Shame on the American Diabetes Association

I have been involved in #diabetes and #obesity research coming up on 46 years.  Over that time, I’ve been a professional member of the #AmericanDiabetesAssociation (#ADA) for at least 35+ years.  I owe much to the ADA.  Attendance at the annual scientific sessions has allowed me to not just share my #science, but also build collaborations, share ideas, and commiserate with fellow scientists.  I have published my work in the Association’s primary journals, #DiabetesCare and #Diabetes.  Finally, the ADA funded my first independent research grant that kick-started my career as an independent investigator.  Throughout it all, I have been a supporter of the Association and its goals to find a cure for diabetes and obesity.  However, events at this year’s annual scientific sessions has made me ashamed to be an ADA member.

So why?  As many of you may have seen in the news and on social media, there was an “incident” at this year’s scientific sessions that not just detracted from scientists, health professionals, and diabetes/obesity patients from learning the latest and greatest in diabetes/obesity research and treatment, but highlighted the weakness of the leadership of the association.  What follows is a description of what I know about the “incident,” but also my broader thoughts about what happened.

The Scene

So, on Friday, June 5, the Director of the #NationalInstitutesOfHealth (#NIH), Dr. #JayBhattacharya was scheduled to be the keynote speaker to open the 2026 annual ADA Scientific Sessions (#ADA2026) in New Orleans.  It should be noted that the ADA Scientific Sessions is THE scientific meeting related to diabetes and obesity and is attended by scientists and health professionals from around the globe.  I made a conscious decision not to attend that session, because I had heard Dr. Bhattacharya speak earlier in the year and figured I wasn’t going to learn anything new and exciting.  In fact, Dr. Bhattacharya canceled at the last minute.  This was due to a sudden scheduling issue related to meeting with the President according to the ADA.  So, instead Dr. #RichardWoychik, a senior adviser to Dr. Bhattacharya and former director of the National Institute of Environmental Health Sciences, attended in his place.  While some have tried to tie this change to the incident, it doesn’t surprise me that an individual in Dr. Bhattacharya's position would be unexpectedly called away and I am willing to accept that he had to truly make a last-minute change and that this was independent of what was happening right outside the hall where the presentation was scheduled to happen.

Outside of the venue, five individuals were handing out copies of a recent editorial that appeared in the Association’s premier journal #DiabetesCare.  The five individuals were:

Dr. Steven (Steve) Kahn – Professor of Medicine at the #UniversityOfWashington and director of the UW Diabetes Research Center

Dr. Aaron Kelly – Professor of Pediatrics at the #UniversityOfMinnesota Medical School

Dr. Justin Ryder – Associate Professor of Pediatrics and Surgery at #NorthwesternUniversity School of Medicine

Dr. Irl Hirsch – Professor of Medicine at the #UniversityOfWashington

Dr. Desmond Schatz – Professor of Pediatrics at the #UniversityOfFlorida, director of the University of Florida Diabetes Institute, and past President of Science and Medicine for the ADA

Each have research programs that have contributed to the success of the annual scientific sessions, have been long-standing members of the ADA, and have supported the ADA in various roles.

The editorial they were distributing addressed the current proposals by the #TrumpAdministration via the #OfficeOfManagementAndBudge (#OMB) that in many of our opinions weaken and heavily politicizes science in the U.S.; something that is the antithesis of what science strives for.  Apparently their goal was to make meeting attendees aware of the current situation and served as a #CallToAction to scientists.  The editorial was co-authored by Dr. #StevenKahn, who is the current Editor-in-Chief of the journal.  If you’re interested in reading the editorial, you can find a copy here.  This link goes directly to a copy of the editorial and not to the Diabetes Care website.  It is important to note the editorial has at the top, in a highly visible location, a disclaimer by the Association that I reproduce here:

“The opinions expressed in this editorial are the personal views of the authors (S.E. Kahn, C.A.M. Anderson, J.B. Buse, and E. Selvin) and do not represent those of the American Diabetes Association or the authors’ employers. The American Diabetes Association had no role in the development or writing of this manuscript. The authors declare that they receive honoraria from the American Diabetes Association for serving as editors of Diabetes Care and are recipients of grant awards from the National Institutes of Health. There are no other relevant conflicts of interest.”

So while the Association claimed “neutral ground” with respect to the publication of this opinion piece, they had no objection to it appearing in their journal.

The Incident

I was not present at the actual incident, but it has been described in detail in multiple media pieces and there is video of the actual confrontation you can view here.  But, there are some facts that need to be clearly stated.  The five researchers were only handing out copies of the editorial to attendees passing by.  They were not disruptive, they were not actively protesting, and there was no signage.  Just five researches handing out this editorial and engaging individuals if they asked questions.  The ADA responded by having all removed from the convention center.  They were confronted again when they attempted to re-enter the convention center and threatened with arrest if they did not comply with requests to remain outside.  Their meeting credentials were confiscated and they were told they could no longer participate in the meeting.  I don’t know about the others, but Dr. Kahn was scheduled to give a presentation later in the meeting.  The Association purged his name and the session from the meeting agenda.

The Immediate Aftermath

News of the incident quickly spread among meeting attendees.  The video that first appeared on MedPage Today and others that appeared since on social media were widely shared and people were asking about what happened in terms of both the incident, but also the fate of the individuals.  The Association quickly sent an e-mail to its membership and meeting attendees that I am sharing in its entirety here.  This initial statement, which essentially says that distributed materials must get prior authorization and only distributed within the exhibit hall, cites these individuals violating this “rule” and sets the justification for expelling them from the meeting.   Note one of the signatories of this e-mail is Dr. Mark Atkinson, who was the chair of the meeting program committee.  This will be relevant below.

This initial “explanation” was followed by an “official” statement from the Association on June 7 that I reproduce here.  In this “official” statement, the ADA cites their 501(c)(3) status as a non-profit organization and that Association activities need to be non-partisan. This statement is in contradiction to the rationale presented in the e-mail sent on June 6.

