Robert F. Kennedy Jr. talks about an “existential threat” that he says can destroy the country.
“We have the highest burden of chronic illnesses in any country in the world,” Mr. Kennedy said at a hearing in January.
He will tour the Southwest on Monday to promote a program targeting chronic diseases that emphasizes nutrition and lifestyle.
But since Mr. Kennedy took office, key grants and contracts have addressed these diseases directly, including obesity, diabetes and dementia (experts agree that this is one of the leading health issues in the United States) have been eliminated.
The size and cost range of these plans. The researchers warn that their demise may mean losing opportunities to address what Mr Kennedy calls public health.
“It’s a huge mistake,” said Dr. Ezekiel Emanuel, co-director of the Institute for Healthcare Transformation at the Pereleman School of Medicine at the University of Pennsylvania.
Decades of diabetes research interrupted
Diabetes prevention programs have helped doctors understand this deadly chronic disease since 1996. This situation is the most expensive in the United States, affecting 38 million Americans in the direct costs of the last year and generating $300.6 billion. About 400,000 people died in 2021, which is the eighth largest cause of death.
The plan has been terminated for reasons that have nothing to do with its advantages. Instead, this seems to be a problem for the main researchers to work in the wrong place at the wrong time.
The program began with doctors at 27 medical centers receiving funding from NIH research to ask if type 2 diabetes can be prevented. The risk of disease was high in 3,234 participants.
The result is a huge victory. Those who follow a healthy diet and routine exercise will regularly reduce their chances of diabetes by 58%. Those taking metformin, a drug that lowers blood sugar, reduces their risk by 31%.
The program enters a new phase, led by Dr. David M. Nathan, a diabetes expert at Harvard Medical School. The researchers followed the participants to understand how they performed without the ongoing attention and support of the clinical trial. The researchers also examined their genetics and metabolism and studied measures of fragile and cognitive function.
A few years ago, investigators had an idea. Some studies have shown that people with diabetes are at a higher risk of dementia. But scientists don't know if it's vascular dementia or Alzheimer's or what exactly is the risk factor. The Diabetes Program could be updated to study this with 1,700 older participants.
The team added new principal investigator, Dr. Jose A. Luchsinger, a dementia expert. For administrative reasons, including newly discovered concerns about dementia, the program decided that its funding should be through Dr. Luchesinger’s family institution, Columbia University, rather than through Harvard or George Washington University (the third major researcher working).
On March 7, the Trump administration signed a $400 million grant and contract with Colombia, saying Jewish students were not harassed during the protests against the Gaza War. Diabetes Grants are terminated: Columbia shares $16 million a year in 30 medical centers. The study ended suddenly.
When asked about the termination, Andrew G. Nixon, director of communications for health and public services, provided a statement to the agency's acting general counsel, saying “anti-Semitism is clearly inconsistent with the fundamental values that should be free education,” and that Columbia University's complacency is unacceptable. ”
By the time their grant ended, the researchers had already begun advanced cognitive testing of evidence of dementia in patients, followed by brain imaging to find amyloid, a hallmark of Alzheimer's disease. They plan to complete the tests within the next two years.
Dr. Luchsinger said the team will study blood biomarkers of amyloid and other signs of dementia, including brain inflammation. For comparison, they planned to perform the same tests on blood samples from participants 7 and 15 years ago.
“There are few studies that collect blood and store it far away,” Dr. Luchsinger said.
Now, most of the work cannot be started, and the beginning part is still incomplete.
Another disturbing question that researchers hope to answer is whether metformin increases, decreases, or has no effect on the risk of dementia.
“This is the largest and longest metformin study ever,” said Dr. Luchsinger. It took more than 20 years for participants who took the drug in the 1990s.
“We think we have the potential to rest this question about metformin,” Dr. Luchsinger said.
Dr. Nathan said the only way to save the program is if Mr. Kennedy agreed to restore Columbia’s funds or transfer the grant to the lead investigator at another medical center.
The research investigators are calling on the Diabetes Caucus in Congress, hoping that this can help them serve health and humans.
Dr. Nathan said: “We hope members of Congress and senators can be competently said: 'This is crazy. It's a chronic disease. It's what you want to learn.'
So far, nothing has changed.
Including diversity. Actually, that's too much.
Compared to the diabetes prevention program, training pediatricians to become scientists is small. But pediatric researchers say the pediatric scientist development program helps ensure that chronic childhood diseases are included in medical research.
It began 40 years ago when the president of the pediatric department asked to establish the program, which has been continuously funded since the National Institute of Child Health and Human Development.
Participants were clinicians trained in subspecialties such as endocrinology and nephrology, practiced as clinicians and were inspired to study to help young patients they witnessed firsthand.
The highly competitive program paid seven to eight pediatricians a year of training, paired them with a tutor and gave them time from the clinic to the study status, including obesity, asthma and chronic kidney disease.
In retrospect, the fate of the program was sealed in 2021, when its leaders applied for renewal of its grant. It seems to be pro-constructive. This is its eighth contract renewal.
But this time, the external committee of the grant examiners told investigators that the biggest weakness of their proposal was the lack of diversity. The program requires finding pediatricians who represent a variety of races, economic backgrounds, states, research and pediatric professions.
Criticism says, for example, “It is necessary to focus on recruitment applicants from different backgrounds, including from groups that have proven undernumbered in biomedical, behavioral, clinical and social sciences.”
Therefore, leaders of the program sprinkle diversity through a rewritten grant app.
“Broadly speaking, diversity is all over the world,” said Dr. Sallie Permar, professor of pediatrics and chairman of Weill Cornell Medical College and director of the program. “That’s exactly what the reviewers thanked when they resubmitted.”
The grant was renewed in 2023. It has now been terminated. reason? Diversity.
An termination letter from officials at the National Institute of Child Health and Human Development says it doesn't make sense to try to rewrite the grant request. The inclusion of diversity makes the application so disconnected that “no modification of the project can align the project with the agency’s priorities.”
Ministry of Health spokesman Mr Nixon did not answer questions about the cancellation of the pediatric program.
Participants in the program were upset.
Dr. Sean Michael Cullen has been studying childhood obesity at Weill Cornell in New York. He has investigated why male mice fed a high-fat diet produce offspring, even if those offspring are fed a standard diet.
He hopes his findings can help people predict which children are at risk of obesity so pediatricians can try to intervene.
Now the funds are gone. He may seek private or charitable funds, but he has no clear prospects.
Dr. Evan Rajadhyaksha is in a similar state. He is a childhood kidney disease specialist at Indiana University. When he was a resident, he cared for a little girl who had kidney disease because some urine was washed from the bladder into the kidneys.
Dr. Rajadhyaksha has the hypothesis that vitamin D supplementation can protect children with this condition.
Now, this work must be stopped. Without funding, he hopes to leave the research and return to clinical work.
Dr. Permar said she did not give up. The program costs only $1.5 million a year, so she and her colleagues are looking for other support.
“We are asking the foundation,” she said. “We are starting to ask the industry – we have never had the industry funding before. We are asking the department chair and the children’s hospital, are they willing to raise funds?”
“We're actually watching under every sofa cushion,” Dr. Pearl said.
“But,” she said, federal support for the program “is already a foundation and cannot be replaced.”
