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Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. Washington (DC): National Academies Press (US); 2010.

Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary.

• Hardcopy Version at National Academies Press

2 The State of Clinical Research in the United States: An Overview

The Institute of Medicine (IOM) reports To Err Is Human: Building a Safer Health System ( IOM, 2000 ) and Crossing the Quality Chasm: A New Health System for the 21st Century ( IOM, 2001a ), focused the nation’s attention on concerns about the quality of health care in the United States. Since those reports were published, efforts have accelerated to develop a health care system that systematically measures and improves the quality of care delivered. Essential to such a system is a systematic approach for assessing which clinical approaches do and do not work and then ensuring that this knowledge is utilized in clinical decision making. This approach is what is often referred to as a learning health care system.

Many different kinds of evidence can inform the policies and practices of a health care system. Clinical trials, a type of clinical research, are one of the most robust sources of this knowledge. A number of workshop speakers from many backgrounds—clinical investigators, research sponsors, practitioners, and patients—expressed the view that the current clinical research enterprise 1 in the United States is unable to produce the high-quality, timely, and actionable evidence needed to support a learning health care system. They identified numerous obstacles to producing this evidence, including the length of time and high financial cost involved in conducting clinical trials, delays associated with navigating the many regulatory and ethical requirements of studies involving human subjects (e.g., Institutional Review Board [IRB] approval), difficulties in recruiting and retaining the appropriate patient population, and the generally fragmented way clinical research is prioritized and undertaken to advance medical care in the United States.

As noted in Chapter 1 , the workshop focused on the randomized controlled trial (RCT), the gold standard in clinical research. Many consider the RCT to be unsustainable as an approach to addressing the large number of research questions that need to be answered because of the time and expense involved. Yet alternative approaches have limitations with respect to producing high-quality data. Christopher Cannon, senior investigator in the Thrombolysis in Myocardial Infarction (TIMI) Study Group, for example, discussed the use of registries, which are large databases that provide extensive observational data on current clinical practice. He commented that while registry data are of good quality and less expensive to obtain compared with data from RCTs, confounding (i.e., why an individual received one therapy versus another) is a significant problem. Because it is difficult to attribute trends in registry data to particular therapies, registries do not provide the conclusive evidence necessary to change clinical practice. Instead, registries generate hypotheses that can then be tested in an RCT. Therefore, while patient registries and other research tools exist, the workshop focused primarily on RCTs.

Results of thousands of RCTs are published each year, yet clinical decision making frequently is not based on the evidence created by these results. A key issue informing the workshop discussions, then, was how RCTs can be conducted in an efficient, timely manner to answer all of the questions and meet all of the needs of a learning health care system. A logical first step in addressing this issue is to examine the clinical research enterprise as it operates in the United States today.

This chapter describes various aspects of clinical research in the United States, beginning with clinical research networks (CRNs). Research commissioned for the workshop from Ronald Krall, former Chief Medical Officer, GlaxoSmithKline, is then presented, addressing tools available for assessing clinical research in the United States; volume and type of clinical trials conducted; the clinical investigator workforce; and the overall capacity of the clinical research enterprise.

• CLINICAL RESEARCH NETWORKS

CRNs have been developed to pool resources and expertise in conducting clinical research. They include clinical sites and investigators usually organized around a specific disease area and can be accessed by many different research stakeholders for the conduct of clinical research.

The National Institutes of Health’s (NIH’s) Roadmap for Medical Research points specifically to CRNs and their ability to rapidly conduct high-quality studies as a way to improve the efficiency and productivity of the clinical research enterprise. In this vein, NIH’s National Center for Research Resources (NCRR) manages the Inventory and Evaluation of Clinical Research Networks (IECRN) project to survey active networks and characterize best practices that could potentially be implemented in other networks or clinical trial settings. Although the exact structures vary, the NIH project defines a CRN as an organization of clinical sites and investigators that conducts or intends to conduct multiple collaborative research protocols. CRNs can carry out a number of different types of studies, including clinical trials, and the organization of sites and investigators can be formal or informal as long as the collaborative accomplishments of the group are clear. For instance, a group of researchers that conducts a single trial and subsequently disbands is not considered to be a network ( NCRR, 2006 ).

By pooling the resources of multiple entities, CRNs can realize efficiencies in implementing and conducting clinical trials. They create a supportive infrastructure for investigators and can facilitate the rapid conduct of trials to answer important research questions. For instance, CRNs organized around a particular disease often have access to patients with that disease who can serve as study participants. The in-house scientific leadership of CRNs can also streamline the protocol development process and create uniformity in clinical trials across the network or disease area. When clinical trials from a particular network generate consistent results, this can also accelerate the drug development pipeline for the disease studied.

TOOLS FOR ASSESSING CLINICAL RESEARCH IN THE UNITED STATES 2

Krall obtained information on the current state of clinical trials in the United States from various public and private sources. A key source was data on submissions to clinicaltrials.gov, a federally sponsored, publicly available registry of clinical trials. Information was also obtained from the Tufts Center for the Study of Drug Development, KMR Group, Citeline, and individual pharmaceutical companies. The Tufts Center and KMR collect data from pharmaceutical companies for the purpose of providing benchmarking data and proprietary analyses. Citeline is a proprietary data source that draws from a number of resources (literature, advertising, and clinicaltrials.gov) to create a comprehensive database of clinical research and the global investigator workforce.

Clinicaltrials.gov

The Food and Drug Administration Modernization Act (FDAMA) of 1997 mandated the creation of the clinicaltrials.gov registry for efficacy trials in serious and life-threatening conditions and interventions regulated by the FDA. Developed by NIH’s National Library of Medicine (NLM) in 2000, it allows interested parties to find information on both completed and ongoing clinical trials. The database includes federally and privately supported clinical trials, and study sponsors are responsible for submitting timely and accurate information about their studies.

The database registered a modest number of clinical trials in its initial years ( Figure 2-1 ). A dramatic increase in trial registration came in 2005 in response to the newly introduced International Committee of Medical Journal Editors’ (ICMJE’s) requirement that studies published in their journals be registered in clinicaltrials.gov or other equivalent publicly available registries. The Food and Drug Administration Amendments Act (FDAAA) of 2007 created a legal requirement for the registration of trials of drugs, biologics, and devices, generating a modest increase in the registration of trials over what had been seen in 2005. Given the increasing number of trials registered on clinicaltrials.gov over time, the database encompasses a broad spectrum of research organized by study sponsor (industry, government, and nonprofit), disease and treatment being studied, and trial design.

Timeline reflecting the number of clinical trials registered on clinicaltrials.gov and regulatory changes affecting the database registration from 2001 to 2009. SOURCE: Krall, 2009. Reprinted with permission from Ronald Krall 2009.

