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Science Policy Around the Web – May 5, 2017

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By: Thaddeus Davenport, PhD

Healthcare Policy

House Passes Bill to Repeal and Replace the Affordable Care Act

Thomas Kaplan and Robert Pear reported for the New York Times yesterday that Republicans in the US House of Representatives voted to pass a bill that would undo a number of central elements of the Affordable Care Act. Only six weeks ago, House Republicans failed to gather enough support to even vote on the first version of this bill, which was predicted to eliminate insurance coverage for twenty-four million Americans over the next decade. Since that time, Republican lawmakers have modified the so-called American Health Care Act (AHCA) bill to appeal to the more conservative members of the House – including provisions that would limit federal support of the Medicaid program, allow states to opt out of requiring that insurance cover services like maternity and emergency care, and also enable states to apply for waivers that would let insurance companies charge higher premiums for some individuals with pre-existing conditions. Like the first version, the bill that passed the House on Thursday does away with the ‘individual mandate’, which imposes a tax on people who can afford to buy insurance but do not – an aspect of the Affordable Care Act that was relatively unpopular but critical to ensure sustainability of the insurance markets. It also replaces government-subsidized insurance plans with tax credits between $2,000 and $4,000, depending on age. Other provisions in the bill would stop federal funding to Planned Parenthood for one year as well as eliminate taxes on high-income individuals, insurance companies, and pharmaceutical companies that helped to fund the Affordable Care Act. Yesterday, 217 Republicans voted in favor of the revised AHCA bill that will certainly  not provide healthcare insurance for everyone, without waiting for a non-partisan Congressional Budget Office analysis of the bill’s impact on the federal deficit or on the American people. These representatives’ haste reveals that they care little about how the AHCA will actually affect their constituents’ lives, and Democrats are counting on voters remembering this in upcoming elections. (Thomas Kaplan and Robert Pear, The New York Times)

Science Funding

NIH Funding Changes to Support More Early Career Investigators

The NIH budget has gradually declined over the last fourteen years, from $40 billion in 2003 to about $32 billion in 2017. Given that a proposed budget from the Trump administration for fiscal year 2018 would further cut funding for NIH by $5.8 billion, it is unlikely that funding for the NIH will increase dramatically in the coming years. To address these budget limitations, and in an attempt to do more with less, Jocelyn Kaiser reported for ScienceInsider this week that the National Institutes of Health will impose a cap on the number of grants awarded to investigators. In an open letter announcing the decision, NIH director, Francis Collins, writes that 40% of NIH funding is concentrated in the hands of 10% of NIH-funded investigators. He notes that this is not inherently problematic, except that many studies indicate that there are diminishing scientific returns on each additional dollar that is granted to any individual investigator. Under the new guidelines, investigators will be limited to a maximum of three R01-equivalent grants in order to support approximately 1,600 more grants to early career and mid-level researchers, who have been particularly affected by the declining NIH budget. While it is difficult to quantify scientific impact, the NIH decision is admirable for its intent to support diversity and efficiency in funding research. (Jocelyn Kaiser, ScienceInsider)

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Science Policy Around the Web – March 14, 2017

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By: Liz Spehalski, PhD

Affordable Care Act

ACA Replacement Bill Released by House

Last Monday, House Republicans released their plan to repeal and replace former President Obama’s Patient Protection and Affordable Care Act (ACA), also known as Obamacare. The American Health Care Act (AHCA), a more conservative vision for the nation’s health care system, was created as a collaboration between the White House and the Senate Republicans. The Republican Party has been critical of the ACA because of the large role that it created for the federal government in health care, such as the need for the IRS to verify eligible people for financial help and federally mandating the public to have health insurance.

The AHCA will maintain some of the popular features of the ACA, such as allowing young adults to stay on their parent’s health care plans until the age of 26, banning lifetime coverage caps, and maintaining the ban on discrimination against people with pre-existing conditions. It also temporarily maintains the expansion of Medicaid to cover millions of low income Americans through January 1, 2020.

Instead of the individual mandate, a fine penalizing Americans for failing to have health insurance, the new bill would try to encourage people to sustain coverage by allowing insurers to impose a 30 % fine to those who have a gap between plans. The AHCA also changes the structure of tax credits given to those who want to buy insurance. Under the ACA, people who earn less than 200 percent of the poverty line get the highest subsidies. The Republican plan would instead give tax credits based mostly on age. The AHCA will also cut off federal funds to Planned Parenthood through Medicaid and other government programs for one year.

