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Science Policy Around the Web – February 16, 2018

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By: Mohor Sengupta, PhD

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source: Max Pixel

Antibiotic discovery

A potentially powerful new antibiotic is discovered in dirt

Antibiotics have been in an ongoing, constant battle with the pathogens they are aimed to eliminate. Bacteria constantly mutate their genetic material to acquire resistance to anti-microbial drugs, making multi-drug resistance a global concern. Misuse or overuse of antibiotics contributes to this phenomenon. To address the issue of multi-drug resistance, a team of microbiologists at the Rockefeller University, NY, have conducted a large screen of natural products produced by soil-dwelling bacteria. According to Dr. Sean Brady, who heads the group, only a small fraction of the bacterial biodiversity is cultured in the lab and only a tiny fraction of chemicals produced by these bacteria are detectable. Identification of naturally produced chemicals by bacteria that have never been cultured in the lab provides a promising new direction towards anti-microbial therapies.

Dr. Brady’s group adopted a “culture-independent”, metagenomics approach to analyze chemicals secreted by unknown bacteria from soil samples. Their aim has not been to identify the bacteria in the samples but to look for DNA signatures associated with calcium dependent antibiotic properties. This means that the chemical they are looking for will act against bacteria only in the presence of calcium. After the identification of a gene potentially encoding a calcium dependent antibiotic, the researchers cloned it and made a laboratory grown bacteria (S. albus J1074) express it. The gene product is a new class of antibiotics that have been named “malacindin”. Dr. Brady’s research has shown that malacidins act by interfering with bacterial cell wall formation and have shown this antibiotic to be effective against a range of superbugs, including methicillin-resistant Staphylococcus aureus (MRSA). Calcium dependent antibiotics are believed to make it more difficult for the target bacteria to evolve resistance. Dr. Brady’s research was published in Nature Microbiology on February 12.

Conventional methods to isolate new antibiotics from laboratory cultured bacteria often lead to the same antibiotics being found over and over again, resulting in abandonment of such approaches in recent times. The novelty of Dr. Brady’s work lies in the use of natural sources, like soil, sewage, water etc. to isolate the genetic blueprint encoding anti-microbial chemicals, made easier with the use of metagenomics and large-scale sequencing. Researchers elsewhere are also using this approach to identify new antibiotics from natural sources. In the modern scenario of increasing deaths due to multi-drug resistance, this type of research is critical to rapid discoveries of novel antimicrobial therapies. Of course, getting the newly discovered drug into the market will not be fast, as Dr. Brady warns, yet this is an ingenious solution to discovering clinically useful antibiotics.

(Sarah Kaplan, The Washington Post)

Risk assessment

He Took a Drug to Prevent AIDS. Then He Couldn’t Get Disability Insurance

Pre-exposure prophylaxis (PrEP) is a practice of taking a drug to prevent HIV infection in persons with high risk of contracting it. In the year 2012, the F.D.A. approved Truvada, a drug originally approved for HIV treatment a decade earlier, for prevention of HIV infection (PrEP). Since then PrEP has become increasingly popular and as of 2017, an estimated 136,000 people in the United States were on PrEP. Several studies have shown that Truvada is highly effective in preventing HIV infection. However in the initial days of Truvada use,  some thought that individuals taking prophylaxis might overestimate its level of protection, leading them to engage in risky behavior they otherwise would have avoided. This belief is prevalent even today, as several insurance companies across the United States regularly deny disability and life insurance to men on PrEP on the basis that this treatment is indicative of an increased level of personal risk.

The repercussions of this policy, was exemplified when Dr. Philip J. Cheng of Brigham and Women’s Hospital at Harvard accidentally cut himself while preparing an HIV positive patient for surgery. The responsible behavior in this situation is to immediately take steps to prevent infection. Dr. Cheng did just that, by enrolling into PrEP. However, when he applied for a disability insurance, he was denied coverage because he was taking Truvada. He could not get the insurance company to cover him even after agreeing to sign a waiver of benefits in case he got infected.