Data Limitations

The information gathered by Krall to inform the workshop discussions of the state of the U.S. clinical research enterprise was not intended to provide an exhaustive analysis of the impact of every role and action of the broad range of research stakeholders involved. Rather, the goal was to highlight the productivity of one aspect of the clinical research enterprise—clinical trials. The data gathered reflect not the “effectiveness” of trials in terms of how well they answer the study questions, but how efficiently they are conducted. The commissioned research was designed to meet the needs of the workshop, however, the topics covered and issues raised by Krall’s analysis could be informative for other areas of the clinical research enterprise as well.

The data collected have some limitations. With respect to certain industry information, individual pharmaceutical company data can vary significantly depending on how the various elements and costs of clinical trials are measured. Also, although NLM reviews information submitted to the clinicaltrials.gov database, neither the accuracy of the data nor the scientific relevance of the study is guaranteed. Thus, while the information gathered on the number and type of clinical trials being conducted today is revealing, it would be incorrect to assume that it reflects the quality or relevance of those trials. Krall also noted that some types of clinical trials do not need to be reported to the database, and that there are concerns about the timeliness and accuracy of the data that are submitted. Variability in the reporting and classification of certain data elements in clinicaltrials.gov (e.g., drugs vs. biologics, phases of research, reporting no funding source, and currency of investigator site information) is another concern. Yet while clinicaltrials.gov is not without limitations, Krall suggested that its creation is undoubtedly a positive step toward developing a clearer picture of the state of clinical research in the United States.

• VOLUME AND TYPE OF CLINICAL TRIALS CONDUCTED

In RCTs, investigators control which participants receive the study treatment by assigning them at random to a particular experimental study group. Observational, non-experimental studies occur in natural settings and involve no manipulation of the interventions or treatments study participants receive. Because RCTs were the focus of the workshop, observational studies were excluded from Krall’s analysis.

Krall reported that as of August 16, 2009, there were 10,974 ongoing, interventional clinical trials with at least one U.S. center. The 10,974 ongoing trials collectively are seeking to enroll 2.8 million subjects. As Figure 2-2 indicates, the majority of trials (59 percent) are testing drugs. A distant second and third to drug interventions are behavioral trials (10 percent) and those testing biologics (9 percent), respectively.

Percentage of the 10,974 ongoing clinical trials and 2.8 million study subjects being sought by intervention being tested. SOURCE: Krall, 2009. Reprinted with permission from Ronald Krall 2009.

Clinical Trials by Phase of Research

The phase of clinical trials (i.e., phases 0-IV; see Chapter 1 ) is considered by some to be a marker of innovation, reported Krall. An analysis of clinical research by phase of experimental clinical trials can indicate the degree to which innovative new therapies are being developed and tested. It takes 10–15 years for a typical drug to be developed successfully from discovery to registration with the FDA. In the earlier phases of research, the chance of a drug reaching patients is small—approximately 1 in 10. In phase III research, however, the odds of registering a new product improve. About two-thirds of drugs that reach pivotal phase III trials will make it to the market ( IOM, 2009c . 85).

To characterize trials by phase more precisely, Krall narrowed the focus of his research to trials for FDA-regulated interventions (drugs, biologics, devices, and dietary supplements). In these FDA-regulated categories, there are 8,386 trials recruiting 1.9 million subjects. As shown in Figure 2-3 , among clinical trials for FDA-regulated products, phase II research is the largest category, followed closely by phase IV. Also referring to Figure 2-3 , although there are larger numbers of phase II and III trials, phase III trials by design involve the largest number of participants; thus it makes sense that 52 percent of all subjects are enrolled in these pivotal trials.

Number of the 8,386 clinical trials involving FDA-regulated products and 1.9 million study subjects being sought for these trials by phase of research. SOURCE: Krall, 2009. Reprinted with permission from Ronald Krall 2009.

Clinical Trials by Disease

Krall described ongoing clinical trials in the four disease areas of focus at the workshop—cardiovascular disease, depression, cancer, and diabetes. Figure 2-4 indicates that approximately half of the 10,974 trials being conducted today are in cancer; however, each such trial involves a relatively small number of participants. Figure 2-4 also reveals that cardiovascular disease trials are seeking more than 300,000 participants—10 percent of all clinical trial participants being recruited and far more than the number of participants sought for cancer, diabetes, or depression trials. Recruiting a large number of subjects per trial is a trademark of cardiovascular disease studies: on average, 275 patients are sought per cardiovascular trial, as compared with 20 patients per cancer trial, 70 patients per depression trial, and 100 per diabetes trial.

Number of the 10,974 ongoing clinical trials and 2.8 million study subjects being sought by disease being studied. NOTE: CV Disease = cardiovascular disease. SOURCE: Krall, 2009. Reprinted with permission from Ronald Krall 2009.

• THE CLINICAL INVESTIGATOR WORKFORCE

Annual surveys from the Tufts Center for the Study of Drug Development indicate a consistently high turnover rate in the clinical investigator community. Investigators conducting a clinical trial to support a New Drug Application (NDA) or a change in labeling are required to complete FDA’s Form 1527. In 2007, 26,000 investigators registered this form with the FDA, 85 percent of whom participated in only one clinical trial. The issues facing clinical investigators were discussed throughout the workshop, and many participants echoed the theme of the Tufts data—it is difficult to conduct clinical trials in the United States and establish a career as a clinical investigator. While opportunities in clinical investigation can vary depending on whether or not an investigator is working in private practice or academia, for example, the challenges to successfully conducting a clinical trial in the United States are substantial. Making clinical investigation an attractive career option for academics and professionals was mentioned by a number of participants as an important component of any approach to improving the capacity of the clinical trials enterprise in the United States.

Globalization

In addition to high turnover, the U.S. clinical investigator workforce is subject to an absolute decrease in its ranks. While there has been an annual decline of 3.5 percent in U.S.-based investigators since 2001, there has been an increase in investigators outside the United States. Figure 2-5 reveals that investigators from the rest of the world increased steadily between 1997 and 2007, making up for the decline in North American investigators over the same period. As of 2007, U.S. investigators constituted 57 percent of the global investigator workforce, a decrease from approximately 85 percent in 1997. According to the Tufts data, there are an estimated 14,000 U.S. investigators, compared with an estimated 12,000 investigators outside the United States. Currently, 8.5 percent of investigators are from Central and Eastern Europe, 5.5 percent from Asia, and 5.5 percent from Latin America.

The proportion of clinical investigators from North America has decreased since 1997, while the proportion of investigators from Western Europe and the rest of the world has increased. SOURCE: Tufts Center for the Study of Drug Development. 2009. Impact (more...)

Finally, Krall noted the difference between the role of a clinical investigator (i.e., the person who establishes the hypotheses to test, designs the trial, analyses and reports the results) and that of the individual who finds patients to participate in a trial and collects information about them. The latter role is essential to the ability to carry out research and should be recognized, rewarded, and developed to a greater degree, according to Krall. Workshop presenters and participants echoed Krall’s sentiment later in the day by discussing the many different levels of staff, in addition to the principal investigator, that ultimately make a clinical trial successful.

