Is Australia's NHMRC grant assessment process corrupted?

In 2013-2014 I led an unsuccessful "Centre of Research Excellence" grant application to Australia's National Health and Medical Research Council (NH&MRC). We proposed to train 15 early career researchers (10 PhDs, 5 post docs). It was my third attempt, but the first time I had led such an application. We were unsuccessful. Nothing surprising there; these grants are notoriously difficult.

However, this grant application (and the previous two) was relevant to climate change, heatwaves and how ecological changes might change infectious diseases epidemiology. Several projects integrated various aspects of these problems. We also had an extensive "research translation" component, involving many community and professional groups. We had advice and support from the Chief Medical Officer of Australia, the Chief Veterinary Officer of Australia and we had the Department of Defence as an Associate Investigator, including for a study to assess the impact of extreme heat on their workforce. It was the best of the three (group) grant applications I have been closely involved with and many people commented on how much they liked it.

But not the assessors. One, especially, ridiculed it, showing his (or her) own bias and lack of diligence. Reviews are an opaque, anonymous process. People whose names we don't know can and in this case did make factually wrong and even insulting comments about us (our names and CVs are of course shown to them), and there is nothing we can realistically do. We did complain, having little faith in a fair hearing, but the NHMRC response to our appeal was perfunctory, showing the same bias and a dismissiveness bordering on contempt.
 

Someone I know who had worked for a while with the NHMRC commented that while they are not “corrupt” (as I had suggested) that they “bend over backwards to not get the Minister (of Health) offside”. Our current Minister of Health, Peter Dutton, is a former drug squad policeman. I have watched him a bit on the ABC. He seems to have a very simplistic understanding of health, such as that it primarily arises from hospitals, health care workers and technologies such as new drugs and maybe surgical techniques, rather than underlying health determinants, such as the expectation of a fair go in the Lucky Country. He could learn from Sir Harry Burns, the former chief medical officer of Scotland who states "we need compassion, not judgments about poor people'.

We all recognize science under the Soviet Union was corrupted; McCarthyism in the US influenced many things (not sure if this included science), George Bush junior's regime did, too. I think for a while, under the Bush/Cheney regime, investigations into whether ground water quality was affected by fracking were legally prohibited.

It would be very naive to think that Australian science is entirely free of such taint, though much of it probably operates via self-censorship, nods rather than spoken or written directions.

The standard advice about applying for scientific grants in Australia is that assessments are random and good applicants should persist. But in the case of climate change and health I do not believe this is the case. And I believe it is in the national interest to state this. Eventually, those with power in the NHMRC system will realise the harm their outmoded beliefs are doing.

Of course, you, the average reader, have no idea if I am exaggerating or simply whinging. Some will assume I have no grounds for complaint. I am, however, the sole editor of the book Climate Change and Global Health. I am one of the three Australian contributors to the health chapter of the most recent IPCC report. I am a recipient of an Australian Research Council Future Fellowship (in 2010). I have given over 70 invited talks at conferences and as special lectures overseas. I am approaching retirement. I do not expect to ever get an NHMRC grant. I do not see how publishing this can do me any good at all, personally, though probably no one of any influence will notice this blog.

But I sincerely feel my perception of bias has validity; it fits with other evidence of disdain for the risk of climate change by the Australian government, and I need to get this off my chest. Keeping quiet about this will do no good either.

Postscript 1 (added February 5, 2017)

In 2017 an article was published in Nature Climate Change also complaining of the lack of NHMRC support for this area. See also a good report in the Sydney Morning Herald.

In late 2014 I became the first Australian IPCC contributor to be arrested for climate disobedience. I explained some of my reasons here. As a result I can no longer go the US. I am still without a grant. The world is burning, from Chile to Syria. And the leader of the free world is a practitioner of "truthful hyperbole", in other words deliberately exaggerating for pride, profit or power.

Climate Change and Global Health was released as a paperback in mid-2016, with an additional chapter. There is more about it, here.

Postscript 2 (added January 15, 2019)

One of our 15 research projects was to consider the possible effect  to the Australian blood supply, in conjunction with the Red Cross, from heatstress and "batfall". Understanding this issue remains vital, and ever more urgent. It is prudent to advise animal rescuers and others to avoid contact with stressed and injured bats, but much more than this is needed.

