Archive for the 'Public Health' category

NIH's rapid growth has let in a bunch of riff-raff!

I am sure Dr. McKnight realizes that when he asserts that "Biomedical research in the 1960s and 1970s was a spartan game" and "Biomedical research is a huge enterprise now; it attracts riff-raff who never would have survived as scientists in the 1960s and 1970s" he is in fact lauding the very scientists "When I joined the molecular cytology study section in the 1980s.. all kinds of superb scientists" who were the riff-raff the prior generation complained about.

From a very prestigious general Science journal in 1962:

Some of [this change] arises from expressions of concern within the scientific community itself over whether the NIH's rapid growth has sacrificed quality to achieve quantity.

The astute reader will also pick up on another familiar theme we are currently discussing.

And some of it reflects nothing more than the know-nothing ramblings of scientific illiterates, who conclude that if the title of a research project is not readily comprehensible to them, some effort to swindle the government must be involved.

1962, people. 1962.
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Greenberg DS. NIH Grants: Policies Revised, but Critics Not Likely To Turn Away. Science. 1962 Dec 28;138(3548):1379-80.

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Bash Science with Gay AND Fat-shaming? It's like a rightwing three-fer

We recently discussed how the Origami Condom project supported under the Small Business Innovation Research Congressional mandate had quite obvious public health implications in a prior post. This was in response to the gleeful Republican bashing of NIH funding priorities in the wake of NIH Director Francis Collins' rather poorly considered claims* that Ebola research has been held back by the flatlining of the NIH budget over the past ten years.

Today we take on another one of these claims that the NIH has not been using its appropriations wisely. Fox news provides a handy example of the claim:

The National Institutes of Health (NIH) has spent more than $39 million on obese lesbians

As the wags are posting on various social media outlets, more Americans have been dumped by [insert popular entertainment personality] than have been killed by Ebola.

In striking contrast, obesity is a big killer of Americans. According to one review of the evidence:

Using data on all eligible subjects from all six studies, Allison et al. estimated that 280,184 obesity-attributable deaths occurred in the U.S. annually. When risk ratios calculated for nonsmokers and never-smokers were applied to the entire population (assuming these ratios to produce the best estimate for all subjects, regardless of smoking status, i.e., that obesity would exert the same deleterious effects across all smoking categories), the mean estimate for deaths due to obesity was 324,940.

Additional analyses were performed controlling for prevalent chronic disease at baseline using data from the CPS1 and NHS. After controlling for preexisting disease, the mean annual number of obesity-attributable deaths was estimated to be 374,239 (330,324 based on CPS1 data and 418,154 based on NHS data).

Over 350,000 Americans die annually of obesity. For the Republican Congresspersons in the audience, "annually" means every year. Last year, this year, next year. Over 350,000.

No biggie, right?
Whoops, maybe it is worse than we thought?

Researchers found that obesity accounted for nearly 20 percent of deaths among white and black Americans between the ages of 40 and 85. Previously, many scientists estimated that about 5 percent of deaths could be attributed to obesity.

And is coming close to beating smoking as the top preventable killer of American citizens?
Flegel et al 2004 and Flegel et al 2013 provide some handy context to estimating mortality causes for the nerdier types. From the 2013 meta-analysis:

[overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) ] ..
CONCLUSIONS AND RELEVANCE: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.

So. Just this easily we can confirm that obesity is a major public health concern from mortality alone. This doesn't even get into non-mortal effect of obesity on personal well-being. Major public health concerns are the very province of NIH-funded academic research.

So once again, the applicability of grants that are targeted at reducing obesity (even if it is just understanding the causes of obesity) to the goals of the NIH, as mandated by Congress, is not in question. At all. This is not a frivolous expenditure.

That leaves us with the specific projects in question. I trotted over to RePORTER and pulled up 6 current awards- two are K-mechanism mentored training awards so we'll focus on the R-mechanism research projects.

R01 HD066963: SEXUAL ORIENTATION AND OBESITY: TEST OF A GENDERED BIOPSYCHOSOCIAL MODEL

nearly three-quarters of adult lesbians overweight or obese, compared to half of heterosexual women. In stark contrast, among men, heterosexual males have nearly double the risk of obesity compared to gay males. Despite clear evidence from descriptive epidemiologic research that sexual orientation and gender markedly pattern obesity disparities, there is almost no prospective, analytic epidemiologic research into the causes of these disparities. It will be impossible to develop evidence-based preventive interventions unless we first answer basic questions about causal pathways, as we plan to do.

I bolded a key part, from my perspective. You waste a ton of money, often public money, if you go off with solutions to problems without having a clear understanding of the things causing or following from this problem. Epidemiological and sociological research guides not just public policy but also additional studies of physiology, genetic liabilities, etc. So this specific project would seem to be of considerable use.

