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Science Policy Around the Web – February 10, 2017

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By: Saurav Seshadri, PhD

Source: pixabay

Sleep

The Purpose of Sleep? To Forget, Scientists Say

Humans spend approximately one third of their lifetime sleeping, yet the purpose of sleep is still largely unknown. A pair of recent studies in the journal Science suggest that a key function of sleep is to give the brain a chance to rewire itself, specifically by cutting down connections between neurons, which naturally scale up during wakefulness, and especially during learning.

In one paper, researchers used 3D electron microscopy to measure the sizes of these connections, called synapses, in mouse brain slices. They found that sleep produced a significant decrease in the size of synapses. Interestingly, this effect was more pronounced in smaller synapses, which were likely strengthened by general information processing while awake, than large ones (~20% of synapses), which may encode more well-established memories. In the other, researchers used two-photon imaging in live mice to observe sleep-induced changes in synapses. They found a similar decrease in synaptic strength, and went on to identify the signaling pathway that caused this effect; blocking this pathway prevented a normal reduction in the scope and magnitude of a learned behavioral response.

These findings underscore the importance of sleep, especially for memory consolidation involved with learning. Studies like these can have far-reaching effects on the public’s perception of sleep, influencing individual habits as well as policy related to education. For example, they suggest that prioritizing sleep when setting school start times (an issue currently under debate in Montgomery County schools) could improve students’ lesson retention and ultimately their test performance. They also point to important cellular and molecular processes that take place during sleep, which could help explain how existing sleep aids adversely affect brain functioning and memory (a public health concern), and ultimately lead to the development of better drugs. (Carl Zimmer, The New York Times)

Drug Policy

Massive Price Hike for Lifesaving Opioid Overdose Antidote

Increased public exposure to the epidemic of opioid abuse, which continues to intensify in the US, has made it increasingly influential in politics, possibly including the recent presidential election.  A crucial tool for communities at the forefront of this public health crisis is naloxone, which can reverse potentially fatal symptoms associated with overdose. The Evzio naloxone auto-injector, produced by Kaleo, is one of two such products approved by the FDA. Kaleo has recently come under fire for increasing the price of Evzio from $690 to $4,500.

Kaleo cites several justifications for the price hike. Firstly, they offer coupons to patients whose insurance doesn’t cover Evzio. Second, they argue that large insurance companies and government agencies (such as the Veterans Health Administration, which sees a high rate of opioid use) can negotiate prices, while other organizations are currently well funded (thanks to public concern) to absorb the increase. Thirdly, they are expanding their donation supply to allow smaller groups to apply for free devices. However, experts say that the increase is not justified by production costs, and some organizations have been forced to switch to alternative drugs.

News of the decision arrives at a time when the public is particularly sensitive to drug pricing, and have made their concern clear to lawmakers. Negotiation with drug companies over prices has been a prominent campaign issue in recent elections. Public outcry following similar moves by investor Martin Shkreli and Mylan led to hearings by a special congressional committee. Soon after the last election, a bill that would have allowed patients to import cheaper drugs from Canada became a high-profile occasion for posturing in the Senate, where it failed despite overwhelming public support. These stories highlight the often antagonistic relationships between the American public, its government, and the pharmaceutical industry, and illustrate how disruptive drug pricing can directly affect policy. (Shefali Luthra, Scientific American)

Scientists in Politics

Geneticist Launches Bid for US Senate; while Empiricists Around the Country Will March for Science

Donald Trump’s agenda of self-serving lies and denial of evidence has led to unprecedented levels of engagement and activism across the country. The scientific community has been especially impacted by Trump’s brand of broad, allegedly populist anti-intellectualism. Thus, although the empirical facts uncovered by scientific research are inherently apolitical and should be treated as such, scientists are beginning to mobilize to oppose the Trump administration in several ways.

One essential path to policy change is increased representation. With that in mind, evolutionary biologist Dr. Michael Eisen, an HHMI-funded investigator at UC Berkeley and co-founder of the People’s Library of Science (PLOS), recently announced his candidacy for the US Senate in 2018. Dr. Eisen’s platform seems to center on bringing a scientific perspective to Senate proceedings, and working towards comprehensive yet practical solutions to issues such as climate change. More of Dr. Eisen’s views can be found on his twitter feed and blog.

