Unfair' medical screening plagues polar research - Science

A storm is brewing over the U.S. polar research program's medical qualifications process, which screens hundreds of scientists for physical and psychological ailments each year before they deploy to field sites in Antarctica and Greenland where they will have limited access to medical care. Scientists are too often rejected for questionable reasons, some researchers argue. "We have learned of far too many accounts of unfair treatment," a group of senior polar researchers asserts in a letter sent today to the National Science Foundation (NSF), which funds research in polar regions and coordinates field logistics. "Systems for transparency, reporting, and accountability are needed."

NSF's screening process is administered by the University of Texas Medical Branch (UTMB) and involves detailed medical questionnaires, blood tests, and a physical examination by each applicants' personal doctor. NSF says it is an important tool for catching potentially dangerous health problems before scientists leave for field sites. "The health and safety of all deployed personnel is NSF's top priority," an NSF spokesperson wrote by email. "The medical professionals tasked with clearing deployers are some of the best in the world."

But in interviews with Science, several of the 25 letter writers and others expressed concern that some seeking medical clearance—many of them early-career scientists and individuals from underrepresented groups—are failing the screening process for reasons that aren't medically sound. Many of the cases involve scientists who were prescribed medication to treat common mental health conditions, such as anxiety and depression. NSF's medical screening guidelines stipulate that anyone with a psychiatric diagnosis needs to have been "stable" for at least 1 year before their deployment.

But it's not clear what is considered unstable. One graduate student received a notice that she was "not physically qualified" (NPQ) last year after her doctor decreased the dose of her antidepressant medication. Another had the same thing happen after she switched insurance providers and doctors, leaving a short period of time when she didn't have a prescription for her antianxiety medication. (Science is not identifying NPQ'd scientists who requested anonymity for fear of future career repercussions.) UTMB did not respond to Science's request for comment about its screening procedures.

It's "really frustrating" that seemingly minor changes in mental health prescriptions appear to be disqualifying researchers from deploying, says Mindy Nicewonger, a climate scientist at Front Range Community College who conducted research in Antarctica as a graduate student and knows one of the students who received an NPQ notice last year. "I also take mental health drugs, and sometimes during seasons you have to up your dose—a lot of people go through seasonal depression," she says.

In another case, a researcher taking antianxiety medication was NPQ'd after moving institutions. A doctor had originally prescribed the medication during the stressful period leading up to her Ph.D. defense. She continued taking it after she moved for her postdoc and started seeing a new doctor. That switch between mental health providers, she believes, is what led UTMB to view her as "unstable." "I later found out that if I had asked anybody in my community, [they] would have told me to lie on the forms about anything mental health related," she says. "I think that's probably what I would have done in retrospect."

Penalizing researchers for actively managing their mental health is counterproductive, says Seth Campbell, a glaciologist at the University of Maine, Orono. "I've spent over 7 years of my life in the field and that's the [kind of] person I want in the field with me," he says. "Someone that's willing to actually get mental health support."

Campbell hasn't experienced any problems with the medical screening process himself. But he's witnessed multiple cases where others have run into difficulties, which is why he signed on to the letter sent to NSF. "I want to make sure the students that I'm working with have a better situation—it seems like there's been one issue after another in the past few years."

Some of the scientists who received NPQ notices in recent years ended up going to Antarctica after NSF granted them a waiver. But the NPQs often come just weeks or even days in advance of scientists being deployed, leaving little time for a waiver process many describe as "stressful and confusing." Individuals must sign a document attesting that they're "not physically qualified for deployment" and that they absolve NSF and its subcontractors of liability should something go wrong in the field. The individual's employer must sign a similar document, a requirement that often puts scientists in the uncomfortable position of disclosing personal medical information to university officials, including their direct supervisor.

The researchers Science spoke with acknowledge the need for a medical screening process. "You definitely should have to be physically qualified in order to go to Antarctica; I don't think anybody's debating that," says University of Kansas, Lawrence, glaciologist Leigh Stearns, lead author of the letter to NSF. But they would like to see more transparency in the entire screening and appeals process and a system for applicants to report allegations of discrimination and abuse to an independent medical ethics board. "If the current system cannot be improved … we petition that another agency or subcontractor be considered for managing polar physical qualifications," the letter authors request.

Michael Gooseff, a hydrologist at the University of Colorado (CU), Boulder, who oversees a project that deploys 31 scientists to Antarctica each year, applauds the letter's recommendations. "The idea of a periodic external ethics review is really a great idea," says Gooseff, who wasn't aware of the letter until Science sent him a copy. He would also like to see UTMB issue its decisions earlier. "The timing of that kind of stuff prior to deployment is really, really problematic and just overstresses an already stressed system."

Some also worry mental health NPQs could disproportionately harm women—an underrepresented group in polar science—because women are more likely than men to experience symptoms of anxiety and depression. But neither NSF nor UTMB make public any breakdown of the NPQs, which concerns some researchers.

"We're scientists—we want to know," Stearns says. She's been glad to see gains in the number of women researchers in Antarctica since she first started traveling to the frozen continent in 1999. But, "Protections for women in the field have been quite slow to evolve," she adds, referring to pervasive problems with sexual harassment. Stearns worries issues with the medical screening process could represent yet another barrier to attracting more women to polar research.

"I suspect if you looked at the stats that you'd see women failing these [medical qualification] exams more than men," says Michael MacFerrin, a glaciologist at CU who received an NPQ notice ahead of a planned deployment to Antarctica in 2020 because he has type 1 diabetes. After tweeting about his experience last year, other scientists—many of whom were women—reached out to him with NPQ stories of their own. He gave a talk about the issue at the American Geophysical Union's annual meeting in December 2022, which inspired the letter writers to take action—intentionally shielding early-career researchers including MacFerrin, a research scientist, from potential career repercussions by not having them sign.

MacFerrin and the letter writers would like to see NSF release aggregate statistics on pass/fail rates by gender, race, and disability status. NSF declined to say whether it was open to releasing such data. "We take the concerns of the community seriously and are working with our prime contractor to evaluate and increase oversight of the physical qualification program," the spokesperson wrote.

The postdoc who received an NPQ notice after changing institutions was able to secure a waiver to travel to Antarctica last year, where she had an "amazing" experience. But she's not sure she'd do it again. "I would have a really hard time convincing myself to try to get to Antarctica again, which is a huge bummer because I study the Antarctic Ice Sheet … and so obviously going there can be a significant benefit for me in my career," she says. "I'm probably better off avoiding the process until they can figure out how to make it right."