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Science Policy Around the Web – December 1, 2017

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By: Kelly Tomins, BSc

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Fake Drugs

Health agency reveals scourge of fake drugs in developing world

The World Health Organization (WHO) released two concerning reports detailing the prevalence and impact of substandard and falsified medical products in low and middle income countries. Although globalization has led to the increase in e-commerce of medicine, making life-saving treatments available to a broader population, it also created a wider and more accessible market to dispense fake and harmful medicines for profit. Despite this, there was a lack of a systematic method of tracking falsified medicines on a global scale. Thus, the WHO created the Global Surveillance and Monitoring System for substandard and falsified medical products (GSMS). With this program, medicine regulatory authorities can enter information about fraudulent drug incidences into a centralized database, making it easier to understand global trends and to possibly identify the source of harmful products. The WHO also conducted an extensive literature search of nine years’ worth of medicine quality studies to assess rates of fake medicines.

Their dual analysis showed that falsified medicines are heavily prevalent, particularly in low-and -middle income countries. They estimate that an incredulous 10.5% of medicines in these countries are falsified or substandard, representing $30 billion in wasted resources. Low income countries are the most vulnerable to this type of exploitation, given their higher incidence of infectious disease and their likelihood of purchasing cheaper alternatives to more reliable and tested medicines. In addition, these countries are more likely to lack the regulatory framework and technical capabilities to ensure safe dispensing of medicines. However, reports of fake drugs were not limited to developing countries. The Americas and Europe each accounted for 21% of the reported cases, highlighting how this is a global phenomenon.

Antimalarials and antibiotics are the two products most commonly reported as substandard or falsified, with 19.6% and 16.9% of the total reports respectively. These findings are especially concerning given a recent finding that the number of malaria infections increased the past year, despite a steady global decrease from 2000-2015. In addition, the number of deaths from the disease have not decreased for the first time in 15 years. By providing an insufficient dose to eradicate the malaria parasite from the body, the use of substandard or falsified antimalarials can foster the emergence of drug-resistant strains of malaria, like those recently found in several Asian countries. Overall, the WHO estimates that falsified products may be responsible for 5% of total deaths from malaria in sub-Saharan Africa.

Despite the clear need for action to ensure drug safety around the world, there are an abundance of challenges to making this possible. The supply chain of drug manufacturing, from the chemical synthesis of the drug, to the creation of packaging and the shipping and dissemination, can span multiple countries with extremely variable regulatory procedures and oversights. The need for strengthened international framework and oversight is necessary to ensure patients receive the drugs they think they are getting and preventing hundreds of thousands of deaths each year.

(Barbara Casassus, Nature)

Biotechnology

AI-controlled brain implants for mood disorders tested in people

Mood disorders have been traditionally difficult to treat due to the often-unpredictable onset of symptoms and the high variability of drug responses in patients.  Lithium, a popular drug used to treat bipolar disorder, for example, can cause negative side effects such as fatigue and poor concentration, making it more likely for patients to elect to stop treatment. New treatments developed by the Chang lab at Massachusetts General Hospital and Omid Sani of UCSF hope to provide real-time personalized treatments for patients suffering from mood disorders, such as depression and PTSD. The treatment utilizes a brain implant that can monitor neural activity, detect abnormalities, and then provide electrical pulses to a specific region of the brain when needed. These electrical pulses, known as Deep Brain Stimulation (DSB), have already been used to treat other disorders such as Parkinson’s disease. Other groups have tried to use DSB in the past to treat depression, but patients showed no significant improvement. In those studies, however, the pulses were given constantly to a single portion of the brain. What is unique about this treatment is that the pulses are only given when necessary, or when the implant receives signals that the brain is producing abnormal neural activity. The researchers have also found ways to map various emotions and behaviors to specific locations in the brain. They hope to utilize that information in order to more finely tune a person’s behaviors. In addition, the algorithms created by the labs to detect changes in the brain can be modified for each patient, providing an alternative to the one-size-fits all pharmacological approaches currently used.

