I WOULD LIKE TO WELCOME EVERYONE
TO THE 1673rd MEETING OF THE
NATIONAL INSTITUTE ON ALCOHOL
ABUSE AND ALCOHOLISM COUNCIL.
I'M GOING TO CALL ON EACH OF OUR
COUNCIL MEMBERS AND NIAA SENIOR
STAFF.
IF YOU COULD JUST SAY YOUR NAME
AND WHERE YOU'RE FROM AND IF YOU
WANT TO MENTION YOUR EXPERTISE
THAT'S FINE TOO.
SO I'M GOING TO START, NANCY, AS
ALWAYS YOU'RE FIRST BECAUSE YOUR
NAME STARTS WITH B SO NANCY
BARNETT.
>>NANCY BARNETT, BROWN
UNIVERSITY I STUDY ALCOHOL AUSE
IN YOUNG ADULTS AND COLLEGE
STUDENTS AND PARTICULARLY
INTERESTED IN PEER INFLUENCES.
I ALSO STUDY ALCOHOL BIO
SENSORS.
>>DR. CHRISTOPHER CARPENTER.
>>I'M AN ECONOMIST AT
VANDERBILT UNIVERSITY AND I
STUDY YOUTH, PUBLIC POLICY AND
GENDER AND SEXUAL MINORITIES.
>>DR. CHRISTINA CHAMBERS.
>>I'M A PERINATAL
EPIDEMIOLOGIST AT THE DEPARTMENT
OF CALIFORNIA SAN DIEGO AND
STUDY PRENATAL EXPOSURE TO
ALCOHOL.
>>DR. WESTLY CLARK.
>>I'M AN ATTORNEY AND
INTERESTED IN ALCOHOL POLICY.
>>DID YOU SAY NANCY IS NOT ON?
OKAY.
WE'LL SKIP TO DR. RHONDA
JONES-WEBB.
>>SHE'S NOT ON VIRTUALLY?
OKAY.
MS. BETH KING DAVIDSON.
-- BETH KANE-DAVIDSON.
>>HELLO.
>>I'M MONITORING MY COUNCIL
MEETING OVER HERE.
>>MICHAEL, I THINK YOU NEED TO
MUTE.
>>MICHAEL, I'VE GOT YOU.
>>HI, EVERYBODY I'M BETH
KANE-DAVIDSON A CLINICIAN IN
PRIVATE PRACTICE AND SPECIALIZE
IN SUBSTANCE USE DISORDERS FOR
TEENS AND ADULTS AND ALSO HAVE A
REAL INTEREST IN PREVENTION BOTH
AT MIDDLE, HIGH SCHOOL AND
COLLEGE LEVEL.
>>THANKS, BETH.
DR. DAVID CARINGTON.
>>I'M THE DIRECTOR OF THE
ALCOHOL RESEARCH CENTER AND MY
OWN SPECIALTY IS HUMAN
NEUROIMAGING AND DOMAINS OF
REWARD SYSTEMS AND EXECUTIVE
SYSTEMS.
>>THANK YOU, DAVID.
DR. CHARLES LANG.
>>HI, EVERYONE.
CHUCK LANG INTERESTED IN ALCOHOL
INDUCED CHANGES IN CARDIAC AN
SKELETAL MUSCLE.
>>THANKS, CHUCK.
THEN DR. DR. LARIMER.
>>I'M A PROFESSOR OF PSYCHIATRY
AND BEHAVIORAL SCIENCES AND
PSYCHOLOGY DIRECTOR OF THE STUDY
FOR BEHAVIORS AT THE UNIVERSITY
OF WASHINGTON AND I STUDY
ETIOLOGY, PREVENTION AND
TREATMENT OF ALCOHOL MISUSE AND
ALCOHOL USE DISORDERS PRIMARILY
IN YOUNG ADULTS.
>>THANKS, MARY.
DR. MICHAEL LEWIS.
>>I'M PROFESSOR OF PSYCHOLOGY
AT CITY UNIVERSITY OF NEW YORK
HUNTER COLLEGE.
I'M A BEHAVIORAL NEUROSCIENTIST
AND INTERESTED IN ALCOHOL'S
NEUROMECHANISMS AND NUTRITION.
>>THANKS, MICHAEL.
DR. LAURA NAGY.
>>HI, I'M AT THE CLEVELAND
CLINIC AND I'M INTERESTED IN HOW
INNATE IMMUNE ACTIVITY AFFECTS
ALCOHOL-INDUCED LIVER DISEASE.
>>THANK YOU, DR. LAURA O'DELL
ARE YOU ON YET?
NOT YET.
OKAY.
DR. KATIE WITKIEWITZ.
>>HI, EVERYONE.
I'M A PROFESSOR OF PSYCHOLOGY IN
THE AND THE DIRECTOR OF THE
CENTER OF ALCOHOL SUBSTANCE USE
AT THE UNIVERSITY OF NEW MEXICO
AND YOU'LL HEAR ABOUT MY
RESEARCH AND I'M ALSO A CLINICAL
PSYCHOLOGIST.
>>DR. CHARLES MILLIKEN.
>>HI, THIS IS CHUCK MILLIKEN.
I DON'T KNOW WHETHER YOU CAN SEE
ME OR NOT.
>>YOU'RE GOOD.
>>OKAY.
I'M THE DIRECTOR THEIR ARMY'S
SUBSTANCE USE TREATMENT AND WE
HAVE DRUG DETERRENT TESTING AND
PRIMARILY ALCOHOL AND IT SKEWS
TOWARDS THE YOUNG MALES
PARTICULARLY AND I'M AN
ADDICTION PSYCHIATRIST.
>>I'M THE DEPUTY DIRECTOR OF
NIAA AND DECIDED NOT TO SHARE MY
GERMS WITH YOU TODAY.
>>VICKY BUCKLEY.
>>I'M THE EXECUTIVE OFFICER OF
NIAA AND ALSO DEPUTY ETHICS
COUNSELOR.
THANK YOU.
>>DR. CATHY YOUNG.
>>I'M CATHY YOUNG THE DIRECTOR
OF THE DIVISION OF METABOLISM
AND HEALTH EFFECTS HERE AT NIAA.
>>DR. ANTONIO NEURONA.
>>I'M THE DIRECTOR OF THE
DIVISION OF NEUROSCIENCE AND
BEHAVIOR.
>>DR. RAY LITTON.
>>I'M WITH THE DIVISION OF
TREATMENT AND RECOVERY AT NIAA.
I'M WITH THE DIVISION OF
DISEASES.
>>I'M [INDISCERNIBLE].
>>THE SOUND ONLINE IS NOT
COMING THROUGH WELL.
>>OKAY.
IS IT BETTER NOW?
>>YES, THANKS.
>>IT'S GOOD NOW WE WERE GETTING
AN ECHO BACK LIKE A RECORDING OF
THE THREE PEOPLE WHO HAD JUST
SPOKEN.
>>MAYBE IT WILL DO THAT WHEN I
TALK.
THAT WILL BE NICE.
>>IS ANYONE IS MONITORING ON
VIDEOCAST PLEASE TURN THAT OFF.
IF YOU'RE IN THE PRIVATE ROOM AS
WELL BECAUSE THERE IS A LAG
BETWEEN THE TWO.
I SUSPECT THAT'S WHAT THAT WAS.
>>ALL RIGHT.
DR. RALPH KINGSTON YOU'RE ONLINE
I KNOW.
>>HE'S THE DIRECTOR OF OUR
DIVISION OF EPIDEMIOLOGY AND
PREVENTION RESEARCH.
DR. SIMMONS IS SITTING NEXT TO
ME BECAUSE SHE'S KEEPING ME
HONEST SINCE TRISH ISN'T HERE.
>>I'M THE DIRECTOR OF THE
OFFICE OF SCIENCE POLICY AND
COMMUNICATIONS AT NIAA AND ALSO
THE ASSOCIATE DIRECTOR FOR BASIC
RESEARCH.
>>THANKS, BRIDGET.
LAURA.
>>I'M LAURA O'DELL A PROFESSOR
AT THE UNIVERSITY OF TEXAS AT EL
PASO.
I'M GLAD TO BE HERE.
>>DR. DAVID LEVINGER.
>>I'M WITH THE DIVISION OF
INTRAMURAL AND BIOLOGICAL
RESEARCH.
>>DR. DAVID GOLDMAN.
ARE YOU ON?
>>
>>DR. PHILIPPE.
>>I'M WITH NIAA.
>>AND DR. RV SRINIVAS.
>>I'M THE ACTING EXECUTIVE
SECRETARY FOR NCAA AND CHIEF OF
THE BRANCH.
>>WE'RE GOING LAUNCH INTO MY
DIRECTOR'S REPORT AND THEN WE
HAVE A COUNCIL DISCUSSION IF I
LEAVE ENOUGH AND THEN WE WILL
TAKE A BREAK OR LUNCH I GUESS.
WELCOME EVERYONE.
THIS IS A HYBRID MEETING.
WE'RE DOING PRETTY WELL.
WE'LL BE GETTING MORE KINKS OUT
AS WE GO ALONG WITH THE HYBRID
ENDEAVORS.
I WANT TO REMIND YOU WE HAVE
COLLABORATIVE RESEARCH ON
ADDICTIONS AT NIH MEETING
TOMORROW WHICH WILL INVOLVE THE
HOST SO IN THE SAME ROOM AND
NIDA WILL BE JOINING US.
SO I'M GOING TO START MY
PRESENTATION WITH A GREAT DEAL
OF SADNESS BECAUSE WE LOST THREE
PROMINENT MEMBERS OF OUR
COMMUNITY.
ALL OF WHOM I KNEW AND
INTERACTED WITH.
GEORGE FEIN WAS A LONG-TERM
FACULTY MEMBER AT THE UNIVERSITY
OF CALIFORNIA SAN FRANCISCO AND
THE SAN FRANCISCO V.A. MEDICAL
CENTER.
FOLLOWING HIS CAREER IN ACADEMIC
MEDICINE HE FOUNDED THE NEURO
BIOLOGY RESEARCH INCORPORATED
AND SERVED AS THE PRESIDENT AND
CHIEF EXECUTIVE OFFICER.
HE WAS RENOWN AS AN INNOVATIVE
RESEARCHER AND ADVANCED OUR
UNDERSTAND OF THE IMPACTS OF
AGING AND ALCOHOL USE DISORDER
AND BRAIN FUNCTION AND MADE THE
FINDING THAT TREATMENT FOR
ALCOHOL USE DISORDER ARE
ASSOCIATED WITH THE COMPENSATORY
NETWORK IN THE BRAIN AND WAS AN
OUTSTANDING SCIENTIST AND
ESTEEMED COLLEAGUE AND MENTOR
AND WILL BE SORELY MISSED.
DR. JOHN LITTLETON PASSED AS
WELL AND RECEIVED HIS TRAINING
AT KINGS COLLEGE IN ENGLAND AND
MOVED KENTUCKY UNIVERSITY WHERE
HE SPENT THE REST OF HIS CAREER
AND CONTRIBUTED TO THE
ALCOHOL-NICOTINE INTERACTIONS
AND USE OF MAMMALIAN MODEL TO
STUDY ALCOHOL AFFECTS.
THIS WORK WITH HIGH THROUGHPUT
PHARMACOLOGIC SCREENING LED TO
THE IDENTIFICATION OF SEVERAL
COMPOUNDS THAT DEMONSTRATED
PRECLINIC EFFICACY ON THE EFFECT
ON THE CENTRAL NERVOUS SYSTEM
AND EXPLORED THE ACTION OF
ACAMPROSATE AND I WORKED WITH
JOHN AND WAS A MENTOR FOR
FACULTY AND WILL BE SORELY
MISSED.
AND EVEN MORE POIGNANT FOR ME IS
THE PASSING OF ENOCH GORDIS THE
FORMER DIRECTOR OF NIAA.
SERVED AS THE DIRECTOR FROM 1986
TO 2001.
HE EMPHASIZED SCIENCE AS A WAY
OF UNDERSTANDING ALCOHOL USE
DISORDER.
HE TRAINED IN INTERNAL MEDICINE
AND CONDUCTED RESEARCH IN THE
LABORATORY OF DR. BERSON AND THE
NOBEL LAUREATE DR. YALOW AT
MOUNT SINAI IN NEW YORK AND
WORKED WITH RESEARCH LABORATORY
AT THE ROCKEFELLER UNIVERSITY
WHERE HE BEGAN HIS CAREER AND
STUDIED ADDICTION AND INTRODUCED
METHADONE TO THE TREATMENT OF
OPIOID USE DISORDER.
HE LATER WORKED WITH PSYCHIATRIC
RESEARCHER DR. FOX WHO
INTRODUCED DISULFRAM AND FOUND A
NEW TREATMENT PROGRAM IN QUEENS,
NEW YORK WHERE HE REMAINED THERE
UNTIL HIS APPOINTMENT TO NIAA.
AT NIAA DR. GORDIS IS REMEMBERED
AS A VISIONARY LEADER.
HE OVERSAW THE LAUNCH OF SEVERAL
INNOVATIVE RESEARCH INITIATIVES
INCLUDING THE STUDY ON THE
GENETICS OF ALCOHOLISM, THE
LONGITUDINAL ALCOHOL
EPIDEMIOLO
EPIDEMIOLOGICAL SURVEY AND
LOOKED AT THERAPIES AND
INTERVENTIONS CLINICAL STUDY HIS
LEADERSHIP EMBODIED HIS LOVE OF
SCIENCE AND COMPASSION AS A
CLINICIAN AND DEMEANOR AS A
GENTLEMAN AND LEFT A LASTING
IMPACT ON NIAA AND NIH AND THE
ALCOHOL RESEARCH FIELD.
WE SURVEYED A NUMBER OF
COLLEAGUES AT NIAA.
MANY OF WHOM WORKED WITH
DR. GORDIS OR KNEW HIM LATER
BECAUSE HE MAINTAINED A VERY
ACTIVE RELATIONSHIP WITH NIAA
AND CAME TO EVERY MENDELSON
LECTURE BEFORE THE CLINIC AND
ESTABLISHED THE GORDIS POSTER
AWARD ON ALCOHOLISM THAT IS
INCREDIBLY POPULAR AND A GREAT
HONOR FOR YOUNG PEOPLE WHO WIN
THE AWARD OR EVEN RUNNER UPS.
SO WE CREATED THE STAFF AND
ASKED THEM FOR REFLECTIONS ON
ENOCH AND I'LL READ THROUGH
THESE WITH YOU.
HE SET A TONE OF COLLEGIALITY
AND SHARED PURPOSE AND MADE NIH
A PLACE TO FEEL RESPECTED AND
VALUED BEYOND THEIR ROLES IN THE
WORKPLACE AND WAS A LEADER IN
THE FIELD AND INSTRUMENTAL IN
CREATING A FAMILY ATMOSPHERE AT
NIAA.
HIS PASSING IS A GREAT LOSS AND
WAS A GREAT SOUL.
SOMEONE WHO ALWAYS MADE YOU FEEL
LIKE YOU WERE THE MOST IMPORTANT
PERSON IN THE WORLD WHICH I CAN
ATTEST TO AS WELL BECAUSE I FELT
THE SAME IN HIS PRESENCE.
I'M NEVER FORGET THE KINDNESS HE
OFFERED IN 2001 WHEN MY HUSBAND
WAS BATTLING AN AGGRESSIVE
CANCER AND HE ALWAYS ASKED FIRST
HOW MY FAMILY AND A WERE DOING
AND OFFERED WORDS OF SYMPATHY
AND CONSOLATION.
THAT MEANT THE WORLD TO ME.
HIS GOOFY ERUPTING LAUGH WHICH
ON A GOOD DAY WE CAN HEAR
THROUGHOUT THE SUITE WAS A GREAT
GUY.
HIS GENUINE INTEREST IN THE WIDE
RANGE OF SCIENTIFIC ISSUES AND
DETERMINATION TO ADVANCE
UNDERSTANDING HOW TO REDUCE THE
BURDEN OF ALCOHOL PROBLEMS LAID
THE FOUNDATION FOR MUCH OF THE
RESEARCH THAT CONTINUES NOW.
THE CONSIDERABLE SUCCESS OF NIAA
AND THE BROADER ALCOHOL RESEARCH
E
ENTERPRISE WILL ALWAYS OWE A
DEBT TO DR. GORDIS.
I LOVE ENOCH.
I ADMIRED HIM AND WAS A GREAT
MENTOR AND MET WITH HIM ON A
REGULAR BASIS AND HE WAS
GENEROUS AND WAS A SCHOLAR AND
ALWAYS HAD PIERCING QUESTIONS
THAT CHALLENGED ME.
I CAN STILL REMEMBER MANY OF
THEM AND THIS ENOCH AT THE MARK
KELLER HONORARY LECTURE AT THE
NIH CLINICAL CENTER AUDITORIUM
AND LIKE I SAID BEFORE HE WAS A
PASSIONATE SUPPORTER OF OUR
SEMINAR PROGRAMS AND ALSO OF
YOUNG PEOPLE AND MOVING YOUNG
PEOPLE INTO THE FIELD OF ALCOHOL
STUDY.
SO IT GOES WITHOUT SAYING WE'RE
GOING MISS ENOCH AND I HOPE HE'S
LOOKING DONE FROM UP THERE AND
AT LEAST GETTING A LITTLE SMILE
ESPECIALLY ABOUT HIS RAGGED
SWEATER, ANYWAY.
AND HE WAS AN OUTSTANDING
MUSICIAN AND PLAYED WITH A TRIO.
>>AND THIS IS DURING MY TENURE.
I'D LIKE TO TAKE CREDIT FOR
THIS.
I THINK YOU SHOULD THANK
DR. COLLINS BECAUSE HE WAS VERY
AT HELPING NIH GET A LOT OF
SUPPORT OVER THE YEARS.
WE ADD AN INCREASE OF 4% IN 2023
AND HOPEFULLY WE'LL BE SPENDING
IT WISELY.
I HAVE NO PREDICTIONS FOR THE
2024 BUDGET.
YOU CAN FOLLOW HOW THINGS ARE
GOING YOU CAN FOLLOW HOW THINGS
ARE GOING FOR THE REST OF US AND
THERE'S NO INFORMATION WE HAVE
YOU DONT HAVE.
AND WE WANTED TO HIGHLIGHT
ADVANCING MENTAL HEALTH
INTERVENTIONS FOR UNDERSTANDING
ALCOHOL RELATED DOMESTIC
VIOLENCE AND TESTING AND
IMPLEMENTATION OF SCALABLE AND
LOW-RESOURCE AND REMOTE
INTERVENTIONS VIA MOBILE DEVICE
RELY ON COMMUNICATION REDUCING
USAGE AND ONE ON PREVENTION OF
ALCOHOL AND INTEND TO PUBLIC A
NEW NOTICE OF FUNDING
OPPORTUNITY NOW KNOWN AS THE
NOFOs TO SOLICIT APPLICATIONS TO
EXPAND THE AIDS PREVENTION TOOL
KIT WITH PATTERNS OF EPISODIC
AND BIOLOGICAL RISK FOR HIV
ACQUISITION.
THIS IS NOFO IS EXPECTED TO BE
PUBLISHED IN BRING IN 2023 AND
THE CONTACT FOR THE MOBILE
HEALTH ONE IS DR. ROBERT
FREEMAN.
>>AND I WANTED TO MENTION
SOMETHING DISCUSSED AT THE
INSTITUTE DIRECTOR MEETINGS AND
AN OPPORTUNITY FOR PEOPLE THE
NIH SCIENCE AND TECHNOLOGY
RESEARCH INFRASTRUCTURE FOR
DISCOVERY, EXPERIMENTATION AND
SUSTAINABILITY INITIATIVE FONDLY
KNOWN AS STRIVES TO REDUCE
ECONOMIC AND PROCESS BARRIERS TO
USING CLOUD SERVICES.
STRIDES PROVIDES THE FOLLOWING
DISCOUNTS AND FAVORABLE PRICING
ON COMPUTING, STORAGE AND
RELATED SERVICES FROM AMAZON WEB
SERVICES, GOOGLE CLOUD PLATFORM
AND MICROSOFT AZURE.
CONSULTATION AND TECHNICAL
SUPPORT AND TRAINING AND
CERTIFICATION.
THIS OPPORTUNITY IS OPEN TO NIH
FUNDED RESEARCHERS GRANTS AND
INTRAMURAL PROGRAM AND CONTACTS.
YOU CAN ENROLL AT CLOUD.NIH.gov
AND THE ARCHIVE IS SUPPORTED BY
THE STRIDES INITIATIVE.
FUTURE STRIDES INITIATIVE
ACTIVITIES WILL PROMOTE DATA
ACROSS NIH AND NIH-FUNDED
INSTITUTIONS AND OUR
REPRESENTATIVES ARE DR. FALK AND
ELIZABETH POWELL.
YOU CAN CONTACT PATRICIA POWELL
BUT BETTER TO CONTACT THE PROPER
POWELL.
THIS IS AN OPPORTUNITY AND I
DON'T THINK WE'RE TAKING
ADVANTAGE OF IT SO PASSING IT ON
FOR YOUR INFORMATION.
THIS WAS INITIATED BY AN ARTICLE
WRITTEN BY MYSELF AND PAUL AND
NORAH VOLKOW AND ON THE
CONSTRUCT OF PRE-ADDICTION.
WE REQUESTED THE INFORMATION ON
THE TERM AND LIKE PRE ADDICTION
FOR IDENTIFYING INTERVENING
SUBSTANCE MISUSE AND MILD EARLY
STAGE SUBSTANCE USE DISORDER
WITHIN HEALTH CARE SYSTEMS.
THE TERM PREADDICTION HAS BEEN A
TERM TO RAISE AWARENESS ABOUT
SUBSTANCE USE AND USE SCREENING
AND INTERVENTION AND PREVENT
OVERDOSE AND PROMOTE THE
DEVELOPMENT OF NEW
INTERVENTIONS.
INPUT WAS SOUGHT BOTH ON
TERMINOLOGY TO DESCRIBE THE
CONCEPT AND THE CONCEPT ITSELF
INCLUDING THE BENEFITS AND
DRAWBACKS OF A TERM.
RFA WAS OPEN FROM MARCH 13 TO
APRIL 27 AND WE'LL ANALYZE THE
FEEDBACK WE GOT FROM THIS AND
INFORM DISCUSSIONS ABOUT THE
CONCEPT OF PREADDICTION.
THERE'S MULTIPLE LEVELS WHERE WE
THOUGHT THIS WOULD BE USEFUL.
ONE IS WE ARBITRARILY DEFINED
PREADDICTION AS MEETING THE C
CRITERION FOR ALCOHOL USE
DISORDER IN THE LOW RANGE AND WE
DEFINE ADDICTION AS THE MODERATE
TO SEVERE RANGE OF DSM5
CRITERIA.
THE HOPE IS THIS WILL AT LEAST
THE DISCUSSION ABOUT THE TERM
PREADDICTION WILL STIMULATE
INTEREST IN TREATING EARLY
BECAUSE WE KNOW FOR ALL MENTAL
ILLNESS FOR THAT MATTER ALMOST
EVERY ILLNESS YOU CATCH THE
DISORDER THE MORE LIKELY YOU ARE
TO SUCCEED AND TOM McLELLAN
PASSIONATELY FEELS AS I SHARE
THAT WE'RE WAITING UNTIL THE
TRAIN HAS LEFT THE STAGE, TO
SOME EXTENT BEFORE WE ENGAGE IN
TREATMENT FOR ALCOHOL USE
DISORDER.
THERE'S BEEN A COUPLE RECENT
SCIENTIFIC MEETINGS.
WE HAD THE INTERAGENCY
COORDINATING COMMITTEE ON
ALCOHOL SPECTRUM DISORDERS.
THIS WAS HELD ON APRIL 17
VIRTUALLY AND AGENCIES PROVIDED
UPDATES RELATED TO THIS ISSUE A
SPECIAL PANEL INCLUDED COMMUNITY
ENGAGED RESEARCH AND WHAT WORKS
FROM LIVED EXPERIENCE
PERSPECTIVE AS WELL AS THE FETAL
ALCOHOL SPECTRUM DISORDER FAMILY
NAVIGATOR PROGRAMS.
AND THERE'S A WEBINAR FOCUSSED
ON EPIDEMIOLOGICAL AND NEURO
SCIENCE RESEARCH AND
DEVELOPMENTS AND TREATMENTS AND
PHARMACO THERAPIES FOR WOMEN WHO
DRINK AT HARMFUL LEVELS.
THE WEBINAR HIGHLIGHTED ONGOING
COLLABORATIVE STUDIES ACTIVITIES
TO IMPROVE ACCESS TO HIGH
QUALITY TREATMENT SERVICES FOR
WOMEN AND GIRLS AND THERE'S A
WEBSITE TO CHECK OUT THE RECENT
MEETINGS.
AND THAT WILL BE IN THE REPORT
THE WRITTEN VERSION OR THE
DOCUMENT VERSION.
DIVERSITY, EQUITY AND INCLUSION
AND ACCESSIBILITY EFFORTS ARE
ONGOING AND VERY ACTIVE AT NIAA.
WE'RE IN THE PROCESS OF TRYING
TO RECRUIT SCIENTIFIC DIVERSITY
OFFICER AND WE'RE IN THE EARLY
STAGES OF A SELECTION PROCESS.
WE ANTICIPATE COMPLETING THE
PROCESS IN THE NEXT FEW WEEKS.
THERE'S A FUNDING OPPORTUNITY
ANNOUNCEMENT OUT THERE RESEARCH
OPPORTUNITIES FOR NEW AND AT
RISK INVESTIGATORS TO PROMOTE
DIVERSITY.
THIS IS TO SUPPORT THE RO1
APPLICATION FROM INVESTIGATORS
FROM DIVERSE BACKGROUNDS
INCLUDING FROM GROUPS UNDER
REPRESENTED IN HEALTH-RELATED
SCIENCES.
AND FOR WORKFORCE DIVERSITY TO
INCREASE THE DIVERSITY IN THE
FIELD AND MAXIMIZING
OPPORTUNITIES FOR SCIENTIFIC AND
ACADEMIC IN DEPENDENT CAREERS
THE MOSAIC PROGRAM.
WE ANNOUNCE LEAD IT NEW MOSAIC
PROGRAMS NIAA SUPPORTED MOSAIC
SCHOLARS IN 2022.
YOU CAN SEE THEM LISTED AND
THESE ARE A LITTLE HARD FOR ME
TO SEE AND SEE LAURA AND
GABRIELLE LOPEZ.
THANKS.
>>WHAT'S AHEAD?
A NUMBER OF US ARE GOING TO THE
ALCOHOL AND STRESS FRAMEWORK
TREATMENT STRATEGIES HELD MAY 16
THROUGH THE 19 IN VOLTERA, ITALY
AND WE HAVE A RESEARCH IN THE
DOMAIN AND ANTONIO AND I WILL BE
THERE.
THE NATIONAL INSTITUTE ON AGING,
NIAA JOINT WORKSHOP ON THE
IMPACT OF ALCOHOL MISUSE ON THE
ONSET AND PROGRESSION
ALZHEIMER'S DISEASE AND RELATED
DEMENTIAS WILL BE JULY 26 AND 27
AT THE NATCHER CONFERENCE CENTER
AND AIMED AT UNDERSTANDS THE
RESEARCH GAPS AND CHALLENGES TO
UNDERSTANDING RELATIONSHIP
BETWEEN ALCOHOL AND MISUSE AND
DEMENTIAS AND THERE'S BEEN
EXCITING NEW STUDIES ONGOING.
