Robert F. Kennedy Jr. has talked about an “existential threat” that said he can destroy the nation.
“We have the greatest burden of chronic diseases in any country in the world,” Kennedy said at a hearing in January before the Senate confirmed it as secretary of health and human services.
And Monday is starting a tour in the southwest to promote a program to combat chronic diseases, emphasizing nutrition and lifestyle.
But since Mr. Kennedy assumed his position, the subsidies and key contracts are being eliminated that directly address these diseases, including obesity, diabetes and dementia, that experts are among the main health problems of the nation.
These programs vary on scale and expense. Researchers warn that their disappearance could mean lost opportunities to address an aspect of public health that Mr. Kennedy has said that it is his priority.
“This is a big mistake,” said Dr. Ezekiel Emanuel, co -director of the Perelman Health Transformation Institute of the University of Pennsylvania.
Discontinuous Diabetes Research Decades
Since its inception in 1996, the Diabetes Prevention Program has helped doctors to understand this mortal chronic disease. The condition is the most expensive of the nation, which affects 38 million Americans and incurs $ 306 billion in a recent year in direct costs. With approximately 400,000 deaths in 2021, it was the eighth cause of death.
The program has been finished, and the reason has little to do with its merits. Instead, it seems to be a matter of a principal researcher who works in the wrong place at the wrong time.
The program began when doctors from 27 medical centers received funds from the National Health Institutes for a study asking if type 2 diabetes could be prevented. 3,234 participants had a high risk of illness.
The results were a great victory. Those assigned to follow a healthy diet and exercise routine regularly reduced their possibilities to develop diabetes in 58 percent. Those who took metformin, a medication that reduces blood sugar, decreased their risk by 31 percent.
The program entered a new phase, directed by Dr. David M. Nathan, a diabetes expert at Harvard’s Faculty of Medicine. The researchers followed the participants to see how they were without constant attention and the support of a clinical trial. The researchers also examined their genetics and metabolism and analyzed fragility measures and cognitive function.
Several years ago, researchers had an idea. Some studies suggested that people with diabetes had a higher risk of dementia. But scientists did not know if it was vascular dementia or Alzheimer’s or what were the precise risk factors. The diabetes program could renew its approach to investigating this with its 1,700 aged participants.
The group added a new principal researcher, Dementia expert Dr. Jose A. Luchsinger. For administrative reasons, including the new approach to dementia, the program decided that its money should flow through the institution of origin of Dr. Luchsinger, Columbia University, instead of through Harvard University or George Washington, where a third principal researcher works.
On March 7, the Trump administration reduced $ 400 million in subsidies and contracts to Columbia, saying that Jewish students were not protected from harassment during protests for the war in Gaza. The Diabetes subsidy was among the finished: $ 16 million a year that Columbia shared in 30 medical centers. The study ended abruptly.
When asked about the termination, Andrew G. Nixon, Communications Director of the Department of Health and Human Services, provided a statement by the agency’s interim general advisor that says that “anti -Semitism is clearly inconsistent with the fundamental values ​​that liberal education should inform” and that “the complacency of the University of Columbia is unacceptable.”
At the time their subsidy ended, the researchers had begun advanced cognitive evidence of dementia in patients, followed by brain images to seek amyloid, the distinctive seal of Alzheimer’s disease. They planned to complete the tests during the next two years.
Then, said Dr. Luchsinger, the group was going to analyze amyloid blood biomarkers and other signs of dementia, including cerebral inflammation. By way of comparison, they planned to perform the same tests in the blood samples of the participants of 7 and 15 years ago.
“Very few studies have collected and stored the blood going so back,” said Dr. Luchsinger.
Now much of the work cannot begin, and the part that had begun remains incomplete.
Another worrying question that the researchers expected to answer was whether metformin increases, decreases or has no effect on the risk of dementia.
“This is the largest and longest study of metformin,” said Dr. Luchsinger. The assigned participants to take the drug in the 1990s took it for more than 20 years.
