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Archive for April 2016

Science Policy Around the Web – April 29, 2016

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By: Rebecca Meseroll, Ph.D.

Photo source: pixabay.com

Smoking cessation policy

British medical group recommends switch to e-cigarettes

The Royal College of Physicians (RCP) released a report this week encouraging cigarette smokers to switch to electronic cigarettes (e-cigarettes) as a step toward quitting smoking entirely.  E-cigarettes provide a source of nicotine, the addictive chemical in cigarettes, without tar and other cancer-causing additives.  The report found that the benefits in switching to e-cigarettes far outweigh the risks, noting that smoking is the largest avoidable public health threat in the UK and the health hazards of inhaling vapor from e-cigarettes amounts 5% or less of the risk of smoking cigarettes. These recommendations are somewhat at odds with the stance of public health officials in the US, including the Centers for Disease Control and Prevention, who have been more cautious about e-cigarette use and have focused on potential risks.  Major concerns include the use of e-cigarettes as a gateway to other tobacco products for nonusers, especially youth, and the unknown effects of inhaling additives in the nicotine liquid.  The Food and Drug Administration is has proposed to extend its tobacco authority to e-cigarettes and is currently devising their recommendations for regulation, so the US public policy on e-cigarette use will likely be addressed formally in the near future.  Public health officials on both sides of the Atlantic will no doubt be observing the impact of the RCP’s recommendation on smoking cessation and amending their policies accordingly. (Sabrina Tavernise, The New York Times)

Priorities in health policy

Proliferation of multiple cancer moonshot programs raises some concerns

Several cancer “moonshots”, initiatives aimed at finding a cure for cancer, have been announced in recent months.  Most famous perhaps is the proposed $1 billion effort spearheaded by Vice President Joe Biden, in addition to three other privately-funded initiatives by the Parker Institute, Johns Hopkins University, and the Cancer MoonShot 2020 program.  Some cancer researchers have expressed concern over the proliferation of these different efforts without a strong central leadership, which could lead to unintended overlap of topics and a waste of precious research funds. One issue in coalescing these efforts is that the private enterprises may have different goals from the moonshot proposed by the government, including the need to satisfy investors.  Yet it does not appear that these efforts will be operating completely at cross-purposes, as all three private enterprises will have representation on the government’s advisory panel for Biden’s moonshot, so there will be at least some awareness among the different projects about what the other initiatives are doing.  One advantage of the involvement of privately-funded cancer moonshots is that they can begin work immediately; the government project still remains to be approved and funded by Congress which may balk at the high price tag or be otherwise reluctant to fund a large White House initiative this late in Obama’s presidency. (Erika Check Hayden, Nature)

Global childhood health

Childhood obesity on the rise in rural China

Childhood obesity has been generally on the rise across the globe in the 21st century, and a decades-long study of children in rural Shandong, China found that childhood obesity has absolutely skyrocketed since 1985.  Previous studies have demonstrated the rise in obesity in China, now second in the world behind the US, but the results from the current study on the rural population are staggering.  The rate of overweight and obese boys rose from 0.5% to 30.7% between 1985 and 2014, and for girls from 0.8% to 20.6%.  The authors of the study implicate a shift toward high energy, high fat, low fiber diets coupled with a decrease in physical activity in this astonishing trend.  The rise in obesity also coincides with increasing wealth in rural Chinese households, with previously poor families able to afford more food, so overfeeding during a time of plenty is likely another contribution to the problem.  Public health outcomes of this trend could be very serious; childhood obesity can lead to major deleterious effects, including cardiovascular disease, diabetes, and osteoarthritis.  The authors of the study conclude that rural China should be included in public efforts and education to curb childhood obesity and prevent a generation from suffering the impaired health complications that come with it.