FOR COMMUNICATION UPDATE IN
RECOGNITION OF ALCOHOL AWARENESS
MONTH IN APRIL, NIAA SHARED
SOCIAL MEDIA MESSAGES AND
ENGAGED IN THE TWITTER CHAT WITH
THE AMERICAN SOCIETY OF
ADDICTION MEDICINE ABOUT ALCOHOL
MYTHS AND TREATMENT.
AND THIS WE LAUNCHED AN UPDATE
TO ALCOHOL FACTS AN STATISTICS.
THIS IS AND WAS A POPULAR ONLINE
RESOURCE WHICH CONSISTENTLY
RANKS AMONG THE MOST VIEWED NIAA
WEB PAGES.
IT HAS BEEN UPDATED WITH RECENT
ALCOHOL STATISTICS EXPANDED WITH
DEMOGRAPHIC INFORMATION AND
REORGANIZED TO IMPROVE
READABILITY AND NAVIGATABILITY.
THE LINK IS AVAILABLE ON THE
NIAA HOME PAGE AND IN THE
ALCOHOL'S AFFECTS ON HEALTH
SECTION.
IF YOU CLICK ON THE WEBSITE
YOU'LL SEE THIS BELOW THE
REDDISH LINE THAT HAS PLACE TO
GO TO ON THE WEBSITE AND A BOX
THAT SAYS ALCOHOL FACTS AND
STATISTICS.
I REALLY URGE EVERYONE TO LOOK
AT THIS AND UTILIZE IT.
I CAN'T TELL YOU HOW MANY
DIFFERENT STATISTICS END UP IN
THE SCIENTIFIC PAPERS.
THERE'S NOW 29.5 MILLION
INDIVIDUALS IN THE UNITED STATES
WITH ALCOHOL USE DISORDER AS
DEFINED BY DSM5.
THERE'S OVER 140,000 DEATHS
ATTRIBUTED TO ALCOHOL FROM THE
CDC.
ALL THESE NUMBERS ARE ON THERE.
WE USE THEM, I WANT MY STAFF TO
USE THEM.
I WANT OUR DIVISIONS TO USE THEM
AND I'D LIKE EVERYBODY IN THE
EXTRAMURAL COMMUNITY TO USE THEM
AND FURTHERMORE IF YOU THINK WE
MADE AN ERROR, THIS IS A LIVING
DOCUMENT.
WE'LL FIX IT.
[SPEAKING FRENCH]
>>AS THEY SAY IN FRENCH.
I PICKED AN INTERESTING GROUP OF
PAPERS THIS ROUND SEVERAL
DOVETAIL TOGETHER WITH A COMMON
THEME.
EYE LIKE TO GO THROUGH THESE
WITH YOU ALL AND OPEN IT UP FOR
COUNCIL DISCUSSION.
NEXT SLIDE.
AND HERE'S ABOUT INTENSITY DR
DRINKING IN YOUNG ADULTS
PREDICTS ALCOHOL ABUSE THAT'S
CONSUMING TEN OR MORE DRINKS IN
A ROW AND THIS IS PARTICULARLY
CONCERNING DRINKING TYPE OF
BEHAVIOR.
IF YOU REMEMBER, RISKY DRINKING
THE FIRST VIGNETTE OF OUR HBO
DOCUMENTARY SHOWS A GOOD EXAMPLE
OF HIGH INTENSITY DRINKING IN
YOUNG PEOPLE.
THE PRESENT STUDY USED A SAMPLE
OF 451 YOUNG ADULTS WHO REPORTED
PAST 30 DAY DRINKING IN 12th
GRATE AND INITIATED HIGH
INTENSITY DRINKING BY AGE 20.
INITIATING HIGH INTENSITY
DRINKING BY GRADE 11 WAS
ASSOCIATED WITH HIGHER WEEKLY
ALCOHOL CONSUMPTION AND HIGH
INTENSITY DRINKING FREQUENCY AND
AUDIT SCORE INDICATING POSSIBLE
ALCOHOL USE DISORDER AT AGE 20
YEARS.
THEY BASICALLY SHOULD ALSO IN
STUDY SHOWED THE MEAN PRIME OF
ESCALATION TO HIGH INTENSITY
DRINKING WAS ALMOST TWO YEARS
WHICH IS PRETTY SHORT AND LESS
THAN TWO YEARS AND 1.9 YEARS AND
FROM A FIRST BINGE TO HIGH
INTENSITY DRINKING WAS ALMOST
JUST A LITTLE MORE THAN HALF A
YEAR.
THAT'S LATER INITIATION OF
DRINKING OR ESCALATION.
THAT'S FOR THOSE WHO WERE LATER
IN BINGING ESCALATION.
THIS IS EVIDENCE THAT SUPPORTS
WHAT WE'VE ANYONE FOR QUITE SOME
TIME.
THE EARLIER YOU ENGAGE, THE MORE
LIKELY YOU ARE TO HAVE SERIOUS
CONSEQUENCES AND IT ARGUES THAT
I BELIEVE WE SHOULD BE DOING A
LOT MORE WORK FOCUSSING ON THESE
DETERMINATES FOR HIGH INTENSITY
DRINKING AND WHAT LEADS TO THIS.
THESE ARE DOSES OF ALCOHOL THAT
IN SOME CASES CAN BE EVEN LIFE
THREATENING.
THIS IS A STUDY FROM UCSD AND
THIS IS A SCHOOL STUDY BECAUSE
IT'S A STUDY OF A FUNGUS.
THIS IS A FUNGUS THAT BASICALLY
WE HAVE IN OUR MOUTHS AND SKIN
AND INTESTINE AND FORTUNATELY
LOW AMOUNTS BECAUSE IT'S AN
OPPORTUNISTIC PATHOGENIC YEAST
ALCOHOL ASSOCIATED LIVER DISEASE
IS ACCOMPANIED BY AN IMBALANCE
OF INTESTINAL MICROBIOME CALLED
MICROBIOME DYSBIOSIS.
AND INFLAMMATORY CYTOKINES ARE
PRODUCED BY LYMPHOCYTES AND IS A
CONTRIBUTING FACTOR OF
AUTOIMMUNE INFLAMMATORY
CONDITIONS.
IL17 IS ONE OF THE BAD GUYS.
THIS REPORT FOUND T HELPER CELL
17 CELLS REACTIVE TO THE YEAST
CAN INCREASE IN THE BLOOD AND
LIVER OF PATIENTS WITH ALCOHOL
ASSOCIATED LIVER DISEASE.
SO THEY STUDIED THIS AND HAVE
SEEN THIS INCREASE IN HUMAN
BEING S BUT ALSO WENT ON TO
STUDY HOW DID THIS TAKE PLACE
USING MOUSE MODELS AND THESE
WERE FEMALE MICE INTERESTINGLY
ENOUGH.
AND THE REPORT FOUND THE
MOLECULAR ACTIVATION REACTIVE TO
CANDIDA REACTED MORE TO FUNGAL
DISEASE AND USED A STATIN AND
THEY USED CHRONIC ETHANOL IN
THEIR DIET AND ADD BINGE MODEL
ON TOP SO THESE CRITTERS GOT A
LOT OF ALCOHOL.
IT SHOWS THE CANDIDA TRAVELS TO
THE LIVER AND THE C REACTIVE
CELLS MIGRATE TO THE LIVER AND
TRIGGER THE ACTIVATION OF
INTERLEUKIN 17 A PROINFLAMMATORY
CYTOKINE AND CONTRIBUTES TO
INFLAMMATION OF LIVER DISEASE.
A NICE PAPER EVEN IF YOU'RE NOT
INTO YEAST BECAUSE IT SHOWS THIS
VERY SPECIFIC AND FAIRLY
DRAMATIC INTERACTION BETWEEN THE
MICROBIOME INFLAMMATORY ACTIONS
AND LIVER DISEASE.
AND WHILE WE'RE ON THE
INFLAMMATORY DOMAIN, THIS IS A
STUDY FROM THE NEUROIMMUNE
PROGRAM WE HAVE AND THIS
PARTICULAR STUDY WAS LED BY
ANGELA OSBORN AND A GREAT DEAL
OF PARTICIPANTS IN THE
PREFERENCE FROM THE NEUROIMMUNE
THEY IDENTIFIED USING A BIO
INFORMATICS APPROACH THAT PD4
INHIBITORS WERE A POTENTIAL AUD
TREATMENT AND THE BIOINFORMATICS
APPROACH WAS PROFILED AND
DRINKING TO INTOXICATION IN GWAS
BUT ALSO IN USING MICE FROM
DRINKING IN THE DARK DRINK
MODEL.
AND PHOSPHODIESTERASES ARE AN
INHIBITOR AND APPROVED FOR THE
TREATMENT OF PSORIASIS YOU SEE
IT ON TV ALL THE TIME IT'S
CALLED ATEZLA.
THAT'S THE SAME COMPOUND.
VIA PD4 INHIBITION IT CYCLES DMP
LEVELS THOUGHT TO DECREASE THE
LEVELS OF PROIN INFLAMMATORY
MEDIATORS AND INCREASE THE
PRODUCTION OF CERTAIN
ANTI-INFLAMMATORY MEDIATORS THE
TREATMENT BY WHICH IT HELPS
TREAT PSORIASIS EFFECTIVELY.
SO THEY WENT ON TO TEST IT IN A
NUMBER OF ANIMAL MODELS IN A
MOTIVATIONAL MEASURE AND
PUNISHMENT RESPONDING WHERE YOU
SUPPRESS DRINKING BEHAVIOR AND
DEPENDENCE INDUCED DRINKING AND
I SHOWED TWO GRAPHS OF ANIMAL
MODELS AND ON THE RIGHT IT
DECREASED IN NON-TREATMENT
SEEKING HUMANS IN A DOUBLE BLIND
PLACEBO CONTROL STUDY THE SAME
STUDY THAT RAY LITTON WAS
TALKING ABOUT A HUMAN LABORATORY
STUDY AND EVEN ON THE ANIMALS
UNDER MOUSE MODELS AND
APREMILAST STUDY WAS RUN AT
SCRIPPS RESEARCH AND I THINK
AGAIN ADDITIONAL TRANSLATIONAL
INFORMATION SUGGESTING
IMMUNOLOGICAL INTERACTIONS WITH
ALCOHOL THAT MAY BE FERTILE
GROUNDS FOR MEDICATION
INTERVENTION.
>>THIS WAS DONE BY DR. AGARWAL
AND THE POLLY JOSEPH LAB IN OUR
INTRAMURAL RESEARCH PROGRAM AND
THEY WERE LOOKING AT 466
PARTICIPANTS IN THE NIAA
COVID-19 PANDEMIC IMPACT ON
ALCOHOL STUDY AND THE DATA I'M
REPORTING NONE OF THE PATIENTS
HAD COVID AT THE TIME BUT THE
DATA WAS CONDUCTED FROM JUNE
2020 TO SEPTEMBER OF 2021.
IN THIS STUDY THE RESEARCHERS
OBSERVED A SIGNIFICANT
IMPAIRMENT AND SMELL ABILITY AND
IT WAS ASSOCIATED WITH
PSYCHOLOGICAL AND SOCIAL AND
VARIETAL QUALITY OF LIFE.
SO THEY ARGUED THE EARLY
ASSESSMENT OF SMELL FUNCTION IN
AUD MAY PREDICT THIS IN QUALITY
OF LIFE DOMAIN AND THEY DIVIDED
THE SUBJECTS INTO THREE GROUPS
ON THE LEFT PANEL BASED ON
ALCOHOL CONSUMPTION AT FOUR TIME
POINTS, LIGHT, MODERATE AND
HEAVY DRINKING AND IT SHOWED A
SIGNIFICANT SMELL DIFFERENCE
BETWEEN NON-DRINKING AND HEAVY
DRINKING INDIVIDUALS.
THE FOUR BARS ON THE LEFT OF THE
RIGHT HAND GRAPH AND FOUR BARS
ON THE RIGHT OF THE RIGHT HAND.
I THOUGHT IT WAS INTRIGUING AND
IT ALSO BEGS THE QUESTION THAT
I'M SURE POLLY IS FOLLOWING UP
ON GIVEN COVID ITSELF CAN IMPAIR
SMALL IS THERE AN ALCOHOL-COVID
INTERACTION DOMAIN?
WE DON'T KNOW THE ANSWER YET BUT
SOMETHING I'M SURE IS AND WILL
BE EXPLORED AND ONE OF THE
REASONS I HIGHLIGHTED THIS
PARTICULARLY INTERESTING STUDY.
I HAVE TO ADMIT THIS IS A
COMPLICATED EPIGENETIC STUDY AND
THE GOOD NEWS IS I'LL DO MY BEST
TO EXPLAIN WHAT WAS FOUND.
AND YOU CAN ASK QUESTIONS LATER.
WE KNOW STRESS CONTRIBUTE TO
PREMATURE AGING AND ALCOHOL USE
DISORDER AND IT'S A FACTOR IN
PREMATURE AGING AND THIS WILL
SUPPORT THAT IN A UNIQUE WAY.
TO BETTER UNDERSTAND THE
RELATIONSHIP BETWEEN STRESS AND
ALCOHOL USE DISORDER AND
PREMATURE AGING THEY USED
TELOMERE LENGTH ASSAYS IN A
DEEPLY PHENOTYPED SAMPLE OF
PATIENTS FROM THE NIAA
INTRAMURAL PROGRAM.
THIS WAS 615 PATIE PATIENTS TEL
ARE AT THE END OF THE DNA AND IT
SHORTENS WITH AGE.
THE PRESENT STUDY SHOWED THE
COMBINATION OF STRESS AND HEAVY
ALCOHOL USE ACCELERATED THIS BY
4.5 YEARS.
IN THE FINDING WAS REPLICATED IN
EXTERNAL SAMPLES FROM THE GRADY
PROJECT IN SCOTLAND AND IT
ACCELERATED AGE WITH ALCOHOL USE
DISORDER AND STRESS ED INCREASE
THE RISK OF MORTALITY.
THIS SHOWED THE DISCOVERY COHORT
AND THE EPIGENETIC COHORT
COMPOSITE SCORE OF STRESS AND
METHYLATION SCORE USED AND
COMBINING THESE TOGETHER IN
REPLICATION FOR BOTH GRADY
TRAUMA PROJECT AND YOU CAN SEE
WHAT WE CAUGHT THE DOSE-RELATED
INCREASE IN THE PHENOAGE AND
GRIM AGE AND THAT'S A COMPOSITE
OF DNA MENLALATION BASED MARKERS
LINKED TO HEALTH AND LIFE SPAN
AND GRIM AGE IS THE STRONGEST
PREDICTOR OF PATHOLOGY AND IT'S
HARD TO SEE AT THE BOTTOM BUT
BASICALLY WHAT THEY DID WAS LOOK
AT LOW AND HIGH FROM THE
DIFFERENT COHORTS.
BUT WHEN HE TOOK THE HIGH, HIGH
THAT WAS THE MOST DRAMATIC
INCREASE IN EPIGENETIC AGE.
I URGE YOU TO LOOK AT THE
DETAILS OF THIS PAPER BUT IT IS
A COMPELLING STUDY AND PUBLISHED
IN BIOLOGICAL PSYCHIATRY ARGUING
THE ADDITIVE AFFECTS OF STRESS
AND ALCOHOL USE DISORDER
ACCELERATED EPIGENETIC AGING.
I'M SURE FALK WILL TALK ABOUT
THIS STUDY IN HIS TALK TODAY AND
HE'S BEEN DOING A GREAT DEAL OF
WORK IN THIS EPIGENETIC AREA AND
IT'S FASCINATING WHAT HE'S BEEN
ABLE TO PULL OUT OF SOME OF
THESE HUMAN COHORTS.
THIS SHOWS PREDICTED BRAIN AGE
DIFFERENCE BETWEEN COMMUNITY
DEVELOPING OLDER ADULTS.
EVIDENCE INDICATES ALCOHOL
MISUSE CONTRIBUTES TO
AACCELERATING AGING AND IMPAIRED
COGNITIVE, MEMORY AND LUNG
FUNCTION AND HEAVY DRINKERS
SHOWN AS 14 DRINKS A DAY SHOWED
BRAIN DIFFERENCES IN THE BRAIN
PAD.
THAT'S THE DIFFERENCE BETWEEN
BRAIN PREDICTED AGE AND
CHRONOLOGICAL AGE BASED ON
NEUROIMAGING DATA AND THE LIGHT
AND MODERATE DRINKING OLDER
ADULTS DID NOT SHOW PROTECTIVE
BENEFIT ON BRAIN AGING BUT A
GROWING BODY OF EVIDENCE THAT
ALCOHOL MISUSE GOING PAST THE
USDA STANDARD DRINK LEVELS FOR
MODERATE DRINKING CONTRIBUTE TO
ACCELERATED NEURODEGENERATION
AMONG OLDER ADULTS.
YOU CAN SEE THAT ON THE RIGHT
SIDE ON THE PARTICULAR BAR.
WHAT'S INTERESTING IS I LOOKED
UP THE STUDY TO MEASURE BRAIN
AGE IS QUITE COMPELLING AND IT
WAS PUBLISHED IN 2018.
AND USED A DEEP LEARNING
PARADIGM AND IMAGING FROM A
NUMBER OF PATIENTS AND PREDICTS
CHRONOLOGICAL AGE FROM THE BRAIN
IMAGING AGE.
HERE THEY'RE USING THIS BRAIN
IMAGING AGE AND THE DIFFERENCE
BETWEEN THAT AND THE
CHRONOLOGICAL AGE TO INDICATE
THAT YOU'RE AGING MORE RAPIDLY
IF YOU ARE A HEAVY DRINKER.
THAT'S THE BOTTOM LINE.
I THINK IT'S A CLEVER WAY OF
SHOWING LET'S FACE IT YOUR
BRAIN'S NOT DOING SO HOT IF
YOU'RE DRINKING EXCESSIVELY
ESPECIALLY WHEN YOU'RE OLDER.
AND WE HAVE BEEN -- WE MADE
QUITE A BIT OF AN ISSUE OF THIS
OVER THE YEARS BUT IT IS AN AREA
OF GREAT UNDER TO NIAA BECAUSE
AGING BRINGS MANY OTHER ISSUES
ON BOARD FROM MEDICATION
INTERACTIONS TO PROBLEMS
NAVIGATING THE WORLD IF YOU'RE
INTOXICATED WHEN YOU'RE AGED AND
BREAK HIP FOR FALLING OFF A
LADDER OR BOAT AND BELIEVE IT OR
NOT EVERY SUMMER WE HAVE TO DO A
PRESS REMINDER ABOUT DRINKING
AND WATER SPORTS IF YOU ADD IN
AGING YOU'RE ADDING IN WHAT CAN
POTENTIATE THE DELETERIOUS
AFFECTS OF ALCOHOL AND I THINK
BOTH STUDIES I HIGHLIGHTED TODAY
ARE EMPHASIZING THERE ARE
DEFINITE CHANGES OCCURRING IN
HOW WE AGE WHEN WE ADD ALCOHOL
TO THE MIX.
THANK YOU VERY MUCH AND I THINK
THAT'S ALL I PLAN TO COVER.
I THINK THAT'S THE LAST SLIDE.
CAN WE HAVE THE THANK YOU.
I WANT TO THANK A LOT OF PEOPLE
ESPECIALLY LAURA LUNARDI WHO
HELPED ME WITH THE SLIDES AND
TORTURED HER TO SORT THROUGH THE
MORE DIFFICULT CONSTRUCTS AND
HOW DO I SAY THAT PROPERLY, LINH
AND JUDIT O'CONNOR AND LIZ ELIZH
POWELL AND PATRICIA POWELL AND
IT TAKES A VILLAGE.
THANK YOU VERY MUCH.
I'LL OPEN IT UP TO COUNCIL
DISCUSSION.
I'M HAPPY TO TAKE QUESTIONS OR
ANYTHING YOU WANT TO RAISE NOW.
I MENTIONED I WANTED TO ADD ON
TO MY TALK WE ARE -- WITH THE
HELP OF DAVID LOVINGER AND
OTHERS WE'LL BE INCREASING THE
STIPENDS FOR OUR INTRAMURAL
RESEARCHERS.
WE'RE NOT GIVING DETAILS BUT DO
YOU WANT TO MENTION THE GROUP
BEING COVERED AND WHAT ONE OF
OUR AIMS IS TO DO ULTIMATELY
WITHOUT THE NUMBERS?
>>THERE'S A HIGH COST OF LIVING
IN THE AREA AND WE ARE STIPEND
LEVELS FOR POST-BACCALAUREATE
FELLOWS AND THE PRE-DOCTORAL
FELLOWS THOSE IN GRADUATE SCHOOL
AND THE POST-DOCTORAL FELLOWS IN
THE TIME BETWEEN THE Ph.D. AND
HOPEFULLY GETTING A PERMANENT
CAREER JOB, WE'RE FAIRLY LOW AND
THERE WERE EVEN PROBLEMS WITH
SOME OF THE POST-BACS ESPECIALLY
BE ABLE TO MAKE ENDS MEET AND
NIH AS A WHOLE THE SCIENTIFIC
DIRECTORS DECIDED IT WAS TIME TO
INCREASE THEIR STIPEND TO THE
MAXIMUM ALLOWABLE LEVEL AND
WE'VE NOW TAKEN CARE OF THAT AND
IT WILL BE DONE BY THE END OF
THIS FISCAL YEAR WHICH ENDS IN
SEPTEMBER.
>>ANYTHING I LEFT OUT?
>>I WANT TO REMIND PEOPLE TOO
IT'S A MATTER OF EQUITY WE
CONSIDER THE STIPENDS BECAUSE AT
THE SAME TIME WE'RE TRYING TO
BROADEN THE WORKFORCE TO
REPRESENT ALL PEOPLE.
WE DON'T WANT TO INADVERTENTLY
DISENFRANCHISE FOR KIDS WHOSE
PARENTS CAN SUPPORT THEM TO DO
THE WORK.
I WANTED TO ADD THAT AS WE
CONSIDER THIS IN THE BROADER
CONTEXT.
THAT WAS ONE OF OUR MAJOR
CONSIDERATIONS IN PARTICIPATING
AND OTHER INSTITUTES FEEL THE
SAME WAY.
COMMENTS?
>>I'M LOOKING AT INTEREST WITH
THE BUDGET PAGE AND QUICKLY
CALCULATING IT LOOKS LIKE SINCE
2014 THE BUDGET HAS INCREASED
APPROXIMATELY 30% BUT THE RPG
RATE IS SLOWER AT 10%.
I WONDER IF YOU COULD ELABORATE
AS TO SOME OF THE THINGS THAT GO
INTO THE SLOWER RATE OF RPGs
BEING FUNDED.
>>SO I DON'T HAVE ANY NUMBERS
TO ANSWER IT WITH BUT I WOULD
SAY INFLATION HAS BEEN A
COMPONENT.
AND SO THE COST OF DOING
RESEARCH HAS BEEN GOING UP.
THERE'S BEEN A TENDENCY I THINK
WE LOOKED AT IN OUR DIVISIONS
FOR GRANTEES TO ACTUALLY ASK FOR
MORE MONEY.
AND SO THE GRANTS ARE LARGER.
SO THOSE ARE TWO FACTORS I CAN
THINK OFF THE TOP OF MY HEAD.
COST OF HAS GONE UP NOT ONLY
BECAUSE OF INFLATION BUT BECAUSE
OF I'LL GIVE YOU ONE CONCRETE
EXAMPLE I'M IN FAVOR OF BUT WE
KNEW IT WOULD HAPPEN WHEN YOU'RE
DOING MALE AND FEMALE ANIMALS IT
TAKES MORE ANIMALS.
THAT'S ONE CONCRETE EXAMPLE.
I DON'T THINK WE SHOULD NOT TAKE
A STEP BACK AND WE'RE TRYING TO
INDICATE AND WE'LL CONTINUE TO
TRY WHEN WE DO THE HIGHLIGHTING
OF PAPERS, ALL THE PAPERS I
HIGHLIGHTED TODAY WERE USING
BOTH MALE AND FEMALES, IF I
RECALL CORRECTLY.
FEMALE ANIMALS.
I THINK THAT'S ANOTHER ISSUE.
CATHY.
>>I WONDER IF THERE MAY BE AN
APPARENT LAG BECAUSE THERE'S A
COMMITMENT TO ALL THE MONEY AND
THE NUMBER OF RO1s HAS INCREASED
A BIT EVERY YEAR AND WONDER IF
THAT PLAYS INTO THE APPARENT LAG
IN THE INCREASE OF NUMBER OF
GRANTS.
SOME FACTORS IMPACTED THE RO1.
WE ARE TRYING TO KEEP GRANTS
WITHIN A REASONABLE RANGE SO WE
CAN CONTINUE TO FUND EARLY STAGE
INVESTIGATORS AND WE'VE BEEN
CONTINUING TO FUND EARLY STAGE
INVESTIGATORS AT THE 25th
PERCENTILE AND WILL CONTINUE TO
DO SO AND I THINK WE MET IT AT
100%.
THAT'S ANOTHER FACTOR THAT COMES
INTO PLAY.
>>THE FIGURES YOU GAVE,
DR. KERIGAN IS IT FOR THE RPG?
WE'VE SEEN ANNASE IN1
APPLICATIONS.
TREMENDOUS INCREASE.
>>A COU MORE DETAILS.
GEORGE, YOU'VE HAD A SIGNIFICANT
EMPHASIS TO FUNDING ADDITIONAL
Ks TO INCREASE YOUNGER PEOPLE
AND ALSO WITH STAFF ONSITE
WE'VE HAD SIGNIFICANT INCREASE
COST IN SALARIES IN BENEFITS AND
HEALTH INSURANCE COSTS HAVE GONE
UP SIGNIFICANTLY AND OUR
OVERHEAD IN ASSESSMENTS FROM NIH
HAVE GONE UP AS WELLWE
>>THOSE ARE COULD TAPS.
IT WOULD INCLUDE R21s AND RPGs
ONLY REPRESENT A PORTION THE
GREATEST PORTION AND THERE'S
OTHER FACTOR GO INTO OUR BUDGET
AS WELL.
>>ONE THING I'LL MENTION AGAIN
AND YOU HAVE A BETTER SUCCESS
RATE OF PUTTING IN AN R10 THAN
R21 AT NIAA.
THE PURPOSE OF R21s THE WAY WE
USE THEM AND REVIEW THEM
IN-HOUSE AND THAT'S ONE OF THE
REASONS WE REVIEW THEM IN HOUSE
IS BECAUSE THEY ARE SUPPOSED TO
BE UTILIZED TO DEVELOP DATA
FRAMEWORK FOR SUBMITTING AN R01.
THAT'S THE USE OF R21s FOR NIAA.
WHAT WE DON'T WANT THEM USED FOR
IS BRIDGING FOR LACK OF FUNDING.
BELIEVE ME I WAS IN THE REAL
WORLD 40 YEARS WRITING GRANTS SO
I KNOW ALL THE TRICKS.
I THINK YOU'RE BETTER OFF
WRITING AN RO1 IF YOU HAVE
ENOUGH PRELIMINARY DATA AND A
PLAN FOR FUTURE WORK THAT
ENTITLED THREE TO FIVE YEARS OF
WORK AND THEN DOING AN R21.
SOMETHING I WANTED TO MENTION
WHICH I MENTIONED ON A REGULAR
BASIS.
OTHER THOUGHTS OR QUESTIONS?
TO MY KNOWLEDGE WE HAVEN'T
EMBARKED ON ANY LARGE SCALE
ANCILLARY PROGRAMS.
OUR CENTERS PROGRAM WE HAVEN'T
ADDED MANY IN MY TENURE AND
THEY'RE CAPPED AND SHOWING THE
STRAIN BECAUSE IT'S THE SAME CAP
FROM 1977.