Disability insurance is usually applied for by people whose livelihood depends on their income. For people like Dr. Cheng this insurance will guarantee him his lifetime of income in the case of a disability. Use of Truvada has not shown any adverse side-effects till date. In fact, it is said to be safer than aspirin, whose long term usage causes gastro-intestinal bleeding. It is a consensus among AIDS doctors across the USA that PrEP is necessary for individuals at high risk of contracting HIV. Denial of insurance to PrEP users by insurance companies has been likened to denying insurance for using car seat-belts by Dr. Robert M Grant, whose group led the clinical trial that established the importance of PrEP. Even more perplexing is the fact that life insurance companies are regularly providing insurance to people with other conditions that are managed by regular medications, like diabetes and heart diseases. Even former alcoholics who are now un-addicted are not denied.

Mr. Bennet Klein, a lawyer with Boston based GLAD, an organization of legal advocates and defenders of GLBTQ community has asked several insurance companies the reason for denying insurance to men on PrEP. In most interviews with various insurance companies he and others have heard a range of answers, some ambiguous. The general understanding is that insurance companies are increasingly following this trend because they suspect potential high-risk behavior in PrEP users. The crux here is that regardless of risky sexual behavior, PrEP is highly protective. A prominent work of research published in The New England Journal of Medicine in 2010 showed that tenofovir, one of the chief components of Truvada reduced the risk of HIV infection by 95 percent. The famous HPTN 052 clinical trial of 2011 also showed the efficacy of PrEP.

Because of the prevalence of insurance denials, several people, like Dr. Cheng have stopped using PrEP. It is critical that this trend is reversed, in the light of clear benefits of taking PrEP. While there are insurance companies that do provide disability and life insurance to PrEP users, cases like Dr. Cheng’s result in disappointment and eventual withdrawal from using PrEP.

(Donald G. McNeal Jr, The New York Times)Have an interesting science policy link?  Share it in the comments!

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February 16, 2018 at 4:58 pm

Science Policy Around the Web – February 13, 2018

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By: Saurav Seshadri, PhD

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Experimental drugs

Trump Endorses “Right to Try” for Terminally Ill Patients

Proponents of the ‘right to try’ received some encouragement from President Trump’s recent State of the Union address, in which he announced his support for such legislation at the federal level.  Right to Try laws are designed to allow terminally ill patients to obtain unapproved but possibly lifesaving drugs directly from pharmaceutical companies, without involving the FDA.  While such laws already exist in 38 states, they are currently superseded by the Food, Drug, and Cosmetic Act; a bill that would eliminate this legal conflict was passed by the Senate last August, but has yet to be approved by the House of Representatives.

In general, Right to Try laws permit terminal patients, with their informed consent, to access investigational treatments if recommended by a physician.  However, they do not mandate that the manufacturer provide the drug or that insurance cover it, and in some cases, they absolve drugmakers and physicians from liability for adverse outcomes.  In addition, the FDA already offers a path to treatment for terminal patients under its ‘expanded access’ program, in which patients are treated as clinical trial participants and their doctor’s office becomes a satellite site, with appropriate regulatory oversight.  Opponents of Right to Try legislation, including FDA Commissioner Scott Gottlieb, argue that bypassing such oversight would critically undermine the clinical trial process (for example, a patient death from a drug obtained under a Right to Try law would not factor into the FDA’s consideration of that drug for approval).  They also suggest that these laws provide false hope for desperate patients – experimental drugs need only clear the safety phase of FDA trials, meaning no data exists on their efficacy – and open patients up to risks of physical harm and medical fraud.

Despite these concerns, Right to Try laws have gained momentum on the strength of anecdotal success stories, and politicians’ unwillingness to appear heartless towards patients suffering from terminal diseases.  Yet in reality, without securing financial support for patients, these laws are likely to result in some patients going bankrupt. Without requiring that treatments be demonstrated to be beneficial and at least safe, these laws are likely to result in patients pursuing ineffective treatments, while reducing their quality of life by enduring side effects, risking complications, and forgoing hospice care.  The future of Right to Try legislation may be influenced by new Health and Homeland Security Secretary (and former Eli Lilly executive) Alex Azar, who seems likely to support Trump’s agenda, though he didn’t mention the right to try in his response to the State of the Union address.  Ideally, the final bill will prioritize the existing drug review process, ensuring safety for the majority of patients while still providing hope for the sickest.