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April 29, 2016 at 9:00 am

Science Policy Around the Web – April 20, 2016

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By: Kimberly Leblanc, Ph.D.

photo credit: Alex E. Proimos via photo pin cc

Mental Health

Investing in treatment for depression and anxiety leads to four-fold return – UN report

According to a new study led by the United Nations health agency, published last week in The Lancet Psychiatry, every one dollar invested in scaling up treatment for anxiety and depression leads to a return of four dollars in better health and ability to work. The study estimates, for the first time, both the health and economic benefits of investing in treatment of the most common forms of mental illness globally, and provides a strong argument for greater investment in mental health services in countries of all income levels. Depression and anxiety disorders cost the global economy $1 trillion each year, and the prevalence of these disorders is increasing. Between 1990 and 2013, the number of people suffering from depression and/or anxiety increased by nearly 50 per cent, from 416 million to 615 million. Close to 10 per cent of the world’s po pulation is affected, and mental disorders account for 30 per cent of the global non-fatal disease burden.

The new study calculated treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030. The estimated costs of scaling up treatment, primarily psychosocial counselling and antidepressant medication, amounted to $147 billion. Yet the returns far outweigh the costs. A five per cent improvement in labour force participation and productivity is valued at $399 billion, and improved health adds another $310 billion in returns. However, current investment in mental health services is far lower than what is needed. According to WHO’s Mental Health Atlas 2014 survey, governments spend on average three per cent of their health budgets on mental health, ranging from less than one per cent in low-income countries to five per cent in high-income countries. “We know that treatment of depression and anxiety makes good sense for health and well being; this new study confirms that it makes sound economic sense too,” said World Health Organization (WHO) Director-General Margaret Chan in a press release jointly issued with the World Bank Group. “We must now find ways to make sure that access to mental health services becomes a reality for all men, women and children, wherever they live.” (UN News Centre)

Substance Abuse

Surgeon General uses bully pulpit to combat opioid crisis

Surgeon General Vivek Murthy has recently made prescription opioid abuse a top priority, taking part in the CDC opioid summit alongside President Obama a few weeks ago and laying out his vision for addressing the painkiller crisis at a health journalism conference earlier this month. The Surgeon General’s office will release a major report this year on substance use, addiction and health — covering topics including opioids, heroin and other substances. Murthy plans to send a letter to every single provider in the country — anyone with access to a prescription pad, including doctors, nurse practitioners, dentists — helping them understand the risks and benefit of opioids and educating them about safer practices. He also wants to help expand access to treatment for people who have a dependency or substance abuse disorder. The Obama administration has already begun this, as have several state governments. But some of it still has to be funded, and there’s also a big educational component.

Disseminating prescribing guidelines, as the CDC recently did, is a first step. But much of the work that Murthy sees ahead involves changing deeply-rooted attitudes. Prescriber patterns are part of that. But so is making health care professionals and the public understand that substance abuse isn’t a moral failing but a chronic medical disorder and that people who become addicted to medicine prescribed by their doctors aren’t “weak” or “bad” or “criminal,” no matter where they come from.

The drug problem is complicated, as is the solution. Physicians need to be retrained to think twice — or three or four times — before writing that first opioid prescription, he said. The medical community has to reexamine — and more thoroughly research — its entire approach to relieving pain, both chronic and acute. And people who are already addicted, who are at risk of overdose and death, need expanded access to treatment, particularly medication-assisted treatment. An Obama appointee whose pro-Obamacare political advocacy had riled some Republicans and whose frank talk about gun violence had alienated the NRA, Murthy now has bipartisan support and works closely with many Republicans who had earlier been skeptical of him. The opioid crisis, he said, isn’t picking sides. (Joanne Kenen, Politico)

The Future of Space Exploration

Is The New $100-Million “Starshot” For Real?

Last week, billionaire Yuri Millner, along with physicist Stephen Hawking and Facebook founder Mark Zuckerberg, announced a $100 million dollar project called Breakthrough Starshot. The goal is to launch a gram-sized spacecraft, or nanocraft, to the nearest star, Alpha Centuri.  The nanocraft,or StarChip, will be packed with cameras, thrusters, and navigation and communications equipment—the kinds of things Silicon Valley is good at making tiny and sticking on chips. Once in space, the craft will be propelled by light rather than combustion, courtesy of a thin, perhaps three-foot-wide (one-meter-wide) laser sail attached to each chip. The sail is hit by a carefully aimed laser to push it up to speed; two decades later, the chip and sail arrive at Alpha Centauri. Then the chip beams data back to Earth at the speed of light, giving scientists insight into another solar system just a quarter of a century after the mission was launched. (Watch an animation of the plan here).

