Alexandra Sifferlin

The United States may no longer be the leader in medical research due to lack of funding

Funding for medical research in the United States is in a sorry state, but other parts of the world are experiencing the opposite, according to a new study published Tuesday in the journal JAMA.

Limited funding is one of the reasons there was no Ebola vaccine approved when the current outbreak got so bad and it’s why already hard-to-fund research for infectious diseases and addiction don’t often make it to clinical trials. For decades the U.S. was responsible for over half of the world’s total funding for medical research. But looking at funding for U.S. and international research from 1994 to 2012, the study authors found current trends are telling a different story.

Research funding from the United States dropped from 57% of the global pool in 2004 to 50% in 2012. Asia on the other hand tripled its investment in research over the same period, from $2.6 billion in 2004 to $9.7 billion 2012. America also experienced a drop in its share of life science patients, with its share of highly value patents filed by American inventors dropping from 73% to 59% from 1981 and 2011.

Overall, research funding in the United States has dropped 0.8% every year from 2004 to 2012.

The data shows that globally, most countries are cutting back. But the United States used to have a unique edge when it comes to science innovation and funding.

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The researchers argue that the United States needs to start looking for other ways to fund research, whether it be through taxes, tax breaks or the adoption of bonds for biomedical research, in a similar way to how bonds have helped build environmentally sustainable infrastructure. In a corresponding editorial, Dr. Victor J. Dzau, the president of the Institute of Medicine, and Dr. Harvey V. Fineberg, the presidential chair of University of California, San Francisco, say researchers themselves need to be part of the solution too. They write: “It is the responsibility of the research community to ensure that money for research will be used effectively and efficiently. A first step is to reduce redundancy and duplication of research through better grant selection and coordination.”

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Ultimately, if the United States wants to maintain its standing as a leader in medical innovation, it needs to start considering non-traditional approaches to research funding, the authors say. They add that even public support has dropped for biomedical research, being replaced with concerns like domestic security, immigration and the economy, possibly due in part to the fact that in the public eye, there haven’t been many breakthroughs in areas like cancer and Alzheimer’s disease.

“Given global trends, the United States will relinquish its historical innovation lead in the next decade unless such measures are undertaken,” the authors conclude.

A new federal report reveals holes in how we treat chronic pain

The clinic has been cited for multiple errors in its care of the late comedian

The New York clinic where TV personality Joan Rivers underwent vocal cord surgery, before her sudden deterioration and death, will lose its federal accreditation at the end of the month.

As of Jan. 31, Yorkville Endoscopy will no longer receive Federal funds for services given to Medicare and Medicaid beneficiaries, the Huffington Post reports.

Earlier this past year, the New York State Department of Health determined that the clinic made multiple errors during Rivers’ care. Rivers died on Sept. 4 after suffering brain damage from lack of oxygen after she quit breathing during surgery only a few days earlier.

An employee of the clinic also reportedly took a photo of Rivers during the surgery.

The clinic released a statement, saying: “We are continuing to work with all regulatory bodies. We intend to communicate with CMS and appropriate authorities to have the decision reversed. Yorkville continues to be a licensed facility and perform procedures while cooperating with the regulatory process.”

This is his third time winning the award

Cristiano Ronaldo has won the FIFA Ballon d’Or, an award that goes to the player with the best performance that year, for the second time in a row.

It’s the third time total that the Portuguese player has won the award. “I would like to continue the work that I have done so far. I want to try to improve, to become better as each day goes by. I never thought that I would bring this trophy back home on three occasions. I want to become one of the greatest players of all time,” Ronaldo said in his acceptance speech.

This year, Ronaldo’s team Real Madrid won the Club World Cup, and Ronaldo was given a rather, ahem, attention-grabbing statue in his hometown of Funchal, Madeira Island.

Ronaldo accepting the award in 2014:

Senators say energy drink companies should not market to youth under age 18

There’s no denying the energy drink industry is booming, with 60% growth between 2008 to 2012. But a new report from three U.S. senators raises questions about one particular segment of the market that’s growing: minors.

