The Bangladesh of Spanish hospitals: their research is outsourced to foundations

Although the figure of the hospital researcher exists, in Spain there is the paradox that much of the research carried out in our hospitals is carried out by personnel who are not even on the staff of the hospital itself. These scientists are 'outsourced' to structures, embedded within the hospitals themselves although administratively unrelated, called biomedical research foundations (FIB). Virtually all hospitals in the country have staff in charge of an FIB within them, an asymmetric relationship that now with the pandemic is overflowing everywhere.

Theoretically, the Biomedical Research Law of 2007 obliges hospitals to have these figures, it is not enough for 'assistance' doctors to take time out of their day to investigate and publish, but rather professional investigators are required full time. They are the ones who perform tasks such as analyzing patient samples to generate a technique that allows detecting a new virus by means of PCR test, for example.

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The reality is that almost no hospital has investigators on staff. "There are some honorable exception, such as the Ramón y Cajal, the Hospital de la Fe in Valencia or centers in the Basque Country or Galicia, where they still have hospital researchers on staff, but the vast majority of National Health Service centers have outsourced us to foundations ", explains Juan Ángel Fresno, another Miguel Servet who for 10 years has led the molecular oncology group at the Hospital La Paz in Madrid, yes, linked to the IdiPAZ research institute, the FIB of the center.

The spearhead against covid-19

These foundations were born more than a decade ago, with the well-intentioned objective of make the hiring of researchers more flexible associated with hospitals, but the 2012 Budget Stability and Financial Sustainability Law – better known as the Montoro law – left them mired in a strange limbo between public and private, with none of the advantages of the first and all the disadvantages of the second. Despite the fact that they make a lot of money, for example, by attracting resources from pharmaceutical companies to carry out clinical trials, they are unable to reinvest those million dollar earnings in their employees, once promising young people who arrived with a Ramón y Cajal or Miguel Servet research grant to end up splicing temporary contracts and getting results against the current until one day they found themselves at the doors of the labor slaughterhouse. Next.

Almost all large hospitals have researchers linked to foundations. (EFE)

To this structural problem, one more, of Spanish medical research has been added the pandemic. Many of the coronavirus awareness or treatment findings that we have looked at in the last year have come out of these FIBs. The researcher in molecular genetics Alma Bracho was one of the pioneers in the sequencing of the SARS-CoV-2 virus in Spain, at the end of February, and is now in charge of monitoring the appearance of the British variant and others. Carlos Spuch directs a novel lithium therapy to treat seriously ill patients with covid-19. Africa Holguín closely follows emerging mutations in key proteins of the virus using data from thousands of patients. Margaret Poza It has been able to predict outbreaks of the disease before the Health notifies them thanks to the analysis of sewage.

The situation with these centers is worrying and our fate in this pandemic depends a lot on them. Some of these complaints – dozens of scientists have sued the centers to be stabilized – are public, but dozens of them are still buried and that are starting to sprout by domino effect.

Elite scientists out on the street

In Cantabria, the Valdecilla Research Institute made the news a year ago when it fired Jose Ramos Vivas, until then director of the Microbiology Laboratory and a well-known researcher in his field. Vivas had arrived at the center 11 years earlier with a Miguel Servet contract – sponsored by the Carlos III Health Institute, which finances the salary of profiles with a solid research career to favor his integration into the National Health System— and once the scholarship was over, he remained at the Idival joining contracts. All the 'know how' accumulated by Vivas, as well as the financing obtained as a result of its leadership there, was lost. The director of the ISCIII, Raquel Yotti, or the Cantabrian Minister of Health tried to intervene to find alternatives to dismissal, but they did not succeed. More recently, in December 2020, another researcher linked to the foundation for a decade, Alain Ocampo, was also fired after the end of his contract Miguel Servet II.

The director of the Research Institute of the Hospital de Valdecilla (Idival), Galo Peralta. (EFE)

The irony wanted that at the beginning of December, the then minister Salvador Illa visited the center and those responsible showed him some images taken by the Ocampo team as an example of the cutting-edge research carried out at the Idival. Ten days later, Ocampo's contract expired. The response of the centre's leaders, who have recently appeared before the Cantabrian Health Commission, is that the Miguel Servet contracts have "beginning and end".

