Funding

Freeing Institutions from the Kochtopus

milhayser — Mon, 20 Apr 2015 15:20:59 +0000

Freeing Institutions from the Kochtopus

In the wake of the Willie Soon scandal, scientists are taking a hard look at the Smithsonian and other institutions at the forefront of research and public outreach. Should these organizations really be supported by industrialists who deny that carbon emissions continue to warm the planet, disrupt the climate, amplify extreme weather, and threaten to swallow us in a deluge of melted ice and presumably locusts? For that matter, should exhibits on evolution be subject to the whims of donors who insist the Earth is only six thousand years old? If not, where will less ideologically tainted money come from? Greg Laden explores the thorny issue, and also shares a letter signed by 67 top scientists and a petition that you can add your name to as well.

For more on the 'Kochtopus' click here.

milhayser Mon, 04/20/2015 - 11:20

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NIH funding: The dreaded issue of conformity rears its ugly head again

oracknows — Mon, 10 Dec 2012 02:08:28 +0000

NIH funding: The dreaded issue of conformity rears its ugly head again

For all the worship of "translational" research that is currently in vogue, it needs to be remembered that a robust pipeline of basic science progress upon which to base translational research and clinical trials is absolutely essential if progress in medicine is to continue. Without it, progress in SBM will slow and even grind to a halt. That's why, in the U.S., the National Institutes of Health (NIH) is so critical. The NIH funds large amounts of biomedical research each year, which means that what the NIH will and will not fund can't help but have a profound effect shaping the pipeline of the basic and preclinical research that ultimately leads to new treatments and cures. Moreover, NIH funding has a profound effect on the careers of biomedical researchers and clinician-scientists, as having the "gold standard" NIH grant known as the R01 is viewed as a prerequisite for tenure and promotion in many universities and academic medical centers. Certainly this is the case for basic scientists; for clinician-scientists, having an R01 is certainly highly prestigious, but less of a career-killer if an investigator is unable to secure one. That's why NIH funding levels and how hard (or easy) it is to secure an NIH grant, particularly an R01, are perennial obsessions among those of us in the biomedical research field. It can't be otherwise, given the centrality of the NIH to research in the U.S.

It's also why the current hostile NIH funding environment, with pay lines routinely in the range of the 7th percentile, has brought this issue to the fore once again, and when NIH funding levels come to the fore, inevitably the topic of the peer review of NIH grants comes to the fore with it. The system by which NIH grants are reviewed involves what is known as a study section, which consists of scientists with (hopefully) the relevant expertise to evaluate the grants submitted, who all read and review a certain number of grants. They then meet, usually in Bethesda but increasingly more often by video conference, to discuss and score the proposals. Having participated in a number of NIH study section meetings as an ad hoc reviewer, I have some appreciation for the process, which sometimes involves a lot of contentious discussion and other times is amazingly cordial.

Regular readers know that over the last five years or so I've become an admirer of John Ioannidis, who is best known for an analysis he published several years ago entitled Why most published research findings are false. Personally, I've commented on a couple of other of Ioannidis' publications, including an analysis of the life cycle of translational research (hint: it takes a loooong time for an idea to make it through basic science studies to clinical trials to become an accepted therapy). This time around, Ioannidis has published, with co-author Joshua M. Nicholson, a commentary in Nature entitled Research Grants: Conform and Be Funded, which is about the very issue of which sorts of grants the NIH funds. As is often the case, Ioannidis is provocative in making his point. As is less often the case, I'm not entirely sure he's on-base here.

The issue of whether the NIH supports "safe" and "unimaginative" science is something that scientists have been debating since long before I ever got into the business. It's a question that particularly comes up during harsh funding times (like now). Back when I was in graduate school 20 years ago, the NIH was in another "bust" phase of a boom-or-bust cycle, and pay lines were as tight as they are now. Well do I remember seeing two different tenured professors forced to shut their labs down because they could no longer secure funding after successfully having done so for a long time before that. In any case, it makes a lot of sense that during tight funding times the NIH would become more conservative in what it funds. After all, when money's tight you don't want to risk wasting it. During such times, study sections have been observed to require more and more preliminary data for grant applications and be more and more critical of ideas that don't look on the surface like a "slam dunk." A measure of arbitrariness to the funding also sets in. After all, the process isn't so objective that there is a clear difference between a grant scoring in the 5th percentile (fundable) and the 10th percentile (probably not fundable).

Ioannidis, as he frequently tries to do with many things, tries to quantify the level of conservativeness and conformity of the NIH review process, introducing the concept this way:

The NIH has unquestionably propelled numerous medical advances and scientific breakthroughs, and its funding makes much of today's scientific research possible1.

However, concern is growing in the scientific community that funding systems based on peer review, such as those currently used by the NIH, encourage conformity if not mediocrity, and that such systems may ignore truly innovative thinkers2, 3, 4. One tantalizing question is whether biomedical researchers who do the most influential scientific work get funded by the NIH.

The influence of scientific work is difficult to measure, and one might have to wait a long time to understand it5. One proxy measurement is the number of citations that scientific publications receive6. Using citation metrics to appraise scientists and their work has many pitfalls7, and ranking people on the basis of modest differences in metrics is precarious. However, one uncontestable fact is that highly cited papers (and thus their authors) have had a major influence, for whatever reason, on the evolution of scientific debate and on the practice of science.

So basically, you can see where this is going. Ioannidis is going to try to analyze whether the most "influential" scientists are NIH-funded. One can quibble about whether the most cited papers are truly the most "influential," of course. After all, sometimes the most cited papers are influential in a bad way or are cited as an example of a paradigm that was later rejected. However, there aren't any really good ways of measuring a scientist's influence; citations are probably about as useful a way as one can come up with. At least it's an objective number that can be measured. After his analysis, Ioannidis also makes some interesting, although perhaps unworkable suggestions for improving the process.

First, let's look at the key finding of the entire exercise. Nicholson and Ioannidis first identified 700 papers in biomedical research journals published since 2001 that have received 1,000 or more citations. They then examined the record of the primary author of those papers. It's fairly amazing what a select group this is. There were more than 20 million papers published worldwide between 2001 and 2012, of which only 1,380 had received 1,000 or more citations. Of these, 700 were catalogued in the life or health sciences and had an author affiliation in the U.S. These 700 papers produced 1,172 discrete single, first, or last authors. The reason Ioannidis concentrated on these authors is because in biomedical research publications, the first author is usually the one who did most of the work and wrote the paper, while the last author is usually the principal investigator (PI); i.e., the researcher in whose laboratory the research was carried out. Frequently, therefore, the first author is a graduate student or postdoctoral fellow working in the laboratory of the PI.

So what were the results? Because I'm going on vacation and feeling a little lazy right now, I'll let Ioannidis describe it:

We discovered that serving on a study section is not necessarily tied to impact in the scientific literature. (see 'Is funding tied to impact?). When we cross-checked the NIH study-section rosters against the list of 1,172 authors of highly cited papers, we found only 72 US-based authors who between them had published 84 eligible articles with 1,000 or more citations each and who were current members of an NIH study section. These 72 authors comprised 0.8% of the 8,517 study-section members. Most of the 72 (n = 64, 88.9%) currently received NIH funding.

We then randomly selected 200 eligible life- and health-science papers with 1,000 or more citations (analysing all 700 would have required intensive effort and yielded no extra information in terms of statistical efficiency). We excluded those in which the single, first or last author was a member of an NIH study section, and those in which the single or both the first and last author were not located in the United States on the basis of their affiliations at the time of publication. This generated a group of 158 articles with 262 eligible US authors who did not participate in NIH study sections. Only the minority (n = 104, 39.7%) of these 262 authors received current NIH funding.

These data are presented in graphical form in the article:

So the basic finding is that researchers viewed as "highly influential" are often not on NIH study sections. Ioannidis notes that these rates of NIH funding are not any higher and might be worse than biomedical scientists in general. Ioannidis cites data that suggests that between 24% and 37% of biomedical researchers applying for grants from 2001 to 2011 were funded as principal investigators. True, Ioannidis points out that the funding rates for individual grants are considerably lower (after all, the pay lines over the last few years have been in the 7th percentile range) and that researchers submit multiple grants, resulting in a significant number of researchers ultimately receiving NIH funding. There is one problem using this particular range, however. The early part of the range is very different from the more recent part of the range as far as pay lines go. from 1998 to 2003, the NIH budget nearly doubled, the result of an initiative started under the Clinton Administration and completed under the Bush Administration. Truly, back then it was the land of milk and honey for researchers trying to compete for NIH grants, with pay lines well over the 20th percentile in some institutes. Then, after the doubling ended in 2003, the NIH came in for what has since become known as a "hard landing." Budget increases did not keep up with inflation. Also, because grants funded during the time of the doubling could be as long as 5 years, the commitments from those grants funded during the time of the doubling remained for several years after the large budget increases ended, leaving less money for new grants. Thus, this period encompasses a "time of plenty" that lasted until around 2003 and 2004 and the current drought, which got really severe after around 2006. Despite all sorts of moves by the NIH to increase the number of new grants, such as cutting the budgets of existing grants and newly awarded grants, the current situation shows no signs of abating any time soon. All of this is why I would be curious if Ioannidis' estimate still holds for the period from, say, 2006 to 2011 as it did in the earlier time period from 2001 to 2005.

