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Tag: Science

Welcome to the (U.S. Science) Apocalypse

By KIM BELLARD

I’m starting to feel like I’m beating a dead horse, having already written a couple times recently about the Trump Administration’s attacks on science, but the hits just keep on coming. Last Friday, for example, not only did the Administration’s proposed 2026 budget slash National Science Foundation (NSF) funding by over 50%, but Nature reported that the NSF was ceasing not only making new grants but also paying out on existing grants.

Then this week, at an event called “Choose Europe for Science,” European leaders announced a 500 million euro ($566 million) program to attract scientists. It wasn’t specifically targeted at U.S. scientists, but the context was pretty clear.

Sudip Parikh, chief executive officer of the American Association for the Advancement of Science, called the proposed budget cuts “a crisis, just a catastrophe for U.S. science.” Even if Congress doesn’t go along with such draconian cuts and grant approval resumes, Dr. Parikh warns: “That’s created this paralysis that I think is hurting us already.” 

One NSF staffer fears: “This country’s status as the global leader in science and innovation is seemingly hanging by a thread at this point.”

Nature obtained an internal NSF April 30 email that told staff members “stop awarding all funding actions until further notice.” Researchers can continue to spend money they’ve already received but new money for those existing or for new grants are frozen “until further notice.” Staff members had already been told to screen grant proposals for “topics or activities that may not be in alignment with agency priorities.”

NPR reports that some 344 previously approved grants were terminated as a result, as they “were not aligned with agency priorities.” One staffer told Nature that the policy had the potential for “Orwellian overreach,” and another warned: “They are butchering the gold standard merit review process that was established at NSF over decades.” Yet another staffer told Samantha Michaels of Mother Jones that the freeze is “a slow-moving apocalypse…In effect, every NSF grant right now is canceled.”

No wonder that NSF’s director, Sethuraman Panchanathan, resigned last week, simply saying: “I believe I have done all I can.” 

If you think, oh, who cares? We still have plenty of innovative private companies investing in research, so who needs the government to fund research, then you might want to consider this: new research from American University estimates that even a 25% drop in federal support for R&D would reduce the U.S. GDP by 3.8% in the long term. And these aren’t one-time hits. “It is going to be a decline forever,” said Ignacio González, one of the study’s authors. “The U.S. economy is going to be smaller.”  

If you don’t believe AU, then maybe you’ll believe the Federal Reserve Bank of Dallas, which estimates that government investments in research and development accounted for at least a fifth of U.S. productivity growth since World War II. “If you look at a long period of time, a lot of our increase in living standards seems to be coming from public investment in scientific research,” Andrew Fieldhouse, a Texas A&M economist and an author of the Dallas Fed study, told The New York Times. “The rates of return are just really high.”

It’s no wonder, then, that European leaders see an opportunity.

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Shocking: Trump Builds a Wall Between Basic and Applied Research

By MIKE MAGEE

The leaders of America’s scientific community seem genuinely surprised by the actions of the past three weeks. They expected to be spared the wrath of Trump because they believed that “Americans of all political persuasions have respect for science and celebrate its breakthroughs.”

Maybe so. But that is an inadequate defense against a multi-pronged attack which includes purposefully selecting unqualified hostiles to key management positions; restricting scientists travel and communications; censuring scientific discourse; and clawing back promised funding for research projects already underway. This “knee-capping” has extended beyond our geographic boundaries with Trump’s vengeful withdrawal from the WHO and the Musk inspired elimination of USAID.

“This too will pass,” whisper Republicans behind closed doors. But even so, the nature of scientific discovery and implementation is a complex rebuild. This is because the path from innovation to invention to implementation is interdisciplinary and requires collaborative interfaces and multi-year problem solving. Not the least of the challenges is gaining access, trust, and cooperation from the general public which requires funding, public education, and community planning.

Take for example a life saving device that is increasingly ubiquitous–found everywhere these days from rural high school cafeterias to the International Space Station and everywhere in between-– the Automated External Defibrillator or AED.

It is estimated that AED’s have the potential to save 1,700 American lives a year. Experts estimate that over 18,000 Americans have a life threatening cardiac arrest outside of a hospital with a shockable rhythm disturbance each year. But 90% don’t survive because access to an AED is delayed or not available. Without a correction in about ten minutes, you are likely to die. This means that the 6 pound AED has be where the patient is, the bystander has to know what to do with it, and there can be no delay.

Creating the modern day AED was a century long affair according to the  “Institute of Electrical and Electronics Engineers” or IEEE .