IF YOU CAN WHAT 2 MILLION DOES
IN 1977 COMPARED TO 2023 YOU CAN
SEE WHERE WE'RE AT.
AND TOGETHER WE TRIED TO HAVE
THE CENTERS FOCUS ON A GIVEN
AREA LIKE MICROBIOME AND THINGS
OF THAT NATURE AND IT'S WORKED
OUT WELL BECAUSE THEY FORMED A
VERY GOOD CRITICAL MASS FOR
GIVING REGIONAL AREA IN THE
UNITED STATES AND BRING IN NEW
MEMBERS AND NEW PEOPLE TO THE
FIELD.
ONE OF REASONS WE CONTINUE OUR
CENTERS PROGRAM.
ANY OTHER THOUGHTS OR QUESTIONS?
FEEL FREE, PLEASE.
EVEN THOSE ONLINE RAISE YOUR
HAND LAURA O'DELL YOU'RE GONNA
MAKE SURE WE STAY ON COURSE WITH
MALES VERSUS FEMALES.
>>THE FIRST DATA SET YOU SHOWED
WITH HIV AND DRINKING AND I
DIDN'T SEE IT DISAGGREGATED BY
GENDER.
>>THERE WERE NO SEX DIFFERENCES
IN AND NO SEX BY DRUG
INTERACTIONS AS I RECALL FROM
THE RESULTS.
THEY WERE POOLED IN THE GRAPHS
AS FAR AS I REMEMBER.
WHEN I PUBLISHED A PAPER AND
PROBABLY WHAT YOU'RE TALKING
ABOUT WE PUT THE SYMBOL FOR A
MALE AND FEEL ON AGGREGATED DATA
SO PEOPLE CAN SEE THE OVERLAP OR
TENDENCY TO A DIFFERENCE
STARTING TO MANIFEST ITSELF.
AND WE RECOMMEND YOU DO BOTH AND
IF THERE'S A HINT YOU CAN DO A
SECOND STUDY AND POWER IT FOR
LOOKING AT DIFFERENCES.
SHOWING DISTRIBUTION IS A GOOD
IDEA.
NEEDLESS TO SAY I DIDN'T REVIEW
THE PAPER.
>>HAVE YOU A GREAT MEMORY.
THANK YOU.
I'VE CHALLENGED LAURA TO TAKE
JILL BECKER'S PLACE IN MAKING
SURE WE DON'T FORGET ABOUT
GENDER SEX DIFFERENCES IN OUR
RESEARCH.
>>NOT ONLY DEALING WITH GENDER
SEX DIFFERENCES BUT RACE AND
ETHNICITY DIFFERENCES IN LGBT
DIFFERENCES AS MUCH AS WE CAN I
KNOW IT'S NOT ALWAYS POSSIBLE
BUT SHOULD BE FOREMOST IN THE
AGENDA.
I LOOKED AT GENDER AND AGE AND
WHILE I FOUND NO PROTECTIVE
EFFECTS I DIDN'T FIND HARMFUL
EFFECTS TO LIGHT AND MODERATE
ALCOHOL CONSUMPTION IT SPOKES TO
THE NEGATIVE BUT DIDN'T SPEAK TO
THE FIGHT THAT LIGHT TO MODERATE
DRINKING IS NOT INHERENTLY TOXIC
AND IT'S HEAVY DRINKERS, FORMER
DRINKERS WHO ARE MOST IMPORTANT
TO THE DISCUSSION.
IT'S CLEAR PEOPLE LOOK FOR
SOLUTIONS OR SOCIAL BEHAVIOR
COMPLEX.
>>POINT WELL TAKEN.
THE CONTROVERSY STILL WIRLS
WHETHER THERE'S BENEFICIAL
EFFECTS TO ALCOHOL AT LOW DOSES.
PAPERS LEAN TOWARDS THE J SHAPED
CURVE FOR LOW DRINKERS COMPARED
TO DRINKING MORE.
>>WHAT'S THE PHRASE I LIKED?
>>IT'S NOT MODERATE DRINKING
THAT'S HEALTHY IT'S THE MODERATE
DRINKERS.
WHAT'S CLEAR IS PEOPLE ARE ABLE
TO AFFORD ALCOHOL ON A REGULAR
BASIS AND REGULATE THEIR
CONSUMPTION, SOMEBODY WHO CAN
HAVE A GLASS OF WINE WITH DINNER
OR ONE BEER IN AN EVENING ARE
JUST DIFFERENT PEOPLE.
THEY EXERCISE MORE AND EAT MORE
VEGETABLES AND GO TO THEIR
DOCTOR MORE AND MAKE MORE MONEY
AND HAVE BETTER EDUCATION.
WHEN YOU USE THE CONTROL GROUP
LIGHT DRINKERS INSTEAD OF THE
NON-DRINKERS WHO HAS A WHOLE
TEND NOT TO BE TERRIBLY HEALTHY
WHEN YOU USE LIGHT DRINKERS AS A
CONTROL AND ADJUST FOR BMI AND
SOCIO ECONOMIC STATUS AND THOSE
SORTS OF THINGS, THE AFFECTS
WHAT LOOK LIKE BENEFICIAL OF LOW
DOSES ALMOST ENTIRELY DISAPPEARS
WITH THE EXCEPTION OF THE
STUBBORN FINDING OF HEART ATTACK
REDUCTION AT LOW DOSES AND
ADDING THE OVER ALL RISK IS NO
BENEFIT AND THE RISK OF HARM
START AT A DRINK FOR LESS PER
DAY DEPENDING ON WHAT OUTCOME
MEASURE YOU'RE LOOKING AT.
>>GOOD DISCUSSION THIS MORN.
I WANTED TO HEAR MORE ABOUT THE
PRE ADDICTION CONCEPT THERE'S
CONCERN ABOUT ADDICTION FURTHER
STIGMATIZING HEALTH BEHAVIOR.
I'M CURIOUS OF THE PROCESS FOR
THAT RFI AND HOW MANY COMMENTS
THAT RECEIVED OR THE ISSUE OF
INCREASING STIGMA WILL BE
CONSIDERED IN THAT PROCESS.
>>THE ANSWER IS I DON'T KNOW.
THE ONE PART I CAN ADD IS THERE
WILL BE A PANEL.
THERE'S BEEN PUSHBACK FROM ASSAM
I'M NOT SURE WHY THEY DON'T LIKE
THE CONSTRUCT AND BRIDGET CAN
SPEAK TO THE RFI PROCESS AND WE
CAN LOOK AT COMMENTS AND SEE
WHERE IT'S AT.
IT WAS A COMMENTARY AND PROPOSAL
BUT IF WE GET TOO MANY TOMATOES
THROWN AT US WE MAY HAVE TO
ADJUST IT.
>>I WANTED TO SPEAK TO THE
PROCESS.
I BELIEVE 80 RESPONSES WERE IN
OUR BRANCH AND NIDA BRANCH AND
WE'LL LOOK AT THOSE AND FORM A
REPORT AND SHARE THE REPORT.
STAY TUNED.
>>DO WE NEED A BETTER OR
DIFFERENT WORD?
WE WANT TO CAPTURE EARLY ONSET
ALCOHOL USE DISORDER AND MAYBE
WE'LL HAVE TO SWITCH TO
TERMINOLOGY LIKE THAT AND A LOT
OF THESE METRICS THAT INVOLVE
HUMAN BEINGS THE END IS USUALLY
TOO SMALL TO FIGURE OUT
DIFFERENT RACE AND CULTURES AND
SO FORTH.
AS DATA ACCUMULATES MAYBE WE'LL
BE ABLE TO GET MORE OF THAT
INFORMATION AND I THINK IT
BEHOOVES US TO TRY AND ALSO
ANOTHER FACTOR IN I'M VERY MUCH
AWARE OF ARE THE METRICS WE'RE
USING ACTUALLY HAVING THE SAME
RECEIVER CURVES FOR DIFFERENT
CULTURES AND RACES.
IN OTHER WORDS, DOES BRAIN PAD
ACTUALLY WORK FOR AFRICAN
AMERICANS VERSUS WHITE ANGLO
SAXONS?
I DON'T KNOW.
I DON'T KNOW IF THERE'S EVEN
ENOUGH DATA TO LOOK AT THAT BUT
SOMETHING WE SHOULD BE LOOKING
AT WITH ALL THE METRICS.
IT COULD HELP US IDENTIFY
VULNERABILITIES WE DON'T KNOW
ABOUT.
THAT'S AN IMPORTANT AREA.
OTHER QUESTIONS?
CHUCK.
>>A COMMENT ON THE PRE
ADDICTION.
I DID NOT GIVE A COMMENT THROUGH
THE FORMAL CHANNELS BUT SINCE
WE'RE TALKING ABOUT IT I HAVE
CITED THE ARTICLE A NUMBER OF
TIMES AS I TALKED ABOUT SEVERAL
TIMES IN THESE FORUMS.
HISTORICALLY THE MILITARY
SUBSTANCE ABUSE PROGRAMS WERE
SET UP TO CONTROL, TO GIVE THE
COMMANDER A MEANS OF CONTROLLING
SUBSTANCE USE PROBLEMS IN THEIR
RANK AND IT REMAINED ABOUT
CONTROL AND THE WAY OUR PROGRAMS
WERE COULD BE FIGURED AND WE
WERE FINALLY ABLE TO GET INSTEAD
OF A MANDATORY PANEL WAY WHERE
THE COMMANDER IS THE SOLDIER'S
LEGAL AUTHORITY BEING INVOLVED
IN EVERY CASE ALSO GET A
TRADITIONAL CLINICAL PATHWAY.
THE MILITARY HAD COURT-ORDERED
TREATMENT FOR EVERYBODY.
THERE WASN'T A CORPS JUST THE
COMMANDER THAT WAS INVOLVED AS
120 SOLDIERS ROUGHLY BUT WAS A
BIG DETERRENT THE FOLKS WERE
ENTERED IN A PERSONNEL DATABASE
AND PEOPLE WOULD HESITATE TO
REFER A SOLDIER BECAUSE I MAY
HURT THIS GOOD SOLDIER'S CAREER.
WE IMPLEMENTED VOLUNTARY CARE
AND NOW FULLY A THIRD OF OUR,
40% OF OUR FOLKS ARE UNDER THAT
PROGRAM AND IT'S CHANGE THE
ECONOMY.
INSTEAD OF SOMEBODY SITTING
THERE SAYING WELL, HE MIGHT HAVE
A DINK -- DRINKING PROBLEM AND I
DON'T WANT TO HURT HIS CAREER,
WE SAY THIS GUY MIGHT HAVE A
DRINKING PROBLEM WE BETTER GET
HIM OVER THERE BEFORE HE HAS A
DUI, DRUNK IN THE BARRACKS.
I'M USING YOUNG MALE
PRONOUNS BUT IT'S STILL EARLY IN
THE GAME.
COVID MESSED UP OUR ABILITY TO
GATHER DATA BGA IT'S BEEN A VERY
HELPFUL PROGRAM AND WELL
RECEIVED.
I WANTED TO MAKE A PLUG FOR THE
CONCEPT.
OVER.
>>I THINK IT'S GOING TO BE
INTERESTING TO GO THROUGH THE
RFI RESPONSES AND SEE WHAT WE
GET AND WFROM THERE.
NORAH WILL BE HERE TOMORROW AND
SO KEEP AN OPEN MIND AND THERE'S
NO ONE BETTER TO STIR THE POT
WITH THAN TOM McLELLAN.
WE HAVE TO THINK HARD ABOUT SOME
OF THESE THINGS.
TO QUOTE JOHN KELLY, WE HAVE AN
ENDEMIC ALCOHOL PROBLEM AND
PAN
WE'RE INURED WITH THIS AND IF
YOU DON'T KNOW WHAT THE WORD
MEANS, LOOK IT UP.
IN FULL DISCLOSURE MY MOTHER WAS
A PROFESSOR OF ENGLISH AND I'VE
TORTURED BRIDGET'S BRANCH TRYING
TO DESTROY SEMI COLONS FOR SOME
YEARS NOW.
>>I'LL SUBMIT A COMMENT BUT I
WANTED TO PUT IN A PLUGNT SAYIN
THE PRE ADDICTION MAY BE THE
WRONG TERM.
AND I THINK IT'S SO IMPORTANT IN
TERMS OF ADDRESSING WOMEN OF
REPRODUCTIVE AGE BECAUSE WE NEED
TO INTERVENE EARLIER IN THE LIFE
COURSE OF PROBLEM DRINKING.
AND THAT COULD BE FORGOTTEN IN
FASD DOMAIN
>>CHUCK, I THINK YOU FINISHED,
RIGHT?
>>WE HAVE EIGHT MINUTES LEFT
BEFORE WE ARE DEFINITELY GOING
TO BREAK.
DOES ANYONE ELSE HAVE THOUGHTS
OR COMMENTS, PLEASE?
WE HAD A FAIRLY ROBUST
DISCUSSION.
IS THERE ANYTHING ELSE?
I KEEP LOOKING AT MYSELF ON THE
SCREEN.
IT'S QUITE INTERESTING.
I FEEL LIKE A NARCISSIST LOOKING
INTO THE POOLS.
THE ISSUE OF HEALTHIER PEOPLE --
NOT HEALTHIER PEOPLE BUT THE
ISSUE OF HEALTHIER PEOPLE BEING
BETTER OFF THAN NON-HEALTHIER
PEOPLE RAISES SIGNIFICANT EQUITY
ISSUES IN THE DISCUSSION.
IF YOU CAN GAIN BENEFIT FROM ONE
SOCIAL PRACTICE BECAUSE YOU ARE
MIDDLE CLASS AND HAVE ACCESS TO
RESOURCES AND DENY BENEFIT TO
THOSE NOT MIDDLE CLASS AND
SOMETHING WE LEARNED FROM COVID
IS WORE CREATING A PROBLEM HERE.
IT'S EASY TO LOOK AND DISTORT
THE DATA BASED ON SOCIO ECONOMIC
STATUS AND LOOKING AT PEOPLE OF
COLOR BEING DENIED ACCESS TO THE
PRIVILEGES OF SOCIETY OR
OPPORTUNITIES OF SOCIETY.
WE NEED TO BE CAREFUL.
AND WE TALKED ABOUT THE J CURVE
BEING COMPENSATED FOR BUT THE
DATA DID SHOW THERE WAS A J
CURVE FOR LOW TO MODERATE
DRINKING WITH REGARD TO
CARDIOVASCULAR PROBLEMS BUT
FOLKSED ED -- FOCUSSED ON THE
NEGATIVE AND WE START TO LOSE A
COMMUNITY BECAUSE PEOPLE SEE
EMPIRICALLY AS WASASASNTED OUT
HEALTHIER PEOPLE HAVE GREATERE
LATITUDE IN THEIR SOCIAL
BEHAVIORS AND THAT CREATES
TENSION BETWEEN THOSE WHO HAVE
AND HAVE-NOT AND CALLED INTO
QUESTION THE LEGITIMACY OF THE
ACADEMIES AS OUR SUPREME COURT
IS DISCOVERING HOW THE BEHAVIOR
COULD BE SUSPECT AND CALLS INTO
QUESTION NEUTRAL AND WE NEED TO
BE CAREFUL PULLING IN THE BRAIN
PAD DATA AND ALL-CAUSE MORTALITM
FOR DAILY DRINKING SHOWS THICKS
NEED TO BE PRES--NGS NEED TO BE
TAKEN INTO CONSIDERATION FOR
EQUITY AND ISSUES.
>>ANY FURTHER THOUGHTS OR
COMMENTS?
>>DID YOU WANT TO COMMENT ON
WHAT WEST JUST SAID.
>>I'D LOVE TO.
GREAT COMMENTS.
I COULDN'T AGREE MORE.
IT'S A THING WHERE WHEN YOU
START PULLING ON THE THREADS YOU
REALIZE HOW MANY THREADS THERE
ARE.
AS DR. KOOB MENTIONED SOMETIMES
WE JUST DON'T HAVE THE DATA TO
LOOK AT THINGS BY SAY GENDER OR
SEXUAL IDENTITY BUT WE'RE
GETTING MORE DATA AND HAVE
LARGER STUDIES AND HAVE ENOUGH
DATA IN THE LARGE NATIONAL DATA
SETS TO AT LEAST PAINT A ROUGH
PICTURE OF WHAT'S IN THERE.
AND I COULDN'T AGREE MORE.
I'M GUILTY OF THIS MYSELF
BECAUSE I'VE BEEN STUDYING
ALCOHOL AND COLLEGE STUDENTS FOR
DECADES WHENEVER YOU PUT UP A
GRAPH WHERE THE TREND LINE IS
AGGREGATE DATA YOU'RE TELLING
THE STORY OF ONE GROUP REALLY
AND MOSTLY WHITE MALES BECAUSE
THEY TEND TO DRINK MORE ALCOHOL
AND LOOK AT THE AGGREGATE FOR
THE POPULATION YOU'RE REALLY
LOOKING AT THE TREND LINE FOR
THAT GROUP AND WHEN YOU START
TEASING A PART DIFFERENT GROUPS
YOU FIND THE TREND LINES MOVE IN
DIFFERENT DIRECTIONS AND
CONTRIBUTE TO THE AGGREGATE
NUMBER.
FOR INSTANCE IF WE LOOK AT DRUNK
DRIVING FATALITIES THEY'RE SMALL
DIFFERENCES BUT THEY'RE THERE.
IT'S BEEN A PRETTY MUCH A FLAT
LINE IN TERMS OF ALCOHOL-RELATED
TRAFFIC DEATHS BUT WHEN YOU
START BREAKING THE DATA A PART
YOU SEE THERE'S BEEN INCREASES
FOR BLACK MALES AND FEMALES,
DECREASES MOSTLY FOR WHITE MALES
WHICH MAKES THAT CURVE FLAT AND
SO AGAIN ONCE YOU START LOOKING
AT THESE THINGS YOU CAN NEVER
NOT LOOK AT THEM THAT WAY BUT
THERE'S SO MUCH TO FIGURE OUT.
I APPRECIATE YOUR COMMENTS.
BY THE WAY OUR NEW FACTS AND
STATUS PAGE HAS IT BROKEN DOWN
TO A MORE GRANULAR LEVEL THAN
THE PAST.
>>IF WE MADE A MISTAKE WE'LL
FIX IT OR WE'LL MAKE A MAJOR
EFFORT TO FIX IT.
BRIDGET, DO YOU WANT TO COMMENT
FURTHER?
>>IT GIVES US IDEA HOW TO
APPROACH THE DATA AND DIFFERENT
RESEARCH QUESTIONS TO THINK
ABOUT AND ASK AND DIFFERENT
EFFORTS AND AB -- ACTIVITIES.
ALL THIS HELPS TO INFORM US
WHICH IS OUR JOB SO THANK YOU.
>>OKAY.
SO THANKS EVERYONE FOR A GOOD
DISCUSSION.
AND WE'LL HAVE TIME PROBABLY
LATER FOR FURTHER DISCUSSION.
WE HAVE SOME GREAT TALKS COMING
UP FROM AS I ALREADY OUTLINED
KATIE WITKIEWITZ AND THEN FALK
LOHOFF WILL HAVE MORE AND HOPE I
SET THEM UP A LITTLE BIT AND
NONI BYRNES WILL TALK TO US FROM
CSR AND THAT SHOULD BE REALLY
EXCITING AND LOOKING FORWARD TO
THAT.
SHE'S DOING A REMARKABLE JOB IN
MY OPINION OF MOVING CSR INTO
WHATEVER CENTURY WE'RE IN.
I CAN NEVER FIGURE IT OUT.
IS IT THE 21st?
ALL RIGHT.
SO LET'S TAKE A BREAK AND WE'LL
SEE YOU ALL HERE AT 1:30.
>>IT'S A REAL PLEASURE TO
INTRODUCE A MEMBER OF COUNCIL,
DR. KATIE WITKIEWITZ GOING TO
TALK ABOUT HARM REDUCTION TO
RECOVERY AND DRINKING REDUCTIONS
AND PRECISION MEDICINE AS PART
OF A BROADER PUBLIC HEALTH
APPROACH TO REDUCE
ALCOHOL-RELATED HARM.
DR. WITKIEWITZ IS A
DISTINGUISHED PROFESSOR OF PS
PSYCHIATRY AT THE UNIVERSITY OF
ALBUQUERQUE, NEW MEXICO AND HEAD
OF THE QUANTITATIVE RESEARCH LAB
AND RECOGNIZED NATIONALLY AND
INTERNATIONALLY FOR HER RESEARCH
IN THE ADDICTIONS FIELD IN HARM
REDUCTION AND MINDFUL -BASED
INTERVENTIONS.
SHE'S A FELLOW AND PAST
PRESIDENT OF THE AMERICAN
PSYCHOLOGICAL ASSOCIATION
DIVISION 50 SOCIETY OF ADDICTION
PSYCHOLOGY.
EDITOR FOR THE JOURNAL OF
PSYCHOLOGY FOR ADDICTIVE
BEHAVIORS AND ON THE BOARD FOR
INTERNATIONAL SOCIETY FOR
BIOMEDICAL RESEARCH ON
ALCOHOLISM AND IS A NATIVE NEW
YORKER AND EARNED HER DEGREE IN
1999 AND EARNED HER MASTER'S
DEGREE IN CLINICAL PSYCHOLOGY
FROM THE UNIVERSITY OF MONTANA
IN DECEMBER 2000 WITH A THESIS
ENTITLED APPLICATION OF
CATASTROPHE MODELS TO THE
RELAPSE PROCESS.
SHE EARNED HER Ph.D. IN CLINICAL
PSYCHOLOGY FROM THE UNIVERSITY
OF WASHINGTON IN JUNE, 2005 WITH
A MINOR IN QUANTITATIVE
PSYCHOLOGY WITH A DISSERTATION
ENTITLED PREDICTING ALCOHOL
RELAPSE USING NON-LINEAR
DYNAMICS AND GROWTH MIXTURE
MODELLING.
UNDER THE MENTORSHIP OF G.ALLEN
MARLAK AND HAS LEADERSHIP IN
ADDICTION PSYCHOLOGY FROM THE
SOCIETY OF ADDICTION PSYCHOLOGY
AND EARLY CAREER ACHIEVEMENT
AWARD FOR THE ASSOCIATION FROM
BEHAVIORAL AND COGNITIVE
THERAPIES.
HER RECENT TRANSLATIONAL
IMPLEMENTATION STUDIES FOCUSSED
ON CLINICS USING TELEHEALTH
MODALITIES IN REAL-WORLD
SETTINGS AND ADAPTATIONS TO THE
NUMBER OF SESSIONS AND HOW
TREATMENT IS DELIVERED.
SHE'S CONDUCTED NUMEROUS
EMPIRICAL STUDIES ON THE
EFFICACY AND EFFECTIVENESS OF
TREATMENT PROGRAMS FOR SUBSTANCE
USE DISORDERS AND FOLLOWING
ALCOHOL AND DRUG USE DISORDERS
AROUND MECHANISMS OF SUCCESSFUL
TREATMENT OUTCOMES FOLLOWING
TREATMENT AND ALSO INTERESTED IN
MENTAL HEALTH APPROACHES TO
REDUCE HARM TO REDUCE ALCOHOL
AND OTHER SUBSTANCE USE AS WELL
AS STUDYING POLICY AND HER
IMPACT FOCUSSED ON DEVELOPMENT
OF BEHAVIORAL TREATMENT FOR
ADDICTION AND CO-MORBID MENTAL
HEALTH AND PHYSICAL HEALTH
CONDITIONS.
MECHANISMS OF SUCCESSFUL
TREATMENT OUTCOMES AND PRECISION
MEDICINE APPROACHES TO
ADDICTION.
KATIE, IT'S ALL YOURS.
LOOKING FORWARD TO YOUR TALK.
>>EXCELLENT, THANK YOU SO MUCH,
DR. KOOB.
IT'S SUCH AN HONOR TO PRESENT TO
COUNCIL TODAY ALSO AN HONOR TO
BE ON COUNCIL AT THIS TIME UNDER
YOUR LEADERSHIP I'M EXCITED
ABOUT THE MANY DIRECTIONS NIAA
HAS BEEN TAKING WITH RESPECT TO
STIGMA AND HEALTH EQUITY HOPE TO
HAVE MORE CONVERSATIONS WITH THE
TALK.
I'LL JUMP IN.
I'LL BE TALKING ABOUT HARM
REDUCTION AND RECOVERY AS WELL
AS THROWING IN SOME OF OUR
RECENT RESEARCH ON PRECISION
MEDICINE AND HOW ALL THIS CAN BE
BROUGHT TOGETHER TO REDUCE
ALCOHOL HARM.
A FEW DISCLOSURES, MOST THE WORK
I'LL BE PRESENTING TODAY IS
FUNDED BY NIAA BUT DOESN'T
REPRESENT NIAA'S VIEWS AND I'M
ALSO A PARTICIPANT AND ACTIVE
MEMBER OF THE ALCOHOL CLINICAL
TRIALS INITIATIVE OR ACTIVE
GROUP WHICH IS IN THE PAST 36
MONTHS HAS BEEN SPONSORED BY A
NUMBER OF PHARMACEUTICAL
COMPANIES AND DISCUSS ONE NEW
PROJECT FUNDED.
AS A STARTING POINT AS WE TALKED
ABOUT THIS MORNING, ALCOHOL DOES
HAVE TOXIC EFFECTS ON THE BODY
AND AROUND FIVE YEARS AGO NOW IT
WAS FIVE SUMMERS AGO THE GLOBAL
BURDEN OF DISEASE RISK FACTOR
CAME OUT IN THE LANCET AND MADE
A LOT OF HEADLINES FOR BEING
CLEARLY STATING EVEN ONE
STANDARD DRINK INCREASED
RELATIVE RISK OF MORBIDITY AND
MORTALITY AS WE TALKED ABOUT
THIS MORNING, ALCOHOL HAS
AFFECTS ON MANY ORGAN SYSTEMS
AND INCLUDING THE BRAIN AS WE
TALKED ABOUT TODAY ALREADY.
I THINK IT'S IMPORTANT TO
ACKNOWLEDGE THIS AS A STARTING
POINT THAT WHEN WE DRINK ALCOHOL
WE ANYONE WHO CHOOSES ALCOHOL IS
KNOWNINGLY PUTTING TOXINS IN
THEIR BODIES AND WE MAKE OTHER
OTHER CHOICES AROUND OTHER
UNHEALTHY THINGS WE DO AND
WANWA
WANTED TO CONTEXTUALIZE IT AS A
CHOICE WE MAKE AND ABSTINENCE IS
A HARM REDUCTION AND ACHIEVE
RECOVERY THROUGH ABSTINENCE
WE'RE EXCITED WHEN A CLIENT
COMES TO THE CLINIC AND IS
INTERESTED IN PURSUING
ABSTINENCE AS A PATH.
AND I THINK WE ALSO NEED TO
THINK OF OTHER WAYS TO DEFINE
SUCCESS.
ABSTINENCE HAS LONG BEEN
CONSIDERED THE OPTIMAL OUTCOMES
BUT FEW ACHIEVE CONTINUOUS
ABSTINENCE.
MOST WHO CURRENTLY SEEK
TREATMENT DO NOT WANT TO ABSTAIN
AND MANY WITH ALCOHOL USE
DISORDER DO NOT SEEK TREATMENT
BECAUSE THEY DON'T WANT TO
ABSTAIN.
SO WE HAVE A SITUATION WHERE WE
HAVE ABSTINENCE AS TARGET MOST
PEOPLE DON'T ACHIEVE OR WANT AND
IN FACT MAY IMPEDE PEOPLE FROM
SEEKING TREATMENT.
