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Science Policy Around the Web – March 12, 2019

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By Andrew Wright, BSc

Source: Pixabay

The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?

Diabetes is highly prevalent in the United States, affectingnearly 10% of the US populationand accounting for approximately 80,000 deaths every year. While the pursuit to reduce or mollify the societal and economic impact of this disease is undoubtedly necessary in a country where fully 39.8% of adults are obese, there are some who wonder if such efforts have slipped into problematic territory. 

            Similar to how the introduction of pain as a fifth vital signhelped to unintentionally spur on the devastating opioid crisis, there is fear that the expanding diagnostic criterion of prediabetes could lead to the familiar territory of unnecessary treatment. For one, the risk of prediabetic patients developing diabetes from year to year is low: just under 2% according to the Centers for Disease Control (CDC).  At the same time the methods of treatment for prediabetes, designed to prevent progression to the full disease, are not particularly effective in achieving that goal. While a 2009 study demonstrated that exercise intervention or metformin, a common drug used to treat diabetes, did prevent some prediabetic patients from transitioning to full diabetes, methodological concerns have been raised with the authors’ results. One of the major issues is that the study used high risk patients at the upper end of the prediabetic spectrum, which is significant given that the American Diabetes Association (ADA) reduced the lower threshold of what counts as prediabetes around the same time. Of these “less” prediabetic patients, many never transition to the full disease. This suggests at the very least that treating these patients, especially pharmacologically, is not necessary or beneficial.

            Despite these issues being raised, there is a worrying trend of medical professionals doing just that. While no drug has been approved to treat prediabetes, doctors are continuing to treat prediabetic patients with diabetes drugs by prescribing them off-label at the recommendation of the ADA. Not only does this include metformin, which has its own difficult side-effects, but also several medications with “black box” labels that denote severe risks. Particularly when one considers that those who progress to full diabetes will be treated with these same drugs as their condition worsens, using them prophylactically is likely overzealous.

            Finally, there have been concerns raised about financial conflicts of interest, to which the medical and pharmaceutical industry are certainly not strangers. The companies behind the most prominent diabetes drugs have gifted millions of dollars to those in positions of influence at the ADA and other medical institutions. Perhaps as a result, while international groups such as the World Health Organization (WHO) have rejected prediabetes as a condition outright, the American medical community seems to be falling in line with the diagnosis. When top-down societal changes to reduce obesity may a be more effective means to reduce diabetes according to the WHO, the over-medicalization of prediabetes could ultimately do more harm than good.

(Charles Piller, Science)

Microplastic pollution revealed ‘absolutely everywhere’ by new research

With estimates that the ocean will have more plastic than fishby weight by 2050, it should come as no surprise that global plastic pollution is becoming rapidly untenable.  It is well understood that plastic does not biodegrade, but rather breaks down into increasingly smaller pieces know as microplastics. These pieces of plastic can become so small that they can be ingested by zooplankton, one of the fundamental building blocks of the marine food chain, which means they eventually make their way to the human digestive system.  

            While the problem was previously thought to be relegated to the worst polluted waterways and places like pacific vortexes (colloquially known as the “Great Pacific Garbage Patch”), recent studies have shown that microplastic pollution is so pervasive that pieces are found in every area tested. This includes freshwater bodies in the United Kingdom, groundwater supplies in the United States, the Yangtze river, off the coast of Spain, and in tap water around the world.

            The problem is not relegated to shallow water bodies either, with microplastics being found at the bottom of the Mariana Trench at levels of up to 2,200 pieces per liter of sediment. While these levels of contamination are undoubtedly perilous to wildlife, the affect they might have on humans is unclear. However, research from the National University of Singapore has demonstrated that microplastics harbor both bacteria that cause coral bleaching and those that cause gastroenteritis.  Further,  the possibility remains for chemicals contained in microplastics such as polychlorinated biphenyls (PCBs), which are carcinogenic, to cause deleterious health effects as chronic exposure leads to cumulative effects. What is clear is that without some method of reducing plastic pollution or monumental cleanup efforts, microplastics will become a troubling global burden in the years to come.