Despite the promising and appealing aspects of this personalized treatment, it also raises several ethical issues regarding privacy and autonomy. First off, with such detailed maps of neural activities, the patient’s mind is practically an open book to their doctor. They have little agency of what emotions they would want to share or, more importantly, hide. Also, the patient may feel a lack of autonomy over their treatment, as the implant itself decides when the patient is displaying an unwanted mood or behavior. The algorithms could also potentially change the patient’s personality for worse by limiting the spectrum or intensity of emotions that a patient can feel. Any type of manipulation of brain activity could be viewed as worrisome from an ethical standpoint, and although promising, this proposed treatment should undergo intense scrutiny in order to maintain autonomy for the patients.

(Sara Reardon, Nature)

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December 1, 2017 at 4:03 pm

Science Policy Around the Web – August 29, 2017

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By: Allison Dennis, BS

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Science funding

1 Million fewer dollars available for studying the health impacts of coal mining

The National Academies of Sciences, Engineering and Medicine, was instructed to stop its ongoing research into the potential health effects of surface mining by the U.S. Department of the Interior on August 18, 2017. The US$1 million study was established on August 3, 2016, “at the request of the State of West Virginia,” by the Office of Surface Mining Reclamation and Enforcement (OSMRE). OSMRE, an office within the U.S. Department of the Interior, selected the National Academy of Science to systematically review current coal extraction methods, the framework regulating these methods, and potential health concerns. Critics of the study point to the findings of a similar review undertaken by the National Institute of Environmental Health Sciences that were made public on July 21, 2017, which determined that the current body of literature was insufficient to reach any conclusions regarding the safety of mountaintop removal on nearby communities.

Mountaintop removal, a form of surface mining, employs the use of explosives to efficiently expose coal deposits that would otherwise require a large number of workers to extract over time. The excess soil and rock that has been blasted from the mountain is placed in adjacent valleys, leading to alterations of stream ecosystems, including increases in selenium concentrations and declines in macroinvertebrate populations.

The people of rural Appalachia experience significantly higher rates of cancer than people in the rest of the U.S., of which environmental exposures are only one potential risk factor. Widespread tobacco use, obesity, and lack of accessible medical care are all believed to underlie the cancer epidemic in Appalachia, culminating in a tangled web of risk.

It is unclear how the money from this study will be repurposed. The Obama administration cancelled a study of surface mining to redirect funds towards examining the little known effects of hydraulic fracturing.

(Lisa Friedman and Brad Plumer, The New York Times)

Cancer treatments

For breast cancer patients the cost of peace of mind may be both breasts

Between 2002 and 2012 the rates of women with a breast cancer diagnosis opting for a double mastectomy increased from 3% to 12%. In a majority of these cases, a lumpectomy may be medically sufficient. However for many women, this choice may stem from a personal pursuit of peace of mind rather than the advice of their doctors. The mastectomy procedure can extend time of recovery from a few days, in the case of a lumpectomy, to 4 to 6 weeks. Yet for many women, undergoing a lumpectomy followed by 5 to 7 weeks of radiation therapy would offer the same long-term survivorship. Additionally, 1 in 8 women with invasive cancer in a single breast is electing to remove both breasts.

The reasons for this increase is unknown. While the procedure has not been demonstrated to increase survivorship, the procedure itself is relatively risk free. Breasts are not vital organs, and improvements in reconstruction methods have provided women with a natural-looking, cosmetic replacement. For many women the cost of feeling their struggle with breast cancer is behind them is the removal of both breasts. Double mastectomies, along with the reconstruction surgeries they normally require, are usually covered by insurance.

Breast cancer is the most commonly diagnosed cancer type in the U.S. Mortality from the disease decreased by 1.9% per year from 2003 to 2012. Yet, for many women facing breast cancer, the choice of a double mastectomy may feel like the only empowering choice, one their doctors are willing to let them make.

(Catherine Caruso, STAT News)

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August 30, 2017 at 8:57 pm

Science Policy Around the Web – August 15, 2017

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By: Liu-Ya Tang, PhD

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Public Health

Obesity and Depression, Entwined or Not?