WE TALKED ABOUT THIS IDEA OF
LARGE NUMBER OF PEOPLE WITH MILD
ALCOHOL USE DISORDER THAT WE
REALLY WANT TO GET THEM TO
REDUCE THEIR DRINKING TO GET
THEM HELP BUT SETTING UP THE
ABSTINENCE AS THE BAR HAS
DETERRED THAT.
SO DRINKING REDUCTIONS MAY BE
MORE DESIRABLE FOR MORE PEOPLE
AS SUCH HAVE GREATER PUBLIC
HEALTH BENEFIT IF MORE PEOPLE
EITHER SEEK TREATMENT BECAUSE
IT'S TARGETING DRINKING
REDUCTION OR AS WE KNOW IS THE
MOST COMMON PATHWAY TO REDUCE
THEIR DRINKING WITHOUT
TREATMENT.
I'D LIKE TO REVISIT THE GRAPH
FOR A SECOND OF THE GLOBAL RISK
OF DISEASE AND SHOWS STANDARD
DRINKS DAILY ON THE X AND
RELATIVE MORBIDITY ON THE Y AXIS
AND INSTEAD OF READING FROM LEFT
TO RIGHT READ IT FROM RIGHT TO
LEFT AND IMAGINE THE HEADLINES
IF THE STUDY CAME OUT AND ALL
THE NEWS OUTLET SAID REDUCING
THE DRINKING REDUCE THE RISK AND
MORTALITY WOULD HAVE BEEN A
DIFFERENT MESSAGE FROM A PUBLIC
HEALTH PERSPECTIVE LESS IGNORED
THAN WHEN IT WAS SAID ANY
DRINKING WILL KILL YOU AND
INSTEAD OF FOCUSSING ON IF WE
REDUCE DRINKING WE'LL EXPERIENCE
REDUCTIONS AND RISKS.
OUR RESEARCH HAS FOCUSSED ON
THIS AND SHOWN THROUGH MANY
EMPIRICAL STUDIES THAT DRINKING
REDUCTION SHORT OF ABSTINENCE
EVEN FOR PEOPLE WITH ALCOHOL USE
DISORDER AND SEVERE ALCOHOL USE
DISORDER ARE ACHIEVABLE.
THE DRINKING REDUCTIONS ARE
ACHIEVABLE AND SUSTAINABLE AND
ASSOCIATED WITH IMPROVED HEALTH
AND FUNCTION.
INDIVIDUALS CAN REDUCE THEIR
DRINKING AND REDUCE THEIR
EXPERIENCES OF HARM WITH WHO
WILL USE WITHOUT ACHIEVING
ABSTINENCE.
THIS IS CRITICAL FOR US TO THINK
ABOUT AS WE'RE THINKING ABOUT
HOW WE COMMUNICATE WITH THE
PUBLIC AND THINK ABOUT SELLING
OUR TREATMENT AND THINK ABOUT
OUR RESEARCH MORE GENERALLY.
SOO A QUESTION THAT ALWAYS COMES
UP IN MY EXPERIENCE OF BEING A
RESEARCHER IN THIS AREA AND AS A
CLINICAL PSYCHOLOGIST IS WHAT
LEVEL OF REDUCTION DO WE TARGET?
THIS IS AN IMPORTANT QUESTION.
WHAT LEVEL OF DRINKING SHOULD WE
BE THINKING ABOUT?
FOR MANY YEARS WE FOCUSSED ON
WELL MAYBE TALK TO YOUR CLIENT
OR PATIENT AND SEE WHAT THEY'RE
INTERESTED IN AND WHAT WOULD BE
A MEANINGFUL REDUCTION FOR THEM.
IS RECENTLY THE WORLD HEALTH
ORGANIZATION IN 2000 PUBLISHED
REDUCED LEVELS OF DRINKING AND
HAD DRINKING GUIDANCE AND IT'S
SEX SPECIFIC GUIDANCE PER DAY
FOR MALES AND FEMALES GIVEN
DIFFERENT RATES OF METABOLISM
AND CONSEQUENCES FOR MALES AND
FEMALES WHEN DRINKING.
IT'S PROVIDE IN GRAMS PER DAY
BUT I CONVERTED IT TO
U.S. STANDARD DRINKS PER DAY AND
WEEK.
THIS PROVIDES A TARGET FOR AN
INDIVIDUAL'S RISK AND THEY CAN
REDUCE THEIR RISK BY LESS
DRINKING.
IT'S A USEFUL METRIC FOR
PATIENTS IN MY EXPERIENCE AND
FOR PROVIDERS TO BE THINKING
ABOUT NOT JUST ABSTINENCE OR NOT
BUT WHAT LEVEL OF RISK AND WHAT
LEVEL OF DRINKING MAY CORRESPOND
WITH THAT LEVEL OF RISK.
SO SURPRISINGLY WHEN THIS
GUIDANCE CAME OUT IT WAS
ACTUALLY BASED ON A GOVERNMENT
REPORT IN AUSTRALIA.
AND THAT GOVERNMENT REPORT IN
AUSTRALIA WAS BASED ON A SMALL
NUMBER OF STUDIES ABOUT A DOZEN
STUDIES THAT LOOKED AT MORBIDITY
AND MORTALITY RELATED TO ALCOHOL
USE.
NOT MUCH HAD BEEN DONE TO
VALIDATE THE RISK LEVELS AND HOW
THEY CORRESPOND TO PATIENTS.
THE ACTIVE GROUP AND THE
CLINICAL TRIALS INITIATIVE AND
MYSELF AND OTHERS HAD BEEN BUSY
IN THE LAST SEVERAL YEAR TRYING
TO UNDERSTAND THE RISK DRINKING
LEVELS AND ARE THEY VALID
INDICATORS OF HOW INDIVIDUALS
FEEL AND FUNCTION AND COULD THEY
BE USEFUL IN CLINICAL TRIALS OR
RESEARCH TO ASSESS PEOPLE'S
LEVEL OF SUCCESSFUL TREATMENT.
THIS IS A PRETTY FULL SLIDE
BECAUSE WE'VE NOW DONE A LOT OF
WORK OVER THE LAST SIX YEARS TO
EVALUATE THE W.H.O. RISK
DRINKING LEVELS AND FOUND
THEY'RE QUITE USEFUL AND
REDUCTIONS ARE ASSOCIATED WITH
REDUCED RISK OF DEVELOPING
ALCOHOL USE DISORDER AND MOST
RECENTLY FOUND THEY'RE
ASSOCIATED WITH AUD REMISSION OR
REMISSION FROM ALCOHOL USE
DISORDER.
WE FIND INDIVIDUAL WHO'S REDUCE
THEIR W.H.O. DRINKING LEVELS
HAVE FEWER CONSEQUENCES, BETTER
MENTAL HEALTH, DECREASES IN
ALCOHOL CRAVING, IMPROVEMENTS IN
QUALITY OF LIFE, BLOOD PRESSURE
AND LIVER FUNCTION AND
IMPORTANTLY REDUCED RISK OF
LIVER DISEASE, DEPRESSION AND
ANXIETY DISORDERS AND
IMPORTANTLY DAN FALK AND
COLLEAGUES FOUND THESE W.H.O.
RISK DRINKING LEVELS ARE
SENSITIVE TO TREATMENT EFFECTS.
YOU CAN DEMONSTRATE AN EFFECTIVE
MEDICATION OVER PLACEBO USING
THE W.H.O. DRINKING LEVELS AS A
CLINICAL TRIAL END POINT.
ANOTHER IMPORTANT FINDING WAS
REDUCTIONS IN W.H.O. RISK
DINKDI
DRINKING LEVELS ARE ASSOCIATED
WITH REDUCTIONS IN HEALTH CARE
COSTS AND MEANINGFUL OUTCOMES
ASSOCIATED WITH REDUCTIONS IN
THOSE LEVELS.
WE HAVE SHOWN PEOPLE MAINTAIN
THESE REDUCTIONS OVER TIME AND
SO WE HAVE FOUND THAT THE
REDUCTIONS IN W.H.O. RISK
DRINKING LEVELS PEOPLE WHO
ACHIEVE THEM MAINTAIN THEM UP TO
ONE YEAR AND THREE YEARS
FOLLOWING TREATMENT AND WE
ALWAYS GET A QUESTION ABOUT
WELL, PEOPLE MORE SEVERE THE
QUESTION WE GET ARE PEOPLE MORE
SEVERE THAN THEY REDUCE THEIR
DRINKING AND THE ANSWER IS YES.
THE EFFECTS ON HEALTH AND
FUNCTION AND STABILITY ARE NOT
MODERATED OVER TIME AND
INDIVIDUALS MORE SEVERE CAN
REDUCE THEIR SHRINKING AND
DEMONSTRATE IMPROVEMENT IN
HEALTH AND FUNCTIONING.
WE'RE PRETTY EXCITED ABOUT THE
WORLD HEALTH ORGANIZATION AND A
GET ASKED ABOUT LONGER TERM
RECOVERY.
I WANT TO SHUT OUT TO MY
COLLEAGUE JILL TUCKER AND WE DUG
INTO THE RESEARCH ON RECOVERY
FROM ALCOHOL USE DISORDER AND
THINKING ABOUT DIFFERENT
PATHWAYS TO RECOVERY.
AND PARTICULARLY THINKING ABOUT
NOT JUST ALCOHOL USE BUT
FUNCTIONING AND HOW PEOPLE ARE
DOING IN THEIR LIVES AND
THINKING ABOUT RECOVERY MORE
BROADLY FROM A QUALITY OF LIFE
PERSPECTIVE.
AND WE HAVE DONE EMPIRICAL WORK
TO EXAMINE BEFORE WE CAN DEFINE
IT THIS WAY.
WE DID TWO INDEPENDENT STUDIES
AND THESE GRAPHS ARE TWO
SEPARATE STUDIES PROBABLY THE
MOST REPLICATIVE FINDING IN MY
CAREER AND WE FOLLOWED IN
IMPROVEMENT IN TWO TREATMENT
SAMPLES.
A NIAA STUDY OF PSYCHOTHERAPIES
FOR ALCOHOL USE DISORDER AND THE
COMBINED STUDY THE NIAA STUDY OF
PHARMACO THERAPY AND BEHAVIORAL
THERAPY FOR ALCOHOL USE
DISORDER.
AND WE FOUND THAT 51% OF THE
SAMPLES WERE DO REALLY WELL.
THEY WERE FUNCTIONING VERY WELL
ON OUR FUNCTIONAL INDICATORS AND
WERE NOT DRINKING VERY MUCH OR
ABSTINENT.
WE ALSO FOUND ABOUT 15% ACROSS
BOTH STUDIES IN THE BLACK HERE.
THERE IS ABOUT 15% OF PEOPLE
DOING POORLY NOT FUNCTIONING
WELL AND ENGAGING IN FREQUENT
HEAVY DRINKING.
BUT WE ALSO FOUND THE TWO
INTERMEDIARY GROUPS AND A FIFTH
OF THE SAMPLE ALMOST 20% IN BOTH
STUDIES WAS A GROUP OF
FUNCTIONING WELL AS ABSTAINERS
AND ENGAGING IN OCCASIONAL HEAVY
DRINKING AND HAD SOME HEAVY
DRINKING WHERE IT WITH YOU
DEFINED AS MORE THAN FOUR DRINKS
PER FEMALES AND ANOTHER GROUP
THAT WAS INTERESTING TO US THAT
HAD REDUCED THEIR DRINKING QUITE
A BIT AND SOME WERE EVEN
ABSTINENT BUT NOT FUNCTIONING
VERY WELL.
AND SO THIS IS CRITICAL FOR US
AS A COMMUNITY OF RESEARCHERS
AND TREATMENT PROVIDERS TO THINK
ABOUT BECAUSE WE ESSENTIALLY
HELPED THESE INDIVIDUALS REDUCE
THEIR DRINKING BUT DID NOT HELP
THEM IMPROVE THEIR FUNCTIONING
AND QUALITY OF LIFE.
SO I THINK BY ONLY TARGETING
DRINKING WE MIGHT BE MISSING OUT
ON HELPING PEOPLE WITH THEIR
FUNCTIONING AND HAVING A LIFE
WORTH LIVING IS ONE WAY WE'VE
DESCRIBED IT AND GOING BACK TO
THIS PROFILE THREE IN BLUE THERE
SEEMS TO BE A GROUP OF PEOPLE
DOING QUITE WELL EVEN IF THEY
CONTINUE TO ENGAGE IN SOME HEAVY
DRINKING AND THIS IS LIKE ONCE
WEEKLY HEAVY DRINKING OR LESS.
DL
THIS IS A SNAPSHOT AND WE LOOKED
UP TO A DECADE FOLLOWING
TREATMENT WE SEE INDIVIDUALS IN
THE HIGH FUNCTIONING PROFILES
HAD SIGNIFICANTLY GREATER LIFE
AND LESS DEPRESSION AND ANGER
THAN THE LOWER-FUNCTIONING
PROFILES EVEN 10 YEARS LATER AND
ALSO HAVE HIGHER SELF-REPORTED
HEALTH AND FEWER HOSPITAL STAYS.
THIS TELLS US FUNCTIONING IS
IMPORTANT IN THINKING ABOUT
RECOVERY AND ALSO THERE'S A
GROUP OF PEOPLE WHO CAN MAINTAIN
HIGH FUNCTIONING EVEN IF THEY
CONTINUE TO DRINK AND SO WE
DEFINED THIS AS NON-ABSTINENT
RECOVERY AND PEOPLE MAY NOT BE
ABSTINENT BUT STILL HAVE GOOD
QUALITY AND PURPOSE OF LIFE AND
HEALTH.
I'LL TRANSITION TO SOME WORK ON
PRECISION MEDICINE.
AND I'M VERY PASSIONATE ABOUT
PRECISION MEDICINE.
I THINK OF IT AS SIMILAR TO HARM
REDUCTION MEETING PEOPLE WHERE
THEY'RE AT AND TRYING TO
IDENTIFY WHAT A PARTICULAR
CLIENT MAY NEED OR PATIENT MAY
NEED IN TREATMENT.
THERE'S 2048 WAYS TO BE
DIAGNOSED WITH ALCOHOL USE
DISORDER IN DSM5 SO THERE'S
HETEROGENEITY IN ALCOHOL USE
DISORDER AND GOALS AND IN
TALKING ABOUT PRECISION MEDICINE
IT'S A NICE WAY OF
CHARACTERIZING IT.
IF WE THINK OF ANY ENTIRE
POPULATION OF INDIVIDUALS WITH
ALCOHOL USE DISORDER AND GET
THEM ALL THE SAME TREATMENT.
SAY I LIKE COGNITIVE BEHAVIORAL
TREME OR NALTREXONE AND WE'LL
IDENTIFY THOSE CHARACTERISTICS
THAT MAY DISTINGUISH PEOPLE AND
GIVE THEM TREATMENT
SUPPORTINGLY.
AND ATTEMPTS HAVE BEEN DONE
GENOTYPING AND SIMILAR STORY FOR
GRIK SEEMED PROMISING AND FAILED
IN TRIALS AND SIMILAR FOR
ONDANSETON AND ONE STUDY THAT
LOOKED AT THE DA
-- GABRA TWO-STEP FACILATION
AND WHAT'S NICE ABOUT PHENOTYPIC
APPROACHES WE CAN ADMINISTER
SELF-REPORT MEASURES TO TRY TO
BETTER UNDERSTAND THE
PHENOTYPES.
AS FAR AS GUIDING THE WORK WE
LOOKED AT DR. KOOB'S ADDITION
CYCLE IN GUIDING OUR THINKING OF
PHENOTYPING.
THIS IS A WELL-SUPPORTED MODEL
FROM BASIC NEUROSCIENCE AND LOTS
OF TRANSLATIONAL WORK OVER THE
LAST TWO DECADES SHOWING THAT
THERE APPEARS TO BE DIFFERENT
TYPES OF DRINKING ASSOCIATED
WITH DYSFUNCTION AND THINKING
PEOPLE IN THE CRAVING OR REWARD
PHASE WHERE IT'S MAINTAINED BY
POS OF POSITIVE REINFORCEMENT
AND IN THE WITHDRAWAL IT BECOMES
NEGATIVE IN SEEKING RELIEF FROM
NEGATIVE EXPERIENCES AND
WITHDRAWAL AND THEN IN THE
PREOCCUPATION AND ANTICIPATION
PHASE WE SEE LOSS OF CONTROL
OVER DRINKING.
AND OUR LAB HAS REALLY BEEN
WORKING ON HOW DO WE ASSESS THE
PHENOTYPES IN CLINICAL
POPULATIONS AND CLINICAL
SETTINGS.
SOME OF THIS WORK STARTED BY A
FORMER GRADUATE STUDENT AND WE
TOOK A MEASURE BASED ON THE
ALCOHOL ABSTINENCE SELF-EFFICACY
WORK AND DID MODELLING AND WERE
ABLE TO IDENTIFY THESE REWARD
AND RELIEF PHENOTYPES.
MORE RECENTLY MY GRADUATE
STUDENT WHO JUST DEFEND HER
DISSERTATION YESTERDAY
IDENTIFIED A 10 ITEM SCALE THAT
CAN CAPTURE REWARD AND RELIEF AS
WELL WITH GREAT PSYCHO METRIC
PROPERTIES AND THAT WAS A
COLLABORATION WITH HANK KRANZLOR
AND WE DEVELOPED A 15 OR TESTED
A 15-ITEM MEASURE AND FOUND THE
DIMENSIONS OF REWARD AND RELIEF
NEGATIVE EMOTIONALITY AND LOSS
OF CONTROL AND THE DIMENSIONS
SEEM TO BE PREDICTIVE OF VARIOUS
THINGS AND FIT REALLY WELL.
NOW THAT WE CAN EMPIRICALLY
DERIVE THE PHENOTYPES USING
SELF-REPORT MEASURES THE NEXT
QUESTION IS DOES THIS WORK FOR
PRECISION MEDICINE?
AND WE STARTED THIS
COLLABORATION AND WORK AROUND
THE REWARD DRINKING PHENOTYPE
AND LEANING ON YEARS OF RESEARCH
THAT WOULD SUGGEST ALTERATIONS
FOR PEOPLE TO DRINK PRIMARILY IN
THE CONTEXT OF POSITIVE
REINFORCEMENT AND THEY MAY
BENEFIT MORE FROM NALTREXONE.
THIS IS A LONG STANDING
HYPOTHESIS IN THE FIELD AND SURE
ENOUGH IF YOU LOOK AT A TOTAL
SAMPLE APPROACH IN THREE
SEPARATE STUDIES WE SEE SMALL
EFFECT SIZES FOR NALTREXONE
VERSUS PLACEBO IN THE TOTAL
SAMPLE CONSISTENT WITH THE IDEA
THAT MAYBE THE TREATMENT WORKS
FOR SOME BUT NOT MOST AND IF WE
BREAK OUT REWARD DRINKERS SO IF
WE PHENOTYPE REWARD DRINKERS AND
LOOK AT THE NALTREXONE
COMPARISON WE SEE LARGE SIZES OF
NALTREXONE VERSUS PLACEBO USING
THE PRECISION MEDICINE APPROACH
OF TAILORING THE TREATMENT OR
BREAKING OUT THOSE PARTICULARLY
REWARD DRINKING WHO MAY BE
DRINKING IN THE CONTEXT OF
POSITIVE REINFORCEMENT AND SEEM
TO BENEFIT QUITE A BIT FROM
NALTREXONE.
AND THE OTHER NALTREXONE AND THE
AFFECTS ARE MEDIATED BY
REDUCTION IN DESIRE TO DRINK.
NOT ONLY IS THE MEDICATION
WORKING FOR REWARD DRINKERS BUT
WORKING IN THE INTENDED
MECHANISM OF REDUCING CRAVING
AND DESIRE TO DRINK.
MOST OF OUR WORK FOCUSSED ON
REWARD DRINKING BUT BASED ON
EARLIER WORK AND JOHN LITTLETON
AND DR. KOOB WE EXPECT
INDIVIDUALS WITH ALTERATIONS OF
THE GLUTAMATERGIC SYSTEM THERE
WAS NO EFFECT OF THE PLACEBO BUT
IN RELIEF DRINKERS THERE WAS A
SMALL EFFECT.
AND I'M A BEHAVIORAL
INTERVENTIONIST AND I LOOK TO
LOOK AT BEHAVIORAL TREATMENTS.
THESE ARE HOT OFF THE PRESS.
I JUST ANALYZED THE DATA LAST
WEEK AND WE WERE ABLE TO
IDENTIFY A RELIEF DRINKING SCALE
AT BASELINE IN ONE OF OUR
STUDIES OF MINDFULNESS BASED
RELAPSE PREVENTION AND LOOKED AT
HEAVY DRINKING DAYS AT A
12-MONTH FOLLOW UP AND IN THE
TREATMENT AS USUAL CONDITION
THERE'S A CORRELATION BETWEEN
HEAVY DRINKING AND THOSE WITH
THE HIGHER RELIEF PHENOTYPE SEEM
TO HAVE WORSE OUTCOMES AND IN
THE MINDFULNESS AFFECT WE SEE
ATTENUATION THOSE INDIVIDUALS
HIGHER IN RELIEF DRINKING ARE
NOT ENGAGING IN HEAVY DRINKING
AT 12 MONTH FOLLOW UP AND
MINDFULNESS INTERVENTION IS MORE
USEFUL IN THE HEAVY DRINKING.
THE BIG QUESTION IS BRINGING
THIS TOGETHER TO MY PRIOR WORK I
MENTIONED IN RECOVERY AND I WAS
INTERESTED IN DO THE ADDICTION
CYCLES AND PHENOTYPES PREDICT
RECOVERY OUTCOMES AND WE DID
FIND THAT WAS THE CASE.
INTERESTINGLY PEOPLE WILL HAVE
HIGHER ODDS OF ACHIEVING
RECOVERY AND THOSE WITH LOWER
RELIEF AND NEGATIVE AFFECTIVE
DRINKING HAVE HIGHER ODDS OF
ACHIEVING RECOVERY AND DIDN'T
SEEM TO BE MUCH OF AN EFFECT ON
EXECUTIVE FUNCTION BUT CLEARLY
THE DOMAINS AND THIS IS
PREDICTING RECOVERY THREE YEARS
LATER.
TO ME THAT'S IMPORTANT FROM A
CLINICAL TRANSLATIONAL
PERSPECTIVE WE COULD MAYBE
PREDICT PEOPLE'S RECOVERY
THROUGH A 15-ITEM SCALE.
ANOTHER PIECE I WANT TO END WITH
GOING BACK TO DR. CLARK'S
QUESTION COMMENT EARLIER IS THE
IMPORTANCE OF ENVIRONMENT.
WE HAVE DONE WORK LATELY LOOKING
AT COMMUNITY-LEVEL FACTORS AND
THE IMPORTANCE OF ENVIRONMENTAL
CONTEXT AND IN A RECENTLY
PUBLISHED PAPER FOUND SOCIAL
ENVIRONMENT IS ALSO IMPORTANT
FOR PREDICTING RECOVERY.
THIS IS COMMUNITY-LEVEL INCOME
AND INDIVIDUALS WHO LIVE IN
HIGHER INCOME, HIGHER RESOURCED
COMMUNITIES HAVE A HIGHER
LIKELIHOOD OF ACHIEVING RECOVERY
AND SIMILAR EFFECT FOR HEALTH
INSURANCE.
THOSE WHO LIVE IN COMMUNITIES
WITH GREATER PROPORTION OF THE
POPULATION HAS HEALTH INSURANCE
ARE MORE LIKELY TO ACHIEVE
RECOVERY.
I THINK COMING BACK TO THE
COMMENTS THAT WE NEED TO THINK
ABOUT SOCIAL ENVIRONMENT IN ALL
OF OUR RESEARCH I WOULD ALSO
CHALLENGE THE TRANSLATIONAL AND
ANIMAL RESEARCHERS TO THINK OF
ENVIRONMENT AS WELL.
WE KNOW PEOPLE DEVELOP ALCOHOL
USE DISORDER IN AN ENVIRONMENTAL
CONTEXT AND RECOVER IN AN
ENVIRONMENTAL CONTEXT.
WE NEED TO THINK MORE ABOUT
ENVIRONMENT.
AS FAR AS WHERE WE'RE GOING, I'M
EXCITED ABOUT THE W.H.O. RISK
DRINKING LEVELS AS AN END POINT
FOR ALCOHOL CLINICAL TRIALS AND
THANKFUL FOR THE NIAA PURSUING
THE W.H.O. RISK DRINKING LEVELS
WITH THE FDA.
FINGERS CROSSED IF THAT GOES
THROUGH.
A SHOUT OUT TO AN EARLY CAREER
INVESTIGATOR CASSIE BONESS
LOOKING AT THE ADDICTION CYCLE
DOMAINS AND HOW DO WE TAKE A
PATIENT-CENTERED APPROACH AND
GET PATIENT FEEDBACK ON THE
MEASURES TO MAKE SURE WE ARE
MEASURING THESE CONSTRUCTS IN A
WAY THAT ARE CONSISTENT ACROSS
SOCIO DEMOGRAPHIC GROUPS THAT
ARE RELEVANT ACROSS THE SOCIO
DEMOGRAPHIC GROUPS AND
EVERYTHING WE'VE DONE SO FAR
WITH THESE ADDICTION CYCLE
DOMAINS HAS BEEN RETROSPECTIVE
PULLING ITEMS AVAILABLE IN
EXISTING DATA.
AND DR. BONESS IS DOING
MEASURES.
I'M EXCITED WE HAVE LAUNCHED A
PROSPECTIVE STUDY OF NALTREXONE
FOR REWARD DRINKERS AND STAY
TUNED FOR RESULTS FROM THAT
PROSPECTIVE STUDY AND I'M ALSO
INTERESTED IN SEEING WHETHER
MINDFULNESS BASED REDUCTION MAY
BE EFFECTIVE FOR ALL CYCLE
DOMAINS NOT JUST RELIEF
DRINKING.
I THINK THERE'S EVIDENCE TO
SUGGEST THAT IT MAY BE
PARTICULARLY EFFECTIVE FOR
HELPING PEOPLE WITH IMPAIRED
EXECUTIVE FUNCTION AND ALSO
PEOPLE WHO ARE DRINKING FOR BOTH
REWARD AND RELIEF REASONS.
I WANT TO HAVE A PENDING GRANT
TO STUDY LONG-TERM RECOVERY AND
TARGETING THESE DOMAINS.
I WANT TO ACKNOWLEDGE AND THANK
NIAA FOR LEADING THE FIELD AND
NEW DEFINITION OF RECOVERY AND
THIS IS REALLY IMPORTANT.
WE HAVEN'T HAD A RESEARCH
DEFINITION OF RECOVERY IN THE
FIELD AND SO I'M THRILLED WITH
THIS NEW DEVELOPMENT AND WE NOW
WOULD ENCOURAGE EVERYONE IN THE
EMPIRICAL STUDIES OF THE
DEFINITION AND I ALSO THINK THE
NEW DEFINITION BY FOCUSSING ON
QUALITY OF LIFE AND REQUIRES US
TO THINK OF WHOLE PERSON HEALTH
AND MECHANISMS OF BEHAVIOR
CHANGE AND HOW PEOPLE ARE DOING
IN THEIR LIFE NOT JUST
ASSOCIATION OF HEAVY DRINKING
AND I WANT TO GIVE ANOTHER PLUG
WE NEED TO LOOK AT SOCIAL
DETERMINATES OF HEALTH WHEN
STUDYING INDIVIDUAL OUTCOMES AND
I WOULD ENCOURAGE EVERYONE TO
CONSIDER ENVIRONMENTAL FACTORS
IN EXAMINING ALCOHOL USE
BEHAVIOR IN TRANSLATIONAL MODEL.