(Ike Swetlitz, STAT news)

Chemical safety

The truth about glyphosate may be getting lost in the weeds

The World Health Organization (WHO) kicked off a massive controversy in 2015 with its report labeling glyphosate, a component of an herbicide marketed by Monsanto, as ‘probably carcinogenic to humans’.  The report has faced stiff opposition from Republican Representatives on the US House Science, Space, and Technology Committee, largely fueled by a pair of Reuters reports suggesting that key data was suppressed by the WHO to support its conclusion.  Now Dr. Christopher Wild, Director of the group that conducted the research (the IARC, International Agency for Research on Cancer) has sent a detailed response to the Committee to rebut these criticisms and defend its original finding.

The response, which was presented at a recent Committee hearing by Democratic Representative Suzanne Bonamici, specifically addresses two issues raised by Reuters.  First, that a senior scientist failed to disclose data that would have exonerated glyphosate: the data was unpublished and therefore didn’t meet IARC’s criteria for consideration.  Second, that the published version of the report had several changes from an earlier draft, all of which involved deleting or revising statements that cast doubt on glyphosate’s link to cancer.  Dr. Wild claims that most of these changes were related to a single review article, whose conclusions were reconsidered when it was found to have been ghostwritten by a Monsanto scientist, and that its drafts are works in progress and therefore confidential.  Still, the response doesn’t explain the IARC’s discrepancy with other regulatory agencies: the European Food Safety Authority (EFSA) and US Environmental Protection Agency (EPA) have both found glyphosate to be safe, and claim their review processes are more transparent than the IARC’s.

The IARC’s stance on glyphosate puts it in a delicate position with the US government, from which it receives ‘valuable support’, especially as the topic becomes more partisan.  Republican lawmakers have already threatened to pull funding to the IARC, ostensibly over its refusal to provide a witness for the hearing (Dr. Wild invited them to visit his facility in France instead).  On the other side, the EPA’s assessment has been called into question by the discovery that an EPA official may have colluded with Monsanto to ‘kill’ investigation into glyphosate, leading Democratic Representative Ted Lieu to request a probe into the issue.  In the midst of a heated debate on climate change, the glyphosate story may initially seem to be another case of Republicans denying science to fight regulations and side with big business; however, the reality may be more complicated.  A recent protest in Paris by farmers, opposed to a proposed ban on glyphosate, highlights how those most affected by such policies must balance their economic stability against potential health risks.  Ultimately, though lawmakers may earn political points by siding with these individuals, if the price is discrediting accurate science and eroding public trust in regulatory agencies, no one wins.

(Corbin Hiar, E&E News)

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February 13, 2018 at 6:01 pm

Science Policy Around the Web – February 9, 2018

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By: Rachel Smallwood Shoukry, PhD

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Ethics

Big tobacco’s offer: $1 billion for research. Should scientists take it?

A controversial debate has arisen in recent years about whether scientists should accept funding from sources that have interests at odds with improving the human condition and promoting health. Specifically, should researchers accept research money from tobacco companies? This practice used to be generally accepted up until a couple of decades ago, but as the harmful effects of smoking have become more clear, as well as evidence of the tobacco industry’s attempts to cover-up and misdirect the public from becoming aware of those effects, the scientific community has become reluctant to partner with “big tobacco” and is more aware of conflicts of interest.

The tobacco company Philip Morris International (PMI), makers of Marlboro and other cigarette brands, is looking to invest in research of illegal cigarette trade and smuggling. It recently established a partnership with the University of Utrecht (UU) in the Netherlands to investigate this phenomena, but UU has now pulled out of the deal after a large amount of backlash. However, PMI is still looking to fund research on the tobacco industry, setting up the potential for more controversy.

There is additional concern about this possibility due to PMI’s funding of the Foundation for a Smoke-Free World. The foundation has stated that its goals are related to smoking cessation and preventing smoking deaths through several approaches. However, many fear that the foundation is simply a front for PMI to be able to distribute funds under a better-sounding name while continuing to fund research that can be presented in a misleading way to distract from legitimate health concerns. Several top institutions have denounced the Foundation for a Smoke-Free World for using PMI’s funds, and many have vowed that they will not seek grants from or collaborations with the foundation.

Proponents of allowing the funding via the tobacco industry are interested in research of cigarette alternatives aimed at harm reduction, arguing that little is known about their long-term health implications. They say there is little funding outside of the tobacco companies for these types of studies and don’t know where else to turn. They are also worried about the climate surrounding the topic, after the response UU received when accepting research dollars from PMI. But opponents do not believe that PMI and other companies are seeking harm reduction or to hide the truth about tobacco’s health effects through their research activities and marketing tactics. This ethical debate is sure to continue as PMI disclosed that it has had over 50 applications for funding.

