Reflect upon oneself, observe others.
The advancement of medical education and healthcare quality is my lifelong mission. Therefore, in the more than 30 years since returning from the United States, medical education and healthcare quality have always been my main concerns.
In the 1990s, as Taiwan's economy took off, the government invested in higher education to elevate Taiwan's standing, establishing numerous universities and research institutes in an attempt to enhance research quality. However, policy decisions were made in haste for quick success, prioritizing quantity over quality, which was a misguided approach.
Since the quality of teaching determines the caliber of future physicians, I actively participated in the evaluation of different medical schools' teaching quality, treating it as a profoundly sacred duty. Throughout this process, I frequently discovered that presenters from the evaluated hospitals would proudly explain that their medical schools placed great emphasis on medical research, hence significant funds were allocated to encourage research activities.
When I first heard this, I was pleased, thinking it meant the hospital was investing resources to allow physicians and basic medical science teachers interested in medical research more time and funds to devote to the exploration of new knowledge.
However, what they told me was they were offering bonuses to encourage physicians and teachers to publish more papers. The higher the impact factor of the journal in which they published, the higher the bonus, resulting in an ever-increasing number of papers from that institution. This revelation startled me, and I hastily said that the motivation for academic research should come from curiosity or the desire to find answers when facing challenges in patient care.
Especially for in-depth research that can truly contribute to patients, which may require multifaceted discussion and numerous trials, often with more failures than successes. What is needed is self-demand and self-driven motivation.
Offering bonuses only encourages those who chase after external fame and gain. Not only does it make it difficult to produce truly impactful papers, but it also leads to the adverse effect of bad money driving out good.
In recent years, I have observed that the academic atmosphere in Taiwan's biomedical field has not improved but has gotten worse. Even though the output of papers has doubled, most lack originality, and yet there are boasts of developing the biotech industry to become Taiwan's next guardian mountain, which is disheartening.
Recently, I came across two investigative reports in the survey by Associate Professor Gao Zhiwen from the School of Public Health at Taipei Medical University: "Taiwan's Biomedical Science Community Says Goodbye to Bad Practices, Seeking Excellence" and "Why Doesn’t Taiwan Have a Single University in the Global Top 100?".
In these two reports, Associate Professor Gao Zhiwen used real data to confirm my concerns. In the first report, he mentioned that China Medical University, without a department of mathematics and the corresponding faculty, published nearly 900 highly-cited mathematics papers in one year. The authors of these papers were all foreigners who did not teach any relevant courses at China Medical University.
Professor Gao believes that it is highly likely that the university, in an effort to quickly increase its institutional citation count and boost its global ranking, has recruited retired scholars with high research output from other countries, offering them financial terms to affiliate with China Medical University.
In the second report, Professor Gao observed, upon returning from the International Cancer Organization in Switzerland five years ago, a prevalent attitude in Taiwan's biomedical community that favors quantity over quality in research publication. This has led to a culture where academic paper authorship is often granted based on power/relationships, with small circles exchanging authorship to inflate their publication numbers. Even worse, the biomedical community has been using national research funds to publish a large number of papers in substandard, profit-driven journals that have emerged in recent years, which is a clear reflection of the mediocrity in Taiwan's biomedical research.
Here's how this could be presented to an American audience while retaining the original details:
Recently, the insightful reports from Gao Zhiwen, an Associate Professor at the School of Public Health of Taipei Medical University, caught my attention. These reports, titled "Taiwan's Biomedical Science Community Says Farewell to Mediocrity, Aiming for Excellence" and "Why Does Taiwan Lack a Presence in the Global Top 100 Universities?" resonated with my worries.
Professor Gao, using hard data, brought to light in his first report that China Medical University managed to produce nearly 900 highly-cited mathematics papers within a year, despite having no mathematics department or faculty. Interestingly, these papers were authored by international scholars who were not part of any course offerings at the university.
He suggests that the university's strategy to climb the global ranking ladder may involve engaging financially with retired, high-output researchers from abroad, thus affiliating them with the university's brand.
In his second report, Professor Gao describes the situation he found upon returning to Taiwan from the International Cancer Organization in Switzerland five years ago. He points out the rampant practice within the Taiwanese biomedical sector of prioritizing quantity over quality when it comes to research publications. This has fostered a culture of name-dropping and quid-pro-quo authorship exchanges within closed academic circles, artificially inflating publication counts. More troubling is the trend of utilizing national research funding to publish numerous low-quality papers in the burgeoning, profit-centric journals, a testament to the mediocrity plaguing biomedical research in Taiwan.
Rejecting the culture of academic publication that values quantity over quality is the path to academic excellence. In the past two years, the continuous outbreaks of plagiarism scandals among politicians, resulting in revoked degrees, compel us to question what exactly has gone wrong with Taiwan’s higher education. Professor Gao poses the question: Is this trend a desperate measure for Taiwanese scholars to survive, or is it due to flawed management? He believes that the government and academic community should renounce the mediocre, quantity-over-quality culture of academic publishing to rightfully pursue academic excellence.
Consider ourselves and look at others. The Nobel Prize in Physiology or Medicine announced this year was jointly awarded to Katalin Karikó and Drew Weissman in recognition of their discovery concerning nucleoside-modified messenger RNA, which facilitated the development of effective mRNA vaccines against COVID-19. Moreover, the mRNA technology may potentially be applied to various other vaccines, personalized precision cancer vaccines, and treatments for multiple diseases. Particularly, Dr. Katalin Karikó's research journey epitomizes the pursuit of academic excellence.
Dr. Karikó completed her PhD in Hungary and embarked on her mRNA research career. Soon after, in 1985, she moved to the United States to continue her research. However, due to the obscurity of her field, she faced many setbacks and frequently grappled with the discontinuation of her research funding. In academia, one needs publications to apply for funding. When research topics are too niche and papers are difficult to accept, a vicious cycle ensues.
Dr. Karikó once mentioned that in the first 20 years, she was demoted four times because she could not secure funding. Such experiences are humiliating for any dignified scholar. I believe most people would change their research topics to make their lives easier.
Yet, Dr. Karikó believed in herself and in the certainty that the sun would rise again. She persevered through the hardships as long as there was even a slight progress in her research. After more than 30 years, her efforts finally bore fruit. However, for her, this was just a step towards her goal, a moment when things naturally fell into place. The Nobel Prize was never her actual aim.
Taiwan’s higher education and national health insurance are two pillars that determine the quality and health of its people. It is hoped that the people of Taiwan will be able to elect a president in less than a hundred days who understands the issues with Taiwan’s higher education and health insurance and has the courage to challenge the status quo and is determined to substantially reform Taiwan’s higher education and national health insurance system.
Author: Dr. Andrew T. Huang, President & CEO, KFSYSCC