Awesome Infographic: Sleep

As someone who has trouble falling asleep no matter how tired I am or what time I have to wake up in the morning, I'm hyperaware of how much we need sleep…and how easy it is to not get enough. This awesome infographic from National Heart, Lung, and Blood Institute highlights the health problems associated with sleep deprivation and the research being done to develop treatments. Sleep info graphic

Study shows no link between HPV vaccine and increased sexual activity

Big news on the sexual health front: a new longitudinal study was published yesterday in JAMA showing that young women who have received the HPV vaccine are no more likely to contract other STIs than unvaccinated women. While it is never a good idea to make generalizations about anything based on one study, this particular one seems well-designed and will hopefully lead to further study on this question. 'The Public Vaccinator' by Lance Calkin. Credit: Wellcome Library, London.

HPV causes cervical, vaginal, and anal cancer and has been connected to various head and neck carcinomas. The vaccine protects against four strains of the virus most often responsible for those cancers. To be clear: the HPV vaccine is a vaccine against cancer. Despite the potential benefits, many parents (and non-parents) fear that by giving their child the HPV vaccine, their child will feel free to engage in risky sexual behavior.

Because of this fear, HPV vaccine uptake has been abysmal in the United States. Only about half of young women and one-third of young men have received the first dose of the HPV, and even fewer have completed the three-dose series.

Looking at a sample group of women over 208,000 women aged 12-18, researchers found that young women recieved the HPV vaccine were no more likely to seek treatment for chlamydia, gonorrhea, herpes, HIV/AIDS, or syphilis than were unvaccinated women. That’s right, there was no evidence that getting the HPV vaccine increased the likelihood of being diagnosed with an STI.

Using pharmacy claims, researchers also determined that vaccinated women were more likely to use oral contraceptives. 17.9% of vaccinated women across age ranges received a prescription for hormonal birth control while 9.2% of unvaccinated women did. This could be due to a few factors: young women who intended to engage in any sexual activity were more likely to request the vaccine as well as contraceptives; the HPV vaccine was suggested by doctor during appointments for acquiring contraceptives; or parent perception of daughters’ likehood of being sexually active influenced their decision to vaccinate or seek contraceptives for their child.

There are, of course, some limitations to this study. The researchers were only able to access records, so by design they missed undiagnosed STIs, may have included STI screenings rather than diagnoses, and omits the use of non-prescription contraceptives like condoms. Researchers were also unable to use records from anonymous clinics. Researchers also could not acquire information about SES and motivations for receiving the vaccine. This study also does not look at young men in the same age range, which would give a more complete picture of how HPV vaccine impacts adolescent sexual activity.

The psychology of vaccine risk perception is fascinating. Beyond the concerns of “naturalness,” parents who are less inclined to vaccinate may feel more responsible for potential injury to their child if the injury is connected to a vaccine rather than to a disease that could have been prevented by that vaccine. A parent whose child has a seizure after the HPV vaccine may feel more responsible for that event than if the child contracts HPV. I wonder how the parents would feel if, after a decade, their child is diagnosed with an HPV-related cancer.

To an extent, I get it. I’m not a parent, but I do possess empathy and can imagine how frightening parenting must be. The world seems full of danger, and parents want to do everything in their power to keep their children safe. Sometimes not acting--not vaccinating--seems safer than risking the side effects of the vaccination or of the disease itself.

Fearing risky adolescent sexual activity also makes some sense to me. Most parents don’t want to see their child become a parent during their sophomore year of high school. Most parents don’t want their child to live with HIV or herpes.

But nearly everyone becomes sexually active at some point in their lives, and about 70% of people have their first sexual experience before age 19.  Half of sexually active men and women will have HPV. That means that means that when parents decide not to vaccinate their children, they allow their children to have a one-in-two chance of contracting HPV. And while most cases of HPV clear up on their own with no adverse effects, there are more than 33,000 cases of HPV-related cancer diagnosed each year in the United States.

No study can stand alone. We should not take the results of this study and make bold proclamations about young women’s behavior and sexual activity. I do believe, however, that this robust study provides some much-needed evidence that reducing young women’s risk of infection does not turn them into crazed sex machines making risky choices. I look forward to subsequent studies that can provide more evidence for parents to use to make informed choices.

Note: I know that women over age 18 don’t need parental permission in order to get the vaccine and may be more inclined to seek it out. But this study looked only at women under age 18, so I stuck to that age group as well.

STEM research & Obama's budget proposal

STEM research and Obama 2016 budget proposalYesterday, I wrote about new data showing that medical research funding has not increased significantly since 2004. Because of the ever-rising cost of research, flat funding levels are worrisome--because of this funding plateau, we may not have the advanced treatments that could save or improve lives available to us as our population ages. Moreover, the United States is on its way to being surpassed in innovation by other countries funding research more vigorously. The Pew Research Center for Internet, Science, and Techonology released a report late last week examining the beliefs the public and scientists hold about STEM (science, technology, engineering, and medicine) research. Using representative samples of the public and of members of the American Association for the Advancement of Science, Pew delved into the nitty-gritty of individuals’ attitudes about science and its role in society. Especially for public funding, these views are important to consider because government funding options are influenced by voters and the political environment. (The report is rich and full of fascinating statistics, most of which I won’t be able to address here, so I recommend reading it in full at your leisure.)

