Mike's Blog

As we hurtle towards the end of the fiscal year (9/30), program staff and grants management are working feverishly through the final application awards. Please be super-responsive if contacted. This year, the contract side of the house is overloaded and still dealing with staff reductions along with an ongoing NIH reorganization. As such, some funding actions may be postponed to FY27, potentially freeing up available FY26 funds for last-minute processing and offering some unexpected, good news to a select few.

Following up on an issue discussed in last month’s Ansible, Congress is showing more interest in the U.S.-China biotechnology and R&D rivalry. One Texas Congressman, Rep. Nathaniel Moran (R-Texas), remarked that Chinese biotechs were “beating us on our ground game” (take note TRCC!). Also catching Congress’ eye is the fact that Chinese biotech and pharmaceutical assets are projected to account for two-thirds of total (global) licensing deal value this year whereas five years ago, the figure was only 5%. In the House, a new bill would apply review requirements found in the COINS (Comprehensive Outbound Investment National Security) Act to potential Chinese biotechnology investments. A similar proposal is making its way in the Senate. Of relevance for CTSAs is the recognition by members of Congress that we need to be “identifying private-public partnerships where research, particularly in colleges and universities and medical institutions, can grow significantly, so that we spend the time necessary to see the next generation of pharmaceuticals that need to come.” 

Another emerging issue for 2027 will be the cuts to Medicaid (roughly $1 trillion over ten years). Stat has a useful summary of contingency planning that many states and largely rural based health care facilities are embarking upon. For example, projections suggest a 1% revenue drop for hospitals in Maine. The problem is that many of these facilities operate with less than 1% margins suggesting severe service cuts at best and complete closure at worst. In addition to lost revenue, nationwide >7 million Americans are projected to lose all coverage due to Medicaid reforms. One area that may engage CTSAs is the increasing focus on telehealth/telemedicine options that will need to be expanded along with attendant training and workforce development to realize adoption and efficient utilization of necessary technology to support these efforts.

Beyond Medicaid, there are additional headwinds. The fallout from the expiration of the ACA subsidies has been estimated at about 3 million fewer signups for this year. At the same time, small businesses offering health insurance have declined from 80% to 59% over the past 25 years leading to a decline in the percentage of working age adults obtaining health care insurance through employers from 67% in 1998 to 60% today. And for those still receiving employer based health insurance, a recent report from the Business Group on Health reveals a consistent pattern of health care premium projections leading to health plan modifications with the result leading to overall higher premiums compared to earlier projections both before and after those modifications, consistently year after year after year. When exactly all this fecal matter hits the circulating blades of our current health system is merely a matter of time. The question increasingly appears to be when, rather than whether, these pressures become unsustainable. CTSAs can expect to be addressing this issue with both quick and dirty band-aids as well as hopefully more comprehensive solutions.

And now for something completely different. A recent Nature article draws attention to another issue of trust in science. Following on the identification of >100 suspicious images in an antibody catalogue from a single company, suspicion has now grown to >18,000 images from fifteen companies. The basis of suspicion is frequently the appearance of an identical background in multiple western blots (>800) demonstrating antibody specificity. This apparent photoshopping or image manipulation does not mean that the antibodies aren’t performing as advertised, but doctoring the data that documents the quality of the product does create questions in the mind of the purchaser.

Lastly, if you’re looking for summer food ideas, you might want to check out the CDC’s open foodborne disease outbreaks investigations first. Current open investigations (as I’m writing this), which also include pet issues, include Salmonella outbreak due to backyard poultry, E. coli outbreak linked to frozen blueberries, Cyclospora outbreak linked to iceberg lettuce, Salmonella outbreak linked to shell eggs, Salmonella outbreak linked to turtles, Salmonella linked to jalapenos, and E. coli and Salmonella outbreak linked to alfalfa sprouts. All these outbreaks are ongoing as the CDC transitions to a permanent Director; hopefully, she has a strong stomach. Maybe it’s a good time to start that diet.

What I’m reading: The Tragedy of the Cognitive Commons: How AI Could Disrupt the Regeneration of Professional Expertise. The title is a variation on Garrett Hardin’s 1968 Science article entitled The Tragedy of the Commons. Hardin argued that ‘commons’ or shared public resources that are utilized on an individual basis will degrade over time without some sort of collective action to sustain the ‘commons.’ The cognitive commons is defined “as the collective pool of deep human expertise within a profession that functions as a shared resource whose regeneration can no longer be taken for granted.” The author’s term ‘regeneration’ is essentially what we typically refer to as training. The concern is that AI adoption will reduce the numbers of humans in the process, particularly entry level positions, generally the most unproductive. Over time, there will be fewer replacements resulting in a loss of expertise and institutional knowledge as the ‘old guard’ retire. “Without intervention, organizational responses to competitive pressures will deplete the shared expertise that all organizations rely on. By eliminating entry-level positions, organizations prioritize efficiency while socializing the costs of diminishing knowledge. This leads to increased systemic fragility…” The bottom line is that we can’t allow ‘efficiency’ (which has generally become a code word for cost cutting) to obliterate our valuable seed corn, otherwise known as early-stage investigators. 

Sometimes the needs of the mission outweigh the requirements of the rulebook.
-Gareth L Powell, Embers of War

Note: Special thanks to the above and beyond editorial review by Rebecca Katz.