(Damian Carrington, The Guardian)

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Written by sciencepolicyforall

March 12, 2019 at 4:53 pm

Science Policy Around the Web – June 27, 2017

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By: Sarah Hawes, PhD

Source: pixabay

Influenza

An Arms Race with Nature

H7N9, a new bird flu emerging in China, has infected roughly 1,500 people and killed 40% of them. The virus is contracted directly from infected birds but is not yet easily transmissible between humans, however researchers at The Scripps Research Institute have evidence H7N9 could potentially become transmissible between humans fairly easily. They examined a fragment of the virus that interacts with receptors on animal cells to gain entrance, and identified three minor mutations that could cause the fragment to shift from preferentially entering avian cells to preferentially entering human cells. If these mutations were to occur, it could rapidly result in a pandemic.

Tests in a viral fragment do not prove functionality in the intact virus; that would require mutating H7N9 itself. A 2014 moratorium on mutating three types of viruses (SARS, MERS, influenza) to more dangerous forms is expected to lift when the Department of Health and Human Services finishes current work drafting a new policy establishing reviews designed to assess benefit/risk ratios before funding research.

The subject is divisive, even among scientists in the field. Stanford researcher David Relman says he would support efforts to test mutations in a weakened strain of flu, but not in the H7N9 virus.  Bioterrorism expert Thomas Inglesby opposes increasing the contagious lethality of a virus, and opposes publishing such procedures due to concern that less benevolent actors would be enabled to replicate the process. NIH funded researcher, Ron Fouchier in the Netherlands, whose alteration of H5N1 to become highly contagious between ferrets (the animal model for humans) in 2011 influenced the moratorium, believes examining dangerous virus mutations in a controlled lab environment is important to identify potential pandemic viruses.

Many of these topics were discussed at the recent Immunology and Evolution of Influenza Symposium, and are sure to be a hot topic at the July 16 – 19 Centers of Excellence for Influenza Research and Surveillance meeting. With policy guidance needed on benefit/risk, potentially safer models, security, and publication limitations, the new HHS policy will be critical. (Nell Greenfieldboyce, NPR)

Conservation

Modeling with Dough – Pick your Species

The Supreme Court found the Endangered Species Act was “intended to halt and reverse the trend toward species extinction—whatever the cost.” Today, in light of the cost, conservation policy makers are being invited to triage species extinctions. Fish and Wildlife Service representatives recently met with ecologist Dr. Leah Gerber to discuss her proposed use of an algorithm guiding conservation funding.

A self-proclaimed environmentalist, Gerber says her model suggests that defunding “costly failures,” including the spotted owl, golden-cheeked warbler and gopher tortoise, could help save about 180 other species. Gerber says policy makers may opt to continue to support species that her algorithm rejects, as was done for the koala in Australia where algorithm triage has been used. In this case, a popularity contest may determine who lives and who goes extinct.

Details of the algorithm are not explicit, but Dr. Gerber’s recent publication in PNAS is a straightforward return-on-investment calculation analyzing the mathematical relationship between funds requested, spent, and species success or decline.  Gerber finds “the cost–success curve is convex; funding surpluses were common for the species least likely and most likely to recover” so it’s not simply ‘money in – species out’. Other factors – endemism, keystone status, level of species risk – are also important, though Gerber acknowledges they are not currently included.