Postscript 3 (added October 12, 2021)

I'm speaking on October 16, 2021 at the 20th anniversary conference of Drs for the Environment (Australia)* https://www.dea.org.au/event/save-the-date-idea-conference/
 

My talk says in part "Heat and humidity may also have a “long tail” of adverse effects, including on chronic diseases – not just MS, but conditions such as organ failure and even dementia. This is plausible because extreme heat and humidity cause excess mortality. What happens to people who are vulnerable, eg from a chronic illness – but who do not die? It is unlikely that all will return to their previous level of function. I’ve tried several times to win research funds to study this question, so far without success. The question is under-explored."

For the record, this hypothesis (conceived and witten by me) was in NHMRC grant applications I submitted in 2012, 2013, 2014 and 2015. None of these attempts were funded.

* Drs for the Environment Australia now has over 2,500 members; I recall when there were fewer than ten.

Clive Hamilton vs Andy Revkin (Earth Poisoning diary 18 months)

I just read the debate between the distinguished and prolific Australian public intellectual Professor Clive Hamilton and Andrew Revkin, the New York Times environmental journalist who is the driving force behind "Dot Earth". There are several discussions on the internet, here is an extract from one:

Hamilton: "I guess this is my essential message: Carry on as we are, even with quite good outcomes from the incremental approach, and we're screwed. My argument in Requiem for a Species is that we can either face up to this, or we don't. We can choose not to think about it, we can tell stories to ourselves about how it must just be exaggerated, or we can imagine that some technology will come along and everything will be okay. Or we can look at it with open eyes, and allow it to blast away all our utopian imaginings, and say, well, we are in really deep trouble, and it's extremely unlikely that we are going to get out of it unscathed. So what do we do in that situation? And what does it mean for how we act? Does it mean we go for the muddle-through approach even though we know the consequences are likely to be catastrophic? Or do we fundamentally try to rethink and change strategies?"

"... Mind you, I've got much more time for those engaged in civil disobedience who are really trying to take on the system."

Elsewhere, Hamilton writes: "So the 'good Anthropocene' is a story about the world that could have been written by the powerful interests that have got us into this mess and who are fighting so effectively to prevent us from getting out of it. In the long term this kind of thinking will prove more insidious than climate science denial."


I think Hamilton won this debate hands down, though Revkin stood his ground. For me it was interesting how Revkin revealed his thinking about his own sons:

Revkin: "Over the last three years - in having this shift in my focus from goals that are numbers to goals that are qualities - there's this resonant metaphor I used in my talk: I have two boys, one 16, one 23, and when they were little I could have watched them sleeping in their beds and thought "I'd really like them to be doctors making $400,000 a year." More recently I think I would look at them and think what are the traits I would want to have in these two kids to maximize their chances of thriving and being productive and collaborative and generous ... This shift from "I want to make this kid's life good," to "I want this kid to have good qualities," requires letting go. And it's really scary that".

**

I took heart from this. (I am a medical doctor but such a salary seems astronomical to me, and could only be achieved in this country by taking advantage of vulnerable people). It made me think that Revkin has in more recent times become a bit less materialistic and more altruistic. As one of the most influential environmental journalists on the planet that is important. I thought for him to say that this apparent shift was "really scary" particularly interesting and revealing.

About six years ago I managed to correspond briefly with Andy Revkin, attempting to interest him in the poverty (and indeed famine) alleviating benefits of slower population growth in low-income countries, but in the end without success.

My own impending arrest

My own plans to be arrested to protest the reckless scale of Australian coal exports continue to strengthen and develop, but the exact circumstances are currently on hold due to personal circumstances that I can't explain here. I am however greatly heartened by the growth of this movement, such as recent arrests of students at Harvard and North Western Universities, in order to encourage that their campuses divest from investment in fossil fuels. I am also encouraged by the leadership of Archbishop Desmond Tutu, the World Council of Churches, and Pope Francis concerning the crucial challenge of climate change. My edited book, Climate Change and Global Health, is now in the final proof stage and will, I hope, be available in September 2014. Meantime, surface melt in Greenland continues to be too high and rising sea levels are contributing to flooding on the US East Coast. These events erode health determinants, and must be reversed while there is time.

Blogs, other forms of social media and gatekeepers

I have been reflecting on why I write this blog, without making more effort to publish in newspapers and other grey (non peer-reviewed) literature, such as The Conversation. First, a lot of these blog-entries are expanded facebook comments, or retrieved from emails, thus, do not take much extra effort. In some cases, they are the first draft of serious papers or editorials for our NGO, BODHI. Sometimes, the reverse occurs - they are old newsletter articles or fragment of papers rescued from behind paywalls. Unlike many other formats, I can change blogs and improve them over time. Blogs, as grey literature, count little for my CV or grant-winning capacity, but neither do other forms of grey literature.