I THINK WE'RE MISSING THIS IN
OUR FIELD GENERALLY.
THERE'S SOME GOOD WORK BUT WE
COULD BE DOING MORE TO THINK OF
SOCIAL DETERMINATES OF HEALTH
AND THE ENVIRONMENT.
I WANT TO ACKNOWLEDGE PEOPLE OUT
THERE WORKING IN THE COMMUNITY
AND AT THE UNIVERSITY OF NEW
MEXICO WE HAVE A WHOLE CENTER
FOCUSSED ON OPIOID USE AND PAIN
AND DOING COMMUNITY-RESEARCH
WITH THAT.
WE'RE DOING CULTURAL ADAPTATIONS
AND WE LAUNCHED AN ALCOHOL USE
AND MENTAL HEALTH ECHO WITH THE
LINK THERE'S AND WE ALSO OFFER
MINDFULNESS ONLINE AND EXPANDING
TO THE UNHOUSED POPULATION TO
BRING THIS TREATMENT TO A
BROADER POPULATION.
WITH THAT THANK YOU ALL FOR
LISTENING AND THANKS TO NIAA FOR
FUNDING AND HAPPY TO TAKE
QUESTIONS.
>>KATIE, THAT WAS A GREAT TALK
AND I'M SURE EVERYONE'S REALLY
APPRECIATIVE.
WE'RE GOING TO HOLD QUESTIONS
UNTIL AFTER FALK TALKS AND DO
THEM TOGETHER AND I PROMISE I
ALREADY HAVE A QUESTION READY SO
I'LL STIMULATE ACTIVITY IN YOUR
REGARD BUT I THINK IN THE
INTEREST OF THE WAY WE'RE
ORGANIZED TODAY WE'RE GOING TO
LET FALK DO HIS TALK AND TAKE
QUESTIONS FOR BOTH OF YOU AND
THAT MEANS YOU HAVE TO STICK
AROUND, FALK, AS WELL.
KATIE, THINK ABOUT SOME
QUESTIONS.
I'LL GIVE YOU A CHANCE THINK OF
MY QUESTION WHICH IS IF WE USE
THE DIFFERENT DOMAINS AS
CRITERION WHICH I'M IN FAVOR FOR
WILL WE HAVE TO ADJUST THEM FOR
THE INDIVIDUAL DIFFERENCES IN
RACE AND CULTURE AND GENDER?
THINK ABOUT THAT AS A QUESTION
AND I'LL ASK IT AGAIN.
LET ME INTRODUCE HIM WHILE HE
GETS HIS SLIDES UP.
DR. FALK LOHOFF WORKS ON
GENOMICS ON NIAA AND RECEIVED
HIS DEGREE FROM HUMBOLDT
UNIVERSITY IN 2002 AND HAS A
FELLOWSHIP IN NEURO PSYCHO
FELLOWSHIP AT THE UNIVERSITY OF
PENNSYLVANIA AND WAS ASSISTANT
PROFESSOR OF PSYCHIATRY AT THE
UNIVERSITY OF PENNSYLVANIA FROM
2007 TO 2014 AFTER WHICH HE
JOINED THE NIH INTRAMURAL
PROGRAM AS A LASKER CLINICAL
RESEARCH INVESTIGATOR AND HAS
BEEN INVOLVED IN DIRECT PATIENT
CARE AND HIS RESEARCH IS
FOCUSSED ON TRANSLATIONAL
MEDICINE THAT SPANS MOLECULAR
AND EPIGENETICS AND PHARMACO
GENETICS AND EXPERIMENTAL
TRIALS.
FALK, IT'S ALL YOURS.
I'M LOOKING FORWARD TO YOUR TALK
ON ALCOHOL, AGING AND EPIGENETIC
TALKS.
>>THANK YOU FOR THE
INTRODUCTION AND INVITATION.
I'M EXCITED TO BE HERE TODAY.
CAN EVERYBODY HEAR ME OKAY?
GREAT.
I'LL BE TALKING ABOUT ALCOHOL,
AGING AND EPIGENETIC CLOCKS.
SO CLINICALLY WHEN WE SEE
PATIENTS WITH AN ALCOHOL USE
DISORDER OFTEN TIME THE
INDIVIDUALS LOOK OLDER THAN
STATED AGE THEY LOOK TIRED, WORN
AND AGE AND WE KNOW ALCOHOL USE
DISORDER HAS BEEN ASSOCIATED
WITH AGE-RELATED MORBIDITIES AND
OFTEN LEADS TO PREMATURE DEATH
THE UNDERLYING MECHANISMS OF
AGING IN AUD ARE LARGE LARGELY
UNEXPLORE AND THE ASSOCIATION
ARE NOT WELL UNDERSTAND BETWEEN
AGING AND ALCOHOL.
WHY IS THIS IMPORTANT?
THIS SLIDE SHOWS THE PROFOUND
SOCIETY'S UNDERGOING NOW.
YOU CAN SEE THE DEMOGRAPHIC
CHANGES AND THIS IS INDIVIDUALS
65 YEARS AND OLDER AND IN THE
'70s AND '80s WAS 25% AND IN THE
NEXT YEARS WE'LL HAVE A MASSIVE
AMOUNT OF INDIVIDUAL THAT ARE
OLD AND THE INCREASE IN AGING IS
GOING TO CREATE CHALLENGING TO
THE HEALTH CARE SYSTEMS AS WE'LL
HAVE MORE AND MORE INDIVIDUAL
WHO'S DEVELOP CHRONIC DISEASES
AND IT WILL GET CHALLENGING TO
TREAT.
WE'VE BEEN FOCUSSING ON SICK
CARE.
AN INDIVIDUAL'S HEALTHY AND THEN
GETS SICK AND THEN FOCUS ON
WHATEVER IT IS, THE HEART
DISEASE, DIABETES AND DEVELOP
TREATMENTS FOR THESE DISEASES
AND A LOT OF TIMES THERE'S VERY
LITTLE INTERACTION BETWEEN THE
SPECIALTIES AND TREATING THE
DISEASES.
THIS IS REALLY THE HALLMARK OF
THE LONGEVITY, RESEARCH FIELD
AND THAT IS THAT ONE OF THE
FACTORS -- THE BIGGEST RISK
FACTORS IN CHRONIC DISEASE IS
AGING.
PERHAPS A PARADIGM SHIFT IS
GOING FROM SICK CARE TO HEALTH
CARE.
THIS IS ANOTHER CARTOON SHOWING
THE APPROACH.
WHEN YOU START OUT AS A NEWBORN
AND WE HAVE A RELATIVELY HEALTHY
LIFE AND THEN AT SOME POINT
CHRONIC DISEASE SETS IN.
THE FIRST CHRONIC DISEASE AND
SECOND AND THIRD AND SO FORTH.
WE GET TREATMENT AND WE'RE
PRETTY GOOD IN DEVELOPING SOME
TREATMENT AND THE TREATMENT
UNFORTUNATELY RIGHT NOW IS NOT
CURING DISEASE BUT A LOT OF
TIMES JUST MANAGING DISEASE.
WE HAVE VERY FEW CURES AND
ULTIMATELY THE INDIVIDUAL FACES
MORTALITY.
THE IDEA OF INCREASING HEALTH IS
TO INCREASE THE DISEASE-FREE
PERIOD, ENHANCE HEALTH SPAN AND
COMPRESS MORBIDITY AS MUCH AS WE
CAN SO THAT THE INDIVIDUAL HAS
MUCH BETTER QUALITY OF LIFE BUT
ALSO WE CAN HARVEST THE ECONOMIC
BENEFITS FROM THIS.
WHY'S THIS SO IMPORTANT?
IT'S A GRAPH SHOWING SOME OF THE
ECONOMIC COST AND BENEFIT
ANALYSIS.
THIS IS SHOWING YOU IF WE DELAY
CANCER OR HEART DISEASE SHOWN
HERE WE HAVE SOME IMPACT BUT
REALLY IF WE DELAY AGING BY AND
LARGE WE OUTPERFORM, CANCER,
HEART DISEASE AND MOST OTHER
CHRONIC DISEASES.
A STUDY CAME OUT TWO YEARS AGO
THAT SHOWED IF YOU HAVE A
ONE-YEAR SLOW DOWN IN AGING,
THIS WOULD CREATE A $38 TRILLION
ECONOMIC BENEFIT.
THIS IS VERY IMPORTANT.
NOW WHAT ABOUT AGE AND ALCOHOL
AND WHAT'S THE MODIFIABLE RISK
FACTOR, IN THIS CASE, ALCOHOL ON
AGING?
HOW CAN WE MEASURE ALCOHOL
EFFECTS ON BIOLOGICAL AGING AND
WHAT IS IS A GOOD BIOMEDICAL
THAT TRACKS AGING AND WE FOCUS
ON METHYLATION TECHNOLOGY AS A
MEASURE OF AGING AND DNA
METHYLATION IS AN ADDITION OF
THE METHYL GROUP CYTOSINE FIVE
POSITION AND WE CAN MEASURE THEM
WITH TECHNOLOGY ACROSS THE
GENOME AND THIS IS SHOWN HERE.
THIS IS ONE OF THE CHIPS HERE
AND IT MEASURES OVER 850,000CPG
SITES, METHYLATION SITES ACROSS
THE GENOME AT THE SAME TIME.
SO WE CAN USE THIS TECHNOLOGY TO
ASK A LOT OF QUESTIONS REGARDING
AGING AND BIOMARKERS.
SO THIS IS WHERE REALLY THE
BIOLOGICAL AGE IN EPIGENETIC
CLOCKS COME INTO THE SPACE.
EPIGENETIC AGE CAN BE ESTIMATE
DNA LEVELS AND THIS IS SOMETHING
THAT UCLA HAS PIONEERED AND HE
USED MACHINE LEARNING MODEL TO
ASK OUT OF MY 850,000CPG SITES
WHICH ONES TRACK CHRONOLOGICAL
AGE AND WAS ABLE TO COME UP WITH
A SET OF CPG SITES THAT VERY
ACCURATELY TRACK CHRONOLOGICAL
AGE.
YOU CAN GET A BLOOD DRAW AND GET
YOUR CPG SITES AND IT WILL
PREDICT YOUR BIOLOGICAL AGE.
WHEN YOU DO THAT YOU HAVE AND
YOU CAN HAVE DECELERATION AND
YOU'RE BELOW THE CURVE HERE.
SO WITH THE EPIGENETIC CLOCKS
LEE HORVATH WAS THE FIRST TO
DEVELOP THEM IN 2013 AND SINCE
THEN THERE HAVE BEEN OTHER
ITERATIONS AND SECOND GENERATION
CLOCKS, ETCETERA.
YOU CAN SEE INITIALLY WE HAVE
353 CPG SITES AND THEY GET MORE
AND MORE ACCURATE AND ALSO START
TO MEASURE DIFFERENT ASPECTS
INCLUDING LIFE SPAN, HEALTH SPAN
AND TAKE INTO ACCOUNT SEVERAL
OTHER PHYSIOLOGICAL MEASURES.
THIS IS ONGOING WORK THE
EPIGENETIC CLOCKS, ALGORITHMS,
IF YOU WILL, ARE GETTING BETTER
AND BETTER AT PREDICTING
BIOLOGICAL AGE.
WE DECIDED TO LOOK AT THESE IN A
SAMPLE OF ALCOHOL USE DISORDER
IN INDIVIDUALS AND LOOKED HAD 59
BLOOD CASES WITH THOSE WITH
ALCOHOL USE DISORDER AND LIVER
SAMPLE, 46 CASES AND 46
CONTROLS.
AND WE HAD AT THE TIME A CHIP
THAT ONLY LOOKED AT 450,000
MARKERS AT THE TIME AND FOR
LIVER WE LOOKED AT 850,000
MARKERS.
HERE'S SOME OF THE
CHARACTERISTICS AND LET'S JUMP
TO THE RESULTS.
YOU CAN SEE IS THE BLOOD SAMPLE.
HERE'S THE AGE ACCELERATION.
THE EPIGENETIC AGE ACCELERATION
IN THE FIRST HORVATH CLOCK AND
THE DARK SPOTS ABOVE THE LINE
ARE THE INDIVIDUALS WITH ALCOHOL
USE DISORDER.
WHEN WE LOOKED IN LIVER, WE SAW
THE SAME RESULT CASES OF
CIRRHOSIS AND THIS IS AGE
ACCELERATION IN INDIVIDUALS WITH
CIRRHOSIS AND DECELERATION OF
NORMAL LIVER.
WE INCREASED OUR SAMPLE SIZE
NEARLY FIVE FOLD AND HAT 532
INDIVIDUALS AVAILABLE AND HERE'S
SOME OF THE DEMOGRAPHICS.
I WANTED TO HIGHLIGHT THIS IS SI
SEVERE ALCOHOL USE DISORDER
SAMPLE AND ABOUT 12 DRINKS PER
DAY.
THIS SAY PHENOTYPE STUDY.
WE USED THE AGE ACCELERATION
CLOCK AND IN THE CONTROLS WE SAW
MILD DECELERATION.
THEN AGAIN YOU CAN SEE BY AND
LARGE THE INDIVIDUALS WITH THE
AUD ARE ABOVE THE LINE AND SOME
HAVE A LARGER ACCELERATION.
WE ASKED WHAT ABOUT THE
INDIVIDUALS WHO HAVE AN AUD BUT
ALREADY HAVE DAMAGE OR AN AUD
THAT IS ALSO HAVE ESSENTIALLY
ELEVATED LIVER ENZYMES AS A
SURROGATE MARKER FOR DISEASE
SEVERITY LET'S SAY.
WHAT YOU SEE HERE IS WE HAVE THE
ALT, ALP, GGT AND INDIVIDUALS
WITH THE HIGHEST GGT COMPARED TO
THE LOWEST GGT LEVEL AND ALL AUD
CASES AND YOU SEE A THREE YEAR
OR SO INCREASE IN EPIGENETIC AGE
ACCELERATION.
WE WERE INTERESTED IN FOLLOWING
THIS UP FURTHER AND ASKED QUA
ABOUT STRESS AND ALCOHOL AND
AGING AND WE KNOW STRESS CAN
ACCELERATE AGING AND IS THERE AN
INTERACTION AND ADDITIVE EFFECT?
WHAT WE DESIGN IS A STUDY WHERE
WE HAD A DISCOVERY COHORT AND
USED FACTOR ANALYSIS TO GENERATE
A COMPOSITE SCORE OF STRESS AND
WANTED TO TAKE IT FORWARD IN OUR
EPI GENGENO GENGENOMIC COHORT AD
OUR FINDINGS IN A LARGE
GENERATION SCOTLAND EPIGENETIC
COHORT AND THE GREATER TRAUMA
PROJECT SHOWN HERE.
WE HAVE CLINICAL MEASURES
AVAILABLE IN BIOLOGICAL MEASURES
AVAILABLE FROM OUR AUD MEASURES
AND DEPRESSION MEASURES AN
TRAUMA QUESTIONS AND WE ASKED
THE QUESTION DOES EPIGENETIC
AGING CORRELATE WITH THE STRESS
WHEN WE LOOK AT THE TOP AND
BOTTOM QUARTILES YOU SEE ROBUST
AGE ACCELERATION IN INDIVIDUALS
MOST STRESSED BASED ON THE
COMPOSITE SCORE WE ESSENTIALLY
DESIGN A METHYLATION TEST SCORE
AND WHAT ARE THE CPG SITES THAT
TRACK THIS STRESS SCORE
ACTIVELY?
THROUGH STATISTICAL MODELLING WE
IDENTIFIED 211 CPG SITES THAT
TRACK STRESS EXPOSURE ACCURATELY
AND THIS IS IN WHAT BIOLOGICAL
FUNCTION THEY'RE INVOLVED IN.
YOU SEE A LOT OF THEM ARE IN
CELL CYCLE FUNCTION, REGULATION
OF CELL DEATH, ETCETERA,
INTERESTINGLY ENOUGH SOME
NEUROGENESIS AND SO FORTH.
WHAT'S ALSO INTERESTING IS THE
211 CPG SITES THAT TRACK STRESS
DON'T OVERLAP WITH THE AGING CPG
SITES THAT TRACK CHRONOLOGICAL
AND BIOLOGICAL AGE.
THAT WAS INTERESTING.
WE TOOK FORWARD THE METHYLATION
SCORE OF STRESS AND YOU CAN SEE
THE HIGHER METHYLATION SCORE OF
STRESSES THE HIGHER AND FASTER
YOU AGE AND WE SHOWED THIS AGAIN
ACROSS ALL THREE CLOCKS WE USED.
WHEN WE LOOK AT LOW AND HIGH
STRESS QUARTILES YOU SEE ROBUST
AGE ACCELERATION WITH STRESS AND
HERE WHEN WE JUST LOOK AT
INDIVIDUALS WITH AUD, WE SEE
EVEN MORE SO A DRAMATIC INCREASE
IN AGE ACCELERATION ALMOST LIKE
THREE OR FOUR YEARS ALMOST.
SO THEN BASED ON THAT FINDING WE
THEN ASKED A QUESTION, CAN WE
INTEGRATE ALCOHOL USE MEASURES
AND STRESS MEASURES IN THE SAME
MODEL AND FOR THAT WE USED
METHYLATION SCORES OF ALCOHOL
CONSUMPTION AND USED METHYLATION
SCORES FOR STRESS WE JUST
DEVELOPED AND HERE ARE THE
RESULTS.
WE CAN SEE BASICALLY IF YOU ARE
A LOW METHYLATION STRESS SCORE,
LOW METHYLATION SCORE FOR
ALCOHOL CONSUMPTION YOU ARE HERE
AND THIS IS THE LOW HIGH.
THIS IS THE HIGH-LOW AND THE
HIGH-HIGH.
THOSE WITH HIGH METHYLATION
STRESS SCORE AND HIGH
METHYLATION ALCOHOL CONSUMPTION
SCORE.
YOU SEE THIS NICE STEP WEDGE
INFECTIOUS FOR THE PHENOAND GRIM
AGE AND IMPORTANTLY WE THEN WENT
INTO AN INDEPENDENT SAMPLE AND
REPLICATED ROBUSTLY THE SAME
FINDING HERE.
AND REALLY IT'S AN ADDITIVE
EFFECT THAT STRESS AND ALCOHOL
IS ADDITIVE AND ACCELERATES YOUR
AGING EVEN FURTHER.
THEN THE NEXT QUESTION IS ARE
THERE ADDITIONAL MARKERS OF
CELLULAR AGING.
THIS IS WHEN WE LOOKED AT
TELOMERES.
YOU MAY BE FAMILIAR WITH THEM
THEY'RE REPETITIVE NUCLEOTIDE
SEQUENCES AT THEN OF THE
CHROMOSOME AND PROTECT THE DNA
AGAINST DOUBLE-STRAND BREAKS AND
SHORTEN WITH EVERY CELL CYCLE
DIVISION ULTIMATELY CONTRIBUTING
TO CELL CYCLE ARREST.
A TELOMERE CAN BE MEASURED
TYPICALLY BY PCR OR BLOTTING AND
THESE TECHNIQUES HAVE BEEN
CHALLENGING AND FINICKY AND IT'S
HARD TO MEASURE AND IN 2019
HORVATH'S GROUP DEVELOPED AN
ALGORITHM BY WHICH WE CAN USE
SITES TO TRACK TELOMERE LINKS WE
SAID THIS IS AN OPPORTUNITY AND
LET'S LOOK IN OUR SAMPLE AND
THIS IS WHAT WE FOUND.
YOU SEE THE TELOMERE LENGTH AND
THE AGE AND ROBUST NOT ONLY THE
TELOMERES SHORTEN WITH BUT IN
THE AUD GROUP YOU HAVE EVEN
SHORTER TELOMERES AND YOU SEE IN
THE BAR GRAPH REDUCTION IN
TELOMERE LINK QUITE SIGNIFICANT.
SO INTERESTING FINDING
CONFIRMING WHAT WE SEE IN THE
EPIGONETIC CLAUSE.
-- EPIGENOMIC CLAUSE AND WE LOOK
AT PHENOTYPES AND SEVERITY OF
DRINKING AND GGT, ETCETERA, WE
SEE ALL THE PHENOTYPES HAVE A
STRONG CORRELATION WITH REDUCED
TELOMERE LENGTH.
I'VE SHOWN YOU ALCOHOL SHORTENS
TELOMERE LENGTH AND THE
INCREASES AGING AND WHAT ARE THE
MECHANISMS OF ALCOHOL-RELATED
AGING?
TO ADDRESS THAT QUESTION OUR LAB
USES A MULTIOMICS APPROACH AND
METABOLOMICS AND THE KEY IS TO
INCORPORATE THEM TO ANSWER SOME
OF THE COMPLEX QUESTIONS.
AND SO WE HAVE RIGHT NOW WE HAVE
A LARGE OPPORTUNITY IN THE FIELD
BECAUSE LARGE GENOMIC DATA SETS
BECOME AVAILABLE AND HAVE BECOME
AVAILABLE AND WE HAVE
TRANSCRIPTOMICS, METABOLOMICS
AND DATA SETS AND HAVE GWAS
AVAILABLE INCLUDING THE FIRST
GWAS OF EPIGENETIC AGE
ACCELERATION.
WE CONTRIBUTED TO THIS AND THE
GWAS IDENTIFIED LOCI AND THERE
WERE GWAS THAT ANALYZED SNIPS
WITH HEALTH SPAN AND PARENTAL
LIFE SPAN AND EXCEPTIONAL LIFE
SPAN.
OUR IDEA WAS TO USE THESE DATA
SETS AND GET TO SOME OF THE
UNDERLYING BIOLOGY.
HERE ARE THE DATA SETS WE USED
AND THEN FIRST CONDUCTED A
TRANSCRIPTOME-WIDE ASSOCIATION
STUDY THEN FOLLOWED UP BY A
RANDOMIZATION ANALYSIS AND ALSO
PERFORMED A METABOLOME ANALYSIS
AND I'M JUST GOING TO HIGHLIGHT
A COUPLE OF THE FINDINGS FOR
TODAY.
AND WE JUST PUBLISHED THIS PAPER
IN NATURE COMMUNICATIONS.
SO IN OUR TRANSCRIPTOME-WIDE
ASSOCIATION STUDY OF EPIGENETIC
AGING WHAT YOU CAN SEE REALLY
AND I'M GOING STRAIGHT TO THE
FINDING IS HERE ARE OUR FOUR
CLOCKS WE LOOKED AT AND ABOVE
ARE UP REGULATED AND DOWN
REGULATED TRANSCRIPT AND THE
LONG STORY SHORT IS YOU SEE SOME
OF THE TRANSCRIPTS BETWEEN ALL
THESE CLOCKS YOU HAVE UP AND
DOWN REGULATION BUT THERE'S
LITTLE OVERLAP AND WHEN WE LOOK
AT WHAT IS THE OVERLAP BETWEEN
THE CLOCKS, WHAT WE SEE IN
PARTICULAR COMPARING IT TO
LONGEVITY IS THE CLOCKS MEASURE
A LITTLE BIT OF DIFFERENT THINGS
THAN THE MULTIVARIATE LONGEVITY
AND THAT'S DIFFERENT.
WHEN WE LOOK AT THE TOP FINDINGS
THE TRANSCRIPTOMES AND SOME HAVE
BEEN BRAND NEW INCLUDING FLOAT 1
AND K-NA4 AND OTHERS IDENTIFIED
SEVEN HIGH-CONFIDENCE
ASSOCIATIONS WITH MULTI-VARIATE
LONGEVITY.
WHAT IS THE BIOLOGICAL FUNCTION
REALLY?
FOR EXAMPLE, ONE IS FLOT 1 AND
ONE IS ASSOCIATED WITH AMYLOID
FORMATION AND CELLULAR RESPONSE
TO OXIDATIVE STRESS.
WE HAVE KPNA 4 ASSOCIATED WITH A
FACTOR INVOLVED IN MULTIPLE
CANCERS AND WE HAVE TMX2 ENCODE
ED WITH A PROTEIN FOLD IING AND
ASSOCIATED WITH BRAIN
ABNORMALITIES.
WHEN WE LOOK AT THE GENES AND
TRANSCRIPTS ONE AND IDENTIFY
GENES IN SIGNALLING AND
MITOCHONDRIAL FUNCTIONS AND
CELLULAR ROOMINGS -- RESPONSES
TO STRESS AND METABOLISM AND
IT'S INTERESTING BECAUSE ALL
THESE ARE INVOLVED WITH AGING.
WE LOOKED AT THE MENDELIAN
RANDOMIZATION AND WE USED THE
BIO BANK PLATFORM AND HAVE
115,000 INDIVIDUALS AND WE HAVE
FINDINGS IN TERMS OF METABOLITES
BAD FOR LONGEVITY AND YOU SEE
THE RATIO AND RIGHT BEHIND IT IS
LDL CHOLESTEROL.
AND ON THE OTHER SIDE THE GOOD
METABOLITES HDL COMES UP AND
THIS CONFIRMS WHAT WE'VE SEEN IN
MEDICINE FOR A LONG TIME AND
THIS IS THE TARGET OF STATINS
AND THE STAR GET OF RECENT PCSK9
INHIBITORS AND WHAT'S
INTERESTING IN PARTICULAR FOR
THE PCSK9 INHIBITERS THE
LONGEVITY FIELD IS GETTING
INTERESTING IN TARGETING SOME OF
THESE.
IN SUMMARY I'VE SHOWN YOU
ALCOHOL ACCELERATES CELLULAR
AGING AND SHORTENS LONGEVITY AND
ON AVERAGE THERE WAS A FOUR-YEAR
ACCELERATION AND ONE YEAR OF
SLOW DOWN SAVED $38 TRILLION AND
WE LOOKED AT LIPIDS PLAYING A
MAJOR ROLE IN LONGEVITY AND
UNDERSTANDING THE MECHANISM OF
LIPIDS AND I'LL FINISH HERE AND
ACKNOWLEDGE MY LAB TEAM.
THIS IS WORK BY JEESUN YOUNG AND
THE TEAM.
THANK YOU.
I'M HAPPY TO TAKE QUESTIONS.
>>THANK YOU, FALK.
THAT WAS REALLY GOOD.
I'LL BE THE MONITOR OF THE
QUESTIONS AND SO I'M GOING TO
ALTERNATE QUESTIONS.
I'LL START WITH KATIE.
AND MY QUESTION, KATIE TO REMIND
YOU WAS, ARE WE GOING HAVE TO
CHANGE SOME OF THE SCALES AND
TESTS PUT INTO THE DOMAIN
CRITERIA MODELS TO ACCOMMODATE
DIFFERENCES IN RACE, CULTURE AND
GENDER?
I MEAN, IN OTHER WORDS, LOOKING
THE FUNCTIONING.
>>WE FOUND DIFFERENCES
DEMOGRAPHIC GROUPS INDICATING
THE ITEMS WERE NOT FUNCTIONING
EXACTLY THE SAME ACROSS THE
DIFFERENT GROUPS AND THAT'S WHY
THE PROSPECTIVE WORK IS CRITICAL
TO IDENTIFYING ITEMS THAT MAY BE
MORE UNIVERSAL THAT MAY WORK
ACROSS DIFFERENT GROUPS AND
DOING SO VIA EXPENSIVE COGNITIVE
INTERVIEWING AND QUALITATIVE
MIXED METHODS AND ADAPTIVE
TESTING TO IDENTIFY WHICH ITEMS
MIGHT WORK BEST TO STUDY THESE
DOMAINS IN A WAY THAT WOULD BE
AS UNIVERSAL AS WE CAN.
