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"NSF's mission mandates attention to the entire spectrum of science. Emphasizing some sciences at the expense of others handicaps discovery and compromises innovation."
NSF Director Subra Suresh, PCAST, 1/7/11
"Clearly, drug addiction is a serious problem facing our country, and finding new medical treatments is a high priority," .... "I don't know if the critics want us to experiment with humans, or just give up on the problem of drug addiction, but we aren't going to do either."
NIH Director Francis Collins, 8/5/2010
“We are all sick because of AIDS - and we are all tested by this crisis. It is a test not only of our willingness torespond, but of our ability to look past the artificial divisions and debates that have often shaped that response. When you go to places like Africa and you see this problem up close, you realize that it's not a question of either treatment or prevention – or even what kind of prevention – it is all of the above. It is not an issue of either science or values – it is both. Yes, there must be more money spent on this disease. Bu there must also be a change in hearts and minds, in cultures and attitudes. Neither philanthropist nor scientist, neither government nor church, can solve this problem on their own - AIDS must be an all-hands-on-deck effort.”
Barack Obama, World AIDS Day Speech, Lake Forest, CA, Dec. 11, 2006
“When you look at a cursory examination of the title or an abstract [of a grant] you don’t have an idea. That’s why we have peer review...Prohibiting specific grants sets a dangerous precedent for scientific research that has progressed and advanced for decades through freedom of inquiry into a broad spectrum of subjects…second guessing peer-review in this way could compromise the fabric of our public research enterprise one thread at a time.”
Rep. Brian Baird (D-WA), Chairman of the House Science Committee’s Basic Research Subcommittee on the House floor, May 2, 2007
"De-funding meritorious grants on the floor of Congress is unjustified scientific censorship. It undermines the historical strength of American science which is based on our world renowned, apolitical and transparent peer review process."
NIH Director Elias Zerhouni 6/23/05
"When we looked at the public-health relevance, there was no question that these projects should have been funded and should continue to be funded."
NIH Director Elias Zerhouni
The Chronicle of Higher Education, 1/13/04
"I strongly urge the Members to resist the temptation to select a few grants for defunding because they do not like the sound of them based on one paragraph out of what probably was a number of pages of information. It would set a dangerous precedent and put a chill on medical research if we start to micromanage individual NIH grants.
This has worked well over the years. We have had enormous progress because of these grants in achieving medical knowledge and giving the public a better health care system. I do not think this body, this committee, wants to get into the process of reviewing 120,000 grants and trying to pick 40,000 out of that group for funding."
Rep. Ralph Regula -- Chairman, House
Labor, Health and Human Services and Education Appropriations Subcommittee,
House floor July 11, 2003
"I have served on the subcommittee that deals with NIH for a long time, and the one thing I came to understand very quickly is that the day that we politicize NIH research, the day we decide which grants are going to be approved on the basis of a 10-minute horseback debate in the House of Representatives with 434 of the 435 Members in this place who do not even know what the grant is, that is the day we will ruin science research in this country. We have no business making political judgments about those kinds of issues."
Rep. David Obey -- Ranking Member, House Labor, Health and Human Services and Education Appropriations Subcommittee, House floor July 11, 2003
"When you look at the impact of sexually transmitted disease, you're talking about HIV/AIDS and many others that affect millions of people and their reproductive lives."
NIH Director Elias Zerhouni
USA Today, Jan. 13, 2004
"Decisions about medical research should be made by scientists, not by politicians promoting an ideological agenda.”
Democratic House Leader
Rep. Nancy Pelosi, July 2003
"Here we have people saying, 'I don't like how that disease was contracted, so I don't want to study that disease.' It's equivalent to sticking your head in the sand. It's very important that the scientific community rises up and objects to the imposition of ideology in these areas."
Alan Leshner, President and CEO, AAAS, Washington Post, 1/19/04
“Obviously, in areas such as HIV/AIDS, it’s a sexually-transmitted disease, it’s a disease that is transmitted by injection drug use, by a variety of other mechanisms . . . we cannot avoid addressing the issues that are at the very foundation of why millions and millions of people are getting infected.
Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, House Energy and Commerce Subcommittee on Health, June 2, 2004
"Central to the NIH peer-review process is objective evaluation based on a proposal's scientific merit. . . Many would argue that it is the scientific objectivity of this process and the fact that scientists -- not politicians, political appointees, advocacy groups, or lobbyists -- who decide what gets funded, that is in large part responsible for the nation's world leadership in science."
