Most of us involved with Vital Signs are practical hospital workers, but we think that it is important to understand how medical knowledge is produced. Capitalism as an exploitative system relies not primarily on repression or the glitzy world of consumption, but on the idea that it is a progressive society – and who could argue against the fact that there have been plenty of innovations since the 18th century, whether in the medical field or elsewhere. But how do these innovations emerge, do they stem from the clever minds of individual great men or are they products of a more complex social process, with its own internal class contradictions? Could science be done differently? Every now and then we read books about these issues and discuss them – you can read a review of ‘Can medicine be cured’ or ‘Metastasis’. If you work in medical science or research, feel free to get in touch!
Intro
I studied population health at university up to PhD level. I was always interested in the socio-structural background of health and why some people die earlier than others, why some people live in better health than others. I found out during my PhD that there is already a lot that has been researched. I was hoping that I could become some kind of critical academic doing this health inequalities research, but I only managed to get short term contracts in teaching at the university. They said there was no funding. So I found another job in my university, which is as an impact officer working in the Faculty of Medicine and Biology.
Impact work
My specialism is helping them to improve their impact outside academia. The government is interested to know how their research money is spent and what the benefits are. How does research benefit so-called ordinary people outside academia rather than just some closed circuit around academia? This factor is even part of the decision making about how much money universities receive in research funding. The UK government distributes around £2 billion a year, based on certain criteria. The better impact your research has, the more money you get. For example when a team of researchers develops a medicine or a vaccination that goes through clinical trials, is tested and then finds a company that markets this medication or vaccination for a price that is affordable. Then this product gets sold on markets in poorer countries and the researchers at the origins of the story can show in their case study that the research benefited millions of people. There is a national panel that rates these impact studies from universities. A top rated study in this discipline of medicine can get £350,000 pounds. So the university will get £350,000 for such a study, which is not as much as some professors can bring in, as they can bring in millions in funding. But it is still good enough for managers, universities and faculties to push this agenda and to try to make academics submit their impact cases. This is a lot of extra work for them.
So the impact agenda is not as commercialized, but it can be. I don’t want to work in a commercialization department, because I don’t agree with privatizing publicly funded research. In general, what the government gets out of impact studies is good publicity. They are a bit worried that the wider public are getting increasingly detached from research, because they don’t understand research and don’t trust research. It’s in the state’s interest to showcase examples where academics work with so-called ordinary people. It’s difficult, because I work in the health sector and there we usually have research products such as medications, therapies, health innovations, various technologies and policies as well. So changing policy or law or regulation is seen as an impact. But it’s good for the government to raise people’s or societal support for research, because otherwise they may end up in a situation where people would be hostile to research and would not engage with it. This is true even for people like Trump. During Trump’s first presidency, despite all his talk against science, the US government’s funding for scientific research went up. This definitely appeased the liberal science sector.
Commercialisation of science
The research impact studies have a contradictory nature, as ‘impact’ in our current society normally comes in the form of commodification. The government gives subsidies to research that creates commodities – and has an impact beyond academia this way. At the same time impact and commercialisation are not the same thing. There are specialist teams in universities which work only on commercialization. A lot of funding is going there. Every big university can support academics to choose two basic paths when it comes to commercialization, either they choose the licensing path or spinouts. When they choose the licensing path, this means that they develop a product with public money, with university research funding. This product is then licensed to the private sector, because they have got more money to develop it further and bring it on the market. The researchers then get shares from it, they are shareholders. The university takes 20% from that on average. The rest is divided between the academics who are the holders of the patent and the private investors. That’s the easy way of commercializing, because it doesn’t require as much work and as much risk from academics compared to the more risky spinouts.