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(We Don’t) Trust The Science

By KIM BELLARD

I know the A.I. community is eagerly waiting for me to weigh in on the Sam Altman/OpenAI dramedy (🙄), but I’m not convinced this isn’t all a ploy by ChatGPT, so I’m staying away from it.  A.I. may, indeed, be an existential issue for our age, but it’s one of many such issues that I fear we’re not, as a society, going to be equipped to handle.

Last week the Pew Research Center issued an alarming report Americans’ Trust in Scientists, Positive Views of Science Continue to Decline. Now, a glass half-full kind of person might look at it and say – no, it’s good news!  Fifty-seven percent of Americans agree science has a mostly positive impact on society, and 73% have a great deal or a fair amount in confidence in scientists to act in the public’s best interests.  For medical scientists it was 77%. Only the military (74%) also scored above 70%. That’s good news, right?

The glass half-empty person would point to the downward trend in just the past few years: at the beginning of the pandemic (April 2020) the respective percentages were 87% (scientists), 89% (Medical scientists), and 83% military.  The faith in them has continued to drop since.  Things are trending in the wrong direction, quickly.

If the glass was half full, it’s spilling now.

About a third (34%) of the public thinks that the impact of science on society has had an equally positive and negative impact, while 8% think science has had a mostly negative impact. Again, the trend has been negative since the pandemic; the 57% who think science has a positive impact was 73% in January 2019. That’s alarming.

The skepticism about scientists and the value of science has increased generally but is more pronounced among Republicans and those without a college degree.  E.g., only 61% of Republicans have a fair/great amount of confidence in scientists, versus 85% in April 2020 and versus 86% of Democrats now.  Fewer than half (47%) of Republicans think science has had a mostly positive impact on society, versus 70% on January 2019.

In the supposed most developed country in the world, 39% of Americans think the U.S. is losing ground in science achievement versus the rest of the world, and only 52% even agree it is important for the U.S. to be a world leader in scientific achievements.  10% didn’t think it was important at all. Young people, surprisingly, were most skeptical.

I wonder what they do think it is important for us to be the world leader in.

The problem may be that a third thought developments in science were changing society too quickly (43% among Republicans).  They want their new iPhones, they like fast internet speeds, they demand the latest treatments when they get sick, but somehow they don’t connect those to science.

I think about this when I read about the Texas board of education fighting about how science is taught in Texas schools.

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We’re Disrupting Disruption

By KIM BELLARD

The Sunday Times featured an op-ed by Mark Britnell, a professor at the UCL Global Business School for Health, with the headline Our creaking NHS can’t beat its admin chaos without a tech revolution. Substitute “U.S. healthcare system” for “NHS” and the headline still would work, as would most of the content.   

I wouldn’t hold my breath about that tech revolution. In fact, if you’re waiting for disruptive innovation in healthcare, or more generally, you may be in for a long wait.

A new study in Nature argues that science is becoming less disruptive. That seems counterintuitive; it often feels like we’re living in a golden age of scientific discoveries and technological innovations. But the authors are firm in their finding: “we report a marked decline in disruptive science and technology over time.” 

The authors looked at data from 45 million scientific papers and 3.9 million patents, going back six decades. Their primary method of analysis is something called a CD Index, which looks at how papers influence subsequent citations. Essentially, the more disruptive, the more the paper itself is cited, rather than previous work.       

The results are surprising, and disturbing. “Across fields, we find that science and technology are becoming less disruptive,” the authors found, “…relative to earlier eras, recent papers and patents do less to push science and technology in new directions.” The declines appeared in all the fields studied (life sciences and biomedicine, physical sciences, technology, and social sciences), although rates of decline varied slightly.  

The authors also looked at how language changed, such as introduction of new words and use of words that connote creation or discovery versus words like  “improve” or “enhance.” The results were consistent with the CD Index results.

“Overall,” they say, “our results suggest that slowing rates of disruption may reflect a fundamental shift in the nature of science and technology.”

“The data suggest something is changing,” co-author Russell Funk, a sociologist at the University of Minnesota in Minneapolis, told Nature. “You don’t have quite the same intensity of breakthrough discoveries you once had.”

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A War on Science is a War on Us

By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

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“I Like (Political) Science and I Want to Help People”

I thought I was an oddball in college. I’ve only recently learned that I was avant-garde.

Right before beginning college in 1975, I decided I wanted to be a doctor. Being the first-born son – with decent SATs – of an upwardly mobile Long Island Jewish family, I had relatively little choice in the matter. Notwithstanding this predestiny, I felt confident that medicine was a good fit for my interests and skills.