• CAPACITY OF THE CLINICAL RESEARCH ENTERPRISE

KMR data from 2006 for the 15 largest pharmaceutical companies show that the majority of patient visits associated with an industry-sponsored clinical trial occur outside the United States. According to Krall, this statistic speaks to the costs and difficulty associated with conducting clinical research in the United States. In terms of cost-effectiveness, 860 patient visits occur in the United States per $1 million spent on clinical operations, whereas for the same cost, 902 patient visits occur outside of the United States. Thus, by the measure of cost per patient visit, U.S.-based clinical trials are not as cost-effective as those in the rest of the world. Krall urged caution in interpreting these data, however, given the high degree of variability among pharmaceutical companies in patient visit and cost measures.

U.S. investigators enroll two-thirds as many subjects into clinical trials as investigators in the rest of the world. Among U.S. investigators participating in a clinical trial, 27 percent fail to enroll any subjects, compared with 19 percent of investigators elsewhere. Investigator performance in the United States and the rest of the world is similar in that 75 percent of investigators fail to enroll the target number of subjects; also, 90 percent of all clinical trials worldwide fail to enroll patients within the target amount of time and must extend their enrollment period. Krall commented that these data on patient enrollment are from one pharmaceutical company but that, based on his industry experience and conversations with colleagues from other companies, he believes the data are generally consistent with the pharmaceutical industry as a whole.

According to clinicaltrials.gov data, clinical trials today call for the enrollment of 1 in every 200 Americans as study participants. Because this is such a remarkable undertaking, Krall questioned whether this high level of human participation is being put to the best use possible—that is, are the right questions being asked through the thousands of clinical trials being conducted today?

The clinical research enterprise is a broad term that encompasses the full spectrum of clinical research and its applications. It includes early-stage, laboratory research and the processes, institutions, and individuals that eventually apply research to patient care ( IOM, 2002 ).

The remainder of this chapter is based on the presentation of Dr. Krall.

• Cite this Page Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. Washington (DC): National Academies Press (US); 2010. 2, The State of Clinical Research in the United States: An Overview.
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2023-2024 Best Medical Schools: Research

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A medical career starts with finding the program that best fits your needs. With the U.S. News rankings of the top medical schools for research, narrow your search by location, tuition, school size and test scores. Footnotes below specify schools that declined to fill out the U.S. News statistical survey. Please review our methodology to see how those schools' data were used in the ranking. Read the methodology »

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Here are the 2023-2024 Best Medical Schools: Research

Harvard university, johns hopkins university, university of pennsylvania (perelman), columbia university, duke university, stanford university, university of california--san francisco, vanderbilt university, washington university in st. louis.

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• # 1 in Best Medical Schools: Research

$66,284 (full-time) TUITION AND FEES

699 ENROLLMENT (FULL-TIME)

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Philadelphia , PA

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626 ENROLLMENT (FULL-TIME)

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New York , NY

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Durham , NC

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Cornell University (Weill)

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The Anatomy of Medical Research : US and International Comparisons

• 1 The Alerion Institute and Alerion Advisors LLC, North Garden, Virginia
• 2 Johns Hopkins School of Medicine, Baltimore, Maryland
• 3 Boston Consulting Group, Boston, Massachusetts
• 4 University of Rochester School of Medicine, Rochester, New York
• 5 Stanford University School of Medicine, Stanford, California
• Editorial Restore the US Lead in Biomedical Research Victor J. Dzau, MD; Harvey V. Fineberg, MD, PhD JAMA
• Editorial Scientific Discovery and the Future of Medicine Phil B. Fontanarosa, MD, MBA; Howard Bauchner, MD JAMA

Importance   Medical research is a prerequisite of clinical advances, while health service research supports improved delivery, access, and cost. Few previous analyses have compared the United States with other developed countries.

Objectives   To quantify total public and private investment and personnel (economic inputs) and to evaluate resulting patents, publications, drug and device approvals, and value created (economic outputs).

Evidence Review   Publicly available data from 1994 to 2012 were compiled showing trends in US and international research funding, productivity, and disease burden by source and industry type. Patents and publications (1981-2011) were evaluated using citation rates and impact factors.

Findings   (1) Reduced science investment: Total US funding increased 6% per year (1994-2004), but rate of growth declined to 0.8% per year (2004-2012), reaching $117 billion (4.5%) of total health care expenditures. Private sources increased from 46% (1994) to 58% (2012). Industry reduced early-stage research, favoring medical devices, bioengineered drugs, and late-stage clinical trials, particularly for cancer and rare diseases. National Insitutes of Health allocations correlate imperfectly with disease burden, with cancer and HIV/AIDS receiving disproportionate support. (2) Underfunding of service innovation: Health services research receives $5.0 billion (0.3% of total health care expenditures) or only 1/20th of science funding. Private insurers ranked last (0.04% of revenue) and health systems 19th (0.1% of revenue) among 22 industries in their investment in innovation. An increment of $8 billion to $15 billion yearly would occur if service firms were to reach median research and development funding. (3) Globalization: US government research funding declined from 57% (2004) to 50% (2012) of the global total, as did that of US companies (50% to 41%), with the total US (public plus private) share of global research funding declining from 57% to 44%. Asia, particularly China, tripled investment from $2.6 billion (2004) to $9.7 billion (2012) preferentially for education and personnel. The US share of life science patents declined from 57% (1981) to 51% (2011), as did those considered most valuable, from 73% (1981) to 59% (2011).

Conclusions and Relevance   New investment is required if the clinical value of past scientific discoveries and opportunities to improve care are to be fully realized. Sources could include repatriation of foreign capital, new innovation bonds, administrative savings, patent pools, and public-private risk sharing collaborations. Given international trends, the United States will relinquish its historical international lead in the next decade unless such measures are undertaken.

• Editorial Restore the US Lead in Biomedical Research JAMA
• Editorial Scientific Discovery and the Future of Medicine JAMA

Read More About

Moses H , Matheson DHM , Cairns-Smith S , George BP , Palisch C , Dorsey ER. The Anatomy of Medical Research : US and International Comparisons . JAMA. 2015;313(2):174–189. doi:10.1001/jama.2014.15939

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Advancing Biomedical Research in the United States

By many accounts, there has never been a better time than now to do biomedical research.

Scientists can take advantage of the multiple technologies that came of age across multiple fields around the turn of the 21st century — from the advent of fast and inexpensive DNA sequencing to the leaping bounds in data science and computing power to the explosion of imaging tools. Such sweeping advances, combined with decades of painstaking molecular breakthroughs, have made it possible to determine the structure of proteins within cells for the first time, to develop possible cures for sickle cell and related diseases using CRISPR genome editing, and to build on a long record of molecular biology and vaccine research to produce COVID-19 vaccines in less than a year.