While Republicans did not offer any estimate of how much their plan would cost, or how many people would gain or lose insurance coverage, the Congressional Budget Office released its estimate yesterday, raising concerns. Two key House committees swiftly approved the bill, but uncertainty surrounds how this bill will fare in Congress, as some conservatives are concerned that it does not go far enough to remove government from health care, while others are concerned about their constituents losing coverage due to the loss of Medicaid expansion. No Democrats are expected to support the bill. (

Obesity

Fewer Overweight Americans Trying to Lose Weight

A study published in the Journal of the American Medical Association this week found that the percentage of Americans trying to lose weight is declining. In 1990, when researchers asked overweight Americans if they were trying to lose weight, 56% responded yes, while that number decreased to 49% in 2014. Researchers analyzed US government health surveys from 1988 through 2014 which involved in-person physical exams and health- related questions including whether the participants had tried to lose weight within the last year. The study included over 27,000 adults ages 20-59, and weight status was determined using body mass index (BMI).

The explanation behind this trend seems to be the shift in public perception over dieting and overweight people. “Socially accepted normal body weight is shifting toward heavier weight. As more people around us are getting heavier, we simply believe we are fine, and no need to do anything with it,” said lead author Dr. Jian Zhang, a public health researcher at Georgia Southern University. The authors of the study also discuss other possible reasons for this data, such as primary care physicians not discussing weight issues with their patients.

Though the decline of 7% may seem low, this number could represent up to seven million Americans, as more than two thirds of adults are considered to be overweight or obese, according to recent NIH statistics. Scientists say this is concerning because obesity increases the risk of a host of diseases such as heart disease, diabetes, cancer, liver disease, osteoarthritis, and stroke. However, “There’s a possible good news story in this,” says Janet Tomiyama, a psychologist at UCLA who studies eating behavior and weight stigma. “We’re not going to shame people into health,” Tomiyama says, “a lot of research shows that having a healthy body image is what leads to better health outcomes. Maybe people are taking the focus off the number on the scale, and going more towards focusing on their health.” The CDC’s current  obesity prevention efforts focus on policy and environmental strategies that target the affordability of healthy eating and active living, noting that fad diets can be unhealthy and tend to fail over the long term. (Allison Aubrey, NPR)

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March 14, 2017 at 10:00 am

Science Policy Around the Web – July 26, 2016

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By: Ian McWilliams, Ph.D.

photo credit: Newport Geographic via photopin cc

Infectious Diseases

Research charities help marry two major South African HIV/TB institutes

Two institutes, the Wellcome Trust and the Howard Hughes Medical Institute (HHMI), have announced that they are joining efforts in to fund the fight against HIV and Tuberculosis (TB) in South Africa. South Africa has the largest population infected with HIV. Because TB thrives in HIV-infected individuals, South Africa is experiencing a co-epidemic that has been challenging to battle. This collaboration will mark the first time that HHMI and The Wellcome Trust have worked together on a global health institution.

The new Africa Health Research Institute combines the Africa Centre for Population Health’s detailed population data gathered from over 100,000 participants with basic laboratory science and medical research of the KwaZulu-Natal Research Institute TB-HIV (K-RITH). Together the organization will work towards eliminating HIV and TB by training African scientists and will “link clinical and laboratory-based studies with social science, health systems research and population studies to make fundamental discoveries about these killer diseases, as well as demonstrating how best to reduce morbidity and mortality.” Projects funded by the institute include maintaining the longest running population-based HIV treatment as prevention (TasP) trial in Africa and using genomics to study drug resistant TB.

The organization is funded by a $50 million grant from The Wellcome Trust that is renewable over the next five years. Additionally, HHMI has already spent $40 million for the construction of new facilities, including a new biosafety level 3 laboratory that is designed to handle dangerous pathogens. These new efforts aim to apply scientific breakthroughs to directly help the local community. Deenan Pillay, the director of the new institute, has expressed his support of the organization’s mission by stating “There’s been increasing pressure and need for the Africa Centre not just to observe the epidemic but to do something about it. How long can you be producing bloody maps?” (Jon Cohen, ScienceInsider)

Scientific Reproducibility

Dutch agency launches first grants programme dedicate to replication

While a reproducibility crisis is on the minds of many scientists, the Netherlands have launched a new fund to encourage Dutch scientists to test the reproducibility of ‘cornerstone’ scientific findings. The €3 million fund was announced on July 19th by the Netherlands Organisation for Scientific Research (NWO) and will focus on replicating work that “have a large impact on science, government policy or the public debate.”

The Replication Studies pilot program aims to increase transparency, quality, and completeness of reporting of results. Brian Nosek, who led studies to evaluate the reproducibility of over 100 reports from three different psychology journals, hailed the new program and stated “this is an increase of infinity percent of federal funding dedicated to replication studies.” This project is the first program in the world to focus on the replication of previous scientific findings. Dutch scientist Daniel Lakens further stated that “[t]his clearly signals that NWO feels there is imbalance in how much scientists perform replication research, and how much scientists perform novel research.” The NWO has stated that it intends to include replication in all of its research programs.