AND I LIKE TO THINK IN ANY
PSYCHO METRIC STUDY WHERE
MEASUREMENT IS A TOPIC AND AT
THE SAME TIME CURRENTLY WE'RE AT
SMALL TO MEDIUM EFFECT SIZES AND
IF WE CAN GET A LITTLE BIT
HIGHER AND NOT HAVE AS PERFECT
MEASUREMENT BUT PRETTY GOOD
MEASUREMENT IT WOULD BE GOOD.
I THINK WE WANT TO IMPROVE OUR
MEASUREMENT AND THINK OF AND
GENDER AND ALL THE DIFFERENT
GROUPS THAT MIGHT INFLUENCE HOW
PEOPLE RESPOND TO THESE ITEMS
AND AT THE SAME TIME I THINK
IT'S A FEATURE.
>>GREAT.
I'M LOOKING FORWARD TO SEEING
SOME OF THOSE ANALYSES.
IT WILL BE INTERESTING FOR HOW
YOU GO FORWARD.
FALK, MY QUESTION IS A
SIMPLISTIC ONE.
IS THERE EFFECT BY WHAT WE AUTO
EAT AND HAVE YOU LOOKED AT DIET?
WHETHER SOME SUBJECTS ARE
DIABETES OR PRE-DIABETES.
>>THANK YOU, GEORGE, GREAT
QUESTION.
OF COURSE SO DIET IS A BIG
FACTOR.
WEIGHT AND BMI IS ONE OF THE
BIGGEST FACTORS FOR AGE
ACCELERATION AND WHAT'S
INTERESTING IS WHEN HAVE YOU
SOME INDIVIDUALS DRINKING 12,
15, 20 DRINKS A DAY IS A LOT OF
CALORIE AND A CERTAIN TYPE OF
CALORIE.
MAYBE NOT THE HEALTHIEST
CALORIE.
I THINK YOU'RE RIGHT THERE IS
PROBABLY SOME UNDERLYING
METABOLOMIC EFFECTS THERE AND
THAT'S BEING ACTIVELY
RESEARCHED.
>>OKAY.
SO I SAID MY QUESTIONS BUT I CAN
ALWAYS KEEP GOING WITH LOTS OF
QUESTIONS BUT CHRISTICHRISTINA.
>>-- LINEARLY AND THERE WAS A
PAPER PUBLISHED LAST WEEK IN THE
NEW ENGLAND JOURNAL SHOWING LONG
TELOMERE LIFE ASSOCIATED WITH
CANCER AND WONDERING IF IT WOULD
BE INTERESTING TO LOOK AT PEOPLE
WITH INTERESTINGLY LONG TELOMERE
LENGTH AS WELL.
>>GOOD SUGGESTION.
THANKS.
>>OTHER COMMENTS OR QUESTIONS?
>>I'M WONDERING WITH THE
EPIGENETICS AND YOU FOUND
FACTORS IN THE METABOLITES IS
THERE A CONNECTION IN TERMS OF
PATHWAYS OR IS THAT IN PROGRESS?
>>THIS IS IN PROGRESS OF COURSE
TO OVERLAY THEM THEN
FUNCTIONALLY AND MAKE SENSE OF
THEM GOING FROM TRANSCRIPTOMICS
TO PROTEOME TO METABOLOME.
ONE IS VIABILITY OF TISSUE FROM
ALL SOURCES.
THAT'S A CHALLENGE AND SO RIGHT
NOW WE'RE USING AVAILABLE BIG
DATA THAT'S AVAILABLE AND THE
DATA I SHOWED YOU WAS MOSTLY IN
HEALTHY INDIVIDUALS FOR THE
TRANSCRIPT OMICS WORK.
WE NEED TO GET BETTER DATA SETS
AND SOME ARE ASSOCIATE.
WITH DEMENTIA AND ALZHEIMER'S.
>>THEY SHOW UP IN THOSE
DISEASES AS WELL.
>>THE MAYO GROUP AND I'M
FORGETTING THE GENTLEMAN'S NAME
BUT IT STARTS WITH A W AND IT'S
LONG HAVE LOOKED AT FALK-LIKE
EFFECTS WITH THE GLUTAMATERGIC
METABOLOMICS AND WONDERED IF YOU
TAPPED INTO ANY OF THEIR WORK.
DOES ANYONE REMEMBER THE
GENTLEMAN'S NAME THAT GAVE US
THE TALK IN THE INTRAMURAL
PROGRAM.
>>I THINK IT'S DICK
WEINSHALBAUM.
>>YOU MAY FIND INTERESTING
COHORTS TO TAP INTO THERE.
>>ONE STUDY JUST IDENTIFIED THE
DATA SET.
WE'D LOVE TO WORK WITH ANYONE IN
THIS AND THE REWARD PHENOTYPES
WE CAN IDENTIFY WITH
STANDARDIZED QUESTIONNAIRES
ADMINISTERED IN CLINICAL TRIALS
AND IDENTIFIED THEM WITH FOUR OR
FIVE QUESTIONNAIRES.
CHANCES ARE THEY MAY HAVE
SOMETHING IN THEIR DATA SET WE
CAN LOOK AT TO SEE IF THERE'S AN
EFFECT BECAUSE WE DID SHOW IT
AND I WOULD LOVE TO FOLLOW-UP
AND SEE IF WE CAN REPLICATE THE
FINDINGS.
>>I'VE ADMIRED HIS WORK AND I
CAN'T SPELL IT BUT THAT'S MY
PROBLEM.
BRIDGET.
>>HI, KATIE.
I ENJOYED YOUR TALK AND I REALLY
APPRECIATED HOW YOU'RE LOOKING
AT THE IMPACT OF ENVIRONMENT ON
THOSE RECOVERY PROFILES.
I WAS WONDERING CAN YOU SAY MORE
ABOUT THE SOCIAL DETERMINATES
STRONGLY ASSOCIATED WITH THOSE
PROFILES FOR THE LOWER
FUNCTIONING ONES?
>>YEAH, THANK YOU FOR THE
QUESTION AND BEING A PROPONENT
OF THIS AREA GENERALLY.
WE HAVE PRETTY LIMITED DATA IN
THIS PARTICULAR FIRST STUDY.
I WOULD SAY IT'S A FIRST PASS
AND WE HAD COMMUNITY LEVEL
INCOME AND COMMUNITY-LEVEL
HEALTH INSURANCE AND INCOME
INEQUALITY AND THAT WAS ONE OF
THE BIGGER PREDICTORS AND WHAT I
WISH WE HAD MORE OF IS ALCOHOL
OUTLET DENSITY AND WISH WE HAD
GREEN SPACE AND RECOVERY
RESOURCES.
I THINK IN FUTURE WORK WE'LL BE
COLLECTING MUCH MORE FINE-GRAIN
INFORMATION ABOUT COMMUNITY AND
NEIGHBORHOOD CHARACTERISTICS.
I THINK IT'S SOMETHING WE NEED
TO THINK ABOUT RECOVERY AND
RECOVERY PROMOTION.
TO SOME EXTENT SOME IN THE FIELD
HAVE FOCUSSED ON THAT.
THE TREATMENT RESEARCHERS HAVE
GENERALLY NOT PAID AS MUCH AS
ATTENTION TO THOSE FACTORS.
>>WE HAVE A QUESTION FROM USEF
FROM HOWARD UNIVERSITY.
>>THE COMBINATION OF INSULTS
TOGETHER, IS IT POSSIBLE TO HAVE
AUD WITHOUT STRESS?
BECAUSE YOU'RE COMBINING THEM
YOU MENTIONED ANXIETY,
DEPRESSION, ETCETERA BUT CAN AUD
EXIST WITHOUT STRESS?
>>GOOD QUESTION.
I WOULD REFER TO GEORGE ON THIS.
WHAT'S INTERESTING IS SO WE
DEVELOPED THIS BIOLOGICAL
MEASURE OF STRESS.
THIS METHYLATION SCORE OF STRESS
TRACKING A COMPOSITE SCORE OF
STRESS AND WHEN WE LOOKED IN OUR
SAMPLE WE IDENTIFIED INDIVIDUALS
WITH AN AUD WHO HAD RELATIVELY
LOW STRESS SO IT IS IN THAT
REGARD POSSIBLE TO HAVE LOW
STRESS INDIVIDUALS THAT STILL
HAVE AN AUD.
IN FACT THEY DIDN'T SHOW MUCH IN
AGE ACCELERATION.
WHAT'S WORSE, HAVING STRESS OR
AUD?
I'M NOT SURE BUT IT'S AN
IMPORTANT QUESTION WE'LL LOOK
INTO MORE.
>>KATIE CAME UP WITH THE
DRINKING LEVELS AND LOW-RISK
DRINKING AND HAVE YOU LOOKED AT
THIS IN CURIOSITY?
>>THERE'S BEEN A LOT STUDIES
LOOKING AT METHYLATION AND
ALCOHOL CONSUMPTION LEVELS FROM
VARIOUS DEGREES RANGING AND AS
YOU INCREASE ALCOHOL
CONSUMPTION, AGING SEEMS TO
ACCELERATE AND WHAT I'VE SHOWN
IS THE MORE SEVERE PHENOTYPES
AND WE SEE CLEARLY A DOSE
RESPONSE CURVE HERE.
SO TO THE POINT ABOUT HARM
REDUCTION AND SO FORTH IF YOU
REDUCE YOUR DRINKING, YOU
PROBABLY WOULD REDUCE EPIGENETIC
AGE ACCELERATION AS WELL AND
REAG
REDUCE AGING SO YES.
>>ONE LAST QUESTION, KATIE,
SINCE THAT REMINDED ME OF THE
W.H.O. LEVELS AND WHAT WOULD YOU
SAY IF THE COMPLAINED ABOUT THE
W.H.O. LEVELS AS A SUCCESS FOR A
MEDICATION TO TREAT ALCOHOL USE
DISORDER GOING FROM SEVERE TO
HIGH INTENSITY DRINKING TO JUST
BINGE THINKING AND THEY WOULD
SAY IT'S NOT ADEQUATE.
>>IT'S A QUESTION FOR ME?
>>I THINK I WOULD POINT THEM TO
THE DATA THAT SHOWS CONVINCINGLY
THAT EVEN PEOPLE WHO ARE AT THE
HIGH RISK LEVEL EVEN IF AT BINGE
LEVELS THEY'RE FEELING AND
FUNCTIONING AS WELL AS PEOPLE
WHO ABSTAIN.
THAT'S THE KEY ALMOST AS PEOPLE
WHO ABSTAIN COMPLETELY.
THAT'S THE KEY AND SHOWING THE
VERY LARGE IMPROVEMENTS IN HOW
PATIENTS FEEL AND FUNCTION.
ADDICTION IS MADDENING THAT
ADDICTION IS THE ONLY DISEASE
THE FDA REQUIRES A BINARY, NO
SYMPTOMS OF THE DISORDER.
YOU LOOK AT DEPRESSION,
DIABETES, HYPERTENSION AND OTHER
DISEASES AND IMPROVEMENT IN
SYMPTOM INDICATORS IN THE OTHER
DISEASES WOULD GET MEDICATION
APPROVED BUT IN OUR FIELD WE
HAVE TO CURE THE CHRONIC DISEASE
AND THAT'S -- IT'S BEEN AT A
DISSERVICE TO MEDICATIONS
DEVELOPMENT AND WE SEE PEOPLE
MAKE BIG IMPROVEMENTS IN THEIR
FUNCTIONING AND HEALTH WITH
REDUCTIONS IN DRINKING.
SO WHY AREN'T WE ALLOWING A
MEDICATION THAT DOES THAT BE
AVAILABLE TO PATIENTS WHO NEED
IT?
>>I AGREE WITH YOU.
I THINK IT'S KEY.
IT'S GOT TO BE AT LEAST 20 YEARS
AGO I HEARD ONE OF THE
INVESTIGATORS PART OF THE
MASSIVE EUROPEAN CLINICAL TRIALS
GIVE A TALK ON QUALITY OF LIFE
IMPROVING WITH THE USE OF
CAMPROSATE.
>>WE'VE BEEN WORKING WITH THE
FDA FOR A LONG TIME.
WE'RE NOT RESPONSIBLE FOR WHAT
THEY DO JUST INTERACTING WITH
THEM.
IN TERM OF AN END POINT THEY'RE
INTERESTED IN EVALUATING THE
MEDICATION.
DID THE MEDICATION IMPROVE?
THEY'RE NOT SETTING POLICY PER
SE THEY JUST WANT TO EVALUATE
WHETHER OR NOT THERE'S SOME
IMPROVEMENT.
THEY'RE SAYING THIS DRUG MAY
HELP YOU GET TO A PLACE WHERE
YOU NEED TO BE AND THAT'S SORT
OF HOW THEY SEE IT.
AND WE RAISED THE ISSUE OF
ALTERNATIVE STRATEGIES TO REDUCE
CONSUMPTION AND BEHAVIORAL
STRATEGIES TO REDUCE CONSUMPTION
AND I THINK WE NEED TO KEEP THAT
IN MIND WHETHER YOU'LL CHANGE
THE LENGTH OF THE TELOMERE OR
OTHER STRATEGIES THAT IN FACT
LOWERS DRINKING IN A SOCIETY
THAT STILL EMBRACES SOME ALCOHOL
CONSUMPTION AS BETTER THAN HIGH
RISK DRINKING.
I THINK THAT'S WHAT KATIE IS
SAYING IN HER ANALYSIS.
CAN I SPEAK FOUR ON THAT POINT.
>>ABSOLUTELY.
YOU GOT IT.
I'M GLAD YOU RAISED THE
CONTINGENCY MANAGEMENT.
I WOULD LOVE FUTURE CONTINGENCY
MANAGEMENT TRIALS FOCUSSED ON
REDUCTIONS NOT ON TOTAL
ABSTINENCE BECAUSE WE
POTENTIALLY MISS THE MARK WITH
HELPING PATIENTS IMPROVE WHO MAY
BE SHOULD HAVE BEEN REINFORCED
FOR THEIR REDUCTION IN DRINKING.
>>THERE WAS A RECENT CHANGE
WITH CONTINGENCY MANAGEMENT BY
THE FDA.
>>THERE'S BEEN AN ARTIFICIAL
CAP ON THE INCENTIVE STRUCTURE.
THERE'S NO CAP AND THERE'S
WASTE, FRAUD AND ABUSE AND IF
YOU PROVIDE INCENTIVES AND
THEY'RE TARGETED TOWARDS
SPECIFIC OUTCOMES THAT CAN BE
QUANTIFIED AND MEASURED THAT
THEY WERE CONCERNED ABOUT THAT
AND WANT IT MAKE SURE THAT THE
FIELD DOESN'T ENGAGE IN, SHALL
WE SAY, HANKY-PANKY.
THAT'S A GOOD POINT AND WE
CONTINUE TO PRESS TO HHS AND THE
ADMINISTRATION TO REMOVE THE $75
CAP.
>>THANKS FOR THE UPDATE.
SO RV, OKAY.
AND IS NONI -- AT 3:00.
OKAY.
ALL RIGHT.
SO FIRST CONCEPT CLEARANCE IS A
HEAL INITIATIVE CONCEPT
DEVELOPING AN EVIDENCE-BASED --
OH.
SORRY.
BRAD, I MISSED YOU AND I
APOLOGIZE.
CONCEPT CLEARANCE WAS THE AEDS
STAND FOR.
>>ALCOHOL EPIDEMIOLOGICAL
SURVEY SYSTEM, I BELIEVE.
>>BRAD, WE'LL LET YOU EXPLAIN
IT.
>>YOU MAY HAVE HEARD THE STORY
BEFORE BUT WHEN I JOINED NIH ONE
DAY AT AN INSTITUTE DIRECTOR'S
MEETING SOMEBODY MENTIONED AN
ACRONYM AND FRANCIS COLLINS
MENTIONED AN ACRONYM AND LOOKED
AROUND THE ROOM AND ALL THE
INSTITUTE DIRECTORS AND SAID I
DON'T KNOW WHAT THAT STANDS FOR
AND NOBODY DID EITHER AND
THEY'RE ALL FRANTICALLY PUNCHING
IN THEIR COMPUTERS WHAT IT STOOD
FOR AND AT THE END OF THE TABLE
IT WAS YELLED OUT, KOOB, IF YOU
LEARN ALL THE ACRONYMS IT'S TIME
TO RETIRE SO CLEARLY I AM NOT
RETIRING YET FOR THE RECORD.
SO IT IS THE ALCOHOL
EPIDEMIOLOGICAL DATA SYSTEM.
YOU GET THE AWARD FOR ACRONYM
MEMORY.
BRAD, IT'S ALL YOURS.
>>GOOD AFTERNOON.
I'M BRAD KERRIDGE AND I'LL TRY
TO MAKE IT BRIEF TO GET BACK ON
SCHEDULE.
THIS DESCRIBES THE ALCOHOL
EPIDEMIOLOGIC DATA SYSTEM AND
REQUIRES CONCEPT CLEARANCE FOR
THE CONTRACT.
THIS IS A RECOMPETITION YEAR OF
THE CONTRACT WHICH IS SET TO END
ON SEPTEMBER 26, 2023.
IN ACCORDANCE WITH THE
AFOREMENTIONED SLIDE NIH MANUAL
CHAPTER RULES AND CODES OF
VIOLATIONS REGARDING SCIENTIFIC
PEER REVIEW OF RESEARCH AND
RESEARCH AND DEVELOPMENT
CONTRACT PROJECTS.
THIS R&D SUPPORT ACQUISITION
REQUIRES CONCEPT AND TECHNICAL
PROPO
PROPOSALS.
THE AEDS IS A CONTRACT EFFORT TO
PROVIDE IN-HOUSE STATISTICAL
ANALYSIS AND PROGRAM SUPPORT BY
USED BY NIAA STAFF CONDUCTING
ALCOHOL-RELATED EPIDEMIOLOGIC
RESEARCH AND HAS BEEN OPERATING
IN SUPPORT OF THE NIAA MISSION.
THE CONTRACT IS CURRENTLY
ADMINISTERED BY CSR INCORPORATE
AND PROVIDED STATISTICAL
ANALYSIS AND SUPPORT AND
PROGRAMMING TO FACILITATE
PUBLICATIONS BY NIAA STAFF AND
SECONDARY ANALYSES OF EPILOGIC
SURVEY REPORTS AND PUBLICATION.
THE AEDS SUPPORTS
ALCOHOL-RELATED RESEARCH IN
NEWLY ROUSE SCIENTIFIC AREAS AND
SOME ARE LISTED HERE.
IT SUPPORTS RESEARCH IN
ALCOHOL-RELATED MORBIDITY AND
MORTALITY.
IN ALCOHOL-RELATED SCREENING AND
BRIEF INTERVENTIONS.
>>THANK YOU.
WELL DONE IN FIVE MINUTES.
WE NEED A COUNCIL TO APPROVE THE
CONCEPT, WESLEY IS ON BOARD AND
ALCOHOL AND OPIOIDS INTERACT
MECHANISTICALLY.
>>THAT'S THE POINT I WAS TRYING
TO MAKE.
>>I APPROVE.
>>NONI, WELCOME.
I'LL INTRODUCE YOU.
SHE'S THE DIRECTOR FOR THE
CENTER OF NATIONAL REVIEW AT THE
NATIONAL INSTITUTES OF HEALTH
AND WORKED IN THE PHARMACEUTICAL
INDUSTRY WHERE SHE CONDUCTED
RESEARCH FOR INVESTIGATIONAL NEW
DRUGS SUBMISSIONS AND SERVED ON
PROJECT TRIAL TEAMS AND PROVIDED
OVERSIGHT OF CONTRACTS WITH
CLINICAL RESEARCH ORGANIZATIONS.
FONDLY KNOWN AS CROs AND HOLDS
B.S. IN CHEMISTRY AND Ph.D. FROM
EMORY UNIVERSITY AND IN HER
CAPACITY AT CSR DIRECTOR SHE'S
RESPONSIBLE FOR OVERSEEING THE
MAJORITY OF NIH PEER-REVIEWED
PROCESS AND REVIEWS
THREE-QUARTERS OF GRANT
APPLICATIONS AND HANDLES THE
RECEIPT AND REFERRAL TO OTHER
AGENCIES TO CDC AND FDA AND
BRINGS A DEEP KNOWLEDGE OF NIH
PEER REVIEW AND HISTORY OF
ENGAGEMENT WITH EXTERNAL
SCIENTIFIC COMMUNITY IN
DISCIPLINES AND A TRACK RECORD
OF LEADING CHANGE AND PROVIDED
LEADERSHIP AND OVERSIGHT OF PEER
REVIEW OF SEVERAL TRANS-NIH
INITIATIVES SUCH AS THE AMERICAN
REINVESTMENT AND RECOVERY ACT,
CHALLENGE GRANTS, THE NIH
DIRECTOR'S COMMON FUND AND THE
ALL OF US PRECISION MEDICINE
COHORT INITIATIVE AMONG OTHERS.
UNDER HER LEADERSHIP CSR HAS
LAUNCHED A NEW DATA-DRIVEN
FRAMEWORK FOR CONTINUOUS
EVALUATION OF ALL OF ITS MORE
THAN 170 STUDY SECTIONS USING
QUANTITATIVE MEASURES AND EXPERT
INPUT FROM STAKEHOLDERS IN THE
SCIENTIFIC COMMUNITY.
WE'RE GRATEFUL TO HAVE YOU AND
TO HAVE YOU HERE TO TALK ABOUT
STRENGTHENING PEER REVIEW.
>>THANK YOU VERY MUCH.
AND WE HAD AN AWARD CEREMONY
PRECEDING THIS.
HAPPY TO JOIN YOUR COUNCIL.
I THINK I HAVE LESS TIME THAN I
THOUGHT I HAD SO I'LL SKIP OVER
SOME OF THE SLIDES I HAD MADE
AND GET MORE DOWN TO TALKING
ABOUT THE SIMPLIFIED REVIEW
FRAMEWORK AND SOME ISSUES TO
ADDRESS FAIRNESS IN THE PEER
REVIEW PROCESS.
YOU'RE PROBABLY FAMILIAR WITH
OUR MISSION FOCUSSED ON
SCIENTIFIC PEER REVIEW WE HANDLE
FOR FUNDING INSTITUTES AND
CENTERS AT THE NIH.
AND A QUICK GLIMPSE OF THE SCOPE
CSR HANDLES OVER 60,000
APPLICATIONS IN PEER REVIEW..
THAT'S MORE THAN THREE-QUARTERS
OF THE APPLICATIONS AND VAST
MAJORITY OF THE RO1s AND
FELLOWSHIPS.
WE DO THAT WITH -- WE HAVE A
STAFF OF 275 SCIENTIFIC REVIEW
OFFICERS AND OF COURSE WE ENGAGE
WITH A LARGE NUMBER OF 19,000
REVIEWERS AND 1200 MEETINGS
EVERY YEAR TO GIVE YOU AN IDEA
OF THE SCOPE IN FISCAL '23.
IN ADDITION TO OUR STUDY
SECTIONS AND RO1s AND ALL THAT
WE DO A MAJORITY OF THE SPECIAL
INITIATIVES AT NIH AND IN FIZZ
FISCAL '23 WE HANDLED
INITIATIVES.
THESE ARE JUST EXAMPLES I'M SURE
ARE FAMILIAR TO YOU.
I WON'T GO THROUGH OUR STRATEGIC
FRAMEWORK.
WE RELEASED THE STRATEGIC PLAN
RECENTLY IN THREE DOMAINS
RELATED TO STUDY SECTIONS,
PROCESS AND REVIEWERS.
AND DIFFERENT ASPECTS WHICH
IMPACT THE REVIEW AND STAFF ARE
CENTRAL TO CARRYING OUT THE
MISSION.
MY PLAN TODAY WAS TO TALK ABOUT
INQUIRE WHICH IS THE
QUANTITATIVE RESTRUCTURING OF
STUDY SECTIONS WITH STAKEHOLDER
INPUT AND DATA.
I'M NOT GOING TO DO THAT.
I'LL JUST JUMP TO SIMPLIFYING
REVIEW AND IMPROVING THE REVIEW
OF FELLOWSHIP APPLICATIONS AND
RPG APPLICATIONS AND TALK ABOUT
OUR EFFORTS TO PROMOTE DIVERSITY
AND FAIRNESS IN THE REVIEW
PROCESS.
I'LL SKIP OVER AND YOU'LL BE
ABLE TO SEE I'VE DONE A LOT OF
THESE SINCE 2020 WHEN THEY
STARTED AND IT DOES RESULT IN
SUBSTANTIVE CHANGES IN STUDY
SECTIONS AND THESE ARE SOME
AREAS WHICH ARE EMERGED AS A
RESULT OF THE INQUIRE PROCESS.
LET ME TALK ABOUT THE
SIMPLIFYING REVIEW PROCESS FOR
RESEARCH PROJECT GRANTS THAT'S
UNDERWAY RIGHT NOW.
THERE'S TWO MAIN GOALS.
ONE WAS THE IMPRESSION A LOT OF
ADMINISTRATIVE COMPLIANCE CHECK
ITEMS HAVE BEEN ADDED TO THE
FIRST LEVEL OF NIH PEER REVIEW.
OF COURSE NIH PEER REVIEW HAS
THE SINGULAR GOAL AND THE SECOND
LEVEL AS THE COUNCIL AND FIRST
LEVEL OCCURS AT THE STUDY
SECTION AND IT IS SET UP TO
PROVIDE ADVICE TO THE AGENCY
ABOUT THE SCIENTIFIC AND
TECHNICAL MERIT ABOUT THE GRANT
APPLICATIONS UNDER REVIEW.
OVER THE YEARS INCREMENTALLY
MORE AND MORE ADMINISTRATIVE
BURDEN ITEMS HAVE BEEN ADDED TO
THE REVIEWERS WHICH ACTUALLY
REDUCES INCENTIVE AND
PARTICIPATION IN REVIEW AND ALSO
DETRACTS FROM THE REVIEWERS FROM
FOCUSSING ON THE SCIENCE.
THAT'S ONE OF THE MAIN GOALS TO
FOCUS REVIEW ON THE MAIN GOAL.
THE OTHER ONE WAS TO MITIGATE
THE ROLE OF REPUTATIONAL BIAS.
THIS IS IN THE PEER-REVIEW
PROCESS.
THIS MEANS IT USUALLY COMES IN
IN THE INVESTIGATOR AND
ENVIRONMENT WHERE WE HAVE
REVIEWERS AND PEER REVIEWERS ARE
NOT THAT DIFFERENT FROM THE REST
OF THE BIO MEDICAL COMMUNITY.
I'LL SEE THESE IN YOUR
INSTITUTIONS.
SCIENCE AND SCIENTIFIC NETWORKS
THERE'S A BIG ROLE OF REPUTATION
AND WHO TRAINED WITH WHO AND WHO
TRAINED WHERE AND WHICH
INSTITUTION.
WE WANTED TO EVALUATE THE
INVESTIGATOR AND THE ENVIRONMENT
AND IS IT A FAMOUS INSTITUTION.
THESE WERE THE TWO MAIN GOALS.
THE OVERARCHING GOAL IS TO
ENSURE THEY CAN IMPACT RESEARCH.
THE PROCESS STARTED WITH RPTs
AND RO1s AND CSR WORKS CLOSELY
WITH THE ADVISORY COUNCIL IN OUR
INITIATIVES AND ADVISORY COUNCIL
WORKING GROUPS WERE CONVENED TO
CONSIDER NON-CLINICAL TRIALS
WHICH IS ABOUT 90% OF ALL NIH
APPLICATION AND AS WELL AS
CLINICAL TRIAL RPGs.
