NIH grant application topics by IC

As you will recall, the Hoppe et al. 2019 report [blogpost] both replicated Ginther et al 2011 with a subsequent slice of grant applications, demonstrating that after the news of Ginther, with a change in scoring procedures and changes in permissible revisions, applications with Black PIs still suffered a huge funding disparity. Applications with white PIs are 1.7 times more likely to be funded. Hoppe et al also identified a new culprit for the funding disparity to applications with African-American / Black PIs. TOPIC! “Aha”, they crowed, “it isn’t that applications with Black PIs are discriminated against on that basis, no. It’s that the applications with Black PIs just so happen to be disproportionately focused on topics that just so happen to have lower funding / success rates”. Of course it also was admitted very quietly by Hoppe et al that:

WH applicants also experienced lower award rates in these clusters, but the disparate outcomes between AA/B and WH applicants remained, regardless of whether the topic was among the higher- or lower-success clusters (fig. S6).

Hoppe et al., Science Advances, 2019 Oct 9;5(10):eaaw7238. doi: 10.1126/sciadv.aaw7238

If you go to the Supplement Figure S6 you can see that for each of the five quintiles of topic clusters (ranked by award rates) applications with Black PIs fare worse than applications with white PIs. In fact, in the least-awarded quintile, which has the highest proportion of the applications with Black PIs, the white PI apps enjoy a 1.87 fold advantage, higher than the overall mean of the 1.65 fold advantage.

Record scratch: As usual I find something new every time I go back to one of these reports on the NIH funding disparity. The overall award rate disparity was 10.7% for applications with Black PIs versus 17.7% for those with white PIs. The take away from Hoppe et al. 2019 is reflected in the left side of Figure S6 where it shows that the percentage of applications with Black PIs is lowest (<10%) in the topic domains with the highest award rates and highest (~28%) in the domains with the lowest award rates. The percentages are more similar for apps with white PIs, approximately 20% per quintile. But the right side lists the award rates by quintile. And here we see that in the second highest award-rate topic quintile, the disparity is similar to the mean (12.6% vs 18.9%) but in the top quintile it is greater (13.4% vs 24.2% or a 10.8%age point gap vs the 7%age point gap overall). So if Black PIs followed Director Collins’ suggestion that they work on the right topics with the right methodologies, they would fare even worse due to the 1.81 fold advantage for applications with white PIs in the top most-awarded topic quintile!

Okay but what I really started out to discuss today was a new tiny tidbit provided by a blog post on the Open Mike blog. It reports the topic clusters by IC. This is cool to see since the word clusters presented in Hoppe (Figure 4) don’t map cleanly onto any sort of IC assumptions.

https://nexus.od.nih.gov/all/2020/08/12/institute-and-center-award-rates-and-funding-disparities/

All we are really concerned with here is the ranking along the X axis. From the blog post:

…17 topics (out of 148), representing 40,307 R01 applications, accounted for 50% of the submissions from African American and Black (AAB) PIs. We refer to these topics as “AAB disproportionate” as these are topics to which AAB PIs disproportionately apply.

Note the extreme outliers. One (MD) is the National Institute on Minority Health and Health Disparities. I mean… seriously. The other (NR) is the National Institute on Nursing Research which is also really interesting. Did I mention that these two Is get 0.8% and 0.4% of the NIH budget, respectively? The NIH mission statement reads: “NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.” Emphasis added. The next one (TW) is the Fogerty International Center which focuses on global health issues (hello global pandemics!) and gets 0.2% of the NIH budget.

Then we get into the real meat. At numbers 4-6 on the AAB Disproportionate list of ICs we reach the National Institute on Child Health and Development (HD, 3.7% of the budget), NIDA (DA, 3.5%) and NIAAA (AA, 1.3%). And clocking in at 7 and 9 we have National Institute on Aging (AG, 8.5%) and the NIMH (MH, 4.9%).

These are a lot of NIH dollars being expended in ICs of central interest to me and a lot of my audience. We could have made some guesses based on the word clusters in Hoppe et al 2019 but this gets us closer.

Yes, we now need to get deeper and more specific. What is the award disparity for applications with Black vs white PIs within each of these ICs? How much of that disparity, if it exists, accounted for by the topic choices within IC?

