Drug Development Failure: How GLP-1 Development Was Abandoned in 1990.

Many factors determine whether and when a class of therapeutic agents will be successfully developed and brought to market, and historians of science, entrepreneurs, drug developers, and clinicians should be interested in accounts of both successes and failures. Successes induce many participants and observers to document them, whereas failed efforts are often lost to history, in part because involved parties are typically unmotivated to document their failures. The GLP-1 class of drugs for diabetes and obesity have emerged over the past decade as clinical and financial blockbusters, perhaps soon becoming the highest single source of revenue for the pharmaceutical industry (Berk 2023).

Politicizing science funding undermines public trust in science, academic freedom, and the unbiased generation of knowledge.

This commentary documents how federal funding agencies are changing the criteria by which they distribute taxpayer money intended for scientific research. Increasingly, STEMM (Science, Technology, Engineering, Mathematics, and Medicine) funding agencies are requiring applicants for funding to include a plan to advance DEI ("Diversity, Equity, and Inclusion") in their proposals and to dedicate a part of the research budget to its implementation. These mandates undermine the academic freedom of researchers and the unbiased generation of knowledge needed for a well-functioning democracy.

Moderating "the great debate": The carbohydrate-insulin vs. the energy balance models of obesity.

The increased prevalence of obesity in recent decades is a topic of great scientific and medical interest, but despite many advances, the causes of this increase have not been adequately identified. In this context, two conflicting models for obesity-the carbohydrate-insulin model (CIM) and the energy balance model (EBM)-are being vigorously debated by distinct cohorts of experts in the field. The goal of this perspective is to assess this "conflict of models" from a neutral perspective.

The Diversity of Institutions Conducting Biomedical Research.

Biomedical research in the United States has contributed enormously to science and human health and is conducted in several thousand institutions that vary widely in their histories, missions, operations, size, and cultures. Though these institutional differences have important consequences for the research they conduct, the organizational taxonomy of US biomedical research has received scant systematic attention. Consequently, many observers and even participants are surprisingly unaware of important distinguishing attributes of these diverse institutions.

Publishing Biomedical Research: .

The advancement of science requires the publication of research results so other scientists may examine, confirm, and build upon them, and the publishing ecosystem that mediates this process has undergone dramatic change over recent decades. This article takes a broad view of the biomedical research publishing system from its origins in the 17th century to the present day. It begins with a story from the author's lab that illustrates a scientist's complex interactions with the publishing system and then reviews the history, growth, and evolution of scientific publishing, including several recent disruptive developments: the digital transformation, the open access (OA) movement, the creation of "predatory journals," and the emergence of preprint archives.

The Problem of Irreproducible Bioscience Research.

Over recent decades, progress in bioscience research has been remarkable, but alongside the many transformative advances is a growing concern that a surprisingly high fraction of published research cannot be reproduced by the scientific community. Though experimental and interpretive errors are unavoidable features of the scientific process, recent evidence suggests that irreproducibility is a serious issue requiring analysis, understanding, and remediation. This article reviews the meaning of research reproducibility, examines ongoing efforts to estimate its prevalence, and considers the factors that contribute to it.

Is France Once Again Looking for a Scapegoat?

On September 10, 2021, a special tribunal established by the French government launched an inquiry into the activities of former health minister Dr. Agnes Buzyn who was charged with "endangering the lives of others". It is surprising to learn of this accusation and inquiry into the actions of a public health official whose response to the epidemic was, to all appearances, exemplary.

Misconduct in Bioscience Research: a 40-year perspective.

Fraud in biomedical research, though relatively uncommon, damages the scientific community by diminishing the integrity of the ecosystem and sending other scientists down fruitless paths. When exposed and publicized, fraud also reduces public respect for the research enterprise, which is required for its success. Although the human frailties that contribute to fraud are as old as our species, the response of the research community to allegations of fraud has dramatically changed.

Insulin: A pacesetter for the shape of modern biomedical science and the Nobel Prize.

Background: The 100th anniversary of the discovery of insulin in Toronto in 1921 is an important moment in medical and scientific history. The demonstration that an extract of dog pancreas reproducibly lowered blood glucose, initially in diabetic dogs and then in humans with type 1 diabetes, was a medical breakthrough that changed the course of what was until then a largely fatal disease. The discovery of the "activity", soon named "insulin", was widely celebrated, garnering a Nobel Prize for Banting and McLeod in 1923.

The US Health Provider Workforce: Determinants and Potential Paths to Enhancement.

The health provider workforce is shaped by factors collectively influencing the education, training, licensing, and certification of physicians and allied health professionals, through professional organizations with interlocking and often opaque governance relationships within a state-based licensing system. This system produces a workforce is that is insufficiently responsive to current needs and opportunities, including those created by new technologies. This lack of responsiveness reflects the complex, nontransparent, and cautious nature of the controlling organizations, influenced by the economic interests of the organized professions, which seek protection from competitors both local and international.