The National Association of Hospital Investigators explains to El Confidencial that "in this case, the investigator also has current projects of the National R + D + i Plan that will be lost. And the most bloody thing is that he is an expert microbiologist, just the most necessary profile in this time of pandemic. "The secretary of the association, the geneticist Francisco J. del Castillo, indicates that" what we fear is that the researcher is 'used' while his salary is subsidized by the central government in whole or in part and, when the FIB has to assume it, it is put out on the street. "

"The vast majority of National Health Service centers have outsourced us to foundations"

Del Castillo himself, an employee at the Ramón y Cajal Institute for Health Research (linked to the Madrid hospital of the same name), had to go to court so that the foundation would stabilize his situation and not put him on the street after 12 years. "This is how we have all achieved our permanent contract: it had a working research group, with projects underway, collaborations set up … and I was not going to let that go to waste"So he sued and won his stability." Hospital investigators have won all the lawsuits, I think we have 65 or 70 and we have won them all. "

This is how many researchers throughout the country spent years, usually middle-aged and who had spent years splicing contracts of various categories and bordering on, when not clearly committing, a fraud of law. But 2012 arrived and these centers were prohibited from making permanent contracts. All those scientists who have entered these centers in recent years have been caught in a 'Trap 22' of manual.

Although they were essential in the organization chart of the foundation, every three years they had to be fired and spent six months in the SEPE refrigerator to be able to hire them again. One of them tells this newspaper that she went to SEPE in one of these periods and they asked her what professional category she had. "Researcher," she replied and the administrative officer told her that her profession did not appear in the gazette: "I don't get anything like a researcher, Do you mind if I call you a detective?".

The first to sequence SARS-CoV-2

"Now they are stabilizing the Miguel Servet contracts, if you pass the publication and scientific production cuts, they will stabilize you if you pass the ISCIII evaluation, but for many years they told us that once you pass the evaluation, you will look for another site", explains Alma Bracho, who has worked since its creation at the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community, Fisabio. The center has had a popularity boost during the pandemic due to the work they are doing with sequencing and the bioinformatic analysis of SARS-CoV-2 virus genomes sent from hospitals throughout Spain.

Together with professor Fernando González Candelas and Iñaki Comas, Bracho and his colleagues carried out the first sequencing of the virus genome in mid-March, which allowed them to verify how since he left China he had already suffered some mutations. Despite the scientific merit that has allowed Spain to position itself as one of the countries with the most sequence of variants (after the United Kingdom and Denmark), the situation of the technical and research staff at Fisabio is quite precarious.

The research staff of the Valencian FIB (Fisabio)

Bracho's contract, whose work (coordinating the epidemiological surveillance of the potentially dangerous variants of the pandemic coronavirus in the Valencian Community) is currently essential, not only for Fisabio but for all of Spain, concludes next March 13. "We are still governed by the Montoro law, by which at three years they have to make you permanent, but the foundation cannot because they depend on the salary mass of the Ministry of Finance," explains the scientist to El Confidencial. All those who, like her, arrived with a Miguel Servet contract have had to make administrative bobbin lace in order to continue with their investigative activity. "In fact, the contract I currently have is under the collective agreement of offices and offices: Depending on the year you enter the company, the staff is assigned to a collective agreement or another ".

The disparity with the hospital researchers or the CSIC with whom they usually collaborate is bloody, since under their current agreement they do not have the right to supplements for scientific productivity or six-year terms, but even those details are minor compared to the drama that is not having a guaranteed job in the medium term. "Now we have 83% temporary employment, but there are worse ones, the Foundation of the Research Institute of the Hospital La
Fe de Valencia has reached more than 95% and these are rates that you cannot afford in such a specialized field, where people have to be highly trained, "explains Bracho. His salary, obviously, is also inappropriate for someone with a Ph.D., an immaculate scientific resume, and 25 years of meritorious professional experience.

"The contract that I currently have is under the collective agreement of offices and offices"

The 'public' part of these foundations forces them to advertise job offers. For example, a few days ago, two positions of pathological anatomy technician left in Fisabio to work in tumor biobanks. Among the requirements, an accredited experience in the area is valued, knowledge of the Valencian Biobank Network, training in the use of biological samples for research and publications or presentations at conferences. The salary? 19,450 euros gross per year, in principle for 12 months. In reality, these two people, although hired by the foundation, will be employed in the Pathological Anatomy Services of the Castellón and Arnau de Valencia hospitals, but they will charge much less than their colleagues on the hospital payroll. A luck of legal subcontracts to strengthen hospitals with good scientists at bargain prices.

Another offer from the same center is looking for a researcher with experience in air quality projects for an eight-month project. The contract is for 26 hours a month for 253 euros gross. The hook here is the "possibility of carrying out a doctoral thesis"Probably outside of the six and a half hours a week.

When everything went wrong

"The foundations were created with the objective of facilitating the management of research funds in a hospital, which requires greater flexibility than the management of other items," explains Fresno. "I still think the idea was good, because the foundations have a margin of maneuver that the public administrations themselves do not have: the problem is when they are ordered to manage personnel ".

In summary, as a public sector, they suffer a 5% reduction in salaries for civil servants, the suppression of extra pay or the impossibility of chaining temporary contracts, but they have none of their advantages: neither stability nor promotion. "We don't see any advantage to foundations"says Fresno. In 2019, the first specific agreement for the FIBs was started from the Community of Madrid, but the situation of these dozens of investigators on no man's land continues to be irregular throughout Spain.