“At this point in time, you are really only limited by your creativity and your boldness,”

says Kit Pogliano, dean of biological sciences at University of California, San Diego. “You can answer just about any biological question, and the tools are developing so rapidly, especially if you love to collaborate across different disciplines,” she adds. Collaborations across different sectors — academia, the biotech and pharmaceutical industry, philanthropic organizations, and communities of patients — are also more compelling than ever before.

NIH Building One under construction, 1938 The first building constructed at the newly formed National Institutes of Health, Building One began to take shape in 1938. President Franklin Roosevelt dedicated the National Institutes of Health in 1940 at the top of the stairs leading to the entrance. Building One, later named the James H. Shannon building in honor of NIH’s director from 1955 to 1968, now houses the Office of the Director among other administrative offices. Courtesy of National Institutes of Health

Biomedical research has arrived at this moment globally in no small part because of the ongoing federal funding and fierce advocacy in the United States. “We are seeing the fruits of 75 years of steady investment at the National Institutes of Health (NIH) that the Lasker Foundation has been promoting,” says Elias Zerhouni, who directed the NIH from 2002 to 2008 and currently serves on the Lasker Foundation Board of Directors.

In some ways, the dream of Mary Lasker, who founded the Lasker Foundation with her husband Albert in 1942 as a medical research advocacy group, has been realized. Lasker’s dedicated lobbying of Congress to prioritize medical research put the NIH budget on a mostly upward trajectory starting in the late 1950s. The agency became a model for countries around the world setting up their own national systems for funding science. Prior to World War II, biomedical researchers had to rely primarily on funding from state governments or private philanthropic groups, such as the Rockefeller Foundation.

But many warn that the US is now in danger of losing its edge — not just in biomedical science but in all science and technology (S&T). The nation’s investment in research and development has been hovering around 2.5% of its GDP (gross domestic product) for the last few decades, whereas the amount of GDP invested into S&T by other countries, particularly China and Korea, has been on the rise, as outlined in a 2020 report, The Perils of Complacency, by the American Academy of Arts & Sciences (AAAS) and Rice University. The report cautions that the United States is at a tipping point for becoming less competitive with countries such as China in its S&T research enterprise, and thus in its ability to create jobs and improve healthcare and overall quality of life.

According to Zerhouni, who was part of the committee that created the AAAS report, the most pressing need is to increase federal funding of physical sciences, especially federal agencies such as the National Science Foundation (NSF). Although the NSF does not fund biomedical research directly, it supports all other S&T disciplines, including other biological sciences. These fields have made enormous contributions to biomedical science and are critical to interdisciplinary or convergent research.

There is no question that the stakes are high. “We are in two global competitions right now — one is a competition against China and India and Europe,” says Sudip Parikh, chief executive officer (CEO) of the American Association for the Advancement of Science. “The second competition that we are in is against time, against the economic tidal wave that is coming from Alzheimer’s, cancer, and aging [diseases],” he adds.

Same Mission, Updated Strategies

The mission of the NIH, NSF, and other federal agencies has remained steadfast since the middle of the 20th century, when the US government committed to continuing its wartime support of scientific research. These agencies aim to promote scientific progress and support advances and discoveries that improve health and prosperity. That may sound ambitious, but the NIH can point to many examples of how it has fulfilled its mission over the decades — the most poignant of all may be its response to the COVID-19 pandemic.

Three NIH directors, Elias A. Zerhouni (left), Francis Collins (middle), Harold E. Varmus (right) led the last 28 years of the federal agency. Courtesy of Chia-Chi Charlie Chang

The good news in recent years is that the NIH budget for funding extramural (not conducted on NIH campuses) biomedical research has been rebounding — growing 2% to 5% annually since 2014, following a 10-year stagnation — allowing the agency to diversify the types of research programs and teams it supports. However, these increases still do not allow the agency to award as many research grants as in the past — the success rate of NIH grants in 2020 was 21%, compared with 31% in 2003. ACT for NIH, a biomedical research advocacy organization, recommends that the NIH budget increases 10% in 2022, which would finally make up for inflationary loss since the early 2000s. In the longer term, ACT for NIH is trying to make the case to members of Congress to fund another NIH budget doubling (as Congress did from 1998 to 2003), arguing that the agency would then be able to support research at the scale needed to turn the many recent technological advances into medicines, such as immunotherapy for cancer and mRNA-based vaccines for infectious disease.

Despite its unwavering mission, the NIH has made some tweaks in how it operates over the years. A recent change was inspired by the rapid progress that NIH-funded sciences made during the pandemic, dissecting the SARS-CoV-2 virus and paving the way for diagnostics, treatments, and vaccines. “Never before have we seen research move to practice at this fast a clip,” says Marina L. Volkov, director of the NIH Office of Evaluation, Performance, and Reporting. “What can we learn from the pandemic; what were the active ingredients?” she says.

There will be a stepped-up focus on self-assessment of the NIH’s impact in the upcoming NIH Strategic Plan (2021–2025). There will also be greater emphasis than in the previous plan (2016–2020) on supporting the scientific workforce and physical infrastructure such as research facilities.

Undergraduate Angela Jimenez (foreground right) and PhD student Joscelyn Mejias (foreground left) conduct National Science Foundation-supported research at Georgia Tech to develop therapeutic cells. The lab is one of four NSF Engineering Research Centers working to develop new technologies that support health and energy research. Courtesy of Rob Felt, Georgia Tech

Similar to the NIH, the NSF has been making adjustments in how it strives to achieve its mission. The agency, which accounts for about 2% of the federal investment in health and medicine research and development, compared with the NIH’s 82%, has been working to bolster funding for convergence research since the 1990s, through mechanisms such as Big Ideas and RAISE grants. “I think you’ll see more and more of that coming,” says Theresa Good, a program director in the NSF Biological Sciences Directorate.

Divvying Up the Pie: How to Make Research Support Fairer?

Many have sounded the alarm in recent years that the NIH needs to combat the growing disparity in research funding. Recent reports have found that 40% of NIH research dollars go to only about 10% of academic investigators, and they tend to be senior investigators at prestigious research institutions. One idea floated in 2017 and quickly thrown out, was to cap the number of R01s — the NIH’s most common type of grant — that any one investigator could have to free up money for other investigators.

However, some point out that ambitious research costs more than ever, and investigators need more grant money than ever. Many projects today aim to synthesize the myriad molecular discoveries of previous decades about individual components of a biological system, such as single genes or proteins. “We’ve gone from a reductionist phase to integrationist [approaches] where we integrate all the knowledge,” Zerhouni says. This kind of research can be expensive because it involves big groups, often coming together from different disciplines, such as computer scientists and engineers working with biologists.