(Martin Enserink, Science)

NSF

US science agency will require universities to report sexual harassment

The NSF has announced it will implement a new requirement that institutions receiving grants must report grant-funded investigators who have sexual or other types of harassment claims against them and whether they were put on leave pending investigation. Many are welcoming this step as movement toward a code of conduct that has been called-for in recent years. It is also coming on the heels of several research initiatives into sexual harassment in STEM fields and other organizations implementing policies to expose and prevent harassment. Although the #MeToo movement only brought sexual harassment claims to the forefront of our culture a few months ago, the STEM field had its own bombshell revelation followed by the unveiling of many stories of sexual harassment a couple of years ago when a renowned astronomer resigned after an investigation revealed years of sexual misconduct and harassment. This new policy is also likely related to the US Congress commissioning the Government Accountability Office to look into sexual harassment by individuals funded by federal scientific agencies.

The notice the NSF sent out also directs the recipient institutions to have clear policies on what constitutes harassment and what is appropriate behavior, as well as giving clear instructions to students and employees on how to report harassment. The institutions themselves will be responsible for conducting investigations and deciding repercussions. Until now the NSF has had an option to voluntarily report sexual misconduct of award recipients, but it was rarely used. The notice states that the NSF can remove the responsible personnel from the grant or even suspend or terminate the grant following the mishandling of a report.

Despite the general positive view of this attempt by the NSF to deter harassment and establish serious consequences, some have expressed concerns at the potential implications and logistics of implementation. It was suggested that this step may discourage universities from undertaking investigations of sexual harassment, since universities benefit from grant money and reputation just as the investigators do. Another aspect to consider is that universities have different policies on sexual harassment and misconduct, and what may be allowable at one institution may be a severe breach at another. It was not immediately clear from the notice how decisions will be made with regard to the grant following investigations. While perhaps not perfect, this policy by the NSF is a first step in the right direction to ensuring everyone can pursue their scientific endeavors in a harassment-free environment.

(Alexandra Witze, Nature)

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February 9, 2018 at 4:01 pm

Science Policy Around the Web – February 6, 2018

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By: Liuya Tang, PhD

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Cancer treatment

Breast cancer treatments can raise risk of heart disease, American Heart Association warns

Common cancer treatments include surgery, chemotherapy and radiation therapy. Chemotherapy and radiation therapy are always applied before or after surgical removal of a tumor, or applied to cancer patients when surgery cannot be performed. Not only will they attack tumor cells, chemotherapy or radiation therapy will also damage normal cells at the same time, which increases risks for other diseases. A recent report in the journal Circulation said that breast cancer treatments can raise risk of heart disease. It has been noticed that “breast cancer survivors who are 65 and older and were treated for their cancer are more likely to die of cardiovascular problems than breast cancer.” The possible cardiovascular consequences of breast cancer treatments may not be new to oncologists, but new cancer treatments have complex side effects which may not fully understood as they work differently from conventional cancer treatments. For example, the newly-developed cancer treatment, immunotherapy, stimulates the patient’s immune system to attack tumors, but sometimes the surging immune response can overshoot its target and attack healthy tissues and organs.

It is not a good idea to stop cancer treatment due to side effects, as saving ones life from a dangerous cancer is critical. But for this double-edged sword, how to make one edge blunt while keeping the other edge sharp? This requires surgeons and oncologists to work together to make a personalized treatment plan. As suggested by Dr. Deanna Attai, a breast surgeon at the University of California at Los Angeles, the patients with less-aggressive tumor may skip chemotherapy based on the test results on the cancer’s risk of recurrence. In addition, adopting different ways to deliver chemo drugs and developing more-targeted radiation can reduce the risks of cardiac damage for breast cancer patients.

It is not solely a doctor’s responsibility to monitor the side effects of cancer treatments, patients also need to be aware of what types of treatments and what the possible side effects are. Wrong treatments of side effects can aggravate symptoms, which may lead to severe problems. The new emerging immunotherapy presents a big challenge to the health care system as the side effects are not thoroughly understood. Doctors’ organizations and nonprofit groups are joining information campaigns to narrow the knowledge gap on immunotherapy, which will help patients better understand procedures of cancer treatment and manage any side effect if it occurs.