It might seem that obesity and depression are not related since they are diseases from different parts of the body; however, health care practitioners have observed that these two diseases have a close relationship. The development of obesity and depression can be a vicious cycle, one favoring the other. Extra weight brings anxieties to obese people, which can cause poor self-image and social isolation. These are known contributors to depression. On the other hand, people experiencing depression tend to overeat and avoid exercising. According to the federal Centers for Disease Control and Prevention, about 43 percent of people with depression are obese, compared with 36.5 percent of the general population. People with obesity have a higher risk to develop depression, and vice versa, according to one 2010 study.

Both obesity and depression are chronic diseases that are hard to treat, placing a big burden on the health care system. Obesity rates in the United States are among the highest in the world. Obesity alone costs almost $150 billion per year in direct expenses, and this number is estimated to increase about $1.24 billion each year till the year 2030. The cost of treating depression is even higher, which is more than $200 billion every year. So it is urgent to find ways to treat both diseases more effectively if they are bidirecitonally comorbid.

When depression and obesity coincide, the combination of physical and mental health interventions becomes important, which has been supported by several studies. Researchers from the University of Texas-Southwestern found that patients’ depression were alleviated when they did weekly exercise sessions, which were prescribed by physicians. Another study from Duke University found that the rate of depression in obese women was decreased by 50 percent simply by helping them control their weight. The combinatorial treatment has been adopted. Dr. Sue McElroy, a psychiatrist in Mason, Ohio, screens patients for weight and BMI, and treats obesity and depression together. She tailors her prescription, as some antidepressants can cause weight gain. Her “self-taught” method was welcomed by her patients. However, this is not a general practice in treating patients with both symptoms. To benefit patients’ health and reduce cost for curing obesity and depression, the whole health care system needs a change.

(Shefali Luthra, Kaiser Health News)

 

The ACA

What do people and health-policy experts think about repealing the ACA?

Since March, the Trump administration has strived to repeal and replace the Affordable Care Act (ACA), but the Senate rejected this repeal, as 3 republican senators voted “no” last month. How do people feel about repealing the ACA? What do most people say the Trump administration should do after the Senate failed to repeal? There were two reports about it.

The first one was about a survey conducted Aug. 1-6 by the Kaiser Family Foundation, which capture the opinions of 1,211 adults. Their analysis found that a majority of people (78 percent) think that the government should make the ACA work better. Grouping this majority by Political Party ID, reveales 95 percent are Democrats, 80 percent re independents and 52 percent are Republicans. Even 51 percent of President Trump’s supporters think both parties should work together to improve the health law.

The second report said that a coalition of liberal and conservative health-policy leaders is making suggestions for how to strengthen the existing ACA law, aligned with a favorable view in the public. The nine group members are from think tanks, universities and advocacy groups, who can be influential in health-policy formation of the government. The coalition was founded when it appeared that the Republican-controlled Congress would pass a repeal of the ACA without a replacement plan. It took the group eight months to come up with a five-point set of principles. It says that the government should continue providing subsidies to insurers that extend plans to 7 million lower-income customers and strong incentives for Americans to carry health insurance. The latter will help the cost of expensive care be shared by a stable insurance pool with healthy customers. They also urge the government to bring health plans to about two dozen counties, which would be left providerless in the ACA marketplace for 2018. The group said they intend to present their idea to Republican and Democratic lawmakers. “We are trying to model bipartisanship so incremental steps can be taken,” said by Ron Pollack, chairman emeritus of the liberal consumer-health lobby Families USA.

To prevent the potential collapse of health insurance market, the Senate is planning a bipartisan hearing on health care in September. In the House, a group of around 40 Republicans and Democrats known as the Problem Solvers Caucus aims to making urgent fixes to the ACA law. On September 27th, insurers will sign contracts with the federal government over what insurance plans to sell on the marketplace for 2018, which pushes Congress to come up with a solution before then.