However, academics can make loads of money with spinouts, where the university supports them to start a startup company. This usually means that some academics of the team leave the university and become business owners and other academics stay. For example at our university, a neurologist became such an entrepreneur because she was a computation specialist and into neuroscience. She developed an AI application that reduces operational time in her field and this was very successful in the private market. She complained though that in the UK, the commercialization was not advanced enough. It took too long within the university to reach the private market. She only managed to raise £100,000 in funding. So she went to America and after a couple of months she raised £500,000 from venture capitalists. And she might be soon able to get another £500,000 from another state in the US. She says there is much more venture capital for health research in America. After she said that, our commercialization manager looked a bit panicked and embarrassed and said: “Oh, don’t worry, we will catch up very soon. We have plans and government support. We will catch up.”
From my experience in this job, there are two types of senior professors in health and biology. There are those who are entrepreneurs, who are very good at bringing millions to the faculty, who have amazing contacts with people in politics and in the industry. They want to be excellent in impact ratings, but sometimes they understand it narrowly as mainly being about launching new products or technologies. For example, they work with digital healthcare and they hire software engineers to produce some digital integrations. No one often knows what exactly it is supposed to be good for. It costs millions of pounds, but what is the exact benefit for patients, for carers or health care workers? I keep asking them and they can’t give me a concrete answer. There are whole university teams of specialists helping them to do the legal stuff, the tenders and finding markets, identifying markets, finding partners, companies, users, everything. And then you have the other type of a professor – these serious old style academics who do science and who are very honest about their limitations. These people don’t get the best awards, they don’t get as much funding. And women are more common in this group than in the first.
The links between science and application
There are links between the university and the hospitals. Many leading professors in my faculty are part time consultants. I don’t know how much of the research actually applies in the everyday consultant work or how much their daily work links up to research. It takes time for them to apply their research because they have to wait for the results of the clinical trials and that can take years. I worked with one respiratory research team which is actually based in the hospital. I am also working with lab analysts. I’m interviewing them for a professor who really cares about improving science and quality of life. She, of course, doesn’t get as much prestige as the ones who are competitive and greedy. She does science with lab technicians and analysts and she talks to them all the time, and includes their practical knowledge into her tests. It’s a slow process, but it’s very nice because you can see that there’s still something positive in science. It’s not pure commodification. It’s not pure capitalism. So I like to offer to do hands-on things for them, not just to improve their funding bits, which I could be doing. For example I do patient surveys for them, or interviews for them, so that they can focus more on the hardcore science, and they get better results.
But people like them give me hope that there is a possibility to organize health science in a different way. Or the lab technicians, who speak about hierarchies between themselves. They talk about the clinicians. In joint workshops, the clinicians like to take over and try to make everyone believe they know best and disregard knowledge that is actually based on experience from the labs themselves. The lab technicians also tell you that they would like to be able to collaborate between labs and share and standardize what they do. That’s powerful. If they would follow the same procedures that would be more beneficial. The problem is that they have to compete with each other as private commercial labs. They say that this is a serious problem, that the managers don’t share information between labs. So they share information as workers between each other when they have a meeting, a workshop or a conference. But it’s kind of an unofficial thing to do. Also the suppliers are an obstacle, so the private corporations that supply them not just with drugs, but more commonly with testing equipment. These people are very keen on keeping things inside the company and not sharing their know-how. So there’s another additional barrier that limits socialization of science and research.
In the 1950s the American sociologist Merton studied the values of science as an institution, rather than values of individual scientists. He identified four basic norms of the scientific community. One of them was something that he called Communalism, when scientists share and collaborate in exchange for recognition. (Originally he called it communism, but he renamed it because he was scared of McCarthyism). The other norms were: universalism, organised scepticism and disinterestedness. I am convinced from my own experience that this communalism still exists. It makes the organization of science workers possible. For the creation of an organic joint organization of science workers, we need some commonality coming from the work itself. Workers have to be engaging between themselves because the tasks they are doing require that. They have to believe that it’s good to collaborate, rather than to compete. The subjective side of it is not a given, of course, because we’ve been living through decades of commodified science and increasing competition.