The report, titled “Buzz Kill,” is part of senators Edward J. Markey (D-Mass.), Dick Durbin (D-Ill.), and Richard Blumenthal (D-Conn.)’s ongoing investigation into the energy drink industry. Their primary concerns are lack of regulation by the U.S. Food and Drug Administration (FDA) over the drinks, which may pose health problems for kids, adolescents and teens.

In 2013, the three senators sent letters to 16 energy drink companies asking about their willingness to report any adverse reactions to their products as well as to voluntarily submit to restrictions against marketing to young people. In “Buzz Kills,” the senators report that just four of the 12 companies say they avoid marketing their energy drink to people under 18.

“Unfortunately, as long as early development of brand loyalty is seen as a competitive market advantage, energy drink companies will continue with the practice of marketing to teens in the absence of regulation that prohibits it,” the report reads.

The American Beverage Association has long offered guidance to the beverage industry on labeling, advisory statements, and marketing to children, recommending voluntary statements that the drinks are not recommended for kids and that the products not be promoted at K-12 schools. While several energy drink companies, including Red Bull and Monster, have made a commitment not to market to kids 12 and under, some critics say people over age 12 are still at risk for possible health consequences, like neurodevelopment interactions and heart-related effects.

In response to the report, American Beverage Association spokesperson Christopher Gindlesperger said this, in a statement:

“Energy drinks have been enjoyed safely by millions of people around the world for more than 25 years, and in the U.S. for more than 15 years. Energy drinks, their ingredients and labeling are regulated by the FDA, and, like most consumer products, their advertising is subject to oversight from the U.S. Federal Trade Commission.

This report ignores crucial data about energy drinks and caffeine consumption in the U.S. Based on the most recent government data reported in the journal Pediatrics, children under 12 have virtually no caffeine consumption from energy drinks. This study’s findings are consistent with an analysis commissioned by FDA and updated in 2012, as well as a published ILSI survey of more than 37,000 people which shows that caffeine consumption in the U.S. has remained stable during the most recent period analyzed, while coffee remains the primary source of caffeine in most age groups.

Leading energy drink manufacturers voluntarily go far beyond all federal requirements when it comes to labeling and education. In fact, ABA member companies voluntarily display total caffeine content – from all sources – on their packages along with advisory statements indicating that the product is not recommended for children, pregnant or nursing women and persons sensitive to caffeine. They also have voluntarily pledged not to market these products to children or sell them in K-12 schools.

Based on current regulations, the companies are not breaking rules. An FDA regulatory category for “energy drinks” does not exist, and companies can file their energy drinks to the FDA as either foods or dietary supplements. Some companies do not need to label the amount of caffeine in their products, and others are not required to report adverse health events linked to their products. Given the regulatory confusion, the report authors say the FDA and manufacturers need to make some changes for better transparency.

The senators call on the FDA to set a recommendation for the amount of caffeine a child or adolescent can safely consume each day. They also argue that all energy drink companies should commit to providing adverse-event reports to the FDA, and companies should stop promoting their beverages as “sports drinks.”

You can read the full report, here.

As the energy drink market continues to grow, and research continues to develop, the debate over whether energy drinks should be allowed in the hands of teens will continue.

Does who you are online match who you are in real life? A new study published in the journal Personality and Social Psychology Bulletin shows that avatars, the little icons you can customize in video games and Internet forums, are pretty good depictions of the people who created them.

Since more and more people meet and develop friendships and relationships online, researchers at York University in Toronto looked into whether the impressions people get from avatars, like the kind you use on Nintendo Wii and World of Warcraft, are true reflections of the real-life players they’re interacting with. To measure this, the researchers had about 1oo people create an avatar representation of themselves, and then asked nearly 200 others to rate the avatars on openness, conscientiousness, extraversion, agreeableness and neuroticism.

The results show that traits like being outgoing or anxious are pretty easy to assess, but other traits like conscientiousness and openness to new experiences are more difficult. People with agreeable traits were better able to get their personalities across through their avatars than narcissists.

Specific physical traits of the online characters helped translate personalities more than others. Smiles, brown hair, sweaters and open eyes were more likely to come across as friendly and inviting, compared to avatars with neutral expressions or those that didn’t smile. Avatars with black hair, a hat, short hair or sunglasses were less likely to come across as friendly or desiring friendship.