June 7 also included a key session that included an address by the President of Medicine and Science, Dr. A. Enrique Caballero along with the #BantingMedal recipient, Dr. #TakashiKadowaki.  The Banting Medal is the highest honor for scientific achievement awarded by the ADA, so congratulations to Dr. Kadowaki who over the course of his career has done elegant work to help identify key components of #Type2Diabetes...but I digress.  Dr. Caballero attempted to address the "incident" by essentially not directly mentioning the "incident" and dancing around it with flowery language about how we can disagree about any topic, that we shouldn't be confrontational, and we need to focus on helping people living with diabetes and obesity.  This seemed to be the theme the Association was trying to push; ignore the "incident" and tell everyone to focus on the people we are trying to help.  However, by not specifically addressing the issue, he created more confusion among people who were unaware of what had happened.  Additionally, some attendees were clearly upset by how he handled things and walked out of the session, obviously in protest.  While I remained because I wished to hear Dr. Kadowaki's presentation, I was simultaneously baffled and disgusted at how Dr. Caballero handled things.  It was beyond pathetic and did nothing to clarify or mitigate, let alone resolve, the situation.  I do not know if Dr. Caballero did this statement on his own (highly unlikely) or whether he was given what to say (most likely).

The same day, there was supposed to be a session where Steve Kahn was scheduled to give a presentation.  However, because he was persona non grata he was unable to make his presentation.  Instead, Dr. John Buse (Professor of Medicine at University of North Carolina at Chapel Hill (#UNC) School of Medicine and past ADA President for Science and Medicine) gave a presentation in Dr. Kahn's place.  However, before his formal presentation, Dr. Buse addressed those in attendance.  His comments can be seen in a video posted by Dr. Alice Cheng here.  The open letter and #petition Dr. Buse mentions can be found here if you are interested.

The Continuing Aftermath

So this "incident" has generated much discussion and activity, particularly online.  Dr. Atkinson resigned as chair of the Scientific Planning Committee.  In talking with folks with knowledge of his decision, he did not agree with how the ADA handled the situation and was unhappy that his name had to be attached to the initial e-mail that went out to membership and meeting attendees.  The ADA President-elect for Science and Medicine, Dr. Jennifer Green of #DukeUniversity, resigned her position and the ADA has already stricken her from their website.  It's not clear how ADA intends to fill these important positions.

I have been hearing rumblings of additional potential resignations, so things are still in flux.  I have also heard from colleagues who have declared they will refrain from supporting ADA and halt participation in any ADA activities until the Association apologies to the individuals involved.  Thus far, the ADA has responded by saying they wish to resolve this situation to everyone's satisfaction and will schedule a meeting with the individuals as quickly as possible.  However, whether they will be successful or not is questionable.  I have already heard that at least Steve Kahn has said he will not meet with them until they issue an apology.  I wouldn't be surprised if the others take a similar stance.  So we will see what transpires.

My Thoughts

So at the top I said I was ashamed of the Association's actions with respect to this incident.  Let me explain why.  

First, and foremost, the Association's handling of this situation has been, and continues to be, disastrous at best.  The shifting explanations for their actions were stupid, but more importantly, nonsensical.  Unauthorized distribution outside of the exhibit hall?  I get tons of #propaganda from pharmaceutical, tech, and other companies that are included in my meeting packet, slipped under the door of my hotel room, and other forms of distribution directly related to the meeting.  The Association clearly condones these distributions "outside the exhibit hall" and has provided these parties necessary information to target me and other attendees.  Second, given the editorial being distributed was published in the Association's premier journal, is already in the public domain, and included a neutrality statement essentially means the Association had no problem with it.  In fact, I would have assumed they would be happy to see something they published being distributed to additional readership.

Second, the statement on protecting their #NonProfit status does not hold water.  The #IRS rules for 501(c)(3) organizations state that issue advocacy is permitted, so long as the advocacy does not clearly favor one side in an election.  Thus, groups can advocate for issues related to their missions.  Dr. Kahn and his colleagues were not being partisan, were not advocating any specific candidate or political party, there was no election at stake, and they were not even protesting.  They were simply advocating for science.  In fact, in the Association's distorted logic, if what these individuals were doing jeopardized the Association's non-profit status, then the Association's own activities advocating for the exact same issue put their non-profit status in jeopardy.  As evidence, I present the ADA's press release regarding their stance on the very same issue that was issued on June 3, just a few days before the start of the scientific sessions.  Of course, the Association's past history of lobbying and advocating for issues related to diabetes and obesity just adds to their hypocritical statement that they were only protecting their non-profit status.

Third, their efforts to misdirect members and meeting attendees by not directly addressing the incident and underlying issue and repeatedly telling folks to focus on the people living with diabetes and obesity just reveals their inability to truly stand up and advocate when they absolutely need to.  The scientific sessions and all the wonderful discoveries and promising treatments for people living with diabetes and obesity would not exist if it were not for the dedication of all of those who do the science.  That science is being threatened in a way that we have not seen at least in my lifetime.  If there was ever a time for the ADA to be taking a strong advocacy position on behalf of the people living with these chronic diseases, it's now.  Individual scientists and the Association must make a stand, lest there be no attendees and science to present at future scientific sessions.

Lastly, there is the issue of #FreeSpeech and #FreedomOfExpression.  The majority of us attending the ADA Scientific Sessions are academics where #integrity and #AcademicFreedom are core principles.  However, beyond academics, we, as the #democracy that we are supposed to be, hold free speech and expression as founding principles of our country.  Suppression of these activities takes us down a dark path.  Given what actually happened with this "incident," the ADA comes across as invoking #censorship simply out of fear and protecting themselves from reprisal from an administration that clearly does not have the health of America and the world at heart.  