Rep. John Edward Porter -- Former Chairman, Subcommittee on Labor, Health and Human Services and Education in JAMA September 21, 2005.
CPR sponsors Congressional briefing -- Lost in Translation: Public Health Implications of Sexual Health Research
NIH Responds to Congress (Download letter to Congress)
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Lost in Translation: Public Health Implications of Sexual Health Research: A Congressional Briefing
As some Members of Congress continue to press the National Institutes of Health on its support of sexual health research, the Coalition to Protect Research (CPR), the Decade of Behavior, and 20 other organizations, including the American Association for the Advancement of Science (AAAS), sponsored a congressional briefing, on March 5th to educate and inform Members of the important public health significance of sexual health research. Three distinguished scientists, John Bancroft, Thomas Coates, and Janet Shibley Hyde, discussed sexual health research across its continuum.
Coates, Leshner (standing), Bancroft, and Hyde
Issues of Critical Health Importance
Alan Leshner, Chief Executive Officer of the AAAS, served as moderator for an audience of nearly 100 individuals which included congressional staff, NIH officials, and representatives of the broader scientific community. Noting that AAAS is “the largest scientific society with about 120,000 individual members and about 270 affiliated societies that in fact represent some 10 million scientists around the world,” Leshner explained that the briefing was designed to address “issues of critical public health importance.”
But the underlying value of doing this kind of research along with “protecting the integrity of the research process at all costs are, in fact, issues of interest and importance to all of science and technology,” Leshner emphasized. There is an “opportunity for the entire scientific community to be speaking in support of” the research addressed by the briefing, he added.
Explaining that the CPR briefing was designed to talk about why studying sex and its consequences are important, Leshner observed that the supporters of the briefing, “view sex from a health perspective” with respect both to personal health and public health. These organizations also “recognize that sex is an inevitable central part of human life and that sexual health is critical to overall health and well-being of both individuals and the public.” Leshner also noted that “Sexual health is a major public health issue since it is a major mechanism for the transmission of many devastating diseases facing human kind.” He asserted that there is no way that we can get a handle on these public health crises without understanding the mechanisms of their transmission. Leshner concluded his opening remarks by expressing his confidence and that of the broader scientific community “that science has a contribution to make in this important aspect of public health.”
Sexuality and Marriage
Hyde, the Helen Thompson Woolley Professor of Psychology at the University of Wisconsin, Madison, highlighted the 2001 Surgeon General’s Call to Action on Sexual Health and Responsible Sexual Behavior released by former Surgeon General David Satcher (see www.surgeongeneral.gov/library/sexualhealth/default.htm) before discussing her own research on sexuality in marriage. The Call to Action explicitly:
§ Promotes basic research in human sexual development, sexual health, and reproductive health, as well as social and behavior research on risk and protective factors for sexual health.
§ Encourages expanding the research base to cover the entire human life-span – childhood and adolescence, young and mid-adulthood, and the elderly.
§ Urges research on and the development, dissemination, and evaluation of educational materials and guidelines for sexuality education covering the full continuum of human sexual development for use by parents, clergy, teachers, and other community leaders.
To begin the presentation of her research on “Sexuality in Marriage,” Hyde noted the 1946 World Health Organization definition of health: “Health is not just the absence of disease, but the presence of positive well being.”
She observed that “Viagra has been used by roughly 16 million men worldwide since its introduction in 1998.” Much of that use is for sexual expression in marriage, she explained. Hyde also noted that today, “50 percent of marriages will end in divorce.” According to Hyde, sexual satisfaction correlates positively with marital satisfaction and “sexual dissatisfaction in marriage predicts divorce three years later.”
She emphasized that it is important for people to know about normal patterns in their marital relationships. But we cannot get this information until we do the research to collect the data. She cited as an example what happens when there is a lack of data, such as the recent stories in the popular press regarding DINS (dual income no sex) couples. Contrary to what is being reported, the research reveals that there is no significant difference between these and other couples. Hyde expressed her concern that erroneous reports such as these will lead to a “self-fulfilling prophecy” for couples who are experiencing “marital” trouble. This could cause them to not seek out the root of their problems, which may be symptomatic of something else, because they believe what they are experiencing is “normal.”