Protests are another way for individuals to make their voices heard by policy makers. The March for Science, which currently has over 350,000 followers on Facebook, will be an opportunity for ‘scientists and science enthusiasts’ to both call for and demonstrate support for the scientific community, and promote solidarity between science and the public. The main march will be held on April 22nd, 2017 in Washington D.C.; satellite marches are scheduled in over 100 additional cities. Organizers hope to maintain the momentum gained by January’s Women’s Marches, which saw historic attendance. (Sara Reardon, Nature News; Lindizi Wessel, ScienceInsider)

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Science Policy Around the Web – November 22, 2016

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By: Rachel Smallwood, PhD

Photo source: pixabay

Federal Research Funding

US R&D Spending at All-Time High, Federal Share Reaches Record Low

Recently released data from the National Science Foundation (NSF) showed trending increases in scientific research funding in the US across the past several years. Estimates of the total funding for 2015 put the value at an all-time high for research and development (R&D) funding for any country in a single year. In 2009, President Obama stated a goal to devote 3% of the USA’s gross domestic product (GDP) to research, and we have been making slow progress to that point; in 2015, 2.78% of the GDP went to research. Businesses accounted for the largest portion of overall scientific funding, contributing 69% of the funds. The second largest contributor was the federal government; however, it had the lowest percentage share of the total since the NSF started tracking funding in 1953, and the actual dollar amount contributed has been declining since 2011. Therefore, although the overall percentage of GDP going to research is increasing, that increase is driven by businesses, whereas the GDP percentage contributed by the federal government has dropped to almost 0.6%.

When taking a closer look at types of research, the federal government is the largest funding source for basic science research, covering 45% of the total. However, businesses make up the majority of the funding for applied research (52% in 2014) and experimental development (82% in 2014). This disproportionality in funding types combined with the decreases in federal research spending are concerning for the basic science field. There is more competition for less money, and this concern is compounded by uncertainty and questions about President-Elect Trump’s position on and plans for scientific funding. Aside from a couple of issues, primarily concerning climate change and the environment, he has said very little about science and research. Many scientists, institutions, and concerned citizens will be watching closely to see how science policy develops under Trump’s administration and its effects on federal spending and beyond. (Mike Henry, American Institute of Physics)

Biomedical Research

‘Minibrains’ Could Help Drug Discovery for Zika and for Alzheimer’s

A group of researchers at Johns Hopkins University (JHU) is working on a promising tool for evaluating disease and drug effects in humans without actually using humans for the tests. ‘Minibrains’ are clusters of human cells that originated as skin cells, reprogrammed to an earlier stage of development, and then forced to differentiate into human neural cells. They mimic the human brain as far as cell types and connections, but will never be anywhere near as large as a human brain and can never learn or become conscious.

A presentation earlier this year at the American Association for the Advancement of Science conference showcased the potential utility for minibrains. A large majority of drugs that are tested in animals fail when introduced in humans. Minibrains provide a way to test these drugs in human tissue at a much earlier stage – saving time, money, and animal testing – without risking harm to humans. Minibrains to test for biocompatibility can be made from skin cells of healthy humans, but skin cells from people with diseases or genetic traits can also be used to study disease effects.

A presentation at the Society for Neuroscience conference this month demonstrated one such disease – Zika. The minibrains’ growth is similar to fetal brain growth during early pregnancy. Using the minibrains, Dr. Hongjun Song’s team at JHU was able to see how the Zika virus affected the cells; the affected minibrains were much smaller than normal, a result that appears analogous to the microcephaly observed in infants whose mothers were infected with Zika during the first trimester.

Other presentations at the meeting showcased work from several research groups that are already using minibrains to study diseases and disorders including brain cancer, Down syndrome, and Rett syndrome, and plans are underway to utilize it in autism, schizophrenia, and Alzheimer’s disease. Though there might be a bit of an acceptance curve with the general public, minibrains potentially offer an avenue of testing that is a better representation of actual human cell behavior and response, is safer and more affordable, and reduces the need for animal testing. (Jon Hamilton, NPR)

Health Policy

A Twist on ‘Involuntary Commitment’: Some Heroin Users Request It

The opioid addiction epidemic has become a significant healthcare crisis in the United States. Just last week the US Surgeon General announced plans to target addiction and substance abuse. He also stated the desire for a change in perception of addiction – it is a medical condition rather than a moral or character flaw. Earlier this year, the Centers for Disease Control published guidelines that address opioid prescribing practices for chronic pain, strongly urging physicians to exhaust non-pharmacologic options before utilizing opioids. In response to the rising concern over prescription opioid abuse, steps have been taken to reduce prescriptions and access. This has resulted in many turning to heroin – which is usually a cheaper alternative anyway – to get their opioid fix.

