Broken incentives in medical research

Last week, I sat down with Scott Johnson of the Device Alliance to discuss how medical research is communicated only through archaic and disorganized methods, and how the root of this is the “economy” of Impact Factor, citations, and tenure-seeking as opposed to an exercise in scientific communication.

We also discussed a vision of the future of medical publishing, where the basic method of communicating knowledge was no longer uploading a PDF but contributing structured data to a living, growing database.

You can listen here: https://www.devicealliance.org/medtech_radio_podcast/

As background, I recommend the recent work by Patrick Collison and Tyler Cowen on broken incentives in medical research funding (as opposed to publishing), as I think their research on funding shows that a great slow-down in medical innovation has resulted from systematic errors in organizing knowledge gathering. Mark Zuckerberg actually interviewed them about it here: https://conversationswithtyler.com/episodes/mark-zuckerberg-interviews-patrick-collison-and-tyler-cowen/.

3 thoughts on “Broken incentives in medical research

  1. The problem with “living, growing databases” is that they are constantly changing.

    Occasionally in science you get publications that demonstrate the state of knowledge of a field at a specific time. “The Dinosauria” is one such publication. It presents, to the best of the abilities of the editors and contributors, the state of our knowledge of dinosaurs as of the date of its publication.

    These are important for a number of reasons. First, they serve as save states for a field of science. Yes, science has advanced beyond what’s in “The Dinosauria”–but if everything went wrong and we ONLY had that book, we could rebuild the field. Not such an issue with paleontology (only us fossil lovers risk our lives over this information), but with a field such as medicine this is critical. We CANNOT afford to lose the knowledge we have in medicine; the death toll would be in the billions.

    Especially with something as ephemeral as a database (how old is the oldest database you’re currently using? The oldest paper on my hard drive is written in Latin), you need these check points or save states. You need a foundation upon which to build. Without these, a lightning strike or fire in the wrong server room is catastrophic to the field in question.

    Second, they serve to force people to essentialize the field. No one can fit all information available into one book on any topic. You have to provide the most important information–and that means you have to CHOOSE what’s most important. That’s not a trivial thing, even in purely academic sciences. What we consider important is what we focus on. And scientists being who we are, if I disagree with you on what’s important I’m going to say so, loudly and clearly. Which may be annoying to the individual researcher, but spurs scientific innovation. To provide but one example: the primary focus in evolutionary theory for the first half-century was to figure out the mechanism of evolution, because its detractors were right that without that mechanism, there was no theory.

    Third, such works provide a way to present data together. What I mean is, a researcher can flip casually between various parts of the book and find inspiration for future research. This isn’t magical thinking; people highly trained to find real connections within relevant data often find these subconsciously. A database doesn’t do that. You have to know what you’re looking for to find correlations within a database. You can’t pull out a database because your kid asks a question, and realize as you flip through the pages that X and Y share Z trait, and I wonder why that is….. Such accidents are more common in science than anyone wants to admit. State-of-the-art textbooks provide a breeding ground for such accidents.

    The exact same arguments can be made for any individual paper or journal. Having a hard copy is important.

    That’s not to say that databases are bad. They certainly are useful tools, and vitally important ones! But I think people overly used to relying on computers for everything from education to work to entertainment downplay the importance of stable resources.

Please keep it civil

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