And lets consider the upside. If, by some miracle, a given IC is doing particularly well with respect to funding applications with Black PIs fairly….how are they accomplishing this variance from the NIH average? What can the NIH adopt from such an IC to improve things?

Oh, and NINR and NIMHHD really need a boost to their budgets. Maybe NIH Director Collins could put a 10% cut prior to award to the other ICs to improve investment in the applying-knowledge-to-enhance-health goals of the mission statement?

Update from CDC on vape-related lung injury: No single cause yet

The CDC has posted a MMWR report on the 2019 spate of serious lung injuries reported as a consequence of vaping. The first culprit to hit the news was vitamin E, it turns out this is not a unique factor after all.

Schier and colleagues report: No consistent e-cigarette product, substance, or additive has been identified in all cases, nor has any one product or substance been conclusively linked to pulmonary disease in patients. … authors identified lipids within alveolar macrophages from the three bronchoalveolar lavage (BAL) specimens stained with oil red O. All five patients reported using marijuana oils or concentrates in e-cigarettes, and three also reported using nicotine (3). In a report describing the clinical course and outcomes of six patients from Utah, health care providers described the potential diagnostic utility of identification of lipid-laden macrophages from BAL specimens (4). Among the 53 cases from Illinois and Wisconsin, however, the pathologic findings were heterogeneous. Whereas almost half (24/53) of these patients underwent BAL, seven reports described the use of oil red O stain that identified lipid-laden macrophages

Perrine and colleagues report: Among 514 patients with information on substances used in e-cigarettes, or vaping products, in the 3 months* preceding symptom onset, 76.9% reported using THC-containing products, and 56.8% reported using nicotine-containing products; 36.0% reported exclusive use of THC-containing products, and 16.0% reported exclusive use of nicotine-containing products. *erratum for the original which says “30 days”.

It’s frustrating that the takeaway message so far is that nobody knows if there even is a unique cause or set of causes for the recent spate of lung injuries. We certainly don’t know the cause. We probably don’t even know if the injuries *are* recently occurring or have always been a consequence of vape device use that simply wasn’t connected to the e-cigarette device use. We know how long it took to recognize that cannabis was causing a hyperemesis syndrome, after all.

My suspicion at the start was that it wasn’t anything to do with cannabinoids, specifically. This reported diversity would appear to confirm that. It always seemed more likely to me that if there was a unique cause that appeared to be associated with cannabis vape cartridges that this is a classic case of a third variable. Perhaps a new vehicle constituent or an extraction method that was being used only, or primarily, with cannabis vape preparation. Well, clearly even that is not the case since there seem to be some nicotine-only users who have experienced lung injury.

Keep your eye on PubMed for updates on this health crisis.

Schier JG, Meiman JG, Layden J, et al. Severe Pulmonary Disease Associated with Electronic-Cigarette–Product Use — Interim Guidance. MMWR Morb Mortal Wkly Rep 2019;68:787–790. DOI: http://dx.doi.org/10.15585/mmwr.mm6836e2external icon

Perrine CG, Pickens CM, Boehmer TK, et al. Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping — United States, 2019. MMWR Morb Mortal Wkly Rep 2019;68:860–864. DOI: http://dx.doi.org/10.15585/mmwr.mm6839e1

Erratum: Vol. 68, No. 39. MMWR Morb Mortal Wkly Rep 2019;68:900. DOI: http://dx.doi.org/10.15585/mmwr.mm6840a5

Cannabis hyperemesis syndrome rates increase with marijuana legalization

A report by CBS News reports on a 2015 paper:

Howard S. Kim, MD, John D. Anderson, MD, Omeed Saghafi, MD, Kennon J. Heard, MD, PhD, and Andrew A. Monte, MD Cyclic Vomiting Presentations Following Marijuana Liberalization in Colorado. Acad Emerg Med. 2015 Jun; 22(6): 694–699.
Published online 2015 Apr 22.
[pubmed

From the Abstract:

The authors reviewed 2,574 visits and identified 36 patients diagnosed with cyclic vomiting over 128 visits. The prevalence of cyclic vomiting visits increased from 41 per 113,262 ED visits to 87 per 125,095 ED visits after marijuana liberalization, corresponding to a prevalence ratio of 1.92 (95% confidence interval [CI] = 1.33 to 2.79). Patients with cyclic vomiting in the postliberalization period were more likely to have marijuana use documented than patients in the preliberalization period (odds ratio = 3.59, 95% CI = 1.44 to 9.00).