One of the first steps in treatment and recovery for addiction and dependence is detoxing. However, opioids are highly addictive and many people struggle with the temptation to relapse. Additionally, many of the programs designed to help with the initial detox have long wait lists, are expensive, and may not be covered by insurance, further deterring those with addiction and dependence from getting the help they need. These factors have caused many to start turning to their states, asking to be voluntarily committed to a program on the basis that they are a danger to themselves or others because of their substance abuse. This is currently an option in 38 states. These programs can be held in either privately-run institutions or in state prisons. However, this practice is controversial because if the person’s insurance does not cover their stay, it falls to tax payers to foot the bill. While this is unpopular with some, advocates say the civil commitment laws are important options while there may be no other immediate ways for an individual to get help. (Karen Brown, NPR)

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Written by sciencepolicyforall

November 22, 2016 at 9:00 am

Science Policy Around the Web – November 6, 2015

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By: Sylvina Raver, Ph.D.

Photo source: pixabay.com

Education and Mental Health

Sesame Street’s new brand of autism education

There’s a new Muppet on the block: her name is Julia, she’s in preschool, and she has autism. Julia’s arrival on Sesame Street is part of a coordinated effort by the Sesame Workshop – the nonprofit organization behind the long-running educational children’s program – to reduce the stigma associated with autism and to normalize the disorder among preschool children. The initiative, called Sesame Street and Autism: See Amazing in All Children, is a web-based project with resources for parents that include videos aimed at educating kids ages 2-5 about their peers with autism, a storybook featuring Julia and her friends, and free daily routine cards that parents can use to teach their autistic children basic skills like teeth brushing.

The new initiative was created based on solid academic research thanks to input from multiple universities, professional organizations, and advocacy groups. The Sesame Workshop also worked to ensure that these resources included the viewpoints of individuals with autism. One in 68 children in the US is diagnosed with autism, which ensures that young kids are almost assured to interact with an autistic peer.  Despite the prevalence of the disorder, bullying is still extremely common. One recent study by the Interactive Autism Network found that 63 percent of children with autism have been bullied. The Sesame Street initiative aims to foster tolerance and acceptance with preschool age children in the hope of decreasing bullying among older children, in part by normalizing the features of autism, rather than by exaggerating how they may be disabling to children with the disorder. There’s plenty of room for optimism concerning the effectiveness of using Sesame Street as a platform for this type of education. A 2015 report from the National Bureau of Economic Research found that the program is “the largest and least-costly [early-childhood] intervention that’s ever been implemented” in the US. (Lauren McKenna, The Atlantic; Elizabeth Blair, NPR)

Drug Policy

In heroin crisis, white families seek gentler war on drugs

The nation’s long-running war on drugs has been defined by zero tolerance and stiff prison sentences. It emerged during a crack cocaine epidemic of the mid 1980’s that was primarily concentrated in poor, predominantly black, urban areas. In contrast, the heroin epidemic of the last decade is concentrated in white communities, many of which are suburban and middle-class. This demographic shift in drug use is starting to have profound consequences on how the drug war is being waged. Families who have lost loved ones to heroin are increasingly channeling their anger and grief into efforts to change the language surrounding addiction, and to urge politicians and government to treat drug use as a disease instead of a crime. For example, the derogatory term “junkie” is falling out of favor in lieu of softer and more understanding language. President Obama visited West Virginia recently, a mostly white state with staggering numbers of heroin overdose deaths, to discuss a new proposal to expand access for drug treatment and prevention programs. Presidential hopefuls from both parties have adopted a tone of compassion, rather than punishment: Hillary Clinton has been hosting forums on the issue in New Hampshire, and Jeb Bush is openly discussing his family’s experiences with drug addiction. In a dramatic shift, the Gloucester, Massachusetts police department is employing a new approach to heroin use that at least three dozen other departments have now adopted: users will no longer be arrested if they walk into a police station for help, even if they are in possession of heroin or its associated paraphernalia.

Many people welcome this shift as a needed course correction in light of our scientific understanding of the biology of addiction. However, some black scholars express frustration that similar calls for a more empathetic approach to drug addiction were not heard when they originated from the black community.  Kimberle Williams Crenshaw, a scholar of racial issues at Columbia and UCLA law schools, notes …”had this compassion existed for African-Americans caught up in addiction and the behaviors it produces, the devastating impact of mass incarceration upon entire communities would never have happened.” (Katherine Q. Seelye, The New York Times)

Microbiology

Create a global microbiome effort

In last weeks’ issue of Science magazine, a group of leading scientists in the US called for the creation of a Unified Microbiome Initiative (UMI) which would assemble researchers with representatives from private and public agencies and foundations to study the activities of the Earth’s microbial ecosystems. Nearly every organism and habitat on Earth hosts a unique population of microorganisms, known as its microbiome. These microbial communities are fundamental to nearly all aspects of life on Earth. For example, soil microbes drive the production of usable forms of crucial planetary elements like carbon and nitrogen, and their manipulation shows promise for reducing agricultural use of pesticides, fertilizers, and water use. Ocean microbes produce much of earth’s oxygen, and may be able to be engineered to remove gases from the Earth’s atmosphere that contribute to global warming. Emerging research has revealed the role played by microbes that live within our own bodies in driving overall health and shaping our behavior. This human microbiome is increasingly seen as a target for new drugs, and is an essential tool for precision medicine.