However, an important reason for this blog is that I have not been very successful in getting either the Conversation or mainstream media (MSM) interested in my ideas .. I did try hard with the Conversation with one of my blog entries about the evolving fortress world and they still rejected it. I haven’t tried since, though I have published there a bit, in the past (and more recently with co-authors concerning the IPCC health chapter). Overall however, I have concluded it’s not worth the effort, I think I must be a little too extreme for the Conversation and certainly for MSM. For example, I have likened Australia to an emerging Nazi Germany and a land which George Orwell would recognise, with regard to our cruel treatment of asylum seekers and the deliberately biased language apparently now used by all politicians in the ruling parties.  I don't think many Australians agree with me about that, it is too disheartening and confronting. Certainly Bob Carr doesn't; he has attempted to excoriate Malcolm Fraser for making a similar suggestion. But while it's true that Sri Lanka does not treat all Tamils in the way that Nazi Germany treated all Jews, it's also undeniable that our government, with strong public support, is comfortable not only about rapidly deciding that numerous people seeking asylum are in fact seeking economic opportunity, but in then sending them to an island where the occasional practice of torture appears to be condoned, including by Tony Abbott.

I have also started to tweet quite a bit .. including to some journalists .. I think, eventually, these forms of social media could be a back door to more MSM interest; before social media, when I used to write to them “cold” not a single one ever replied. I no longer bother.

With the blog I don’t have to go through a gatekeeper. I have had a lot of gatekeeper problems in my academic career; some of the papers which I regard as my best, even years later (i.e. they stand the test of time), were rejected by reviewers .. but rescued by wiser editors .. (eg Human carrying capacity and human health, published in 2004 in PLoS Med has now been viewed almost 30,000 times, and is one of the most widely read articles in the medicine and health sciences category of the PLoS family of journals published in 2004. It still gets looked at several thousand times a year, unfortunately it has not gone out of date. It was, originally, rejected. My 8,000 word Borrie Prize winning essay (2001), on the rise and fall of Malthusian thinking within demography, won the prize but was then rejected by many learned demography journals, with hostile gatekeepers. Eventually I hope it will appear in The Human Titanic, in a chapter called "Keeping the lower decks crowded".  But some of its thinking is in the PLoS Med paper.

Essentially, we can live as one human species on one full planet, or we can live as dozens, hundreds or even thousands of separate groups competing with each other for resources that are only abundant if we stabilise (or reduce) our consumption of those resources. We have evolved to live as these small competing groups; if we do we not evolve a better alternative then the next few centuries will be very ugly indeed as Clive Hamilton argues in his reply to Andrew Revkin in "The Delusion of the Good Anthropocene".

Limits to growth, deepening inequality and Australia

This is a postscript to my recent post "The future health of the emerging Australian underclass" but it can be read on its own.

Why am I so sure there is already an underclass? This is in part because, between 1988 and 2008, I worked as a locum general (medical) practitioner (a GP) for more than 30 different GPs in about 20 different practices in over 12 towns and small cities, as well as running my own practice for several years. In all this summed to about ten years. I did this not only to get medical experience but because my ambition was always international health; locums at different times allowed me the chance to study and travel more, especially to India for the charity I co-founded in 1989.

As a result, I estimate I saw, as a GP, well over 10,000 different people (though only in Tasmania, Australia's poorest state). Perhaps I saw 25,000.. Whatever the number, it is far more than the average GP would see in his or her working life. Few Australian GPs look after more than 2,000 people. It is this experience which informs my conclusion that there is a culturally distinct underclass at least in parts of Australia, especially in rural areas and poor suburbs. (I also worked extensively for the after hours medical service in both Launceston and Hobart, in both cities 90% of my patients were poor; I did many house calls in poor suburbs.) One day I hope to write in more detail about this; the patterns of names, cultures and behaviours, repeated in neighbouring towns. Remember, much of general practice is social medicine, by which I mean that the social context of the patient is very important in determining risk factors, behaviour and health outcomes.

Primarily, here, my intent is to link this underclass to inequality and to limits to growth. It is, I hope, self evident that today there are many examples of individual who have succeeded in life, even from poor backgrounds. However, my view is that societies can influence the setting, the "milieu" from which many more from this group can do well, and to influence the average, in terms of life expectancy, education,  and living standards. Some from this class also contribute to a participatory democracy; if more could then that would be good.