The epilogue of this story is yet to be played out.  Much more is likely to happen in the days to come.  One hopes the ADA will make appropriate adjustments and realize their errors, but I am not holding my breath.  We live in a time where various groups are cow-towing to the Trump Administration and its various threats.  Standing against the administration threatens the very existence of various organizations and rather than risk their livelihood, many have chosen to comply.  This is exactly what the administration is hoping for and only helps them achieve their goals.  We are at a critical juncture where organizations like the ADA need to grow a spine.  If they truly want to focus on people living with diabetes and obesity, then they need to actively advocate on behalf of science and push back against the proposed changes.  If they don't and these proposals become policy, then the goalposts for finding a cure for diabetes and obesity will be significantly pushed back further into the future.

#DrWattAtUSC  #LetsMakeAmericaBuenoAgain 

Update:  No sooner had I published this blog, that I became aware that I might be mistaken about which editorial was being distributed at the meeting.  My original information suggested the one from the link above, but just yesterday, a new editorial penned by members of the Diabetes Care editorial board was published in the journal.  You can read it here,  This may have been what was being distributed at the scientific sessions.

 

The Attack on Biomedical Research - Part 6, Leadership (or Lack Thereof)

This will be the last segment in my series.  While there are additional important topics I can be discussing, I feel like I have hit the major ones.  Besides, it will be interesting to see what develops over the next several months as the current administration continues its remodeling of the executive branch of the government.

What is Leadership?

If you look up the term on the Mirriam Webster Dictionary website, you will see:

1. the office or position of a leader
2. capacity to lead
3. the act or an instance of leading 

Sometimes I hated the dictionary as a kid, because it would take a word and rather than explicitly define it for you, would essentially use the word you were looking up to define it...like "leader" and "leading" as it does above.  Parsing the answer I get using ChatGPT: 

Leadership is the process of influencing, guiding, and motivating a group of people toward achieving a common goal. It involves setting a vision or direction, inspiring commitment, and coordinating efforts to bring that vision to life.....Leadership can take many forms—such as transformational leadership (inspiring change and innovation), servant leadership (prioritizing the needs of others), transactional leadership (focused on rules and performance), and situational leadership (adapting style to context)

Traditionally, the Secretary of Health and Human Services (HHS) has the leadership role that spans policy formulation, inter-agency coordination, regulatory oversight, and emergency management.  HHS has 13 agencies that include the Centers for Disease Control and Prevention (#CDC), the Food and Drug Administration (#FDA), the National Institutes of Health (#NIH), Indian Health Service (#IHS), and others.  The primary overall leadership goal is to protect the health of the nation and support vulnerable populations.

 

When I first heard that Robert F. Kennedy Jr. was being considered for the position of HHS Secretary, I knew the nation was in for troubled times.  As most of you know, RFK Jr. had a reputation of being a vaccine denier and built a significant proportion of his career around challenging the efficacy and safety of #vaccines.  It was ludicrous to even put him on a list of individuals to consider for HHS Secretary given this background, but also the fact the he has ZERO, NONE, ZILCH experience in #health, #biomedicine, or #PublicHealth was a larger deficiency.  Despite the zero experience, he was asked to lead an agency with the responsibility of providing the best possible health information for Americans and others across the globe.  This included directing the world's leading and best research enterprise, the NIH.  

 

RFK Jr. was appointed HHS Secretary in February 2025 and has immediate led the nation down the path of chaos, misinformation, and degraded health.  The real danger of RFK Jr. is that many of the things he says have a kernel of truth in them.  Some examples...yes, we should review the #VaccineSchedule given the number and types of recommended vaccinations have increased over the years.  Yes, the quality of our #FoodSupply has gotten worse and we should work towards limiting the amount and types of additives in our foods.  Yes, we should probably review if it makes sense to continue fluoridating the water supply given improvements in oral health, but also the broader access to fluoride through other sources.  Yes, it makes sense to do "gold standard" science to address the multitude of health questions affecting humans.

 

However, RFK Jr. jumps from the kernel of truth to outright nonsense and conspiracy theory-based thinking.  Taking each of the examples I noted above:

• First and foremost, vaccines prevent disease....full stop.  RFK Jr. seems to have a problem saying this and jumps to the crazy notion of vaccines causing autism or causing unnecessary deaths.  Let me just be clear at this point.  The overwhelming evidence from studies in multiple populations across the globe support two important conclusions;  1) approved vaccines are safe and effective in preventing disease, 2)  there is no evidence vaccines cause #autism.   Instead of supporting the science that shows the efficacy of vaccines, he pushes alternative approaches that have little to no research supporting them.  The whole #Tylenol thing had me rolling my eyes.  Another example is our current #measles crisis.  RFK Jr. has not made a full-throated statement advising parents to vaccinate their children and instead has pushed alternatives that have exacerbated the crisis.  An example is his suggestion parents give their children vitamin A to treat their kids' measles.  Vitamin A has been shown to have some positive effects in children who are vitamin A deficient due to poor #nutrition.  However, there is no evidence vitamin A is helpful in children with sufficient vitamin A levels and, in fact, excessive vitamin A can have toxic effects.  Cases of what appear to be vitamin A toxicity have been reported in Texas, the epicenter of our current measles crisis.  Sorry...I went off on a tangent to the original statement I made.  In terms of the vaccine schedule, rather than cite science or recommend funding for studies to examine the vaccine schedule, RFK Jr. has made statements that may put children as risk for those diseases where vaccinations would provide protection.  He has essentially put children at risk whose parents listen to what he says.  We need research to assess what the "best" schedule might be to help maximize health, but protect and minimize any side effects.