For background on the slow, Case Report driven appreciation that a chronic cyclical vomiting syndrome can be caused by cannabis use, see blog posts here, here, here.

The major takeaway message is that when physicians or patients are simply aware that there is this syndrome, diagnosis can be more rapid and a lot less expensive. Patients can, if they are able to stop smoking pot, find relief more quickly.

As far as the present report showing increasing rates in CO, well, this is interesting. Consistent with a specific causal relationship of cannabis use to this hyperemesis syndrome. But hard to disentangle growing awareness of the syndrome from growing incidence of it. We’ll just have to follow these relationships as more states legalize medical and recreational marijuana.

Additional coverage from Dirk Hansen.

Surgeon General Murthy Issues A Report on Facing Addiction

Surgeon General’s Report On Alcohol, Drugs and Health can be found at addiction.surgeongeneral.gov. You may be particularly interested in the Executive Summary [PDF] or the chapter on the Neurobiology of Addiction [PDF].

There was also a brief interview with the Surgeon General on NPR.

A few factoids from the Executive Summary:

In 2015, substance use disorders affected 20.8 million Americans—almost 8 percent of the adolescent and adult population. That number is similar to the number of people who suffer from diabetes, and more than 1.5 times the annual prevalence of all cancers combined (14 million). Of the 20.8 million people with a substance use disorder in 2015, 15.7 million were in need of treatment for an alcohol problem in 2015 and nearly 7.7 million needed treatment for an illicit drug problem.

Substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment. Only about 10 percent of people with a substance use disorder receive any type of specialty treatment. Further, over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half (48.0 percent) receive treatment for either disorder.

Treatment is effective. As with other chronic, relapsing medical conditions, treatment can manage the symptoms of substance use disorders and prevent relapse. Rates of relapse following treatment for substance use disorders are comparable to those of other chronic illnesses such as diabetes, asthma, and hypertension. More than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives.

For instance, people who first use alcohol before age 15 are four times more likely to become addicted to alcohol at some time in their lives than are those who have their first drink at age 20 or older. Nearly 70 percent of those who try an illicit drug before the age of 13 develop a substance use disorder in the next 7 years, compared with 27 percent of those who first try an illicit drug after the age of 17. Although substance misuse problems can develop later in life, preventing or even just delaying young people from trying substances is important for reducing the likelihood of more serious problems later on.

Many more people now die from alcohol and drug overdoses each year than are killed in automobile accidents. The opioid crisis is fueling this trend with nearly 30,000 people dying due to an overdose on heroin or prescription opioids in 2014. An additional roughly 20,000 people died as a result of an unintentional overdose of alcohol, cocaine, or non-opioid prescription drugs.

emphasis added.

A Repost to mark the passing of Nancy Reagan

In terms of health and biomedical science, the Reagan Administration left a shameful legacy of refusing to respond to (or acknowledge, really) the HIV/AIDS crisis that blew up during their tenure in office.

As many of you recall, First Lady Nancy Reagan took up drug abuse and substance dependence as one of her signature issues and this is probably one of the other larger Reagan Administration legacies on health.

To mark her passing, I thought I would repost the following which first appeared on the blog 21 July 2008.

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If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of “The (US) War on Drugs is a complete and utter failure”. Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.

Now I’m open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I’m most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.

I’m following up a story I started in a prior post by putting up the long term trends for cocaine use in the US. These data are from the 2006 Volume II monograph which focuses on the 18 yr old and older populations. As you will recall my hypothesis was / is that the Len Bias fatality had a dramatic effect on cocaine use. I still think this is the case and that this explains much of the timing of a reduction in cocaine prevalence observed consistently from the 18 yr old to 45+ age groups. However Len Bias’s death was not an exclusive effect and must be considered in the context of changes in other drug use patterns. That context is something I want to delve into just a little bit.