The rising cost of doing biomedical research can make things even more stressful for academic scientists, who generally have to apply every few years for new or renewed grants. The philosophy of the Howard Hughes Medical Institute (HHMI), a US-based philanthropic medical research organization, which provides long-term support to over 250 US-based investigators, is to invest in “people, not just projects” and to do so based on the investigators’ track records. This type of support frees scientists from the pressure of regularly applying for grants, says David Clapham, vice president and chief scientific officer. As a result, they can pursue fundamental, less application-focused questions, which must nevertheless be answered before we can find disease treatments. Centers such as the Stowers Institute in Kansas City, MO, and the Scripps Research Institute in La Jolla, CA, and Jupiter, FL, can also accomplish this goal, Clapham says, because they have large endowments and let scientists loose to explore basic biological processes.

One of the newer types of NIH grant mechanisms, MIRA (short for Maximizing Investigators’ Research Awards), which was launched by the National Institute of General Medical Sciences (NIGMS) five years ago, seems to take a page out of the HHMI playbook: It provides longer-term funding, and thus more stability and research freedom. Each NIH institute has leeway to decide how to spend its congressionally determined piece of the NIH budget pie. Although other Institutes have created HHMI-like mechanisms, MIRA is special because it limits the amount of NIGMS funding that an investigator can receive, similar to the NIH-wide quota idea in 2017.

Following the Money: Funding from Industry and Philanthropy

For scientists pursuing biomedical research with possible clinical applications, there are increasing opportunities to get funding from industry and philanthropic groups and move discoveries beyond the walls of academic labs. The biggest gains in spending on health and medical research in the United States in recent years have come from industry, namely pharmaceutical and biotech companies, according to a recent report by Research!America, a science advocacy organization.

Following the money Top left: R&D investment as a percentage of overall US health spending (2018) Top right: US medical and health R&D expenditures by funding source (2018) Middle: Academic and research institution investment in medical and health R&D, by funding sector (2018) Bottom: Federal investment in medical and health R&D, by funding sector (2018) Courtesy of Research!America

This sector actually accounted for 67% of spending in 2018, most of it supporting clinical and applied research, while 22% came from federal agencies, overwhelmingly from the NIH. Part of the reason for the rising investment from industry is that “larger [pharmaceutical] companies aren’t doing as much of the research themselves internally as they used to and so… they are looking more to academia to fuel the very earliest part of the research cycle,” says Paul Roben, associate vice chancellor of innovation and commercialization at University of California, San Diego. A company might fund an academic investigator’s entire research program in an area, such as immuno-oncology therapies, for a set period of time with clear milestones, which might be the discovery of a novel compound with certain characteristics, and then create a biotech or startup company to take the compound into early-stage clinical trials.

To help bolster the biotech stage of the academia-biotech-pharma life cycle, President Joe Biden has proposed creating a new NIH organization called ARPA-H (Advanced Research Projects Agency for Health).

“For small companies, the biggest and riskiest part is when they transition from a lab concept into product development, and that involves a lot of technology development and bioengineering that is really critical,”

as was the case for the development of COVID-19 vaccines, says Gary Nabel, president and CEO of the biotech company, ModeX Therapeutics, and former director of the NIH Vaccine Research Center. ARPA-H aims to fund the most ambitious of these types of projects, which private investors tend to shy away from. The agency’s success will depend on the budget that Congress allocates and how it decides to award grants. Nabel thinks that a model similar to that of the Department of Defense’s DARPA (Defense Advanced Research Projects Agency) could work well, in which federal and industry stakeholders agree on business plans that include a set of milestones.

The philanthropic sector contributes a much smaller piece of the pie of health and medicine investment in the United States, only about 2%, but as many point out, it is growing. And it can have outsized influence, particularly for large private foundations, such as the Bill & Melinda Gates Foundation, Chan Zuckerberg Initiative, and Simons Foundation. Philanthropy is once again providing critical support for science research, just as it did before the United States began committing federal funding in the mid-20th century, says France A. Cordova, president of the Science Philanthropy Alliance.

Overall, the interests of philanthropic individuals and groups run the gamut from basic to translational to clinical research, but one generality holds true:

“there’s a higher tolerance for risk”

says Melissa Stevens, executive director of the Milken Institute Center for Strategic Philanthropy. Stevens co-founded the Center in 2015 to help private foundations, as well as individuals, families, advocacy groups, and public charities, decide how to strategically invest in research on health, medicine, education, and the environment. Philanthropists may want to support basic research to tease out the biological underpinnings of a poorly understood disease to de-risk that field of study, she explains. Or they may want to support otherwise underfunded preclinical or early clinical research in academic labs and biotech companies, with the hope of generating data to entice pharmaceutical or venture capital investment, she explains. As Cara Altimus, Stevens’s colleague at the Milken Center, notes, philanthropy can be particularly successful in this so-called Valley of Death space, often by infusing a small biotech company with research support to advance a discovery along the development pipeline.

What Does the Future Hold for US Biomedical Research?

Despite concerns that the United States is not doing enough to maintain its S&T powerhouse status or to maintain its competitive edge with China and Korea, there may be some reasons for optimism. “I am actually pretty bullish that we are going to see much larger increases for NIH this year,” says Parikh. That is because budget sequestration is over, and Congress appreciates more than ever the need to support science to stay competitive with other countries and be positioned to find the next big thing — whether it is a new genome-editing technology or a platform for rapid vaccine development for the next pandemic.

Alondra Nelson, Harold F. Linder Professor in the School of Social Science at the Institute for Advanced Study and President of the Social Science Research Council (SSRC), has been appointed to the position of Deputy Director for Science and Society in the Office of Science and Technology Policy. Nelson will be the first person in this role, which brings social science expertise explicitly into the work of federal science and technology strategy and policy. Courtesy of Ragesoss

In another positive sign that the US government is prioritizing science, President Biden elevated the director of the Office of Science and Technology Policy (OSTP), Eric Lander, to a Cabinet position, a first for the White House. One of the major goals of the OSTP is to improve the diversity of the scientific workforce. As Lander explained in an interview after he was sworn in, he and Alondra Nelson, who is creating a science and society division within the OSTP, will talk with various groups about solutions to “have everybody at the lab bench.”

It will be important, according to Parikh, to put more emphasis on how the next generation of scientists will be trained to communicate their work with the public.“We are going to have 100,000 scientists who are 35 and younger who are going to be participating in their communities and building bridges with policymakers,” Parikh says.

The importance of advocacy is one of the many legacies of Mary Lasker. Starting in the late 1940s, she and her partners recruited researchers and clinicians and prepared them to make their case at congressional budget hearings for research funding. “Doctors aren’t used to selling anything,” Lasker explained, but as she emphasized, they need to step into the role because the future of biomedical research is at stake.

by Carina Storrs

How geography acts as a structural determinant of health

In unincorporated communities in the United States-Mexico borderlands, historically and socially marginalized populations become invisible to the healthcare system, showing that geography acts as a structural determinant of health for low-income populations. So concludes a study by a University of California, Riverside, team that focused its attention on the borderland in Southern California, specifically, eastern Coachella Valley.