• The quality of our food supply has gotten worse in many different ways over the years.  Industrialized food production, mass food distribution, and other modern aspects of feeding our huge nation has put profits over health.  As an example, I read an interesting description regarding the revival of #HostessFoods, the makers of the famed #Twinkie.  One reason for the demise of the original company was the fact that they operated their own shipping/delivery of product directly to stores.  Given the relatively short shelf life of their baked goods (25 days for the Twinkie) the timing of baking, shipping, and selling the product was limited by the short shelf life.  This essentially became a challenge that Hostess could not overcome as their business expanded and they went bankrupt.  The person who revived Hostess purchased the majority of the company sans the shipping group.  He then figured out the main issue related to shelf life of the product and reformulated products to have a longer shelf life and relied on a third party shipper to distribute the product.  The Twinkie went from a shelf life of 25 days to 45 days (sorry folks, they don't last forever).  This, of course, was accomplished by adding different preservatives.  We really do need to think of how we process and distribute our food in terms of not just profit, but also in term of relative health.  However, simply jumping to everything needs to be "organic" (I hate this word, since everything we eat is organic....it's not like we're eating rocks) or unprocessed is not a solution.  Also, jumping to the way we did things in the "old days" is also not a solution, since it's not just the food additives that are affecting health.  The interactions amongst diet, physical activity, genetics, and other factors all play into our health and simply saying that removing additives will solve our problems is a gross misunderstanding of how all this works.  Sadly, there is no #MagicBullet when it comes the many health challenges we face as humans.  

• The addition of #fluoride in our water supply has been credited with significant improvements in #OralHealth.  However, with the addition of fluoride to a multitude of oral products, one can question whether it makes sense to continue to fluoridate water.  We need research into whether this policy should be continued.  Unfortunately, RFK Jr. claims fluoride is #toxic and cites a single study that examined fluoride at concentrations 5-10 times higher than that used to fluoridate water.  Too much of anything can be bad and selectively choosing one study that supports your position is not putting the science into the right context.  As far as i am aware, the vast majority of research shows that fluoride at low concentrations can have benefits for oral health, while having no toxic side effects.  However, in this modern age where there are multiple sources of fluoride, it does make sense to do the science to see if maybe, just maybe, we don't need to fluoridate the water supply.

• As you can see from the above examples, RFK Jr. cherry picks bits of "evidence" to support his own misguided positions, without considering the spectrum of studies that have been performed on a given topic.  As I always teach my students, no single scientific study proves anything.  It's only after we repeat studies over and over and get the same result, then we can come to some conclusion.  RFK Jr. clearly does not understand how science works.  He also does not understand that the US has been the home to the most innovative and creative minds that have been doing high-quality research for decades.  His current statements of the need to do "gold standard" research or the idea that we seen do start implementing "gold standard" research clearly shows what little he knows about #BiomedicalResearch and its history.  The US has been doing "gold standard" research for decades and it's because of that research human health has significantly improved over the years.  In fact, you can even say we've been doing "gold standard" research despite the limitations place on science due to outdated funding policies (a different topic).  Just because the research doesn't generate the result that YOU want, doesn't mean it was not performed to the highest standard.  Furthermore, the research community replicating and validating findings has the secondary effect that bad science tends to be weeded out and good science tends to be perpetuated.   

So it's one thing to be biased and attempting to push #HealthPolicy in a direction that aligns with your misguided thinking, but RFK Jr. can't do it all by himself.  So, he's been very busy pushing out career professionals in the various agencies under his purview and installing like-minded individuals.  The alarming thing about this is that he's bringing in individuals with equally little to no experience in health or individuals who have their own agendas that loosely align with RFJ Jr.'s who sadly have titles that make them sound like experts.  He has also invited non-health professionals to meetings as if they were experts in health.  The most recent example was the "Make America Healthy Again" (#MAHA) Summit where leaders in the #SelfHelp, #AlternativeHealth, #NutritionalSupplement, and other unregulated industries were invited to sit and discuss along with other fringe scientists.  I had to laugh at some of the reporting from that summit, since these individuals all railed against the #PharmaceuticalIndustry while touting the benefits of what their individual industries provide.  The reason I laugh is that while it's easy to target the pharmaceutical industry as the root of all evil, it is regulated.  They have to follow rules, go through a regulatory process, and meet certain standards for their products to make it out to the market.  I'm not saying they're angels, but at least they're regulated.  In contrast, the industries invited by RFK Jr. are not regulated.  They can essentially create a product, fire up a website, tout its benefits, and start selling you a product.  They are, for the most part, the modern equivalent of hustlers of snake oil.  They are, to me, the worst of the worst as they claim to be helping those with health issues when, in fact, what they hustle does nothing to help people seeking solutions and only lines their pockets.

 

Finally, I continue to be appalled by the injection of individuals with #MD, #PhD, or other titles who are either not experts in the areas they are commenting on, have been identified as having past histories of #ScientificFraud, or have put their egos ahead of everything else and inflated their stated expertise.  This is probably the most dangerous group of individuals, as they give an air of authority to the bad decisions being made in the name of improving health.  The most recent example of this is the realignment of the CDC's Advisory Committee on Immunization Practices (ACIP). Membership of this committee has been realigned to include individuals with clear anti-vaccine positions.  At their most recent meeting where they made the recommendation to discontinue universal #HepatitisB vaccination of infants, they invited speakers to discuss the evidence for or against universal vaccination.  Among the individuals who provided "scientific evidence" to support the discontinuation included a scientist who has no expertise in vaccination research (well, let's say they do very poor vaccination research), a scientist who previously had publications retracted due to scientific misconduct and has zero expertise in this particular arena, and an individual who has overstated their expertise in the field of vaccines.  It drives me bonkers when people of science place their own egos and agendas ahead of doing good science and letting the data tell you what the answer might be.  This again is tantamount to cherry-picking the "science" to generate a specific outcome.  

 

Look, I'm not saying science is perfect.  It isn't.  In fact, science is inefficient and subject to change.  When I was a student I learned that adipose tissue was simply a form of energy storage and that excess energy was diverted to adipose tissue as long-term storage to provide energy as needed.  Aside from a few other minor contributions, adipose tissue seemed pretty boring and straightforward.  However, in the middle of my career it was discovered that adipose tissue was actual an endocrine organ that secreted a whole host of different hormones, primarily involved in feeding regulation, although some performed other critical functions.  This new discovery totally changed the way I had to think about adipose tissue.  I can cite all kinds of examples like this and if you think about what we "knew" as "facts" as humans hundreds or thousands of years ago, but now know differently, this shouldn't be a surprise.  That doesn't mean you shouldn't believe science and it doesn't mean that we as scientists don't keep open minds about what may or may not be.  However, we do maintain the standard that scientific evidence should support any new knowledge.  It can't be just because you want to believe something to be true, which is what RFK Jr. and his friends seem to want and seem to push for in their efforts to change health policies.