Interestingly, the people in the study didn’t seem to apply usual gender stereotypes to the avatars, though avatars made by females were rated as more open and contentious over all. The researchers speculate that perhaps the digital realm has gender stereotypes that differ from the ones we more commonly experience offline.

“The findings from this study suggest that we can use virtual proxies such as avatars to accurately infer personality information about others,” the study authors conclude. “The impressions we make on others online may have an important impact on our real life, such as who becomes intrigued by the possibility of our friendship.”

Addiction is a growing epidemic in the United States. So why don't we have a vaccine?

Every week, the chemist Kim Janda at the Scripps Research Institute gets at least one email—from an heroin addict or a person who loves a heroin addict—that goes something like this:

“I know you have no idea who I am, but I, as any true mother, want to save my son’s life—as does he! The problem is he can’t beat the craving and we are out of money. I will do whatever it takes to help him…Is there any way that he can become a part of a study for this vaccine?”

Janda responds to each email with the bad news that he has no current trials to enroll them, despite the fact that he has created what is likely the most promising vaccine against heroin addiction ever developed. Unfortunately, as is the case with lots of promising addiction research, no one wants to bankroll it.

“No pharmaceutical company is going to fund trials for heroin, no way,” says Janda, who’s been working on addiction vaccines for decades. “For meth? No way. Forget about it.” Janda has also worked on a meth vaccine. He has one for cocaine and one for a date rape drug too, but the heroin vaccine is the one he’s most confident about because it was proven to work a in clinical trials on rats. “The heroin one has been our best success in over 25 years of working—it’s the best data we’ve seen,” says Janda.

In 2013, preclinical trials of the drug on heroin-addicted rats showed those vaccinated didn’t relapse into addiction and were not hooked by high amounts of heroin in their system. “It’s really dramatic,” says Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) who was involved in the heroin vaccine research. “You can inject a rat with 10 times the dose of heroin that a normal rat [could handle] and they just look at you like nothing happened. It’s extraordinary.”

Meanwhile, heroin addiction and overdose deaths are sharply increasing in the United States. A record number of people now use the drug, many of them “graduating” to heroin from painkillers. In July 2014, the CDC reported that 46 Americans die from an overdose of prescription painkillers every day. Doctors wrote 259 million prescriptions for pain killers in a single year—enough for every U.S. adult to have a bottle of pills. Painkillers and heroin both come from the opioid poppy, but heroin is considerably less expensive than painkillers and, while it’s illegal, it does not require a prescription.

“In the 60s and 70s, if someone was addicted to heroin, it meant they began by putting the needle in their arm,” says Dr. Andrew Kolodny, chief medical officer of the rehabilitation nonprofit Phoenix House. “That’s different from the average person using heroin today. It’s affecting mainstream, white America.”

The heroin vaccine, should it go to market, would not be the first pharmacological attempt to treat addiction. There are a handful of FDA-approved drugs like naltrexone and acamprosate for drug and alcohol addiction, and buprenorphine, which treats opioid addiction by curbing withdrawal symptoms. But they’re imperfect. For example, the medications must be taken every day, and stopping too quickly can also cause withdrawal.

Lack of funding for vaccine research aside, success has been elusive for the trials that have tested addiction vaccines on humans. A 2014 cocaine vaccine study showed disappointing results, and in 2011 a late-stage trial for a vaccine to help nicotine smokers fell short.

Such setbacks in the field hinder Janda’s own work and hopes at getting funding for his vaccines, he says.

Creating a vaccine for addiction is tricky because addictive drugs toy with the body and the brain, tapping directly into the brain’s reward systems, which are needed for survival. Vaccines have to interfere with that—without causing a number of other problems.

Janda’s vaccine works a bit like a sponge in the blood stream. If a person—or, in this case, rat—is inoculated, that “sponge” sucks up the drug and prevents it from reaching the brain. Some drugs for addiction will block receptors in the brain so when a drug reaches the brain it can’t activate it like it used to; the heroin vaccine prevents the drug from reaching the brain at all.

Janda and Koob are hoping to get investigational new-drug (IND) distinction from the FDA so that they can test the vaccine in humans. They have backing from the National Institutes of Health experts—National Institute of Drug Abuse allocated $27.1 million dollars to addiction-vaccine research in 2014—but it’s not enough for a human clinical trial.