Instead of sending just one tiny spacecraft, the idea is to send hundreds or thousands — so many could be lost along the way, without the mission’s being useless. The Starshot team still has a long list of challenges, including potential impacts with space debris, taking in-focus pictures while moving at 20% of the speed of light, and the delay in receiving the pictures, since it will take more than four years for those photos to get back here. Ultimately, launching something like the StarChip will be a multibillion-dollar enterprise, but the team sees it as the first step on the path to the future of humanity. As Stephen Hawking said, “The limit that confronts us now is the great void between us and the stars. But now we can transcend it. With light beams, light sails and the lightest spacecraft ever built, we can launch a mission to Alpha Centauri within a generation.” (Nadia Drake, National Geographic).

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April 20, 2016 at 9:00 am

Science Policy Around the Web – April 15, 2016

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By: Daniël P. Melters, Ph.D

Photo credit: Holly Pavlika at Shot@Life.org

Social health policy

Paid maternity leave reduces infant death

In developing nations, more generous maternity leave can save the lives of babies, according to a recent study in PLoS Medicine. The paper estimates that each extra month of maternity leave is linked to about eight fewer infant deaths for each 1,000 live births, or a reduction of 13% in infant mortality. The advantages of paid maternity leave are that mothers-to-be will be able to make use of health services before and after childbirth as their income and jobs are protected. It will also reduce anxiety in mother, improving her health besides that of her baby, the study says. Maternity leave also increase the likelihood that mothers will breastfeed their child and stick to vaccination schedules, potentially increasing the power of paid maternity leave.

Based on our analysis, I’m fairly convinced that increasing the duration of paid leave is an effective way to reducing infant mortality”, the lead author Nandi from McGill University says. He adds that his team controlled for other factors that reduce infant death, such as gross domestic product and national health spending. The researchers compared rates of infant death in two groups of low- and middle-income countries, covering 300,000 life births between 2000 and 2008.

Child health researcher Zulfiqar Bhutta from the University of Toronto is cautious about extrapolating the results from this study over all low- and middle-income countries. “The major limitation here is the assumption that maternity leave policies in a country are universally applied, which they are not.” A cautionary note that Nandi agrees with on the end of implementation, as they did not study this. He also points to research in other areas, which suggest that policies improving the conditions of employees tend to have spillover effects. (PLoS Medicine)

Gene-editing technology

Committee to study oversight of GMOs

The United States is revamping its rules for regulating GMOs, which collectively are known as the Coordinated Framework for Regulation of Biotechnology. To that end, the National Academies of Sciences have convened a committee that is charged with predicted what advances will be made in biotechnology products over the next 5-10 years. It will hold its first meeting on April 18th. To date, GMOs are regulated by three US agencies: US Food and Drug Administration (FDA), US Environmental Protection Agency (EPA), and US Department of Agriculture (USDA). The USDA’s Animal and Plant Health Inspection Service (APHIS) regulates any genetically engineered organisms that may pose a risk to plant health. In addition, GMOs may still undergo a voluntary review at the FDA (as Oxitec did with their GMO mosquito), or face oversight by the EPA.

Recently, the USDA allowed a mushroom that has been genetically modified with the new gene-editing technology CRISPR (removing several base-pairs knocking-out a gene responsible for browning) to allowed on the US market without going through a review process. It is one of about 30 GMOs to sidestep the USDA regulatory system in the past five years. In each case, the USDA deemed that each GMO did not qualify, as something the agency must regulate. In other words, the USDA itself acknowledges that it might be overregulating some crops if they have traits that have already been scrutinized.

