The adults in the room

Do you want to talk about what a pleasure it was to see actual adults in the Democratic debate yesterday?

And about what a contrast it made with the preening, unserious clowns running for the Republican nomination?

My take is this: Hillary is the most Presidential of any candidate running….on either side and by a considerable margin. Bernie has the right policies. Clearly. And O’Malley made great strides in introducing himself to a national audience. His closing comment was really strong and you should check it out. Maybe the Dem’s bench isn’t empty* after all?

Second take: I am of the opinion this is the Republican’s election to lose. It just seems to me that enduring inability to see what Obama has accomplished (with Repubs holding one of his hands behind his back) will put another Democratic administration far behind in this race. No matter who the Democratic candidate is. Well, Bernie and Hillary gave me a little more hope last night. Decency may win out after all.

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*I still say Hillary and Bernie are too old and am disappointed there has not been a very deep bench on the Democratic side this cycle.

Well, they got a good run out of their pet Critter before being exposed

The new House Republican Whip went to speak to a David Duke associated group when he was working his way up. Claims he had no idea they were a Klan despite Duke being a front and center politician in the same state of Louisiana at the time.

Yeah, that denial is credible.

NIH’s rapid growth has let in a bunch of riff-raff!

I am sure Dr. McKnight realizes that when he asserts that “Biomedical research in the 1960s and 1970s was a spartan game” and “Biomedical research is a huge enterprise now; it attracts riff-raff who never would have survived as scientists in the 1960s and 1970s” he is in fact lauding the very scientists “When I joined the molecular cytology study section in the 1980s.. all kinds of superb scientists” who were the riff-raff the prior generation complained about.

From a very prestigious general Science journal in 1962:

Some of [this change] arises from expressions of concern within the scientific community itself over whether the NIH’s rapid growth has sacrificed quality to achieve quantity.

The astute reader will also pick up on another familiar theme we are currently discussing.

And some of it reflects nothing more than the know-nothing ramblings of scientific illiterates, who conclude that if the title of a research project is not readily comprehensible to them, some effort to swindle the government must be involved.

1962, people. 1962.
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Greenberg DS. NIH Grants: Policies Revised, but Critics Not Likely To Turn Away. Science. 1962 Dec 28;138(3548):1379-80.

Bash Science with Gay AND Fat-shaming? It’s like a rightwing three-fer

We recently discussed how the Origami Condom project supported under the Small Business Innovation Research Congressional mandate had quite obvious public health implications in a prior post. This was in response to the gleeful Republican bashing of NIH funding priorities in the wake of NIH Director Francis Collins’ rather poorly considered claims* that Ebola research has been held back by the flatlining of the NIH budget over the past ten years.

Today we take on another one of these claims that the NIH has not been using its appropriations wisely. Fox news provides a handy example of the claim:

The National Institutes of Health (NIH) has spent more than $39 million on obese lesbians

As the wags are posting on various social media outlets, more Americans have been dumped by [insert popular entertainment personality] than have been killed by Ebola.

In striking contrast, obesity is a big killer of Americans. According to one review of the evidence:

Using data on all eligible subjects from all six studies, Allison et al. estimated that 280,184 obesity-attributable deaths occurred in the U.S. annually. When risk ratios calculated for nonsmokers and never-smokers were applied to the entire population (assuming these ratios to produce the best estimate for all subjects, regardless of smoking status, i.e., that obesity would exert the same deleterious effects across all smoking categories), the mean estimate for deaths due to obesity was 324,940.

Additional analyses were performed controlling for prevalent chronic disease at baseline using data from the CPS1 and NHS. After controlling for preexisting disease, the mean annual number of obesity-attributable deaths was estimated to be 374,239 (330,324 based on CPS1 data and 418,154 based on NHS data).

Over 350,000 Americans die annually of obesity. For the Republican Congresspersons in the audience, “annually” means every year. Last year, this year, next year. Over 350,000.

No biggie, right?
Whoops, maybe it is worse than we thought?

Researchers found that obesity accounted for nearly 20 percent of deaths among white and black Americans between the ages of 40 and 85. Previously, many scientists estimated that about 5 percent of deaths could be attributed to obesity.

And is coming close to beating smoking as the top preventable killer of American citizens?
Flegel et al 2004 and Flegel et al 2013 provide some handy context to estimating mortality causes for the nerdier types. From the 2013 meta-analysis:

[overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) ] ..
CONCLUSIONS AND RELEVANCE: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality.

So. Just this easily we can confirm that obesity is a major public health concern from mortality alone. This doesn’t even get into non-mortal effect of obesity on personal well-being. Major public health concerns are the very province of NIH-funded academic research.