From September to December 2020, the team, led by Ann Cheney, an associate professor of social medicine, population, and public health in the School of Medicine, conducted interviews in collaboration with María Pozar, a community investigator and CEO of Conchita Servicios de la Comunidad, with 36 Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. The researchers found communities in the "colonias" (unincorporated areas in the borderlands) lack basic critical infrastructure including healthcare access.

The U.S.-Mexico borderland is home to nearly 2.7 million Hispanic or Latinx individuals. The immigrant population in the colonias has limited English proficiency, health literacy levels, and income, and lower levels of formal education. Many are undocumented.

"Our work shows the importance of geography in health and how geography acts as a structural determinant of health," Cheney said. "For example, foreign-born caregivers who speak Spanish or Purépecha prefer to take their children across the U.S.-Mexico border for respiratory health care because physicians there provide them with a diagnosis and treatment plan that they perceive improves their children's health."

The study, published in the journal Social Science & Medicine , found the caregivers perceive U.S.-based physicians as not providing them with sufficient information since most physicians do not speak their language and do not adequately listen to or are dismissive of their concerns about their children's respiratory health. The caregivers perceive Mexican-based physicians as providing them with a diagnosis and treatment plan, whereas U.S.-based physicians often prescribe medications and provide no concrete diagnosis.

"Further, only those with legal documentation status can cross the border, which contributes to disparities in children's respiratory health," Cheney said. "Thus, caregivers without legal status in the U.S. must access healthcare services in the U.S. for their children and receive, what these caregivers perceive, as suboptimal care."

Cheney added she was surprised to learn that caregivers who did not have legal documentation status in the U.S. asked trusted family and friends to take their children across the border to receive healthcare services for childhood asthma and related conditions.

"Geography, meaning living in unincorporated communities, harms health," she said. "Geography and the politics of place determines who can and cannot cross borders."

Study participants discussed the distance they needed to travel to pediatric specialty care for the care and management of their children's respiratory health problems. Some commented on the lack of interaction and communication with physicians during medical visits. Some participants commented on the lack of physicians' knowledge about the connections between their children's exposure to environmental hazards and poor respiratory health and allergic symptoms.

The research took place in four unincorporated rural communities -- Mecca, Oasis, Thermal, and North Shore -- in eastern Coachella Valley, along the northern section of the Salton Sea. People living in the colonias here are subject to the health effects of environmental hazards. Many are farmworkers living and working in the nearby agricultural fields. Most of the workforce lives in mobile parks and below the federal poverty line.

"In addition to toxic water and dust from the Salton Sea, other environmental health hazards, such as agriculture pesticide exposure, waste processing facilities, and unauthorized waste dumps, also contribute to this community's high incidence of poor respiratory health," said Gabriela Ortiz, the first author of the research paper and a graduate student in anthropology who works with Cheney. "These communities are vulnerable to the policies and governing decisions around exposure to environmental hazards and infrastructure development. The absence of infrastructure and lack of healthcare infrastructure limits their access to primary care and specialty care services."

Ortiz explained that anthropologists and social scientists have long argued that environmental injustices are a product of structural violence.

"This is indirect violence caused by social structures and institutions that prevent individuals from meeting their basic needs because of political economic domination and class-based exploitation," she said. "Understanding the complex interplay between geography, borderlands, and health is essential for coming up with effective public health policy and interventions."

The title of the research paper is "Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress."

Cheney, Ortiz, and Pozar were joined in the study by Ashley Moran and Sophia Rodriquez of UCR.

The study was funded by the National Institutes of Health/National Institute of Minority Health and Health Disparities.

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Story Source:

Materials provided by University of California - Riverside . Original written by Iqbal Pittalwala. Note: Content may be edited for style and length.

Journal Reference :

• Gabriela Ortiz, Sophia Rodriguez, María Pozar, Ashley Moran, Ann Cheney. Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress . Social Science & Medicine , 2024; 347: 116736 DOI: 10.1016/j.socscimed.2024.116736

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Helping women get better sleep by calming the relentless 'to-do lists' in their heads

Yuki Noguchi

Katie Krimitsos is among the majority of American women who have trouble getting healthy sleep, according to a new Gallup survey. Krimitsos launched a podcast called Sleep Meditation for Women to offer some help. Natalie Champa Jennings/Natalie Jennings, courtesy of Katie Krimitsos hide caption

Katie Krimitsos is among the majority of American women who have trouble getting healthy sleep, according to a new Gallup survey. Krimitsos launched a podcast called Sleep Meditation for Women to offer some help.

When Katie Krimitsos lies awake watching sleepless hours tick by, it's almost always because her mind is wrestling with a mental checklist of things she has to do. In high school, that was made up of homework, tests or a big upcoming sports game.

"I would be wide awake, just my brain completely spinning in chaos until two in the morning," says Krimitsos.

There were periods in adulthood, too, when sleep wouldn't come easily, like when she started a podcasting company in Tampa, or nursed her first daughter eight years ago. "I was already very used to the grainy eyes," she says.

Now 43, Krimitsos says in recent years she found that mounting worries brought those sleepless spells more often. Her mind would spin through "a million, gazillion" details of running a company and a family: paying the electric bill, making dinner and dentist appointments, monitoring the pets' food supply or her parents' health checkups. This checklist never, ever shrank, despite her best efforts, and perpetually chased away her sleep.

"So we feel like there are these enormous boulders that we are carrying on our shoulders that we walk into the bedroom with," she says. "And that's what we're laying down with."

By "we," Krimitsos means herself and the many other women she talks to or works with who complain of fatigue.

Women are one of the most sleep-troubled demographics, according to a recent Gallup survey that found sleep patterns of Americans deteriorating rapidly over the past decade.

"When you look in particular at adult women under the age of 50, that's the group where we're seeing the most steep movement in terms of their rate of sleeping less or feeling less satisfied with their sleep and also their rate of stress," says Gallup senior researcher Sarah Fioroni.

Overall, Americans' sleep is at an all time low, in terms of both quantity and quality.

A majority – 57% – now say they could use more sleep, which is a big jump from a decade ago. It's an acceleration of an ongoing trend, according to the survey. In 1942, 59% of Americans said that they slept 8 hours or more; today, that applies to only 26% of Americans. One in five people, also an all-time high, now sleep fewer than 5 hours a day.

Popular myths about sleep, debunked

"If you have poor sleep, then it's all things bad," says Gina Marie Mathew, a post-doctoral sleep researcher at Stony Brook Medicine in New York. The Gallup survey did not cite reasons for the rapid decline, but Mathew says her research shows that smartphones keep us — and especially teenagers — up later.