Whether it does or not, the finding remains that there doesn't seem to be a discernable difference between the NIH funding rates between these highly cited scientists and the rest of us hoi polloi, which does rather suggest that the current NIH system isn't identifying the truly best and brightest. At least, this is what Ioannidis argues. First, however, he also points out another interesting observation. Study section members and non-members showed no significant difference in their total number of highly cited papers:

Among authors of extremely highly cited papers, study-section members and non-members showed no significant difference in their total number of highly cited papers, despite the fact that members of study sections were significantly more likely than non-members to have current NIH funding. This was true both for authors with multiple highly cited papers (13/13 versus 13/19, p = 0.024) and for those with a single eligible highly cited paper (51/59 versus 91/243, p

It's important to clarify here. There is a reason why study section members are significantly more likely to have NIH funding, and that's because the NIH invites holders of NIH grants, particularly R01s, to join study sections, and many do. Indeed, among the requirements for study section members is that they must be a principal investigator "on a research project comparable to those being reviewed." In other words, to be an official standing member of a study section, in general you have to have an NIH grant, usually an R01 or larger. The rest of the study section is then rounded out with a rotating band of ad hoc reviewers picked for specific areas of expertise. That's the point, and that's why Ioannidis mentions this. The point is that being on a study section or holding an NIH grant has no correlation with being one of these highly cited scientists.

Another observation made by Ioannidis using the similarity or "match" score on the NIH rePORTER website, where you can find listings of all federally funded research projects, is that the grants of study section members were more similar to other currently funded grants than were non-members' grants. In other words, the funded grants of members of NIH study sections resemble each other and grants in general funded by the NIH. I can certainly guess why this might be true. One of the pieces of advice I received when I was starting out (and that is given to lots of young investigators) is to find a way to get on a study section. The rationale is that by learning how the NIH evaluates grants you can learn how to craft grants more likely to be funded. It therefore makes sense that a certain level of conformity creeps in, and there's little doubt that that conformity becomes more pronounced when funding is tight. Study sections and the NIH do not want to "waste" taxpayer's money on risky projects.

Or, as Ioannidis puts it:

If NIH study-section members are well-funded but not substantially cited, this could suggest a double problem: not only do the most highly cited authors not get funded, but worse, those who influence the funding process are not among those who drive the scientific literature. We thus examined a random sample of 100 NIH study-section members. Not surprisingly, 83% were currently funded by the NIH. The citation impact of the 100 NIH study-section members was usually good or very good, but not exceptional: the most highly cited paper they had ever published as single, first or last author had received a median of 136 (90–229) citations and most were already mid- or late-career researchers (80% were associate or full professors). Only 1 of the 100 had ever published a paper with 1,000 or more citations as single, first or last author (see Appendix 1 of Supplementary Information for additional citation metrics).

And, from a news report about the Ioannidis' study:

Top scientists are familiar with NIH's penchant for the safe and incremental. Years ago, biologist Mario Capecchi of the University of Utah applied for NIH funding for a genetics study with three parts. The study section liked two of them but said the third would not work.

Capecchi got the grant and put all the money into the part the reviewers discouraged. "If nothing happened, I'd be sweeping floors now," he said. Instead, he discovered how to disable specific genes in animals and shared the 2007 Nobel Prize for medicine for it.

Although I think Ioannidis definitely has a point, anecdotes like this are rife in the research world. Usually, they take the form of scientists with ideas that they couldn't persuade the NIH to fund despite multiple grant applications but that later turned out to be revolutionary or to lead to highly useful new therapies. The most common such anecdote that I hear is that of Dennis Slamon, who proposed targeting the HER2 oncogene in breast cancer. I've touched on his saga before, along with the whole issue of supporting risky science versus safer, more incremental science. It's the issue of "going for the bunt versus swinging for the fences," along with the related issue of the viability of clinician-scientists. Basically Slamon likes to go on and on about he had trouble getting NIH funding to develop a humanized monoclonal antibody against HER2, but, as I pointed out, the story was actually a lot more complex than that. For instance, Slamon's applications were submitted around a time when other scientists were having difficulty replicating their results, and very likely study section members knew that. Also, Slamon had no trouble getting NIH funding for other projects at the time.

To me, these anecdotes represent the scientific variant of the mad scientist in horror movies ranting, "They thought me mad, mad, I tell you! But I'll show them." OK, I'm being a bit sarcastic, but these stories are so ubiquitous whenever anyone complains about the "conformity" and conservativeness of the NIH review process that I tend to want to gag every time I read one of them. They're pure confirmation bias. Yes, occasionally the daring or bizarre idea will pay off. However, far more often risky ideas do not pan out because, well, they are risky. Most risky ideas fail. It's very easy to recognize innovative ideas with a high potential for impact in retrospect. With the benefit of hindsight, we now know that Slamon and Capecchi have made huge contributions to science. At the time they were doing their seminal work, it wasn't nearly as obvious. Both Slamon and Capecchi got lucky. Such is the fate of riskier ideas that it could just as easily have gone the other way and their big ideas gone nowhere.

But back to Ioannidis. I see a lot of problems with his analysis, not the least of which is his metric. For one thing, in some specialized fields, even papers with a very high impact would have difficulty reaching 1,000 citations, because there just aren't enough scientists working in that field to produce such blockbusters. Another issue is consistency. Truly influential and creative scientists tend to produce multiple influential papers, and even an average scientist can stumble onto something. Even Ioannidis concedes that "one cannot assume that investigators who have authored highly cited papers will continue to do equally influential work in the future." Indeed, how many of these papers analyzed by Ioannidis were one-shot papers in which the scientists who published them never published papers anywhere near as influential again? To be fair, Ioannidis does make a good point that such investigators have reached a bar that should entitle them to a chance to prove that they can keep doing such good work.

Finally, as NIH Director Francis Collins pointed out, scientists funded by the NIH have won 135 Nobel Prizes. The situation is not as clearly a problem as Ioannidis makes it sound. Besides, it is the very nature of science that "game changing" studies tend to be relatively few and far between. Most of the hard work of advancing science does come from incremental work, in which scientists build upon what has come before. We fetishize the "brave mavericks" and "geniuses," and, yes, they are important, but identifying these geniuses at the time they are doing their work is not a trivial thing. Often the importance of their ideas and work is only appreciated in retrospect.

In the end, as much as I admire Ioannidis, I think he's off-base here. It's not that I don't agree that the NIH should try to find ways to fund more innovative research. However, Ioannidis' approach to quantifying the problem seems to suffer from flaws in its very conception. In light of that, I can't resist revisiting the discussion in my last post on the question of riskiness versus safety in research, and that's a simple question: What's the evidence that funding more risky research will result in better research and more treatments? We have lots of anecdotes of scientists whose ideas were later found to be validated and potentially game-changing who couldn’t get NIH funding, but how often does this really happen? As I've pointed out before, the vast majority of “wild” ideas are considered “wild” precisely because they are new and there is little good support for them. Once evidence accumulates to support them, they are no longer considered quite so “wild.” We know today that the scientists whose anecdotes of woe describing the depradations of the NIH were indeed onto something. How many more proposed ideas that seemed innovative at the time but ultimately went nowhere?

Ioannidis does bring up a disturbing point, namely that scientists who have authored highly influential papers are apparently no more likely to achieve NIH funding than the rest of us and, more relevant, that scientists on NIH study sections differ from those not on study sections only in their ability to persuade the NIH to fund them. NIH study sections are a lot of work, and there is also a culture there, with a definite "in" crowd. It is quite possible that the truly innovative thinkers and scientists don't want to be bothered with the many hours of work that each study section meeting involves, which can require members to review five to ten large grants and then travel to Bethesda, and it is equally possible that such scientists "don't play well with others" in the study section. It is certainly worthwhile to investigate whether this is the case and then to try to find a way to bring such creative minds into the grant review process. However, the assumption underlying Ioannidis's analysis seems to be that there must be "bolts out of the blue" discovered by brilliant brave maverick scientists. It's all very Randian at its heart. However, science is a collaborative enterprise, in which each scientist builds incrementally on the work of his or her predecessors. Bolts out of the blue are a good thing, but we can't count on them, nor has anyone demonstrated that they are more likely to occur if the NIH funds "riskier research." It's equally likely that the end result would be a lot more dud research.

No one can say, and that's the point.

Note: Even Orac needs some downtime and is taking a rare winter vacation right now. So if this post looks a bit "familiar," oh, well. A lot of posts this week are likely to look fairly familiar—but, with the exception of this one, probably only to long-time readers. If you're not a long time reader, then they'll still be new to you, and if you are it won't hurt you to read such brilliance again. Who knows? I might even slip some new material in there if there's a rainy day where I'm staying (which is someplace nice and warm right now). If you don't check back every day and I do slip an odd new post or two in, you might miss it.

oracknows Sun, 12/09/2012 - 21:08

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As National HIV Testing Day approaches, communities struggle with cuts to HIV prevention, screening services

lborkowski — Tue, 26 Jun 2012 07:00:50 +0000

As National HIV Testing Day approaches, communities struggle with cuts to HIV prevention, screening services

by Kim Krisberg

Just a few years ago in Butte County, Calif., it wasn't unusual for public health workers to administer more than 1,000 free HIV tests every year. In true public health fashion, they'd bring screening services to the people, setting up in neighborhoods, parks and bars, at special community events and visiting the local drug treatment facility and jail. The goal was prevention and education, and no one got turned away.

