Francis Collins, director of the National Institutes of Health, has a new blog out on how gastric bypass surgery affects the development of type 2 diabetes.
Today’s news include the passing of Arlen Specter, former Senator from Pennsylvania. Most of the obituaries will focus on his important role in Supreme Court nomination fights, the impeachment of President Clinton, being one of only 3 Republican votes for the Affordable Care Act and for supporting NIH, including stem cell, breast cancer, Alzheimer disease research. All this is true of course. But when it comes to NIH, his contribution is so much greater.
When Specter came to Congress in 1983, the NIH budget was about $3.6 billion. Now, it is about $30 billion. Much of that increase is due to the year-in-year-out work on the Appropriations Committees of which Senator Specter was a leader…for all areas of research. His staff was always open and interested in how basic biomedical research can be expanded. Specter was part of a cadre of Republicans in the 80s and 90s which included Lowell Weicker, Pete Domenici, and, in the House of Representatives, Silvio Conte, who continually worked with Democratic allies like Senator Tom Harkin, Ted Kennedy, Dave Obey and William Natcher to grow NIH. These Members had a huge respect for NIH, often referring to it as the “crown jewel” of the federal government. They understood that biomedical was an engine not only to improve treatments and cure diseases but to support drug and device developers, the biotech industry, hospitals, the health professions and others grow and prosper. Unfortunately, today, we do not have a similar senior cadre with the same commitment to biomedical research. And, as a result, the NIH budget is stagnant. There are great shoes which other Members of Congress can, and should, fill.
On March 30, 2011, NIH released a new version of its Strategic Plan for Obesity Research. There isn’t anything particularly new in the plan. It is more or less a signal to researchers what the NIH expects to fund in the next few years. As with earlier plans, this one lacks any sense of urgency in addressing and views most issues as interesting from a research point of view rather than fitting into a comprehensive strategy for obesity prevention and treatment. There is weak attention to the challenges of developing medicines to treat obesity, to the value of engaging obesity prevention/interventions on an international scale and to attacking obesity in lower socioeconomic groups and ethnically diverse communities most in need. In other words, it is largely academics talking to other academics. Nevertheless, it does an insight into the complexity of obesity which the policy-makers who spout the diet-and-exercise line would do well to read. Strategic Plan for NIH Obesity Research
December 30, 2008
By Morgan Downey
At this time of year, millions of Americans are hoping the new Administration will solve our seemingly intractable problems at home and abroad. Millions are also hoping to lose weight in the New Year. The two are not unrelated.
Over the past three decades, obesity has increased among all segments of the population, in the United States and abroad. Obesity is now recognized as the fuel behind many major health problems from cancer to diabetes to heart disease, and a significant cause of increasing health care utilization and health care costs.
While this recognition has increased among both Republicans and Democrats (for the first time, both parties recognized obesity in their 2008 party platforms), changing public policy has not caught up with the problem. Under President George W. Bush, Medicare did undo its policy that obesity was not a disease and did expand coverage of surgery for the treatment of obesity. There have been modest increases in the research and prevention budgets at the National Institutes of Health and the Centers for Disease Control and Prevention. But by and large, the efforts of the last eight years have been largely educational: tell people they should lose weight, eat more nutritiously, and exercise more.
Duh! We get it. And it doesn’t work. Frankly, other than bariatric surgery, nothing works very well to lose significant amounts for a long period of time. There simply is not one ‘fix’ that will reverse this disturbing trend.
So here is some advice to the incoming Administration. It should be noted that many appointees named so far have a solid exposure to obesity from a public policy perspective, including former Senator Tom Daschle, nominee for Secretary of Health and Human Services, Peter Orszag, named to head the Office of Management and Budget, Governor Bill Richardson, nominated for Secretary of Commerce, and Melody Barnes, incoming chief of domestic policy at the White House.
Universal health insurance is often put forward as the panacea for all ills. However, Democrats may have to learn that expanding health insurance coverage alone does not translate to a healthier population, especially if obesity continues to increase among children and adolescents. Truth be told, we do not have adequate medical interventions to affect the rates of obesity and its effects. So, if we do not know how to truly prevent obesity or create a long term treatment, what should a new Administration do? Basically, it should focus on how to create the conditions where it is more likely than not that we will find effective strategies for prevention and treatment in the future.
The obesity epidemic is more likely than not to continue to grow over the next four to eight years. However, the new Administration can position the United States for meaningful change if it takes its time and devotes attention to organizing the effort. With any luck, we can make future New Year’s resolutions more likely to be successful.
January 5, 2011
A new paper from the Agency for Healthcare Quality and Research finds limited evidence for long-term changes in body weight through lifestyle interventions for Type 2 diabetes, breast cancer, Metabolic Syndrome and Prostate cancer. Comments are being accepted until January 13, 2011. http://www.ahrq.gov/clinic/ta/lifeintrvrev/lifeinterv_draft.pdf
Overall Reviews and Assessements of Treatment Options
AHRQ Clinical Aid: http://www.ahrq.gov/clinic/obesaid.pdf
Evaluating weight programs IOM report Weighing the options: criteria for evaluating weig…[Obes Res. 1995] – PubMed Result