But on my med school interviews four years later, I stumbled when the time came to answer the ubiquitous, “Why do you want to be a doctor?” question. The correct (but hackneyed) response, of course, is “I like science and I want to help people.” You’ll be comforted to know that I had no problem with the helping people part. It was the science thing that threw me for a loop.

It wasn’t that I didn’t like science, mind you. I found biology interesting, and organic chem was kind of cool, in the same way that Scrabble is. But I barely tolerated Chem 101, and disliked physics.Continue reading…

Thomas Kuhn, Health Care Reform and Vascular Disease

The puzzle of improving care and reducing costs in American medicine and in vascular conditions (that is, diseases associated with blood vessel metabolism) in particular – these are responsible for 60 percent of all cost – has been in part due to the nature of medicine itself.  Physicians are at their core scientists. Our undergraduate degrees are in the scientific disciplines of biology, chemistry, physics. We have been educated in the culture of science and that is the environment in which we practice.

Thomas Kuhn’s The Structure of Scientific Revolutions perfectly describes a central problem in cardiovascular diseases.  A scientific community cannot practice without a set of core beliefs. These central constructs are, in Kuhn’s terms, the foundation of the “educational initiation that prepares and licenses the student for professional practice.” The student’s instruction is “rigorous and rigid,” with the purpose of ensuring that these beliefs are firmly fixed in the student’s mind.

Scientists go to great lengths to defend the idea that they know what the world is like. It should come as no surprise then that “normal science,” – that is, the framework to explain the world used by the scientists who lead the current paradigm – will often suppress novelties that undermine its foundations.

So research often is not about discovering the unknown, but rather “a strenuous and devoted attempt to force nature into the conceptual boxes supplied by professional education.” A generally-accepted paradigm, essential to effective scientific investigation, requires “some implicit body of intertwined theoretical and methodological belief that permits selection, evaluation and criticism.” That paradigm, in turn, forms the basis of a new profession or specialty, like Interventional Cardiology, and from this follows the establishment of journals, societies, and a special place in the medical academic structure.  The articles in those journals are intended for professional colleagues who share the the field’s knowledge and who are the only ones capable of fully understanding them.

A shift in the accepted scientific construct occurs when research aimed at further developing that formulation of the evidence runs into an anomaly — a fact that does not fit the paradigm and cannot be explained away. When anomalies pop up, they typically are not welcome and may be ignored. The current paradigm’s scientists may make little or no effort to formulate a new theory to explain the phenomenon. They are also likely to be intolerant of practitioners who try to do so.

All the same, the discovery of anomaly is the stimulus that leads to a new paradigm. The failure of  existing beliefs and rules is the necessary but insufficient platform for the development of new scientific and practice structure.

The leaders of an entrenched paradigm strongly resist alternate systems of science and practice. Only in  crisis can that resistance be overcome. No better example of this can be found than the current situation in the treatment of cardiovascular and arterial disease.

*****

The fixed blockage is the dominant paradigm today for both the science and practice of cardiovascular and arterial disease management. In other words, it is viewed as a plumbing problem. This paradigm has persisted because it made so much sense.

Angina is a historical diagnosis – particularly in a man.  Just talk to the patient and you can make the diagnosis. If a man walks and gets chest pain that is relieved by rest, he has angina. Almost all of those men have a blockage of 70% or greater.

If the cardiologist does a catheterization he will demonstrate the blockage.  If he opens the blockage with a stent the pain will go away.  But many men with angina go on to have heart attacks – it is high risk.  So it is no surprise that blockage became the dominant scientific paradigm. To this day, virtually the entirety of the science, practice, and financing are organized around this idea: Heart attacks are caused by a progressive blockage. If we open that blockage before it becomes complete, we will save the patient.

Now the anomaly. In 1988, WC Little and his colleagues at Wake Forest performed a study “to help determine if coronary angiography can predict the site of a future coronary occlusion.” If the plumbing model were correct and a progressive blockage of the artery caused myocardial infarction, the findings on coronary angiography should predict the site of heart attack. It did not.

Little and his colleagues studied 42 consecutive patient records of patients who had had coronary angiography before and up to a month after having a heart attack. In 19 of 29 (66%) patients, the artery that occluded subsequently had less than a 50% occlusion on the first angiogram. In 28 of 29 (97%) the stenosis (or narrowing of the vessel) was less than 70%, even though it takes a stenosis of 70% or greater to justify angioplasty with stenting.