That was before 2009, which is when California state legislators cut millions in HIV prevention and education funds from the state budget. The cut meant that Butte County Public Health had to completely shutter is HIV screening and education program. A quick visit to the department's HIV/AIDS web page reads:

"Due to recent state budget cuts the state sponsored counseling and testing program has been eliminated in Butte County. These services continue only in select California counties with high HIV incidence.

Anonymous and confidential HIV testing and counseling used to be a free service under this program. Due to the cuts we will no longer be able to provide free HIV testing at outreach testing and alternative anonymous test sites."

Today, the department does about 50 HIV screenings a year, most of them related to partner testing as part of HIV treatment and case management services, said Kiyomi Bird, program manager in Butte County Public Health's Communicable Disease and Emergency Response Division.

"Bringing services to the people and giving them the education and saying 'we can test you for free right now' is a huge incentive for a lot of people to get tested," Bird explains. "It would be fair to say that a good portion of those folks probably would not have been tested had we not gone and reached out to the them.

"What we're seeing in our county — and I'm confident that this is reflected throughout the state — is that the number of cases of HIV being detected has gone down since funding has been reduced, and it's not because there's less disease out there,” Bird said.

For Butte County, in particular, the HIV case detection rate has dropped by at least half since funding was cut and Bird noted that it's not because of a drop in transmission, but because of a drop in screening.

Despite the funding setback, Bird said Butte County Public Health is determined to observe National HIV Testing Day on Wednesday, June 27.

"This is one day we all really try to recognize and participate in," she said. "It's an opportunity to reinvigorate the community in regard to responding to the HIV epidemic and remind people not to forget the importance of testing."

Time to get tested

In 1995, the National Association of People with AIDS (NAPWA) founded National HIV Testing Day, which takes place every June 27. The observance was the very first AIDS awareness day in history, according to Frank Oldham Jr., president and CEO of NAPWA. This year, the association has a number of events planned for the observance, including an invitation to all members of Congress to get tested at a mobile HIV testing van that will be parked just blocks from the U.S. Capitol building in Washington, D.C., on June 26.

Oldham said he's "extraordinarily worried" about the impact that state budget cuts are having on screening services, noting that health departments are major players in the efforts to get people screened and linked to treatment.

"Cutting budgets and reducing the amount of care that people can access is detrimental not only to people living with AIDS, but for all of us," he said. "This is wrong and it shouldn't happen...these cuts cost lives."

The National Coalition of STD Directors reports that 69 percent of states cut sexually transmitted disease funding in 2009. The coalition noted that such cuts cost more in the long run: For every HIV infection that is prevented, an estimated $360,000 is saved in the cost of providing a lifetime of HIV treatment.

According to the Centers for Disease Control and Prevention, the United States was home to about 50,000 new HIV infections annually from 2006 to 2009. Since the first cases of AIDS appeared in the United States, 1.7 million people are estimated to have been infected, including more than 619,000 who have died. As of 2008 — the most recent year for which data is available — about 1.2 million U.S. residents were living with HIV, according to AIDS.gov. Still, about one in five residents who have HIV are unaware of it. Knowing HIV status dramatically reduces the risk that people will transmit the disease.

Natalie Cramer, director of prevention at the National Alliance of State and Territorial AIDS Directors, said federal funding for HIV prevention and screening has remained about level in recent years, however the way it's being distributed has changed. As of this year, CDC is using a new funding methodology that shifts more funding to regions that are home to the highest HIV burdens. The funding shift coupled with state budget cuts means that some states and communities are experiencing severe funding reductions.

"While certainly there's been shifts in funding and while there have been cuts at the state level, I would say that testing is really an area that continues to be prioritized as a first line of defense," Cramer told me. "Health departments are absolutely on the frontline of a coordinated response to the HIV epidemic. And while we're increasingly seeing people getting tested as part of routine (primary) care, many of the people who health departments see are more marginalized, people who may not have a medical home, who are really on the periphery...public health programs are well equipped to find people where they are and find folks who are most in need."

'A short-sighted approach'

In Memphis, Tenn., a short-lived suspension of free HIV testing services wasn't the result of HIV funding cuts per se, but a collateral effect of a larger legislative assault on Planned Parenthood. Early this year, Tennessee legislators cut off Planned Parenthood's access to HIV prevention funds. The move meant that the Memphis Gay & Lesbian Community Center had to shutter its free HIV screening services — the only after-hours HIV screening service in the area.

For three years, the center had partnered with Planned Parenthood to provide free HIV testing and education on site four times a month. They typically tested about eight to 10 people every week, said Will Batts, the center's executive director. Luckily, Planned Parenthood promptly sued and a judge reinstated the funds, so the center's screening services were only down for a week. Still, "we had 10 people that week that we had to turn away...it was very frustrating," Batts told me. Today, Batts said the center is in the process of building the capacity to do HIV screening completely on its own.

"It's so important for our community to have access to testing," he said. "If we have a community where HIV rates are rising, which is what's happening in the gay community, screening will give people the tools to protect themselves."

In Illinois, HIV prevention took a huge hit when lawmakers recently enacted a budget that cuts funding for HIV prevention, care and related housing programs by 42 percent. The cut, which goes into effect in July, will result in an estimated 6,500 fewer HIV tests being administered and "will undoubtedly result in new HIV infections," said Ramon Gardenhire, director of government relations at the AIDS Foundation of Chicago.

While it's too early to say for sure, Gardenhire said the cuts will likely mean some organizations will have to eliminate free testing, begin charging a fee or possibly shut their doors altogether. He noted that communities already hardest hit by the epidemic would be most impacted by the budget cuts.

"We acknowledge the fact that Illinois was in a dire fiscal situation, but we should make public policy decisions based on being cost-effective," Gardenhire told me. "We have done a tremendous job in the state of educating people on the importance of knowing their HIV status...these cuts just undermine that work. It's a short-sighted approach to save some money."

To learn more about National HIV Testing Day or to find an HIV testing site near you, visit www.napwa.org or www.aids.gov.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for a decade.

lborkowski Tue, 06/26/2012 - 03:00

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Public Health - General

paying for research

catdynamics — Tue, 05 Jun 2012 23:54:25 +0000

paying for research

there is a curious result in behavioural economics, which shows that paying people to do what they like to do, sometimes provides a disincentive for them to do it, and people correspondingly lower their effort to do the task.

The example I recently came across, from the 7 Rules of Behavioural Economics, or some such, was that if you pay people to have their friends for dinner, they entertain less.

But, enough about the decline of intradepartmental socialization...

The reason I thought of this, is that yesterday we congratulated a colleague on a nice result, and another colleague asked some question about "which agency the grant was from", which lead to a quick chortle, and "no, this was unfunded research".

Which is true, quite often. In fact one of my mentors, many years ago, told me that he found the grant system quite irritating, because by the time you got the proposal through and had a grant, it wasn't interesting any more...

There is quite a lot of truth to that.
Now, it is not universal - there are many important large projects which take long term funded efforts, and are fun, mostly, through the years.

But, it is also true, that a lot of the really nice results, especially the little and medium results, come from unfunded research - stuff people do because they can, and it is fun.

Effectively, a lot of this research is subsidised by the more ponderous, bread'n'butter, grant funded research. The people and facilities are still paid for, somehow. And, mostly, the agencies know this and tolerate it.

So, why don't we do more of it?
Why the pretense?
Well, apart from the need to do large systematic multi-year projects which actually employ most of us most of the time?
Why don't we just accept that researchers do random fun stuff a lot of the time, as the mood strikes them, and really that is where a lot of the good results come from?

Here I'd bemoan the loss of the Golden Era, when it was ever such, but it wasn't really, unless you were an independently wealthy English aristocrat in the Enlightenment, or a precocious upper middle class scion at an Ivy during the Gilded Age.

Research ought to be fun.
It works better when the people doing it enjoy it.
The current system is structured to make what ought to be progressive joy into dreary drudgery (ok, I exaggerate).
Worse than that, it, may be producing disincentives for good research and lowering net productivity.

catdynamics Tue, 06/05/2012 - 19:54

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Academia

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behavioural economics

Funding

Research

There is a story I heard years ago from Leon Lederman about an unnamed physicist who had a remarkable track record of discovering what he proposed to discover. The system worked smoothly until one of his proposals was rejected. He went to talk to his program officer about that, and the PO asked him why he think he could do what he had proposed. He pulled a bunch of papers out of his coat and said something along the lines of, "Because, you fool, it's already been done!" His game all along had been to propose doing what he had just done and use the funding to support his follow-up project.

The above tale is probably apocryphal, but some days I feel that a proposal to do work that isn't already substantially underway has a much lower probability of success than a proposal to do what you have already done. Especially during proposal season, which is right now for the NASA programs I usually propose to.

"Why don’t we just accept that researchers do random fun stuff a lot of the time, as the mood strikes them, and really that is where a lot of the good results come from?"

Because that is not the researcher's call to make. it's his patron's. If his patron accepts that he'll spend a lot of the patron's money just playing, then he can go and play; iif not, then he can't. When the patron is the public purse, which is to say the taxpayer, it seems unconscionable to simply assume that he doesn't mind the researcher playing.

