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The president of the National Academy of Medicine tells Playbook that medical research must change
More than two years since Covid-19 first began to spread across the US, a pandemic-weary public finally got the news they had been longing to hear last month. “We still have a problem with Covid, we’re still doing a lot of work on it, but the pandemic is over,” Joe Biden told CBS.
While the president has officially declared the end of the Covid-19 pandemic, some of those closer to the research are not so sure. Shortly before Biden’s remarks, the World Heath Organization’s head took a more cautious line. “We have never been in a better position to end the pandemic,” said Tedros Adhanom Ghebreyesus. But he added that the world was “not there yet”.
For Victor Dzau, too, the situation is far from clear-cut. “It may not be as severe in our country and yours as it was a year or two ago, but it’s certainly not gone,” the president of America’s National Academy of Medicine told Playbook in a recent interview. “The virus continues to mutate; who knows what the next variant is? I would say we’re not done with it yet.”
Dzau was speaking to Playbook before giving the International Health Lecture in London on 20 September, organised by the Academy of Medical Sciences and medical journal The Lancet. The focus of his lecture was whether, after the pandemic, traditional academic medicine that focuses on curing individual diseases rather than tackling the root causes in the general population has had its day.
Strategic absence
Covid-19 shone a light on the “lack of strategy” in the US and the UK on how to tackle a pandemic, he says, with fragmentation between the people making decisions about public health and those on the front line in hospitals.
It also exposed a “lack of trust in the community” that, along with virulent misinformation, made scientists’ jobs harder when rolling out vaccines. Here, Dzau feels there are lessons to be learned.
“The medical community believes that once they have all the facts, all they have to do is communicate and then everybody accepts [them],” he says. “But the problem when you have a new pandemic is you don’t know the facts—it’s an evolving issue.”
Dzau points to official advice from some governments about wearing a mask as the pandemic progressed, which switched from a belief that masks did not significantly stop the spread of the disease to ordering the public to wear masks as the evidence of their efficacy grew.
Conflicting messages over vaccine safety also led to a loss of confidence among some members of the public in scientists. This is why a cross-disciplinary approach to medicine is important, he believes.
“We have a huge amount of learning to do in communication. But that links to social behavioural sciences,” he says. “Because if you don’t understand people’s behaviour, how are you going to influence their behaviour?”
Breaking with tradition
The problems that arose in the pandemic offer a snapshot of the problems with “traditional medicine”, meaning not ancient practices such as herbal remedies but the way doctors normally work.
In traditional medicine, Dzau says, the focus is on healing the sick and relieving suffering. But there is less consideration of how to prevent disease and how wider community issues play a role in that work.
While medical research explores the mechanisms of disease and searches for new drug discoveries, “we don’t think enough about research and population health”.
This will have to change.
Widespread health challenges like pandemics, diabetes and disparities in life expectancy between those living in affluent and deprived areas would all benefit from a more joined-up system. “There’s no way that you can turn the tide around from this tsunami of significant health challenges without a more coordinated system looking at population itself,” says Dzau.
Encouraging a broader overview of population health in medicine and research is easier said than done. Fragmentation within healthcare means that “different people have different turfs”, while the separation of healthcare and social services means that the amount of money spent on each differs significantly.
When it comes to universities, that fragmentation can still be seen in the split of different disciplines and departments. In an article published by The Lancet in 2018, Dzau argued for universities to adopt “convergence science”—a transdisciplinary approach to research—to explore ways to improve population health.
At the time, Dzau wrote that “population health needs to be reconceived as a new science and practice of convergence”.
“Improving the health of populations requires an understanding of the myriad factors that influence health. Progress in population health cannot depend on a single sector and requires scientific understanding of education, social services, economic development, environment, nutrition and food marketing, urban design and health.”
Healthcare disciplines, along with areas like economics, law, social science and ethics, should come together to tackle the big challenges, he believes, arguing that universities should create centres to study population health.
But linear structures in universities can disincentivise working across disciplines, says Dzau, pointing to potential issues with promotion if an academic’s work does not tick the right boxes. Not all grants are open to multidisciplinary working either, he adds.
These changes need to happen to encourage a broader approach to improving health across a whole population. “Many people understand this issue. Whether they have the political will to do this or not is another story altogether,” he says.
