facebook twitter RSS
HOT TOPICS: Alcoholism  Addiction  AA  Cocaine  Heroin

A Fix Special Report—The Maddening State of Addiction Research Funding

Image: 

shutterstock

(page 3)

WHAT ABOUT NEW RULES FOR THE GAME TO BREAK THE IDEOLOGY TRAP?

Throughout history, those in power have ostracized new, alternative thought. Ideas first conceived as lunacy are often later viewed as genius. Consider Joseph Lister, Albert Einstein, and Galileo. There are scientists who argue that these geniuses would never get approved for a federal grant today because they wouldn’t fit into the strict criteria for an award.

The larger point here is that alternative ideas have positive consequences when they enter mainstream thought. One example already mentioned in the substance abuse treatment field is harm reduction - strategies that have proven effective in needle exchange programs and other areas such as minimizing but not eliminating drinking alcohol. “I really think it is problematic to only present abstinence to a 20-year-old,” says Sheigla Murphy, PhD, San Francisco. “My god, it’s so much part of their social life and culture and then we ask them to give it up forever. I think we need to put money into research for harm reduction.”

Dr. Murphy is a medical sociologist who has been researching various types of illicit drug use, violence, medical and drug treatment for more than 25 years. She has been the principal investigator of eight NIH grants and published numerous articles concerning heroin use, methadone maintenance, needle sharing, needle exchange, cocaine selling, natural recovery from drug use, drug users in health care systems and women’s drug use and pregnancy and violence. Her work has been seen in Addiction Research, The Journal of Psychoactive Drugs, Journal of Drug Issues, Contemporary Drug Problems, Qualitative Sociology and Social Science and Medicine

“I am lucky right now,” says Dr. Murphy. “I have two grants. So many new and seasoned are not getting funded.”

Murphy is among a growing number of dissenters who point to the inflexibility of today’s research funding environment. Many stress the importance of taking an epidemiological view in making grants and they cite a combination of limiting factors now controlling grant decisions and preventing an expanded research focus. These factors include outright prejudice, a drug war mentality, and temperance views.

“Barriers are based on prejudices and false beliefs perpetuated by a stigma so intense most can’t think of someone addicted to a substance as responsible,” says Josepher. “They are demoralized and vilified. The way I see it, people use drugs because they are in pain, they are in a negative relationship with self…if they are not in as much pain, they won’t need to self-medicate. Evidence equals research and for the last 50 years the research has supported a government policy of abstinence.”

Josepher notes that much of his own program’s funding comes through AIDS money under the Ryan White CARE Act or SAMSHA rather than NIH. “I think there is hope and we could be reaching and engaging a lot more people than we are. …we’re just locked into the way we think about treatment and recovery.”

PARTNERSHIP WITH PRIVATE INDUSTRY - A PATH TO SUCCESS OR SOMETHING ELSE?

In an attempt to stimulate a partnership of ideas and technologies between innovative small business and non-profit research institutions, the NIH offers its Small Business Technology Transfer (STTR) Grant program. By providing cash awards for cooperative R/R&D efforts with non-profit research institutions, the program assists the small business and research communities to commercialize innovative technologies.

The STTR program is structured in three phases, the first two of which are supported with STTR funds. The objective of Phase I is to establish the technical and scientific merit and feasibility of the proposed research and development efforts. The objective of Phase II is to continue the research or R&D efforts initiated in Phase I. 

Bill Chin, MD, executive vice president of scientific and regulatory affairs for PhRMA in Washington, D.C., sees the recent development of public and private collaborations as a positive trend. “It will take more than one lab and one government agency,” said the former dean of research at Harvard. “We need to come together. Multiple brains together are better than one.”

Nonetheless, a great many people question private industry research quality and motives given a past history of questionable research and accusations of publishing bias. Many scientists are wary of substance abuse research funded by pharmaceutical companies or the alcohol industry, Humphreys for one. "I chose to not go that route,” he says about his research (he focuses on the prevention and treatment of addictive disorders, the formation of public policy and the extent to which subjects in medical research differ from patients seen in everyday clinical practice). “People of great integrity do get this funding,” he said. “But are the results affected? The question is for the public - do you want the people who evaluate care or those with an economic interest in the issue to do the research?”

The validity of privately funded research is "a major problem we’re trying to address,” Says Srijan Sen, MD, PhD, assistant professor of psychiatry, neuroscience and bioinformatics at the Molecular and Behavioral Neuroscience Institute of the University of Michigan, Ann Arbor. “It’s problematic when we are relying almost exclusively on drugs funded by pharmaceuticals companies.“

A major reason for skepticism is the growing practice of selectively publishing trial results that serve an agenda. Dr. Sen points to a study published in the New England Journal of Medicine which found that Pharma-funded research has a 97% "significant effect" on the outcomes of published studies, as compared to a 51% significant effect on studies funded by government or non-profits. “There’s a huge bias in what’s getting out,” Sens says. “Only positive results are published.”  