She says sleep, as well as diet and exercise, is considered one of the three pillars of health. Yet American culture devalues rest.

"In terms of structural and policy change, we need to recognize that a lot of these systems that are in place are not conducive to women in particular getting enough sleep or getting the sleep that they need," she says, arguing things like paid family leave and flexible work hours might help women sleep more, and better.

No one person can change a culture that discourages sleep. But when faced with her own sleeplessness, Tampa mom Katie Krimitsos started a podcast called Sleep Meditation for Women , a soothing series of episodes in which she acknowledges and tries to calm the stresses typical of many women.

Shots - Health News

Many grouchy, error-prone workers just need more sleep.

That podcast alone averages about a million unique listeners a month, and is one of 20 podcasts produced by Krimitsos's firm, Women's Meditation Network.

"Seven of those 20 podcasts are dedicated to sleep in some way, and they make up for 50% of my listenership," Krimitsos notes. "So yeah, it's the biggest pain point."

Krimitsos says she thinks women bear the burdens of a pace of life that keeps accelerating. "Our interpretation of how fast life should be and what we should 'accomplish' or have or do has exponentially increased," she says.

She only started sleeping better, she says, when she deliberately cut back on activities and commitments, both for herself and her two kids. "I feel more satisfied at the end of the day. I feel more fulfilled and I feel more willing to allow things that are not complete to let go."

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5 facts about Hispanic Americans and health care

Hispanic Americans have long faced health care challenges in the United States, including lower health insurance coverage rates and less access to preventative care.

Language and cultural barriers, as well as higher levels of poverty, are among the social and economic factors contributing to disparate health outcomes for Hispanic Americans. These disparities were apparent during the early stages of the COVID-19 pandemic , when Hispanics were far more likely than White Americans to have died from the virus .

Pew Research Center conducted this analysis to highlight Hispanic Americans’ attitudes about and experiences with health care. We surveyed U.S. adults from Nov. 30 to Dec. 12, 2021, including 3,716 Hispanic adults (inclusive of those who identify as any race). A total of 14,497 U.S. adults completed the survey.

The survey was conducted on the Center’s American Trends Panel (ATP) and included an oversample of Black and Hispanic adults from the Ipsos KnowledgePanel. Respondents on both panels are recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the  ATP’s methodology .

Here are the survey  questions used for this analysis , along with responses, and its methodology .

This study was informed by a group of advisers with expertise related to Black and Hispanic Americans’ attitudes and experiences in science, health, STEM education and other areas. Pew Research Center remains solely responsible for all aspects of the research, including any errors associated with its products and findings.

This analysis includes additional information from sources including KFF and the U.S. Census Bureau. Further information about these sources can be found through the links in the text.

Here are five key facts about Hispanic Americans and health care, based on a 2021 Pew Research Center survey of Hispanic adults and other sources:

Hispanic adults are less likely than other Americans to have seen a health care provider recently and to have a primary care provider. Seven-in-ten say they’ve seen a doctor or other health care provider in the past year, compared with 82% among Americans overall. Hispanics are also slightly less likely than Americans overall to say they have a primary care provider (68% vs. 76%).

Health care access among Hispanic immigrants differs markedly based on how long they have lived in the U.S. More recent arrivals are less likely than those who have been in the country longer to have seen a doctor recently and to have a primary care provider. For example, 48% of Hispanic immigrants who have been in the U.S. for a decade or less report having a primary care provider, compared with 79% among those who have been in the U.S. for more than two decades.

Recent arrivals make up a declining share of Hispanic immigrants in the U.S. And more broadly, immigrants account for a declining share of the overall U.S. Hispanic population . In 2021, they made up 32% of all Hispanic Americans, down from 37% in 2010.

Hispanic Americans are less likely than people of other racial and ethnic backgrounds to have health insurance. As of 2021, the uninsured rate among Hispanics under age 65 was 19%, according to KFF, formerly known as the Kaiser Family Foundation . That was higher than the share among Black (11%), White (7%) and Asian Americans (6%). (These figures include rates among children as well as adults.)

While comparatively high, the uninsured rate among Hispanic Americans under age 65 in 2021 was down from 33% in 2010, before the implementation of the Affordable Care Act, according to KFF.

Lower rates of health insurance coverage play a major role in Hispanic Americans’ less frequent interactions with health care providers.

The relative youth of the U.S. Hispanic population may be another factor at play. The median age of Hispanic Americans was 30 as of 2020, compared with 41 for non-Hispanic Americans, according to the U.S. Census Bureau . Among both Hispanic and non-Hispanic Americans, younger people are less likely than their elders to have seen a health care provider recently and to have a primary care provider.

Many Hispanic Americans say worse health outcomes for Hispanics are tied to occupational and structural factors. Some 53% of Hispanic adults say a major reason why Hispanic people generally have worse health outcomes is that they’re more likely to work in jobs that put them at risk for health problems. About half (48%) say a major reason is that Hispanic people have less access to quality medical care where they live.

At least four-in-ten Hispanic adults also point to communication problems arising from language or cultural differences (44%) and preexisting health conditions (40%) as major reasons. (Majorities view all of these factors as at least minor reasons for disparate health outcomes among Hispanic adults.)

The coronavirus outbreak took an especially heavy toll on Hispanic Americans when compared with White Americans. Hispanics also face higher rates of certain diseases like diabetes than some other Americans.

When it comes to progress in health outcomes for Hispanic people, 51% of Hispanic adults say health outcomes have gotten a lot or a little better over the past two decades, compared with 13% who say they’ve gotten a lot or a little worse; 34% say they’ve stayed about the same.

About a third of Hispanic Americans – including 58% of Hispanic immigrants – say they prefer to see a Spanish-speaking health care provider. Overall, 35% of Hispanic adults strongly or somewhat prefer seeing a Spanish-speaking doctor or other health care provider for routine care. A larger share (51%) say it makes no difference whether the doctor they see speaks Spanish or not. And 13% say they would rather not see a Spanish-speaking doctor.

Attitudes are broadly similar when it comes to seeing a Hispanic doctor or health care provider. A third of Hispanic adults say they would prefer to see a Hispanic doctor for routine care, while 59% say it makes no difference and 7% would rather not.

Among Hispanic adults, immigrants are much more likely than those born in the U.S. to prefer seeing a Spanish-speaking doctor (58% vs. 12%) and to prefer seeing a Hispanic doctor (47% vs. 20%). About half of Hispanic immigrants in the U.S. mostly speak and read in Spanish.

Hispanic Americans account for 19% of the U.S. population . But only 9% of the nation’s health care practitioners and technicians are Hispanic, according to a 2021 Pew Research Center analysis of federal government data . And just 7% of all U.S. physicians and surgeons and 7% of registered nurses are Hispanic.