As a data point, I made my money in industry, and then retired and did some self-funded research into acoustics and audio synthesis. So it's still eminently possible to be an independently wealthy English gentleman - in fact, I'd recommend it! Afterwards, I found that I became a lot less approving than I had been of a lot of the taxpayer-funded research that's out there. And especially of the kind where the researchers consider "obtaining grants" to be their primary job function!.

As a supplementary data point, when I was being paid to produce the best software in my market (by being paid royalties and not just a salary), I was really motivated to do just that. When I was working for my own enjoyment, the results were good, certainly, but by no means great. So I'd suggest that the most important word in the first paragraph of your article is "sometimes".

Thanks, Steinn! This is a topic near and dear to my heart. I gave up long ago on writing proposals. My MO is to find a project which someone else is already doing which sounds really cool, and ask if I can join to do some little piece of the big puzzle -- for free. It's a win for me, because I get to do something interesting. It's a win for the project, because they get a small bit of effort without having to pay.

It's certainly true that one can't do a big project in this way -- or, more properly, one can't lead a big project this way -- but as the astronomical community builds larger and larger collaborations, there will be more and more opportunities for people to work in this fashion.

And some tiny little fun projects can be done without any funding. When SN 2011fe went off last August, I realized that it was a rare chance for me to get back to my roots in supernova photometry with the 12-inch telescope at our campus observatory. It took a lot of work -- getting up at 2 AM in the middle of January and spending half an hour setting things up in the dome was hard -- but watching that light curve grow each morning was terrific. It made me feel like a grad student again :-)

On a related note, I am always amused by the process of submitting revised proposals. In my field (and I expect most others), you rarely get the first grant submission funded. But, if you got a reasonable score and make specific changes in response to the reviewers, you can get funding on your second attempt.
However, I rarely see people actually implement the revisions - they are just word service to appease the reviewers. In reality the research that gets done is often only related to what was proposed not precisely what was proposed. Fortunately there is little oversight other than to be able to tie some publications to the grant in some way and show that you spent the money more or less how you had it budgeted.
And, in a sense this all works - science gets done and researchers get to do what interests them. But, it would be nice to get the funding system to match the actual research mechanism. That is, fund those who produce in the fields that are of greatest importance - general aims rather than specific aims.

"But, it is also true, that a lot of the really nice results, especially the little and medium results, come from unfunded research – stuff people do because they can, and it is fun."

Interesting point, but do you have any specific examples? Are you talking about the kind of unfunded projects that ultimately support a funded research project (or answer questions tangent to a funded project)? Are you talking about unfunded research projects that are intriguing enough to receive later funding? Or are you talking about unfunded projects that stand alone yet have a significant impact on a particular field?

It seems to me that the small projects alluded to in this blog post are of the type that reaffirm a scientist's love of science, although have little impact. Even on tiny budgets, I think we will always find ways to enrich our lives.

I would have to agree with BKsea - fund general aims rather than specific aims. I would add that even though you may state a specific aim in a grant, carrying out a specific aim is quite a different matter. Troubleshooting the techniques in specific aims and trying new approaches to achieve specific aims are a large part of the daily creative process of science. These types of issues leave a lot of flexibility, and can produce interesting, unforeseen results. They can also be engaging and exciting.

I also suppose that the ease of doing unfunded projects will depend on the field of research. I work in a biology lab. People in my research group (myself included) have been known to do small side projects for fun and interest. However, few of these results get published and, therefore, have little impact. This is mostly because 1.) it is very time consuming and expensive to do the kinds of experiments that will get nice results and 2.) small side projects usually don't tell a very complete story.

@Ian - clearly economic incentives are often motivating. The interesting thing is that not only are they sometimes not an incentive, but can be disincentives. In fact I'd argue that the way economic incentives are tied into the grant system is what makes researcher "obtaining grants" become the end rather than the means. I think it can lead to research focused on long term projects that make incremental progress - a phenomenon also seen in the software industry.

"Becoming rich, then doing fun shit" is an excellent business plan, some of my best friends have done it, but it is not very practical as a way of providing a sustained large scale research effort supporting long term growth of a tech heavy economy.

Pure research doesn't work the way applied development does.

@CFP - so, my example was the paper that just came out.
More generally, none of my Nature or Science papers were based on funded research when they came out.
All lead to or were part of long term research projects, some of which was fundable for part of the time, some of which were even fundable for me to do the research, as opposed to others being funded to follow through on the work. All are well cited and continue being cited and all initiated lines of research I continue pursuing.

I find funding panels to be annoyingly conservative. Even when I sit on the panels - the guidelines for funding and need to show proven incremental progress forces that dynamic.

From a European perspective, doing 'unfunded' research is effectively what many people in faculty positions do, since we don't need to apply for funds to pay our salary when we are not teaching (in fact, in most cases such funds don't even exist, unless you land a very large grant which you can use to buy yourself out of teaching). There is still pressure to write grant proposals though, if you want funding for travel, postdocs, grad students etc. and also simply to help you with career progression. Effectively I can do what I like during my research time... but it doesn't usually work that way due to commitments of collaborations, supervision etc. I would feel bad about giving a student or postdoc a project which didn't have a strong guarantee of good results at the end of it.

Doesn't the obvious solution deserve mention? More tenured faculty positions with their associated academic freedom.

Well, my jaundiced perspective is that fellowship postdocs are the people with most freedom to do blue sky and radical research. Tenure track faculty are driven to conservative incremental research, because that is what maximises the chance for grants and reduces the risk of having insufficient grants. Once they have tenure, there is a trap - there is now an infrastructure which relies upon the flow of funding, you lose it other people get hurt. So the tenured faculty are driven, to some extent, to protect their sunk costs and preserve the research infrastructure they built; which continues the motivation for conservative, long term, incremental research. Much of which is still good of course. Some of which must be done that way. But I fear it sometime squeezed out more interesting research.

@SS: Agreed about the reality that tenured faculty are under great pressure to bring in grants. Isn't that one of the features of the current system that you are critiquing? Also the "grass is always greener" applies to your comment about fellowship postdocs, who have similar pressures to conservatively produce results in 1-2 years to prepare for the next job cycle.

I really like the NSERC Discovery Grant system (the mainstay of grad student funding in Canada)--5-year grants that support a researcher to do a broad category of research. Pretty high success rates, too (I think something like 60% or so these days, used to be rather higher), so obviously they're not terribly large; but it's a reliable source of funding for grad students.

So Steinn, this sounds like you'd be more in favor of a block-grant or rolling-grant model (like many European countries). However, that model has its problems too: Big-names tend to score the cash since they've produced in the past so talented newbies may not get a look in.
Maybe the solution is to have say 10% of a funding pool devoted to high-risk projects or people who haven't gotten funding before or are at institutions without a big soft money population?

From the other side, too often I have seen grants to get basic data needed for just about everything turned down for being number grubbing.

Another member of Congress wants to micromanage research funding

lborkowski — Wed, 16 May 2012 15:22:29 +0000

Another member of Congress wants to micromanage research funding

Last week, the House of Representatives approved an amendment to a 2013 spending bill that would prohibit the National Science Foundation from devoting any of its budget to its political science program, which, according to Inside Higher Ed, allocated around $11 million in peer-reviewed grants this year. The amendment was the brainchild of Congressman Jeff Flake of Arizona, who objected to NSF funding studies that "might satisfy the curiosities of a few academics" without benefiting society. Among the previously funded studies Flake apparently considers to be poor use of taxpayer funds are research on (his descriptions):

a new model for international climate change analysis
if policymakers actually do what citizens want them to do
gender and political ambition among high school and college students
why political candidates make vague political statements

I actually don't find Congressman Flake's singling out of these studies to be as appalling as Senator Coburn's annual lampooning of NSF-funded projects. Coburn and his colleagues rely heavily on mockery and seem to be willfully obtuse about potential societal benefits of research involving anything that might sound funny to a 12-year-old, laundry-folding robots or Wii-playing septuagenarians. Flake at least acknowledges that political science research has benefits, and his argument is more about considering priorities in tough economic times. But he still does a disservice by advancing the idea that one can evaluate the worth of research study with a glance at its title or abstract.

Federal agencies that distribute grant funding put a great deal of time and energy into determining research priorities and evaluating the merits of the thousands of research proposals they receive. Among the criteria on which proposals are considered are their likely applications -- for instance, the possibility that research involving older adults and Wii might identify low-cost ways to help older adults improve their cognition and reduce age-related decline, which could have important implications for Medicare and Medicaid spending as well as less-quantifiable benefits. Respected external researchers volunteer their time to evaluate and discuss proposals in detail, and the grantmaking agencies work hard to ensure that they're allocating grant dollars wisely. When politicians mockingly list study titles as Flake did, they belittle the extensive thought and effort that agencies and reviewers put into scoring and funding decisions.

Over at The Monkey Cage, which has several excellent posts on the benefits of NSF-funded political science research, Christopher Zorn explains the problem eloquently:

The panelists, ad hoc reviewers, and program officers at NSF operate in a scientific peer review system that is second to none. (During my time at NSF, even the NIH folks often acknowledged that the NSF's review process was better than theirs). Moreover the funding rate at the NSF's Political Science program is below 20%; that is, there are four proposals that are declined for every one that is funded. That means that hundreds of very smart people spent thousands of hours evaluating many, many proposals to distribute the funding that Representative Flake finds unnecessary.