Despite the crucial functions that microorgansms play, and the spectacular promise that they show for addressing challenges to environmental and human health, scientists know very little about how microbes interact with each other, their environments, and their hosts. This is in large part due to an absence of tools currently available that would “enable a mechanistic, predictive, and actionable understanding of global microbiome processes.” Addressing these technical limitations are central to the proposed UMI. The team calling for its formation describes a need for enhanced multi-disciplinary collaboration between physical, life, and biomedical sciences; engineering, and computer science in order to implement hypothesis-driven approaches that can establish causal relationships between microorganisms and their environments.

A second – and equally important – aspect of a UMI involves the need for enhanced collaboration between researchers who study different microbiome populations. Boundaries between scientists who investigate various microorganism communities are artificial and are largely due to historical divides between scientific disciplines, rather than reflecting fundamental differences between microbes that colonize a human mouth or the ocean floor. Furthermore, microbe communities are not limited to national borders but are instead part of a global microbiome. Indeed, the journal Nature contains an accompanying call for the creation of an International Microbiome Initiative to provide universal insight into the microscopic organisms all around and within us. (Alivisatos et al., Science; Dubilier, McFall-Ngai, & Zhao, Nature; Ed Yong, The Atlantic)

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Written by sciencepolicyforall

November 6, 2015 at 9:00 am

Evidence-Based Treatments for Alcohol Use Disorder

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By: Sylvina Raver, Ph.D.

Alcohol use disorder, or AUD, is a medical diagnosis given to people who seriously struggle to control their drinking. Approximately 7.2% of American adults suffer from AUD, the consequences of which are hard to overstate. The Centers for Disease Control and Prevention (CDC) estimate that excessive alcohol use contributes to approximately 88,000 deaths per year, and costs the US economy billions of dollars annually in health care costs, criminal justice, automobile accidents, and lost workplace productivity. For those who seek treatment for excessive drinking – either voluntarily or through court-mandated recovery programs – the traditional treatment method has been a faith-based 12-step program, such as Alcoholics Anonymous (AA). For many people, AA is a life-saving experience. But for many others, AUD persists despite determinedly “working the 12 steps” of the program.

A recent article published by The Atlantic calls into question Americans’ reliance on 12-step programs as the primary method to treat AUD. The article’s author claims that compelling data in support of AA’s efficacy are seriously lacking, and that accumulating scientific evidence argues against many tenants of the program. In contrast to AA, which is notoriously difficult to study, many other treatments have been rigorously tested, and now have large bodies of research that support their efficacy. Since its passage in 2010, the Affordable Care Act (ACA) has mandated that health insurance plans and state-run Medicaid programs must cover substance abuse services, which include treatments for AUD, as an “essential health benefit.” However, the law does not specify which treatment programs are the most effective and thus should be covered. As private insurers and government health care programs expand coverage for AUD treatments under the ACA, it’s crucial to consider those methods that have sound experimental support and that are in accordance with what modern neuroscience tells us about disorders of alcohol use and abuse.

The precise mechanisms that underlie AUD, as well as the genetic underpinnings responsible for people’s differential susceptibility to the disease, are the focus of ongoing research, and accumulating evidence indicates an intersection between the brain’s arousal, reward, and stress systems. Early use of alcohol is pleasurable and positively reinforcing, but the drug can take on negative reinforcing qualities during the transition to dependence, as users drink to prevent negative consequences, including withdrawal symptoms. Chronic alcohol abuse leads to adaptations in brain networks and neurotransmitters that control motivation, reward, stress, and arousal. If AUD’s progression is not halted through interventions and appropriate treatments, these alcohol-induced neuroadaptations can worsen over time and contribute to the deadly nature of severe AUD.