(Phil Galewitz, Kaiser Health News, and Amy Goldstein, The Washington Post)

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August 15, 2017 at 6:27 pm

Science Policy Around the Web – July 25, 2017

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By: Allison Dennis B.S.

TopSecretMosquito

Gene Drives

With Great Power There Must Also Come–Great Responsibility!

 

On the horizon of life-changing biotechnology up for ethical debate, nestled between CRISPR and whole genome sequencing, are gene drives, which have the potential to alter genes for better or for worse across generations. During sexual reproduction each of the two versions of a gene carried by a parent has a 50% chance of being inherited by each offspring. The frequency of each version of a gene across a population is influenced by rates of mutation, migration, genetic drift, and natural selection. Gene drives present the technology to circumvent these natural forces. By introducing molecular machines capable of damaging a particular version of a gene along with the version they prefer to the cells that give rise to eggs or sperm in an organism, scientists can shift the likelihood that their version will be inherited by that organism’s offspring from 50% to 100%. Upon fertilization the undesired gene will be damaged by the molecular machine and the desired gene will used as a template to repair the damaged copy, allowing two copies of the desired gene to be permanently introduced in the offspring and inherited by the next generation. Clever applications have been proposed to design mosquitoes resistant to malaria, mice unable to transmit lyme’s disease, or salmon able to grow to full size in half the time. More bold applications would use the technology to render female mosquitoes sterile, the ultimate insecticide. However, for each one of these beneficial applications exists the devastating opposite, which could be employed to accelerate the spread of disease. Altering population genetics of one species could accidentally devastate ecosystems.

U.S. defense organizations have taken notice of this powerful technology. DARPA, the Defense Advanced Research Project Agency, has launched the Safe Genes program in an effort to anticipate and address potential risks of introducing uncontrolled or undesired gene drives. The program awarded a collective $65 million to seven labs hoping to develop counter technologies including self-fizzling drives, chemical control methods, and gene drive vaccines. This summer, to delve deep into the intellectual discussion JASON, tackled the issue. This independent group of scientists, holding stellar academic records and top-secret clearances, meets once a year to address questions posed by the U.S. Department of Energy, Department of Defense, CIA, and FBI. However, their report is likely to be classified. (Ewen Callaway, Nature News)

Violence Against Women

Beginning to Understand the Nature of Intimate Partner Violence Through Data Curation

Careful evaluation of the nature of homicides of women has revealed that 55% result from intimate partner violence (IPV). The study conducted by the US Center for Disease Control (CDC) looked into the circumstances surrounding the deaths of 10,018 women over the age of 18 between 2003 and 2014 across 18 states. In addition to cases where the victims were intimate partners of the suspect, IPV-related homicides included cases where the female victims were friends, family, or those who intervened during an incident of IPV.

Nationwide political attention was drawn to the issue of IPV starting in the 1990s. The Violence Against Women Act was passed by Congress in 1994 and sought to legally define domestic violence as a crime external to the purview of private family matters. Research has revealed several risk factors associated with intimate partner violence, including threats with weapons, stalking, obsessive jealousy, sexual assault, and controlling behavior. However, the effectiveness of political and public health interventions remain unclear due to the overall decline in violence over the last decade and believed underreporting of individual incidence.

In an effort to more broadly understand the “who, when, where and how” surrounding violent deaths that occur in the United States, including those connected with IPV, the CDC created the National Violent Death Reporting System in 2002. By pooling information gathered by local law enforcement officers, coroners, medical examiners, and state agencies the CDC is hoping learn more about “why” so many violent deaths occur, towards the goal of developing and evaluating public health interventions. At its inception, funding only supported the participation of six states. However, involvement has been increasing from 17 states in 2006 and 42 in 2016 with the goal of eventually including all 50 states, U.S. territories, and the District of Columbia.

