Building an institution & “research manifesto”

A medical student reached out to me to explore a career in Oncology. While the preliminary interaction focused on understanding the motivation levels and clarity of purpose on the individual, I am due to share a wider perspective later in the day today. It also spurred me to think about building institutional capacities and brought me in a privileged position to shape the outlook to steer people towards cancer research and delivery.

We end up forgetting the primary purpose of being a medical professional in routine clinical practice. Healthcare becomes increasingly bureaucratic as individuals progress in the clinical ladder. Building a local, national and global reputation involves several trade-offs on personal time/capacity, with competing priorities of running an institution (administrative/financial domains) while being empathic towards its specific constituents-patients. In this, it becomes easier to forget the “middle-layer” (clinicians and para-clinical staff), where it is assumed everyone is aware and swears by the institutional ethos. Therefore, an elevation on the “high-seat” often comes with a trade-off of continuing with the predecessor’s policies (“because they worked before”) or a radical departure to push new boundaries (“move fast and break things”). The paradoxical truth, I reckon, is somewhere in between.

There are several questions, and the following represents the several streams of thoughts, as I attempt to look at it from both an administrative perspective and as a knowledge-seeker.

How do we “refresh” the idea of being “focused on research”? What is “cancer research”? Do we move new boundaries when we discover yet another pathway and “hopefully” a new molecule (therefore, aligning with the goal of fiscal compensation)? Or do we radically pivot towards pushing our knowledge boundaries? Or, we merge the two and attempt to bring in efficiencies by eliminating bureaucratic barriers?

The next obvious question, on lines with the ongoing chatter about the “diversity-inclusion” check boxes- how do we attract and retain meritorious international talent and as a “research-council” to imbibe and encourage the best ideas/practices for healthcare? How do we eliminate the “protectionist” impulses without making it a political hot-potato? These require careful calibration of policies designed to eliminate inherent biases, with a larger goal of fostering meritocracy.

These questions merit soul-search, because we haven’t had a “breakthrough” in cancer. Unless we assume that combining the newest molecule with a proven record of Stereotactic Radiation for specific malignancies requires an elaborate system of “late-breaking abstracts” and embargoed articles. Those mechanisms are a fanciful way to burnish credentials for the next round of “funding cancer research”, while in reality we are forced to deal with enhanced expectations in clinic, in the face of piffling “disease free survival”.

We can do better.

Last, but not the least: importance of “ideas” and retaining the intellectual curiosity. Early clinicians used to be scientists. For example, Sir Ronald Ross discovered the malarial parasite, but only because he was curious to discover the “blood-elements” causing “febrile episodes”. We, in turn, have “outsourced” our research capabilities to different sets of meritorious individuals, but divorced from the “ground-truths”. I agree there has been a counter-movement to build capacities around “clinician-scientists”, but admission criteria and talent pool are directed towards the application of medicine to treat, but not heal individuals. As such, outstanding clinicians (or oncologists) are turning more towards “intellectual thought leadership” via well-rehearsed demonstration of survival curves from “collaborative research groups”. Clinicians have stopped with the “higher order of thinking”, which allows us to find order in chaos.

Building a Research Manifesto

I am including some generic pointers here. These rely on past experiences and future challenges:

• Liberate ourselves from practices that are not working to liberate research, or else we risk bring our own obsolescence.
• Eliminate redundancy and capture relevant insights into what matters by opting to change.
• A re-look at the index scores (scientific metrics/h-indices) by judging qualitative/quantitative matrices of novel ideas instead. Indicators should not be a substitute for informed judgement.
• Institutional policy determines a review of research (either advancing the frontiers of knowledge) or addressing societal concerns. A single evaluation model to assess application in all contexts will fail to deliver.
• Understand the context of subtle impacts of technology on research, and alter research manifestos in step with time by keeping decision-making processes open and transparent.
• A conscious effort to avoid misplaced concreteness and false precision by understanding conceptual ambiguities.

I’d quote a memorable quote from my mentor:

The depth of the abyss should be evaluated to determine the consequences of a slip.