“We thought we had the potential to rest this question about metformin,” said Dr. Luchsinger.
The only ways to save the program, said Dr. Nathan, are that Mr. Kennedy accepts to restore financing in Columbia or transfer the subsidy to a principal researcher in another medical center.
Study researchers are appealing to Diabetes Caucus in Congress, hoping that it can help present their case to health and human services.
“We hope that congressmen and senators can prevail and say: ‘This is crazy. This is a chronic disease. This is what you wanted to study,” said Dr. Nathan.
Until now, there have been no changes.
Include diversity. Actually, that is too much diversity.
Compared to the diabetes prevention program, a program to train pediatricians to become scientists is small. But pediatric researchers say that the pediatric scientific development program helps ensure that chronic childhood diseases are included in medical research.
It began 40 years ago when the presidents of the pediatric departments requested the creation of the program, which has been continuously funded by the National Institute of Children’s Health and Human Development.
Participants are trained doctors in subspecialties such as endocrinology and nephrology, practiced as doctors and were inspired to investigate to help young patients with the diseases they had seen firsthand.
The highly competitive program pays seven to eight pediatricians to train in university medical centers for a year, combining them with mentors and giving them time out of the clinic to research conditions, including obesity, asthma and chronic renal disease.
In retrospect, the destiny of the program was sealed in 2021 when its leaders requested a renewal of their subsidy. It seemed pro -form. This was his eighth renewal.
This time, however, an external committee of subsidy reviewers told researchers that the greater weakness of their proposal was the lack of diversity. The program needed to find pediatricians representing diverse ethnicities, economic history, states, types of research and pediatric specialties.
Criticism said, for example, that “attention should be paid to the recruitment of applicants from various origins, including groups that have been shown to be sub -present nationwide in biomedical, behavioral, clinical and social sciences.”
Then, the leaders of the program sprayed diversity generously through a rewritten subsidy application.
“Diversity, in its broader sense, was throughout the subsidy,” said Dr. Sallie Perger, professor and president of Pediatrics at Weill Cornell Medical College and program director. “It was exactly what the reviewers appreciated when we sent ourselves again.”
The subsidy was renewed in 2023. It is now finished. The reason? Diversity.
The Termination Charter, from officials of the National Institute of Children’s Health and Human Development, said it made no sense to try to rewrite the subsidy application. The inclusion of diversity caused the application to be so out of line that “no modification of the project could align the project with the agency’s priorities.”
Mr. Nixon, the spokesman for the Department of Health, did not respond to consultations on the cancellation of the pediatric program.
The participants in the program are distressed.
Dr. Sean Michael Cullen had been studying childhood obesity at Weill Cornell in New York. He has investigated why male mice fed a high fat diet produced from offspring that became fat, even when those descendants fed with a standard diet.
I expected their findings to help predict in humans which children were at risk of obesity so that pediatricians could try to intervene.
Now the funds have gone. You can search for private or philanthropic funds, but it has no clear perspective.
Dr. Evan Rajadhyaksha is in a similar situation. He is a specialist in children’s renal disease at the University of Indiana. When I was a resident, he cared about a girl who developed kidney disease due to a condition in which some urine was wandered from the bladder to the kidneys.
Dr. Rajadhyaksha has the hypothesis that vitamin D supplementation could protect children with this condition.
Now, that work has to stop. Without funds, he hopes to leave the research and return to clinical work.
Dr. Perrar said he had not surrendered. The program costs only $ 1.5 million every year, so she and her colleagues are looking for another support.
“We are asking foundations,” he said. “We are beginning to ask the industry: we have not had industry funds before. We are asking the presidents of the department and children’s hospitals, are they willing to raise funds?”
“We are literally looking under each sofa cushion,” said Dr. Perger.
“But,” he said, the federal support for the program “has been the base and cannot be supplanted.”