This study confirmed that homicide as a result of IPV occurs across all age groups and racial ethnic groups. However, young black and Hispanic women are disproportionately affected compared with white and Asian women of the same age group. Overall, black and indigenous women experienced significantly higher higher homicide rates, including non IPV related cases, than women of other races. Women died as a result of the use of firearms in 53.9% of all cases. While the “why” still remains unclear, this 15 year glance back sheds some light on the groups most affected by violence inflicted by their own partners, providing opportunity for targeted prevention. (Camila Domonoske, NPR)

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July 25, 2017 at 6:42 pm

Science Policy Around the Web – July 7, 2017

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By: Leopold Kong, PhD

Food Policy

Food and Microbiota in the FDA Regulatory Framework

More and more probiotic food products, or microbiota-directed foods, claiming to “improve” the body’s microbiota have been hitting the shelves, with sales valuing over US$700 million in the US alone and US$36.6 billion globally this past year. However, there is little framework regulating their ingredients or guaranteeing the scientific accuracy of their health claims that has resulted in costly legal action. For example, in September 2009, Dannon settled a US$35 million consumer class action suit challenging the claimed health benefits in their ads. A similar class action suit against Procter & Gamble’s Align probiotic has been certified and set for Oct. 16, 2017. A paper recently published in the journal Science calls for greater clarity in policy regulating probiotic products. Importantly, the authors urge that probiotics should be clearly classified as a dietary supplement, a medical food, or a drug. If classified as a dietary supplement, probiotics can make claims on nutrient content and effect on health, but not on treatment, prevention or diagnosis of disease. If classified as a medical food, probiotics must contain ingredients that aid in the management of a disease or condition, with “distinctive nutritional requirements”, that is scientifically recognized. Finally, if classified as a drug, probiotics will require clinical trials to prove its medical claims. An alternative, and perhaps cheaper, way forward is to regulate probiotics as a kind of over-the counter medical food, requiring testing only for their active ingredients that can be used in a variety of products. (Green et al., Science)

Antibiotic Resistance

Untreatable Gonorrhoea on the Rise Worldwide

Over 78 million people are infected with gonorrhea each year, a sexually transmitted disease that has traditionally been treated effectively with anti-microbials. However, recently published data from 77 countries show that antibiotic-resistant gonorrhea is getting more pervasive and harder to cure. “The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” said Dr. Teodora Wi, Medical Officer, Human Reproduction, at the WHO. The data found widespread resistance to ciprofaxacin, azithromycin, and even to the last-resort treatments, oral cefixime and injectable ceftriaxone. New drugs are under development, including a phase III trial of a new antibiotic, zoliflodacin, launched by the non-governmental organization Drugs for Neglected Diseases Initiative and Entasis Therapeutics, a biotech company in Waltham, Massachusetts. Better prevention through education on safer sexual behavior and more affordable diagnostics will also be needed moving forward. (Amy Maxmen, Nature News)

Maternal Health

U.S. has the Worst Rate of Maternal Deaths in the Developed World

A recent six-month long investigation by NPR and ProPublica has found that more women in the US are dying of pregnancy related complications than any other developed country. Surprisingly, this rate is increasing only in the US, which stood at ~ 26.4 deaths per 100,000 births in 2015, translating to nearly 65,000 deaths annually.  This is three times worse than for women in Canada, and six times worse than for women in Scandinavian countries. Reasons include older new mothers with more complex medical histories, unplanned pregnancies, which are the case half the time in the US, greater prevalence of C-sections, and the fragmented health system. This is in contrast with progress in preventing infant mortality, which has reached historic levels in the US. Better medical training for maternal emergency and more federal funding for research in this area may improve the situation for American mothers. (Nina Martin and Renee Montagne, NPR)

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Science Policy Around the Web – May 16, 2017

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By: Sarah L Hawes, PhD

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Preventative Medicine

Fresh Foods a Day Keep Disease and Deficit Away

If you have recently shopped for health insurance, you likely encountered incentives for self-maintenance, such as discounted gym membership, or reimbursement for a jogging stroller. These incentives are motivated by the enormous ticket price of failing health. The CDC estimates that over $500 billion is spent annually on direct medical expenses to treat chronic diseases, which can be prevented or postponed through lifestyle practices – including heart disease, obesity, and diabetes.