The former Secretary General of Health, Faustino Blanco. (EFE)

The Foundation for Research and Biosanitary Innovation of the Principality of Asturias (Finba) is another FIB at the center of the controversy. This time, due to the appointment of Faustino Blanco, Secretary General of Health at the beginning of the pandemic, as director of Finba. The once number two of Salvador Illa was selected by hand and not by a public contest, like his predecessor in office, Dr. Enrique Caso, and also his salary of 110,000 euros is double that of the previous director of the foundation.

In this case, it is the board of trustees, chaired by the radio entrepreneur Blas Herrero, who has decided to place Blanco there. The straw that broke the camel's back is the complaint of the unions, which in addition to a clamorous case of revolving doors see a provocation that the director sees his salary doubled while the The vast majority of Finba researchers are mileuristas and temporary workers. This week, Podemos Asturias has demanded that, one of two, Blanco take a step back or withdraw all public funding for the foundation.

Where is the money

Something these foundations are obliged to do is be fully transparent with your accounts, which allows to observe first-hand the optimal business that they turn out to be.

For example, of the 2.39 million that the FIB of the Niño Jesús University Children's Hospital entered in 2019, almost 1.47 million came from collaborations with private companies, specifically, clinical trials. These are carried out in the hospital itself, but are managed by the foundation, both in terms of resources and personnel. The rest came from private donations (almost everything) and around half a million euros from grants. Other majors, such as Ramón y Cajal, earn more than eight million euros each year for these concepts and end up generating a surplus of more than three million.

Johnson & Johnson Vaccine Clinical Trial. (Reuters)

Its 'non-profit' nature means that this money has to be reinvested, but it rarely ends up in more stability or better conditions for researchers. All the money that has been earned in an exercise with the research activity is usually injected directly into the reserve funds, a huge sum of money (millions of euros) that is never touched.

"The biomedical research foundations take part of the projects that are carried out in these foundations," explains a source who knows closely how these institutions work and prefers not to be named. "That money comes from public projects and then in the hospital setting by clinical trials, which are very important: for its foundational purposes, that money should be used to promote research, but that is what we do not see happening ".

"As the pharmaceutical companies are very interested, they can pay an extra 40, 45, 50 or 57%"

"When a foundation asks, for example, 100,000 euros from the Health Research Fund of the Carlos III Health Institute, to carry out the projects, it automatically receives 121,000 euros, where the 21,000 are the necessary expenses to manage the 100,000 that they have given me, which is a nice pinch", he continues." But if we go to clinical trials, which are private and not public, the amount you can request is optional, and since the pharmaceutical companies are very interested, then they can pay 40, 45, 50 or 57% extra, that is, if they are 100,000 euros, they will give them 157,000 ".

All this makes it more striking that the laboratory technicians who carry out these tests are charging net amounts, they say, of about 800 euros per month.

Light at the end of the tunnel?

"What people usually do is leave after chaining several contracts, they seek oppositions and, as a consequence, the National Health System is impoverished," says Del Castillo. "When a crisis like this comes, we find that a quite a few brilliant microbiologists have fledAnd those who are now in college don't have access to patient data like us, so they can only do basic research, never translational. "

The tension is clear. The machine of the biomedical foundations extracts maximum economic profit at the expense of its researchers, but such a productive machine had to start to catch the flu. After years of negotiations, at the end of December 2020 the first collective agreement for the 1,087 employees in the 13 FIBs in the region was presented in the Community of Madrid. It is a very important step, given that until now the precariousness of these researchers was one of those balls that are passed between the Ministry of Health and the 17 autonomous communities, who have the powers to do so.

Labor inspectors tell them their only option is to report, because they earn insurance

"The law says that we have to integrate ourselves into the hospital staff, from a legal point of view it was very clear and this agreement had to have arrived a long time ago," explains Fresno. "What was the problem? There was something political and someone stopped it, told us that it could not be done: the hospital researchers in the rest of Europe is something that happens, it is only a problem of Spain".

For scientists subcontracted outside of Madrid, the battle is not over yet. "In these last four years of the left-wing government in Valencia, nothing has changed," explains Bracho. "We have been demonstrating, promoting concentrations, calling for labor inspection … But they tell us that the only solution, which the labor inspectorate itself recommended to us after recognizing the irregularities in the hiring, is to denounce, because in accordance with the law we win insurance, and that is what, in fact, is happening ", despite the fact that all the favorable sentences these workers are appealed at the request of the Generalitat.

The researcher, currently focused on identifying the irruption of variant B. 1.1.7 of SARS-CoV-2 in our country, she sighs aloud and wishes that when she is called for an interview, it will only be to talk about her science, and not about her precariousness in science.