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Supporting Health Research Comes at a Cost

By December 12, 2018December 13th, 2018No Comments

“Federal agency racks up big expenses after scientists reject web meetings” is the kind of click-bait headline that will get your attention.

The CBC news story, based on an Access to Information request, revealed that the Canadian Institutes of Health Research was spending “$2,600 a day on meals and refreshments” and even more on “travel and hospitality.”

All told, CIHR spent $4.7-million on meetings in 2017, “more than double the previous year’s sum.”

To summarize the reader comments: Yet another example of fat-cat scientists sucking from the public teat! A bunch of cardigan-wearing academics rejecting modern technology so they can rack up air miles and luxuriate in fancy hotels.

It makes for a compelling narrative in these anti-science, anti-government times. But is that really the case?

The CIHR is the principal federal funding agency for health research. It has a budget of close to $1-billion annually.

Most of that money for research on everything from Alzheimer’s to Zika virus is doled out in grants. The allocation is done principally using a method called “peer review” – where professionals in the same or a similar field judge the merit of grant applications.

Last year, the CIHR received 12,128 grant applications. They were reviewed by panels of peers, ranging from 10-25 people. Each grant has three discussants who provide an in-depth analysis and then the panels make funding recommendations.

About one in eight applicants got approved. Clearly, health research is underfunded in Canada.

To make their decisions, panels of scientists read a lot of paperwork, and then they meet to discuss and debate. These meetings take place in Ottawa, in the late spring and early winter.

The scientists spend days on end in windowless conference rooms, sipping mediocre hotel coffee, rewarded with the occasional granola bar. In penny-pinching Ottawa, this is what passes for “hospitality.”

All the peer reviewers volunteer their time, but their expenses – travel, hotel and meals – are covered by the CIHR. Reimbursement is based on strict Treasury Board criteria.

This does not seem to be the least bit unreasonable. Yes, the meetings may cost $4.7-million in total, but that’s about 0.5 per cent of the total budget.

Still, a couple of years back, in a bid to save money, the CIHR decided to scrap face-to-face peer review meetings in favour of “asynchronous online discussions.” What that meant, practically, is that grant reviewers typed their scores into a standardized web form, and grants were allocated based on rankings.

The system was a disaster.

The quality of reviews plummeted. The scores varied widely. The decisions were poor. There was no discussion.

Technology is wonderful, but it is not always an adequate or appropriate substitute for human interaction.

Travel costs were reduced by about $1-million. But the CIHR spent $1.7-million purchasing a computerized reviewing system that never worked well, so the savings were illusory.

Alain Beaudet, a long-time president of the CIHR, resigned, in part because of the debacle. The first thing the new interim director, Roderick McInnes, did was restore face-to-face reviews.

Technically, travel and hospitality costs doubled from one year to the next but, in reality, they returned to what they were previously. Hardly a scandal.

Peer review is not a perfect method. There is a risk of cloistered thinking and a “you scratch my back and I’ll scratch yours” mentality.

But what are the alternatives?

Grants applications could be reviewed and granted/refused by full-time CIHR staff, but replacing volunteer expertise with paid staff would no doubt cost much more.

If we want a no-cost alternative, we could pick names out of a hat, but that’s hardly the way to support good science.

There’s an adage in business that you need to spend money to make money. The same philosophy needs to apply to public spending. If we want to get the best return on investment for public funding, we need to ensure the money is well spent.

Virtually every grant-making agency in the world, including the massive U.S. National Institutes of Health (US$32-billion in research spending annually) and the Bill and Melinda Gates Foundation (which allocates about US$6-billion annually in grants), uses face-to-face meetings to do their reviews.

They do so because, despite the cost, it ensures the best decisions. We should expect no less from the CIHR, as stewards for the tax dollars invested in health research.