 

This particular post was difficult to write, because I had to fight the temptation to rave on about other aspects of RFK Jr.'s "leadership" and where it's taking us.  I'm already very disturbed by many of the changes implemented at the NIH, including the review of grants by an administrative official to determine its suitability....this reeks of a "#PoliticalOfficer" reviewing grants to ensure they align with "#PartyIdeology."  We are definitely moving down a dark path...  

 

#DrWattAtUSC  #LetsMakeAmericaBuenoAgain   

The Attack on Biomedical Research - Part 5, DEI

Disclaimer

The views I provide in this segment are founded in the following premises:

    ●    Everyone should be treated with dignity and respect

    ●    Everyone should have the opportunity to live a healthy life

    ●    Everyone should have ready access to healthcare

    ●    Everyone should have their health concerns addressed so as to achieve the above points 

When I say "everyone" I mean EVERYONE.  Your citizenship, race, ethnicity, religion, sexual orientation/preference, or any other label that might differentiate you from another person does not matter.  If you do not agree with these premises, then you may as well stop reading and go elsewhere in the digital domain, since you likely will not agree with anything I say below.  

Background

It is of interest to me how the Heritage Foundation and current administration have deftly hijacked the term "Diversity, Equity, and Inclusion" (DEI) to mean something totally different from its original meaning.  Their efforts have resulted in a large segment of the general public believing DEI meaning an unqualified person of color who was unjustly given an opportunity that should have gone to another person (primarily meaning a White individual).  It has also become a weird synonym for racism, with tons of things being labeled as being "DEI."

If you don't believe this is the case, I will digress here a bit and point out one example.  Immediately following the current administration's edict eliminating anything DEI related, groups across the country immediately began to scrub their websites of anything considered "DEI."  This was particularly true of government operated websites.  The various armed services began to scrub their websites by eliminating pages related to war heroes of color or the "wrong" sexual orientation, segregated units of color, anyone whose name included words that were on their verboten list (example, medal of honor recipient Thomas H. Gay), or any piece of equipment (yes, equipment) that had a name included words on their verboten list (example, the B-29 "Enola Gay" that dropped the first atomic bomb, which was named after the pilot's mother "Enola Gay Tibbets").  In the end, the only "White" heroes, units, etc. remained on these websites until public outcry forced many (not all) of them to be restored.  

The chair of the Board of Trustees for the Japanese American National Museum (JANM), Bill Fujioka, declared that JANM would scrub nothing from their websites.  When interviewed by The Los Angeles Times, Fujioka was quoted as saying "Our community is based on diversity, equity is guaranteed to us in the Constitution, and inclusion is what we believe in."  This stance highlights the fact that life is not just about a subgroup of the population nor is it about how a subgroup views the world.  It also highlights that we, as a country, have a long way to go in terms of achieving that idealistic society where everyone is treated equally with equal opportunity and "...with liberty and justice for all."  

In terms of science, I am going to confine my comments to two very broad areas that have been adversely affected by new DEI-based mandates; research that includes components that this administration considers "DEI" and training opportunities.  DEI in biomedical and basic research extends well beyond these two areas, but I focus on these two as they are the two I am most familiar with.  

DEI in Research

I start this section by sharing a shot of a key segment of a grant termination letter received by one of my colleagues earlier this year when the first of the National Institutes of Health (NIH) grants were being clawed back. 

Note some of the language, particularly the part that DEI-based studies are "...often used to support unlawful discrimination on the basis of race and other protected characteristics, which harms the health of Americans."  Huh?  This colleague was studying some of the challenges faced by certain racial groups and their ability to receive cancer treatment. 

One has to remember that disease, infectious or chronic, does not care about any of the political or social factors that divide us as a people.  It does not care about your political affiliation, religious preference, sexual orientation, religion, race, ethnicity....none of that matters.  However, the risks underlying these diseases are significantly affected by these factors, which is why we need to do research in an attempt to understand those inequities, how they affect health, and how we might rectify those inequities to improve health.  The idea that DEI-related work "...harms the health of Americans" is not only laughable, but cutting off such research is what will harm the health of Americans and people across the globe.  The fact that this administration is labeling research as "DEI-related" ignores the fact that health is very diverse, inequalities exist, and when trying to improve the health of Americans, everyone should be included.

An example of this is improving ones lifestyle to either prevent or deal with a chronic disease.  Typically, when you doctor notices you might be at elevated risk for a chronic disease like diabetes, hypertension, or cardiovascular disease, they will tell you to stop smoking, cut your alcohol consumption, increase your physical activity, and change your diet to eating healthier foods.  Sounds straightforward, doesn't it?  Unfortunately, because of historic racism, such as redlining, individuals in certain environments cannot easily make these changes.  Why is that?  What can we do to change that?  What are the components that create barriers for these individuals?  What changes are most effective?  These and other questions are research topics that are studied by a number of investigators.  There may also be genetic factors that play into how these inequities affect disease (an area of research interest for me).  However, researchers now find themselves unable to study these problems, because they are considered "DEI-related" and no longer an NIH "priority."  The politicization of science (a future topic in this series) has formalized a decision before ascertaining the research answer.  In other words, rather than research driving decisions, we are allowing politics to drive the decisions.  This has negative consequences for everyone's health.