The direct implication of the Flake amendment is that we should substitute his judgment for all of those individuals', regarding the merits of both the work that has been funded to date and all potential future work that NSF might fund in our field. It is hard to believe that anyone would take seriously such a call to substitute political for scientific judgment if the program in question was physics, or computer science, or even economics. But even if we grant that Representative Flake may have some degree of expertise in political science that qualifies him to pass judgment on the projects that have received support, are we also to believe that (a) there was nothing that should have been funded in previous years, and that (b) there will never be any political science research in the future that merits NSF support?

More broadly (and as I allude to on the ELS blog), the precedent this sets is seriously dangerous. The idea that individual members of Congress should sit in judgment over individual programs of scientific research opens up the possibility of the politicization of the scientific process by people across the political spectrum. This is of course not limited to NSF: NIH, NIJ, DOD, etc. could all see their research arms' funding compromised by legislators looking to make some political hay. Don't approve of homosexuality? Defund Prevention Science at DAR/NIMH. Against contraception? Get rid of CRH at NICHD. And so forth.

I hope the Senate will have more respect for the NSF's ability to allocate research funding appropriately, and insist on a spending bill without Congressman Flake's problematic prohibition on political science research.

lborkowski Wed, 05/16/2012 - 11:22

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Public health vs. the mosquito: Pushing back against dengue

lborkowski — Thu, 29 Mar 2012 10:05:51 +0000

Public health vs. the mosquito: Pushing back against dengue

by Kim Krisberg

A couple weeks ago on the southern-most tip of the continental United States in Key West, nearly 70 residents gathered at a town hall meeting to talk about mosquitoes. And not just any mosquito. A special, genetically modified mosquito designed to protect people's health.

While the modified mosquito has yet to make the two-mile wide island its home, local mosquito control officials are busy making the case that its intentional release will help safely contain the risk of mosquito-borne dengue fever, which made a startling reappearance in Key West in 2009. The male mosquito is genetically altered so that when it mates with wild Aedes aegypti females, the main carrier of the dengue virus, the offspring die as larvae and never become full-grown mosquitoes.

The mosquito control strategy is so new that Key West officials are struggling to find a state or federal agency with the appropriate authority to sign off and oversee the plan as well as a risk assessment. So for now the prevention strategy is in limbo.

"We were looking for a new tool because although we use some of the most cutting-edge and environmentally friendly techniques to control this mosquito, it's not enough," said Coleen Fitzsimmons, a biologist with the Florida Keys Mosquito Control District. "We're here to protect public health, so we felt like we needed something new."

Whether or not genetically modified mosquitoes get added to Key West's mosquito control toolkit, the recent re-emergence of dengue have officials looking for new ways to control the resilient bug. After decades without a single documented human case of locally acquired dengue, 27 such cases were found in Key West in 2009. In 2010, the locally acquired caseload jumped to 67, Fitzsimmons told me. A locally acquired case means the person was infected by a local mosquito and not due to travel outside the country.

And while no cases have been identified since, Fitzsimmons said it's no time scale back control efforts. Because hotter temperatures speed up the development of adult mosquitoes, cause females to bite more often and shorten the amount of time the dengue virus needs to develop inside the mosquito, "whether or not dengue comes back can be the difference between a two- or three-degree change in the temperature," she said. And the female mosquito that spreads dengue is particularly difficult and costly to control. The Aedes aegypti is well suited to human environments, laying it eggs in flower pots, buckets or birdbaths -- "they don't swarm, they just linger close to home," Fitzsimmons said.

She noted that although the species of mosquito that transmits dengue accounts for less than one percent of the Florida Keys' entire mosquito population, it takes up about 10 percent of the agency's budget.

"We can't just say our efforts are working," Fitzsimmons said. "We have to be on all the time."

According to the World Health Organization, incidence of dengue has increased 30-fold in the last five decades, and between 50 million and 100 million infections are estimated to happen every year in more than 100 countries. That means that half the world's population is at risk for dengue. Researchers also predict that warming temperatures related to climate change could help the disease spread more efficiently in the future.

Even in countries like the United States, where vigilant mosquito control and public health efforts have reduced the risk so much that dengue barely registers on the public radar, the tropical disease is poised to make a comeback. In fact, experts say that as dengue spreads in South and Central America, it's only a matter of time before it becomes a bigger problem in the United States.

Tiny bug, big problems

Dengue is a viral infection primarily transmitted via the bite of an infected female mosquito known as the Aedes aegypti, which contracts the virus after biting an infected human. The Aedes aegypti bites during the day, likes to feed indoors and its eggs are particularly hardy. Dengue is caused by one of four related viruses and oftentimes presents itself via flu-like symptoms. Some people with the virus don't even realize they have it. However, a more serious form of the virus, known as dengue hemorrhagic fever, can be life-threatening if not treated.

Dengue is a quintessential public health disease -- its control and prevention is directly tied to environmental conditions, sanitation and human behavior. When the outbreak happened in Key West, health officials blanketed the island in handouts and public health service announcements, encouraging residents to protect themselves from mosquito bites and get rid of standing water where mosquitoes breed, said Vincent Conte, senior physician and deputy director of Epidemiology, Disease Control and Immunization Services at Miami-Dade County Health Department.

"We're lucky enough in the U.S. that we have the money and public funds to have adequate and efficient mosquito control measures," he said. "But the frequency of occurrence is on the rise, and unless it's dealt with in appropriate ways, we could be looking at a gradual increase in cases."

Miami-Dade County has had three locally acquired cases of dengue since 2010 -- before that the last locally acquired case in the south Florida area was in the 1940s, Conte said. The health department also documents about 12 to 15 cases of imported dengue a month. Fortunately, Conte said the Miami area is home to many physicians familiar with tropical diseases and astute at recognizing dengue symptoms.

Unfortunately, however, dengue and vector control come with same funding problems as other public health efforts. People don't consider dengue to be a major threat at the moment and so Miami-Dade County has seen cuts to mosquito control and staffing services.

"With dengue, we do have the opportunity to prevent its rise," Conte told me. "It's just a matter of legislators making the commitment so we can be more proactive rather than reactive."

Jim Kazura, president of the American Society of Tropical Medicine and Hygiene, said "it's hard to get money for mosquito control when there's no problem going on." A professor and director of the Center for Global Health and Diseases at Case Western Reserve University, Kazura said cases of dengue are probably under-reported in the United States -- "clinically, the disease is not always easy to distinguish from myriad of other illnesses," he said. He noted that a dengue vaccine combined with effective mosquito control has the potential to eliminate the risk of dengue around the world. Clinical trials on five dengue vaccine candidates are now underway.

"Mosquito control is a perfect example of public health always working in the background," Kazura said. "And unfortunately, public health doesn't become noticeable until we have a problem."

No borders for dengue

In Brownsville, Texas, Art Rodriguez can practically see Mexico from his office window. The public health director for the Brownsville Public Health Department, Rodriguez told me that while Brownsville hasn't had a locally acquired case of dengue since 2005, it's a year-round challenge to prevent the disease and control the mosquitoes that spread it.

"We always know that the danger is lurking," Rodriguez said. "Just footsteps from us people are getting sick and dying from dengue hemorrhagic fever."

Rodriguez works with his counterparts across the border to maintain mosquito control and reports that surveillance efforts haven't uncovered a mosquito carrying the virus in three years. The health department holds annual trainings with local physicians about vector-borne diseases, and Rodriguez said that most physicians who come to Brownsville are surprised the community is at risk for tropical diseases. Because of the barriers to diagnosing dengue in Brownsville residents, he said it's hard to say if or how many residents are carrying the virus.

Rodriguez said dengue is only an emerging threat in Brownsville because of the constant work of public health and mosquito control officials.

"Public health is a never-ending battle to maintain a balance and we always have to be proactive," he told me. "Outbreaks occur too quickly for us not to be prepared for them."

To the northwest in Laredo, Texas, which also sits on the border with Mexico, there hasn't been a locally acquired case of dengue in five years, and across the border in New Laredo, there hasn't been a case in three years, said Hector Gonzalez, director of the City of Laredo Health Department.

Like Rodriguez, Gonzalez works with his counterparts in Mexico to contain mosquito populations. The city employs an integrated pest management approach that includes insecticide spraying, sanitation improvements and community education, Gonzalez said. Minnows have also been employed against dengue: For the past eight years, thousands of minnows, which have a short life span, have been distributed into retention ponds, creeks and lakes to eat mosquito larvae.

"Everything combined is working in an integrative manner to prevent dengue," Gonzalez told me.

Despite the success, Laredo public health workers are bracing for funding cuts that could impact dengue prevention. For years, the federally funded Early Warning Infectious Disease Surveillance Program has been operating at the border, facilitating the exchange of data and information that can serve as an early warning for disease. When a case of dengue popped up across the border in New Laredo three years ago, Gonzalez said he learned about it through the surveillance program. Next year, funding for the program has been zeroed out, he said.

"We have to sustain basic public health surveillance," said Gonzalez, who noted that the Laredo department now monitors for more than 200 diseases. "It's critical for a disease like dengue."

