Posted on by rjonakait

The Texas Tragedy

Does Trump bear responsibility for deaths in the Texas floods? Do Elon and Doge? They recklessly slashed government, including the National Weather Service. (Funny how Musk was a genius when upending departments, but now, according to Trump, he is off the rails. Mature people don’t change that radically in only a few months.) We do know that the NWS was understaffed in Texas, but we can’t know how results would have been different if positions had not been vacant.

The harm from Trump policies will often be unknowable. How much will farmers and others be hurt by cuts to weather forecasting? We can’t really know.

Trump, Musk, and Kennedy, Jr., have decimated the National Institutes of Health. We can assume discoveries will not be made that would have been made without the chainsaw, but we don’t know what those discoveries would have been.

Trump is transforming FEMA. Will recoveries from natural disasters be…well, more disastrous? That may be almost impossible to measure.

Sometimes we might be able to assess damage. How have telephone wait times increased after cuts to the IRS? But often the measurable harm will not be known for a while. IRS revenue collection may drop but that will take time to learn. Sometimes the harm will happen only after the Trump presidency ends (and IT WILL END). We won’t know about deaths or illnesses from the vaccine and other health policies of the HHS. Already consequential, the full effects of the decimation of USAID will not be known for a long time.

Sometimes the consequences will be hidden from us. Tariffs are akin to a sales tax, but unlike the sales tax, the consumer will not see the explicit cost of tariffs at checkout. We will only see the new list price of the product. And we won’t see some business practices that tariffs encourage. For example: A friend runs an upscale sportswear company. During Trump’s first term, he made shirts in China for the American market. Trump instituted a fifteen percent duty on such goods. The retailer for the friend’s product had been charging $145 for each shirt. A fifteen percent increase would have been $167. The retailer, however, decided to use the tariff to raise the price to $185. That extra $18 is also a consequence of the tariffs, but its cause is invisible to the consumer.

Sometimes trickery is used for dampening negative consequences. So, for example, Trump’s recent legislation is expected to remove many people from Medicaid. Rural hospitals that depend on Medicaid are expected to close, bringing suffering to many small communities. If the cuts to Medicaid are a good idea, they are a good idea now. Nevertheless, that Big (Beautiful? Bullshit?) Bill delays their implementation. The delay is not for any sensible policy reason. Instead, Trump and the Republicans anticipate a backlash, but they hope it won’t peak until after the midterm elections and will have waned by 2028.

This might make you (even more) cynical about Trump and Republicans, but my cynicism extends deeper. We don’t know whether more staffing at the National Weather Service or a different warning system might possibly have lessened the Texas tragedy, but we should find out. This is a job for Congress. Hearings should be held seeking information about what happened and about possible changes going forward. The goal should be to see whether new legislation is warranted. But Republicans who control Congress will not hold such hearings for fear they may suggest that Trump made mistakes. Moreover, if such hearings were held, the Democrats would not seek information but use them to score partisan points. They would be like Jim Jordan in a clip I recently saw. He was questioning New York Governor Kathy Hochul. He asked if she knew how a local sheriff had responded to an immigration issue. She predictably ducked the question, and he predictably insisted that she answer. It was all a charade. Jordan knew the answer to his question. In a real hearing, our congresspeople would be seeking information by asking questions where they did not already know the answer. When was the last time you saw that?

We should be trying to learn from the Texas tragedy, but that won’t come from Congress, for, unfortunately, this Congress is not there to solve problems.

Posted on by rjonakait

Ozempic Triumph vs. Scientific Defeat (Guest Post from the Spouse)

It has become clear in recent weeks that the “humanoid alien beings” (as a friend calls them) who run the White House have less than zero understanding of the way medical, biological, or chemical science works. It isn’t that they don’t understand scientific facts (okay, not all of us love the minutiae of alkaloid biochemistry), but they don’t understand the sociology, economics, methodology, or history of science. In particular, they don’t seem to know how scientific knowledge accumulates — tiny steps over long periods of time. As a result, the proposed layoffs and drastic funding cuts in the National Institutes of Health and the National Science Foundation threaten to bring scientific progress, particularly in medical science, to a halt.

Elon Musk may think that the design and construction of his electric car sprang full-blown from his brilliant mind. It didn’t. It was the result of incremental increases over time in the understanding of combustion engines, mechanical and electrical engineering, and so on. Similarly, most of us don’t appreciate where life-saving drugs come from, and even those of us who work or have worked in science don’t know the history of most of the drugs we take every day. I certainly didn’t. We don’t know the many, many hours of research and the many years of effort that culminate in these drugs seeing their way into the clinic. So I took a shallow dive into the history of the well-known drug Ozempic to see how it came to be.

