Saying something new on the looming landscape of medical research in Italy isn’t trivial thing. It requires astuteness, stomach, and a fair degree of imagination.
Today, I will try to pull all of this out of the hat as panelist of a conference organised by the University of Bologna on the “evaluation and perspective of its biomedical research”. The meeting is held at Aula Magna in “Nuove Patologie” at St. Orsola’s University Hospital, on Monday 5th October.
The Director of the Medical and Surgery School, Luigi Bolondi, has gathered some University’s alumni to discuss the good, the bad and the ugly of medical science in Italy and abroad, and to assess whether the biomedical research of Bologna is in healthy condition.
I am confident the reader and I share the same answer to that very question.
Among the invited speakers, Riccardo Dalla Favera (Director of Institute of Cancer Genetics, Columbia University, New York, USA) and Stefano Pileri (Director of Haematology Unit at European Institute of Oncology, Milan, Italy) will give authority to a conference that doesn’t even appear on the University’s Calendar.
Opposite to the keynote speakers, the panelists will deliver “inspiring stories” to an audience of future medical practitioners, part of which is there because forced into the room. Giving the premises, I will close my eyes and pretend to talk to the policy makers of the University, and drop some chilled advises.
Forget about structural reforms
Last summer I visited a friend who works in public engagement for the University of Cambridge. I learned from him that the oldest university in England has a management structure stunningly similar to Bologna’s. In one sentence: professors are on the loose. Any attempt to modernise the ancient Academic Senate has failed
due to the pressure of the lobby. It appears that Cambridge is attached to its traditions as much as other historical institutions, and it enjoys the democratic representation of every member of its elite, at the cost of keeping rules stagnant and having a slow decision making process. Yet – everyone agrees – it works. Last year, a Japanese committee flight to Cambridge to learned the secrets of its success; and The Economist recently compared Cambridge to the U.S. San Francisco: a boiling tech-hub that attracts brains and build companies by the minute.
So no, let’s not focus on the most wanted things of all politicians: more structural reforms. I wouldn’t be too concern about a change in the way Bologna runs. Stripping off people benefits and push them outside their confort zone will be counterproductive and will resolve little, in particular in a contest where researchers and professors feel less and less gratified for what they do. Moreover, the same people will still be there, with the same influence as before.
Instead, let’s take a look at the budget.
Money Money Money
A colleague who exercise patience in Bologna doing biochemical research told me that since the Ministry cut basic funding “we are left with 500€ a month”. I sincerely hope the Government is considering the cost of having an army of trained scientist parked in a lab where all they can do is scrolling PubMed.
But stubbornness is a necessary virtue among Italians, who begun to organise themselves to buy new equipment on eBay from closed-down companies, or manage to stay afloat with revenues from patents or international funds.
If its not the Government, the University of Bologna must give more money to its researchers. To do so, it must set up a serious Foundation with long-term communication and engagement plans to attract private capital. Every cent should then be invested for infrastructures [I am saying this again: infrastructures] to which all researchers can have access to, from histology services to animal houses to Next Gen Seq platforms. Labs should not be asked to pay for such facilities, unless they exceed the basic use.
To enable this, Bologna needs to revise its relationship with private capital. Seen as constrainers of “pure science”, industry and philanthropist’s money look like devil. This attitude has changed across the most prestigious institutes of the world, and Bologna must follow quickly. University of Cambridge is about to unveil its most ambitious fundraising campaign, to which people like Bill Gate are expected to contribute. The newly born Francis Crick Institute (the biggest biomedical centre in Europe) plans to ask philanthropists to directly sponsor PhD and PostDoc fellowships, and organises dinners where the wealthy donors interact with the sponsored scientists. All this should be expected and welcome.
PhD means PhD
A concerning number of MD undertakes doctoral studies as a mean to prolong the work experience at the hospital. Italian MD-PhD fellas enjoy a minimal salary of just 15hr-week to dedicate to science, without money for extra research cost. On top of this, MD-PhD are expected to continue to work as usual in an understaffed public health service. These conditions make it impossible to perform serious research, and cause young doctors to see the PhD as an extension of a working contract. This must rapidly cease.
If more doctors are required to help hospitals, get them another contract and don’t use research fellowship just to get another pair of hands. A serious MD-PhD program must be put in place to let doctors equilibrate their time between patients and data, and high-impact science must be expected from it.
A change in such system will be difficult – as the offer to work in a good hospital greatly exceed the demand – nevertheless essential. Either the number of positions are reduced and the budget of fellowship raise, or more rigid guidelines on the Medical PhD should be introduced [and followed].
The way out
Italy has been praised for its effort in assessing the quality of its Universities, together with Germany and UK. Similar efforts have been done within Bologna’s establishment, and a policy to reward the best laboratories is now long waited. Rewarding the brave and successful is not difficult to do, but for someone it is politically despicable. There are different tools to do so, and in the absence of money, the “opt-out” option should be carefully considered.
Every few years, the least productive research units must be dismissed. Public employee from that lab should be offered to service the University in a different manner, perhaps focusing on teaching, outreaching or [wait for it] helping out administration: the self-perpetuating paperwork in Bologna would greatly benefit from scientists who know how to optimise a process, and know students and researchers needs. The money saved should be reinvested in two ways: either opening a new research unit affiliated to an existing laboratory, or improving facilities. The decision should be made upon the rational of how many scientists the University can/want to sustain. This decision will than be used to reinforce trust with the private capital about the seriousness of the research business at the University, where excellence should be seen as the driving force.
I’ll sit on this panel the same week as Massimo Pizzato’s lab publishes an Article on Nature on the discovery of the function of the HIV-1 protein Nef, the fall of another mystery on the virus infection strategy. Pizzato operates at University of Trento, supported by high-profile international fellowships and grants. The research is set to be a landmark in HIV biology, and it was done in Italy.
Recognition of Italy’s contribution to science is not as bad as it could be, yet in times of economy stagnation and unstable European policy, it surprise no one that the Bel Paese ditches public research into the drawer of the “maybe-later” reforms. A tiny slice of the country’s GDP comes from cutting edge technology, and public see science as an expensive exercise to keep the academic elite happy, and not as a real support for development and growth.
Government disattention on public research is no-excuse. The University of Bologna prides a growing independency, and must act rapidly to enable all possible resources to further support its researcher body. It’s a matter of will, and a matter of money.