Tag Archives: funding

The Real World Consequences

A majority of Americans are aware of the damage being done by this disastrous administration to our governing institutions,  the rule of law, and the economy. I think far fewer are aware of the thousands of preventable deaths caused by Trump’s version of “policy.”

The most visible are those caused by the defunding of USAID. USAID funding helped save an estimated 91 million lives over the past 20 years. Now, a peer-reviewed study tells us that Trump’s defunding of the agency will lead to more than 14 million preventable deaths globally by 2030, a number that includes more than 4.5 million children under the age of five.

Far less visible–but equally horrific– are the likely consequences of Trump’s indiscriminate war on medical science, and his termination of grants supporting clinical trials. A recent article from the Washington Post explored those terminations. Citing research published in JAMA Internal Medicine, the article reported that funding for 383 clinical trials had been pulled, and that the funding disruptions affected more than 74,000 trial participants. The researchers found that the cuts disproportionately affected trials focused on infectious diseases (such as covid-19 and HIV); prevention; and behavioral interventions. More than 100 of the canceled grants supported cancer research.

Robert Hopkins, medical director for the National Foundation for Infectious Diseases, said the study showed that funding cuts disproportionately hit areas “that are critical to public health.”

“Clinical research is a long game,” he said. “Developing new vaccines, antivirals and treatments takes years, often decades. Cutting funding now risks slowing progress on interventions that could help save lives for years to come.”

Some of the clinical trials that lost their grants sued, and several got their funding back, but they experienced delays during the course of the trials that are likely to have significant negative impacts on the studies and on their participants. As one researcher explained, “If you pause an experiment, especially when it comes to experiments involving drugs and patients where you need a consistent dose over time and consistent measurements, it’s possible that you just screwed up the entire research.” Another noted that much of the clinical infrastructure was crippled or entirely destroyed during the grant terminations, making it very difficult to resume the research. 

And of course, when clinical trials are delayed or canceled, the patients who were enrolled often lose access to care.

The funding terminations weren’t limited to clinical trials; numerous other research studies also lost funding. A study published in JAMA Internal Medicine in May found that between February and April, nearly 700 NIH grants had been terminated across 24 of the federal agency’s 26 institutes and centers. (It shouldn’t come as a surprise that studies focused on minorities–especially those investigating health concerns of non-Whites and LGBTQ+ citizens–appear to have been disproportionately targeted.)

Partners in Health addressed the likely consequences–and the importance of clinical research to public health.

Some of the greatest advancements made through research include vaccines, insulin, anesthesia, and treatments for infectious diseases. From laboratory studies to clinical trials and epidemiological investigations, scientists around the world use different methods of research to advance disease treatment, enhance diagnostics, and improve our overall understanding of diseases.  

“Research is the key to advancing health on the individual, community, national, and global level,” said Cora Cunningham, PIH Engage member, Harvard T.H. Chan School of Public Health student, and research assistant with the Lantagne Group at Tufts University. “Whether about drinking water quality, disease dynamics, health systems, or the patient experience, research in public and global health is what allows us to access, receive, or deliver quality and patient-centered health care.”

Without research, there would be no breakthroughs, no clinical advancements, and no new cures. Despite its importance to humankind, biomedical research—particularly research funded through the National Institutes of Health (NIH)—has been targeted by the current U.S. administration.

The bottom line is that years of progress in public health have been disrupted. Thanks to a combination of frozen funding, the erection of new, onerous roadblocks to financing, and imposition of overly complicated new procedures, experts predict that the setbacks in research will cause generations of delays in breakthroughs and cures. As the linked article from Partners in Health warns, “patients who were part of clinical trials will face health risks due to the abrupt end to their treatment and support. Advancements made on cures and treatments for various diseases will be squandered. Jobs will be lost, and public health will suffer.”

The question is: why? This particular vendetta wasn’t a response to citizen demands. It isn’t even likely to line the pockets of the billionaires to whom this administration disproportionately caters. Like the destruction of USAID, it is simply gratuitously cruel.

Like Trump. 