This story goes back to research that began in the 1920’s. But, before going there, some basic human biology:

Blood sugar (glucose) levels are carefully regulated in the healthy human body. When blood sugar levels are too high, the pancreas produces insulin to encourage cells all over the body to take up that sugar and either use it or store it. When blood sugar levels are too low, the pancreas produces a different hormone, glucagon, that tells the liver that it’s time to release some of that stored glucose. It’s an important biological yin and yang. Insulin and glucagon are on two ends of a physiological seesaw, keeping sugar levels steady. If the system gets out of whack (as it does in Type 2 diabetes), too much blood sugar threatens the body with myriad catastrophes including organ failure, blindness, immune system dysfunction, etc. etc. etc. The importance of the seesaw to human health and the distressful increase in Type 2 diabetes have meant that interest in insulin and glucagon have been keen since their discovery in the 1920’s.

In the early 1980’s (more than 40 years ago and some 60 years after the discovery of insulin and glucagon) researchers at the National Institutes of Health who were interested in diabetes (already identified as a disease of the pancreas) began screening venoms for possible effects on guinea pig pancreatic cells, the insulin producers. (These days such a study would be called “a fishing expedition” and would be an unlikely candidate for funding.) It was tedious work. Nevertheless, after looking at venom from bees and wasps and snakes and such, the researchers found that venom from gila monsters (those ugly black and yellow reptiles of the US southwest) had a unique effect on pancreatic cells; the cells became enlarged and started producing lots of insulin. In short order they determined that the venom — or something in it — regulated blood sugar levels in animals. 

Around the same time, an American biologist at Massachusetts General Hospital and a Danish physiologist (working separately) were intrigued by glucagon. Reminder: Glucagon is made in the pancreas and promotes glucose release from the liver, thereby increasing blood sugar levels. However, a small piece of the glucagon molecule, which they called glucagon-like peptide-1 (GLP-1), triggered pancreatic production of insulin and…and…and seemed to suppress appetite and trigger weight loss in laboratory mice. Could this be a drug to treat diabetes and curb obesity? Side bar: the technology they used to identify this molecular “fragment” had taken its own sweet time in coming to fruition.

It was a short-ish step to determine that the substance found in gila monster venom was very like GLP-1. In the early 1990’s John Eng at the VA Center in the Bronx found a molecular look-alike to GLP-1 and named it Exendin-4. Later, a researcher at the National Institute on Aging, working with a pharmaceutical company, obtained FDA approval in 2005 for its use in Type 2 diabetes. Side bar: the technology used to purify and get the DNA sequence of this molecule had been developing on a separate track, but they couldn’t have identified the molecule without it.

But there was a problem with both GLP-1 itself and Exendin-4. They had to be injected (bad enough), but they disappeared quickly from the blood, not hanging around long enough to be very effective. Importantly, chemists at Novo-Nordisk came up with a method for changing the molecule so that it stayed active in the bloodstream. Side bar: you get the picture.

But what about obesity? This effort took a different track and gets murky in part because obesity was not yet considered a “disease” or even an eating disorder. Obesity was long considered to be the personal failure of individuals to limit their food intake and/or their refusal to exercise. Another line of research was being done leading to the realization that for many, obesity was a physiological abnormality that just might succumb to drug treatment. And so it is. In short, the same drug (semaglutide, a GLP-1 look-alike) is indicated for both Type 2 diabetes (Ozempic) and obesity (Wegovy).

People are still a bit unsure how these drugs work to increase weight loss and suppress appetite. They just know that they do. There are hints, though, that it involves direct actions in the brain. This observation, in turn, has led to the hypothesis that there could be a link between metabolic imbalance and neurodegenerative diseases such as Parkinson’s disease, Huntington’s, and/or Alzheimer’s. Clinical trials using Exendin-4 on Alzheimer’s-prone patients have begun. However, those trials and this promising line of research will be stopped when NIH research funding is stopped…as it is now.

In short, Ozempic is the result of almost 100 years of research involving incremental discoveries in physiology, chemistry, molecular biology, neuroscience, and research methodology. That’s a long time, but sometimes science takes a long time. These sorts of breakthroughs will take longer or not even occur if research funding is brought to a halt…as it is now.