Nearly 100 studies have drawn the same conclusion: publishing bias occurs far more often when studies are funded by industry versus non-industry. 

Of course, even by these stats, not every industry-funded research is tainted. As ADIAL’s CEO Stilley notes: “We are highly regulated and it would be difficult to tamper with.”

Stilley points to AD04’s primary investigator, ADIAL’s chairman, Professor Bankole Johnson, MD, a neuroscientist and pioneer in the development of medications for the treatment of alcohol abuse. He was the 2001 recipient of the Dan Anderson Research Award for his “distinguished contribution as a researcher who has advanced the scientific knowledge of addiction recovery” along with many other awards, including Distinguished Senior Scholar of Distinction Award in 2002 from the National Medical Association.  Johnson also was an inductee of the Texas Hall of Fame for contributions to science, mathematics, and technology. “He’s in there to help patients,” says Stilley. 

For its part in seeking to limit industry influence, the Food and Drug Administration (FDA) requires registration and full financial disclosure by clinical investigators concerning their compensation sources and all financial interests.  

Says PhRMA’s Dr. Chin: “We need to get together, hold hands and help each other in the near and distant future.”

No doubt true. Still, another important factor in drug research by industry is what Dr. Sen calls the phenomenon of funding "me-too" drugs, using Prozac as an example. “The most original drugs were in the 1940s to the 1960s. So many of the drugs today are the same chemical derivatives of old drugs. Eight-to-10 new SSRIs are just tweaks of Prozac,” he says. “They are no more effective but a lot more expensive."

Nor has the industry dived in to substance abuse relief where there is no clear path to high profits. One major example: not funding research vaccines that block the craving for heroin or other drugs because vaccines are seen as unprofitable for most drug abuse.  

According to Humphreys, addictions contribute to nearly a quarter of all deaths. “It’s a huge problem. We do have new care models, new things are going on and it is a pity that at the same time, funding is contracting,” he says. “People will continue to innovate but how will we know if it is effective or dangerous? Addictions contribute to nearly a quarter of all deaths. It’s a huge problem. If you are out there and looking for treatment, this is a good time, but not for research.”
{ADDENDUM: Post publication of this article, a spokesperson for NIDA sent the following information relative to its practices and the schedule below:  
"I thought it might be best to explain why the numbers you used in your article could be made more specific.  It is true that the $141 million on the 'Success Rates'page is the funding for NEW grants distributed by NIDA in 2013---but only for the first year of the project. However, virtually all of those grants are for multiple years. So scientists are competing for far more than $140 million in any given year. So while $141 million in NEW grant money went to scientists in 2013, those scientists will receive much more money in subsequent years, and five times that amount went to scientists already working on grants.
"Also the “'Success Rates' page only lists grants; there is also a considerable amount of money that goes to contracts (not grants) and other funding mechanisms for certain kinds of research - as well as training money that is distributed to scientists via various training programs. These programs also produce science. So the total amount of money given to external (“extramural”) scientists in 2013 was actually $848,733,590. This does not include the funding given to our own labs in Baltimore, MD."}

 

Institute or Center

Type of Grant

Success Rate Base

Number Awarded 

Total Cost Awarded 

Applications Success Rate

Fiscal Year

NIAAA

New

796

146

$46,812,395

18.3% 

2013

NIAAA

Renewal

56

20

$8,479,583

35.7% 

2013

NIAAA

Supplement

1

0

$0

N/A 

2013

Total

 

853

166

$55,291,978

19.5% 

 

 

NIDA

 

Institute or Center

Type of Grant

Success Rate Base

Number Awarded 

Total Cost Awarded 

Applications Success Rate

Fiscal Year

NIDA

New

1,720

324

$121,687,046

18.8% 

2013

NIDA

Renewal

150

40

$19,580,714

26.7% 

2013

NIDA

Supplement

4

1

$121,875

25.0% 

2013

Total

 

1,874

365

$141,389,635

19.5% 

Kathleen Phalen Tomaselli has written for the Washington Post, the LA Times, USA Today and American Medical News, among other publications. This is her first article for The Fix.

Rehabilitation Directories

Most Popular
The Rehab Review
Cliffside Malibu
 
 
 
 

The “beach-house-relaxed” Cliffside Malibu claims to provide an oasis for recovering addicts and alcoholics. And that’s just what you'll get—if you’ve got the cash.

Morningside Recovery
 
 
 
 

For a “rehab near the beach” experience that isn’t quite as costly as similar SoCal competitors, head to this Newport Beach treatment facility.

AToN Center
 
 
 
 

Whether you’re interested in the 12 Steps, SMART Recovery, or holistic treatments, this luxurious, appealing and commendable 4.5 star (our system doesn't yet show the 1/2 star) San Diego rehab has a program for you. 

Reflections
 
 
 
 

This exclusive Northern California rehab is all about client choice—as well as golf outings, Buddhist field trips and keeping up with the office.

The Ultimate Guide to Rehab
 
 
 
 
 

What you need to know when choosing an addiction treatment center.

the fix tv