Might β3-adrenergic receptor agonists be useful in disorders of glucose homeostasis?

Brown and beige adipose tissues contain thermogenic fat cells that can be activated by β3-adrenergic receptor agonists. In rodents, such drugs both diminish obesity and improve glucose homeostasis. In this issue of the JCI, O'Mara et al.

Liver-derived FGF21 is essential for full adaptation to ketogenic diet but does not regulate glucose homeostasis.

Background: Fibroblast growth factor 21 (FGF21) is expressed in several metabolically active tissues, including liver, fat, and acinar pancreas, and has pleiotropic effects on metabolic homeostasis. The dominant source of FGF21 in the circulation is the liver.

Objective And Methods: To analyze the physiological functions of hepatic FGF21, we generated a hepatocyte-specific knockout model (LKO) by mating albumin-Cre mice with FGF21 flox/flox (fl/fl) mice and challenged it with different nutritional models.

Credit and Priority in Scientific Discovery: A Scientist's Perspective.

Credit for scientific discovery plays a central role in the reward structure of science. As the "currency of the realm," it powerfully influences the norms and institutional practices of the research ecosystem. Though most scientists enter the field for reasons other than desiring credit, once in the field they desire credit for their work.

Starvation in the Midst of Plenty: Reflections on the History and Biology of Insulin and Leptin.

Insulin and leptin are critical metabolic hormones that play essential but distinct roles in regulating the physiologic switch between the fed and starved states. The discoveries of insulin and leptin, in 1922 and 1994, respectively, arose out of radically different scientific environments. Despite the dearth of scientific tools available in 1922, insulin's discovery rapidly launched a life-saving therapy for what we now know to be type I diabetes, and continually enhanced insulin therapeutics are now effectively applied to both major forms of this increasingly prevalent disease.

Deficiency of fibroblast growth factor 21 (FGF21) promotes hepatocellular carcinoma (HCC) in mice on a long term obesogenic diet.

Objective: Non-alcoholic fatty liver (NAFL) associated with obesity is a major cause of liver diseases which can progress to non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Fibroblast growth factor 21 (FGF21) plays an important role in liver metabolism and is also a potential marker for NAFL. Here we aimed to test the effect of FGF21 deficiency on liver pathology in mice consuming a conventional high fat, high sucrose (HFHS) obesogenic diet for up to 52 weeks.

Dealing with Consequences of Irreproducibility and Modifying the Published Literature: Retractions versus Revisions.

One of the barriers to revising the literature when new data are produced, demonstrating the lack of reproducibility of particular published findings, is the stigma associated with the current tools available, most notably the use of retractions. We suggest an additional tool: revisions, which could be linked to prior manuscripts by the original authors and by others (upon peer review). We hope new approaches such as the ability to revise prior reports will help to keep the literature up-to-date and representative of the most complete understanding of an issue.

Fibroblast growth factor 21 (FGF21) is robustly induced by ethanol and has a protective role in ethanol associated liver injury.

Objective: Excess ethanol consumption has serious pathologic consequences. In humans, repeated episodes of binge drinking can lead to liver damage and have adverse effects on other organs such as pancreas and brain. Long term chronic consumption of ethanol can also result in progressive alcoholic liver disease and cirrhosis.

Categorizing biomedical research: the basics of translation.

As biomedical research has evolved over the past century, the terminology employed to categorize it has failed to evolve in parallel to accommodate the implications of these changes. In particular, the terms basic research and translational research as used today in biomedicine seem especially problematic. Here we review the origins of these terms, analyze some of the conceptual confusions attendant to their current use, and assess some of the deleterious consequences of these confusions.

Beta-adrenergic receptors are critical for weight loss but not for other metabolic adaptations to the consumption of a ketogenic diet in male mice.

Objective: We have previously shown that the consumption of a low-carbohydrate ketogenic diet (KD) by mice leads to a distinct physiologic state associated with weight loss, increased metabolic rate, and improved insulin sensitivity [1]. Furthermore, we identified fibroblast growth factor 21 (FGF21) as a necessary mediator of the changes, as mice lacking FGF21 fed KD gain rather than lose weight [2]. FGF21 activates the sympathetic nervous system (SNS) [3], which is a key regulator of metabolic rate.

Leptin's Physiologic Role: Does the Emperor of Energy Balance Have No Clothes?

The discovery of the obese gene and the demonstration that its encoded protein leptin can reverse obesity due to genetic deficiency of the hormone were landmark discoveries in endocrinology and metabolism. Regarding leptin's role in physiology, it is now established that falling leptin levels are a key signal of the starved state in mice and humans. Repleting leptin reverses the starvation signal both in physiologic starvation and in obesity resulting from genetic leptin deficiency.