On Medical Research Gone Wrong

At the NY Times, Ari Schulman on Jay Bhattacharya, the new head of the NIH. Bhattacharya got the job because he was a strident critic of Covid lockdowns, but he is a real scientist with an agenda:

Take Alzheimer’s research. Nearly every scientific research reformer will cite the fact that the N.I.H. funded vast amounts of research based on a single theory of the disease that largely turned out to be wrong.

Dr. Bhattacharya argues that this happened because science is structured around authority. “You have, in field after field after field, a kind of set of dogmatic ideas held by the people who are at the top of the field. And if you don’t share those ideas, you have no chance of advancing within those fields,” he told me.

He told Congress that he believes there are promising ways to prevent Alzheimer’s that haven’t received support because they don’t align with the “dominant narrative,” as he called it. “This is why I’m so interested in replication,” he told me, referring to the need for researchers to repeat each other’s findings, because it “turns over the determination of what’s true to nature rather than authority.”

Which is interesting, and perhaps explains why MAGA types like Bhattacharya. But it is, I think, far from sufficient to understand the problems with our scientific establishment. Schulman agrees:

It’s a plausible diagnosis and a good prescription. Science can’t answer questions if it’s conformist. But there’s another way to think about the problem.

Dr. Susan M. Fitzpatrick, a former biochemist, has pointed not to ideology but the mechanics of research. Large-scale medical studies rely on standardized methods, one of which is testing theories on mice. But mice don’t get Alzheimer’s, only humans do. So studying them might be useless. Yet, she wrote, this approach “dominates federal funding and academic science” on Alzheimer’s research because it easily produces the publications and citations that careers depend on.

From this angle, the N.I.H. looks like a big factory that churns out research papers. Dr. Bhattacharya is like a new manager trying to figure out why sales are down and proposing more diversity in the product line.

For the sharpest reformers, like Dr. Cook-Deegan and Dr. Fitzpatrick, the issue isn’t which group of scientists’ ideas win out. It’s that when countless jobs and storied institutions depend on the mills to keep churning, it stops mattering what comes out on the other end. The question is not whether the factory’s settings are wrong but whether it should be a paper factory in the first place.

Here is the fundamental point that science reformers keep screaming about: the system can't be reformed until we have some other way, besides publication counts, of  judging researchers and research. Since nobody has any idea what that might be, real reform seems unlikely.

There seem to be whole fields of research that exist mainly because scientists can publish about them and thus keep their jobs. But what else are scientists supposed to do? They, like everybody else, want to keep their jobs. Many of them would probably rather do weird, cutting-edge stuff that will most likely fail; others would rather switch to a completely different area of science, but our system makes that extremely difficult.

In his conclusion, Schulman comes back to the weirdness of Bhattacharya talking scientific reform in a department headed by RFK, in an adminstration headed by Trump. True, those are big hurdles, but until we have a workable model for reforming science it almost doesn't matter who the president is.