To learn more about dengue, visit www.cdc.gov/dengue or www.who.int/topics/dengue/en.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for almost a decade.

lborkowski Thu, 03/29/2012 - 06:05

Tags

infectious diseases

Public Health - General

Cuts to mental health funding leaving the most vulnerable behind

lborkowski — Tue, 31 Jan 2012 11:30:21 +0000

Cuts to mental health funding leaving the most vulnerable behind

by Kim Krisberg

Joy Jay has the sweetest Southern accent you'll ever hear. It's the kind of accent that makes her news about the state of mental health services in South Carolina harder to hear than usual.

"Mental health has taken some of the biggest (funding) cuts of any agency in the state," said Jay, executive director of Mental Health America of South Carolina. "It's really affected the number of people who can be served -- the door is very narrow now for people with chronic, persistent (mental) illness. And for people with temporary problems, they can't even get into the system; there's no money for them to be served. It's a major, major problem."

From fiscal year 2009 to 2012, South Carolina decision-makers enacted some of the largest reductions to mental health services in the nation, cutting funds by nearly 40 percent, according to a November 2011 report from the National Alliance on Mental Illness (NAMI). In 2009, more than 95,000 South Carolina residents seeking mental health services were served; in 2011, that number dropped to about 90,000 -- and not because demand went down, Jay said. Jay noted that her organization is now busy building a 14-unit housing project for adults living with mental illness, and 46 people are already on the waiting list. It's the biggest waiting list they've ever had for their housing services, Jay told me.

"I believe we have an obligation to serve our elderly, our children and our disabled and when we don't do that well, we end up with lots of problems," she said. "If we don't spend money on one end, we'll spend it on the other."

Since fiscal year 2009, states have cut more than $1.6 billion in general funds from mental health agency budgets, the NAMI report states. The cuts come at a time when significantly more people are seeking mental health services. Many of those looking for help have never sought such services before, but have been hit hard by the recession, job losses and foreclosures. The state cuts also coincide with recent declines in federal Medicaid funds (which were boosted through a stimulus measure that's now expired ), forcing many states to shift existing resources into their Medicaid programs. This leaves little for residents who don't qualify for Medicaid and have no insurance. For example, in the summer of 2010, Arizona eliminated nearly all services for 12,000 residents diagnosed with serious mental health illnesses who weren't eligible for Medicaid, NAMI reports.

"What we've seen in a number of states is across-the-board cutting of programs without really having regard for what's being cut or whether one area is more meritorious than another," said Ron Honberg, NAMI's director of policy and legal affairs. "Hopefully, we've seen the worst of it...there's not a lot more to cut and states are having to come to grips with that. Eventually, you start cutting the heart and soul of the system."

Shifting costs
Typically, when mental health service cuts of this magnitude are enacted, money isn't really saved -- costs just shift, Honberg told me. Costs and care are shifted to correctional systems, homeless agencies, hospital emergency departments and police, whom Honberg said are often the first responders to people in crisis. In reality, "large city jails have become the country's de facto psychiatric hospitals," he noted. On the brighter side, Honberg said the Affordable Care Act (ACA) does have the potential to expand access to mental health services. For example, millions of people living with mental illness could benefit from ACA's Medicaid eligibility expansion starting in 2014, and insurance plans offered via state-based health insurance exchanges will have to abide by federal parity laws that require equal coverage for mental and physical health services. Though Honberg added that "what parity actually means is still the source of some debate."

"People with mental illnesses are among the poorest of the poor," he said "Even with parity, only about 15 to 20 percent of people with serious mental illness are able to work, so many people will still rely on the public mental health system."

In Chicago, mental health funding cuts are being exacerbated by changes in how services are paid for. Previously, mental health providers received annual grants that let them serve a wide range of vulnerable community members, but starting in fiscal year 2011 these providers have to file claims for treatment of uninsured clients with the state mental health agency. Sharon Kayser, executive director of Chicago's Counseling Center of Lake View, called the changes "euphemistic cuts" -- in other words, it may not look like funding cuts on paper, but it has a considerable impact on services. The changes mean that the counseling center must either absorb the cost of services that don't fit into the new fee-for-service model or simply turn people away.

"When you make it harder to access funding, that's a cut," Kayser told me. "It takes productive time out of a clinician's day because they have to engage in the billing process, it ups our administrative costs...a grant allows us to focus on the work."

Overall, the Counseling Center of Lake View has had to cut more than $1 million from its budget, eliminate some services and lay off more than a dozen staff members, Kayser said.

"In the end, it does cost more money, especially if people end up in the criminal justice system," she said. "You begin to criminalize mental illness and poverty."

Sarah Steverman, director of state policy at Mental Health America, said she's worried that the mental health safety net is "seemingly disappearing." With services and staff being cut and community mental health centers shutting down, even people with insurance coverage "may not have access to care because there won't actually be any providers available," Steverman told me.

"We were hoping that legislatures would attempt to protect services for their more vulnerable populations, but in many states that wasn't the case," she said.

On the west coast of Florida -- a state near the bottom in per capita mental health spending, according to NAMI -- demand for services at the Crisis Center of Tampa Bay has doubled since 2008, according to David Braughton, the center's president and CEO. In that same period of time, government dollars have declined by more than 40 percent, he said. So far, through fundraising, operating efficiencies and moving to a more fee-for-service model, the center hasn't had to cut core services or turn away people in need. Nonetheless, more funding problems are on the horizon: Later this year, the center will lose funding that supports counseling for sexually abused children. That's a $350,000 hole that will have to be filled to continue what can often be life-saving care, said Braughton, who cited research showing that early identification and treatment of childhood trauma can help lessen the chance of related risky behaviors and health problems in adulthood.

"I guess we're all eternal optimists and I thought 2011 would be the worst of it, but 2012 is still worse," Braughton told me. "Reality is starting to temper my optimism. With the erosion of government support and the erosion of our tax base...people are going to have fewer resources to turn to and what the long-term consequences of that may be, well, only God knows."

For a copy of the NAMI report, "State Mental Health Cuts: The Continuing Crisis," visit www.nami.org.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for almost a decade.

lborkowski Tue, 01/31/2012 - 06:30

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I don't think it is right to cut services that help people with mental illness cause then they sometimes go backwards in their recovery. I went to a mental health center in Paola, KS. Unfornately, many services had to be cut because of money and they merged with another mental health center.

More on mental health parity: The safe harbor for outpatient benefits, http://www.healthcaretownhall.com/?p=2973

mental heaLth has been dissolved for many years; you just notice it now, People are homeless-mostly, who are mentally ill, they cannot work, often, or made too little money to put a roof over their heads.,

I found out a graVe truth of govt. funding: when you really need it it is never there. In CA, Jewish family services _a_ private funded agency, and religious group backed, saved my life, when I could not walk, or work, and (as usual) all govt funding for all social ser, was nonexistent My words of wisdom to you "Don't ever count on govt,, programs, they are always the first cut, ahead of all!" Make private funded agencies, from private, local peoples, agencies, religious organize organizations are best,

why? they always help all the poor, sick, old, ect., that the govt cuts, all religious groups, for example, are doing all the charity work social work, in the pacific northwest 'there is no state, and most of all, no, fed. govt. funding or agencies anymore. Obama has done nothing. No govt, does anything. religious local groups of all kinds, of community, do it ALL. the govt. only cuts and cuts all soc. serv.>,no matter what. Over the last 30 and 20 years, all soc. Serve, and Medicaid, Medicare, food stamps, every govt. agency is gone, or barely exists.

All you govt. Lovers need to get wise; all soc. serve, everything, is being made extinct by the fed. govt. you need to fund, support, work with, and for, all religious groups in the U.S.,and private funders, that do all the work for the needy, cause all Govt. help, funds, soc. serve, agencies, wiLL be extinct. this is the on going plan in WA DC. Get wise to it, like we have; do private funded help,local groups,religious groups, there is no other help! And there will be no more govt, funds, ect.,that is the reality .

a-pacific northwest native and activist.

A very disheartening article about the state of our mental health care system. I know of several people with severe OCD, (which is absolutely treatable)that are suffering needlessly because they cannot afford proper treatment. It's so sad.

I don't think it is right to cut services that help people with mental illness cause then they sometimes go backwards in their recovery.

Funding cuts put public health's emergency response capabilities on the line

lborkowski — Thu, 19 Jan 2012 13:48:57 +0000

Funding cuts put public health's emergency response capabilities on the line

by Kim Krisberg

It only takes a few minutes of talking with Scott Becker to realize just how passionate he is about public health. In fact, his enthusiasm is contagious. Maybe that's why he isn't mincing his words.

"What keeps me up at night is how we are going to maintain the core and critical services we have," said Becker, executive director of the Association of Public Health Laboratories. "If the question is 'how low can we go?' My answer is 'we're there.' I used to be on a more hopeful note, but I can't do that anymore."

Becker is talking about the worrisome state of public health preparedness funding and its effect on the nation's network of public health laboratories, which Becker describes as the "hidden jewel within the public health system." Public health labs and their highly skilled workers are frontline defenders of the nation's health, protecting the public against disease and providing critical support in the wake of natural and manmade disasters.