(Laurie McGinley, The Washington Post)

 

Drug development

Racing to replace opioids, biopharma is betting on pain drugs with a checkered past

The opioid epidemic has become a significant problem in the US, as 116 people died every day from opioid-related drug overdoses in 2016. To resolve this issue, biopharma continues to develop pain drugs. The class of drugs are called NGF inhibitors, which were halted by FDA in 2010 due to their severe side effects. NGF is short for nerve growth factor, which is a neuropeptide. When an injury occurs, the production of NGF is increased, which helps the brain perceive the pain. Theoretically antibodies that specifically bind NGF before it reaches cell receptors could be a good choice to inhibit NGF function, therefore treating people with chronic pain. But it was found that NGF antibodies are not suitable for a subset of patients with osteoarthritis, for whom treatment lead to dramatic joint deterioration. To obtain FDA’s approval of entering further clinical trials, drug companies showed that NGF drugs will probably be safe for patients not at risk of joint deterioration and shouldn’t be taken with nonsteroidal anti-inflammatory drugs such as Advil. So the clinical study was resumed in 2015. Will it become a replacement drug of opioids? Will the benefits outweigh its risks? The results will be put on table this year after drug companies finish their Phase 3 studies.

 

The severity of the opioid epidemic and the high need of non-addictive painkillers have kept drug companies optimistic about developing NGF drugs despite the side effects. However, there are opposite voices. The watchdog group Public Citizen criticized that the side effects are obvious and “further pursuit of testing in humans was an unreasonable course of action”. Criticisms also come from the business side. Leerink analyst Geoffrey Porges has warned Regeneron’s NGF drug would carry “all of the liabilities” of the past and scolded their continuing to pour money into the project. The failure has already been seen in the development of fulranumab, which is one type of NGF antibody. Even if NGF antibodies were approved by FDA, doctors would have concerns for prescribing a medication with potentially dangerous outcomes for patients with certain conditions.

(Damian Garde, STAT News)

 

 

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February 6, 2018 at 10:53 pm

The impact of the growing student loan burden on graduate education

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By: Rebecca McPherson, Ph.D.

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source: pixabay

Every individual has his or her reason for pursuing a graduate degree. For many, a graduate degree is a path to a specific career; for others, it is simply a personal goal; and at times, it is a requirement for job advancement. Although the benefits of a higher degree are as numerous as the types of degrees and disciplines offered, there is one unifying theme across higher education: rising and often unavoidable student loan debt. Forbes reported that in 2017, the student loan debt in the U.S. had reached an astonishing $1.3 trillion. Of the 44.2 million U.S. borrowers with some type of student loan debt, over 2 million owe at or more than 100,000 dollars. At the top of this mountain of debt are U.S. graduate students, a quarter of whom will borrow close to $100,000 to complete their education,  while a tenth will end up borrowing upwards of $150,000.

Educational debt can extend beyond the typical student loan programs. While tuition poses a major cost to the student, many may not be able to make enough money through stipends or part-time work to meet their cost of living. The Report on the Economic Well-Being of U.S. Households in 2016-May 2017 showed an increase in the rate of borrowing for educational related expenses. Although student loans remain the primary source of borrower debt, credit cards, home-equity loans, and private loans also make up a portion of the total educational debt burden.

With a climate of ever-increasing educational costs and associated debt, many current, past, and future students are left asking, what is being done to curb the impact of mounting educational debt? The Institute for College Access & Success (TICAS) is responsible for enacting and overseeing the National Agenda for the Student Debt Policy in the U.S. Currently, TICAS focuses on risk-reduction strategies for student borrowers, including developing income-driven repayment plans, increasing access to Pell grants, and streamlining student borrower application processes.

The growing concern surrounding the ever-increasing student debt load is also being tackled at the state level. In recent years, several individual states have introduced policies aimed at protecting the student borrower, especially from predatory private student loan lenders. The Private Student Loan Transparency and Improvement Act was passed in Oklahoma in 2013 and requires private and alternate student loan providers to be transparent in the lending and repayment conditions. The state of Connecticut followed by being the first state to implement a borrower’s bill of rights in 2015. Several states offer student loan forgiveness and repayment incentives to entice student loan debt holders to work in specific regions.

