On Monday, the Nobel Prize in Physiology or Medicine will go to a few scientists for work that untangles the intricacies of the human body and may advance treatments for cancer, heart disease or other major illnesses. The prize comes with a sizable check and virtually ensures that the winners’ research will be well funded for the rest of their careers.
Every recent recipient has undoubtedly deserved the honor. But that doesn’t mean that prizes for medical research are a good idea.
The Nobel, along with the Dickson, Lasker-DeBakey, Canada Gairdner and other major awards, honors the scientists who are usually in the least need of recognition and funding, which squeezes out opportunities for other scientists.
More important, by emphasizing the importance of scientific breakthroughs — serendipitous occurrences that rely on decades of research — these prizes play down, and diminish, the way that great medical advances build on one another.
All scholarship is, to some extent, built on prior work — but this is especially true in scientific research. Consider James P. Allison, the winner of this year’s Lasker-DeBakey prize in clinical medical research. His work helped clarify one way cancer cells hide from the immune system.
Around 1990, a team of scientists found a protein on the surface of immune cells and proposed that it stimulated the immune system. Dr. Allison’s lab and a third group suggested that the protein put the brakes on immune responses. A fourth group confirmed that it halted the immune system, rather than stimulating it. Dr. Allison later showed that blocking this protein with an antibody could unleash an immune response in animals that could lead not only to rejection of but also immunity to many kinds of cancers. A decade later, similar antibodies to this protein and other related ones were found to prevail against several types of human cancers.
Dr. Allison’s work is surely impressive. But it occurred alongside and in dialogue with a number of related findings. Researchers analyzed the citations that led to Dr. Allison’s drug and concluded that it relied on work conducted by 7,000 scientists at 5,700 institutions over a hundred-year period. Yet only he was recognized.
The prize industry contributes to a deeper problem in scientific research: We throw resources at a privileged few who have already achieved enormous fame.
One study that tracked funding for university professors and researchers over an eight-year period found that about 80 percent of research funds in basic medical sciences were concentrated among the top fifth of researchers. This is bad for the long-term health of the discipline: After top scientists retire, who will replace them? We should be giving more support to midcareer scientists whose work will contribute to major advances in the future.
And there’s yet another problem. By honoring breakthroughs, award committees reinforce the misconception that science is all about discoveries, when the cornerstone of science is replication and corroboration of results, which ensure that a finding is real and not a false lead.
We especially need to dispel this myth now because the scientific community is in the midst of a replication crisis. Nearly all published medical papers report significant or positive results, but many efforts to duplicate the findings failed, putting subsequent research in doubt.
The regular occurrence of false leads also hints at the enormous role serendipity plays in discoveries, which some Nobel Prize winners have acknowledged in their acceptance speeches. In one study of 101 basic science discoveries published in top journals that claimed a drug had promise, just five led to approved drugs. Even the most promising research may never translate into actual medicine. This means that a majority of creative, persistent and passionate scientists do not win awards, and may advance their fields only incrementally, if at all.
That’s because science is hard. It’s like exploring an unknown land; we’ll never know whether over the next hill lies an expansive vista or just another hill. A finding that seems mundane or trivial may become immensely important years later when a parallel discovery contextualizes or clarifies its implications. Medical research is even more elusive. We seek not only to understand the inner workings of human biology, but also to perfect the body and manipulate it to our desires. And, unlike physics, it can’t be advanced by purely theoretical work, or by a single individual.
If we keep giving prizes, let’s award them to experiments with rigorous methods — large sample sizes, representative populations, appropriate controls and blinded experiments that eliminate subconscious bias — instead of ones that achieve headline-grabbing results. Great scientists can control all these things, but they can’t control the outcome.
Or we could break up big prizes and give out many smaller awards. This may be more effective in supporting science, a view shared by Terence Tao, a mathematician who won $3 million from the inaugural Breakthrough Prize in Mathematics but tried to talk the man who gave it to him into spreading it around to more people. Alternately, instead of giving out big science awards, let’s use the prize money to study better ways to fund science.
All the winners of this year’s Nobel Prizes deserve praise. But the most important scientists are the ones who demand better experimental design and pursue the truth, regardless of how things turn out.
Vinay Prasad, an assistant professor of medicine at Oregon Health and Science University, is co-author of the forthcoming book Ending Medical Reversal: Improving Outcomes, Saving Lives.