Sex: Unique Link of Behavior and Physiology
Bancroft, the Director of the Kinsey Institute, discussed the “Psycho-biological Factors in Human Sexuality and their Relevance to Research.” He began by explaining that sex is a fundamental part of the human condition and there’s a need for good science to help us understand normal sexual development.
Bancroft also explained that sex is “associated with enormous sexual problems,” problems of public health and private health. These include: sexually transmitted diseases, unplanned pregnancies, sexual assaults and rape, child sexual abuse, and sexual dysfunctions.
Bancroft, Hyde, Leshner and Coates
Why is this research so difficult, Bancroft asked? Because sex is unique in the link between behavior and physiological response, he answered. In addition, Bancroft explained that “our behavior is influenced by the physiological state we call “sexual arousal.” Problems arise because “people get sexually aroused when they shouldn’t or they don’t get sexually aroused when they should.” It is a state of mind that can lead us to do some things that we regret, he noted.
Accordingly, there are some important research questions that need addressing, Bancroft underscored. These include:
§ Why do some people take sexual risks?
§ Why do some people develop sexual interests which get them (and others) into trouble? (e.g., sexually assaulting adults or abusing children)
§ Why are there problems with sexual response? Why are some people more vulnerable to such problems?
§ How can we help people to manage their sexual lives more sensibly?
§ How can we reduce the likelihood of unacceptable sexual behavior?
§ How can we help with the problems of sexual response?
Bancroft noted that sex research is “mostly asking people questions about their sexual lives.” This is done through face-to-face interviews, questionnaires, and computerized methods, he further explained.
Silence Equals Death
Coates, Professor of Medicine at the David Geffen School of Medicine at UCLA, presented “Sexual Behavior Research, Worthwhile? Useful?” He observed that the questions asked of NIH Director Elias Zerhouni regarding the agency’s support of sexual behavior and function research are “reasonable questions.” Is sex research: A good use of taxpayer monies? Scientifically valid? Ethically appropriate? Review process followed? Is funding, disproportionate to disease burden? If we are being judged by that measure, “we stand up well,” Coates asserted.
The burden is easy to demonstrate, Coates noted. Recent data show that there are 18.9 million sexually-transmitted infections annually. Roughly half of those (9.1 million) occur among 15-24 year olds. There are 42 million people with HIV worldwide, 800,000 to 1 million of these in the U.S. The annual cost to the Federal government is approximately $12 -15 billion.
Coates used eight case studies to demonstrate the utility of sexual behavior research. One of the case studies addressed how do we understand continued high risk behavior following a diagnosis of HIV? It is a conundrum that many legislators have had to grapple with, he noted. He cited research that addressed why individuals in sub-Saharan Africa were not getting tested for HIV? Sexual behavior research tells us the principal reasons individuals were not being tested are logistical: inconvenient hours, inconvenient location, and high cost. The solution has to fit the diagnosis and the diagnosis has to be based on data, Coates stressed.
Coates also highlighted prevention programs that have been shown to work, including an often cited example, the Uganda ABC (Abstain ‘til Marriage, Be Faithful, and Condoms) program. He cautioned, however, that at times the prevention messages miss the point. While the ABC intervention has increased the use of condoms and reduced the spread of HIV/AIDS, it does not address other factors that impact the spread of HIV/AIDS in women. These factors include: rape and forced sex, as well as women being infected by unfaithful partners.
Violence is a risk factor for women getting infected with HIV. Intimate partner violence is endemic in many societies and it is something we haven’t addressed, Coates observed.
Addressing abstinence education, Coates noted that we don’t know if abstinence education works because we don’t have the research. This does not mean that it doesn’t work; it means that we don’t have the research to support it. It is an example of where we are not spending our money on evidence-based approaches, he emphasized.
Coates concluded his remarks by cautioning that silence about sexuality will equal death because it won’t allow us to take care of the people we need to take care of or put in place the programs we need to put in place. Furthermore, he warned, “when scientists are silenced and they can’t criticize one another, the science can’t get better.”
The Coalition to Protect Research consist of 49 scientific and public health organizations representing scientists, physicians, health care providers, patients, and advocates that support federal investment in basic biomedical, behavioral, and social science research in human sexual development, sexual health, HIV/AIDS and sexually-transmitted diseases. The March 5th briefing is one of the ways CPR is attempting to educate policymakers about the consequence of not supporting research in such a critical area. For more information on the Coalition see: www.COSSA.org/CPR/cpr.html.