The medical research establishment is reeling as budget cuts loom for the National Institutes of Health. A colleague involved in funding research at my alma mater, Albert Einstein College of Medicine told me: “It’s been all hands on deck as we struggle to defend our grants.”According to Healthcaredive:
“Much of the nation’s cutting-edge medical research happens at leading universities and academic medical centers. Academics say cutting funding for their teams will lead to ripple effects in patient care for years to come, with innovative treatments taking longer to show up at the bedside.”
But incoming NIH Director Jay Bhattacharya, MD, PhD, says reform is needed:
“Describing his goals for the agency, Bhattacharya said he wanted to establish a ‘culture of respect’ for free speech and scientific dissent within the agency, expressing a desire to support research that is not necessarily aligned with prevailing scientific theories. Bhattacharya said, for example, that NIH research into the cause of Alzheimer’s disease could have progressed faster had it not been constrained by a ‘single dominant narrative’ about the cause of the disease.”
He’s referring to paradigms like the “amyloid hypothesis”, neuroscience groupthink that has yielded pricey “plaque-buster” drugs with uncertain benefits and serious side effects, a topic Intelligent Medicine addressed in a recent podcast episode.
With Bhattacharya taking a scalpel to NIH’s budget, will we really miss studies like the following?
Minimizing the Effects of Surgical Care on Climate Change: It may be cynical to point it out, but grant proposals tying anything to climate change have gotten a leg up lately. For the record, I’m not a climate denier, and recognize there’s likely a warming trend, but I’m not all-in on apocalyptic scenarios. I also acknowledge the role manmade activities may play, but am not sure to what extent.
This study—published in the high impact journal JAMA last week—mirrors the current vogue. It argues that surgery generates a disproportionate percentage of the 8.5% of emissions that medical care is said to contribute to the world’s carbon burden.
What, then, are we to do? Ration surgery? Dispense with climate-unfriendly anesthetic gases in favor of knocking patients out with a mallet? Waste less energy by limiting handwashing to five seconds? Reduce electricity dependency by operating in open-air solariums?
A small percentage of 8.5%—even if the model were true—doesn’t seem like much. Surgery seems an unlikely a target for halting progression to planetary oblivion. I’ll wager that studies like these will find less favor under Bhattacharya’s scrutiny.
Climate change and childhood mental health: Increasing global temperatures have been improbably blamed for all kinds of medical problems, from skin problems to insomnia; speculation over their effects has generated lots of study grants. But the latest vogue seems like more hot air.
The Harvard T.H. Chan Center for Public Health—yes, the same folks who brought you the “Red meat causes dementia” and the “Vegetable oil is healthier than butter” studies that I recently critiqued have an entire division devoted to climate/health research: the “Center for Climate, Health, and the Global Environment”. They promote this resource for parents:
“This guide explains how climate change matters to your child’s mental health and explains some steps that you can take to keep your child healthy in a changing climate. Climate change, driven by our reliance on fossil fuels, is leading to more frequent and intense natural disasters, which may increase a child’s risk of having depression, anxiety, or post-traumatic stress disorder (PTSD).”
The novel term “climate anxiety” has gained currency. UNICEF credulously explains:
“Climate change is impacting almost every aspect of a child’s health and well-being. Direct exposure to climate events, as well as indirect exposure through news and social media about subjects like environmental devastation and government inaction, can further increase stress leading to anxiety, depression and a lack of hope for the future. The world is failing to protect children from climate change, but parents and caregivers can play an important role in helping their children navigate the realities of a changing world.”
I’m not sure about climate anxiety, but I have a lot of financial anxietyevery quarter when my soaring estimated federal taxes are due—inflated in part by lavish research awards whose ideological bent only stokes more climate anxiety.
Racism causes Alzheimer’s: Articles abound tying racism to poor health outcomes, especially for African Americans. And that makes sense, given socioeconomic factors and often barriers to access to medical treatment for minorities. An important project of U.S. healthcare is to eliminate these inequities.