The Geisinger health care system reports encouraging results from the first year of a lifestyle-modification program called Fresh Foods Pharmacy, piloted in central Pennsylvania. This program provides patients with Type 2 diabetes nutrition counselling, hands-on classes in healthy cooking techniques, and a weekly prescription for five days’ worth of fresh food – fillable for free at a hospital based “food pharmacy.” This means patients are not just advised to eat better; they are comprehensively enabled to eat better.

David Feinberg, president and CEO of Geisinger, reports that all 180 participants in the pilot group have made substantial improvements in their health, including reductions in blood pressure and body weight, and that many have seen a several-point reduction in a blood marker used to diagnose and monitor their disease, called A1C. A1C reduction means that blood sugar levels are being better controlled, which also means fewer costly diabetic complications for patients down the line. Feinberg calls the program “life changing,” adding that participants “won’t go blind; [they] won’t have kidney disease, amputations.”

Many Fresh Foods Pharmacy participants are low-income, so there is powerful financial incentive to ‘follow doctors’ orders’ and eat the free, healthy food. But what does supplying a person with nutritional counsel and weekly fresh foods cost?

Geisinger spends approximately $1,000 per year on each Fresh Foods Pharmacy patient. Meanwhile, a mere one-point drop in A1C levels saves Geisinger roughly $8,000 per year. Feinberg says that many participants trimmed about 3 points off their A1C level in the first year, saving roughly $24,000 on a $1,000 investment. “It’s a really good value” says Feinberg, who is already working to expand the program to additional sites.

Improved patient health and medical cost-cutting in the first year of this program are independently exciting. In addition, the value of engendering better patient health through comprehensive dietary support is very likely to extend beyond patient and provider. Patients who are enabled to engage in healthful food preparation will share a healthier diet and food-culture with their families, enhancing program benefits in as-yet unmeasured dimensions. (Allison Aubrey, NPR)

Research Funding

Climate Science Policy Lessons from Down Under

Pretend for a moment that everyone firmly believes that climate change is real, and is a real threat. Is this enough to safeguard basic climate science research? Recent events in Australia give us our answer – no.

Australia is the most active contributor to climate science in the Southern Hemisphere. As such, Australian researchers provide a truly international service. Public appreciation of this fact, together with public activism, recently saved funding for Australian climate science.

In 2015, Dr. Larry R. Marshall was appointed to lead Australia’s national scientific agency (CSIRO). Dr. Marshall planned to champion initiatives motivated by his faith in climate science. He wanted to develop technologies to respond to inescapable climate change, and to mitigate damage through reduced emissions. Paradoxically he proposed to fund these by laying off droves of basic climate researchers.

Dr. John A. Church was a climate scientist at CSIRO, having published highly regarded studies indicating accelerated sea level rise paralleling greenhouse gas emission. On catching wind of Marshall’s plan, Church reached out to his contacts in the media and wrote an open letter to Marshall in defense of basic science. Public marches, hearings, and protests from thousands of international scientists ensued.

Ultimately, the rally of public voices instigated by Dr. Church and others like him was effective. Far fewer layoffs occurred than were initially slated to occur. Dr. Church was among those let go by CSIRO, but was rapidly recruited by the University of New South Wales to continue his climate research.

Bear in mind that Dr. Marshall was no climate change denier. He showed great willingness to use scientific findings to guide policy, which is admirable. He addressed an Australian Senate committee saying that the climate “absolutely is changing,” and “we have to do something about it.” In a recent interview, he summarized his reasons for wanting to lay off scientists saying this: “Unfortunately, with a finite funding envelope, you’ve got to make choices where you fund.”

Australia’s example shows us that even in a political environment with great faith in science, reverence for basic research is a separate issue, and merits independent attention and protection. Staying abreast of science policy matters. And for those of us who believe there is no shortage of natural complexity, and no end to the fruitful pursuit of knowledge, it pays to speak out in defense of basic research. (Justin Gillis, The New York Times)

 

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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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