Maybe these are the kinds of reforms that politicians will be able to focus on now that they think the pandemic is over.
And finally…
There’s still time to vote for the chunky champion of Fat Bear Week—a celebration of the bulkiest brown bear in Katmai National Park, Alaska.
With millions of viewers tuning in to the 24/7 livestream, and hundreds of thousands of votes cast, the competition has been a roaring success that has thrust ursine scholars into the spotlight.
Of particular interest to scientists is what happens after the bears gorge themselves on salmon and go into hibernation, managing to stay healthy after months of starvation and inactivity. “Hibernation is so much more complicated and nuanced than we once thought,” said Joanna Kelley, a biology professor at Washington State University, in an interview with The Washington Post.
In a recently published research paper with the punning title A Beary Good Genome, Kelley and her colleagues explore bear metabolisms at the molecular level. We recommend reading the paper while watching the bears fishing on YouTube in the background. Look out for bear 747, aka Bearforce One—he’s our top pick, and you can’t miss him.
Highlights from Research Professional News this week
Lindsay McKenzie brings us news that the US has been urged to take a more open approach to R&D.
She also writes that the President’s Council of Advisors on Science and Technology has published a report outlining how president Joe Biden’s administration should maximise the $11 billion investment in semiconductor R&D that was authorised by the recently approved Chips and Science Act.
Andrew Silver reports that the president of the United States has signed off on actions implementing a deal with the EU that is intended to make it easier for organisations in the country and bloc to share data, including for research.
In our US news roundup, Biden has re-established the President’s Committee on the Arts and the Humanities, which was dissolved by his predecessor.
Rachel Magee tells us that the 2022 Nobel Prize in Chemistry has been awarded to three researchers from the US and Europe, whose discoveries were lauded for leading to a “revolution” in scientific thinking on linking molecules together. Another US researcher features among the winners of the physics prize.
Surfaced from our Funding Insight archive: how to win a Smithsonian fellowship.
In the news
The New York Times reports that Barnard College is planning to offer abortion pills on campus, and a professor has been dismissed after a student petition.
In The Washington Post, Chicago scientists are testing an unhackable quantum internet, the University of North Carolina is fighting for affirmative action, and a SpaceX launch is the latest sign of lasting Russian-US space partnership.
In The Wall Street Journal, Columbia University is to pay $165 million to settle sex abuse claims, Northeastern University’s law school has accidentally sent acceptance letters to thousands, and a student has been killed at Purdue University.
Reuters says that the latest SpaceX crew has been welcomed aboard the International Space Station.
The Associated Press reports that SpaceX has delivered Russian and Native American women to the International Space Station, a former University of Arizona graduate student is being held following the fatal shooting of a professor, and the president has said that an IBM investment will help to give the US a technological edge against China.
Science says that the Department of Energy is requiring plans to promote diversity from grant applicants.
The Chronicle of Philanthropy looks at how alumni like to engage with their alma maters.
The week ahead
Monday
Today is Indigenous Peoples’ Day, a national holiday.
Tuesday
The National Academies of Sciences, Engineering and Medicine will host a Jefferson Science Fellowship distinguished lecture from Stephen Eubank on the role of high-fidelity, high-resolution modelling and simulation in policymaking.
The National Science Foundation will host a webinar discussing how to increase the research capacity of new faculty in biology.
Wednesday
The Food and Drug Administration is hosting a town hall meeting to answer questions on test development and validation during public health emergencies, with a focus on monkeypox.
Stat News is hosting a discussion on the potential impact of biosimilars for several drugs hitting the pharmaceutical market in 2023.
The National Academies’ first US-Africa Frontiers of Science, Engineering and Medicine Symposium begins.
Thursday
The National Institute of Standards and Technology is holding a webinar to review the R&D programme described in the recently published Chips for America Strategy Paper.
The American Association for the Advancement of Science is hosting a Q&A about its Science and Technology Policy Fellowships, which have a deadline of 1 November.
Friday
The National Academies’ Division on Engineering and Physical Sciences will have an open meeting of its Space Weather Roundtable.
The Playbook would not be possible without Lindsay McKenzie, Martyn Jones, Craig Nicholson and Daniel Cressey.
Thanks for reading. Have a great day.