This is of course not to say that no oversight is needed. The use of gene editing technology in humans is still controversial, especially in human embryos, as became clear again by a second study published by a Chinese group where they used CRISPR to alter human embryos, or the approval of project in the United Kingdom. New hurdles will be encountered as well. The successful removing of HIV from an HIV infected cell by CRISPR was hailed, but its success was short-lived as HIV found a way to outsmart the power of the current CRISPR technology. The fast moving pace at which gene-editing technology is developing and how its use if being exploited highlights the need for the US regulatory agencies to keep up with these chances both from economical growth as well as a public safety perspective. (Heidi Ledford, Nature)

Precision Medicine Initiative

Dishman to lead PMI Cohort

Dr. Francis Collins, the director of the National Institutes of Health, has announced that the permanent director of the Precision Medicine Initiative (PMI) Cohort Program will be Eric Dishman, taking over the helm from interim director Dr. Josephine Briggs. Dishman, 48, who now heads the Health and Life Sciences Group at Intel Corporation in Santa Clara, California, will start his new job next month. He is not an obvious choice to lead the cohort program as he does not have a background in genomics or large, long-term health studies, nor a PhD or MD degree. He does have a trove of knowledge about health technologies, which will play a key role in the PMI-cohort. At Intel, he oversaw research on devices to help Alzheimer’s patients and elderly living independently. Dishman also battled and overcome a rare type of kidney cancer at the age of 23. Several years ago he has his tumor sequences, which pointed to a treatment that might help save his life. According to Collins, Dishman is the right person to the lead PMI-Cohort program with his “wealth of health innovation experience … as a social scientist and researcher, entrepreneur and business leader, patient and patient advocate, and policy advocate and thought leader.” (Joselyn Kaiser, Science Insider)

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April 15, 2016 at 1:00 pm

Zika Update: Current Knowledge and New Directions

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By: Keith Jacobs, Ph.D.

Zika is the newest international viral outbreak alarming physicians, researchers and the general public. The virus, which is related to dengue, yellow fever, and West Nile viruses, was first isolated in 1947 from a rhesus monkey in the Zika forest of Uganda. Very limited research was performed on the virus over the next several decades. Of the limited work that was done – including one researcher even injecting himself (under the generic description of a “human volunteer”) and several others documenting their symptoms from accidental exposure – none of it was able to shed any light on the true nature of the virus. Due to its relative obscurity and mild symptoms, there was not any interest in even studying Zika.

Times have certainly changed, however, as Zika has now been declared a “public health emergency of international concern” by the World Health Organization (WHO) in the wake of a 2015 outbreak in Brazil. Zika is transmitted through the Aedes aegypti mosquito which is endemic to South America, however strong evidence suggests that Zika may be sexually transmitted as well. While mosquitos carrying Zika have not been found in the US, over 300 Americans have contracted Zika through either travel or sexual contact with a partner who has traveled to regions where Zika is endemic. The majority of adult patients infected with Zika fail to show any symptoms, with the minority who do only exhibiting mild, general maladies such as aches, fever and rash (with no deaths reported).

While Zika infection is not a concern for adults, Brazilian physicians have noticed a stark increase in cases on microencephaly (small heads/brains) in newborns concurrent with the recent epidemic. Zika virus has also been found in the brains of affected fetuses. These correlations did not provide enough evidence however to definitively state that Zika infection was causing these deformities. A careful assessment of the reported cases cited in Brazil indicates that the recent increased incidence of microencephaly may be at least partially due to awareness bias and a lack of standardized criteria for defining deformations. In other words, physicians may be simply observing what they are already looking for based off the initial reported correlation.

As the Zika story began to spread, an alternative explanation for the explosion of microencephaly surfaced. A group of Argentinian doctors argued that it is not the Zika virus but instead the larvicide pyriproxyfen that is responsible for the increased risk of microencephaly. Ironically, pyriproxyfen is added to water in order to control the spread of the very mosquito that carries Zika and other viruses. This report cited a recommendation by the nonprofit Brazilian public health organization the Brazilian Association for Collective Health (BACH) that criticized the use of pyroxifen and warned against its potential environmental and neurotoxic effects. To add to the controversy, pyriproxyfen is manufactured by a Japanese company that is very loosely connected to the agricultural corporation Monsanto, a popular enemy of environmentalists due to its corporate practices concerning the sale of genetically modified crops. Following these assertions, BACH curiously backed off their initial claims and decried the misinterpretation of their statement. In addition to the increasingly strong data connecting Zika infection with fetal brain abnormalities, there is no evidence to support a link between microencephaly and larvicides, and these claims have been disparaged by numerous authorities including the Brazil Ministry of Health:

“Unlike the relationship between the Zika virus and microcephaly, which has had its confirmation attested in tests that indicated the presence of the virus in samples of blood, tissue and amniotic fluid, the association between the use of pyriproxyfen and microcephaly has no scientific basis.”

