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Genetics: Receptors Discovered that Direct Rod Cell Development
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Special Report: Visa Woes Threaten Conduct of Science
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Neurology: Mutation Suggests Novel Signaling Mechanism in Brain Development
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Metabolism Kinase Pathway Seen to Regulate Urge to Eat
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Medical Education Fourth-years Make Matches, Favor Internal Medicine, Pediatrics
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Doctors Struggle with Complex Issues When a Patient is Dying
HMOs May Improve Diabetes Care by Providing Home Monitors
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Proceedings of the HMS Faculty Council
Projects in Epidemiology, Nutrition Take Prizes at HSPH Poster Day
Rabkin Fellows Announced
HMS Dean's Community Service Awards Deadline Extended
In Memoriam:
Wayne Streilein
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 Practice Principles Have to Stand on Actual Data
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 Medical Records Hit Slow Going from Paper Trail to Digital Highway
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Front
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SPECIAL REPORT
Visa Woes Threaten Conduct of Science
Last July, Xinhua Chen's research project ground to a halt only two months into his postdoctoral fellowship. His father had suddenly died. The same day, Chen flew home to Beijing.
Soon, for Chen and his family, feelings of loss and grief were compounded by increasing uncertainty about his future during a six-month wait for an updated visa stamp to return to Boston.
In the nation as a whole and in the Harvard Medical community, international scholars make up more than half the postdoctoral research fellow population whose daily work fuels the U.S. research enterprise. (Sources, clockwise, from top left: National Science Foundation; HSPH Academic Affairs, HMS Human Resources; National Science Foundation; National Institutes of Health)
Chen believes his graduate field of study--biochemistry and molecular biology, one of about 200 fields of study on a U.S. technology alert list--triggered an extra security check known as Visas Mantis. Other biomedical fields on the 2002 alert list (the latest version publicly available) include biochemistry, immunology, virology, microbiology, pathology, genetic engineering and recombinant DNA technology, and neurology. The longer list and tougher enforcement are part of beefed-up U.S. security measures in response to the Sept. 11 terrorist attacks.
Reality Check
To many, the alert list seems unnecessarily broad, catching people who present no special risk and possibly discouraging some of the smartest people needed to sustain America's leadership in science and medicine. Over the last three years, the shifting U.S. visa procedures and border protocols have slowed down the visa process for many, creating some ambiguity and much dread about entering or reentering the country.
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"The U.S. is a very special place if you are in science. All the best people come to the U.S." --Gökhan Hotamisligil
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The State Department does not track how long it takes for a science student or scholar to obtain a visa, but a security review seems to be the key factor, according to a February report from the U.S. General Accounting Office (GAO), the investigative arm of Congress. A security check took an average of 67 days, the GAO calculated, based on a review of a random sample sent to the FBI and other agencies between April and June 2003. On a September visit to embassy posts in China, the GAO found 174 security checks pending for two to four months and 49 cases that had been pending for more than four months.
"Our experience has been that people eventually get their visas," said Sharon Ladd, director of the Harvard International Office, which sponsors visas for about 3,500 international students and 2,500 international scholars (usually postdoctoral fellows) at Harvard and some affiliated institutions in the Harvard Medical community. "It's just a question of how long. That in and of itself is just really hard on people. The University has tried to express its concern about these delays and at the same time acknowledge the government's concerns about security."
While Chen waited, the return trip on his airline ticket expired. His paycheck stopped. His rent and other bills in Boston came due monthly. Meanwhile, his adviser, J. Thomas Lamont, the Charlotte F. and Irving W. Rabb professor of medicine at HMS and Beth Israel Deaconess Medical Center, petitioned the Departments of State and Homeland Security and Senator Edward Kennedy's office to no apparent effect. With the clock ticking on the grant, Lamont eventually hired another postdoctoral fellow to take over Chen's project, which aims to identify the receptor for toxins of Clostridium difficile, a bacterial pathogen that causes antibiotic-associated diarrhea and colitis.
Chen returned to Boston in January. He is in debt, but he has a new project in Lamont's lab to define specific mechanisms for the protective and therapeutic effects of Saccharomyces boulardii, a probiotic yeast, in inflammatory bowel disease.
Postdoc Dilemmas
Stories of unprecedented travails are increasingly common among the Harvard Medical community. When Daniel Panne, a German postdoc in the structural biology laboratory of Howard Hughes investigator Stephen Harrison, HMS professor of biological chemistry and molecular pharmacology, returned from a scientific meeting in Heidelberg last March, Logan airport security officials presented two options--prison or a plane ticket. His crime? His passport was missing an updated stamp required to accompany other paperwork on his visa extension. Panne purchased the $2,000 one-way ticket home.
It took about six weeks to schedule an appointment with the U.S. embassy in Frankfurt for the mandatory interview, but then he received his new stamp the same day.