This pilot program will focus both on the reproduction of findings using datasets from the original study and replication of findings with new datasets gathered using the same research protocol in the original study. The program expects to fund 8-10 projects each year, and importantly, scientists will not be allowed to replicate their own work. The call for proposals will open in September with an expected deadline in mid-December. (Monya Baker, Nature News)

Health Care Insurance

US Sues to block Anthem-Cigna and Aetna-Human mergers

United States Attorney General Loretta Lynch has announced lawsuits to block two mergers that involve four of the largest health insurers. Co-plaintiffs in the suits include eight states, including Delaware, Florida, Georgia, Illinoi, Iowa, Ohio, Pennsylvania, Virginia, California, Colorado, Connecticut, Main, Maryland, and New Hampshire, as well as the District of Columbia. The lawsuits are an attempt by the Justice Department to block Humana’s $37 billion merger with Aetna and Anthem’s $54 billion acquisition of Cigna, the largest merger in the history of health insurers. The Justice Department says that the deals violate antitrust laws and could mean fewer choices and higher premiums for Americans. Antitrust officials also expressed concern that doctors and hospitals could lose bargaining power in these mergers.

Both proposed mergers were announced last year, and if these transactions close, the number of national providers would be reduced from five to three large companies. Furthermore, the government says that Anthem and Cigna control at least 50 percent of the national employer-based insurance market. Lynch further added that “competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.” The Affordable Care Act (ACA) aimed to encourage more competition between insurers to improve health insurance options and keep plans affordable. The Obama administration has closely watched the health care industry since the passing of that legislation and has previously blocked the mergers of large hospital systems and stopped the merger of pharmaceutical giants, such as the proposed merger of Pfizer and Allergan.

Health insurers argue that these mergers are necessary to make the health care system more efficient, and would allow doctors and hospitals to better coordinate medical care. In reaction to the announcement by the Justice Department, Aetna and Humana stated that they intend to “vigorously defend” the merger and that this move “is in the best interest of consumers, particularly seniors seeking affordable, high-quality Medicare Advantage plans.” Cigna has said it is evaluating its options. (Leslie Picker and Reed Abelson, New York Times)

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Written by sciencepolicyforall

July 26, 2016 at 11:00 am

Science Policy Around the Web – November 3, 2015

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By: Danielle Friend, Ph.D.

Photo credit: photo credit: Grandfather Healing via photopin (license)

Healthcare Costs

Costs for Dementia Care Exceed Most Other Diseases

A recently study examining the cost of care for individuals suffering from dementia found that the cost of this care is exceeding the cost for caring for those that die from heart disease or cancer. In addition to costing more, the new study also reports that out-of-pocket spending for these patients and their families is 81 percent higher than for people without the disease and suggests that the economic burden is higher for individuals with dementia if the patient is black, has less than a high school education, or is widowed or unmarried. The study used data from Medicare recipients who died between 2005 and 2010 and found that the average cost for caring for these patients was $287,038 compared to $175,136 for those who died from heat disease or $173,383 for those who died from cancer. The increased costs for caring for an individual with dementia have been attributed to the fact that these individuals often require care for many years, that there are currently no treatments that effectively slow the disease, and that the care is not covered by insurance. For example, Medicare does not cover homecare service and non-rehabilitative nursing care, support often need for those with dementia. Additionally, individuals with dementia often need constant supervision as well as assistance with everyday activities such as eating, dressing, and bathing – again, care that is costly but not covered by Medicare. Certainly as the Baby Boomer population nears their elderly years concerns for how individuals pay for this much needed care will increase. (Gina Kolata, New York Times; Tara Bahrampour, Washington Post)

International Scientific Community

Canadian Scientists have High Hopes for Increased Government Support Following Election

Prior to Canada’s Election Day on October 19th, Canadian scientists made a rare push for federal science funding to be an issue in the elections. The Professional Institute of Public Service of Canada, a union made up of 15,000 scientists, aired radio ads accusing the governing Conservative Party of not supporting scientists.  However, with the ousting of the Conservative Party, which had held power for nearly 10 years and the election of Canada’s Liberal Party to a majority government led by Justin Trudeau, Canadian scientists are looking to the future with higher hopes for science. Since taking hold of leadership in 2006, the Conservative Party had eliminated the position of the national science adviser, a position that the Liberal Party states they will restore.  Additionally, the Conservative Party was also accused of ending climate and environment science programs and closing research libraries in government departments, as well as placing a greater emphasis on applied industrial research which left basic science lacking resources. In Canada, government support for science research is particularly important because private industry contributes proportionally less to research compared to other countries. If commitments are upheld by the new Liberal Party, Canadian scientists hope a new era of Canadian science will see a bright future. (Brian Owens, ScienceInsider)

