Restructuring Diversity in the Biomedical Research Enterprise

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.

Author: Carlos S. Moreno, PhD, is an Associate Professor in the Department of Pathology & Laboratory Medicine at Emory University School of Medicine in Atlanta, Georgia.

Summary: The consensus is clear that more must be done to promote a successful, diverse biomedical workforce. A key factor in the career success of any biomedical scientist is research funding. Below, I propose six structural changes to funding pathways and opportunities, including the establishment of a new National Institute of Diversity, Disparities, and Equity (NIDDE) at the National Institutes of Health (NIH). These changes could not only expand the number of diverse biomedical researchers, but also improve their success and retention throughout their careers.

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While there is much to be proud of in the biomedical research enterprise, it is evident that there is a need for systemic reforms to nurture a diverse biomedical workforce and to advance equitable health outcomes. Indeed, the representation of women and minorities in STEM fields drops at each level of advancement, from undergraduate to graduate, postdoctoral, junior faculty, and senior faculty positions [1].

A decade ago, the National Academy of Sciences, National Academy of Engineering, and Institute of Medicine issued a joint study [2] on expanding the underrepresented minority workforce in STEM fields, calling the problem “urgent.” The NIH has actively attempted to enhance the size of the pipeline of underrepresented minorities through targeted funding mechanisms, including R25, F31, F32, T32, K22, and K99 awards, as well as administrative supplements to R01 research grants. These programs span the career spectrum from middle school student to assistant professor.

And yet the problems persist.

To create major changes in the outcomes of the careers of women and minority biomedical investigators, bold changes are necessary. Here I propose six such changes that could have a big impact on expanding and sustaining a diverse biomedical workforce, as well as reducing health disparities. While these proposals are focused on the research enterprise in the U.S., similar parallel efforts could be applied across the globe.

1. Create a new National Institute of Diversity, Disparities, and Equity (NIDDE) at NIH

A new Institute at NIH dedicated to promoting a diverse workforce and performing research on health disparities would have its own budget, set by Congress. The NIDDE could consolidate NIH efforts towards a diverse workforce pipeline, as well as support diverse faculty once they reach the end of that pipeline. Other Institutes would not have to carve out sections of their own budget to address these issues, and applications from diverse investigators could be reviewed by diverse panels assembled by the NIDDE. This Institute could support research in any disease—from cancer, to diabetes, to mental health—as long as it addresses disparities in some way, or is led by an underrepresented investigator.

The NIDDE would represent a reimagining and expansion of the current National Institute on Minority Health and Health Disparities (NIMHD), with a broader mission and vision and an expanded budget. It would support research into all forms of health disparities, whether local or global. Importantly, while the NIDDE would create new funding opportunities for minority researchers, it would in no way deter or limit their ability to compete for any NIH funding opportunity, should not be interpreted as less rigorous or competitive, and should not stigmatize or marginalize underrepresented investigators.

2. Create 5-year, renewable career awards for underrepresented minority faculty

The new NIDDE could implement a five-year, renewable career award for faculty based on applicants themselves, rather than solely on research projects—similar to the NIH Director’s Pioneer Award or to the way NIH currently supports internal investigators. Such awards could potentially be made available to outstanding junior and senior level investigators to enhance the stability of funding of diverse laboratories, even at the pre-tenure stage.

3. Create a NIDDE bridge funding program

The NIDDE could implement a bridge funding program for underrepresented investigators whose funding has lapsed, in order to enable generation of key data necessary for resubmission of grant proposals. Applicants with unsuccessful NIH grant applications could apply with a rapid (less than 3-month) turnaround time for funding to help maintain their laboratories and prevent layoffs. Some academic research institutions have their own bridge funding programs, but not all, and few have the resources to make the kind of funding commitment to an investigator necessary to carry them through funding lapses. A NIDDE bridge funding program could be critical in reducing the dropout rate of underrepresented investigators early in their careers.

4. Expand the loan repayment program for biomedical graduate degrees

The NIH student loan repayment program should be expanded and advertised to women and underrepresented minority undergraduates. Loan forgiveness should not be limited to a funding cap, but rather made available up to the total amount of undergraduate student debt for underrepresented minority applicants. College career and financial counselors should be made more aware that women and underrepresented minority undergraduates can have their student loans put on hold while they pursue graduate degrees, and then repaid completely by NIH once they complete their graduate education.

5. Pilot test applicant-blinded review of R-series grants

An NIH-wide pilot test should be performed in which R01 and R21 grants are reviewed using only the Summary, Specific Aims, and Research Narrative sections, with all identifying information of the applicant removed. In this way, grant applications would be judged solely on their scientific merit, and not on impressions or reputations of the applicant. The grant award rates for women and underrepresented minority investigators selected via blinded review should then be compared to award rates from conventional reviews. Such an experiment must be large enough to include a substantial number of underrepresented minority applications, but it could determine if unconscious implicit bias is hampering the success of women and underrepresented minority investigators during the grant review process. If the success rates of women and underrepresented minority applicants is greater in blinded reviews, consideration should be given to making blinded reviews permanent across NIH.

6. Give equal weight to team-based funding in promotion and tenure review

The importance, creativity, and effectiveness of team science is abundantly clear, and has long been given lip service by universities and research institutions. However, when the time comes for a faculty member to submit a package for tenure and promotion, their contributions to team science matter little. What really matters are grants in which the candidate is the principal investigator (PI).

This attitude is in need of reform. The totality of contributions of faculty members should be taken into account by promotion and tenure committees. Faculty contributions to team science and team grants should carry similar weight as grants in which the candidate is the PI. If team science really matters and should be incentivized, then it needs to be rewarded.

Unlike the first five proposed changes, which could be implemented by Congress and NIH, this final change would have to be implemented across academic research institutions, which may be more (or less) challenging. Academic research institutions should publicize their commitment to acknowledging the contributions of faculty members to team science, which could help attract talented and creative faculty interested in team science to their institutions.

In conclusion, while no single action by Congress, NIH, or the biomedical research community will eliminate disparities in health outcomes or the makeup of the biomedical workforce, inaction will necessarily perpetuate the status quo. If the consensus from the scientific community is that change is needed, then significant changes must be made.

References

1.     Estrada M, Burnett M, Campbell AG, Campbell PB, Denetclaw WF, Gutierrez CG, et al. Improving Underrepresented Minority Student Persistence in STEM. CBE Life Sci Educ. 2016;15(3). Epub 2016/08/21. doi: 10.1187/cbe.16-01-0038. PubMed PMID: 27543633; PubMed Central PMCID: PMCPMC5008901.

2.     Sciences NAo, Engineering NAo, Medicine Io. Expanding Underrepresented Minority Participation: America’s Science and Technology Talent at the Crossroads. Washington, DC: The National Academies Press; 2011. 286 p.

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