 

 

 
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Death, Taxes and Attacks on Planned Parenthood

Attacks on Planned Parenthood are as inescapable as death and taxes.

The most recent episode in this never-ending effort began with a doctored tape of an interview obtained under false pretenses . But let’s ignore the dishonesty. Let’s assume that medical employees of the organization were flip and “cold blooded” in their conversations about fetal tissue research—which is essentially the message the editing was intended to convey.

What facts would that change?

As the unedited tapes clearly show, and subsequent investigations confirm, Planned Parenthood isn’t selling fetal tissue or profiting from its use in medical research. Some affiliates, in states where the practice is legal, are assisting medical researchers by making such tissue available when the patient has authorized it, and being reimbursed for the costs incurred in that process.

The availability of embryonic stem cells and fetal tissue for research has led to cures for many diseases and saved many lives. As with stem cells, the choice is between using fetal tissue for lifesaving research or destroying it. Which of those options is truly “pro life”? Much the same moral calculus is involved when transplant surgeons harvest organs from people who’ve just died in order to prolong the lives of those with organ failures. (Most of us wouldn’t care to watch either grisly procedure.)

More to the point, most of Planned Parenthood’s services have absolutely nothing to do with abortion.

Planned Parenthood of Indiana & Kentucky treats 65,000 patients annually, the vast majority of whom are low-income women who would not otherwise get needed Pap tests, breast exams, STD testing and treatment, and birth control. A not-insignificant number are low-income men who come for testicular cancer exams.

The importance of the testing services provided by Planned Parenthood became painfully obvious when state funding cuts forced closure of Scott County’s Planned Parenthood, in southern Indiana, leaving the county without a testing facility. The resulting HIV epidemic is costing the state far more than it “saved” by closing the clinic—and that doesn’t take into account the likely increase in teen pregnancies or the negative health consequences for poor women unable to afford pap smears and other lifesaving services.

Proponents of defunding Planned Parenthood glibly assert that these services can be provided elsewhere. They can’t. Not only is there no other network or organization with the capacity to replace Planned Parenthood, there is no other organization willing to raise significant private funds—as Planned Parenthood does—to supplement inadequate government funding and ensure that women are not denied health care simply because they can’t pay for it.

These recent attacks on Planned Parenthood are part and parcel of what has been called–aptly– a “war on women.” Over the past five years, state-level lawmakers have passed nearly 300 new restrictions on reproductive health access. A report from the Roosevelt Institute lays it out:

In the first quarter of 2015, lawmakers in 43 states introduced a total of 332 provisions to restrict abortion access, which is increasingly out of reach for women throughout the country. Republicans have voted more than 50 times to repeal the Affordable Care Act (ACA), which has dramatically improved women’s health coverage and access. In the fall of 2013, the party orchestrated a costly government shutdown motivated by their opposition to the ACA’s contraceptive mandate. And in June, House Republicans proposed eliminating funding for Title X, the federal family planning program.

When conservatives talk about “women’s health” funding, they aren’t talking about funding for abortion. Federal law already prohibits public dollars from being spent on abortion or abortion-related care. They’re talking about funding for family planning and other reproductive health services (pregnancy counseling, cancer screenings, STD treatment, etc.), which mainly comes through Medicaid and Title X, two programs that are consistently in conservative crosshairs.

So here’s the bottom line.

Genuinely pro-life people can oppose abortion and still support the other life-saving work done by Planned Parenthood—which is the only work being funded with tax dollars. Of course, if what they really oppose is women’s moral autonomy, as the efforts to restrict access to birth control strongly suggest, then the deaths of poor women denied access to critical medical care is just unavoidable collateral damage.

At the end of the day, there’s reality and there’s rhetoric. The reality is that women did not start getting abortions after Roe v. Wade. They just stopped dying from them.

Research confirms that the best way to reduce the number of abortions is by providing women with reliable birth control–and the best way to reduce deaths from abortion is by supporting high quality clinics like those operated by Planned Parenthood.

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Putting Our Money Where Our Mouths Are….

Today’s blog is a departure from my usual content.

As regular readers of this blog know, three years ago I received a grant to establish a Center for Civic Literacy at IUPUI. (You can find out much more about the Center by clicking through to its website.)

