People or projects?

The big news in scientific philanthropy right now is the Wellcome Trust announcement that it is shifting some of its funding from projects to people.

In this way, they are following in the footsteps of HHMI and in the older traditions of the Rockefeller Foundation (“make the peaks higher”) and Carnegie (” find the exceptional man”).   The reaction is predictable.    Some scientists are enthusiastically supportive of awarding funding to a person while others argue that the typical 3 year investigator-initiated project grant is the right and proper way to fund science.   underlying both views is the certainty of each camp that there is a best way to fund scientific research.

In reality – the “people” people have always reviewed proposals valueing the person over the project.    We have all sat on review panels where the first thing said about a proposal is that Dr. X is a great guy (and in such discussions Dr. X is typically a guy).   We then hear about how well the person knows Dr. X, the wonderful person Dr. X trained with, and how if given the money Dr. X will do great things.   ‘Nuff said.    My own advisor (a great guy) often said grants were about “the man, the plan, the fan.”

But what if you are Dr. Y?   When your proposal is introduced with “I don’t know Dr. Y…”, you can almost feel the oxygen being sucked out of the room.   Dr. Y may or may not get funded when all is said and done, but the chances are slimmer than Dr. X’s.   And in today’s tight funding climate slim may actually be closer to slim to none.

And so the rich – right schools, right pedigree, right pals, right meetings, and the right way of thinking about a question – get richer.     And for foundations – who should be taking chances, supporting alternative models, and questioning the status quo, especially when it turns out the status quo might be teetering on a less secure foundation than common wisdom suggests – making the rich richer may be a less than ideal strategy.

There is another way to think about the people vs. project funding dilemma.

Think about programs.   Not the aim 1, aim 2, aim 3 projects and not just the reputation of the proposer.   Rather, focus on what it is that this line of research will tell us?   What will we know if it is pursued?   Will we care?    Besides personal knowledge of the PI, what is it in his or her record that supports the belief that this person is likely to do something interesting?  Make the proposal focus on the program — because sometimes it becomes obvious that while someone (even a great guy) might have a lot of good projects it is not quite clear that it adds up to a serious  program.  

Will supporting her or his program take us someplace?

The “person”-centered review always makes me a little nervous.   There are lots of bright, creative researchers who didn’t go to the right lab for training, don’t look just like the review panel, don’t mingle effectively at meetings, and don’t ever question authority.

I do think that long term, flexible funding is one of the best ways to support science.   And focusing on programs rather than people or projects tends to help spread the wealth.   Most likely Dr. X will still get funded.   But maybe so will Dr. Y.

A call for bold action

The buzz right now is “public-private partnerships”.    What does this mean in the sphere of biomedical research?   What is often meant is that private donors should join their dollars with those provided by federal funders to cost-share large projects.   One selling point for such projects is the efficient use of resources.  What becomes lost when private dollars are yoked to centralized goals is the diversity of decision making that allows for new, and sometimes unpopular, ideas to flourish.   private dollars should take more risks, fund ideas early in their inception, provoke new thinking, and question the perceived wisdom of authority.   It is this idea of distributed decision making increasing the likelihood that a less than mainstream idea will get funded somewhere that, to me, makes private funding of research and scholarship appealing.

So, it is surprising to me that the study on the utility of screening for breast cancer was funded, not by private dollars, but by a government agency.   Of course, it was funded by the government agency that is supposed to look at questions of health care effectiveness.   But still, it is a bold study bringing into question common wisdom assumptions.

We assumed that annual mammography for all women over 40 was effective.   In reality the data — and not just from this most recent study but from a number of studies over the years has indicated that the truth was more complicated.   So why didn’t one of the breast cancer advocacy groups fund a study to answer the question?     Why wasn’t ongoing assessment part of the huge public education effort that has made an annual mammogram part of many women’s lives.

False positives have real effects.   They require follow-up.  They create anxiety.   They undermine confidence in our body’s integrity.   They turn us from well people into diseased people.

I am completely bemused by the headlines shouting how confused women are about the new recommendations.   I am not confused.   They make perfect sense to me.  All tests carry the risk of error.   There is the risk of diagnosing cancer where there is no cancer.    There is also the risk of being given a clean bill of health in January and finding out that you have agressive, metastatic disease months later.   Diagnostic tests should be used carefully.

Private funders with an interest in breast cancer should have been the ones questioning the common wisdom of authority.    There is still much that we do not know about breast cancer.   Too many women die from it every year.    Diagnosing more and more women with small changes that are unlikely to alter the course of their lives is not progress.    Private funders could refocus the question.   They could keep researchers’ eyes on the truly ill and keep us all from being distracted by the worried well.

Advocates should embrace the new recommendations and call for bold action.  Ask new questions.   Fund new ideas.    Diversify thinking.    We might actually make some real progress.

Whither Philanthropy?

The Monday Nov 10 WSJ contained a special section offering solutions to the problems with charitable giving.   I immediately noticed that one of the “problems” not given special attention is that many pundits of philanthropy seem to know very little about the history and philosophy of organized philanthropic giving and charitable giving in the US.   The one basic thing they always seem to overlook is why we have such a rich tradition of giving.   One reason is, our history of distrusting central authorities.   Private giving allows a distributed system of decision making that allows ideas to be tried and tested.    And maybe inefficiency is necessary.    Philanthropy is not business.  It need not make a profit.   It does not have to follow common wisdom or yield to political whims.   These are core characterisitcs that should not be casually trifled with.

There is an unfortunate tendency in most of the articles I have read, and the collection in the WSJ this week falls into the trap, of the lumping together what are very different forms of giving with very different purposes and outcomes.

In general, individual charitable giving (think supporting your local soup kitchen or putting money in the buckets or boots thrust at you at intersections or the entry to a supermarket) tends to be palliative.   The hungry are fed, the sick are cared for, the local child gets the needed operation paid for by strangers.    More organized public charity -(think civic organizations or voluntary health organizations focused on curing a particular disease)- often raise funds broadly from the public, usually on an annual basis, and tend to spend funds via a number of directed programs.   Organized strategic philantropy by foundations that spend incomes from private endowments and do not raise funds from public campaigns tend to support strategic initiatives intending to be alleviative.   Private foundations using a social venture capital model (private funds investing in the public good) often aim their efforts at root causes.    How can we not just care for the sick, but understand the causes of illness and how they can be better treated?    How can we not just feed the hungry but understand why in a world of plenty people are hungry?   Private foundations also invest in the public good through their support of educational and cultural institutions so that we all have access to art, music, history, and other opportunities for informal learning.

In my experience, most attempts to discuss “problems” with charitable giving bog down in worrying about “processes.”    How to write proposals?  How much funding for how long?   What should be the reporting requirements?   In reality – the mechanics of giving and granting are easy.    The problem with philanthropy is not the 5% payout.    The hard part of philanthropy is thinking carefully about what you are doing.    Believe it or not – this is hard.    It is expecially hard in a profession filled with outer humility masking inner hubris.  it is hard to maintain skepticism.  It is hard to ask the right questions.    It is hard to risk failure.  There is no magic way to solve social problems.   There is no right way to make grants.    Non-profits needing to raise funds to support themselves are not all equally deserving.    Sure, most non-profits can do a better job.   But they do not need confused “experts” selling them trendy advice.