Fortunately, treatments for AUD can be extremely effective, although many of them are not well known outside of the medical and addiction communities. The 12 steps outlined by Alcoholics Anonymous have become synonymous with treatment for alcohol abuse in the US, and are deeply entrenched in rehabilitation culture. When it was introduced in the 1930’s, AA was modern in treating alcoholism as a disease, rather than simply as a failure of moral character. However, some of its central tenants are now at odds with our current knowledge of AUD. For example, AA members are instructed to admit that they are “powerless” over alcohol and to completely abstain from drinking. While this approach may be necessary for some individuals, total alcohol abstinence can actually be detrimental to many patients’ recovery process. Basic and clinical neuroscience research has shown that complete abstinence from alcohol can actually increase one’s urge to drink, leading animals and humans to binge once they have access to alcohol again. Furthermore, the type of black-or-white dichotomy inherent to AA – either completely abstinent or not, alcoholic or not – does a disservice to the vast majority of those with AUD who land along a spectrum of problematic alcohol use. The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) combines two previously distinct disorders, alcohol abuse and alcohol dependence, into the single, overarching Alcohol Use Disorder (AUD). AUD is further classified as mild, moderate or severe, depending on the number of criteria that a person meets, and treatment programs must be individually adopted for the severity of one’s disorder. Approximately 15% of adults with AUD fall on the severe end of the spectrum and require intensive treatment for their disease. However, the remaining 85% fall in to the mild or moderate categories, and seem to benefit most from brief interventions by medical professionals that help them change unhealthy drinking habits.

Twelve-step programs, such as AA, are not the only options available for AUD treatment, and many approaches are supported by decades of solid research. These treatment practices are collectively called “evidence-based treatments” and can be broadly classified as pharmacotherapies and behavioral therapies. Many experts in addiction medicine believe that pharmacotherapy, or medication-assisted treatment, represents a powerful yet underutilized tool to address moderate and severe AUD. A recent panel convened by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a report that describes the use of FDA-approved medications in clinical practice for the treatment of AUD. These include:

  • Naltrexone (in both oral and extended-release injectable forms), which blocks opioid receptors in the brain to interfere with the rewarding effects of drinking and reduces cravings for alcohol,
  • Disulfiram, which interferes with alcohol degradation to produce an unpleasant reaction if a person drinks alcohol,
  • Acamprosate, which acts on the GABA and glutamate neurotransmitter systems to help reduce the effects of alcohol withdrawal, including anxiety, insomnia, restlessness, and dysphoria.

The NIAAA/SAMHSA panel concludes, “Medication-assisted treatment shows a lot of promise in reducing alcohol use and promoting abstinence in patients diagnosed with alcohol use disorder.”

            Behavioral therapies are also highly effective for addressing AUD, and can be combined with pharmacotherapies or pursued on their own. These approaches help people to modify their attitudes and behaviors about alcohol, become engaged in their treatment, and increase their arsenal of coping skills to better handle stressors and environmental cues that may trigger problem drinking. Evidence-based behavioral therapies for AUD include:

  • Cognitive Behavioral Therapy, which recognizes that learning processes play a central role in alcohol addiction and helps patients to enhance their self-control through developing effective coping strategies,
  • Contingency Management Interventions/Motivational Incentives, which involve giving patients tangible rewards (often financial) to reinforce positive behaviors, such as reducing their alcohol use, attending counseling sessions, and completing goal-related activities,
  • Motivational Enhancement Therapy, which helps patients resolve any ambivalence about engaging in AUD treatment to stop or reduce their alcohol use, and aims to evoke rapid and internally motivated changes, rather than guide the individual stepwise through the recovery process,
  • Community Reinforcement Approach Plus Vouchers, a 24-week outpatient therapy that uses a range of recreational, familial, social, and vocational reinforcers, combined with material incentives, to make a non-alcohol or responsible-alcohol-using lifestyle more rewarding than the alternative,
  • 12-Step Facilitation Therapy (such as Alcoholics Anonymous), which is an active engagement strategy to promote abstinence with the support of 12-step self-help groups and adherence to the principals of: 1) acceptance of the chronic, progressive nature of the disease; 2) surrender to a higher power/fellowship of the support structure; and 3) active involvement in 12-step meetings and related activities.

Of the estimated 17 million Americans who suffer from AUD, only about 13% receive any type of treatment. The ACA may have the power to drastically improve this situation with its emphasis on primary prevention, so that patients struggling with mild symptoms of AUD can be more easily identified before the disorder progresses. Addiction experts and other health care providers have identified the crucial roles that general and mental healthcare settings – including primary, urgent, and emergency care – can play in early identification of problematic alcohol use, and in providing initial brief interventions for patients. These types of early screening and intervention efforts, combined with evidence-based treatments, can provide hope to the tens of millions of Americans struggling with AUD.

Written by sciencepolicyforall

May 20, 2015 at 9:00 am

Posted in Essays

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