R01 DK099360:TYPE 2 DIABETES AND SEXUAL ORIENTATION DISPARITIES IN WOMEN

lesbian and bisexual (LB) women may be at elevated risk for developing T2D because they are more likely than heterosexual women to experience obesity and other risk factors linked with T2D such as cigarette smoking, violence victimization, and depressive distress. Nonetheless, knowledge of T2D and how it may disproportionately affect LB women is severely limited. Studies using longitudinal designs that have comprehensively examined how lifestyle, diet, and psychosocial risk factors for T2D may differ between LB and heterosexual women across the life course are virtually nonexistent.

This project emphasizes non-mortal morbidity, i.e., Type 2 Diabetes (T2D). And again, the abstract describes how we know almost nothing about the reasons for the obesity disparity between lesbian and heterosexual women. If we are going to disentangle potential social, behavioral, cultural, physiological and genetic contributors to the disparity, we need information. And very likely, through this research we will come to know more about how these variables affect obesity risk for all Americans, across all subpopulations. This will help us design better interventions to reduce the obesity burden. Clearly this is another grant that is clearly non-frivolous and fits into the public health mandate of the NIH.

R21 HD073120: UNDERSTANDING DISPARITIES IN OBESITY AND WEIGHT BEHAVIORS BY SEXUAL IDENTITY

Previous research indicates that lesbian, gay, bisexual and transgender (LGBT) adults experience more adverse health outcomes than their peers. Findings from the few studies examining weight disparities among adults suggest that lesbian women are more likely to be overweight or obese compared to their heterosexual peers, though less is known about gay men and bisexuals. Given the scant research to date in this area, the Institute of Medicine (IOM) recently issued a call for additional research on LGBT health. Furthermore, IOM highlighted the need to utilize a life-course framework when examining health disparities by sexual identity, acknowledging the unique influence of various life stages on health

What's this now? Even the US Institute of Medicine has reported on how important it is to combat obesity in US citizens? I mean dang, guys, it's the IOM.

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

And they do investigations, review evidence, compare the facts...

anyway, this R21 is going to focus on young adults and do studies under the following Aims:

(1) Quantify disparities in obesity, dietary intake, physical activity, unhealthy weight control behavior, body satisfaction and other weight-related health outcomes among LGB and heterosexual students; (2) Identify major weight-related health behavioral patterns, or profiles, and the extent to which these behavioral profiles differ by sexual identity and gender; and (3) Characterize these behavioral profiles by demographic factors and health outcomes (e.g., age, socioeconomic status, health care coverage, obesity, and health status). We hypothesize that LGB students engage in more adverse behaviors than their heterosexual peers and exhibit differential behavioral patterning.

Yep, more psycho-social research but I continue to assert that without this evidence, we run the risk of wasting more money pursuing directions that could have been falsified by the epidemiological and social science studies of this type.

The final research project is an R15/AREA grant:
R15 AA020424: MINORITY STRESS, ALCOHOL USE, AND INTIMATE PARTNER VIOLENCE AMONG LESBIANS

Ok, going by the Abstract this one is indeed focused on Alcohol abuse and intimate partner violence and I don't see why it is being triggered by the obesity keyword on the search. But still, I think we can see that this one ALSO would draw right wing fire. Even though, once again, alcoholism and intimate partner violence are huge health issues in the US.

As with the Origami Condom NIH Grant, we can find with relatively little thinking that the "National Institutes of Health (NIH) has spent more than $39 million on obese lesbians" comment is wrongly placed in an article addressing "wasteful" spending on the part of the NIH. These projects address the causes of obesity, which is basically a top predator of Americans at the moment. Obesity causes excess mortality and morbidity, which is of course associated with financial costs. Costs to the individual and costs to us all as a society that shares some degree of social support for the health care of our fellow citizens. It is in our direct and obvious interests to conduct research that will help us reduce this burden of obesity. As far as studying subpopulations who appear to be at increased risk for obesity goes, there is no reason not to want to help African-Americans, Southern Americans, Flyoverlandia Americans or...Lesbian-Americans. Right? And while it may take a little bit of a leap of faith for those who haven't thought hard about it, understanding the causes of a major health condition in those other people over there helps to understand the causes in people who are just like ourselves. By subtraction if by no other means.

For my regular Readers I'll close with a plea. Use analysis like this one to beat back this stupid meme that is going around about "frivolous" NIH expenditures. This is not just about this current Ebola fervor. This is about the normal operations of the NIH as it has progressed over decades. There are always those wanting to score cheap political points by bashing science as trivial or obviously ridiculous. Nine times out of ten, these charges are easily rebutted. So take the time to do so, even if it just posting some text pulled from the grant abstract and a link to a morbidity report on whichever health concern happens to be under discussion.

