The Great Diseases Project: NIH or NSF – Who’s Got the Money and the Mandate?

high school student with molecular model

Editor’s Note: The following post is the final part of a series on “The Great Diseases Project: A Partnership Between Tufts Medical School and the Boston Public Schools,” in which AM Rounds asked a few of the projects’ participants to share their thoughts and impressions on the collaboration.

By: Karina Meiri, PhD, Professor of Anatomy and Cellular Biology, Department of Anatomy and Cellular Biology, Director, Center for Translational Science Edication, Tufts University School of Medicine, Boston, MA.

We were so excited to see news about our paper in Academic Medicine; within a couple of days, school districts around the country began contacting us about using our curriculum. We were particularly delighted because the fundable score on our National Institute of Allergy and Infectious Disease (NIAID) proposal would take the project to the next level – national dissemination using our graduate student and post-doc team to mentor teachers in the best way to implement this challenging new material in their classrooms.  The districts contacting us would begin this process, and maybe even start a legitimate career opportunity for PhDs who didn’t want a life at the bench but loved education. If even a few of the 100,000 new science teachers President Obama was proposing were already scientific experts trained in curriculum development, they could provide on-the-job support for teachers already in classrooms and hungry to learn about up-to-date health science.

And then the other shoe dropped. Grantees of our program, run by the Office of the NIH Director, were invited to a conference call. We were optimistic – the new K-12 science standards had effective health education up-front and center on the very first page of the rationale for why new standards were necessary in the first place. Was NIH planning to increase its commitment to health science education? Not so fast. The Deputy Director told us that NIH is pulling out of K-12 health education altogether. The Department of Health & Human Services (HHS), getting a jump on the Office of Science and Technology Policy’s report and the President’s 2014 budget call to consolidate K-12 STEM education programs, is ceding NIH’s STEM programs to National Science Foundation (NSF) and the Smithsonian. All funding would ‘pause’ while the logistics were worked out: This means axing all recently awarded grants and cutting off non-competitive renewals after 2013. To put this sequester windfall in perspective, these programs cost NIH about 0.001% of its budget, not much more than a single clinical trial.

We need to understand the unhappy outcomes this hasty policy decision will engender. The fact is that STEM education and STEM health education are not superimposable, moreover STEM health education is in the crossfire of a fundamental philosophical difference about how education in general should be approached. The aim of STEM health education is to engage students in learning in order to improve their capabilities to evaluate some critical aspect of their health. As practiced via NIH programs like the Great Diseases project, STEM health education is above all a practical enterprise embarked on with very clear goals in mind – do or do not students acquire enhanced capabilities to do something: understand a particular topic, like flu viruses, solve a particular problem, like how to limit exposure to infection, and then make a particular decision such as getting vaccinated. Intrinsic to this practicality is the notion that these capabilities must be embedded in understanding the underlying science. NSF, on the other hand, requires its STEM education programs to focus on research that is deeply rooted in educational philosophy such as “theory of learning.” The emphasis on how students learn, rather than what they learn, means that evaluating student capabilities is often not the end product. STEM health education has no place in this process-driven world.

The new science standards acknowledge the importance of health in STEM education: “..some knowledge of science and engineering is required to.. make informed everyday decisions, such as selecting among alternative medical treatments.” So let’s make the issue clear. Genetics is anchored in the same science whether we’re talking about flu or fruit flies, but has implications far beyond DNA mutations when we’re talking about pandemics: Why do new flu strains keep appearing? When should we be worried? Who should be immunized first – and why? The point is: wouldn’t you be better equipped to “select among medical treatments” if you had actually learned about the health implications of flu virus genetics rather than just about fruit flies? Is it even possible to make an informed decision about vaccinating your children without understanding the significance of herd immunity? This is NIH’s responsibility, and not only because NSF doesn’t have a mandate for health education and so has actively shunned it for as long as anyone can remember.

NIH is clearly not responsible for this decision, but neither can they protest it, at least no publicly. Moreover NIH is hampered by an outmoded charter, which focuses on research at the expense of other civic responsibilities like education. It seems odd, at the cusp of the 21st century, to encounter a decision to divorce research to improve health from education about how that research will impact our lives, precisely what this plan will end up doing. Even more so when we consider the HHS report that 9/10 adults have limited health literacy, costing us over 100 billion dollars a year in extra medical costs – never mind biomedical jobs that remain unfilled because we lack skilled applicants. In fact we believe we only need look around to understand how limiting NIH’s ability to support STEM health education is already coming home to roost: resurgences in previously controlled infectious diseases, surely reflect nothing more than the fact that our children have not grown up learning how to evaluate critical health science information. And so, as our Great Diseases Project, which has had nearly 1000 high schoolers debating  ‘Is vaccination worth the risk?’ and which was set to have many more learning about the newest flu virus, is about to be axed, we are left asking ourselves:  Is it too much to expect our science policy makers to be able to identify the baby in the bathwater before they pull the plug?

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