We should be performing research to address everyone's health issues and identify those things we can change to improve the health.  Preventable morbidity and mortality is at the core of most biomedical research and the investment the United States has made has put us at the forefront and made us worldwide leaders in biomedical research.  However, these new restrictions and the subsequent downstream effects beyond the actual research, like unemployment for staff, is having catastrophic effects on U.S> research that even if reversed tomorrow, will have negative effects for decades.  The idea that somehow DEI-based research "supports unlawful discrimination" can only come from a political agenda that prioritizes certain groups or ideals over others.  In other words, using the veil of discrimination to claim unlawful discrimination.  Again, disease doesn't care about these things and removing this area of research limits our ability to reduce morbidity and mortality.

DEI in Training

A significant number of training programs have been terminated and research support for young investigators just starting their research careers have come to a screeching halt because the program or research has been declared "DEI-related" and, again, not an NIH priority.  However, the extremely biased interpretation of DEI taken by this administration has actually terminated opportunities for a wide spectrum of individuals; not just those of color.  I can use myself as an example.

Although I was fortunate that my father worked his ass off to provide us with a middle class lifestyle, the fact that both my parents never finished high school and English was not their primary language created certain barriers for my own educational path.  My parents did not have "connections" to help me find extracurricular activities like research experiences that my "connected" friends easily found.  I could not turn to them for advice on how to apply to college or what to write in my personal statement.  Although technically middle class, our financial situation raised concerns about how to pay for college.... my folks nor I were aware of financial aid.  In other words, I had to navigate all these things pretty much on my own, relying on friends and my high school's college counselor (who, in retrospect, was not all that good).  I did have the great fortune that my folks put a premium on education and I performed well in school.  So, when I got accepted into various universities, the financial aid was fairly generous.  When I told my folks I wanted to go to graduate school, my dad thought he was going to have to fork out more money.  However, I was supported by an NIH training grant that covered my tuition and paid me a stipend.  Similarly, when I transitioned to my post-doctoral training, I was initially supported by an NIH training grant, before I was able to apply for and received my own NIH fellowship.  These opportunities allowed me to apply for and receive my first independent grant, a young investigator award from the American Diabetes Association.  That initial award then led to my first NIH research grant.

The various programs that supported my training and that first young investigator award are what allowed me to build my scientific career and become the successful biomedical investigator I am today.  Without them, it is not clear to me how my career path would have evolved.  However, with NIH now eliminating many training programs arguing they are "DEI", many young investigators will not have the same opportunities that I had.  I was an example of why we need such programs, but I had one advantage that many did not....I lived in Los Angeles.  There were numerous universities, research labs, and other institutions that would allow me to seek training opportunities.  But what if I had lived in the middle of the country where the density of universities is much lower?  What if I came from a low socioeconomic family who could not afford to send me elsewhere to find such opportunities?  

These are just a some of reasons why these training programs exist.  It's not about advancing certain individuals because of their skin color or religion.  Many are just like I was...disadvantaged due to various other circumstances.  These programs help identify young individuals with great potential to help nurture them and train them to become our next generation of scientists.  These training programs recognize that society is not fair and equitable and that we need to uplift some who show great promise, but face certain barriers.  It's not about giving someone an unfair advantage.

This administration faults DEI as discriminatory and that merit should be a primary factor in deciding many aspects of society.  Merit is important and should be a significant component of any decision.  However, making decisions solely based on merit assumes all other things are equal.  Sadly, society does not work that way, which is why many of these training programs were created.  Bright and intelligent people of color, with physical disabilities, or with financial hurdles many times do not get to choose science as a career path because of those inequities.  Many of these training programs were designed to give them opportunities.  I have been involved in three such program, one of which I co-directed.  The goals across all three of these programs are the same; provide research opportunities to undergraduate students who might not otherwise might not have access to research opportunities.  Fortunately, one of these programs exists without Federal funding and another so far continues to receive Federal funding.  However, the one I co-direct has lost its Federal funding and likely trained its last cohort this past summer.  It is doubtful we will identify an alternative source of funding by next summer.  Our program, over the past 7 years, have helped over 40 undergraduate students from varied backgrounds gain research experience and transition into medical or graduate school.  These include a student with a hearing disability, a student from Guam, and a Native American student living on a reservation, just as examples.  I was extremely proud of the students we trained and how their various careers are moving forward.  I worry about those who might be affected by these recent changes that may derail their career paths.

DEI means different things to different people.  However, as Bill Fujioka noted, our communities are based in diversity (even if you cannot see it), equity is supposed to be guaranteed to us in the Constitution, and we should not be excluding anyone just because we do not like some perceived characteristic.  Merit-based decisions are only fair when the playing field is level and these programs were working to try to make that playing field a bit more level.  They were not designed to replace merit with some other characteristic.  In science, that's the last thing you want to do....have someone who is not qualified to be doing the job (the next topic in this series). 

The Attack on Biomedical Research - Part 4, Morale in Science

Slight break in my series due to both a family and personal health issue that had me a bit sidelined for a while.  But, I'm now back online and moving forward with the series.

The progress of science is, like many things, tied to the morale of those who are doing the work.  I have been doing biomedical research for over forty years (sure doesn't seem that long).  During that time, I have seen both highs and lows both personally, but also as experienced by the industry as a whole.  There were exciting times where one could see new avenues of insight and research direction opening new discoveries and directions.  There were other times where significant roadblocks were thrown in front of us, resulting in scientific progress crawling along at a snail's pace.  The one thing I learned over the years of highs and lows, is that keeping my head down, focusing on my science, writing my grants and papers, and thinking of the next step regardless of what was going on around me, would get me through the tough times.  

However, this new political environment we face continues to dramatically change science, primarily not in a positive direction, has me and others questioning not just our personal futures, but that of scientific research in general.  Some of the issues that have contributed to this massive shift in science I briefly touch on below.

Public Trust in Science

There has been a number of major shifts in society over the past couple of decades.  One of them being the lack of public trust in science.  This shift in how the public perceives and understands (or doesn't understand in many cases) science has changed how many of us in the field operate.  Part of this shift can be blamed on scientists themselves.  The broad model had always been that the scientist would do the research, write up the results for publication in a scientific journal, and then move on to the next question to be answered.  The publication of our results would be considered the dissemination of our findings, but that audience was generally the scientific community.  How many in the general public actually reads the scientific literature?  Thus, dissemination of our findings to the broader public was usually left up to others. 