The delay endangered a collaboration with a postdoc in another HMS lab who needed to return home to Japan, a project aimed at defining the molecular details of how the immune system turns on the interferon-beta gene to fight infections. Nationwide, Panne is one of 436 postdocs employed by Hughes on temporary visas, a number that does not include those who have become permanent residents or U.S. citizens, said Hughes spokeswoman Jennifer Michalowski.
 Sharon Ladd directs the Harvard International Office, which sponsors visas for about 3,500 students and 2,500 scholars from China, France, Germany, Japan, South Korea, the United Kingdom, Canada, and more than 100 other countries. (Photo by Jeff Cleary)
At the lab of Li-Huei Tsai, a Hughes investigator and HMS professor of pathology, Farahnaz Sananbenesi, an Iran-born German postdoc, arrived in January. Her visa allows only a single entry into the country. If her mother, 70 and living alone in Iran, became sick, Sananbenesi would have to risk derailing her scientific career if she traveled to Iran to care for her. She also faces the dilemma of looking for work after her fellowship ends, a process that begins in the fellowship's last year. "With a single-entry visa, I cannot go for job talks to Europe," she said.
 International students make up less than a quarter of people enrolled in M.D. and Ph.D. programs based at HMS and HSPH. (Sources, left to right: HMS Registrar's Office; HSPH Student Services and Harvard University GSAS Admissions Office)
Tianzhi Shu, a postdoc from China in the Tsai lab, chose to forgo a Gordon Conference in June in Hong Kong on developmental neurobiology rather than risk a visa delay.
The Security Gauntlet
Gökhan Hotamisligil, the James Stevens Simmons professor of genetics and metabolism and chair of the new Department of Genetics and Complex Diseases at HSPH, took his entire lab of mostly foreign-born postdocs to a major Keystone meeting in Calgary in February. His group works on understanding the molecular basis of obesity, diabetes, and related disorders. Those from the lab who reentered the country through Chicago were hassled by security officials, he said, but fortunately made it back to Boston without delay.
"The U.S. is a very special place if you are in science," said Hotamisligil, who travels on a Turkish passport. "All the best people come to the U.S."
Good Fences, Good Neighbors?
The real and perceived U.S. barriers to foreign students and scientists are particularly vexing to people who believe the surest route to national and economic security lies in the exchange of information and expertise designed to improve health.
"Quite frankly, if we work together to find solutions to root causes we would be better off than building the equivalent of a wall," said Robert Crone, president and chief executive officer of Harvard Medical International and HMS clinical professor of anesthesia at Children's Hospital.
Crone is appalled at how some expert faculty from other countries traveling to the United States have been treated. In one particularly egregious case, a German professor who missed a flight connection to Boston and flew instead to Philadelphia was detained for four hours and treated disrespectfully while his Harvard colleagues worked furiously to gather and fax confirming paperwork and contact U.S. government officials for help. Senior government officials from Dubai and Lebanon working with HMI to build national health care systems in their countries have also been delayed by suspicious security officials in U.S. airports, Crone said. |
Several surveys in the last few months suggest that visa problems may threaten America's status as a scientific mecca. Foreign graduate student applications for fall 2004 have dropped, a possible harbinger of decreased enrollment in two to three years, according to a report last month from a coalition of several higher education organizations. International applications to PhD programs are also down at Harvard, especially from China, said Russell Berg, dean for admissions at the Harvard Graduate School of Arts and Sciences. He is not clear whether the drops and the visa delays are linked.
In an October survey, about half of 331 institutions reported fewer total international students for fall 2003 compared with fall 2002. Yet the number of foreign scholars and students actually coming to Harvard and its medical community has continued to increase, Ladd said.
Since last year, an ad-hoc University-wide group chaired by the University General Counsel has been monitoring these visa issues, planning strategies to influence government policies, and advising students, faculty, and scholars, said Kevin Casey, senior director of Federal and State Relations at Harvard.
FBI and State Department officials say they are working to speed up security checks and give priority to students and scholars, but close observers do not expect the visa problems to disappear any time soon. Adding to the U.S. bind, Britain, Australia, Canada, and other countries have been successfully ramping up efforts to attract foreign scholars, according to a news report in the Jan. 15 Nature.
Meanwhile, foreign scholars and scientists still struggle with the U.S. system. Two years ago, Xiao Dan, a Beijing physician, received an NIH-funded Fogarty International Fellowship to spend one year of study in collaboration with the group of David Christiani, HSPH professor of occupational medicine and epidemiology and HMS professor of medicine at Massachusetts General Hospital. After much delay, including two visa refusals, she finally arrived in Boston on March 21. Then she had to scramble to apply for an extension to her visa, which expired on March 31.
--Carol Cruzan Morton
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