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*"poorly considered" meaning he didn't apparently anticipate handing such a bunch of base-bait to the Republicans.

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The Origami Condom and NIH Ebola funding

One of the NIH funded research projects that has been bandied about with much glee from the right wing, in the wake of Francis Collins' unfortunate assertion about Ebola research and the flatlined NIH budget, is the "Origami Condom". It shows why NIH Director Collins should have known better. The Origami Condom sounds trivial and ridiculous, right? "Origami". hahah. Oooh, "condom". Wait, what are we, 12 year olds?

Rand Paul provides a convenient example.
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Eisen Nails Down Why Collins Was Wrong on Ebola Assertion

Oct 13 2014 Published by under NIH, NIH funding, Public Health

Endorse. Go read:

But what really bothers me the most about this is that, rather than trying to exploit the current hysteria about Ebola by offering a quid-pro-quo “Give me more money and I’ll deliver and Ebola vaccine”, Collins should be out there pointing out that the reason we’re even in a position to develop an Ebola vaccine is because of our long-standing investment in basic research, and that the real threat we face is not Ebola, but the fact that, by having slashed the NIH budget and made it increasingly difficult to have a stable career in science, we’re making it less and less likely that we’ll be equipped to handle all of the future challenges to public health that we’re going to be face in the future.

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NPR on the NIH Grant situation

Sep 10 2014 Published by under NIH, NIH Careerism, NIH funding, Public Health

In the event that you missed it, NPR has been running stories on the current situation with NIH-funded biomedical research in the US. These seem to be mostly the work of Richard Harris, so many thanks to him for telling these stories to the public. You will note that these are not issues new to this readership for the most part. The themes are familiar and, perhaps necessarily, latch onto one position and therefore lack breadth and dimension. Those familiar with my views on "the real problem" with respect to NIH funding will see many things I object to in terms of truthy sounding assertions that don't hold water on examination. Still, I am positively delighted that this extensive series is being brought to the NPR audience.

Enjoy.

When Scientists Give Up

"When I was a very young scientist, I told myself I would only work on the hardest questions because those were the ones that were worth working on," he says. "And it has been to my advantage and my detriment."

Over the years, he has written a blizzard of grant proposals, but he couldn't convince his peers that his edgy ideas were worth taking a risk on. So, as the last of his funding dried up, he quit his academic job.

"I shouldn't be a grocer right now," he says with a note of anger in his voice. "I should be training students. I should be doing deeper research. And I can't. I don't have an outlet for it."

U.S. Science Suffering From Booms And Busts In Funding

"If I don't get another NIH grant, say, within the next year, then I will have to let some people go in my lab. And that's a fact," Waterland says. "And there could be a point at which I'm not able to keep a lab."

He notes that the hallway in his laboratory's building is starting to feel like a ghost town as funding for his colleagues dries up. He misses the energy of that lost camaraderie.

"The only people who can survive in this environment are people who are absolutely passionate about what they're doing and have the self-confidence and competitiveness to just go back again and again and just persistently apply for funding," Waterland says.He has applied for eight grants and has been rejected time and again. He's still hoping that his grant for the obesity research will get renewed — next year.

Built In Better Times, University Labs Now Lack Research Funding

PAULA STEPHAN: In many ways, the research university that's evolved today is much like a shopping mall.

HARRIS: She says think of universities as mall owners and individual scientists as the shopkeepers. Scientists get research grants and then pay rent to the universities out of that money. When grant funding doubled between 1998 and 2003, construction cranes went up all over the country to build more lab space.

STEPHAN: Universities were exuberant. They thought that they could keep running this kind of scheme - where the NIH budget would keep going up, and they could keep hiring more people.

HARRIS: But that didn't happen. After the NIH budget doubled, it stagnated. In fact it's declined more than 20 percent when you take inflation into account.

STEPHAN: We greatly overbuilt the shopping malls.

By The Numbers: Search NIH Grant Data By Institution (support site for the pieces by Richard Harris)

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Thought on the public funding of science

Simple truth of the recentEbola hysteria and the ensuing media coverage of scientists working on hemorrhagic viruses. Approximately 85% of bioscience now wishing ill on a whole lot of people so as to draw attention to their scientific domain.

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Repost: The War on Drugs Didn't Work, Eh?

Sep 02 2014 Published by under Cannabis, Drug Abuse Science, Public Health

There's a strawman-tilting screed up over at substance.com from my current favorite anti-drug-war-warrior Maia Szalavitz. She's trying to assert that Trying to Scare Teens Away From Drugs Doesn’t Work.

