Presentations

Remarks by Neen Hunt, former President of the Lasker Foundation, presented on April 29, 1999, at the National Academy of Engineering at a conference convened by the President's Economic Council on the role of incentive awards and other prizes toward advancing the progress of science and technology.

The Albert Lasker Medical Research Awards are the most prestigious and coveted awards presented in this country for biomedical research. I have been asked to tell you briefly about what can be learned about designing and administering an awards program that is so highly successful. Although there has never been a formal, systematic evaluation of the Lasker Awards, I believe that I can shed some light on the reasons for their prominence and a few of the challenges which face those of you who intend to create awards which have a high profile and which are respected. My remarks stem from conclusions that I have reached after four years of managing the Awards Program. They also include some of the opinions and impressions of our Laureates, offered through anecdotal material and survey data.

First let me give you a brief profile of the Awards. Their purpose is to recognize significant research contributions in diseases that are the main causes of death and disability, including cardiovascular, respiratory, neurological and viral diseases, as well as cancer, mental illness, arthritis and blindness. Since their inception a little over 50 years ago, the Awards have been presented in basic and clinical research, and for public service in support of the medical research enterprise. In 1996, the Board of Directors of the Foundation inaugurated the Lasker Special Achievement Award for contributions to research which are of unique magnitude and immeasurable influence on the course of science, health and medicine.

A little over 300 Lasker Awards have been given. While most of the honors have gone to Americans, about 25 percent of the winners in basic and clinical research are from all over the world. Many have gone to investigators in the middle of their careers for dazzling work still progress, but some have been presented to seasoned scientists for a revolutionary finished product. The award guidelines encourage that the winners be limited to no more than three individuals for each prize; however, there have been several years where teams of plus-three investigators have won one of the Awards. The prize consists of a $25,000 honorarium, a citation, and an inscribed statuette of the Winged Victory of Samothrace, symbolizing conquest over death and disease.

In 1945, when the Lasker Award was created, it was a unique prize in the medical research community. Today there are many more such prizes, but none have achieved the stature and respect of the Lasker Award. This is the good news, and the reason is intuitively obvious:

Lasker established a gold standard for achievement, and it has rarely, if ever, been compromised in the selection of the winners. The Lasker winner must demonstrate superlative work that opens up new areas of knowledge, and changes how a problem is understood. The achievement must qualify as extraordinary—profoundly insightful, uniquely creative and an invaluable contribution to the progress of science against human disease. Mrs. Lasker set the highest standards because she had the greatest expectations for medical research. They have remained at this peak level, helped by the design of the program and rigorous management of the nomination and selection process.

Let me point out a few of the key elements of the process. First, candidates do not apply; they are nominated from the American and international professional community through a wide net that is cast to survey fields appropriate for consideration. This process ensures a pool of qualified candidates. Second, the nomination materials require substantive and substantiated support. This means, in effect, that a nominator must be well prepared to argue on behalf of the candidate and must take considerable time and effort to perform this task. This ensures that the nominator believes the candidate to be worthy. Third, the judging is done by an international jury of 25 preeminent scientists, representing multiple disciplines, who are carefully selected by a core of senior jurors. This ensures that the professional community will respect the decision of the jury. Fourth, the judging process is systematic, exhaustive and fair to the nominees. Take as one example the fact that of the nominations which are received, and these usually number in the several hundreds, all are reviewed and scored by each juror. This ensures that the jurors can live with their choice. Fifth, the jurors pledge that the deliberations will remain confidential. This ensures the jurors that they can be honest in the deliberations. Sixth, the jury is instructed that no award need be presented if the standards for selection are not met. This ensures the Foundation that the decision of the jury has integrity. Lasker has learned that these many insurances have been necessary to safeguard the decision emerging from each jury deliberation.

At the risk of belaboring the obvious, I want to place particular emphasis on the composition of the jury. Lasker has been fortunate to attract jurors whom their peers view as science luminaries.

The Foundation has insisted on a jury that is second to none, assuming rightly that a venerable jury would elevate the credibility of the Award. The consistent track record of the Lasker juries selecting winners whose achievements have had a quantum impact on our progress against disease has increased the stature of the Award. I have been questioning people to identify the Lasker "bloopers," and I have yet to hear of any. The lesson here is that brilliance begets wisdom—and it is the wisdom that generates respect.

The impeccable reputation of the Lasker Award is also linked directly to the independence of its jurors from political pressures, special interest and loyalties, and other factors that might bias their choice of a winner. The Lasker juries continue to be highly respected for prescient and brave judgment: a willingness to take risks in recognizing surprising or seemingly arcane or abstract work, or work that has been greeted with skepticism or criticism by the mainstream community; the courage to honor meritorious work when faced with unpopular, disliked or relatively unknown recipients. Government agencies thinking about sponsoring awards particularly need to bear in mind how the political process and institutional obligations may intrude on the management of an awards program and, worst of all sins, influence the selection of the winners.