That initial grant has run out, and together with a small group of political and business leaders, I am engaged in fundraising to keep the Center alive. (What I have discovered during the past three years is that–although everyone agrees that civic ignorance is a problem–civic literacy is not a high priority for most potential donors.)

So today I am posting a recent “pitch” I have used (below), for two reasons: first, the readers of this blog often share really good ideas and perspectives that I hadn’t considered, and I welcome suggestions for how I might sharpen and improve the “case” for philanthropic funding; and second–and more shamelessly– to provide an online mechanism to support the Center with a tax-deductible donation by those who may be so inclined. (The Center appears in the drop-down menu.) (Feel free to share!!)

I’m grateful for your help–whichever form it takes!

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Only 36 percent of Americans can name the three branches of government. Fewer than half of 12th grade students can describe the meaning of federalism. Only 35% of teenagers can identify “We the People” as the first three words of the Constitution. Fifty-eight percent of Americans can’t identify a single department in the United States Cabinet. Only 5% of high school seniors can identify checks on presidential power, only 43% could name the two major political parties, only 11% knew the length of a Senator’s term, and only 23% could name the first President of the United States.

In today’s media environment, these and other deficits in civic knowledge are too often filled with propaganda, internet “memes” and misdirection.

Productive civic debate requires shared understandings.  When citizens lack basic knowledge, or argue from different realities, we fail to clarify areas of dispute and leave the parties feeling unheard and angry. If I say this is a table and you say it’s a chair, we aren’t going to have a very constructive conversation about its use.

Indiana’s recent RFRA debate was an unfortunate and costly example of what I call “the civic deficit.” The arguments for RFRA’s passage–as well as some of the claims about its probable effects–displayed some very basic misunderstandings of what the First Amendment’s Free Exercise Clause protects.

It’s not an isolated example.

Essential civic knowledge goes beyond basic American history and the Constitution. If Americans don’t know what science is, we can’t debate the implications of climate change. If we don’t know the difference between the deficit and the debt, we can’t evaluate the merits of economic policy proposals. And we can’t keep our elected officials accountable if we don’t know anything about the Constitution to which they are supposed to be faithful.

Research shows a high correlation between civic knowledge and civic participation. The Center for Civic Literacy recently co-operated with the Indiana Bar Foundation on the most recent Civic Health Index for our state.

  • 5% of Hoosiers report working with neighbors to solve a community problem.  Indiana ranks 47th among the states.
  • 5% of us participate in associations or organizations. We rank 44th.
  • 62% of those who are eligible are registered to vote. We rank 37th.
  • In the last off-year election, as you may have heard, 39.4% voted, ranking Indiana dead last among the states.
  • Only 11% of Hoosiers report ever contacting a public official. We rank 30th.

The Center for Civic Literacy has spent its first three years researching the causes and consequences of civic ignorance, because you can’t prescribe remedies if you don’t understand the problem. More recently, in addition to this ongoing research, we are engaging in what academics call “translational research”—on-the-ground efforts in Indiana to see if we can’t turn things around and raise those civic health indicators.

We are co-operating with the Indiana Department of Education on an effort to recognize and encourage innovative approaches to the teaching of civics; planning a three-forum series in Indianapolis in advance of the upcoming municipal elections, called “Electing Our Future: What You Need to Know about Indianapolis Government in order to Cast an Informed Vote”; partnering with the Indiana Humanities Council to highlight the importance of civic literacy during Indiana’s Bicentennial celebration next year; and fielding a survey to measure Hoosiers’ civic knowledge and provide a baseline for measuring improvement, among several other efforts.

Maintaining a research center is expensive. Fielding a small survey costs 10,000. The annual cost for a graduate student working 25 hours a week is 24,000. Buying 25% of the time of the PPI senior researcher who serves as our project manager runs another 20,000-25,000 annually. Even when we are able to secure grants for specific projects, those “infrastructure” costs must be covered by operating funds.

With your help and support, we think we can improve informed civic participation in Indiana. But we can’t do it without you.

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Suggestions?

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