Addiction vaccines are not without skeptics. Some experts think that the vaccine approach to addiction is small minded, since addiction is physical and psychological—and a vaccine would only treat part of the problem. Others cite earlier trials of other vaccines that didn’t pan out, such as a recent one for cocaine addiction. “I understand why there are skeptics,” says Dr. Andrew Kolodny of Phoenix House. “We have this expectation that for every kind of medical problem, there’s a perfect pill out there. But I think vaccines do hold tremendous promise for future treatments of addiction.”

If the heroin vaccine is to make it to human clinical trials, and even to market, it needs more research and the research needs more money. And while our understanding of addiction has evolved in recent years, many still view addiction as a moral failure of the addict, not something that can be cured or prevented using the same framework used for any communicable disease.

“I am not sure Americans realize that if they treated alcoholism and drug addiction they would save quadrillions of dollars in health care costs,” says Koob. “Go into any emergency room on the weekend and you will see half are there for alcohol and drugs. If for no other reason, investing in research on addiction will reduce health care costs in the future. That’s something I believe in.”

The mosquito-borne disease chikungunya infected more than one million people in 2014 (including actress Lindsay Lohan), and is continuing to spread across the globe. But a new study from scientists at Smithsonian Tropical Research Institute (STRI) suggests a strategy for squashing the disease.

Eradicating mosquito-borne diseases is notoriously tricky. Countries around the world are home to the same types of mosquitos, which means that if someone is bitten and infected with a disease while on vacation, they might return home and be bitten by native mosquitos. Those mosquitos may mate or bite someone else, spreading the disease. That’s how chikungunya, which causes debilitating joint pain, appears to have hopped around the globe in recent years.

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In their new study, the researchers looked specifically at the spread of chikungunya in Panama. They observe that it started in Panama when people got the disease on vacation and brought it into the country, but now the disease is now spreading across Panama via roadways. To combat this, the scientists say vehicles should be fumigated at check points to prevent mosquito transport and stop the disease from reaching areas in Panama that haven’t seen cases yet.

Other strategies need to be implemented delicately, the researchers say. Chikungunya spreads with the help of two types of mosquitos: Aedes aegypti and Aedes albopictus, the same mosquitos that spread dengue fever. Many countries, Panama included, have fought dengue in ways that could unintentionally complicate chikungunya efforts. For example, in May 2014, Panama allowed the company Oxitec to release genetically modified sterile male mosquitos. When the mosquitos mate, offspring do not survive into adulthood and mosquito populations will die out.

The worry is that when the genetically modified mosquitos lower the populations of Aedes aegypti, Aedes albopictus mosquito populations could grow because of the lack of competition. It hasn’t happened yet, but the researchers worry it’s a potential consequence.

While understanding the full spectrum of mosquito-borne diseases may lead to pathways for prevention, this study shows just how complicated that process can be.

"Cassandra C" reportedly believes chemotherapy will do her harm rather than save her life

A 17-year-old cancer patient does not have the right to refuse treatment for her disease, the state of Connecticut’s highest court has ruled.

In a significant decision Thursday, the State Supreme Court upheld a lower court’s ruling allowing the girl, identified as Cassandra C. in court papers, to be forced to undergo treatment for Hodgkin lymphoma, according to the Hartford Courant. Her doctors say that she will die unless she undergoes chemotherapy.

Cassandra’s mother, Jackie Fortin, says her daughter believes the chemical treatment will do more damage to her than the cancer. Fortin said she respect’s Cassandra’s decision.

Cassandra was removed from Fortin’s care after the mother and daughter missed follow-up appointments and placed into the custody of child welfare officials, who forced her to undergo the cancer treatment. The teenager ran away from hospital after just two days of chemotherapy.

The court made its expedited decision Thursday following a 45-minute hearing, during which lawyers for Cassandra and her mother argued that even though Cassandra is a minor, she can make her own health decisions. Cassandra is months away from turning 18.

“The general rule for adults is that you can say no to treatment no matter how life-saving it may be,” said one of Cassandra’s attorneys, Joshua Michtom. “You can say no even to helpful treatment. If she were 18, no matter what anyone said, it would be her choice to make.”

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