In this she cites a few outcome studies of interventions that last over relatively short periods of time and address relatively small populations. I think the most truthful thing in her article is probably contained in this quote:

Another study, which used more reliable state data from the CDC’s Youth Risk Behavior Survey, concluded that “When accounting for a preexisting downward trend in meth use, effects [of the Montana Meth Project] on meth use are statistically indistinguishable from zero.”

This points out the difficulty in determining broad, population based outcomes from either personal introspection (where a lot of the suspicion about anti-drug messaging comes from, let's face it) or rather limited interventions. Our public policy goals are broad- we want to affect entire national populations...or at least state populations. In my view, we need to examine when broad national popular behavior shifted, if it did, if we want to understand how to affect it in the future.

The following originally appeared 21 July 2008.


If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of "The (US) War on Drugs is a complete and utter failure". Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.

Now I'm open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I'm most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.

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Ebola and ZMapp...A scientist explains

Aug 07 2014 Published by under Conduct of Science, Public Health

Erica Ollman Saphire (lab website, PubMed, RePORTER) was interviewed on KPBS in San Diego about the use of highly experimental antibody therapy for the US health workers infected with Ebola virus.

It's a pretty interesting viewpoint on basic science, translation to humans and what we do when an emergency situation like an infectious disease outbreak happens. I have been struck in past days about the huge international discussion this ZMapp treatment has been sparking. As you might expect, we have dark thoughts being expressed along the lines of "Why does this apparently miraculous treatment emerge all of a sudden when Americans are infected but it hasn't been given to suffering Africans, hmmmm?". There are all kinds of ethical issues to think about.

The television version linked below is 5 minutes but be sure to click on the link to the "midday edition" which is a longer voice interview. It gives a much fuller discussion.

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Additional Reading:

CDC: Questions and Answers on experimental treatments and vaccines for Ebola

Experimental Ebola drug based on research from Canada’s national lab

Ebola experimental drug, ZMapp sparks ethical controversy

UPDATE:
David Kroll on ZMapp

David Kroll on two other Ebola therapies

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Insinuations, misdirections, straw arguments and obsfucation in drug abuse journalism

Jul 18 2014 Published by under Drug Abuse Science, Public Health

Maia Szalavitz has penned a new article on addiction that has been circulated, credulously and uncritically, on social media by people who should know better. So, once more, into the breech, Dear Reader.

The article in question is Most of Us Still Don't Get It: Addiction is a Learning Disorder is posted at substance.com.

We can start with the sub-header:

Addiction is not about our brains being "hijacked" by drugs or experiences—it's about learned patterns of behavior. Our inability to understand this leads to no end of absurdities.

From whence comes learning if not from experiences? And what is the ingestion of a psychoactive drug if not an experience? She is making no sense here. The second sentence is pure straw-man, particularly when you read the entire piece and see that her target is science, scientists and the informed public rather than the disengaged naive reader.

Academic scientists focused on drug abuse have talked about the learning aspect, of habits and of the lasting consequences of drug experiences since forever. This is not in the least little bit unknown or novel.
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Medical marijuana "researcher" fired by U of A

Jul 02 2014 Published by under Cannabis, Public Health, Science Politics

From the LA Times:

The University of Arizona has abruptly fired a prominent marijuana researcher who only months ago received rare approval from federal drug officials to study the effects of pot on patients suffering from post traumatic stress disorder.

The firing of Suzanne A. Sisley, a clinical assistant professor of psychiatry, puts her research in jeopardy and has sparked indignation from medical marijuana advocates.

I bet. Interestingly I see no evidence on PubMed that this Sisley person has any expertise in conducting research at all. I'm not saying I need exhaustive credentials but I'd like to see a published study or two.

Cue the usual raving about how this is all a vast right wing conspiracy to keep down miraculous medication...

Sisley charges she was fired after her research – and her personal political crusading – created unwanted attention for the university from legislative Republicans who control its purse strings.

“This is a clear political retaliation for the advocacy and education I have been providing the public and lawmakers,” Sisley said. “I pulled all my evaluations and this is not about my job performance.”

Well, this IS Arizona we're talking about. I'm going to want to see more* but I guess I am going to have to score myself as sympathetic to the notion that this was a political squelching.
Still, the University is denying the charge...

University officials declined to explain why Sisley’s contract was not renewed, but objected to her characterization.

“The university has received no political pressure to terminate any employee,” said Chris Sigurdson, a university spokesman. He said the university embraces research of medical marijuana, noting that it supported a legislative measure in 2013 permitting such studies to be done on state campuses.

Ok, "embraces", eh? We'll see if that turns out to be true.

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h/t: clbs

*if this holds true to form the University will be compelled to make a case for how she wasn't competent at the "clinical assistant professor" category of association with U of A.

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