One-Man Peer Review

In annual ritual, lawmaker questions wisdom of U.S. research grants, this time about spread of HIV in foreign lands. House backs the critic, striking the funds.
July 28, 2009

WASHINGTON -- Virtually every year, like clockwork, some member of Congress or another questions the legitimacy of research that peer reviewers for federal agencies have selected as worthy of support. The lawmakers behind these efforts typically focus on their desire to protect the American taxpayer, but the targets of their enmity tend to be studies on such topics as gay people in foreign lands. (Odd, that.)

Often the lawmakers get no further than scoring their political points and putting the scientists through a little bit of hell. But Friday, Rep. Darrell Issa, a California Republican, actually got his wish, at least temporarily, when the House of Representatives, in enacting a 2010 spending bill for the National Institutes of Health and other agencies, appears to have persuaded his Democratic and Republican colleagues that they should strike $5 million for three projects that had been approved through the NIH's extensive peer review process.

Rep. Darrell Issa

“It is my mission to hold the federal government accountable for its spending and the NIH is no exception, especially during the current economic crisis,” Issa said in a news release with the catchy title, "Issa Amendment to Strip Funding for Taxpayer-funded Studies of Foreign Prostitutes Passes House." “These studies are clearly not high priorities for U.S. citizens, suffering from disease here at home, who could benefit from the $5 million the NIH plans to spend on foreign alcoholics and prostitutes. We need to get the NIH’s priorities in line with those of the American people.”

The studies in question have the sorts of titles that might jump out as unusual to someone perusing a list of scientific projects: "Substance Use and HIV Risk among Thai Women," "Venue-based HIV and alcohol use risk reduction among female sex workers in China," and "Maximizing Opportunity -- HIV Prevention in Hospitalized Russian Drinkers."And indeed, according to Issa's press secretary, Kurt Bardella, that's exactly what happened.

"In reviewing legislation, these things stuck out," Bardella said, adding that his boss had offered an amendment to the appropriations bill for the Departments of Labor, Health and Human Services, Education and Related Agencies because he "doesn't believe the government should be directing research" at health issues such as these when there are so many serious public health concerns in the United States.

"And the entire Congress agrees with us," Bardella said. While that may seem like a bit of hyperbole, since the Senate has not weighed in yet, he is on solid ground in noting that Issa's stand against peer reviewed science proceeded pretty far Friday, garnering no obvious opposition in a "voice vote" on the House floor during debate over the spending bill. Opponents had two chances to stop Issa's amendment, Bardella said: once in the House Rules Committee, where amendments are declared to be legitimate or out of order, and then on the House floor, where Rep. David Obey (D-Wisc.), who heads the Appropriations Committee and controlled debate, allowed the vote to proceed.

Aides to Obey did not return e-mail and telephone messages asking if the Wisconsin Democrat supported Issa's amendment. But advocates for academic science were troubled not only by Issa's measure but by the fact that it advanced as far as it did.

“NIH’s peer review system is the envy of the world because it ensures only the highest quality science is supported through federal funding,” said Mark O. Lively, president of the Federation of American Societies for Experimental Biology. “Any short-term compromise of the peer-review process, through Congressional micro-management of the grant-making process, is a grave threat to biomedical research, the quality of U.S. science, and the health of our fellow citizens.”

Added David Gorski of Wayne State University on the blog Science Based Medicine: "If Rep. Issa can force his ideology on the NIH (and let’s face it, this is almost certainly about conservative religious views more than anything else), then what’s to stop any other Representative (of which there are 435) or Senator (of which there are 100) from doing the same thing? Nothing."

'First Public Bludgeoning'

It was that reality, more than their personal frustration (though they felt that, too), that troubled the researchers who were on the receiving end of Issa's broadside.

Jeffrey Samet, professor of medicine and public health at Boston University Medical Center, is lead investigator on the Issa-targeted study on HIV and hospitalized Russian drinkers. Samet's $3 million, five-year grant from the National Institute on Alcohol Abuse and Alcoholism, which is already in its third year, is designed to show that a program of HIV intervention aimed at alcohol and drug users getting in-patient substance abuse treatment settings bolsters safe sex practices. Russia is in the midst of a significant HIV epidemic.

Samet first got wind of what he calls his "first public bludgeoning" late Thursday (after returning, ironically, from a visit to the NIH in the Washington suburbs) when he received an "alert" from the American Psychological Association indicating scrutiny for three studies related to HIV. "Oh crap," he thought to himself when he discovered that his was among them.

He lists the various ways in which he believes Issa's inquiry to be shortsighted. Some engage the Congressman's suggestions that the NIH should be focusing its attention and money on health problems that directly affect the United States (the techniques used to study Russian alcoholics are aimed less at protecting the drinkers themselves than their "unknowing partners," Samet said; the HIV epidemic is one of many factors that could further destabilize Russia, which could have significant political and economic implications for the U.S.; HIV can lead to the spread of tuberculosis, which is not contained within borders, etc.).

But after ticking through those rebuttals to Issa's arguments, Samet stops himself, as did Bonita Stanton, chair of pediatrics at Wayne State University, in discussing the work of Xiaoming Li, whose five-year, $2.6 million grant was also on Issa's hit list. (Li is in China and could not be reached for comment.) After explaining how Li's study about models for preventing the spread of HIV among sex workers in China could have implications for young women in the U.S. and around the world, Stanton said researchers "have to be careful about going down [the] path" of justifying that their studies have implications only for Americans or for people who don't happen to have stigmatized conditions like HIV or alcoholism.

Samet joked that the House "thoughtfully considered the issue" for "about three seconds" that it took for its members to pass Issa's amendment on a voice vote; Stanton said that she "wished we had been able to speak to someone" in Issa's office about his concerns. Instead, the researchers said, the California Congressman -- and, for now, his colleagues -- decided to substitute their judgment for the "intense scrutiny of the NIH review process," as Stanton put it.

"The fact that we might have wasted an enormous amount of time, energy and money from the first three years of this grant is the trivial part of it," said Samet. "The much bigger issue is what's Congress doing mucking around with this elaborate [peer review] process they put in place."


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