Infectious Diseases

Ebola Virus Appears to be Long-Lived

As the number of new cases of Ebola appears to be dwindling, researchers are startled by new findings that the Ebola virus may leave traces in survivors that could contribute to new epidemics. Although researchers have known since 1999 that Ebola virus could be found in the semen of male survivors for months, new work published in The New England Journal of Medicine demonstrate that in 93 Ebola virus survivors, Ebola viral RNA could be found in semen samples from 46 men up to 9 months after contacting Ebola. Additionally, a second paper details the sexual transmission of the Ebola virus to a Liberian woman. The paper indicates that there were no cases of Ebola in the 30 days prior to the woman being diagnosed, however she reported having unprotected vaginal intercourse with an Ebola survivor prior to being diagnosed in March 2015. The male survivor had Ebola in September of 2014 but had tested negative in October 2014. However, a semen sample taken from the man in March tested positive for Ebola. Much more work will need to be done to definitely determine whether Ebola can be sexually transmitted and for how long after the survivor has recovered. The original articles detailing these findings can be found here and here.

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Written by sciencepolicyforall

November 3, 2015 at 9:00 am

Science Policy Around the Web – June 30, 2015

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By: Eric Cheng, Ph.D.

Photo credit link: Affordable Care Act via photopin (license)

Health policy

Affordable Care Act survives Supreme Court challenge

On June 25, 2015, the Supreme Court upheld a key provision of the Affordable Care Act that allows the federal government to provide subsidies to people in all 50 states, and not just the 16 states that administer their own online insurance exchanges. This ruling means that people in states without their own exchanges can still get federal subsidies for the purchase of health insurance allowing an estimated 6.4 million people to keep their health care coverage, according to the Kaiser Family Foundation. Without access to subsidies, millions of Americans would have been at risk of failing to meet the mandate that requires every American to buy health coverage. This ruling affirmed that the legislation that created the Affordable Care Act intended to improve the health care system and to provide support to all who needed help to buy health insurance.

Two of the court’s conservatives, Chief Justice John G. Roberts Jr. and Justice Anthony Kennedy, joined the court’s four liberal Justices in rejecting the lawsuit in a 6-3 vote to side with the Obama administration. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote for the majority. While Justice Antonin Scalia, who wrote in dissent, called the majority’s reasoning “quite absurd” and “interpretive jiggery-pokery.”

President Obama made a statement on the recent ruling, saying the Affordable Care Act “is here to stay.” (Robert Barnes, Washington Post)

Federal research funding

Senate panel approves $2 billion raise for NIH in 2016

A Senate appropriations subcommittee voted to approve $32 billion in funding for the National Institutes of Health (NIH) for the 2016 fiscal year, representing an increase of $2 billion from 2015. This increase in funding could be the largest increase since 2003. Senator Roy Bunt (R-Mo.), chairman of the Senate Labor, Health and Human Services, and Education and Related Agencies Appropriations Subcommittee commented that “this year’s Labor-HHS appropriations bill prioritizes programs that will provide a significant benefit to all Americans and, most importantly, provides the National Institutes of Health with a $2 billion increase to make critical life-saving medical treatments and high-quality cures available to all Americans.”

The Senate panel approval will match the $200 million request by President Obama for the development of the Precision Medicine Initiative along with a $100 million increase for new funding to combat antibiotic resistance from the previous fiscal year. Other highlights include a $350 million increase for the National Institute on Aging, the lead Institute researching Alzheimer’s disease, and an additional $70 million for the BRAIN Initiative to map the human brain. These increases to every Institute and Center are intended help NIH to continue their development of new therapies, diagnostics, and preventative measures to enhance health, lengthen life, and reduce illness and disability. (Jocelyn Kaiser, ScienceInsider)

Environment and public health

House Advances Chemical Safety Reform Bill, Teeing Up Senate Vote

The U.S. House of Representatives passed legislation to overhaul the nearly 40 year old Toxic Substances Control Act (TSCA). This bipartisan bill aims to improve chemical safety. Some updates include the determination of risk by the Environmental Protection Agency (EPA) based on scientific evidence of its health impact instead of the cost of regulation. For new chemicals, the bill would shift the burden to industry to show that the substances they manufacture are not unreasonably risky. Other provisions in the bill would increase transparency by preventing industry efforts to keep safety data secret by declaring them confidential business information. This would allow EPA to more easily share chemical information with states, doctors, and first responders. These new reforms will help address an outdated law to protect human health and the environment from significant risks while also protecting commercial and competitive interests of the United States chemical industry and the national economy. (Kate Sheppard, Huffington Post; Puneet Kollipara, ScienceInsider)

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Written by sciencepolicyforall

June 30, 2015 at 9:00 am