So once again, the applicability of grants that are targeted at reducing obesity (even if it is just understanding the causes of obesity) to the goals of the NIH, as mandated by Congress, is not in question. At all. This is not a frivolous expenditure.

That leaves us with the specific projects in question. I trotted over to RePORTER and pulled up 6 current awards- two are K-mechanism mentored training awards so we’ll focus on the R-mechanism research projects.

R01 HD066963: SEXUAL ORIENTATION AND OBESITY: TEST OF A GENDERED BIOPSYCHOSOCIAL MODEL

nearly three-quarters of adult lesbians overweight or obese, compared to half of heterosexual women. In stark contrast, among men, heterosexual males have nearly double the risk of obesity compared to gay males. Despite clear evidence from descriptive epidemiologic research that sexual orientation and gender markedly pattern obesity disparities, there is almost no prospective, analytic epidemiologic research into the causes of these disparities. It will be impossible to develop evidence-based preventive interventions unless we first answer basic questions about causal pathways, as we plan to do.

I bolded a key part, from my perspective. You waste a ton of money, often public money, if you go off with solutions to problems without having a clear understanding of the things causing or following from this problem. Epidemiological and sociological research guides not just public policy but also additional studies of physiology, genetic liabilities, etc. So this specific project would seem to be of considerable use.

R01 DK099360:TYPE 2 DIABETES AND SEXUAL ORIENTATION DISPARITIES IN WOMEN

lesbian and bisexual (LB) women may be at elevated risk for developing T2D because they are more likely than heterosexual women to experience obesity and other risk factors linked with T2D such as cigarette smoking, violence victimization, and depressive distress. Nonetheless, knowledge of T2D and how it may disproportionately affect LB women is severely limited. Studies using longitudinal designs that have comprehensively examined how lifestyle, diet, and psychosocial risk factors for T2D may differ between LB and heterosexual women across the life course are virtually nonexistent.

This project emphasizes non-mortal morbidity, i.e., Type 2 Diabetes (T2D). And again, the abstract describes how we know almost nothing about the reasons for the obesity disparity between lesbian and heterosexual women. If we are going to disentangle potential social, behavioral, cultural, physiological and genetic contributors to the disparity, we need information. And very likely, through this research we will come to know more about how these variables affect obesity risk for all Americans, across all subpopulations. This will help us design better interventions to reduce the obesity burden. Clearly this is another grant that is clearly non-frivolous and fits into the public health mandate of the NIH.

R21 HD073120: UNDERSTANDING DISPARITIES IN OBESITY AND WEIGHT BEHAVIORS BY SEXUAL IDENTITY

Previous research indicates that lesbian, gay, bisexual and transgender (LGBT) adults experience more adverse health outcomes than their peers. Findings from the few studies examining weight disparities among adults suggest that lesbian women are more likely to be overweight or obese compared to their heterosexual peers, though less is known about gay men and bisexuals. Given the scant research to date in this area, the Institute of Medicine (IOM) recently issued a call for additional research on LGBT health. Furthermore, IOM highlighted the need to utilize a life-course framework when examining health disparities by sexual identity, acknowledging the unique influence of various life stages on health

What’s this now? Even the US Institute of Medicine has reported on how important it is to combat obesity in US citizens? I mean dang, guys, it’s the IOM.

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.

Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

And they do investigations, review evidence, compare the facts…

anyway, this R21 is going to focus on young adults and do studies under the following Aims:

(1) Quantify disparities in obesity, dietary intake, physical activity, unhealthy weight control behavior, body satisfaction and other weight-related health outcomes among LGB and heterosexual students; (2) Identify major weight-related health behavioral patterns, or profiles, and the extent to which these behavioral profiles differ by sexual identity and gender; and (3) Characterize these behavioral profiles by demographic factors and health outcomes (e.g., age, socioeconomic status, health care coverage, obesity, and health status). We hypothesize that LGB students engage in more adverse behaviors than their heterosexual peers and exhibit differential behavioral patterning.

Yep, more psycho-social research but I continue to assert that without this evidence, we run the risk of wasting more money pursuing directions that could have been falsified by the epidemiological and social science studies of this type.

The final research project is an R15/AREA grant:
R15 AA020424: MINORITY STRESS, ALCOHOL USE, AND INTIMATE PARTNER VIOLENCE AMONG LESBIANS

Ok, going by the Abstract this one is indeed focused on Alcohol abuse and intimate partner violence and I don’t see why it is being triggered by the obesity keyword on the search. But still, I think we can see that this one ALSO would draw right wing fire. Even though, once again, alcoholism and intimate partner violence are huge health issues in the US.