A case study reported in late March provided the strongest connection to date between maternal Zika infection and fetal brain abnormalities. A woman was infected with Zika 11 weeks into her pregnancy, after which uterine imaging demonstrated a progressive reduction in fetal head size and eventually abnormal gross morphology of the brain. The pregnancy was eventually terminated, and autopsy confirmed large viral loads in the fetal brain and placenta with lower amounts present in other fetal tissues as well. Zika also remained present in the mother for up to 10 weeks following infection. Finally, on April 13th the Centers for Disease Control (CDC) officially declared that the preponderance of evidence supports a causal link relationship between Zika and birth defects.

Prior to this case, physicians believed that Zika only remained active in the body for a week following infection. Likely due to this study, the Centers for Disease Control now recommends that women wait at least 8 weeks after exhibiting symptoms before trying to conceive, or up to 6 months when a male sexual partner has contracted the disease. The absence of any strong symptoms in adults along with the long duration required for viral clearance may thus contribute to Zika’s danger, as pregnant and soon-to-be-pregnant women may be infected without having any knowledge of their exposure. The true risk of Zika, its potential effect on fetal neural development, can therefore be a hidden danger.

While severe birth defects are the most common and perhaps the most threatening aspect of Zika infection, the dangers of Zika are not restricted to pregnant women. Recently, more severe consequences of Zika exposure have been identified in adults. A study published in late February identified a causal link between Zika infection and diagnosis with Guillain-Barré Syndrome. Guillain-Barré syndrome is an auto-immune neurological disease that affects the peripheral (external from brain/spinal cord) nervous system, resulting in potentially severe muscle weakness. Guillain-Barré is often preceded by infection, especially from viral pathogens such as the related dengue fever virus. Systemic infection with these viruses induces an overactive immune system leading to persistent inflammation, and Zika likely acts through this same mechanism.

By leaving its host alive and utilizing abundant mosquitos as a carrier, Zika is likely more contagious than Ebola (which only spreads through direct contact between bodily fluids). The virus therefore has the potential to spread rapidly over a wide range, and without overt visible symptoms it may be difficult to track its true reach. In contrast with Ebola however, where local African culture and poor infrastructure promoted the spread of the disease, the Americas have much better public health resources and preparation. Additionally, a great deal of research is already underway working towards both improved understanding and treatment of Zika. Published studies have described the cell biology of Zika infection, the Food and Drug Administration in the US is reviewing diagnostic tests, and international efforts have already made progress on a vaccine. While the Zika outbreak is somewhat under control, the virus is not likely to go away any time soon. Hopefully the sum of these efforts will neutralize Zika before it becomes an even more significant international public health issue.

Written by sciencepolicyforall

April 14, 2016 at 1:00 pm

Science Policy Around the Web – April 12, 2016

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By: Amy Kullas, Ph.D.

A representation of the surface of the Zika virus is shown. A team led by Purdue University researchers is the first to determine the structure of the Zika virus, which reveals insights critical to the development of effective antiviral treatments and vaccines. (Purdue University image/courtesy of Kuhn and Rossmann research groups)

Funding the ongoing Zika pandemic

Shifting funds for Zika is a good start, but more money is still needed

Last week, the White House made the decision to redirect $589 million in unspent federal funds, previously allocated for an Ebola response, to cover costs associated with fighting and researching Zika. The White House is still advocating for additional funding for both the ongoing Zika pandemic and to replenish the money that was moved away from Ebola. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), informed ScienceInsider that ~$50 million of the reallocated funds will go to NIAID to fund Zika research. None of the redirected funds will come out of the money that NIAID had previously received for research on Ebola, as the vast majority of those funds have already been spent. Further, Fauci warns “That’s not enough to last me very long. We can start the work, but we can’t finish what we need to do.”

Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention revealed in a press conference on April 12, “Everything we know about this virus seems to be scarier than we initially thought.”