What does the rising burden of student debt mean, and what are the ultimate costs to the borrowers? Ultimately, the price of student debt means that many young adults will have to put off major life decisions. Among graduate student borrowers, 43 percent state difficulty in regularly meeting student debt repayment obligations, 61 percent  say they are unable to save for retirement due to debt load, and 45 percent lack the means to save for an emergency fund. The costs of tuition has substantially increased since the early 1990’s and continues to grow; this initial rise in costs was caused by a decline in state support to colleges and universities.   Although there are no exact numbers showing the impact to low income students, the pursuit of a higher degree may, for many students, be out of reach.

Although several policies at both the state and national levels exist, there are gaps in how to deal with and resolve the mounting student debt crisis, and questions remain as to the impact on future training.  TICAS has indicated several areas of the lending and repayment process in need of continued improvement, such as enhancing educational tax benefits, preventing predatory lenders, and promoting student borrower awareness.

Students pursuing advanced degrees – beyond a bachelor’s degree – shoulder the bulk of the student debt burden. At times, wage outcomes fall below borrower expectations in certain fields of study. This can have a serious economic impact for borrowers who are unable to meet loan repayment requirements. Borrowers who have completed a higher level of education at a not-for-profit institute, and consequently have a higher burden of debt (i.e., $100,000 or more) are less likely to fall behind or default on payments.  Counter to this, student borrowers who have attended a for-profit institute or did not finish their degrees are more likely to fall behind on repayments or default on their student loans.  Additionally, those seeking advanced degrees will find that they have a greater ability to borrow from the federal loan program, which often has high caps and few or no credit checks required before borrowing. This leads some to put the blame for the student debt crisis on the federal government, arguing that unchecked borrowing causes educational institutions to continually raise tuition and fees for graduate education.

As of February 2018, no new federal laws regarding the student loan debt burden have been passed. However, several initiatives have been proposed by the current administration in an effort to tackle the expanding costs of the student debt. One such recommendation is the expansion of the income-based repayment plan (IBR), which would consolidate all loans into a single repayment of 12.5 percent of income with loan forgiveness after 15 years. Other recommendations include lowering federal loan interest rates; eliminating the Public Service Loan Forgiveness (PSLF) program, which would instead give focus to the proposed IBR; and a pushing for tuition reduction by imposing educational institutes to cut administrative costs.  On the upcoming 10 year anniversary of the start of PSLF, many argue that cutting the program would dissuade many young professionals from entering into the lower paying public health service.

Ultimately, the impact of the student loan debt burden may negatively affect graduate level training. There are calls to protect borrowers from predatory lenders and proposed legislation to tackle the debt crisis. The willingness to take on large debt and possibly delay major life decisions lies with the individual. For now, the student debt debate continues.

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February 6, 2018 at 12:13 pm

Science Policy Around the Web – February 2, 2018

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By: Michael Tennekoon, PhD

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source: pixabay

Bias in research

Gender bias goes away when grant reviewers focus on the science

Increased scrutiny has been given to the knowledge that there is a lack of senior female faculty in science. Many reasons have been postulated for this, including a lack of appropriate mentoring, a lack of adequate support when balancing family needs, and a general bias in the field. Highlighting the possible impact of bias, a new study from Canada shows that women are rated less favorably than men when reviewers assess the researcher as compared to when reviewers assess the research proposed on a grant application.

To address the issue of gender bias, the Canadian Institutes of Health Research (CIHR) phased out traditional grant programs that focused on both the science and the investigator. Instead, they ran two parallel programs, in which one focused primarily on the applicant’s credentials and the other focused on the science proposed. In addition, reviewers were trained to recognize unconscious biases that may impact the impartiality of their review decisions.

When grant reviewers focused on the quality of the applicant, the success rate for male applications was 4% higher than for female applicants. When grant reviewers instead focused on the quality of the science that was proposed, this gap reduced significantly to 0.9%, a level similar to traditional grant funding programs.

Furthermore, the impact of training reviewers on unconscious bias was of particular interest. Previous work suggested this type of training could exacerbate the situation, however, in this case, training appeared to help the situation by reducing the gap in successful applications between genders. The authors of the current study are planning to further explore the intricacies of how the training could be neutralizing some of the unconscious bias.

While a strength of this study was that it accounted for applicant’s research areas and age, this study was not randomized, which could have impacted the results. For example, there could have been a sample bias based on who chose to apply for the grants, which could have resulted in differences between male and female applicants in various aspects of their applications (such as publication records).

Is this gender bias prevalent in the United States as well?