THEY WERE PROVIDED WITH LEGAL
AND REGULATORY GUIDANCE AND NIH
CANNOT CHANGE THE CRITERIA WHICH
IS SIGNIFICANT INVESTIGATORS AND
INNOVATION AND APPROACH HOWEVER,
NIH CAN USE ITS DISCRETION IN
INTERPRETING THE CRITERIA OR HOW
THEY WANT TO GROUP THEM AND
EVERYTHING RELATED TO SCORING.
THAT'S THE BUMPER GUARDRAIL WE
PROVIDED TO THE WORKING GROUPS.
THE WORKING GROUP WENT THROUGH
THE INPUT GATHERING THROUGH A
BLOG POST AND ASKED HOW TO
IMPROVE PEER REVIEW.
YOU HEAR A LOT AND WE DID.
THAT CONTENT ANALYSIS FROM THE
TWO BLOG POSTS POSTED ON THE CSR
BLOG AND NIH BLOG WE DID A
CONTENT ANALYSIS AND PROVIDED
THAT BACK TO THESE WORKING
GROUPS AND HELD 11 VIRTUAL
MEETINGS AND REALLY WERE
THOUGHTFUL IN DEVELOPING THE
FRAMEWORK AND RECOMMENDATIONS
THAT CAME TO US.
THOSE WERE APPROVED BY THE FULL
ADVISORY COUNCIL AND PUBLISHED
THE REPORT AND THEN IT WENT TO
INTERNAL NIH AND HIGH-LEVEL NIH
EXTRAMURAL COMMUNITY COMMITTEE
WORKED ON THE RECOMMENDATIONS
AND ADDED IN SOME MODIFICATION
NEEDED TO MAKE THEM WORKABLE FOR
THE NIH FOR THE FRAMEWORK.
THOSE WERE APPROVED BY
LEADERSHIP IN 2022.
IN DECEMBER WE OPENED IT UP TO
PUBLIC REQUEST FOR FINAL
RECOMMENDATIONS WENT UP THE
PROPOSED CHANGES WENT UP AS AN
RFI THAT RAN TO MARCH OF 2023.
NO PROPOSAL IS TO GROUP THE FIVE
EXISTING REVIEW CRITERIA INTO
THREE REVIEW FACTORS.
AND ALL OF THESE FACTORS CAN
AFFECT THE OVER ALL IMPACT SCORE
LIKE THE CRITERIA DO NOW.
IT BREAKS DOWN TO SHOULD IT BE
DONE, CAN IT BE DONE AND WILL IT
BE DONE IN THAT CONTEXT.
SHOULD IT BE DONE IS IMPORTANCE
OF THE RESEARCH.
UNDER THAT LIES IN INNOVATION
AND IT'S A CONFUSING CRITERIA.
OTHER TIMES INNOVATION MATTERS A
LITTLE LESS.
GROUPING THESE ALLOWS A LEVEL OF
FLEXIBILITY IN HOW TO INTERPRET
THIS IN COMING UP WITH A SCORE.
FACTOR TWO IS RIGOR AND
FEASIBILITY UNDER WHICH LIE
APPROACH AND THEY'RE HIGHLIGHTED
IN TERMS OF EXPERIMENTAL DESIGN
AND ANALYSIS.
A BIG CHANGE IS FACTOR THREE
EXPERTISE AND RESOURCE.
THE FACTOR IS NOT INDIVIDUALLY
SCORED ITSELF BUT DROP DOWN
BINARY APPROACH FOR GAPS
IDENTIFIED IN EITHER EXPERTISE
OR RESOURCES UNDER WHICH THE
CRITERIA FALLS.
WHERE YOU HAVE NINE BINS TO PUT
INVESTIGATOR AND ENVIRONMENT AS
WE DO NOW WHAT WE SEE IS BIAS
CREEPING IN.
YOU HAVE THE DEATH BY A THOUS
AND -- THOUSAND CUTS FOR AN
ENVIRONMENT A SCORE OF ONE IF
IT'S A FAMOUS PLACE AND NO
WEAKNESSES OR A SCORE OF I DON'T
KNOW THREE BECAUSE IT'S AN HBCU
OR STATE SCHOOL AND THEY HAVE
APPROPRIATE RESOURCE TO CARRY
OUT THE RESEARCH.
TAKING AWAY THE NINE BINS AND
HAVING BASICALLY TWO BINS.
EITHER IT'S APPROPRIATE AND IF
NOT IT'S OKAY.
THEY HAVE TO SPECIFICALLY
IDENTIFY WHERE THE GAPS ARE.
IT FORCES THE REVIEWERS TO BE
FOCUSSED AND GIVE US INFORMATION
AND CAN FEED INTO THE OVER ALL
IMPACT SCORE.
MOST THE CRITERIA AND SUBJECTS
AND ANIMALS REMAIN UNCHANGED.
THAT HASN'T CHANGED MUCH AND THE
ADDITIONAL REVIEW CONSIDERATIONS
WHICH ARE BASICALLY
ADMINISTRATIVE ITEMS DON'T
IMPACT SCORE HAVE BEEN REMOVED.
THE UPDATE ON THE RFI CLOSED ON
MARCH 10.
WE GOT OVER 800 RESPONSES FROM
INDIVIDUALS, SOCIETIES AND
INSTITUTIONS.
IT'S NOT UNEXPECTED THAT A
MAJORITY OF THE RESPONSES WE GOT
WERE SUPPORTIVE BECAUSE WE GOT A
TREMENDOUS AMOUNT OF INPUT ON
THE FRONT END AND WE ADDRESSED
SOME OF THE PAIN POINTS THE
COMMUNITY TOLD US THEY HAD.
MOST OF THEM WERE SUPPORTIVE.
MINORITY FACTORS IN SCORING WITH
THE INVESTIGATOR AND ENVIRONMENT
IMPORTANT.
A SMALLER MINORITY FELT WE
SHOULD JUST DO BLINDED REVIEWS
AND THERE'S A NUMBER OF ISSUES
WITH BLINDED REVIEWS WE CAN TALK
ABOUT IF YOU WANT TO IN THE Q&A
PART.
THE MAJORITY OF RESPONDENTS
SUGGESTED CSR DEVELOP STRONG
TRAINING RESOURCES BECAUSE IT'S
A BIG CHANGE AND IT WOULD TAKE
TIME TO SOCIALIZE THAT FOR
REVIEWERS, CHAIRS AND PRESENT
REVIEW OFFICERS AND ACROSS THE
NIH WHICH OF COURSE WE'RE TAKING
SERIOUSLY AND PLAN TO DO.
WE CURRENTLY HAVE A TRANS-NIH
IMPLEMENTATION COMMITTEE THAT
HAS A MULTIDIMENSIONAL DOMAIN
EXPERTISE IN POLICY, TRAINING,
REVIEWS, COMMUNICATIONS AND
SYSTEMS THAT REQUIRE A LOT OF
UPDATE TO TEMPLATES AND OTHER
ITEMS.
SO THAT COMMITTEE WILL CONSIDER
RFI INPUT AND DEVELOP A ROLLOUT
STRATEGY.
THE TENTATIVE IMPLEMENTATION
PLAN IS FOR THE OCTOBER 2024
RECEIPT DATE WHICH MEANS THE
STUDY SECTION USING THE FACTORS
WILL BE IN FEBRUARY/MARCH 2025.
AND I'LL HAVE TO ACKNOWLEDGE OUR
ADVISORY COUNCIL WORKING GROUP
FOR CLINICAL TRIALS AND
NON-CLINICAL TRIALS THEY WORK
HARD AND CAME UP WITH SOMETHING
THAT REALLY STRUCK EVERYONE AS
BEING A MOF IN A POSITIVE
DIRECTION SO THANK YOU.
IN ADDITION TO RPG, RESEARCH
PROJECT PLANS, WE WERE ALSO
LOOKING AT THE REVIEW OF NRSA
FELLOWSHIP APPLICATION.
THE BACKGROUND HERE IS THAT CSR
ADVISORY COUNCIL WORKING GROUP
WAS CONVENED LAST YEAR.
THEY SPENT SOME TIME GATHERING
DATA IN COMMUNITY FEEDBACK
SIMILAR TO TWO BLOGS LIKE THE
OTHER WORKING GROUPS AND WE GAVE
THEM THE CONTENT ANALYSIS AND
DATA.
THEY ASKED FOR A LOT OF DATA AND
WE PROVIDED THAT TO THEM AND
THEY HELPED BUILD 14 VIRTUAL
MEETINGS FOR RECOMMENDATIONS AND
ALL THE REPORTS ARE ON OUR
WEBSITE.
YOU CAN FIND THEM THERE.
THE DATA SUPPORTED THE
COMMUNITY.
THE FELLOWSHIP APPLICATIONS ARE
RECEIVE FROM A SMALL NUMBER OF
INSTITUTIONS.
THE VAST MAJORITY OF FELLOWSHIP
APPLICATIONS COME FROM A SMALL
NUMBER OF APPLICATIONS AND THE
APPLICATIONS FROM THOSE
INSTITUTIONS TEND TO DO BETTER
IN REVIEW BECAUSE THEY'RE GOOD
AT WRITING THEM AND KNOW HOW TO
POP THEM OUT, RIGHT.
THE REVIEW OUTCOMES FOR
FELLOWSHIPS ARE DIRECTLY RELATED
TO THE SENIORITY OF THE SPONSOR.
SO BOTH OF THOSE WE FELT WERE
PROBLEMATIC ISSUE AND WE'RE
LEAVING OUT PROMISING SCIENTISTS
OF THE FUTURE BECAUSE OF THE
PROCESS THAT'S HEAVILY FAVORS
ALLEGIANCE TO INSTITUTIONS OR
SENIOR WELL KNOWN SPONSORS.
IT'S THE SAME ISSUE THAT WE WERE
DEALING WITH IN RPG.
ONE IS TO ENSURE THE INFORMATION
FOR THE REVIEW COMMITTEE IS
TARGETED AND ALLOWS THE
APPLICANTS ACCOMPLISHMENTS IN
THE CONTEXT OF THE OPPORTUNITIES
THEY'VE HAD AND REALLY HAVE A
TRAINING PLAN THAT'S TARGETED TO
THE CANDIDATE'S NAME.
AND THEN TO REVISE THE REVIEW
CRITERIA TO BETTER FOCUS ON THE
APPLICANT'S POTENTIAL AND THE
TRAINING PLAN AND WITHOUT HAVING
THE REPUTATIONAL BIAS COME IN.
AND AGAIN THE OVERARCHING GOAL
IS TO FACILITATE THE PEER REVIEW
AND TRAINING FOR THE FUTURE.
OKAY.
SO THE FIRST RECOMMENDATION IS
TO CHANGE THE FELLOWSHIP
APPLICATION WHICH IS THE
INFORMATION PROVIDED TO THE
REVIEWER.
I WENT GO THROUGH ALL OF THIS
OTHER THAN TO SAY UNDERGRADUATE
GRAITS GRADES WERE NOT SEEN AS A
STRONG PREDICTOR OF SUCCESS IN
RESEARCH AND WHAT WE HEARD FROM
THE WORKING GROUP AND COMMUNITY
FEEDBACK.
THAT'S BEEN A BREWING ISSUE.
THEY RECOMMENDED ELIMINATION OF
GRADES FROM THE APPLICATION.
AND REVISING THE REST OF THE
APPLICATION TO BE TARGETED.
THE RESEARCH TRAINING PLAN OR
SCIENTIFIC PART DOES NOT CHANGE.
THAT REMAINS THE WAY IT IS.
THE REVISION RELI ELIMIELIMINAT
CUT AND PASTE AND REVISION TWO
WAS TO CHANGE THE REVIEW
CRITERIA AND ONCE AGAIN WHEN YOU
HAVE CRITERIA THAT SAYS
SPONSORS, COLLABORATORS AND
CONSULTANTS IT'S REALLY HARD FOR
REVIEWERS TO NOT WEIGHT THE
SPONSOR'S REPUTATION BECAUSE THE
SENIOR SPONSORS TEND TO DO
BETTER.
SAME WITH INSTITUTIONAL
ENVIRONMENT.
THAT'S WHERE SOME BIAS COMES IN
AND THE SPONSOR IS REALLY
IMPORTANT SO IS THE
INSTITUTIONAL ENVIRONMENT BUT
HERE IT INTEGRATED INTO
SCIENTIFIC RESOURCES AVAILABLE
TO THE TRAINEE AND THE SPECIFIC
TRAINING PLAN AND RESOURCES.
THAT'S WHERE SPONSOR AND
INSTITUTIONAL ENVIRONMENT WILL
COME IN.
SO THEY RECOMMEND THREE
CRITERIA.
IN 2022 THE FULL ADVISORY
COUNCIL CSR APPROVED THE
RECOMMENDATIONS AND THEN THESE
WENT THROUGH WITHOUT MUCH CHANGE
AND WERE ENDORSED BY NIH
LEADERSHIP.
WE ISSUED AN RFI OPEN THROUGH
JUNE 2025 AND I ENCOURAGE YOU TO
SHARE THIS WITH YOUR NETWORKS
AND SHARE MORE BACKGROUND IN OUR
BLOGS WE POSTED ABOUT THE RFI
AND THERE'S A BACKGROUND PAGE
AND E-MAIL TO ASK QUESTIONS OF.
I URGE TO YOU SHARE THIS BROADLY
AND MAKE SURE WE GET FEEDBACK
FROM A BROAD VARIETY OF SOURCES.
I GET QUESTIONS ABOUT THE
REVIEWER PROCESS.
I TRY TO TAG TEAM IT AND MAKE
SURE I TALK ABOUT EVERYTHING
ELSE WE'RE GOING IN THE SPACE.
FIRST OF ALL CHAIRS ARE REALLY
IMPORTANT.
THE ROLL OF THE CHAIR IN
ENSURING THE PEER-REVIEW PROCESS
IS CRITICAL.
CSR HAS AROUND 180 STUDY SECTION
AND TWO-YEAR APPOINTMENTS FOR
CHAIRS.
EVERY YEAR WE HAVE AROUND OO NEW
CHAIRS WE'RE CYCLING IN AND HOLD
NINE TO TEN TWO-HOUR SESSIONS
VIRTUAL NOW I GUESS IT USED TO
BE IN PERSON.
THESE WORK WELL AS VIRTUAL TO
OUR MEETINGS.
WE BRING IN THE CHAIRS AND HAVE
AN INTERACTIVE DISCUSSION WITH
THE VIGNETTE-BASED FRAMEWORK AND
GET IN THE NUTS AND BOLTS OF
WHAT CHAIRS DO AND ENSURE A
STRUCTURE THAT'S POSITIVE AND
GET INTO THE DETAILS.
THIS HAS BEEN VERY HELPFUL IN
ENSURING OUR CHAIRS ARE GETTING
ON THE SAME PAGE.
WE ALSO LAUNCHED A BIAS
AWARENESS TRAINING MODULE FOR
REVIEWERS BACK IN 2021.
THIS IS NOT IMPLICIT BIAS
TRAINING AND WE CANNOT GET IN
THE REVIEWER'S HEAD AND MAKE
THEM A DIFFERENT HUMAN BEING.
WHAT WE WANT TO DO IS MITIGATE
AND MAKE SURE THEY'RE BIAS IS
NOT CREEPING INTO THE
PEER-REVIEW PROCESS.
SO OUR FOCUS HAS BEEN BIAS AND
THIS IS A 30-MINUTE TRAINING.
WE DID THIS WITH THE HELP OF OUR
ADVISORY COUNCIL.
THERE'S A WORKING GROUP THAT
HELP WIED WITH IDEAS AND CONTEN
AND MORE THAN 19,000 CSR
REVIEWERS HAVE TAKEN THE
TRAINING AND IT'S BEEN WELL
RECEIVED AND THOSE WHO HAVE
TAKEN IT WE HEAR IT MENTIONED
DURING THE STUDY SECTION
MEETINGS YOU CAN'T SAY THAT --
THE TRAINING TOLD US YOU CAN'T
GIVE SOMEONE THE BENEFIT OF THE
DOUBT BECAUSE YOU RECOGNIZE
THEIR NAME, SOMEONE FAMOUS IN
THE FIELD AND INTRODUCED COMFORT
IN INTERVENING AND THE REPORT IS
ON OUR WEBSITE AND WE'RE GETTING
GOOD FEEDBACK.
THIS WEEK WE HEARD MORE GOOD
FEEDBACK ABOUT THE TRAINING ON
SOCIAL MEDIA.
THE PLAN IS FOR THIS TO BE
REQUIRED FOR ALL NIH REVIEWERS
BEGINNING WITH THE MAY 2024
COUNCIL REVIEW MEETING.
SO CSR IS NOW WORKING WITH THE
E.R.A. TO MAKE THAT HAPPEN.
WE ALSO HAVE A REVIEW INTEGRATE
TRAINING WITH VIGNETTES AND
IDEAS FROM AN ADVISORY COUNCIL
WORKING GROUP AND IT'S 30
MINUTES AS WELL.
IT TALKS ABOUT THE REVIEWER'S
ROLE IN PROTECT THE
CONFIDENTIALITY AND GOES THROUGH
SCENARIOS BEFORE, DURING AND
AFTER THE MEETING PEOPLE
ENCOUNTER THAT REVIEWERS HAVE
TOLD US THEY ENCOUNTER AND
PROVIDING TOOLS HOW TO HANDLE
THE SITUATION AND REPORTING.
IT'S BASED ON ACTUAL INCIDENTS
AND MORE THAN 12,000 REVIEWERS
COMPLETED THE TRAINING AND IT
WILL BE REQUIRED FOR ALL NIH
REVIEWERS AND OUR RECORDING OF
PEOPLE TRYING TO TAMPER WITH THE
PROCESS HAS GONE UP AFTER THE
TRAINING AND I THINK IT'S
ACHIEVING ITS GOAL AND HOPEFULLY
WILL BE ABLE TO ALL OF NIH SOON.
WE ALSO HAVE A DIRECT REPORTING
MECHANISM FOR BIAS AND GABRIEL
FOSU IS THE DIRECTOR FOR DEI AND
IT'S AVAILABLE TO ALL APPLICANTS
AND REVIEWERS WHO CAN REPORT
DIRECTLY TO US BIAS IN ANY
ASPECT IN THE MEETING OR REVIEW
OF APPLICATIONS OR ANYTHING AT
ALL.
WE LOOK AT EVERY ALLEGATION AND
HAVE A TRACKING SYSTEM AND DR
DRDR.
DR. FOSU WILL TAKE IT OUT OF THE
LINE OF AUTHORITY.
IF WE THINK THE REVIEW WAS
BIASSED OR FLAWED WE'LL
RE-REVIEW THE APPLICATION TO NOT
DISADVANTAGE THE APPLICANT.
AND THERE'S TIMES THERE'S A
DIFFERENCE IN SCIENTIFIC OPINION
AND IN THAT CASE WE GUIDE THEM
BACK TO THE INSTITUTE COUNCIL
PROCESS FOR APPEAL AND THAT
REMAINS AVAILABLE TO ALL NIH
INVESTIGATORS.
AND THEN THE LAST PART IS REALLY
IMPORTANT BECAUSE I THINK THAT'S
WHAT FOSTERS OUR ATTEMPT TO
FOSTER CUL TAUR CHANGE IN THE
REVIEW COMMUNITY.
IF THERE'S A BIAS REVIEW DUE TO
A STATEMENT WE FOUND BIAS IN THE
SUMMARY STATEMENT THE SCIENTIFIC
DIVISION DIRECTOR GOES BACK TO
THE REVIEWER SAYING YOU SAID
THIS AND THIS RESULTED IN A
COMPLETE RE-REVIEW AND WE
LISTEN.
THE VAST MAJORITY OF PEOPLE WE
CONTACT ARE EMBARRASSED AND
AGREE WITH US AND LEARN ISSUING
AND THAT'S WHAT WE ARE TRYING TO
PROMOTE IS FOSTERING THAT
CULTURE.
SMALL MINORITY ARGUES WITH US
AND THAT TELLS US SOMETHING
ABOUT THE REVIEWER AND THAT
HELPS US DETERMINE IF WE KEEP
THAT PERSON ON COMMITTEE OR NOT.
AND THEN FINALLY TO TALK ABOUT
DIVERSIFYING REVIEW PANELS, SO
WE WANT TO -- WE'RE ALWAYS
ATTEMPTING TO BROADEN THE POOL
OF REVIEWERS AND A COUPLE YEARS
AGO WE LAUNCHED THIS TOOL FOR
SROs BECAUSE THEY TEND TO LEAN
ON THEIR NETWORKS.
IT'S NATURAL AND NORMAL.
I'VE DONE IT MYSELF.
AND THIS ALLOWS SORT OF BEYOND
JUST THE NIH NETWORK.
SO WE HAVE PEOPLE WHO ARE --
WELL, THERE'S ALSO NIH AND
PEOPLE NIH FUNDED BUT HAVEN'T
BEEN USED THAT MUCH OR NEVER
INVITE.
WE HAVE LISTENING SESSIONS A
COUPLE YEARS AGO AND I WAS
APPALLED TO SEE INVESTIGATORS
SAYING I'VE NEVER BEEN CALLED
THOUGH I HAVE AN RO1 OR TWO RO1s
AND THAT'S BECAUSE OF NETWORKS
AND WHO YOU THINK OF IN A
CERTAIN FIELD.
DON'T THINK OF EVERYONE.
WE HAVE I.C. RECOMMENDATIONS IN
THERE AND HAVE OTHER AGENCIES,
NSF AND DOD AND OTHER
AGENCY-FUNDED INDIVIDUALS AND WE
INVITED SOCIETIES TO CONTRIBUTE
NAMES.
EARLY CAREER REVIEWERS IN THE
APPLICANT POOL.
THIS IS A SINGLE INTERFACE FOR
SROs AND IF I'M LOOKING FOR
SOMEONE IN ADDICTION OF A
CERTAIN KIND I CAN GO THERE,
SEARCH OR EVEN SEARCH UNDER MY
STUDY SECTION AND IT WILL MATCH
ME UP WITH A BUNCH OF PEOPLE
MANY OF WHOM I MAY NEVER HAVE
HEARD OF BEFORE.
IT BROADENS THE POOL FOR THOSE
DOING THE RECRUITMENT.
AND OUR STRATEGIES HAVE BEEN
MULTI-PRONGED.
IT'S NOT JUST THE TOOL.
THE MOST IMPORTANT THING IS
MESSAGING TO STAFF.
THE REALLY CRITICAL NEED FOR NIH
TO HEAR DIVERSE PERSPECTIVES TO
ENSURE PEER REVIEW IS LOOKING AT
THE MOST DISRUPTIVE SCIENCE AND
IF YOU INVITE THE SAME PEOPLE
YOU'LL GET DERIVATIVE SCIENCE.
AND EMPHASIZING QUALITY IN
REVIEW MEANS BROAD DIVERSITY IN
MULTIPLE DOMAINS.
THAT'S NOT JUST DEMOGRAPHIC AND
GEOGRAPHIC THOUGH IT'S IMPORTANT
BUT CAREER STAGE AND HOW MUCH
EXPERIENCE YOU HAVE IN PEER
REVIEW.
WE WANT FRESH PEOPLE IN THERE
WHO HAVE NEVER DONE IT.
WE NEED EXPERIENCED PEOPLE AND
PEOPLE WHO NEVER EXPERIENCED
REVIEW AND SCIENTIFIC BACKGROUND
AND PERSPECTIVE.
YOU DON'T WANT FIVE PEOPLE WHO
CAN TRACE THEIR LINEAGE BACK TO
THE SAME PERSON.
IT'S JUST ONE MODEL THEY'RE
FOLLOWING IN THE FIELD, FOR
EXAMPLE.
OUR STANDING STUDY SECTION
PROCESS IS ACTUALLY THOROUGH AND
I'LL SHOW YOU DATA IN A BIT.
IT'S ENRICHED DIVERSITY.
IT HAS MULTIPLE LEVELS OF
OVERSIGHT.
THAT'S A DIFFERENT ISSUE.
OUR ISSUE WAS LOOKING AT SPECIAL
EMPHASIZE PANELS AND THESE ARE
AD HOC PANELS THAT ARE CREATED
WITHOUT THAT MUCH NOTICE AND
THAT'S WHEN PEOPLE TEND TO LEAN
ON THEIR NETWORK.
WE HAVE TO ASSEMBLE SOMEONE VERY
QUICKLY AND YOU THINK ABOUT A
FIELD AND WHO DOES RESEARCH IN
THIS AND GO TO THE SAME FOUR OR
FIVE PEOPLE.
OUR APPROACH HAS BEEN TO RAISE
COLLECTIVE AWARENESS ACROSS THE
CENTER.
TO SET THE EXPECTATIONS.
WE SHARE PANEL-LEVEL DATA WITH
MANAGEMENT AND OUR STAFF.
AND WE PROVIDE TOOLS TO FIND
LESSER-KNOWN REVIEWERS AND THE
MOST IMPORTANT THING HAS BEEN
TRAINING OF SROs AND ESPECIALLY
SROs SHARING BEST PRACTICES WITH
EACH OTHER.
THERE'S NICE STRATEGIES TO BR
BROADEN OUR REVIEW COMMITTEE
WITH EXPERTS.
SO WE'VE HAD SOME SUCCESS.
YOU CAN LOOK HERE THE BROWN LINE
AT THE BOTTOM IS CSR CONTACT
P.I.s AND P.I.s WHO SUBMITTED
APPLICATIONS TO CSR SINCE
OCTOBER 2019 BY ROUND.
YOU CAN SEE WOMEN HAVE BEEN SORT
OF FLAT AROUND 34% HAVEN'T
CHANGED THAT MUCH.
THE MEMBERS OF STUDY SECTION
HAVE ALWAYS BEEN ENRICHED BUT
ARE CONTINUING TO GET ENRICHED
MORE BECAUSE WE MADE A REAL
ATTEMPT IN OUR AD HOC
RECRUITMENT AND YOU CAN SEE THE
INCREASE IN REPRESENTATION OF
WOMEN IN OUR SPECIAL EMPHASIS
PANEL MOVING IN THE RIGHT
DIRECTION.
SIMILAR WITH UNDER REPRESENTED
MINORITIES.
THE DARK BLUE LINE REPRESENTS
THE BENCHMARKING AGAINST THE
P.I.s AND IT WAS ALWAYS ENRICHED
IN OUR MEMBERSHIP BUT CONTINUING
TO GO UP.
SINCE 2019 YOU CAN SEE IT WAS
BELOW THE BENCHMARKS SO PEOPLE
WERE NOT SERVING EVEN IF THEY
CAME IN AS APPLICANTS.
IT WAS LOWER THAN THE BENCHMARK.
UNTIL OUR INTERVENTIONS AND
WE'RE SEEING AN INCREASE AND I
THINK THESE INCREASES ARE
RELATED BECAUSE WE SEE THEY'LL
RECRUIT THEM TO BE MEMBERS AS
WELL.
YOU CAN FIND ALL THE DATA, ALL
OUR REPORTING AND ANALYSIS ON
OUR WEBSITE HERE TO ADDRESS BIAS
AND PEER REVIEW.
AN I'M HAPPY TO DISCUSS FURTHER.
>>THANK YOU, NONI.
THAT WAS GREAT.
I OPEN IT UP FOR COUNCIL
QUESTIONS ONLINE AND IN PERSON.
DAVE, YOU WANT TO SPEAK UP?
>>FIRST, I APPRECIATE THE
EFFORT YOU MADE TO GET EARLY
CAREER INVESTIGATORS TO STUDY
SECTIONS AND SEE HOW IT'S DONE.