As always, I depend on the data from the Monitoring the Future survey (www.monitoringthefuture.org) and I am pulling the figures from the 2006 Volume I monograph which focuses on the 8th, 10th and 12th grade populations in contrast to the older age cohorts outlined in the first graph.

Cocaine

First up are the annual prevalence rates for powder cocaine, which I provide for reference to the previous graph for the older age ranges. I apologize for the blurry figures but my imaging skills are not up to any better- luckily, these reports are freely available on the MtF website. (I also encourage you to get the reports yourself because there are slight changes in the questions asked in some cases- if you see a discontinuity in the longitudinal data this is probably why.) The longest term trends are available for 12th graders, additional grades were added into the survey in the early 1990’s. Prevalence of cocaine was reasonably steady in the 1979-1986 interval and it is stunningly apparent that cocaine became less popular with 12th graders after 1986 . It is also clear that it took about 5 additional years for prevalence to drop to the most recent nadir. So it wasn’t all about Len Bias (he died of cocaine-related cardiac complications on June 19, 1986).
So, if it isn’t all about Len Bias, perhaps we should see similar effects on population prevalence of other illicit drugs?

Marijuana and Amphetamine

It seems reasonable to turn our analysis to two perennial high-prevalence drugs for high school populations; marijuana (duh!) and the amphetamines. (In MtF parlance, the amphetamine class is for tablet or other prescription preparations after 1982.) In this case, the prevalences were at peak in the late 1970s and started to decline in the very early 1980s. Interestingly, there is no evidence of a change in the established trends from 1986-1987 as is observed for powder cocaine; I think this supports the Len Bias hypothesis. Nevertheless we can also see this as additional evidence for something else driving drug use downward.

This brings us to what are illicit drugs for most of these populations but, of course, licit drugs for individuals who have reached the legal age; 21 (alcohol) or 18 (cigarettes; this may be a substantial fraction of 12th graders). In theory, we might use these data to try to dissociate the anti-drug messaging from the drug interdiction / legal penalties side of the equation. Not perfect, but at least a hint.

Alcohol

The trends for annual prevalence of alcohol were very stable from 1978-1988 whereupon a decline was observed (questions were altered in 1993, making further comparison tricky). The trends for 5-drinks-in-a-row (currently the definition of a “binge”) in the past two week interval were very stable from 1978-1983 and thereafter exhibited a slow decline until the early 1990s. Very reminiscent of the above mentioned drugs.

Cigarettes

In this case, please note that we’ve shifted to 30-day prevalence rates (any, daily); obviously this is frustrating for direct comparison but this is what they provide in the monographs. Unfortunately the more recent monographs (it is currently on a reliable annual update schedule with available pdfs, the older ones are not available) seem to only start with the 1986 data in the Tables so one is left with their figures for the earlier part of the trends. With that caveat, we can see that cigarette prevalence in the high school population was reasonably stable during the interval in which the prevalence rates for the illicit-for-all drugs mentioned above were in decline.

So Did the War on Drugs Work or Not?

I do think the jury is still out on this one and the problem of shifting definitions about goals and successes is quite difficult. I feel confident the comments will stray afield a bit and explore some of these issues. However, as I intimated at the outset,
for those of you who insist vociferously that the War on Drugs (considered inclusively with the Just Say No, D.A.R.E, main-stream media reporting, and all that stuff that is frequently rolled into a whole by the legalization crowd) is an abject failure…

for those of you who insist vociferously that you cannot tell teenagers anything about the dangers of recreational drugs and expect them to listen to you…

I would like these data explained to me.
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Update 7/23/08: Followup post from Scott Morgan at StoptheDrugWar.org

420andme

I just had this genius idea.

A public science service modeled on 23andme where you send in your pot sample for both genetic analysis (“You have new strain-relatives, want to connect and share experiences?”) and content of various cannabinoids and what not. Add in some health survey stuff and away we go.

Leegalizeetmon

Looks like both Oregon and Alaska passed initiatives to legalize the recreational use of marijuana.

Interesting.

UPDATE:
Oregon’s initiative.

Alaska’s initiative.