While proponents call use of the equation “doing the best you can with what you have,” lack of data on its predictive validity make it a frightening policy tool governing something as permanent as species extinction. What if region affects costs, population growth is slower in species reaching sexual maturity later, a break-through in understanding one species’ requirements is just around the corner or we haven’t yet discovered the significance of the niche occupied by another species? What if business or political interests conflict with a species’ needs? What if the algorithm developer seeks intellectual property legal status, as is happening now with a proprietary algorithm used in parole and sentencing situations? Algorithms impacting public policy should be vetted by multiple experts in germane disciplines, validated, and kept publicly accessible for healthy scrutiny. (Sharon Bernstein, Reuters)

 

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Written by sciencepolicyforall

June 27, 2017 at 11:42 am

Science Policy Around the Web – November 01, 2016

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By: Eric Cheng, PhD

Source: pixabay

Climate Change

Nations, fighting powerful refrigerant that warms planet, reach landmark deal

Over 170 nations agreed to limit the use of hydrofluorocarbons (HFCs), the key climate change-causing pollutants found in air conditioners and refrigerators. This deal reached in Kigali, Rwanda could help prevent a 0.9°F rise in temperature by the year 2100. Although the negotiations did not produce the same publicity as the climate change accord in Paris of last year, the outcome may have an equal or even greater impact on the efforts to slow the warming of our planet.

Adopting an ambitious amendment to phase down the use and production of HFCs is “likely the single most important step that we could take at this moment to limit the warming of our planet,” Secretary of State John Kerry said in Kigali, in remarks before the passage of the agreement. President Obama called the deal “an ambitious and far-reaching solution to this looming crisis.”

Total global HFC emissions are still far less significant contributors to climate change than the combined emission of other greenhouse gases like carbon dioxide and methane. However HFCs are thousands of times more potent than carbon dioxide on a pound-per-pound basis, making them an obvious target for international efforts to combat climate change.

Many experts still believe that international efforts have moved too slowly as research continues to show significant effects and large scale of global warming. Scientists say 2016 will top last year as the hottest year on record with some months showing a temperature rise close to the 3.6°F benchmark. (Coral Davenport, New York Times)

Wildlife Conservation

Nations agree to establish world’s largest marine reserve in Antarctica

Twenty-four countries and the European Union agreed to establish the world’s largest marine sanctuary in Antarctica’s Ross Sea. This area is home to “50 per cent of ecotype-C killer whales (also known as the Ross Sea orca), 40 per cent of Adélie penguins, and 25 per cent of emperor penguins,” according to a statement from the United Nations Environment Programme.

“The significance of this is that most of the marine protected area is a no-take area,” acknowledged the State Department’s Evan Bloom, head of the U.S. delegation to the meeting. More than 600,000 square miles of the Ross Sea around Antarctica will be protected under the deal. This means that an area about the size of Alaska will be set aside as a no-take “general protection zone”.

No-take areas are zones set aside by authorities where any action that removes or extracts any resource is prohibited. These actions include fishing, hunting, logging, mining, drilling, shell collecting and archaeological digging. (Merrit Kennedy, NPR)

Science Funding

Budget cap would stifle Brazilian science, critics say

Brazil’s interim President Michel Temer proposed a constitutional amendment to limit public spending growth for up to 20 years as a solution to curb a rise in public debt. The proposal, known as PEC 241, would prohibit all three branches of Brazil’s government to raise yearly expenditures above the inflation rate. This would essentially freeze spending at current levels for two decades. The effect of the bill, if passed, would put Brazilian science in a budgetary straightjacket. “It will be a disaster,” says Luiz Davidovich, president of the Brazilian Academy of Sciences in Rio de Janeiro.

The 2016 federal budget for science, technology, and innovation was approximately $1.5 billion, the lowest in 10 years when corrected for inflation. (The National Institutes of Health in the United States currently has a budget of about $30 billion.) Agencies have been reducing scholarships and grants to adjust for the lack of funding. For example, the Brazilian Innovation Agency has slashed funding for national programs and is delaying payments on research grants. This has led to consequences such as finding money to pay for electricity bills. “There is no way we can survive another 20 years like this,” says Davidovich, who is also a physicist at the Federal University of Rio de Janeiro.

“Smart countries increase funding for science, technology, and innovation to get out of a crisis,” says Helena Nader, president of the Brazilian Society for the Advancement of Science in São Paulo. “We are doing the opposite.” (Herton Escobar, ScienceInsider)

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Written by sciencepolicyforall

November 1, 2016 at 9:14 am