In February, the Obama administration had requested almost $2 billion to help thwart the Zika virus and its transmission. Unfortunately, the Republican-controlled Congress failed to act on this emergency funding request. White house officials are nevertheless still trying to persuade Congress to pass the emergency Zika funding. Fauci bleakly predicts, “If we don’t get all of the Zika money, that is when things start getting hurt,” alluding to the possibility of having to further shift critical NIAID funds away from ongoing malaria, influenza, and tuberculosis research. (Puneet Kollipara, ScienceInsider)

Mental Health

Solutions to mental health impairments require global collaboration

Globally, almost 1/3 of people will suffer from a mood, anxiety, or substance-use issue during their lifetime. In fact, these disorders are one of the leading causes of disability. The resources to assist people facing these problems are not only inadequate in the United States, but around the world as well. There are some countries in Africa, where people are extremely underserved leaving them particularly vulnerable because these countries have the fewest resources for mental-health care as they only one psychiatrist for the entire country. In fact, there are only 9 mental health providers per 100,000 people worldwide.

Importantly, support for mental health does not lack political backing. Both the World Health Organization and the World Bank will coorperate to broaden global efforts in mental health. This past September, mental health was included in the United Nations’ Sustainable Development Goals. Since 2011, new investments (estimated at ~$80 million US) have been made by the three largest funders of mental-health research in low- and middle-income countries: the US National Institute of Mental Health, Grand Challenges Canada, and the UK Department for International Development. Recently, research has focused on efficacy, effectiveness and implementation in the low- and middle-income countries. These local research teams often work or consult with colleagues in rich countries. Researchers, clinicians, and caregivers must unite to all work together because “when it comes to mental health, all countries are developing.” (Pamela Y. Collins & Shekhar Saxena, Nature Comment)

Vaccine shortage and Global Health

Dangerous shortage of yellow fever vaccine

Four. There are only four facilities worldwide that produce yellow fever vaccines: the Pasteur Institute, two government facilities in Russia and Brazil, and a French vaccine company Sanofi Pasteur. Unfortunately, their combined efforts have been failing the world’s demands and the ongoing outbreak in Angola only further emphasizes the escalating shortage. Jack Woodall, formerly of the Centers of Disease Control and Prevention and the World Health Organization, warns “another major outbreak…could be impossible to control.” He admits that this potential is something that he’s deeply concerned about.

Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The ‘yellow’ in the name refers to the jaundice that affects some patients. Without treatment, up to half of severely affected people will die. Annually, there are an estimated 60,000-80,000 deaths attributed to yellow fever globally. There is no specific treatment for yellow fever, leaving vaccination the most important preventative measure.

When a yellow fever outbreak occurs in an urban setting, like the one in Angola, it is often relentless as the mosquitoes can easily transmit the virus person to person. William Perea, of the World Health Organization’s (WHO’s) Control of Epidemic Diseases department, stated that Angola has confirmed 490 cases and almost 200 deaths, the actual numbers could be 10 fold higher. Since February, a large vaccine initiative has been underway, reaching 6 million of Luanda’s estimated 7.5 million residents. Currently, yellow fever has stretched into 6 of the 18 provinces in the country. The global emergency yellow fever vaccine stockpile has been left empty, unlikely to be replenished anytime soon. (Kai Kupferschmidt, ScienceInsider)

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April 12, 2016 at 12:00 pm

Science Policy Around the Web – April 8, 2016

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By: Courtney Pinard, Ph.D.

photo credit: 3D via photopin (license)

Science and Environment

A New European Rocket Design Uses 3D Printed Parts

“The dream is moving to reality” was the message from European Space Agency (ESA) boss, Jan Woerner. Woerner was referring to the Ariane 6 launch vehicle, which is the ESA’s next-generation rocket built by Airbus Safran Launchers. The Ariane 6 rocket is under development by the ESA, with a first test flight scheduled for 2020. The new rocket will be used to launch medium-sized government science missions and commercial telecom satellites. Ariane 6 is Europe’s response to the competitive prices offered to satellite operators from the US and California-based SpaceX company. Space X’s Falcon nine rocket is twice the mass and more than twice the price as Ariane 6. One reason for these differences is the use of 3D printed parts for rocket engines in Ariane 6. Airbus CEO Alain Charmeau believes that different market conditions apply in Europe and the US, which means there will not be a single, winner-takes-all approach. In addition, he cites that in Europe there is an “unwritten rule” that European states should use European rockets. For example, there is a procurement in political blocs, especially in the US, which bars foreign rockets from launching home institutional and government satellites. Now Europe is following suit with its new Ariane rocket design. Ariane 6 is projected to lead 11-12 space missions per year, with reduced cost for EU government and private satellite operators. (Jonathan Amos, BBC News)