Public perception of research funding

Just over 70% of Americans believe that government investment in engineering, technology, and basic science research will pay off eventually. About one-quarter say that the outcomes are not worth the investment. However, only 61% of the public supports government investment in STEM research. Over one-third have faith that private investment alone will be enough to progress STEM.

There seems to be little difference between Republicans (and right-leaning independents) and Democrats (and left-leaning independents) in beliefs about the importance of STEM research. Younger people tend to value investing in research more than Americans over age 65.

Scientists’ perception of research funding

About half of scientists surveyed believe that this is a good time for STEM, a notable decrease from 76% in 2009. Scientists are slightly more positive about their own fields, however, with 62% saying that now is a good time for their specialty.

The negative perceptions may be influenced by attitudes surrounding the funding process. More than eight out of ten scientists assert that obtaining federal research dollars is more difficult today than it was in 2009. Nearly half report that getting funding from industry and foundations is also more difficult. And scientists are in nearly total agreement (88%) that lack of funding is a serious problem for the ability to conduct high quality research.

Obama’s budget proposal for 2016

If most Americans believe that funneling money into STEM research is an important investment, why do most scientists feel that federal funding is difficult to obtain? President Obama released his budget proposal--let’s see what it has to say about funding research.

This table highlights just a few key areas relevant to STEM research funding and compares their proposed funding to the funding of other, unrelated program areas in the budget. Rows with red text represent STEM research funding.

Funding Area Proposed budget allocation
Special education $12.5 billion
Science and research laboratories $12.8 billion
NASA $18.1 billion
Health research and food safety $37.5 billion
Veterans health care $66.7 billion
Medicare $589.7 billion
National defense (including personnel, operations, equipment, and supplies) $615.5 billion
Social Security $944.3 billion

STEM research is funded at a much lower rate than the budget behemoths Medicare, Defense, and Social Security. One could argue that if we didn’t need or want to spend so much money on these areas, we would be able to fund more research. However, in the case of Social Security and Medicare, the United States has made a commitment to its citizens to provide health care for selected populations and financial support to those who have earned it. These costs are somewhat non-negotiable.

Political cartoon Obama budget

Whether these funding levels are sufficient for STEM research is not something on which I can meaningfully comment. But if researchers feel like they aren’t being funded well enough, and the American public values STEM investment, I have to wonder whether the United States is providing funding on the levels that the American public would prefer.

Without developing new technologies and advancing our understanding of medical science, we will soon be less innovative than other countries and will not produce the health breakthroughs we so desperately need. If we aren’t properly funding this research, we are the ones who will suffer.

Note: My views do not represent the views of any person or any entity associated with the National Cancer Institute, the National Institutes of Health, the United States government, or anything else. These ramblings are mine and mine alone.

Medical research funding is stagnant

A few weeks ago, an article was published in the Journal of the American Medical Association comparing the United States’ medical research funding to that of other countries. Looking across all sources of funding--pharmaceutical/biotech/medical device companies, foundations and charities, all levels of government, NIH grants, and various private funders--the article authors found that there was a significant increase in funding between 1994 and 2004, but that the increase tapered off between 2004 and 2012. This graph shows a large increase in medical research spending 1994-2004 and illustrates virtually level funding in the past decade.

Though it’s always easy to blame the government of all of our problems, and all levels of government increased their research budgets by just a pittance, the overall leveling off isn’t just due to decreased government spending. Biotech and medical device companies have only increased their spending a tiny bit since 2004. Shockingly, the pharmaceutical industry has slightly reduced its investment in research in that time period.

This isn’t great. Considering the United States has some pretty big health issues to address, I would have hoped to see increasing investment rather than the flat levels of the past ten years. Since the cost of research goes up each year as the questions researchers ask and the technology they use becomes more sophisticated, funding should also rise. And since it can take 25 years or longer for new technology to become clinically useful, we will see the effects as many of us age and need advanced medical interventions.

The authors conclude (bold emphasis is mine):

Clearly, the pace of scientific discovery and need for service improvement have outstripped the capacity of current financial and organizational models to support the opportunities afforded. The analysis underscores the need for the United States to find new sources to support medical research, if the clinical value of its past science investment and opportunities to improve care are to be fully realized. Substantial new private resources are feasible, though public funding can play a greater role. Both will require nontraditional approaches if they are to be politically and economically realistic. Given global trends, the United States will relinquish its historical innovation lead in the next decade unless such measures are undertaken.

So successfully increasing medical research spending will all come down to how much the public believes that (1) the research is crucial and (2) if the United States doesn’t invest more money, it will lose its place as the most innovative country. Tomorrow, I’ll talk about the new Pew report “Public and Scientists’ Views on Science and Society,” which addresses this very issue.

Source: Moses, H., Matheson, D.H.M., Cairns-Smith, S., George, B.P., Palisch, C., and Dorsey, E.R. The anatomy of medical research: US and international comparisons. JAMA. doi:10.1001/jama.2014.15939

Note: My views do not represent the views of any person or any entity associated with the National Cancer Institute, the National Institutes of Health, the United States government, or anything else. These ramblings are mine and mine alone.