When a foodborne illness outbreak occurs or a chemical release exposes a local population to fumes, public health officials need to be able to quickly determine who's affected and how the exposures are happening in order to treat victims promptly and prevent more people from being harmed. Labs play a crucial role in this process. For example, during the 2001 anthrax attacks, public health laboratories tested more than 1,200 specimens a day. Ultimately, they ended up conducting more than one million laboratory analyses in response to the anthrax attacks. Now, the ability of public health labs to quickly respond at that same level of capacity is truly on the line.

"As the dollars shrink, public officials can't expect the same response," Becker told me. "Labs are somewhat intense in terms of budget because we deal with things like supplies, instrumentation, equipment maintenance...but right now, we're struggling just to keep the infrastructure going."

And public health labs aren't alone. According to a December 2011 report from the Trust for America's Health (TFAH), federal funds for state and local public health preparedness declined by 38 percent from fiscal year 2005 to 2012, with many core preparedness activities and programs at further risk of declining funds or elimination.

The influx of preparedness funds as well as the renewed focus on public health preparedness began in earnest after the Sept. 11 terrorist and anthrax attacks -- "these tragedies marked the first time public health was considered central to the nation's emergency preparedness -- marking the beginning of a significant transformation," the TFAH report states. Since then, more than $7 billion in preparedness funding has been provided to states and some major cities, resulting in a tremendous build up of public health's capacity to respond to emergencies. And such capacity not only kicks in during crises, it has strengthened the public health system's overall ability to protect the nation's health on a daily basis. Unfortunately, advocates warn that the recent declines in preparedness funds coupled with cuts in federal, state and local public health budgets are threatening to turn back the clock on years of investment and capacity building.

"We're clearly better off than we were before," said Albert Lang, TFAH's communications manager. "But there's a legitimate and real fear that we'll slide back to 2001 levels of preparedness."

Public health's ability to respond in an emergency "isn't just something you pick off the shelf," Lang told me. It takes constant training to do it right, and a major concern is that "people are just disappearing," he said. According to the TFAH report, more than 49,000 state and local public health department jobs have been lost since 2008 due to layoffs and attrition. So, while a state may have a modernized public health lab, it's losing the highly trained people to staff it, he noted, and "you can't train someone in the midst of a disaster."

"The country has failed to create level and sustained funding streams," Lang said. "It's hard to plan (emergency) responses if you can't count on resources down the road."

The faces of funding cuts
Creating an effective public health response system takes more than training; it takes research too. That's why the Centers for Disease Control and Prevention has invested millions in creating university-based Preparedness and Emergency Response Research Centers (PERRCs) and Preparedness and Emergency Response Learning Centers (PERLCs). These are the places where effective, evidence-based public health response practices are born. According to the TFAH report, funding for a number of the research and learning centers is at risk for being reduced or eliminated in 2012.

"You need to prepare for the worst and hope for the best," said Andrea Hickle, associate director of the University of Minnesota's Simulations and Exercises for Educational Effectiveness Preparedness and Emergency Response Learning Center. "There's a constant need for people to be trained in areas of preparedness... you need refreshers. It's not like you're trained once and you're set to go."

The University of Minnesota's PERRC launched in 2008 and its PERLC began in 2010. Hickle said the two centers are closely linked, with the learning center acting as a live platform for applying the work conducted at the research center. The work being done, however, is hardly confined to the university campus and its students -- the university has become a critical training resource for public health departments in Minnesota, North Dakota and Wisconsin. Over the years, the university has trained thousands of state and local public health workers in effective preparedness and response via face-to-face training as well as distance-based learning, Hickle told me. The first responders are trained in a variety of topics, such as hazardous materials exposure, how to use personal protective equipment and field survey instruments, and risk communication. They can also take advantage of online emergency simulations. If federal funds disappear, it would be a "real challenge" to continue and a number of training and learning opportunities could end, Hickle said.

"State and local health departments are pretty limited for resources, so we're a key resource for them," she said. "We really need to have research about public health preparedness systems in order to know what's worth the resources and what works."

Another area at risk is the Cities Readiness Initiative (CRI), a federally funded program aimed at the nation's largest cities and metropolitan areas and which primarily focuses on enhancing public health's ability to rapidly distribute and administer medications and vaccines in an emergency. According to TFAH, 51 of the 72 cities participating in the initiative face a possible elimination of funds. One of those cities at risk is Baltimore, one of three Maryland regions involved in the initiative.

"It's important for people to understand that training staff to do these kinds of things is a time-consuming process -- you don't train people overnight," said Sherry Adams, director of the Office of Preparedness and Response within the Maryland Department of Health and Mental Hygiene. "When you invest the time and energy and money to train people who are committed and then you lose them, you don't just reinvent them on the spur of the moment...we are talking about the capability throughout the state of Maryland of being able to get life-saving medicines to more than five million people in a very short period of time."

CRI funds in Maryland have supported extensive planning, training and exercises; partnership building with critical community partners such as hospitals; policy development; equipment needs; and the development of effective crisis communication channels between first responders as well as between local officials and the public, Adams said. While the federal initiative was developed to respond to a bioterrorist attack, Adams said the training and skills building are applicable to a variety of public health emergencies. For example, she said, the training was successfully employed during the 2009 H1N1 flu outbreak. If CRI funds start disappearing, it will likely result in job losses and make it difficult to maintain and update preparedness plans -- "it will stress our system considerably, especially at the local level," Adams told me.

"We've built a system to answer that emergency call; we've built the expectation among the residents that we're going to be there," she said. "But will we be there at full capability? That's the question."

The decline in public health preparedness funds will likely result in the erosion of the field's ability to respond to all kinds of threats, said Becker at the Association of Public Health Laboratories. For labs, in particular, TFAH reported that all 10 state labs with "level 1" chemical testing status are at risk for losing top-level capabilities, which would leave CDC with the nation's only public health lab with the full ability to test for chemical terrorism and accidents. If multiple chemical events did happen at one time, it could overwhelm CDC and force the agency to prioritize one region over another, Becker said. Like most public health efforts, he said, the "local response is crucial."

"We're at a critical point in this country," Becker said. "We can't go any lower than we are (in funding) and still be able to say to the public, 'you're protected.'"

For a copy of TFAH's report, "Ready or Not?: Protecting the Public from Diseases, Disasters and Bioterrorism," visit www.tfah.org.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for almost a decade.

lborkowski Thu, 01/19/2012 - 08:48

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Public Health - General

Too Much; Not Enough

milhayser — Mon, 26 Sep 2011 12:18:40 +0000

Too Much; Not Enough

On Starts With a Bang, Ethan Siegel investigates the hamstringing of the James Webb Space Telescope. Originally scheduled to launch in 2013 at a cost of $5.1 billion, the JWST was pushed to 2015 and $6.5 billion by a government review panel that faulted NASA mismanagement. But the revised numbers counted on timely infusions of cash, and because "a miserly US Congress" withheld them, the cost of the project ballooned to $8.7 billion, with a new launch date of 2018. Although its unprecedented mirrors are nearly finished—along with its electrical instruments and their housing—the JWST still waits on its massive sunshield, which means the project will stay grounded even as its price tag gets more astronomical. [UPDATE: funding for the JWST has been restored!] Meanwhile, on Uncertain Principles, Chad Orzel imagines an ark defined by qubits instead of cubits. God decrees, "thou shalt take into thine ark all of the numbers," to which Noah astutely replies, "if the ark is to be 300 by 50 by 30 qubits, then the maximum number to be stored within it must be no greater than 2⁴⁵⁰⁰⁰⁰." The supreme being asks if this is not close enough to infinity—and threatens to start smiting things when Noah suggests including more than just positive integers.

How the US Government Chose to Ruin the James Webb Space Telescope, and Blamed NASA on Starts With a Bang!
This Week's Reading in the Church of the Larger Hilbert Space on Uncertain Principles
News Flash: James Webb Space Telescope SAVED! on Starts With a Bang!

milhayser Mon, 09/26/2011 - 08:18

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Funding

quantum computing

Telescopes

Shrimp on treadmills, laundry-folding robots, and the problem of ridiculing research

lborkowski — Thu, 25 Aug 2011 16:27:21 +0000

Shrimp on treadmills, laundry-folding robots, and the problem of ridiculing research

I felt a sense of dÃ©jÃ vu Tuesday morning when I heard NPR's Nell Greenfieldboyce reporting on Senator Tom Coburn's attacks on National Science Foundation-funded research. I realized that the same thing happened last August, and I wrote about it in a post called "Scoring Political Points by Misunderstanding Science." Last year, the report mocked research into addiction and older adults' cognition (among many other projects) because the projects involved administering cocaine to monkeys and introducing senior citizens to Wii games. This year, the projects up for ridicule include research that involves putting shrimp on treadmills and designing a robot that can fold laundry.

As Greenfieldboyce has noted and Paul Raeburn of Knight Science Journalism Tracker has stated even more bluntly, criticisms by Coburn and others of government-funded research have vastly overstated the amounts spent on the actual items that are singled out for mockery. For instance, Greenfieldboyce reports that the half-million-dollar grant College of Charleston researchers received supported work on economically important seafood species, and the shrimp treadmill only accounted for around $1,000 of that.

This kind of misleading math from politicians and advocacy groups is all too common. What's uniquely disturbing about these kinds of attacks on scientific research, though, is the implication that a wacky-sounding experiments can't represent an important step toward a discovery that improves millions of lives.