Science Funding

U.S. Senators Still Disagree on Mandatory Spending for the NIH

So far the U.S. Senate has approved eighteen biomedical innovation bills with one to go. Lawmakers on the Health, Education, Labor and Pensions (HELP) committee held the last meeting yesterday to approve the bills. The bills form a companion to the House of Representative’s 21st Century Cures Initiative, which aims to encourage medical breakthroughs by reforming the National Institutes of Health (NIH) and Food and Drug Administration (FDA). While Democratic lawmakers on the HELP committee support mandatory funding for the NIH, Republicans in the Senate have yet to agree. Senator Lamar Alexander (R-TN), for example, does not support the selling off of petroleum reserves to pay for mandatory NIH spending. Senator Roy Blunt (R-MO) thinks that using mandatory funding for NIH’s 2017 budget is “risky,” and prefers that the NIH focuses on “specific projects.” NIH director Francis Collins explained that the agency could use a special fund on five specific areas, which include: President Obama’s precision medicine initiative, the recently announced cancer moonshot, the Brain Research through Advancing Innovative Neurotechnologies initiative, a system of grants for “big ideas” across NIH institutes, and support for young investigators. The final Cures package and companion bills could be available for a floor vote next week if bipartisan agreement is reached. (Kelly Servick, Science News)

Sustainable Development

Eradicating Poverty is Possible: Just Take a Small Fraction of Global Military Spending

Two of the Sustainable Development Goals agreed by the United Nations in 2015, eradicating extreme poverty and hunger, are not so out of reach. U.N. figures show an estimated 800 million people live in extreme poverty and suffer from hunger. It turns out that eradicating poverty can be achieved with about ten percent of the world’s military spending. A new study published by Stockholm International Peace Research Institute (SIPRI) on April 5th, shows that global military spending is up for the first time since 2011, at $1.7 trillion in 2015. Overall expenditure increases occurred in Asia, Central and Eastern Europe, and the Middle East. Spending on the military fell in North America, Western Europe, Latin America and the Caribbean, and Africa. Although spending dropped in the US, the country still ranks number one in terms of military expenditures, spending $596 billion last year. China was the second largest spender at $215 billion. The head of the study, Sam Perlo-Freeman, looked at what could be achieved with just ten percent of global military spending. According to a 2015 report from the UN Food and Agriculture Organization, eliminating extreme poverty and hunger sustainably by 2030 would require an estimated additional $265 billion a year on average. Of this, $89–$147 billion would need to come from public funding, putting total annual public spending requirements at $156–214 billion. This amounts to 9.5–13% of global military spending in 2015. “This could stir up some debate although we are certainly not expecting a ten percent cut in military spending at all,” said Perlo-Freeman in an interview with the Thomas Reuters Foundation. The SIPRI military expenditure project was established in 1967 to study developments in world military expenditure. (Belinda Goldsmith, Reuters)

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April 8, 2016 at 12:00 pm

Is there a place for precision medicine in public health?

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By: Megan Roberts, Ph.D.

photo credit: BWJones via photopin cc

In January 2014, President Obama announced the Precision Medicine Initiative (PMI), the goal of which is to transform treatment and prevention from a “one size fits all” approach into an increasingly tailored approach that accounts for an individual’s genes, environment and lifestyle. While bipartisan support and PMI leadership have propelled the initiative forward, some public health researchers have voiced skepticism over whether precision medicine will improve public health. Some have even called precision medicine “a distraction from the goal of producing a healthier population.” These arguments often point to the need for public health researchers to address social determinants of health to improve overall public health, and reduce health disparities in a country that spends more on health care, but endures worse health outcomes compared to other developed countries. Furthermore, by definition, public health refers to the prevention of disease and the promotion of health among populations as a whole, which seems antithetical to the “precision medicine” paradigm, with its focus on individual-level nuances. By focusing on individual health, there is a fear that we will we lose sight of public health’s goal to improve the health of our whole population, particularly underserved groups. This begs the question: is there a place for precision medicine in public health?

