What is wrong with medical research? Boston health writers raise important questions

ss

Do we need evidence-based evidence? How effective is our medical research system? What are we getting for the $30 billion that goes into university and hospital labs? Here are a couple of stories from local writers with some discouraging answers to those questions.

Carolyn Johnson’s piece on poor quality of medical research was tucked under the Globe’s Sunday editorial urging Elizabeth Warren to run for president. If only it could get as much attention:

Evidence of a quiet crisis in science is mounting. A growing chorus of researchers worry that far too many findings in the top research journals can’t be replicated. “There’s a whole groundswell of awareness that a lot of biomedical research is not as strongly predictive as you think it would be,” said Dr. Kevin Staley, an epilepsy researcher at Massachusetts General Hospital. “People eventually become aware because there’s a wake of silence after a false positive result,” he added. The same is true in every field of science, from neuroscience to stem cells.

Ideally, science builds on and corrects itself. In practice, the incentives facing scientists can hamper the process. It’s more exciting and advantageous to publish a new therapeutic approach for a disease than to revisit a past discovery. Yet unless researchers point out the limitations of one another’s work, the scientific literature can end up cluttered with results that are partially or, in some cases, not at all true.

Recently, researchers and the US government alike have sought to assess how much research is irreproducible — and why — and are looking for systematic ways to retest experiments that make headlines but yield no further progress.

Her story follows a piece by another local writer on how stem cell research has not yet delivered on its promises. Karen Weintraub’s piece was in the New York Times in September.     

Stem cells broke into the public consciousness in the early 1990s, alluring for their potential to help the body beat back diseases of degeneration like Alzheimer’s, and to grow new parts to treat conditions like spinal cord injuries.

Progress has been slow. The Michael J. Fox Foundation for Parkinson’s Research, an early supporter of stem cell research, pulled much of its financial backing two years ago, saying that it preferred to invest in research that was closer to providing immediate help for Parkinson’s disease patients.

But researchers have been slowly learning how to best use stem cells, what types to use and how to deliver them to the body — findings that are not singularly transformational, but progressive and pragmatic.

Finally, don’t miss this week’s Health Wonk Review, a digest of health policy blog posts.

Advertisements

Don’t have a hot attack: Framingham Heart Study carries on

fhsWhat is up with the Framingham Heart Study? That long-running research project has been tracking the cardiac health of hundreds of local folk for decades.  (The algorithm used to estimate the 10-year risk of heart disease is called the “The Framingham Risk Score.”)

A story and a blog post recently reported woefully about a 40 percent sequester cut to the study’s National Institutes of Health funding.  Neither quoted anyone from NIH.

So, both pieces failed to note that the cut is to the study’s administrative grant from the National Heart Lung and Blood Institute, not its research grants.  According to BU, the study receives an estimated $5.4 million in NIH grants for research. This funding is not impacted by the 40 percent cut.

In other words, the cuts come from the money used to run the program – office staff, data collection and the management of study subjects, not the scientific research projects that fall under the program’s umbrella. The data collected from the locals helps researcher understand the mechanics and, more recently, the genetics of heart disease as it impacts the rest of us.

In total, NIH says it will spend $21 million this year contracts for the FHS study infrastructure – including a study looking for biomarkers for heart disease. In addition to funding the BU research, NIH says its grants cover 17 FHS related studies at eight different organizations and universities. In addition to the Heart Lung and Blood institute, that money comes from five other NIH institutes and centers, including the National Institute on Aging, The National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Neurological Disorders and Stroke.

None of this was clear in this first, July 20 story from the Metro West Daily:

The Framingham Heart Study expects to lose $4 million in funding as part of the federal budget cuts known as sequestration, study officials confirmed Friday in a statement. The $4 million cut takes effect Aug. 1 and represents 40 percent of funding it receives from the National Heart, Lung and Blood Institute (NHLBI), a division of the National Institutes of Health, the statement said.

 The story quotes a spokeswoman from Boston University, which is home to the study.

The cut with “result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

Then it quotes from a statement about NIH cuts in general from new Sen. Ed Markey:

“Slashing critical federal investment in medical research jeopardizes the health of many Massachusetts residents, while putting at risk tens of thousands of jobs in the commonwealth’s innovation economy and the industries they support,” Markey said. 

Then it quotes from Karen LaChance, a Framingham resident and president of the Friends of the Framingham Heart Study.

“We just hate to see any cut. It delays hopefully finding whatever the magic bullet might be to prevent heart disease.

Then it doesn’t quote anyone from NIH.

In a post on the Metro West Daily story,  WBUR’s CommonHealth blog offers the headline “Famed Framingham Heart Study Faces Deep Cuts From Federal Sequester.”

It was a “Say it isn’t so” moment this morning when I saw this MetroWest Daily News headline: Framingham Heart Study Faces $4 Million Cut. “Heart disease is the country’s number 1 killer, and chances are whatever you do to prevent it or treat it was influenced by the Framingham Heart Study, a venerable epidemiological gem right here in our own Boston suburbia….”

But, you could argue that it ain’t so.

As far as the impact of the cuts, Metro West Daily quote  BU as noting that “This loss of funding will result in a reduction in workforce affecting 19 staff from a variety of clinical and administrative areas, as well as reductions in clinic exams and lab operations.”

BU tells us that approximately 80 people work at the FHS. “The affected staff will see a reduction in hours beginning Aug. 19; if alternative funding sources are not identified, a layoff would occur Nov. 1. “

The FHS site was a little clearer on all this, with note on its home page:

New Information for FHS Participants edited July 20 2013

Q. Is the FHS closing?
A. No. The current Offspring and Omni Group 1 exams are continuing to Oct. 31, 2013. Ancillary studies are continuing as planned. Medical history updates are being collected on the regular schedule. Please respond to calls for FHS participation as usual.

By Wednesday August 1, BU had posted its own story on the BU Today website with the headline: “Framingham Heart Study Carries on, Despite Budget Cuts: 65-year-old core contract loses 40 percent of funding.”

Nature Boston on NIH funding

Nature Boston keeps an eye on research in town. For health care research, that means NIH. So check out reports on who’s getting fundedzm in the era of flat funding. Posts offer highlights for May and June.

Nature Boston: Who in town is getting funded to do biomedical? #research #NIH

Nature Boston takes a trip through the NIH grants database and finds that the number of new grants dropped quite a bit last year.

While the agency funded 403 new projects in Massachusetts in 2010, that number dropped to 335 in 2011.

Does that make the grant winners super superstars? Or was the research in the labs at the right place at the right time? So many variables go into NIH funding, it can be hard to tell. Still it’s worth looking at where the money is going.

The 11 new winners so far for 2012 are looking into influenza, herpes, DNA replication timing, structural vaccinology for malaria and the search for biologically active antitumor and anti-infective agents in natural products. Our data is current as of this morning, but the numbers change constantly as NIH adds new grants to the database.  Grants went to Boston University, UMass med school and Brandeis University. But, Harvard-linked researchers – and infectious disease — dominate the list.

For more, head over to NB. While you are there, check out the site’s well-curated list of science events.