Coburn's report includes links to NSF abstracts of the research it ridicules, so I checked out a couple of the projects to see what the scientists said about the potential applications of their research:

Shrimp on a treadmill
This project - actual name: "Impaired Metabolism and Performance in Crustaceans Exposed to Bacteria" - studies the extent to which shrimp and crabs' physical activity is impaired by bacteria and hypoxia (low oxygen). The researchers suspect that "the immune response [to bacteria] may make it more difficult for an organism to respond to hypoxic environments or to engage in significant physical activity," and to test this they conduct metabolism tests on shrimp and crabs that are resting, exercised, and exposed to hypoxia. How do you get a shrimp "exercised"? On a treadmill, evidently. It sounds funny, but it's a way to answer the research question.

The researchers are addressing "questions related to the health of economically important species" - and, since human activities contribute to hypoxia in coastal waters, I could see this research helping us make better-informed decisions about the costs and benefits of regulating development and agricultural activities in coastal areas.

Laundry-folding robot
Although the Coburn writeup makes it sound like the purpose of this robot is to free us all from laundry drudgery, the abstract for this project - actual name: "Learning for Control of Synthetic and Cyborg Insects in Uncertain Dynamic Environments" - describes very different goals. University of California-Berkeley researchers are developing algorithms that can help robots learn and adapt in complicated environments. When robots have these capabilities, we can use them for search and rescue missions following disasters - which can not only help victims, but reduce the risks to rescuers who'd otherwise be doing that work.

How we ride bikes
This project, at University of California-Davis, is actually called "Human Control of Bicycle Dynamics with Experimental Validation and Implications for Bike Handling and Design." I'm going to quote from the Coburn report here (citations omitted), because the explanation that its authors seems to think condemns the research actually reads to me like an explanation of why it's important:

In 2009, scientists at the University of California-Davis received a $300,000 grant to study how humans ride bicycles. [Researchers are] studying how people interact with and control their bicycles ... By studying motion capture technology and attaching sensors to riders in labs, the research team plans to develop software and computer models to "pave the way to the design of bicycles for a wider population and for a wider range of tasks...which in turn will lead to lower cost, healthier, and more sustainable modes of personal transportation."

Currently less than one percent of local trips in the United States are made on a bicycle, but the research team believes that bicycle usage might increase if designers had more insight into their design choices for different populations and different tasks.

I suppose if you don't see climate change, air pollution, gridlock, and ever-higher gas prices as problems, you might not see the value in helping more people ride bicycles.

So, once again, Senator Coburn paints himself as a prudent steward of taxpayer dollars by ignoring the fact that wacky-sounding experiments can produce important results and lay the groundwork for life-saving innovations. As a taxpayer, I can say that I'm happy to make these investments in research if they lead to better coastal planning, search-and-rescue robots, or reduced transportation pollution. And even if they don't, they may well serve as building blocks for other scientists' breakthrough innovations. That's what science is about - but I suspect Senator Coburn is more interested in scoring political points than improving understanding of the scientific enterprise.

lborkowski Thu, 08/25/2011 - 12:27

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Revere wrote about the laundry-folding robot a while ago (video included) and the whole thing is pretty darn cool:
http://scienceblogs.com/effectmeasure/2010/04/is_it_time_for_humans_to_…

Senator Coburn is my rep. *heddesk* Liberal Oklahoma apologizes, everybody.

Aside from the development of general algorithms from the "laundry-folding robot", even that specific task can be much more worthwhile if you think of what it could do for stroke victims, paraplegics & quadriplegics, and the like. Why does Tom Coburn hate the disabled & elderly?

I can just imagine these guys in times past:
"You want to do what under the University of Chicago bleachers? What's the point?"
"Go fly a kite!" (to Benjamin Franklin, obviously)

@Anne - Make sure you write him and let him know how disappointed in him you are. Most of the rest of us can't do more than roll our eyes, you might be able to show him that it's not worth it for him to carry on with this ridicule.

Tasha, I knew I'd seen the robot video but couldn't remember where - probably because Revere linked to it! Thanks!

Randy, I agree that even if all the robot did was fold laundry, that would still be pretty useful, especially to people with limited mobility.

Anne, I agree with Adam - write to your senator!

Hell, I'd be pleased with a robot that can actually fold laundry! It'd be the few uses of my tax dollars that doesn't make me want to scream or hit something.

This type of science non-understanding reminds me of a certain vice-presidential candidate criticizing fruit-fly research. Some heartless people are this "ignorant" on purpose, some headless people are this ignorant by accident?

To be fair, that shrimp really needed to drop a little weight.

No love for Coburn here. However, there have been plenty of experiments and studies looking at the bicycle over the years (and plenty of manufacturers trying to differentiate their products). I'm skeptical that another look at the vehicle is all that valuable. The types of studies I applaud all have to do with some aspect of this broad question: How can the existing infrastructure be modified to better support bicycle transportation? To use an analogy, we don't have a problem with the lightbulb, but we have some serious problems with wiring.

Scary thing is... I suspect Coburn's still not as bad as OK's other senator, Sen. Inhofe. (Disclaimer: my knowledge of OK's senators might be out of date, but those were the two last I heard of.)

Sam, that's a really odd analogy -- because we have enormous problems with lightbulbs! We really need better ones, and there are some promising new possibilities, even though people have been working on them since Edison burnt his hair!

I saw some of the Davis groups' bikes and posters at MakerFair this year, and they were pretty clear about what reasearch has been done and what they think is open. It really didn't seem like a solved problem to me -- commercially, most of the motives are for either very cheap and familar bikes, or very fast bikes that experts ride. Bikes that are easier and more efficient for everyday people would be a great boon. Just proving that the hundred-year-old diamond frame is an optimum would be impressive.

Coburn's idiotic brand of science-bashing goes back all the way to the beginning of the country. There always have been and always will be politicians like Coburn who pander to the dumbest, most selfish and ignorant inhabitants of their constituencies. Relax and enjoy it, because it will never, ever go away. At least until every American "is above average" as in Lake Woebegone.

Reminds me of Senator William Proxmire's Golden-Fleece awards. About some university's experiments with a walking robot, he snickered about how that robot will do wonders for that university's football team.

I think that William Proxmire and Tom Coburn would have hated some of the great scientific work of the past, if they had been around back then.

Making a ball of lodestone? Cross-breeding pea plants and fruit flies? Flying a kite in a thunderstorm? Working out lots of arcane mathematics that hardly anyone understands???

We're doing ourselves a disservice by conflating scientific progress with public policy. In the end, the politicization of science only benefits politicians. If we don't want politicians criticising our research, we shouldn't involve them in our work. As we so sanctimoniously point out, they're not even capable of understanding it. Why, then, do we continue to associate with government bureaucrats?

Rick: Because research, unfortunately, requires money, and if I have to choose between a government bureaucracy preoccupied with satisfying the general public and a corporate bureaucracy preoccupied with satisfying wealthy investors, I'd say general science has much better chances depending on government bureaucracy. Yes, work gets done under corporate funding, but corporate funding to a large degree comes with corporate interests. If those shrimp studies depended on the fishing industry for funding, for example, I'm not sure how reliable their results would be. Other than making research university tuition prohibitively expensive, I'm not sure where else the money would come from.

Sam, that's a really odd analogy -- because we have enormous problems with lightbulbs! We really need better ones, and there are some promising new possibilities, even though people have been

There used to be a verb (to proxmire) meaning to threaten the funding of a project for political reasons by subjecting it to mindless ridicule of this sort.

This is a driving force behind one of my pet peeves about Science _reporting_: the ridiculous apologetic that is apparently mandated by editors that the Science must somehow be linked to Engineering. Every report must end in one of these statements: "This research may soon lead to {a cure for cancer, a cure for disease, painless weight-loss, saving energy, making computers faster, more television channels, better smartphones, cheaper gasoline, a jacuzzi in every house}. It's an unimaginative, depauperate list that implicitly denigrates pure science, and, often, sticking-on the mandatory disclaimer "this will have short-term easy-to-understand benefits, really" is just silly.

I agree that even if all the robot did was fold laundry, that would still be pretty useful, especially to people with limited mobility.

I would buy a laundry-folding robot even if I weren't disabled.. who wants to fold laundry? Sounds great to me!
I wonder if ben franklin was ridiculed for his far-fetched key on a kite string experiment!

Politicians ridiculing science is not a new thing. As Loren pointed out above, remember the "Golden Fleece Awards" by Senator William Proxmire, which among other things, targeted SETI. I think that in most cases, the motivation behind this is not science or even public welfare; rather it is about publicity.

I know I am preaching to the choir in this thread, but the thing is that in a very real sense, you NEVER know the possible consequences of research. My current favorite example are the conotoxins. Who would have imagined that by studying marine snails you cound end up with a medication that helps alleviate pain in cancer patients?

@sam f: i absolutely agree with your Ben Franklin comment!!!!

I was originally going to write about an amazing article that appeared in the NEJM today, but then, as happens all too often, something more compelling caught my eye. Unfortunately, it's compelling in exactly the wrong way. It's infuriating and saddening, all at the same time

so good of you to put it down to political point scoring and not simply a senatorial lack of highschool science