, we recommend 1) eliminating recommendation letters and standardized test requirements and 2) reimagining applications to probe for qualities needed in a successful applicant.

By removing recommendation letters and standardized test scores from the application process, institutions will reduce the impact of minority identities on one’s ability to apply. Neither recommendation letters nor standardized tests serve as accurate predictors of academic success, and both can penalize low-income applicants and applicants with underrepresented backgrounds. By dropping these two requirements from applications, the number of individuals who can apply will vastly increase. 

Next, by reimagining applications as a probe for qualities rather than a test for achievements, applicant pool diversity will increase. Often admissions committees evaluate applicants based only on research experience, which can be a barrier to working students who cannot afford to pay to conduct research for credit or take time from work to volunteer in a lab. Thus, we recommend adding a series of questions that probe for essential qualities of a strong applicant: creativity, critical thinking, problem-solving, synthesis, and ethics. For example, admissions committees can ask how an applicant would go about investigating a particular research question, or how assumptions may impact a research question. Skills needed to carry out research can be taught, but an inherent passion for understanding the world around oneself must exist in applicants at the start. Finally, a focused assessment of the student’s scientific abilities can also be conducted by their previous mentors as another metric for admission.  

4. Enhance diverse voices in decision making 

While many institutions have some form of student governance, administrations fail to give historically underrepresented identities a seat at the table for major decisions, including committees for admission, hiring, and tenure. Giving voice to trainees and community members will enact both institutional change and a cultural shift, thereby increasing awareness of important equity issues around which the biomedical research ecosystem needs to build trust with underrepresented and diverse communities.

Although many universities have implemented social justice and anti-racism task forces to address such systemic inequities with faculty and underrepresented student members, their influence is limited to making recommendations. Giving such committee members voting power and a voice in planning equity and inclusion strategies is critical for real change.

Furthermore, hiring and tenure place an undue amount of focus on research productivity, yet grant funding, which is directly linked to productivity, is systematically biased. Evaluations to supplement existing metrics for being awarded funding should include: whether an individual has cultivated a diverse and equitable lab group, pursued inter- or intra-institutional collaborations, and made contributions to enhance the positive impact of science on society. These decisions should also include input and data from the IO on harassment history and mentorship quality. Further, upon contract renewal, such data can be used to offer an additional merit increase to one’s salary, incentivizing everyone to prioritize diversity efforts in their daily work. Finally, this data can be stored in a centralized diversity and equity database that is accessible to federal funding agencies and all other institutions to avoid “passing the abuser.” 

5. Link funding to diversity and equity compliance 

To incentivize and promote cultural change within academic settings, institutional adherence to an IO’s plan and recommendations should be required for grant funding. Much like other review boards, we suggest the formation of a review process for laboratory personnel, investigators, faculty, and staff compliance toward constructing a more equitable and diverse environment. In this audit and review process, individual labs and departments will have to develop and present a plan that ensures diverse and equitable representation, mediation, and protocols for addressing issues as they arise. The review committee for the diversity and equity plans will include members of the university administration, staff, and/or faculty from multiple departments, graduate student liaisons, and volunteer(s) from the local community with diverse backgrounds that mirror local demographics. 

Overcoming resistance to change

We acknowledge that any attempt to disrupt the power dynamics inherent in the current biomedical research ecosystem will be met with resistance—even from parties that stand to benefit, due to fear of retaliation. Implementing successful change starts with action from deans and department heads. Administrators need to implement procedures to support and protect trainees, and trainees need to voice their ideas and needs.

To those in power, we offer our framework as an opportunity to leave a lasting legacy defined by equity, inclusion, and unprecedented scientific advancement. The current systems of inequity in the biomedical research ecosystem are unsustainable and change is inevitable; therefore, we want as many voices as possible at the table to determine its future.

To marginalized individuals, we offer these words from Hillel the Elder, echoed by Tracy Chapman: “If not now, then when?” Redesigning the biomedical research ecosystem will take time, patience, and a lot of work, but if we work together, we can create an ecosystem that champions ingenuity and creativity. We can create a space where all future trainees can actually see themselves reflected, and their brilliant ideas encouraged and celebrated. 

In conclusion, the five “bites” we outline could help dismantle decades of discrimination, homogeneity, and inequity and build an equitable, open, and transparent biomedical research ecosystem. Through institutional changes that value, empower, and nurture diversity, we can promote a cultural shift in this global ecosystem. We believe that our recommendation will serve as an agent for the shift from “discussion to implementation” for diversity, equity, and inclusion issues across the biomedical research ecosystem worldwide. 

---