Little concluded

“Because it was difficult to predict the site of subsequent occlusion in our patients from the initial coronary angiogram, coronary bypass surgery or angioplasty appropriately directed only at the angiographically significant lesions initially present in almost all of our patients would not have been effective in preventing the majority of infarctions…instead effective therapy to prevent myocardial infarction may need to be directed at the entire coronary tree…”

And, in keeping with Kuhn’s description of the scientific revolution, the best arterial disease scientists quickly developed a new paradigm that provides a much better explanation of the mechanism of heart attack and other vascular events. Within 7 years of the first anomaly, Erling Falk, Prediman K Shah and Valentin Fuster, leading academic cardiologists, summarized four studies that came to the same conclusion as Little. Only 14% of heart attacks occur in an artery that was 70% blocked on the previous catheterization. Only 14% of heart attacks occurred in an artery with enough obstruction to cause angina and justify bypass surgery or stenting.  Falk and his colleagues described the new paradigm very simply:

“plaque disruption with superimposed thrombosis (obstructive clot) is the main cause of the acute coronary syndromes of unstable angina, myocardial infarction, and sudden death.”

Peter Libby is Chief of Cardiology at Boston’s Brigham and Women’s Hospital, one of Harvard’s teaching hospitals. One of the world’s foremost authorities on the science of heart attack and plaque rupture, he quite literally “wrote the book” on the topic. In the volume of Harrison’s Principles of Internal Medicine, the standard reference text for the discipline, that sits on my desk, Peter Libby wrote the chapter entitled The Pathogenesis of Atherosclerosis.

In 1995, the same year as the Falk article, Libby wrote a piece called “The Molecular Basis of the Acute Coronary Syndromes.”

“Bypass surgery or transluminal angioplasty (dilation of the artery and then, propping it open with stents) provide rational and often effective therapies for these fixed, high-grade stenoses (blockages).  However, these treatments do not address the non-stenotic but vulnerable plaque (which may rupture and suddenly block the artery with clot).  It is of interest in this regard that despite the well-accepted benefit of coronary bypass surgery on anginal symptoms, this treatment aimed at severe stenoses does not prevent myocardial infarction. To reduce the risk of acute myocardial infarction, one must stabilize lesions to prevent this disruptions, particularly the less stenotic plaque.”

In other words, heart attack is not caused by a gradual narrowing of the artery, but rather is the result of sudden cholesterol plaque rupture with subsequent clot formation, which blocks off the artery and cuts off blood flow.

Today, 14 years later, we can dramatically stabilize plaque and reduce plaque progression by smoking cessation and reduction of cholesterol, triglycerides, blood pressure, and blood glucose.  We can prevent clot formation with aspirin and other medications.

The scientific revolution in vascular disease is 20 years old and the new paradigm firmly in place and supported by the very best vascular scientists. Still, the practice paradigm persists as if the science never changed.

Just last year, I heard a brilliant talk by Valentin Fuster, one of the co-authors on the Falk article. Afterward I asked him what it would take to move the practice paradigm forward. He responded that it would take the time required to replace current practitioners wi
th the next generation.

Can we afford to wait for that?  Several years ago, I heard Dr Libby speak at a national meeting of the American Society of Hypertension. I later asked him, “Dr Libby, I read your article from 1995, saying that bypass and stenting do not prevent heart attack, do you still hold that view.”  He became very animated and enthusiastic and said he was convinced that the new science was valid and required action to move it forward.

The science has become irrefutable.  Yet the defenders of the old science still carry the day.  I fear that medical scientists will not move this forward and it will require changes in payment and support for research coming from outside the professional community to bring the latest science to patients.

We have to recognize the suppression of anomalies and new paradigms in medicine. Only then can we develop mechanisms that can bring the latest evidence-based science to patients.

Bill Bestermann is Medical Director, Integrated Health Services at Holston Medical Group in Kingsport, TN.

The New Science of Vascular Disease

BesterrmannVascular
disease and the conditions that produce arterial problems consume
roughly one- third to one-half of the $2 trillion annual spend in
American health care. The science and systems exist today to dramatically improve the quality and cost related to cardio-metabolic
conditions but almost nothing has been done to implement these new
tools since the Institute of Medicine (IOM) published “Crossing
the Quality Chasm
” in 2001.

The most glaring
example of the failure of medical and political leadership in these
matters can be found in the treatment of chronic conditions, which
consume 70 percent of our health care dollars. “Crossing the
Quality Chasm” was a stinging indictment of American medicine,
describing a system that is in need of fundamental change, with many
professionals and patients concerned that the care delivered is not
the care that we need. The report described a system that harms too
frequently and routinely fails to deliver its potential benefits.

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