I'M NOT SURE WHAT THE PROGRAM'S
CALLED BUT I HEAR GREAT THINGS
ABOUT IT.
MY QUESTION WAS THE AVERAGE AGE
OF REVIEWER OR LEVEL OF
EXPERIENCE.
AS YOU POINTED OUT ONE OF THE
THINGS THAT'S HAPPENED WE KEEP
GETTING THE SAME REVIEW OVER AND
OVER AGAIN.
I'M WONDERING IF THAT EXPERIENCE
LEVEL DEMOGRAPHIC IS CHANGING.
>>NO, THANK YOU.
WE'VE MADE CONSIDERABLE EFFORTS
TO BROADEN THE CAREER STAGE OF
OUR REVIEW POOL.
IN FACT THAT'S THE DATA I NEED
TO SHOW.
IT LOOKS BETTER THAN THE GENDER
DATA IN TERM OF ASSOCIATE AND
ASSISTANT PROFESSORS.
A BROAD RANGE OF PEOPLE ON OUR
PANEL.
I DON'T HAVE THE RANGE DATA FOR
VIEWERS.
I THINK WE DO THAT FOR
APPLICANTS.
WE HAVE BEEN LOOKING AT REVIEW
SERVICE AND ENSURING THERE'S
REASONABLE SERVICE AND GET A
BROAD RANGE OF PEOPLE COMING
INTO THE SYSTEM.
YEAH, THANK YOU.
AND THANK YOU FOR YOUR SERVICE.
IT'S NOT LIKE YOU WON'T GET
CALLED.
>>WE HAVE A QUESTION FROM NANCY
BARNETT A COUNCIL MEMBER.
>>THANK YOU.
I THINK THE FEEDBACK HAS BEEN
POSITIVE FROM THE CONVERSATIONS
WITH PEOPLE AND THINK IT WILL
REDUCE BIAS AS YOU SAID.
ONE OF THE SLIDES YOU SHOWED
LAST SHOWED THE SERVICE OF UNDER
REPRESENTED MINORITIES IN WOMEN
HIGHER THAN THE FUNDED AND IS
THAT CORRECT AND THE FUNDING WAS
FLAT --
>>NO, THAT WAS THE PERCENTAGE
OF APPLICANT ARE WOMEN NOT
FUNDING.
IT'S PERCENTAGE OF APPLICANT ARE
WOMEN.
IT'S NOT FUNDED APPLICANTS.
BUT THE PERCENTAGE OF WOMEN
REVIEWERS IS IN OUR STUDY
SECTION IS HIGHER THAN WOMEN IN
THE APPLICANT FOOL.
-- POOL.
>>I THINK IT'S A PROBLEM.
IT'S NOT A PROB OF THE REVIEW
GROUP BUT THE APPLICANT POOL,
RIGHT.
IT MEANS WOMEN AND UNDER
REPRESENTED MINORITIES ARE
SERVING MORE THAN THEY'RE
ACTUALLY BENEFITING FROM WE SEE
THIS WHERE WOMEN AND UNDER
REPRESENTED MINORITIES ARE OVER
SOLICITED COMPARED TO WHITE MEN.
I KNOW IT'S NOT AN ISSUE WITH
THE REVIEW BUT APPLICATIONS.
>>I WOULD SAY WE NEED TO WAIT
AND BE MORE PATIENT.
IT REMINDS ME OF A JOURNAL WHERE
THEY SAID THEY WERE TAGGING THE
EDITORIAL BOARD TO THE CURRENT
POPULATION AND A RAISE THE ISSUE
WHY ARE YOU TAGGING THE CURRENT
POPULATION MECHANICS JUST MAKE
IT 50/50 ON YOUR EDITORIAL BOARD
AND THEY WILL COME.
IF YOU BUILD IT THEY WILL COME.
>>I COULDN'T HELP BUT POINT IT
OUT AND I DON'T THINK THE
SOLUTION IS NOT TO LOWER
PROPORTIONS OF UNDER REPRESENTED
MINORITIES AND WOMEN IN THE
SERVICE ROLES BUT I WANTED TO
POINT THAT OUT.
>>IT IS A BURDEN NO DOUBT.
AND I CAN SAY ANECDOTALLY FROM
THE EARLY CAREER FACULTY I'VE
WORKED WITH AND ENCOURAGED TO
APPLY TO THE NEW REVIEWER
PROGRAM THE TRAINING THEY
RECEIVED HERE'S HOW TO DO A
REVIEW TRAINING I SUSPECT IS
DIFFERENT FROM FOLKS WHO DON'T
DO THE PROGRAM.
>>THROUGH OUR PROGRAM WE
INCREASED IT TO TWO EARLY CAREER
REVIEWERS FOR EVERY STUDY
SECTION COMPARED TO THE ONE IT
USED TO BE.
I AGREE.
LET ME CIRCLE BACK A LITTLE BIT.
I THINK WHAT WITH YOU WERE TALK
IS THE FEMALE TAX AND MINORITY
TAX.
THAT'S WHERE YOU WERE GOING WITH
IT BUT IF WE KEEP GOING TO THE
APPLICANT POOL OR EVEN WORSE
FUNDED POOL TO PULL OUR
REVIEWERS FROM WE'LL NEVER MAKE
A CHANGE AND THAT'S WHERE IT'S
HAPPENING.
THERE ARE MINORITIES WHO HAVEN'T
BEEN ASKED TO SERVE BEFORE.
I THINK THAT'S OUR GOAL TO GET
MORE APPLICANTS IN THE POOL.
THAT'S AN NIH-WIDE IRISH THAT
NIH IS VERY MUCH AWARE OF.
>>I WOULD AGREE AND IN FACT
WHEN MY MENTEES COME TO ME AND
SAY WELL, I'VE BEEN ASKED IF I
SHOULD DO XYZ THE ONLY THING I
SAY NO MATTER WHAT YES TO IS
SERVE ON A REVIEW GROUP.
IF YOU GET ASKED YOU DO IT
BECAUSE OF WHAT YOU'RE SAYING.
THEY BENEFIT FROM IT
IMMEASURABLY IN UNDERSTANDING
THE PROCESS AND BECOME BETTER
GRANT WRITERS SO THANK YOU.
>>THANK YOU, NANCY.
THAT WAS AN IMPORTANT POINT.
>>I'M LAURA O'DELL FROM THE
UNIVERSITY OF TEXAS IN EL PASO.
I FIRST WANT TO SAY THANK YOU
BECAUSE I REALLY AM IMPRESSED
WITH THE BREADTH OF
REPRESENTATION THAT YOU'RE
PAYING ATTENTION TO INCLUDING
INSTITUTIONAL SMALL
INSTITUTIONS.
THANK YOU, I HEAR A LOT OF
REPRESENTATION THERE.
MY SIMPLE QUESTION IS YOUR
PRESENTATION PUBLICLY AVAILABLE?
IT WOULD BE WONDERFUL TO BEGIN
TO SHARE THE THINKING ON THIS
PARTICULARLY AT HSI AND OTHER
SMALLER INSTITUTIONS THAT MAY
NOT HAVE ACCESS TO IT.
THAT'S ONE SIMPLE QUESTION.
AND PERHAPS THE OTHER QUESTION I
HAVE IS I WAS WONDERING AS YOU
WERE PRESENTING ON THE CHAIR
TRAINING, WHAT'S THE TRAINING
AND WHAT'S YOUR THOUGHTS ON THE
EMPOWERMENT OF SROs TO SORT OF
DICTATE THE TONE AND TO HAVE I
DON'T KNOW WHAT OTHER WORD TO
USE BUT EMPOWER THEM BECAUSE THE
CHAIR IS ULTIMATELY A COLLEAGUE
IN THE ROOM AND I'VE ALWAYS SEEN
THAT OPPORTUNITY FOR THE SRO TO
SET A TONE TO ELEVATE ALL VOICES
AND ENSURE FAIRNESS.
I WOULD LOVE YOUR THOUGHTS ON
THAT, AGAIN, THANK YOU.
>>THANK YOU.
FIRST, LET ME ANSWER THE FIRST
ONE, YES, EVERYTHING IS PUBLICLY
AVAILABLE AND IN FACT AS THIS
YEAR WE'RE PLANNING TO REALLY
INCREASE THE REVIEW CRITERIA AND
SO FEEL FREE TO CONTACT CSR AND
ME AND WE'LL PUT YOU IN TOUCH
WITH PEOPLE IF THERE'S GROUPS OF
INSTITUTIONS WE'LL COME OUT AND
I'LL COME OUT AND HAPPY TO
SHARE.
THE OTHER POINT IS REALLY WELL
TAKEN AND I DIDN'T SPEND TIME ON
OUR WE ESTABLISHED THE OFFICE OF
TRAINING AND DEVELOPMENT IN CSR
LAST YEAR AND THE FOCUS OF THAT
IN ADDITION TO REVIEWER TRAINING
IS SRO TRAINING AND WORKSHOPING
AND THE MAIN GOAL IS TO ONE
EMPOWER SROs AND MAKE SURE
THEY'RE OWNERS OF THE MEETING
AND KNOW THAT AND WE'RE VERY
MUCH PUSHING THAT INCLUDING
HOLDING MOCK STUDY SECTIONS AND
TEACHING SROs HOW TO JUMP IN AND
INTERVENE BECAUSE IT'S THEIR
RESPONSIBILITY.
FAIRNESS OF THE PROCESS IS NOT
SOMEONE ELSE'S RESPONSIBILITY
AND I THINK WE'RE GETTING THERE.
VERY MUCH FOCUSSED ON EXACTLY
WHAT YOU SAID.
>>WONDERFUL.
THANK YOU.
>>GREAT PRESENTATION AND I WANT
TO BRING IN A SOURCE OF BIAS
THAT MAYBE WASN'T CONSIDERED AND
COULD BE EN MAHANCED ON THE REV
FORMS AND THERE'S COMMENTARY ON
WELL, THIS RESEARCH ISN'T GOING
TO IMPROVE THE DIAGNOSIS OR
IMPROVE THE ATTEMPT BUT IT'S
BEEN MY UNDERSTANDING NIH
REMAINS INTERESTED IN BASIC
MECHANISMS AND BASIC INFORMATION
EVEN WHEN THERE'S NOT AN
IMMEDIATE APPLICATION FOR THAT
AND IN THE CLINICAL SENSE AND WE
HAVE SEEN THAT QUITE A LOT.
SOMETIMES SROs COVER IT AND
SOMETIMES THEY DON'T AND IT
SEEMS TO ME THAT'S SOMETHING
THAT OUGHT TO BE ADDRESSED AT
SOME LEVEL.
>>THANK YOU.
I AGREE WITH THAT.
WE HAVE BEEN VERY CLEAR ABOUT
THAT AND IT DEPENDS ON THE STUDY
SECTION AND IT DEPENDS ON THE
PROJECT ITSELF.
SO IF THIS WAS -- IF THE
PROPOSAL WAS A BASIC OR
MECHANISTIC PROPOSAL I THINK
IT'S AN UNFAIR COMMENT TO MAKE
IT DOESN'T GET DIAGNOSIS.
IF THE PROPOSAL IS PROPOSING A
CURE OR ADDRESSING IT'S A CYCLE
BECAUSE PEOPLE THINK NIH WANTS
THIS AND SO THEY PUT THIS IN
THEIR REPLICATION.
THIS IS GOING TO CURE SOMETHING.
WHEREAS REALLY IT'S A BASIC OR
MECHANISTIC APPLICATION.
IT'S A MATTER OF BREAKING THE
CYCLE AND THAT HAS TO HAPPEN IN
REVIEW AND ALSO HAS TO HAPPEN
OUT THERE.
I THINK YOUR UNDERSTANDING OF
NIH'S MISSION IS EXACTLY RIGHT.
ADVISE PEOPLE IF THEY'RE DOING A
BASIC STUDY, PACKAGE IT LIKE A
BASIC STUDY.
IT'S WHEN THERE'S CLAIMS BEYOND
WHAT THE STUDY IS AND IT'S NOT
SOMETHING NEW WE HEARD BEFORE
AND WE COVER IT IN TRAINING.
AND I WOULD SAY IF YOU SEE AN
INSTANCE OF THAT, I'D REPORT IT
TO THAT BIAS BOX WE HAVE.
THAT'S PERFECTLY OKAY TO SEND
IN.
SPECIFIC CASES HELP US MAKE THE
POINTS BETTER.
>>AGAIN, THANK YOU, NONI.
THAT WAS REALLY CLEAR.
I THINK I SERVED 15 YEARS ON
STUDY SECTION BEFORE COMING TO
NIH.
I THINK YOU KNOW THAT.
I TOTALLY AGREE WITH ALL THE
CHANGES FROM PUTTING MY OLD HAT
BACK ON OF BEING IN THE REAL
WORLD AND I THINK IT'S GOING TO
IMPROVE AND CONTINUE TO IMPROVE
THE DIVERSITY OF THINKING AND
DIVERSITY OF INDIVIDUALS AND
GOING TO ENRICH NIH ACROSS THE
BOARD.
I THINK EVERYBODY IS GOING TO
BENEFIT FROM THIS.
IF WE CAN HELP AT OUR INSTITUTE
KEEP US IN MIND AND DO YOU HAVE
ANY COMMENTS, PHILIPPE IN YOUR
SHORT TERM AS ACTING DIRECTOR?
>>THANK YOU.
I APPRECIATE THE PRESENTATION.
I WANT TO ALSO THANK CSR FOR
SENDING US REQUEST FOR FEEDBACK
FOR STUDY SECTIONS IN WHICH NIAA
GRANTS ARE BE REVIEWED.
I THINK WE'RE LOOKING AT IT AND
THERE'S A LINK AS WELL TO GIVE
THE OPPORTUNITY FOR THE
INSTITUTE TO SUGGEST FOR THE
STUDY SECTIONS SO IT'S VERY
HELPFUL.
>>THANKS A LOT.
I REALLY APPRECIATE YOU TAKING
THE TIME.
>>BYE-BYE.
>>I THINK WE'RE CLOSE TO ON
SCHEDULE.
SO WHAT DO WE DO NEXT?
>>DISCUSSION AND UPDATES IF
DR. MILLIKEN WANTS TO SAY
ANYTHING AND PUBLIC COMMENTS.
>>CHUCK MILLIKEN WOULD YOU LIKE
TO SAY ANY MORE?
>>THANK YOU.
I'LL BE BRIEF.
THESE ARE MY VIEWS AND NOT THE
OFFICIAL VIEW OF THE ARMY OR DOD
BUT WE DID PUT OUT A DOD V.A.
CLINICAL PRACTICE GUIDELINE
THAT'S PRETTY COMPREHENSIVE AND
AVAILABLE TO THE PUBLIC, EASILY
FINDABLE BY GOOGLING DOD
GUIDELINE ON SUBSTANCE USE AND
HAVE AN ARTICLE PUBLISHED IN
JAMA AND PART OF WHY I MENTION
IT IS -- IN 2022.
PART OF WHY I MENTION IT THE
PRACTICE GUIDELINE IS TIGHTLY
MANAGED BY A GROUP THAT'S
OVERSEEN BY YET ANOTHER GROUP
AND THEY'RE VERY PROUD OF HOW
AUTHORITATIVE THE PROCESS IS BUT
ONLY NEWER RESEARCH LIKE WITHIN
THE LAST FIVE YEARS WOULD BE
CONSIDERED AND OLDER
RECOMMENDATIONS THAT DIDN'T HAVE
NEW RESEARCH OR WORSE YET IF THE
OLDER RESEARCH THAT SUPPORTED AN
ESTABLISHED RECOMMENDATION
DIDN'T MEET THE BAR THAT HAD
BEEN RAISED ON THE QUALITY OF
RESEARCH THAT IT COULDN'T BE
MADE WITH A RECOMMENDATION OR
THE RECOMMENDATION HAD TO BE
DOWNGRADED AND FOR INSTANCE WE
HAD A MEMBER OF THE GROUP ALMOST
RESIGN FROM THE WHOLE PROCESS
LATE IN THE DAY WHEN OR LATE IN
THE WHOLE YEAR LONG PROCESS
BECAUSE BENZODIAZEPINE TO TREAT
ALCOHOL WITHDRAWAL DIDN'T HAVE
ADEQUATE RECENT RESEARCH OR THE
RESEARCH DONE DIDN'T MEET
TODAY'S QUALITY STANDARDS.
SO IT'S JUST AN INTERESTING
OBSERVATION THAT MAY BE RELEVANT
TO HAVE AS BACKGROUND.
AND MY ONLY OTHER COMMENT IS
AGAIN WE'RE IN THE MIDST OF THIS
PROCESS OF DOD ARMY, NAVY AND
AIR FORCE BEING CONSOLIDATED
INTO A HEALTH CARE AGENCY WITHIN
DOD.
AGAIN, MY VIEW IT'S PROVING TO
BE PRETTY BUREAUCRATIC AND THE
FUNDING ALSO SEEMS TO BE TIGHT
AND THE PROCESS SEEMS TO BE ONE
OF MOVING A LOT OF SERVICES THAT
HERETOFORE BEEN PROVIDED IN OUR
DIRECTOR-CARE HOSPITALS OR
CLINICS ON MILITARY BASES
INSTEAD BEING THROWN OUT THE
DOOR INTO THE CIVILIAN COMMUNITY
SOMETIMES IN COMMUNITIES NOT
PARTICULARLY WELL RESOURCED
THEMSELVES AND SO WE STILL HAVE
NOT BEEN DIRECTLY IMPACTED BY IT
TOO MUCH IN OUR SUBSTANCE USE
COMMUNITY AND HOPE THE
RECOGNITION WILL BE THIS IS SUCH
A YOUNG PERSON DISEASE VERY MUCH
IMPACTING THE YOUNG PEOPLE THAT
JOIN SERVICE AND HAVE GOOD
RESEARCH SHOWING THE STRESS OF
WAR AND BEING DEPLOYED IS A RISK
FACTOR FOR ALCOHOL USE TO RETAIN
SERVICES INSIDE THE SYSTEM
RATHER THAN OUTSIDE THE GATE.
I MENTION THAT FROM TIME TO TIME
IN CASE WE NEED TO ASK FOR
SUBJECT MATTER EXPERTISE FROM
THE COUNCIL OR THE NIAA HERE.
THANK YOU AGAIN FOR YOUR TIME.
>>THANK YOU.
I DON'T KNOW IT'S TERRIBLY
RELEVANT BUT I WANTED TO MENTION
TO COUNCIL I WENT TO THIS RX SUM
IT I'LL TALK ABOUT IT BRIEFLY
TOMORROW ON THE HEAL INITIATIVE.
AND JOINED LARRY TABAK AND NORA
VOLKOW IN A PANEL DISCUSSION AND
TALKED ABOUT THE ISSUES IN THE
CONCEPT CLEARANCE MARK TALKED
ABOUT IN THE ALCOHOL-OPIOID
INTERACTIONS.
AT A DINNER THE NIGHT BEFORE WE
WERE TALKING ABOUT THE NUMBER OF
CONGRESSMEN A LADY CAME UP AND
CLAIMED -- AND I NEED TO GET HER
NAME AND MAKE A CONTACT, BUT
APPARENTLY SHE SAYS THERE'S A
GROUP OF INDIVIDUALS OUT THERE
IN THE REAL WORLD WHO BASICALLY
ARE CONVINCED MORE THAN
CONVINCED, HAVE EVIDENCE THAT
ONE OF THE DISEASES IS GROSSLY
UNDER DIAGNOSED AND ACTUALLY IS
VERY PREVALENT AND NOT BEING
TREATED PROPERLY AND NOT EVEN
BEING RECOGNIZED.
I'LL THROW THAT OUT WHEN CHUCK
WAS TALKING ABOUT THE V.A. AND
THE DOD.
WAS THE VETERANS USED TO BE A
PLACE WHERE THIS WAS DIAGNOSED
BUT APPARENTLY WHAT'S HAPPENED
IS THAT GIVING THIAMINE HAS
BECOME SO ROUTINE IN EMERGENCY
ROOMS PEOPLE ARE NOT PAYING
ATTENTION TO THE FACT THAT SOME
OF THESE INDIVIDUALS ARE NOT
GETTING ENOUGH TIME AND THIS
LADY HAD A LOVED ONE IN THAT
SITUATION AND EXPLAINED SHE HAD
TO GO IN AND UP THE DOSE BUT
ALSO THAT IT'S JUST NOT BEING
RECOGNIZED.
AND I MUST SAY WHEN WE PUT THE
FACT SHEET TOGETHER WE HAD A
HECK OF A TIME AND YOU HAD TO GO
TO MARLENE AND OSCAR BURMEN WORK
ON THIS FOR YEARS TO GET ANOTHER
NEUROLOGIST FOR THIS.
I THROW THAT OUT, IF YOU HAVE
INFORMATION PLEASE LET ME KNOW.
I'LL FOLLOW UP WITH THE LADY I
DISCUSSED THIS WITH PART OF THE
BIG INITIATIVE AND I THINK NORRA
PROBABLY KNOWS HER NAME SO I'LL
ASK HER TOMORROW.
I'M PARTIALLY TRYING TO REMEMBER
MYSELF AND TO PUT THE BEE IN
YOUR EAR.
IF YOU HEAR ABOUT THIS I'D BE
HAPPY FOR REFERENCES OR
ANYTHING.
IT'S LIKE IT FELL OFF A CLIFF AS
ONE OF THE PATHOLOGIES
ASSOCIATED WITH ALCOHOL AND
WERNIKI'S IS TREATABLE BUT KO
KORSOKAUF IS NOT AND ONCE YOU
HAVE HOLES IN YOU'RE HIPPOCAMPUS
AND YOU CAN BE TREATED WITH THE
WRONG OF EVERYTHING.
IT'S A KIND OF DEMENTIA.
>>IT DOESN'T MEAN IT'S NOT
VALUABLE WORK FOR WORK THAT'S
ABSOLUTELY SHOULD FORM THE
FIELD.
OVER.
>>CHUCK, I DON'T KNOW YOU
LOOKED AT OUR HBCR HEALTH CARE
PROFESSIONAL CORE RESEARCH BUT
YOU'RE WELCOME TO SHARE IT WITH
THE GROUPS YOU INTERACT WITH AND
SUCH.
>>AND WE'RE LOOKING FOR
ACCEPTANCE OF THE CONCEPT
CLEARANCE.
>>SECOND.
>>ANYBODY OPPOSED?
OKAY.
THE PREVIOUS CONCEPT IS
ACCEPTED.
I NEED TO ANNOUNCE THE FUTURE
MEETING DATES.
THE NEXT MEETING WILL BE ON
SEPTEMBER 7.
HOPEFULLY IT WILL BE A FULL IN
PERSON MEETING AND WE'LL HAVE
ALL THE COUNCIL IN THE MEETING
ROOM UNLESS SOMETHING DRASTIC
HAPPENS.
I'LL KEEP YOU POSTED ABOUT THE
DATES AND LOGISTICS AND DATES TO
MARK IN YOUR CALENDAR FOR 2024
IS FEBRUARY 8, MAY 14 AND 15 AND
SEPTEMBER 12.
I'LL SEND ALL THE DETAILS AND
THE INFORMATION IS IN THE ECB.
AND ALSO ALL THE TALKS DONE
TODAY AND REPORTS INCLUDING
NONI'S PRESENTATION ALL ARE
AVAILABLE IN THE ECB.
YOU'LL BE ABLE TO DOWNLOAD IT
AND THE NIAA SPECTRUM MAGAZINE
IS OUT AND THERE'S A COPY OF
THAT IN THE ECB YOU CAN DOWNLOAD
IT AND LOOK AT IT AND ONLY OTHER
THING I WANT TO MENTION IS ANY
PAPERWORK NEEDED IN MATERIALS OF
POST-MEETING COI INFORMATION AND
SIGN IT AND SEND IT BACK TO ME
TO HAVE THE PAPERWORK SUBMITTED
TO REIMBURSE YOU FOR THE
EXPENSES.
I'LL HAND IT BACK TO GEORGE FOR
CLOSING REMARKS AND ADJOURNMENT.
>>WE'LL CONTINUE TO HAVE A
HYBRID OPTIONS UNTIL WE SAY
OTHERWISE FOR COUNCIL MEETINGS.
IN THE WINTER MEETING I CALL
FEBRUARY, DEPENDING ON THE
WEATHER WILL DEPEND ON WHAT WE
DO.
AND THIS IS THE MILDEST WEATHER
IN WASHINGTON IN THE 10 YEARS
I'VE BEEN BACK BUT I ALSO
REMEMBER SNOWMAGEDDON WHEN I
COULDN'T GET OUT OF THE BACK
DOOR OF MY APARTMENT IN
GEORGETOWN.
SO AND CORRECT ME IF I GET THIS
WRONG ONE OF OUR STUDY SECTIONS
EACH YEAR WILL BE IN PERSON?
>>YES, CORRECT.
AT LEAST ONE STUDY SECTION PER
YEAR IN PERSON AND ONE CLOSE UP.
I THINK SRO WILL POLL THEIR
STUDY SECTION AND SEE HOW THEY
WANT TO DO IT AND OTHER FACTORS
AS WELL.
>>THERE'S ADVANTAGES AND
DISADVANTAGES TO BOTH A LOT OF
OUR EVERYDAY ACTIVITIES GO VERY
WELL VIRTUALLY.
THERE'S A CERTAIN SKILL TO USING
VIRTUAL MEDIA MAKING SURE PEOPLE
RESPOND.
AND THERE'S ADVANTAGE FOR NEW
PEOPLE TO GET TO KNOW EACH OTHER
IN PERSON AND WE'LL KEEP THAT IN
MIND FOR COUNCIL AS WELL.
AND THERE'S AN ADVANTAGE OF
BEING ON STUDY SECTION AS SOME
POINTED OUT WITH NONI.
IT'S CERTAINLY MY FIRST STUDY
SECTION WAS A CAREER CHANGER
BECAUSE I STARTED TO SEE THE
REAL WORLD.
WHEN I WAS ON YOU STUDY SECTION
AT FIRST ONE IT WENT ON FOR A
WEEK AND WE HAD 100 APPLICATIONS
AND SOME HAD OVER 100 PAGES.
WE'LL RECONVENE AT 10:00 A.M.
FOR COLLABORATE RESEARCH AND WE
HAVE A GREAT SPEAKER ABOUT PAIN
AND ADDICTION AND BOTH NORA AND
WILL GIVE BRIEF OVERVIEW.
SOME WILL BE THE SAME AND SOME
DIFFERENT AND EMPHASIZE A FEW
OTHER THINGS.
ANY FINAL QUESTIONS?
ANYBODY ONLINE AND TRISH DO YOU
HAVE COMMENTS YOU'D LIKE TO MAKE
HAVING HEARD THE AFTERNOON
SESSION?
>>EXCELLENT PRESENTATIONS AND
LOTS TO THINK ABOUT AND THANKS
TO THE COUNCIL MEMBERS FOR THEIR
DELIBERATIVE THOUGHTS TODAY.
>>THERE'S A FEW ONLINE AND WE
GOT THEM OUT OF THEIR SPACE AND
I APPRECIATE THE QUESTIONS AND
DON'T EVER GET THE IMPRESSION I
DON'T APPRECIATE THE QUESTIONS
THOUGH I MAY GET DEFENSIVE IN
ANSWERING THEM, OKAY.
IT'S JUST PART OF THE NATURAL
TENDENCY OF THE KOOB.
BUT WE LISTEN AND PAY ATTENTION
AND WE TRY TO CHANGE THANK YOU
EVERYBODY AND THE MEETING IS NOW
ADJOURNED.