Typically, your institution's press operation takes on the responsibility of marketing your findings out to the general public, which means the media becomes the vehicle by which information is disseminated to the public.  Unfortunately, the media gets is wrong too many times, hypes up results, report contradicting findings from different studies as if they were all equally valid, and sometimes get the facts just totally wrong.  John Oliver did a really nice piece on this on his show Last Week Tonight.  The lack of integrity in how the media disseminates scientific information only contributes to the lack of understanding of science and the distrust of science.  Science is not perfect, is many times inefficient, and as I teach my students, no single study proves anything.  Not all scientific studies examining the same question are equal and each needs to be carefully evaluated.  Thus, it's not surprising when the public sees the media reporting contradictory conclusions and get the impression that scientists "can't make up their minds" about a given problem.

Scientists have never been trained to move beyond the scientific publication to help educate the public.  A minority of scientists have embraced social media to do this, but frankly too few have done so and unfortunately a large number of those who do, seem to be doing it more for the "fame and fortune" aspect, rather than the educational aspect.  Scientific journals have also made attempts to make what they publish more publicly accessible, with mixed results.

In this new digital age, the lack of engagement by scientists, the poor reporting by the media, and the variety of digital outlets has allowed those who have a personal agenda to fill the apparent void with pseudoscience, conspiracy theories, and political agendas.  These individual viewpoints have gained more traction thanks to automated algorithms that feed individuals with only things they want to hear, rather than feeding them correct information.  Traction is gained even more so by the invocation of "First Amendment Rights" rather than whether information is factual or not.  We have seen this most prominently with the recent pandemic where sound science was ignored and even vilified in favor of anecdotal information or even wives' tales.  The situation was further exacerbated by people attacking and ignoring scientific experts who have studied such problems for decades, in favor of political hacks or so-called "online influencers" with zero to less-than-zero scientific knowledge or expertise.  Even our President claims to rely on "common sense and gut instincts" rather than scientific expertise.

The increased lack of public trust in science has extracted an immeasurable toll on morale in science.  Students come in with a level of skepticism that has to be overcome that we have never previously encountered.  This requires time and energy we have never had to include in previous teaching or training of students.  The public questions everything we do to try and improve health and quality of life as if it was tied to some giant pharma-conspiracy to keep everyone sick and tied to profit making on medications.  It's as if The Flat Earth Society suddenly captured the national conscience and everyone now believes the earth is flat.  Society is moving in a very dangerous direction that has a direct impact on the morale of science.

This lack of trust in science has widespread implications, particularly in terms of public health.  Vaccines are an excellent example where trust has eroded to the point where diseases we have not seen in decades are appearing across the country.  The hard work that was put into developing vaccines, implementing their deployment, and ensuring their levels to protect the public has degraded primarily due to lack of trust in science. There needs to be a concerted effort to correct this shift in the public perception, as it has implications for future science and the training of scientists.

Political Leadership and Politicization of Science

I have recently been expressing to colleagues that we seem to be undergoing our own version of China's Cultural Revolution, where politics dictate everything.  This is the first time in my career where political leadership have directly interjected themselves into scientific decisions, particularly what research will or will be funded.  The initial purge of research grants based on the 197 verboten words sent shock waves throughout biomedical science, but was just the beginning.  Much like how this administration implemented many of their changes, the claw back of grants based on these words was accomplished by simply doing a simple word search.  If any given word appeared more that 6 times in a grant (including titles of citations from the literature), the grant was flagged.  How bad was this implementation?  Just as a minor example, the word "trans" was part of the list, obviously in reference to this administration's dislike of "transsexual."  However, the term "trans" is used in other scientific contexts, like transgenic mice (genetically altered mice), translocation (movement of something from one location to another), cis vs. trans genetic regulation (regulatory elements on the same DNA stand vs. the opposite DNA strand), and other similar examples.  All these grants were initially frozen and tagged before someone finally figured out they had nothing to do with trans-sexuality.  

However, things did not stop at a mere set of words.  Research perceived to be motivated by Diversity, Equity, and Inclusion (DEI) has been pretty much terminated.  DEI will be a separate topic in this series, but let me just say at this point that the administration's definition of DEI has had extremely negative effects on scientific research, the careers of individual scientists, the training of new scientists, and eventually will have negative effects on public health.  

The Department of Health and Human Services (HHS) is currently led by an individual who has ZERO training or experience in science.  While some of the things he says are broadly true and need addressing, much of the details and justification he provides is just outright wrong, not based in any science, and based on his own perceptions rather than facts.  Such an individual is a huge danger to the overall biomedical enterprise of the U.S.  You can immediately see the negative effects he has had in the short handful of months he has led HHS.  He has removed scientific experts and replaced many of them with charlatans or non-scientists.  He has interjected his own opinions into the scientific process to push for outcomes he prefers to see, rather than letting the science determine the outcomes.  None of of us do science based on a political viewpoint or agenda.  Why?  Because many of the problems we study don't give a flying fuck about your political affiliation, sexual orientation, religious preference, or any of the other social factors that separate us as a society.  Cancer cells only care about replicating.  Viruses only care about reproducing.  For those who think chronic diseases are new problems created by the pharmaceutical industry know nothing about this history or challenges in studying these diseases.  Most have existed way before the pharmaceutical industry was established.  

The degradation of scientific leadership, the layoff of thousands of skilled workers by DOGE, the realignment and restructuring of institutions like the CDC and FDA to align with political views continues to degrade our scientific industry, our leadership in science, and most importantly is leading to a erosion of the health of our nation.  Superimpose upon that changes to Medicare/Medicaid, Federal support for food safety programs, the extinction of USAID, and other changes to our government can only push us in one very negative direction.