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Oregon:

(1) A person commits the offense of use of marijuana while driving if the person uses any marijuana while driving a motor vehicle upon a highway.

(2) The offense described in this section, use of marijuana while driving, is a Class B traffic violation.

a related item that I like because it calls for research:

(4) On or before January 1, 2017, the commission shall:

(a)Examine available research, and may conduct or commission new research, to investigate the influence of marijuana on the ability of a person to drive a vehicle and on the concentration of delta-9 tetrahydrocannabinol in a person’s blood, in each case taking into account all relevant factors; and
(b) Present the results of the research to the Legislative Assembly and make recommendations to the Legislative Assembly regarding whether any amendments to the Oregon Vehicle Code are appropriate.

weird exception:

(13) “Marijuana extract” means a product obtained by separating resins from marijuana by solvent extraction, using solvents other than vegetable glycerin, such as butane, hexane, isopropyl alcohol, ethanol, and carbon dioxide.

aha, found this part:

SECTION 57. Homemade marijuana extracts prohibited. No person may produce, process, keep, or store homemade marijuana extracts.

so you can’t make solvent extractions for home use but you *can* make vegetable glycerine extractions. Weirder. If the idea is to keep people from doing dangerous stuff with explosive solvents, this would be solved short of prohibiting “keep, or store homemade marijuana extracts”, no?

In case you are wondering, vegetable glycerine extracts can be used in vape pen / e-cig type devices.

Alaska:

(b) Nothing in this chapter is intended to allow driving under the influence of marijuana or to supersede laws related to driving under the influence of marijuana.

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.

The Origami Condom and NIH Ebola funding

One of the NIH funded research projects that has been bandied about with much glee from the right wing, in the wake of Francis Collins’ unfortunate assertion about Ebola research and the flatlined NIH budget, is the “Origami Condom”. It shows why NIH Director Collins should have known better. The Origami Condom sounds trivial and ridiculous, right? “Origami”. hahah. Oooh, “condom”. Wait, what are we, 12 year olds?

Rand Paul provides a convenient example.

Eisen Nails Down Why Collins Was Wrong on Ebola Assertion

Endorse. Go read:

But what really bothers me the most about this is that, rather than trying to exploit the current hysteria about Ebola by offering a quid-pro-quo “Give me more money and I’ll deliver and Ebola vaccine”, Collins should be out there pointing out that the reason we’re even in a position to develop an Ebola vaccine is because of our long-standing investment in basic research, and that the real threat we face is not Ebola, but the fact that, by having slashed the NIH budget and made it increasingly difficult to have a stable career in science, we’re making it less and less likely that we’ll be equipped to handle all of the future challenges to public health that we’re going to be face in the future.

NPR on the NIH Grant situation

In the event that you missed it, NPR has been running stories on the current situation with NIH-funded biomedical research in the US. These seem to be mostly the work of Richard Harris, so many thanks to him for telling these stories to the public. You will note that these are not issues new to this readership for the most part. The themes are familiar and, perhaps necessarily, latch onto one position and therefore lack breadth and dimension. Those familiar with my views on “the real problem” with respect to NIH funding will see many things I object to in terms of truthy sounding assertions that don’t hold water on examination. Still, I am positively delighted that this extensive series is being brought to the NPR audience.

Enjoy.

When Scientists Give Up

“When I was a very young scientist, I told myself I would only work on the hardest questions because those were the ones that were worth working on,” he says. “And it has been to my advantage and my detriment.”

Over the years, he has written a blizzard of grant proposals, but he couldn’t convince his peers that his edgy ideas were worth taking a risk on. So, as the last of his funding dried up, he quit his academic job.

“I shouldn’t be a grocer right now,” he says with a note of anger in his voice. “I should be training students. I should be doing deeper research. And I can’t. I don’t have an outlet for it.”

U.S. Science Suffering From Booms And Busts In Funding

“If I don’t get another NIH grant, say, within the next year, then I will have to let some people go in my lab. And that’s a fact,” Waterland says. “And there could be a point at which I’m not able to keep a lab.”

He notes that the hallway in his laboratory’s building is starting to feel like a ghost town as funding for his colleagues dries up. He misses the energy of that lost camaraderie.