As with the Origami Condom NIH Grant, we can find with relatively little thinking that the “National Institutes of Health (NIH) has spent more than $39 million on obese lesbians” comment is wrongly placed in an article addressing “wasteful” spending on the part of the NIH. These projects address the causes of obesity, which is basically a top predator of Americans at the moment. Obesity causes excess mortality and morbidity, which is of course associated with financial costs. Costs to the individual and costs to us all as a society that shares some degree of social support for the health care of our fellow citizens. It is in our direct and obvious interests to conduct research that will help us reduce this burden of obesity. As far as studying subpopulations who appear to be at increased risk for obesity goes, there is no reason not to want to help African-Americans, Southern Americans, Flyoverlandia Americans or…Lesbian-Americans. Right? And while it may take a little bit of a leap of faith for those who haven’t thought hard about it, understanding the causes of a major health condition in those other people over there helps to understand the causes in people who are just like ourselves. By subtraction if by no other means.

For my regular Readers I’ll close with a plea. Use analysis like this one to beat back this stupid meme that is going around about “frivolous” NIH expenditures. This is not just about this current Ebola fervor. This is about the normal operations of the NIH as it has progressed over decades. There are always those wanting to score cheap political points by bashing science as trivial or obviously ridiculous. Nine times out of ten, these charges are easily rebutted. So take the time to do so, even if it just posting some text pulled from the grant abstract and a link to a morbidity report on whichever health concern happens to be under discussion.

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*”poorly considered” meaning he didn’t apparently anticipate handing such a bunch of base-bait to the Republicans.

Of course you are a "political activist"!

Any expression of your opinions and/or presentation of facts or rationale that touches on a political topic, and is heard or read by another person, is by definition an act of political activism.

Francis Collins assures Congress that NCATS won't draw from basic research

via the Nature News Blog we learn that NIH Director Collins has been called upon by Congress to explain NCATS. This is the acronym for his pet project a Center dedicated to “Translational Science” that required axing the venerable National Center for Research Resources.

Collins noted that NIH’s support for basic research has held steady at about 54% of the agency’s budget for decades. “I do not expect that percentage to change,” he said. He added repeatedly that all but 2% of the $575 million funding the translational medicine center this year comes from preexisting NIH programs, and is not “new” money.

Some legislators, understanding quite clearly that money is fungible were keen to press Collins:

Representative Cynthia Lummis, Republican of Wyoming, interrupted Collins to insist that he explain how the $64 million increase proposed for NCATS in 2013 can’t be seen as being largely funded by a cut to the Institutional Development Award (IDEA) program. The NIH in 2013 has proposed cutting $50.5 million from the program, which funds biomedical investigators, trainees and infrastructure in 23 largely rural states that have historically experienced low application success rates for NIH grants.

“I would not want you to see a direction connection between…the IDEA program and NCATS. Those are not the same dollars that just got moved from one box to another,” Collins responded.

“Dollars are dollars,” Lummis replied.

Exactly. And similarly there are plenty of imaginable grants that would be “translational science” that Collins will get to score in the “basic” category as well. Another CongressCritter argued with Collins that a prior boost to the IDEA program was intended to be permanent, something Collins disputed. Yes, keeping track of this slippery customer down the line will be pretty hard for our intrepid Congressional heroes.

There was another bit of testimony that drew my eye because it speaks to the potential upside of NCATS rather than whinging (ahem) about the costs to other programs. NCATS is supposed to somehow do better than the pharma industry. Ok, fine, but it sort of presumes the pharma industry is full of morons*. I’ve seen this before from academics under various guises of “Rational Drug Design” and the like. I am, shall we say, skeptical. In this particular bit of testimony on the “we’re smarter than they are, nyah, nyah” defense for NCATS a BigPharma type observed that FC is full of stuff and nonsense:

That view was challenged later in the hearing by Roy Vagelos, the former CEO of Merck, who said that the pharmaceutical industry spends about $50 billion annually, or roughly 100 times the NCATS budget, without solving the problems, like inadequate toxicology, that cause so many failures in drug development . “Does anyone in the audience believe that there is something that NCATS is going to do that the industry thinks is critical and that they are not doing? That is incredible to think that. If you believe that you believe in fairies.”

Vagelos added that, with success rates for applicants for NIH grants at historic lows, “We would be doing a lot more good for getting important new drugs on the market,” by funding more young investigators.

Word, PharmaDude, word.

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*unless it addresses things that the profit industry is not really capable of grappling with such as their penchant for huge payoff, block buster, serves everyone type of drugs.