I've gotten a few raised eyebrows this week as to why a modestly-compensated, mid-career cancer researcher would choose to (or could afford) to vacation in Aspen, Colorado. I'll have more to say about this, but just one example of why this is such a worthwhile place to visit comes from my 2 hours yesterday at a free Aspen Institute lecture listening to financier, venture philanthropist, and prostate cancer survivor, Michael Milken, talk about how to revolutionize the pace of scientific discovery and implementation of medical innovations.
Many people remember Mr Milken incorrectly, or at least incompletely, only as "the junk bond guy" who only got interested in philanthropic cancer research after his own prostate cancer diagnosis in 1992. Contrary to this conventional wisdom, Milken has been involved in philanthropy, public service, and public policy his entire life. While he is too diverse and complex to categorize in a sentence, I find Milken to be atypical 60s-educated UC-Berkeley hippie whose education from birth, it seems, was transformed by the 1957 launch of Sputnik and the massive kick in the ass it gave to American ingenuity and teamwork (regular Terra Sig readers may recall my writing that Sputnik was also the catalyst for the five decade effort of the Biological Sciences Curriculum Study). In elementary school in 1961, Milken wrote to President Kennedy of his qualifications to lead the nation's space program (he never got a wrong answer on any math test to date).
But most importantly, Milken realized that so many of the world's problems could be addressed by education and the democratic availability of financial capital.
While not a scientist himself, Milken repeatedly presents opportunities for the top minds in science and medicine to gather and exchange ideas on how best to transcend the infrastructural impediments to scientific discovery and accelerating access to medical cures to serious diseases. He has founded a Washington, DC-based think tank called FasterCures - The Center for Accelerating Medical Solutions (www.fastercures.org), including an initative called Patients Helping Doctors (PHD) where patients can get involved in helping physician-scientists overcome HIPAA regulations to broaden access to their medical information and biospecimens (one study of his group's cites that 70% of cancer patients would gladly give up rights granted under HIPAA to open full and unfettered access to their medical records by the research community - Milken asks, "So, how do we as a society tell our federal government that we'd like to opt out of a "right" given to us as patients).
And there's no sugar-coating the fact that Milken comes from a business background that embues him with little tolerance for those medical and scientific administrators who "just say no" to innovative procedures and relationships that impede medical progress and the sharing of data and intellectual property. Administrators of health and science entities (hospitals, research universities) have grown too fat and lived too high on the hog for so long that the purpose of the institutions they represent has been obscured by the parasitic sucking of the teat of the indirect costs (sometimes called overhead or indirect technical expenses) originally designed to provide research institutions with monies to offset facilities costs such as heat, A/C, electricity, etc.
Milken is very wise to the fact that fat cats who sit in fine-art-decorated offices at the top of hospitals and academic medical centers are exanguinating the US medical research enterprise by diverting the funds from those who plan and execute the research. He is very well-aware that adminstrators, vice-chancellors, vice presidents often make upwards of $300,000 to $1,500,000 (USD) while forcing newly-appointed assistant professors making $70,000 (PhDs) to $130,000 (MDs) to bring in 50 to 90% of their own salaries on grants and contracts, not to mention fully supporting the research staff, graduate students, and physician-scientist trainees out of their own grants or institutional training grants. At one institution to which I am privy, the removal of one former chancellor whose current activities appear to be serving on pharma advisory boards (thereby making even more money), could pave the way for generous packages for 12 assistant professors, 8 associate professors, or 5-6 full professors who would still bring in even more money on research grants to support the other parasites that occupy higher administration of non-profit, US research enterprises.
I had the chance to tell Mr Milken that one of my affiliated institutions refused to let me apply for one of his foundation's grant awards because it didn't pay our full overhead rates. Milken clearly saw this as an opportunity to address the well-heeled Aspen audience to be cautious in their own medical philanthropy and hold the feet of institutions to the fire to account for the expenditure of research funds. An overhead rate of 25% should be adequate for any well-managed research institution to "administer" scientific research programs. Milken's foundations even leave the intellectual property of discoveries to the home institution (who then would only share about 25% of future proceeds with the researcher and his/her laboratory) as the bargaining chip in getting the host institution to agree to these lower, but more realistic, overhead rates.
Just a few other highlights:
The top ten problems facing the world can be solved by and reduced to: real and early investment in education and real investment in renewable energy resources (not the vicious and unsustainable cycle of subsidized corn-to-ethanol, but rather solar and wind power).
The earlier investment in childhood education brings a far greater return on investment than a greater number of dollars plowed into secondary and post-secondary education (I believe these numbers came from University of Chicago economist and Nobel laureate, James Heckman).
Milken feels that the US is doomed to fail in economic and intellectual power to China, India, Singapore, Indonesia, etc. if states decide, as in California, that a competency exam to write a one--page essay in English at some point during K-12 education is too demanding while the 600 million children growing up in China and India alone will be more fluent in our language by 2020.