Separations
The detachment between the academic field and application, for example in hospitals, is quite stark. But even within a faculty or an institute there is a separation. The amount of research projects that are happening and the amount of grants is so big that management doesn’t know what’s going on. That’s why they need to hire research support staff like us to help them to bring together a sense of what everyone’s doing, because this kind of understanding disappears through the system of individual grants or turnover of staff. Perhaps I’m acting a bit like a mirror sometimes showing this or that researcher or the whole team, what they’re doing, in particular what they are doing beyond academia. But in terms of everyday knowledge transfer between science and hospital care, there is a disconnection and fragmentation.
Another weak link between university and hospitals is that there are some student positions for nurses, so they can become research nurses. There is some funding for this. But I don’t know if this is actually helping to integrate research with practice. I went to one workshop or seminar where these nurses were present and one was presenting an innovation on bedside intervention and mobility. She showed some stats. So she was doing some research as part of her degree or masters. It probably helps these health workers to get better grades and careers, but I am not sure about the research itself. The projects seem to start from the individual and their particular career path. A lot of research nurses are pretty detached from actual ward life, there is not much feedback between them and the ‘normal’ nurses. At the same time these kinds of worker figures could be the ones that are able to create a material link between research and patients and the wider health work-force. They can circulate ideas and practices. This would be up for discussion: which other groups of workers can play such a role? The consultants who also teach at university or run trials? The private company reps who organise international conferences on particular medical issues?
State measures to tackle the divide between science and public
The government tries to tackle the increasing divide between science and the public by investing money into the National Institute for Health Research, NIHR. It is one of the big agencies for health research in the UK. The NIHR is not part of the NHS, it’s part of the government. So they set up something called Applied Research Collaborations (ARCs). They are organised regionally. So every region has got one and they have their own websites. Their mission or statutory task is to bring together health researchers from universities, the NHS, the private sector, local governments and regional governments and so on. So all these so-called health stakeholders. This is exactly the way the government is trying to address the problem of this fragmentation. In each region more than one university is involved and several hospitals etc.. Each regional ARC has one thematic strand for ‘public and patient involvement’. So they employ a full time worker whose job is just to bring together members of the so-called public to engage them in their research. I went to one of these meetings and 80% of the attendees were retired academics acting like members of the public. So it doesn’t really cut through to the real working class communities with the worst health outcomes, if you know what I mean.
The contradictions of privatisation of medical science
We have to avoid an easy answer when it comes to the NHS or medical research, which claims that the private sector is just leeching profits. There is more of a cooperation and co-dependence between the NHS or public sector and the private companies, which combine more global knowledge. We have to start from the cooperation as it exists. Even inside the NHS, managers and even consultants are usually open to privatisation because they get better equipment, better tools to work. They can even work on some side projects with private partners and universities. Universities act like middlemen between this industrial investment and the NHS. For example, the consultant who is also a researcher, uses the university and the funding to become a medical entrepreneur. You can have three roles in one person, if you have a good team working for you. The grant sharks, as I call them. They usually have research managers who do a lot of work for them. I worked with one professor who set up a space within the university that presents itself more as a private space. It’s in our science park and they do health data integrations and AI. It’s a hybrid space where you don’t know whether it is part of the healthcare sector or university or a private company. It looks very chic, but these workplaces are the worst employers in terms of security because they are churning out millions of bad jobs, many short term contracts of six, nine months.
The impact of precarious science work and the relation to AI
You’ve got maybe six research councils in the UK which distribute government money. There is the Medical Research Council, then there is a research council for biology, another for social science, for Arts and Humanities. They hold hundreds of millions for research and they announce funding calls. So every year each research council has a range of funding calls for certain priority topics, for example improving air quality in cities or for enabling AI solutions in respiratory science, etc., etc. As a principal investigator you can apply for this, you don’t have to be a professor, you can be lecturer or senior lecturer. If you have a permanent contract, you can live without these grants if you teach at university – and for some time the university will tolerate you having no grants. But if you don’t have a permanent position, then you really rely on these grants as your only income. There are more and more researchers now who live from grants and haven’t got permanent contracts. If you apply for a grant and you say in the funding application that the next step will be commercialization, then you are more likely to get this grant, especially if you already have industrial partners.