It is also instructive to note that the relatively small monetary amount of the prize is not related to its prestige value. The Lasker Award apparently is coveted despite modest prize money, and there are lessons for sponsors of awards in this finding. The great reward for winning a Lasker is its "psychic income," says one of our winners. Increased self-confidence to pursue professional goals, deep feelings of satisfaction stemming from the expressions of respect from admired colleagues, more optimism about the value and lasting meaning of one's work. Furthermore, the Award frequently has a catalytic effect on the careers of the winners, yielding practical important consequences because of heightened visibility and the Lasker imprimatur: more funding for their research, younger researchers drawn to their work and to their labs, requests for presentations and papers about their work to important audiences, increased philanthropy from admiring donors at their home institutions. Laureates also report that receiving the Award has elevated their aspirations by causing them to think about the "big picture"—what they are trying to achieve in their lives and therefore the resetting of their research priorities.

Yet let me emphasize that despite these kinds of productive aftershocks, and the memorable and prideful personal experience for the winner and his or her family, there is no evidence to indicate that a scientist's work is motivated by a desire to win a Lasker Award. Most scientists know that the Lasker Award is likely to position a winner for a Nobel Prize. As of today, 60 Lasker Award winners have gone on to receive the Nobel—virtually one in five—yet we have no evidence that the Lasker Award is sought for this purpose either. Perhaps the lesson for government sponsors of incentive awards is that the quest for prizes—even those that are highly prestigious or have significant prize money—is not outweighed by the obvious motivations that drive the best professional scientists: the love of exploration and discovery, their desire to problem solve, their curiosity and quest for knowledge.

And now to the not-so-good news: the Lasker Awards Program—from soup to nuts—is very expensive to administer, costing this modest Foundation several hundred thousand dollars annually. Some of the special aura surrounding Lasker is its reputation for doing things first-class and with super taste—another standard set by Mary. All of the participating scientists, as well as the winners and their families, are treated elegantly by Foundation, which we are committed to continuing. It is also important to remember that programs of this scope and quality require dedicated administrative support. Each year the Lasker Award is presented in the fall and the new nomination cycle begins the very next week. The point is that awards programs can be labor-intensive, financially demanding enterprises. Those who are thinking about establishing a new award might take this fact to heart and perhaps consider how valuable resources might be otherwise deployed, with less management machinery and overhead expense, to reach the desired goal.

There is another not so apparent challenge to bear in mind as new awards are considered: they often take on a life of their own. Like other kinds of operations, they don't necessarily or inevitably accomplish the purposes for which they were created. The Lasker Awards are a good case in point. Mary Lasker believed passionately that the mysteries of disease could be unraveled—and needless suffering and premature death prevented—if adequate funding was available to the most promising scientists. She instituted the Awards Program for the purposes of advocacy: her aim was to increase public support for biomedical research by bringing to the attention of the public the brilliant discoveries of research and their promise for improved health. Mary specifically designed the Awards Program—with ceremonial pomp and in elite circumstance—to attract important media spokespeople, elected officials, and influential citizens in order to educate them about the contribution of medical research to human health, and to enlist them in her campaign for enlarging both public and private funding. Given these early motivations behind the establishment of the Lasker awards, the Lasker leadership today continues to lament that the Award has not been able to sustain broadly its name recognition with the American public—despite a great deal of money dedicated to public outreach. The Award is best at honoring its own and so ironically enjoys the greatest visibility among medical scientists. Part of the problem is that there are very difficult challenges engaging the media to publicize science awards and their achievements, as many of you know. Award giving has become commonplace, and the driving agenda of the mass communications industry does not presently place a value on great achievement in science. Experience suggests that one can spend a great deal of time, money and effort trying to bring a new award to the attention of the popular media, or even to the attention of target audiences. Organizations sponsoring new awards need to continue to monitor their purposes as times change, to assess the effectiveness of the award in light of stated objectives, and to remain somewhat fluid about presentation so that the award assures its relevancy and appeal.

Finally, let me share advice which comes straight from some of our Lasker Laureates:

First, even some of our most appreciative and proud Laureates have expressed the view that prizes are intrinsically unfair because they characteristically applaud the work of one or two individuals when there are so many more deserving scientists. They remain critical of awards that perhaps unwittingly but unfortunately reinforce a skewed message about how discoveries happen and who is responsible for them. Our Laureates suggest that new kinds of awards need to wrestle carefully with this message and design honors in ways that will help to minimize the feelings of resentment and discouragement of deserving people who have been left out.

Second, some of our Laureates argue that high prestige and large money prizes do not serve science well at all because they can increase the competitive tensions among investigators at the expense of essential collaborative relationships.

Third, our sample of Laureates recommend that new awards focus on young investigators whose motivation to continue their careers might indeed be enhanced by an honor. The numbers of awards that continue to honor the honored many times over seem to breed cynicism and result in a devaluation of awards in general. They also recommend that new prizes not be confined to a single discipline or a subspecialty, but address kinds of achievement that will impact many areas of science in recognition of the fundamental and growing relationships across disciplines that lead to real progress.

Lastly, I will venture a guess that most prizewinners in medical science would trade their honor for steady funding for their research. Government sponsors should make no mistake about the relative importance of awards to other factors that might advance the scientific enterprise. Mary Lasker was right from the get-go: sufficient funding, in terms of amount and duration, is numero uno.