 While aspects of the PMI are transformative (e.g., the MATCH trial and the PMI cohort), precision medicine principles are foundational for current prevention and treatment practices. While we might immediately think “genetics” when we hear “precision medicine,” the precision medicine approach is actually much broader than only focusing on genetics, by also incorporating an individual’s environment and lifestyle for both disease prevention and treatment. Since the early 1990s, a large body of evidence has demonstrated that the effects of public health interventions are often moderated by individual level characteristics, including biological, environmental and lifestyle factors. Often, tailored approaches addressing these moderators are more effective than non-tailored approaches. As such, to move public health research forward, we must consider the interactions between individual level factors and public health strategies. This paradigm reflects the same thinking behind precision medicine, and aligns with conceptual frameworks that drive public health research and practice.

Precision medicine is already incorporated into current disease prevention strategies. Increasingly, cancer-screening programs tailor prevention strategies through targeted, risk-based screening. In a health care system with finite public health resources, targeting cancer prevention efforts to those who will receive the greatest benefit is critical. For example, breast MRI is a highly sensitive breast cancer-screening tool; however, the test has high rates of false positive results. As such, the benefits of breast MRI only outweigh the harms for women who are at high risk for breast cancer.  In order to identify women who are at high risk, researchers have developed risk-based models that incorporate individual level risk factors, as well as genetic tests to identify genetic mutations that confer an increased cancer risk.  For those at significantly higher risk of breast cancer, clinical guidelines recommend MRI screening, as breast MRI is cost-effective and improves health outcomes in this setting.  A risk-based approach is also used in lung and cervical cancer screening. Specifically, lung cancer screening tailors on factors including smoking history, and HPV vaccination tailors on high-risk populations, including men who have sex with men and those with HIV. Precision medicine approaches for screening demonstrate an important application of precision medicine in public health, and have led to effective prevention strategies for high-risk groups.

In addition to prevention, linking individuals to high quality care remains a tenet of public health. Improved understanding of the genetic basis for disease has improved treatment strategies, particularly in cancer care. Today, high quality cancer care relies on targeting treatment using genetic tumor markers. Breast cancer, once viewed as a single disease, is now known to be multiple subtypes of breast cancer that can be distinguished by tumor genetics. Conversely, other studies have uncovered similarities between tumors that originate in different organ sites. For example, one study has found that lung squamous cell carcinoma, head and neck, and a subset of bladder cancers cluster by gene expression patterns, meaning these cancers all have genetic similarities. As such, therapeutics that target specific tumor markers have been developed.  There are drugs on the market that target tumor markers that occur in multiple tumor sites, such that a lung cancer patient may receive the same drug as a pancreatic cancer patient who has a similar genetic mutation. This treatment demonstrates a shift toward considering cancer according to a tumor’s genetics rather than by a tumor’s organ site.  Precision medicine programs have emerged that use this cancer treatment approach , and the MATCH trial—a component of the PMI—will elucidate the effectiveness of this approach. Similar precision medicine approaches could potentially be extended to other disease areas in the future.

Overall, the use of individualized information in research, prevention and treatment is neither new nor incongruous with the goals of public health.  “Precision” public health researchers  must ensure that precision medicine is equally accessible to all patients, with a strong focus on dissemination and implementation research around precision medicine approaches. While the PMI and public health priorities may not always mirror one another, to pit public health against precision medicine is a mistake.  Public health and precision medicine can synergize towards common goals of disease prevention and control. Precision medicine has helped researchers and clinicians identify important interactions between individual-level factors and life-saving prevention and treatment strategies. Research findings through the PMI will only further this progress and improve population health.

Written by sciencepolicyforall

April 7, 2016 at 12:00 pm

Posted in Essays

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