Many clerical Research Support workers, including me, fall into this category. I haven’t got a permanent contract, instead my post gets renewed every year but there’s no guarantee. Legally, employers in the UK should give every worker a permanent contract after four years of continuous employment on fixed-term contracts, so I am legally entitled to permanency. But that’s not followed through by the employers and even my union branch can’t do anything about it.
So this must surely create a lot of contradictions within the research. Teams are constantly changed and decomposed and people don’t have much motivation if they are on one short contract after the other. You think you just have to create some artificial outcomes to look good on paper in order to get the next contract. The high fluctuation creates a lot of unnecessary extra coordination work. I think it can only work because research is now to a large extent automated and computerized. So human knowledge is less important than it used to be compared to computer knowledge. And I’m not even talking about AI. I’m just talking about basic software that is used for data analysis in the health sector, for example. So as long as they can hire the person who has got the right data skills for the given methodology and the given software, these people don’t need as much background information or hand over time. They just get a minor task because it’s all very compartmentalized. So they are given this direct task to deliver a certain analysis within a certain time. And the workforce in these precarious jobs is often from outside the UK, because the UK universities still are a magnet. They are often younger without family commitments.
The question is what kind of quality a research has that is mainly based on the digestion of massive amounts of data, less on creativity and cooperation between different fields of science. I was following a seminar about AI in healthcare in my university, where researchers were saying that they’re being literally bombarded by AI manufacturers, promoting and pitching their products, softwares and applications. For the researchers it’s so time consuming to go through all that and to identify what will be useful, what might be useful, what’s total rubbish. They say, for example, that there is a potential for AI when it comes to speeding up the scanning of tumors, say in lung cancer. So these very expensive applications are good to some extent, they can kind of sift through millions of scans and reduce the number of potential risks, but then it still needs an expert eye to look at the AI results.
As science workers you have to defend your working conditions disregarding the outcome of science. At the same time you work in a particular place where society brings together heightened expectations and contradictions. It’s a reflection of society and potentially shapes it in a much more determinant way than if you were working in a food factory. If you work and struggle in the sector there is an additional political level, a responsibility to develop a new critique of how knowledge is produced in science. There is probably a reason why the most active members in the UCU, which is the union for most university workers, are academics from humanities and social sciences, and much less commonly academics from natural or STEM sciences. Among the most active ones, you don’t really find the most precarious ones. So in my university, it’s notoriously difficult to recruit into the union people in STEM sciences, in particular those who just started and are on precarious contracts. Making some individual money on a commercialised research project might seem a much more realistic path than organising collectively as workers.
A new Marxist critique of bourgeois science?
Facing such a new precarious science workforce and the closer integration of science and industries, the old Marxist critique of science from the 1970s has to be reconsidered. Back then science was described as a detached elite field, run by semi-feudal patriarchal professors. This has changed, but how? What would be the tasks for developing a new critique of science on a 21st century level? So the idea of professors who rule autocratically over science is more complex now, because these professors are not as powerful. They’re more dependent on other teams of health workers and researchers and the markets, companies and technologies, as well. So the skills and knowledge are now concentrated in machines and in software that make a single human insufficient in understanding all that complexity. The boundaries between what is private, what’s public, what is healthcare, and what is health research and what are the investors, these boundaries are also very permeable today. Capital is now more mobile and more fluid, with a smart idea and some venture capital, you can make it big time. The question is if all this money creates similar scientific breakthroughs like in the golden age of medical science, let’s say from 1850 to 1950? They throw a lot of money at it, but does it create knowledge? Why is that? Is it due to the inefficient fragmented way that knowledge is produced now or just because things get more and more complex in themselves? And how does the stagnation of science relate to the worsening health indicators? When it comes to typical chronic diseases, the population outcomes are getting worse since around the 1990s. Cancer rates are going up in the US and in the UK, for all cancers except for lung cancer, because of an effective public health campaign. Perhaps it shows the limits of how much science can actually improve health and how health is mainly an outcome of the whole capitalist system and how the system affects individuals and working class people in particular.
