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Concerns Arise as Chronic Disease Programs Face Funding Cuts
Robert F. Kennedy Jr. previously described chronic illnesses as a profound threat capable of undermining the nation’s well-being. Highlighting America’s leading position in chronic disease burden globally, Kennedy, prior to his confirmation hearing as Secretary of Health and Human Services, advocated for prioritizing solutions. Despite his public commitment and upcoming tour promoting nutrition and lifestyle programs to combat chronic disease across the Southwest, significant grants and contracts aimed at tackling these very conditions – including prevalent issues such as obesity, diabetes, and dementia – are reportedly facing elimination. Experts caution that the discontinuation of these programs, varying in scope and financial investment, could severely hinder efforts to address critical public health challenges, directly contradicting Kennedy’s stated priorities.
Diabetes Research Program Faces Discontinuation After Decades of Progress
Dr. Ezekiel Emanuel, Co-director of the Healthcare Transformation Institute at the University of Pennsylvania’s Perelman School of Medicine, labeled the program eliminations a “huge mistake.” The Diabetes Prevention Program, a cornerstone of diabetes research since its inception in 1996, is among those facing termination. This program has been instrumental in enhancing understanding of diabetes, a costly and widespread chronic disease affecting millions. Diabetes impacts 38 million Americans and accounted for $306 billion in direct expenditure in a recent year. In 2021, it was the eighth leading cause of mortality, contributing to approximately 400,000 deaths.
Sources indicate the program’s cessation appears unrelated to its scientific merit. Instead, the discontinuation seems tied to administrative shifts concerning a lead researcher’s institutional affiliation.
The Diabetes Prevention Program originated with National Institutes of Health funding granted to researchers across 27 medical centers. The initial study investigated the potential for preventing Type 2 diabetes in 3,234 participants identified as high-risk.
The initial outcomes were highly encouraging. Participants who adopted a healthy dietary plan and regular exercise regimen experienced a substantial 58% reduction in their risk of developing diabetes. Those who used metformin, a blood sugar-lowering medication, achieved a notable 31% decrease in risk.
Dementia Link and Funding Shift Lead to Program Halt
Under the guidance of Dr. David M. Nathan, a diabetes specialist at Harvard Medical School, the program transitioned into a new phase. Researchers continued to monitor the original participants to assess long-term outcomes outside the controlled environment of a clinical trial. Further research included genetic and metabolic analysis, alongside evaluations of frailty and cognitive function.
Building upon emerging research suggesting a potential link between diabetes and increased dementia risk, researchers sought to investigate this connection further. With a cohort of 1,700 aging participants, the diabetes program was poised to explore the specific types of dementia and associated risk factors.
Dr. Jose A. Luchsinger, a dementia expert, joined as a principal investigator to spearhead this new focus on cognitive decline. For administrative reasons, primarily related to the expanded dementia research, the program’s funding was rerouted through Dr. Luchsinger’s institution, Columbia University, instead of Harvard or George Washington University, where another principal investigator was based.
However, on March 7th, the prior administration announced significant funding cuts totaling $400 million to Columbia University grants and contracts. This action was attributed to concerns regarding insufficient protection for Jewish students from harassment during campus protests related to the conflict in Gaza. The Diabetes Prevention Program grant, valued at $16 million annually and distributed across 30 medical centers, was among those terminated, causing the abrupt cessation of the ongoing study.
Program Termination Sparks Concern Over Lost Research Opportunities
In response to inquiries about the program’s termination, Andrew G. Nixon, Communications Director at the Department of Health and Human Services, issued a statement from the agency’s Acting General Counsel. The statement asserted that “anti-Semitism is clearly inconsistent with the fundamental values that should inform liberal education” and deemed “Columbia University’s complacency unacceptable.”
At the moment of funding cessation, researchers had initiated advanced cognitive assessments to detect early indicators of dementia in participants, complemented by brain imaging to identify amyloid, a key marker of Alzheimer’s disease. These tests were projected to be completed within two years.
Dr. Luchsinger explained that future plans included analyzing blood biomarkers for amyloid and other dementia indicators, including brain inflammation. Crucially, they intended to compare these findings with blood samples collected from participants 7 and 15 years prior.
“Very few studies possess blood samples collected and stored spanning such an extensive period,” Dr. Luchsinger emphasized, highlighting the unique research opportunity now jeopardized.
A significant portion of the planned research cannot proceed, and ongoing work remains unfinished due to the funding disruption.
Another critical question the researchers aimed to address was the potential influence of metformin on dementia risk – whether it increases, decreases, or has no effect.