But that has led to fashionable theories about the impact of the subjective experience of racism on health outcomes. Leading a hardscrabble existence, relying on cheap ultra-processed food, coping with stress by drinking and smoking, and having untreated hypertension can definitely have deleterious effects on the brain. Those factors may, in part, be legacies of our racist past. But is that a uniquely Blackexperience? Could not the same factors affect, say a light-skinned Hispanic immigrant, a homeless Asian, or an unemployed white coal miner from Kentucky?
But Jennifer Manly, Ph.D., professor of neuropsychology at Columbia University Irving Medical Center has staked her academic career on the premise that “racism impacts brain health and contributes to the unfair burden of Alzheimer’s disease in marginalized groups.” One of her studies implies that growing up in states with an historical legacy of lynching causes higher levels of inflammation in older Black people—a “biological signature” of racism.
Critics of Manley say that she draws undue causal inferences from correlations between perceived racism and discrimination and decreased cognitive scores; adverse lifestyle factors, and less access to quality preventive medical care, to which economically-disadvantaged persons of all races and nationalities are susceptible, more plausibly explain the lamentable fact that African Americans, as a whole, are disproportionately burdened by cognitive decline.
Do Black doctors offer better care to Black patients than do white doctors? That was the shocking conclusion of a 2020 study that seemed to show that Black infant mortality was dramatically reduced when Black mothers were attended by Black physicians.
The results were marshaled to boost calls for more access to medical training for African Americans. That’s laudable, because only 5% of U.S. doctors are Black, far under-represented in the overall population. Efforts to graduate Black doctors still lag, despite initiatives to correct the disparity.
But we’re left to wonder: Do white doctors, who predominate in the medical profession, take less good care of Black patients? Are they less careful, or do they harbor racist attitudes? Are they less familiar with the unique health problems of Black people? Alternatively, are they less able to breach cultural barriers to communication?
Most Black people don’t think so, according to a Pew Research survey:
“47% of Black adults say health outcomes for Black people have improved over past 20 years . . . By and large, Black Americans do not express a widespread preference to see a Black health care provider for routine care: 64% say this makes no difference to them, though 31% say they would prefer to see a Black health care provider for care.”
But it turns out the study on birth outcomes, while seemingly making a powerful case for recruiting more Black physicians, was critically flawed. According to a subsequent re-analysis:
“An influential study suggests that Black newborns experience much lower mortality when attended by Black physicians after birth. Using the same data, we replicate those findings and estimate alternative models that include controls for very low birth weights, a key determinant of neonatal mortality not included in the original analysis. The estimated racial concordance effect is substantially weakened, and often becomes statistically insignificant, after controlling for the impact of very low birth weights on mortality.”
In other words, for some reason white doctors were more likely to work in hospitals that attend to high-risk pregnancies, increasing the likelihood that babies under their care would die, through no fault of their own. Ultimately, doctors are doctors—regardless of their skin color.
Is it in our national interest to fund slanted studies that divide us by race?
Combatting “vaccine hesitancy”: To the dismay of many public health authorities, studies on “vaccine hesitancy”—a popular theme since Covid—will no longer be funded under new NIH guidelines.
These studies often discuss ways that the public is being gulled by vaccine “misinformation” and propose countermeasures to increase compliance with vaccine guidelines. They read more like marketing plans than scholarly investigations.
While ostensibly sensible, since vaccines are mainstays of disease prevention, these studies are premised on falsehoods: that vaccines are an unalloyed good, and that vaccine refusal has no rational basis.
Rather than strategize on how to get people to put aside their reservations about vaccines, the public health establishment should acknowledge its egregious missteps during COVID. Candor and transparency would go a long way toward reassuring Americans that authorities are credible.
Instead of ratifying the universal applicability of all vaccines, research should be encouraged to determine if we can do better. Delivering safer vaccines, or offering them on a selective basis by identifying individual vulnerabilities to adverse vaccine reactions, would be the right strategy for overcoming “vaccine hesitancy”.
How close kids live to fast food restaurants tied to obesity: This study is worthy of our “Duh!” award. The lead investigator confidently recommends:
“Just having food outlets a block farther away—and potentially less convenient or accessible—can significantly lessen children’s chances of being obese or overweight.”
Hasn’t he heard of DoorDash, Domino’s, or UberEats? Junk food is now never more than a swipe away. Dr. Bhattacharya, take note!
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