This task is of course difficult but until recently there has been broad agreement in Australia that foundational elements such as reasonable education and a reasonable health system are components, though their existence cannot completely overcome the cultural barriers and constraints.

I agree that too many handouts to this group, with no obligation, is harmful, but what I think is in danger of happening in Australia is that the settings to nurture the "determinants of prosperity" are now being reversed, accompanied by slowly growing cultural tolerance for the failings of the underclass by the non-underclass.

Think of it this way. Imagine you are in rural Russia in 1850, with a Tsar, a court, and a peasantry. I am not an expert on history, but it is clear that the chances for peasants in that environment to "succeed" or even to have a long life are limited. From the perspective of the court, the circumstances of the peasants don't matter much, as long as the peasants have food and prospects to not revolt (and/or as long as the secret police are powerful enough to quell any rebellion.) The determinant of health and well-being for the peasants (and even worse, the serfs who preceded them) were dismal.

We are not Russia in 1850, which shows progress can be made. The question is, can we make even more progress, or will we regress towards Russia in the past? (or Ireland in 1840?)

From my perspective, as someone who values and works for a fairer (though never equal), prosperous and enduring world, the lives of the peasants would matter, and so too do the conditions for the current underclass (including beyond our shores, eg Tamils in camps in southern India). I believe that the policies of current Australian government, via enforcers such as Andrews, Abbott, Dutton and Abetz are worsening their prospects, eroding the "social determinants of health" which has a long history, but is perhaps jargon to most people not working in public health.

I have long argued that global society is now getting poorer (per person especially), due mainly to higher energy costs and other manifestations of "limits to growth" (in part offset by more energy efficiency and invention, but not sufficiently). This is evident at many scales, not just globally, but regionally (eg food banks and soup kitchens in Europe) and also, increasingly, here. Global policy settings have long ignored, denied and suppressed limit to growth, and they largely continue to; hence it will get worse.

A shrinking "cake" with more claimants means either everyone eats less, thus sharing it, or that the poor claimants eat even less, enabling the better off (eg me) to not be very affected, materially, at least for the time being. It would be far better to have global policies to expand the cake, but this is not happening at the rate needed, in fact, the cake is shrinking. 

Taxing the poor in Australia for seeing a GP, forcing them to "learn or earn" (how can that work for rural people who have to travel?) and exploiting them via work for the dole is going to make it worse, as does cutting foreign aid and our increasingly blatant flouting of the refugee convention. (How morally different is handing over Tamil asylum seekers to the Sri Lankan government to returning fleeing Jews to the Nazis?)

I would rather pay more tax, see mining companies like Glencore and technology companies like Google and Apple also pay more tax, and spend that money raised on education, and other ways to change the culture of the underclass, including through deep listening and respect. To do that is a multi-generational process; I used to feel part of it; I do not mean to sound glib, it is not easy.

As for employment: in theory, with the internet, many more rural (or even urban Western suburban) jobs are possible, if there was the culture and skills to make this possible. There also needs to be affordable energy to do this.

The current Liberal National party policies (the Labor Party was not much better, especially internationally) are not thoughtful enough, they will lead to widening inequality, materially, in health and in attitudes. Already the problems of the poor in (say) Kenya or Sri Lanka seem impossible to fix, and in Australia they are becoming very difficult. As Limits to Growth tighten, my prediction is that we will see strengthening disregard for the poor in Australia. When I graduated in medicine in 1986 I was debt-free. Working in rural Tasmania was a way I could re-pay the non-obligatory debt I felt to the Australian people. If I was to graduate in 2016 with a debt of over $100k (still cheap by US standards) I would be far less likely to work in a poor area, and I would be far less likely to care for the common good.

It is well-known that life expectancy in the US is lower than here, despite its enormous health expenditure. The current Australian government policies are leading us in that direction. I know this blog is a tiny offering (as is our charity and even my entire career) even so, I feel obliged to try.

Thanks for reading (if you get this far!)  By the way, I have two edited books in press, including Climate Change and Global Health  and Healthy People, Places and Planet: Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding (ANU E-Press) (co-editors Jane Dixon and Tony Capon). We expect it to be available in early 2015. It will be entirely free, on line. Many of its chapters will be accessible to the general public, though some are quite technical. There is no link yet for the book. Some chapters in both books are relevant to these general issues.