“The only people who can survive in this environment are people who are absolutely passionate about what they’re doing and have the self-confidence and competitiveness to just go back again and again and just persistently apply for funding,” Waterland says.He has applied for eight grants and has been rejected time and again. He’s still hoping that his grant for the obesity research will get renewed — next year.

Built In Better Times, University Labs Now Lack Research Funding

PAULA STEPHAN: In many ways, the research university that’s evolved today is much like a shopping mall.

HARRIS: She says think of universities as mall owners and individual scientists as the shopkeepers. Scientists get research grants and then pay rent to the universities out of that money. When grant funding doubled between 1998 and 2003, construction cranes went up all over the country to build more lab space.

STEPHAN: Universities were exuberant. They thought that they could keep running this kind of scheme – where the NIH budget would keep going up, and they could keep hiring more people.

HARRIS: But that didn’t happen. After the NIH budget doubled, it stagnated. In fact it’s declined more than 20 percent when you take inflation into account.

STEPHAN: We greatly overbuilt the shopping malls.

By The Numbers: Search NIH Grant Data By Institution (support site for the pieces by Richard Harris)

Thought on the public funding of science

Simple truth of the recentEbola hysteria and the ensuing media coverage of scientists working on hemorrhagic viruses. Approximately 85% of bioscience now wishing ill on a whole lot of people so as to draw attention to their scientific domain.

Repost: The War on Drugs Didn't Work, Eh?

There’s a strawman-tilting screed up over at substance.com from my current favorite anti-drug-war-warrior Maia Szalavitz. She’s trying to assert that Trying to Scare Teens Away From Drugs Doesn’t Work.

In this she cites a few outcome studies of interventions that last over relatively short periods of time and address relatively small populations. I think the most truthful thing in her article is probably contained in this quote:

Another study, which used more reliable state data from the CDC’s Youth Risk Behavior Survey, concluded that “When accounting for a preexisting downward trend in meth use, effects [of the Montana Meth Project] on meth use are statistically indistinguishable from zero.”

This points out the difficulty in determining broad, population based outcomes from either personal introspection (where a lot of the suspicion about anti-drug messaging comes from, let’s face it) or rather limited interventions. Our public policy goals are broad- we want to affect entire national populations…or at least state populations. In my view, we need to examine when broad national popular behavior shifted, if it did, if we want to understand how to affect it in the future.

The following originally appeared 21 July 2008.

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If you are a reader of my posts on drug abuse science you will have noticed that it rarely takes long for a commenter or three to opine some version of “The (US) War on Drugs is a complete and utter failure”. Similarly, while Big Eddie mostly comments on the liberty aspects (rather than the effectiveness) of the WoD himself, a commenter to his posts will usually weigh in, commenting to a similar effect.

Now I’m open to all the arguments about personal liberty trade offs, economic costs, sentencing disparities, violations of other sovereign nations and the like. Nevertheless, I’m most interested in the fundamental question of whether the War on Drugs worked. That is, to reduce drug use in the US. For those who believe it has not worked, I have a few figures I would like explained to me.

Ebola and ZMapp…A scientist explains

Erica Ollman Saphire (lab website, PubMed, RePORTER) was interviewed on KPBS in San Diego about the use of highly experimental antibody therapy for the US health workers infected with Ebola virus.

It’s a pretty interesting viewpoint on basic science, translation to humans and what we do when an emergency situation like an infectious disease outbreak happens. I have been struck in past days about the huge international discussion this ZMapp treatment has been sparking. As you might expect, we have dark thoughts being expressed along the lines of “Why does this apparently miraculous treatment emerge all of a sudden when Americans are infected but it hasn’t been given to suffering Africans, hmmmm?“. There are all kinds of ethical issues to think about.

The television version linked below is 5 minutes but be sure to click on the link to the “midday edition” which is a longer voice interview. It gives a much fuller discussion.

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Additional Reading:

CDC: Questions and Answers on experimental treatments and vaccines for Ebola

Experimental Ebola drug based on research from Canada’s national lab

Ebola experimental drug, ZMapp sparks ethical controversy

UPDATE:
David Kroll on ZMapp

David Kroll on two other Ebola therapies