Somewhat encouragingly, research has shown that males and females are funded at equivalent rates early in their careers by the NIH. Of graver concern, however, is that the research also showed that the number of women who apply for funding drops dramatically as their careers progress. As funding success rates do not appear to contribute to this, other factors, such as a lack of senior role models and mentors, or inadequate support for women that wish to have children and continue working in research, may contribute to the drop in female faculty in research. It is also important to note that biases are not limited to gender, but also exist with race. A 2011 study showed that white researchers are funded at nearly twice the rate of African American researchers despite similar publication and training records. While approaches such as those used by CIHR may help increase representation in senior faculty positions, solutions that tackle systemic biases may be needed to address the full scope of the problem.

(Giorgia Guglielmi, Nature News)

Influence of Social Media

Google’s new ad reckons with the dark side of Silicon Valley’s innovations

Studies have shown a rise in the number of teen suicides and self harm in recent years. There is growing concern that an increase in the amount of time spent on social media is playing a role in increasing the rates of teen suicide. Conscientious of this, Google recently debuted a new advertisement to highlight mental health implications of social media and other modern technology. The advertisement starts off by showing pictures of people sharing happy moments and pictures. However, the advert then pivots to suggest that not everything is as it seems in the perfect pictures, as all the people involved had sought support through the national suicide prevention number at one point in time.

Recent research has raised questions about the effects of social media, in particular with the ‘pressure of perfection’ and the impact it can have on social media users. Specifically, the research shows that users who passively scroll through news feeds could be most susceptible to feelings of unhappiness. In addition to this effect, technology companies are under fire for helping to spread offensive material. A recent pertinent example of this was when Logan Paul documented on YouTube how he discovered a dead body in a Japanese forest known for suicides. Furthermore, after Netflix aired ‘13 reasons why’, a documentary centered on a teen’s suicide, googles searches for suicide methods spiked. Alarmingly it has been documented that searches about suicide are linked to individuals committing suicide.

Large technology companies such as Facebook, Apple, Google and others are making efforts to try to rectify the situation. Facebook has begun using artificial intelligence to recognize suicidal thoughts and connect affected individuals with first responders. However, the capability of these companies to effectively prevent suicides is limited by the essence of what these companies are designed to be. For example, while a Google search asking how to commit suicide will display resources to suicide prevention resources and hotline numbers to the user, the search will also bring up pages detailing the “right way” to commit suicide along with would be instructional videos on YouTube. Clearly these companies still have much work to do when it comes to reducing teen suicide rates.

(Drew Harwell, The Washington Post)

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February 2, 2018 at 1:11 pm

How do healthcare and health outcomes in the US compare to those of other developed countries?

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By: Vanessa Gordon-Dseagu, PhD

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For much of 2017, the Trump administration engaged in numerous attempts to repeal the Affordable Care Act – legislation that was considered by many to be the first step towards the introduction of universal healthcare within the US. As the debate continues over the role of the government in the provision of healthcare, comparisons with systems abroad may reveal important shortcomings within those found in the US. There are a number of methods to assess and compare the performance of a healthcare system; this essay focuses upon the key areas set out by the Peterson-Kaiser Health System Tracker – spending and health outcomes (those amenable to health-service provision) as well as the uninsured/access. By looking at the provision of healthcare internationally, we may learn key lessons in how to improve the US system.

Cost

In 2016 the US spent around 17% of its GDP on healthcare (around $3 trillion). This is almost double the amount spent by other industrialized nations, while the amount of healthcare used per capita is similar across countries. The key reason for this appears to be cost. Patients in the US pay far more for their healthcare to be provided than their international counterparts, with one study finding hospital prices in the US to be 60% more than those in Europe. One reason for this appears to be the high cost of insurance administration within the US system caused by, oftentimes, fractured and duplicative provision. Hospitals must employ large departments to properly bill insurance companies and verify insurance coverage, costs that are passed on to the patient. In comparison, nationally or regionally organized systems, free at the point of need, do away with the need for insurance administration. The Affordable Care Act (ACA) sought to address some of the administrative waste and duplication found within US healthcare provision by employing economies of scale and streamlining the insurance procedure.

