I recently interviewed John Todd, a Professor of Medical Genetics at Cambridge, as part of a series of interviews we’re carrying out for a case study. The aim of the series is to find out what key people in the field think about:
What opportunities are best in the medical research field?
What’s the balance between talent constraints and funding constraints?
Who’s a good fit for medical research?
Would our case study candidate be a good fit?
How to go about this kind of career
The main points made in this interview were:
John would prefer a good person in his lab to an extra £0.5mn in annual funding. Generally, there are enough grants, so finding good people is a bigger constraint than money.
People with both medical knowledge and with statistical or programming skills are highly sought after.
Within medical research, it’s not straightforward to try to “pick” an area to work on and it changes quickly, though there are some broad strategies to use (e.g. pick diseases neglected by pharma, take a longer term perspective, avoid bandwagons)
If you want to fund medical research, it would be difficult to beat going with the Wellcome Trust or Gates Foundation. Likewise, if you want to find the best areas to work on, these foundations are a good start.
Getting an MD, then doing a PhD as a registrar is a good way in. If you have programming and statistics, you don’t need the PhD.
He prefers Academia to Pharma.
Other updates for us:
This is evidence in favor of medical research overall being talent constrained by people who could be good researchers, which implies if you have the choice between earning to give in support of medical research and doing the research yourself, it’s better for potentially good researchers to go into research.
There could be a good case to be made for programmers and statistics going into medical research, and combining programming/statistics with medical training.
The interview process
The interview was conducted in person, with a list of questions sent ahead of time (see Appendix). Below, I include some key quotes and summaries of what was said. The write up was run past John to check before posting. We chose this person because we know them personally and they run a research lab, so are well placed to answer high level questions about funding and hiring.
Highlights of the interview
What are the most high leverage problems to work on?
“Gaps in knowledge get filled pretty quick. When a promising new area or tool is identified, there’s a bandwagon effect, because new is easier to publish. Right now, one example is the microbiome. Everyone’s going into it, but it’s really complicated. Lots of the results that come will probably be false positives.”
However, there seems to be several ways to get an edge.
To find the best areas, he thought it would be difficult to beat the major strategic funding bodies.
“A simple way to know is look at the 5 key areas identified by the Wellcome Trust.”
John would recommend focusing on big killers e.g. malaria, TB, type 2 diabetes and obesity (which kill through heart disease). In particular, focus on the developing world diseases that get neglected by pharma.
He also suggested focusing on difficult problems that will take 20-30 years. Many other people rush to publish, so the easy stuff gets done quickly. If you can secure funding, you may be able to have outsized impact by having a more long-term focus.
“Difficult problems are really good to work on.” “The really great researchers have a major fundamental question they want to answer”
A few other ideas
“Someone in charge of a funding body told me they don’t fund lung cancer research because it can be easily prevented by other means.”
“Autoimmune diseases may be an unmet need. They’re very complex, because the immune system is designed to adapt to outside influence.”
Would our case study candidate be a good fit?
Our candidate does data analysis in finance, earning over $100,000 per year. They have an Economics degree for Chicago, and an Masters in Financial Engineering from University of California, LA, and reasonable programming skills. They’re planning to do an MD then PhD.
“This guy looks great. I’d love to hire him.” (when he has his MD, or even before).
“The MD and programming/statistics combo is lethal. Top of the world. There’s major demand.”
He probably wouldn’t need to do a PhD, because of the programming. After his MD, he could just apply to a lab. He should go into genomic medicine, which is what I do. Tailored therapeutics or stratified medicine will be played out for major health and economic benefits over the next 30 years. Check out Atul Butte at Stanford. He’s the perfect profile for this guy. He could be the new Butte”
Why is there so much demand for programming?
“All the kids need to learn to program and understand statistics. The data sets are getting bigger and bigger, and better. You need to learn to move data around. You need to avoid being fooled by randomness.”
Talent versus funding constraints
Would you prefer £100,000 per year or this guy working for you?
“Definitely the guy”
How about £0.5mn per year?
“I’d still the take the person at £0.5mn. By £5mn, I’d prefer the money! There’s a cut off somewhere between the two.”
Why would you pay so much?
“It’s very difficult to find brilliant people who have the true grit to get things done, even if it takes a long time. Most of them end up in the city.”
“The best people are the biggest struggle. The funding isn’t a problem. It’s getting really special people. I call them the one percenters…If you have a good person, it’s easy to get the grants for them. I don’t think there’s a really good researcher out there who couldn’t get funding from the MRC or Wellcome Trust.”
“One good guy can cover the ground of 5, and I’m not exaggerating”
What does the funding landscape look like?
“20 years ago, research was more decentralised. I wrote an MRC project grant as an undergraduate at Edinburgh. That would be impossible now. (Small grants) don’t exist or are so competitive, you can’t get them”
“There has been a shift towards Oxford, Cambridge and London – big centres. If you’re in a major centre, it’s maybe easier to get funding. If not, it’s really difficult.”
“It may be a problem, because we’ve reduced our diversity. On the other hand, it’s important to support elite centres”
What areas might be uncrowded, and easiest for a researcher to get funding in?
“Look up the Wellcome Trust and Gates Foundation funding priorities. Gaps close quickly though.”
More generally, what does a good person look like?
Very smart – will tell you if they know the answer, and will say they don’t know if they don’t
Curious – has big and important questions they want to solve
Wants to make a difference
Routes into medical research
Do you need a medical degree?
“You can get to the top of academia without an MD. If you want to get to the top of pharma or direct a medical school or institute, they’re now mainly only hiring MDs.”
Why’s pharma mainly hiring MDs?
“Because they know about patients, disease, hospitals, therapy. Command greater salaries. It’s a passport. It shows you’re pretty smart.”
“The PhD degree has been ruined over the last 20 years, though Oxford, Cambridge, London, top American universities are more respectable.”
Should you do an MD/PhD?
“I don’t prefer the MD/PhD route. The people aren’t very good, because they’re doctors who don’t really care about research. Also the medical students are too young at this stage to really get to grips with research”
“The good ones do the MD first. Then in your registrar training, do your PhD as you’re doing your first medical job.”
(And note, if you know programming/statistics, you might not need a PhD)
How should you structure your career?
“Get into a really really good lab (in a major centre). (e.g. LMB in Cambridge) Then work on a really difficult important problem for 10 years. Try to get long-term funding.”
“To get the first step, you’ll need to initially focus on publishing in a couple of top journals. There’s a lot of hard work and luck involved; always be asking the question, if I get the answer to my big question, how many people in the world will care?”
Do you prefer Academia to Pharma?
“Always academia. The environment is completely different. It’s really unpredictable in Pharma. Your boss can call you one day and cancel your research.”
“Pharma’s disintegrating at the minute. The low hanging fruit is gone. Now the trend is towards much more specific medicine and tailored therapeutics.” (This is the so-called ‘Patent Cliff’)
What options are there for someone who doesn’t make it as a researcher?
“If you have the MD, just drop out into medicine! There’s lots of other options for someone with those qualifications.
“From research, many people drop out into teaching.”