Restructuring of the National Institutes of Health

There are many negative changes going on at the National Institutes of Health (NIH).  These are too numerous to delineate here, but I will briefly touch on five items that have directly affected morale within science.

First is the overall effect of the various changes that has many scientists questioning their futures.  This is particularly true for young investigators just starting their careers or those trying to decide whether to apply to graduate programs.  The overall attitude, perceived or real, is that America doesn't want them and that their contributions to society will not be appreciated.  This could be the start of a brain drain for the U.S. as foreign countries see opportunities to attract students and scientists to their countries.  Many Ph.D. programs have announced no new incoming classes as support for students have disappeared.  Seeing this, many foreign countries are actively cherry picking young Americans to start their training or careers in foreign lands.  This is not a good thing for America.

Second, the injection of politics and political views into the funding of science has many of us extremely disturbed and concerned.  This approach aligns with how Chairman Mao implemented the Cultural Revolution in China.  Sure, you can do science, just so long as it aligned with how the Central Committee defined things, which was political fealty to Mao-ism.  That's essentially what is starting to happen within the NIH.  Freedom of speech and freedom to choose your scientific question is being replaced by political fealty to whatever ideology the current administration and leadership espouses.  Furthermore, the expert leadership that has guided the NIH research programs, both intramural and extramural, are being replaced by charlatans and political hacks who only have personal or political agendas.

Third, the proposed changes to the NIH budget and overhead will have devastating effects on science in America.  I previously covered the overhead issue in my first post in this series.  However, more recent proposed changes will have additional devastating effects on science.  First, the proposed reduction of the overall NIH budget by 40% will basically gut the American research enterprise.  Coupled with the change to overhead, the loss in research projects, loss in research talent, the inability to train future scientists, and the impact on American health will be immeasurably bad.  

Additionally, the administration has changed the way funds for grants will be awarded.  Traditionally, when one was awarded a multi-year grant, you were required to submit a progress report at the end of each year before the next year's funds would be awarded.  This was a mechanism to ensure that each project was meeting its goals and making appropriate progress.  This also allowed NIH to spread the funding of a given grant across a number of budget years, without having to immediately fund the entirety of the project.  This meant that more projects could be funded across a number of years.  

However, this administration is now requiring that grants be fully funded the year they are awarded.  That means there will be less funds for a given budget year and less projects funded.  This recent change has forced changes to the "payline" (the rate at which grant applications are funded).  The National Cancer Institutes recently announced their payline for grants will now be the 4th percentile.  Other institutes are moving to single-digit levels of funding, although I have not heard what those exact numbers will be.  My guess is most will probably fall around 6-8 %-tile..  So what does this mean?  It means that for a given funding cycle, your cancer research grant application must score in the top 4% nationwide, in order to be funded.  Think about what that means.  Given the thousands of scientists writing thousands of grant applications each cycle, you basically have to be better than the best in order to get funded.  I have been fortunate to have been fairly successful in getting my grants funded and my scores have usually fallen in the 10-15 %-tile range....twice I scored in the single digits....an achievement I am quite proud of.  But, under the new paylines, even at my best, the chances of my grants getting funded have significantly fallen.  This drop in the paylines will probably have the greatest effect on morale in science as funding begins to fall outside of the reach of the majority of scientists.

 Fourth, the NIH is realigning the grant review process and centralizing it into the Center for Scientific Research (CSR).  Previously, CSR handled the administrative parts of grant applications, but then would assign them to the different institutes and the institutes would operate grant review panels, identifying expertise appropriate for a given grant application review.  The final decisions would then be sent back to CSR for final processing.  Now, the entire process is to be handled by CSR and the institutes will no longer be involved in the grant review process.  While in the long run, this change may prove to be an improvement (I have no a priori evidence to suggest it won't), short term, this is a disaster.  Primarily because NIH and CSR have not been transparent in how the new process would work and who might be involved.  Anecdotal evidence suggests individuals who are not familiar with your research area may be handling your grant and its review.  It does not help that NIH will simultaneously be realigning the institutes with some being eliminated and others merged into new entities.  None of us can foresee what our scientific futures will look like in this newly re-vamped NIH.

Fifth, is the discussion of requiring NIH-funded scientists to only publish in some new NIH-based publication system that RFK, Jr. has envisioned.  Again his lack of scientific background and vague perception that scientific journals are all controlled by the pharmaceutical industry and rife with corruption, graft, and bias has resulted in an idea that is not necessary and problematic in its own right.  While the current publication system is not perfect and does need some much needed overhaul, it is definitely not as RFK, Jr. describes.  Furthermore, given the direct injection of politics into science by the current secretary and his minions, I would have no confidence that any publication operated by the current administration would be to the benefit of science.

So, in closing, morale in science is probably at an all-time low.  Surveys like the Biorender State of U.S. Science Funding: 2025 Report bear this out.  My own conversations with friends and colleagues across the nation also bear this out.  Too many bad things have been happening all at once.  I have seen senior colleagues choosing retirement over having to deal with what it going on.  People my age struggle with that option....while appealing on one end, I still have things I'd like to accomplish before I retire.  It's the thing that has driven my entire career; making my tiny contributions to improving the health of Americans and people across the globe.

But you can also see what is happening based on active protest to what the current administration is doing.  NIH scientists and staff issued the Bethesda Declaration raising their concerns regarding the staff cuts and other changes at the NIH.  Their declaration was publicly hosted by the group Stand Up for Science, who has taken stances on other issues such as changes at the National Science Foundation, National Aeronautics and Space Administration, Food and Drug Administration, Center for Disease Control, and others.

At the end of the day, even if everything that has happened is reversed and returned to "normal," the damage has already been done.  We will not recover from these past 6 months for at least a decade.  That's not to say everything before the Trump Administration came to power was perfect.  There were very clear improvements and changes that were necessary.  However, the sledgehammer this administration has wildly wielded within the glass house of scientific research has had only predictable outcomes.