Metformin’s Impact on Dementia Risk Left Unexplored
“This study represents the most extensive and longest-running investigation of metformin to date,” stated Dr. Luchsinger. Participants initially assigned to metformin in the 1990s had continued its use for over two decades.
“We believed we held the potential to definitively answer the question surrounding metformin’s role,” Dr. Luchsinger added, emphasizing the lost opportunity.
Dr. Nathan indicated that reinstating funding to Columbia or transferring the grant to a principal investigator at an alternate medical center are the primary avenues to salvage the endangered program.
Study investigators are actively appealing to the Congressional Diabetes Caucus, hoping for intervention to advocate their case to Health and Human Services.
“Our hope is that congressmen and senators will recognize the gravity of this situation and assert: ‘This is unreasonable. This concerns chronic disease. This aligns directly with your stated research priorities,’” Dr. Nathan conveyed.
As of now, no reversal of the funding decision has occurred.
Pediatric Research Program Terminated Amidst Shifting Diversity Priorities
In contrast to the large-scale Diabetes Prevention Program, the Pediatric Scientist Development Program is a smaller initiative focused on cultivating pediatric physician-scientists. However, pediatric researchers emphasize its crucial role in ensuring that childhood chronic diseases receive adequate attention in medical research agendas.
Established four decades ago in response to a call from pediatric department chairs, the program has enjoyed continuous funding from the National Institute of Child Health and Human Development since its inception.
The competitive program selects clinicians specializing in pediatric subspecialties like endocrinology and nephrology. These clinicians, having practiced and witnessed childhood diseases firsthand, are motivated to pursue research careers.
The program provides funded research training for seven to eight pediatricians annually at university medical centers. Participants are paired with mentors and given protected time away from clinical duties to conduct research on conditions like obesity, asthma, and chronic kidney disease.
Diversity Critique Leads to Initial Grant Renewal, Followed by Termination
The program’s demise was foreshadowed in 2021 during its eighth grant renewal application, which initially appeared routine.
However, an external review committee identified a significant weakness: insufficient diversity. The reviewers underscored the need for greater representation across ethnicities, socioeconomic backgrounds, geographic locations, research areas, and pediatric specializations among program participants.
The critique explicitly stated, “attention must be given to recruiting applicants from diverse backgrounds, including from groups that have been shown to be nationally underrepresented in the biomedical, behavioral, clinical and social sciences.”
Program leaders subsequently integrated diversity considerations throughout their revised grant proposal.
“Diversity, in its broadest interpretation, permeated every aspect of the grant,” stated Dr. Sallie Permar, Professor and Chairwoman of Pediatrics at Weill Cornell Medical College, and Program Director. “This emphasis on diversity was positively received by the reviewers during resubmission.”
The grant was successfully renewed in 2023. However, it has now been abruptly terminated. The stated reason: diversity.
The termination notice from officials at the National Institute of Child Health and Human Development asserted that rewriting the grant request would be futile. The application’s emphasis on diversity rendered it misaligned with agency priorities to such an extent that “no modification of the project could align the project with agency priorities.”
Researchers and Participants Express Disappointment and Seek Alternative Funding
Mr. Nixon, the Health Department spokesperson, did not respond to inquiries regarding the pediatric program’s cancellation.
Program participants are deeply dismayed by the funding revocation.
Dr. Sean Michael Cullen, previously studying childhood obesity at Weill Cornell in New York, has been investigating the intergenerational impact of high-fat diets using male mice models, where offspring exhibit obesity despite being fed a standard diet.
His research aimed to identify early predictors of obesity risk in children, enabling preventative interventions by pediatricians.
With the abrupt funding loss, Dr. Cullen is exploring private and philanthropic funding avenues but currently lacks concrete prospects.
Dr. Evan Rajadhyaksha, a pediatric kidney disease specialist at Indiana University, faces a similar predicament. Inspired by a young patient he treated for kidney disease caused by urine reflux, Dr. Rajadhyaksha hypothesized that vitamin D supplementation could offer protective benefits for children with this condition.
This research is now halted due to funding cessation. Dr. Rajadhyaksha anticipates leaving research to return to full-time clinical practice.
Dr. Permar remains committed to finding solutions. Given the program’s relatively modest annual budget of $1.5 million, she and her colleagues are actively seeking alternative funding sources.
“We are approaching foundations,” she explained. “We are beginning to explore industry funding – an area we haven’t previously pursued. We are also reaching out to department chairs and children’s hospitals to gauge their willingness to participate in fundraising efforts.”
“We are diligently exploring every possible avenue for support,” Dr. Permar stated.
However, she emphasized that federal funding has historically been the bedrock of the program and “cannot be readily replaced.”