Science Policy For All

Because science policy affects everyone.

Science Policy Around the Web – November 28, 2014

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By: Varun Sethi, Ph.D

photo credit: El Bibliomata via photopin cc

Interdisciplinary Science

Gut-brain link grabs neuroscientists

Gut bacteria benefit mental health. Do they? This is what companies selling probiotics have long claimed. Though traditionally skeptical to the theory, many neuroscientists are becoming interested in the clinical implications of the gut microbiome. The National Institute of Mental Health spent more then US$ 1 million this year, on research aimed at studying the microbiome-brain connection. Studies presented at the recent SFN meeting in DC reported this as a paradigm shift in neuroscience. Bifidobacterium and Lactobacillus are genera that have been reported to show beneficial effects on anxiety and depression related behavior. Gut bacteria and bacterial waste products may regulate stress, anxiety and cognition, especially in early life. Mechanisms and therapeutic potential of these associations are the focus of research in the field. The interaction between the gut associated immune system, enteric nervous system and gut based endocrine system has led to intriguing speculations about the impact of the bi-directional signaling between the mind, brain and gut. Are psychobiotics and melancholic microbes going to be the prescription to happiness? Though majority of the studies are in rodent models, the implications of microbiota in our intestines is being increasingly looked at with interest. There maybe some science in the use of the term ‘gut feeling’ after all! (Sara Reardon, Nature)

 

Health Care Policy

Medicare’s Chronic Care Management Payment — Payment Reform for Primary Care

A fee-for-service system, wherein payments for primary care are restricted to office based visits, is unable to provide good support for the core activities of primary care outside the office visit. These include tasks such as patient care co-ordination, patient communication, medication refill and care provided via electronic or telephonic channels. In 2015, the Centers for Medicare and Medicaid Services (CMS) will be introducing a non-visit-based payment for chronic care management (CCM). This is an important and broadly applicable change to primary care payment and reflects an investment in creating a value-oriented healthcare system. The system will allow a practices to receive a monthly fee of $40 for beneficiaries with two or more chronic conditions, that are expected to last at least 12 months and confer a significant risk of death, decompensation or functional decline. Practices will have to use electronic health records (EHR), provide round the clock availability to staff able to access EHR and maintain a designated practitioner amongst other things. The implementation of this policy will, however, have to deal with many challenges. Beneficiaries will be expected to pay a 20% co-insurance for CCM, a fee for a service they have so far received free. They will have the choice to consent, and in the event that they refuse, how will the practice continue to care for such patients ? Smaller practices with limited resources may have trouble meeting the requirements and may perhaps be rendered ineligible. The details of the implementation are unclear as yet. While the payment will provide additional resources to the primary care system, it may not achieve the transformation in practice as per the patient-centered medical home (PCMH) initiatives. (Samuel T. Edwards, Bruce E. Landon, New England Journal of Medicine)

 

Translational Science

Changing the Mindset in Life Sciences Toward Translation: A Consensus

Basic discoveries in biomedical science continue to a fast pace, however, the translation of this knowledge into clinical use lags behind significantly. Biomedical translation is challenged with scientific, financial and political speed-breakers. In May 2014, Translate, a meeting in Berlin, brought together stakeholders from around the world with the common goal of improving biomedical translation. Infrastructure, funding and de-risking issues in biomedical technology were major factors identified as barriers in biomedical translations. An appalling 80 to 90% research projects fail before they are tested in humans, and those that do proceed require up to 15 years to find a clinical use. A multidisciplinary approach involving clinical scientists, researchers, patent agents, industrial partners and regulatory authorities is required to create expert professional translators, who have the expertise to capture those discoveries that have the potential to make it to the clinical market. A change in academic funding and education is warranted. Academic reward systems should focus on not only the publication quality, number and journal impact factor, but also on tangible impacts of research on medical treatments and patient benefits. Cross-talk between scientists from different specialties, with different ideas, perspectives and expertise needs to encouraged and facilitated. The importance of professionalizing translation was emphasized at the meeting. Adequate economic incentives and market forces are essential in driving and directing successful translation. While industry is eager to take over projects beyond phase 2, funding for early phase development is complicated by larger risks and remains an uphill task. This paper discusses the role of a translational researcher in recognizing these challenges and invoking the industry, networking to form partnerships that are essential to collect market data and find solutions. A change in scientific mindset with a greater emphasis on interactive and collaborative relationships is needed. In future articles of this series, funding barriers and derisking will be discussed. Biomedical translation, is not a passive process and is a very crucial step in improving the value of health care, health outcomes and the quality of patient life. (Duda et al., Science Translational Medicine)

 

 

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Written by sciencepolicyforall

November 28, 2014 at 3:50 pm

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