The cost of prescription drugs in the US is also an issue for concern for patients and policy-makers alike. The US spends more per capita on prescription drugs than other countries within the Organization for Economic Cooperation and Development (OECD). A 2016 JAMA study found that per capita spending on prescription drugs was $858 a year within the US, compared with $400 for 19 other industrialized countries. One factor likely influencing this is the more rapid uptake of new and, thus, more expensive prescription drugs within the US compared with other OECD countries. While an equally important factor is the price at which the drugs are sold in the US compared to other countries – drug prices in the US are substantially increased compared with other markets. The experience internationally is that policies, such as centralized pricing and universal healthcare, as well as other price controlling strategies, are effective at reducing drug costs. While the majority of developed countries enact some form of price regulation, within the US, the federal government is legally prohibited from negotiating drug prices for its widely administered Medicare program. Further to this, for each new drug the US Food and Drug Administration approves, it upholds a market exclusivity period, ranging from six months to twelve years, in which it will not approve a generic form of the same drug, limiting access to cheaper generic drugs. This, combined with US patent law protections, means that, on average, a brand-name drug manufacturer can expect their product to be on the market between 12-16 years before  the introduction of generic competitors. In comparison, across Europe 13 countries have policies which make generic drug substitution mandatory, 13 have voluntary protocols, with only five forbidding the practice.

The uninsured and access to healthcare

The World Health Organization considers universal health coverage to be a system within which 1) individuals can use the health services they need; 2) the care is of a sufficient quality to be effective; 3) individuals are not exposed to financial hardship caused by accessing the services. Of the 35 countries within the OECD, 32 have healthcare legislation that is in keeping with the WHO definition of universal healthcare. The US is now the only high-income country not to offer universal health insurance coverage.

Although the introduction of the ACA reduced the number of uninsured in the US from 44 million in 2013 to a low of 28 million in 2016, by the end of 2017 the number of uninsured had again risen by 1.3%, an estimated 3.2 million individuals. The causes of this increase may relate to the uncertainty surrounding the potential repeal of the ACA under the current administration, the repeal of the individual mandate within the Trump tax bill, the exit of several insurers from the ACA market and increasing health insurance costs.

The benefits of healthcare coverage upon health outcomes are well documented and relate to access to preventive, ambulatory, primary and secondary healthcare. Further to this, access to healthcare is particularly important for those with complex or ongoing chronic conditions. A review of the evidence related to health insurance coverage and health concluded:

“There remain many unanswered questions about U.S. health insurance policy, including how to best structure coverage to maximize health and value and how much public spending we want to devote to subsidizing coverage for people who cannot afford it. But whether enrollees benefit from that coverage is not one of the unanswered questions. Insurance coverage increases access to care and improves a wide range of health outcomes. Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence.”

To overcome some of these issues, members of the House of Representatives (with a parallel bill introduced in the Senate in 2017) have been developing the Expanded & Improved Medicare for All Act, colloquially known as ‘Medicare for all’. The bill seeks to take the role of government in healthcare one step further than the ACA and introduce:

“A system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs”.

Health outcomes

In relation to access, the US system has been found to fall short, particularly in the areas of primary care, prevention and management of chronic conditions. In its comparison of healthcare systems, the Commonwealth Fund concluded that the US ranked last on access. The insufficiencies of these areas of care contribute to the lower life expectancy found within the US compared with the majority of OECD countries – in their 2016 report, the US was found to rank 26 out of the 35 OECD countries. The same investigation found that the US also fell below the OECD average in several more nuanced indicators of health (for example maternal and infant mortality). In the same study undertaken by the Commonwealth Fund, the US ranked last out of 11 comparable countries for healthcare outcomes. The report also found that the US had the highest rate of mortality considered amenable to the provision of care. Compared with the other 10 countries under investigation, the US performed better in areas such as in-hospital mortality following a cardiovascular disease related event and five-year survival for some cancers. The lack of easily available preventative services may also contribute to the high, and increasing, rates of non-communicable diseases such as diabetes, as well as other conditions such as overweight and obesity, for which the US has the highest rates within the OECD.

Despite the substantially increased costs of healthcare in the US compared with international counterparts, the population is not experiencing a corresponding improvement in health outcomes. International comparisons suggest that tighter regulation of costs, particularly those related to insurance administration and prescription drugs, may go some way to addressing this issue. The introduction of universal coverage is also likely to allay some of the deficiencies inherent to healthcare provision within the US. How the issue of the provision of healthcare is broached by this, and future, administrations will have a substantial impact upon the health of the nation.

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Written by sciencepolicyforall

February 1, 2018 at 11:42 am