Similarly, he has observed over the last 30 years that while soliciting the advice of Nobel laureates is invaluable, actual financial support of scientists is most cost-effective and return-on-investment is greatest when provided to those in their late 20s, 30s, and early 40s. There is no need for a senior scientist to hold eight R01 grants.
The NIH grant review process has grown too cumbersome, inefficient, and fails to reward true innovation and risk-taking. Compare the 25-page NIH R01 application with its nine-month turnaround (if funded on the first cycle) to the Prostate Cancer Foundation (and others) 5-6 page proposal and 60-90 day submission-review-award notification timeline.
Five countries currently have an excess of unencumbered financial capital of $50,000 USD or more per citizen that will be reinvested in such globally competitive enterprises as Singapore's Biopolis that threaten (or already are) taking the top minds and researchers from Western countries out of situations that don't support their innovation.
Fourteen countries, like India, actively advertise "medical tourism" for procedures like coronary artery bypass grafts (CABG) that can be performed by US-trained foreign physicians and surgeons at a fraction of the out-of-pocket costs in the US, often with mortality rates 1/3 those of the US.
Other valuable and informative links:
Faster Cures - The Center for Accelerating Medical Solutions
Patients Helping Doctors
Prostate Cancer Foundation (formerly CaPCure)
Other Milken Philanthropic Efforts
So, that's one reason I like to "vacation" in Aspen.
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Hi there-
A good friend of ours heard Milken speak at a prostate cancer research event... knowing my history, our friend got me a signed autographed book from Milken wishing me good luck. Received it with some mixed feelings about the guy! Thanks for the update on his philanthropic work
Interesting guy. Do you think this
is right? According to this article, the average overhead rate in the US is 52%.
Anjou: I'd hesitate to call the man a saint, especially after I spent the first part of the week reaming the dearly-departed Ken Lay here and here. However, I went into the Milken talk open-minded, mostly because I had been aware that he was not just some poseur philanthropist and has been very proactive in this arena for roughly 30 yrs. Here's a good overview of the myths and facts about Milken's past and how to differentiate him from Ivan Boesky, a true full-fledged criminal.
Doc Hooker: After coming off study section myself, I can attest to the fact that most institutions average between 45% and 70% facilities and administration (F&A) costs, with nonprofit institutions lacking state general fund monies, tuition, and/or clinical earnings being up in the 106-150% range. This means that a $100,000 USD grant to a research lab in an average, state research university brings in an additional $45,000-$70,000 that your lab or P.I. never sees. Remember that the fringe benefits (retirement contributions, health insurance) for you and your people do not come out of that $45-70K; instead it comes out of your/your P.I. direct costs budget (that original $100K). (Sorry if I'm talking down but I can't recall if you're a senior postdoc or a full-fledged asst prof - maybe I should put up a sample budget page from my lab sometime to illustrate these points).
So, what does that money pay for??? Electricity, ok. Heat, ok. Housekeeping, ok. Hazardous and radiochemical waste disposal, ok. But it's also supposed to cover postage and photocopying fees - at all three of my post-Ph.D. institutions, I've been charged by my dept for postage, photocopying, and even the paper to go in my laser printer. So, while I'm not sure Milken was holding fast to a 25% value, what I think we discussed was that there is a lot of non-research fat being fed by overhead/F&A costs.
So, in essence, universities hire us, rent us lab space, but then ask us to pay our own salaries. They then capture dollars we never see to support the administration whose job it is to tell us we aren't working hard enough.
The American Cancer Society limits overhead charges to 25% and most people outside of those whose jobs depend on overhead generally agree that a 25% value is adequate for a place that also brings in tuition dollars and clinical earnings to offset the lights and heat, A/C, etc.
I know that Orac at Respectful Insolence has been seething about this very issue and I am certain he can address this more eloquently from both the MD and PhD standpoints. We faculty are never involved in the DHHS negotiations whereby our institutions agreed to F&A rates - I would love to see the research faculty assume a far greater role in these negotiations AND for donors to hold feet to the fire of institutional administration whose existence depends on and is supported by the sweat of you, me, our students and professional trainees.
I'd welcome more input from those of you more experienced than I, maybe even some research administrators, as well as our international readers.
I can't recall if you're a senior postdoc
Wow, I suppose I am by now. I've got a 4-year postdoc, a year working for free (immigration issues, couldn't get paid) followed by a year's postdoc in the same lab, and now a year in my current lab. According to the NIH scale, I've got one more year to go before I hit the ceiling (they don't count the free year).
But I'm just starting to think about running my own show, so far from "talking down" I appreciate the information and advice.
(A note to any non-scientists who follow that link: I currently have a fellowship that actually pays nearly what that scale says I should get. Don't be fooled -- it's a very rare postdoc position that pays that much. My last position paid the "0 years' experience" rate, even though I had four, and when my fellowship runs out in August I'll be taking a hefty pay cut, IF I get to keep my job. As things stand, that's a big if. The lower pay rate and uncertain prospects are absolutely typical.)