Black Hispanic adults are more likely to report negative health care experiences than other Hispanic adults. Overall, about half of Hispanic adults (52%) say they’ve had at least one of six negative health care experiences asked about in the Center’s 2021 survey, including feeling rushed or having to speak up to get the proper care. This is similar to the share of all U.S. adults who report having at least one of these types of negative experiences.

However, there are notable differences among Hispanics by race. Hispanic Americans who identify as Black are much more likely than White Hispanic adults to have faced negative health care experiences. For instance, 52% of Black Hispanic adults say they’ve had to speak up to get proper care, compared with 31% of White Hispanic adults. And Black Hispanic adults are 15 percentage points more likely than White Hispanic adults to say they’ve received lower-quality care (37% vs. 22%).

While negative health care experiences are fairly common, most Hispanic adults have generally positive opinions about their latest health care interaction. A 56% majority say the quality of care they most recently received from doctors or other health care providers was excellent or very good, while another 28% say it was good. Fewer (14%) say the care they received was only fair or poor. Black and White Hispanic adults are about equally likely to give positive ratings of their most recent health care experience.

Note: Here are the survey  questions used for this analysis , along with responses, and its methodology .

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Alec Tyson is an associate director of research at Pew Research Center

Mark Hugo Lopez is director of race and ethnicity research at Pew Research Center

9 facts about Americans and marijuana

5 facts about black americans and health care , 8 facts about americans with disabilities, inflation, health costs, partisan cooperation among the nation’s top problems, by more than two-to-one, americans say medication abortion should be legal in their state, most popular.

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2024 National Strategy for Suicide Prevention

Suicide is an urgent and growing public health crisis. More than 49,000 people in the United States died by suicide in 2022. That’s one death every 11 minutes.

National Strategy for Suicide Prevention

The 2024 National Strategy for Suicide Prevention is a bold new 10-year, comprehensive, whole-of-society approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide prevention field. This coordinated and comprehensive approach to suicide prevention at the national, state, tribal, local, and territorial levels relies upon critical partnerships across the public and private sectors. People with lived experience are critical to the success of this work. 

 The National Strategy seeks to prevent suicide risk in the first place; identify and support people with increased risk through treatment and crisis intervention; prevent reattempts; promote long-term recovery; and support survivors of suicide loss. 

Four strategic directions guide the National Strategy:

Strategic Direction 1: Community-Based Suicide Prevention

Goal 1: Establish effective, broad-based, collaborative, and sustainable suicide prevention partnerships.

Goal 2: Support upstream comprehensive community-based suicide prevention.

Goal 3: Reduce access to lethal means among people at risk of suicide.

Goal 4: Conduct postvention and support people with suicide-centered lived experience.

Goal 5: Integrate suicide prevention into the culture of the workplace and into other community settings.

Goal 6: Build and sustain suicide prevention infrastructure at the state, tribal, local, and territorial levels.

Goal 7: Implement research-informed suicide prevention communication activities in diverse populations using best practices from communication science.

Strategic Direction 2: Treatment and Crisis Services

Goal 8: Implement effective suicide prevention services as a core component of health care.

Goal 9: Improve the quality and accessibility of crisis care services across all communities.

Strategic Direction 3: Surveillance, Quality Improvement, and Research

Goal 10: Improve the quality, timeliness, scope, usefulness, and accessibility of data needed for suicide-related surveillance, research, evaluation, and quality improvement.

Goal 11: Promote and support research on suicide prevention.

Strategic Direction 4: Health Equity in Suicide Prevention

Goal 12: Embed health equity into all comprehensive suicide prevention activities.

Goal 13: Implement comprehensive suicide prevention strategies for populations disproportionately affected by suicide, with a focus on historically marginalized communities, persons with suicide-centered lived experience, and youth.

Goal 14: Create an equitable and diverse suicide prevention workforce that is equipped and supported to address the needs of the communities they serve.

Goal 15: Improve and expand effective suicide prevention programs for populations disproportionately impacted by suicide across the life span through improved data, research, and evaluation.

Federal Action Plan

The Federal Action Plan identifies more than 200 actions across the federal government to be taken over the next three years in support of those goals. These actions include:

• Evaluating promising community-based suicide prevention strategies
• Identifying ways to address substance use/overdose and suicide risk together in the clinical setting
• Funding a mobile crisis locator for use by 988 crisis centers
• Increasing support for survivors of suicide loss and others whose lives have been impacted by suicide

These actions will be monitored and evaluated regularly to determine progress and success, and to further identify barriers to suicide prevention.

Get Involved

Join the conversation. Everyone has a role to play in preventing the tragedy of suicide. Find social media material, templates, and other resources to support and participate in the shared effort.

Read the press release

* This content is undergoing Section 508 remediation. For immediate assistance, contact [email protected] .

MDMA (Ecstasy/Molly)

• MDMA, also called Molly or Ecstasy, is a lab-made (synthetic) drug that has effects similar to stimulants like methamphetamine.  Some researchers and organizations consider MDMA to be a psychedelic drug because it can also mildly alter visual and time perception.
• MDMA’s effects may include feeling more energetic and alert and having an increased sense of well-being, warmth, and openness toward others.
• However, MDMA can also cause a number of negative health effects. For example, while deaths from MDMA are rare, overdoses can potentially be life threatening—with symptoms including high blood pressure, faintness, panic attacks, and in severe cases, a loss of consciousness and seizures.

MDMA (Ecstasy) Abuse Research Report

Describes the science behind MDMA (ecstasy) abuse, including what it does to the brain, whether it is addictive, and the latest research regarding prevention and treatment of MDMA.

Latest from NIDA

Marijuana and hallucinogen use among young adults reached all time-high in 2021

Find more resources on mdma.

• Find basic information from MedlinePlus , a service of NIH’s National Library of Medicine (NLM).
• Learn more about MDMA from the Drug Enforcement Administration (DEA). 
• Read more about MDMA research from the National Institutes of Health. 

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Institutes at nih, list of institutes and centers, nih institutes.

National Cancer Institute (NCI) — Est. 1937 NCI leads a national effort to eliminate the suffering and death due to cancer. Through basic and clinical biomedical research and training, NCI conducts and supports research that will lead to a future in which we can prevent cancer before it starts, identify cancers that do develop at the earliest stage, eliminate cancers through innovative treatment interventions, and biologically control those cancers that we cannot eliminate so they become manageable, chronic diseases.

National Eye Institute (NEI) — Est. 1968 The National Eye Institute’s mission is to conduct and support research, training, health information dissemination, and other programs with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight, and the special health problems and requirements of the blind.

National Heart, Lung, and Blood Institute (NHLBI) — Est. 1948 The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives. The NHLBI stimulates basic discoveries about the causes of disease, enables the translation of basic discoveries into clinical practice, fosters training and mentoring of emerging scientists and physicians, and communicates research advances to the public.

National Human Genome Research Institute (NHGRI) — Est. 1989 NHGRI is devoted to advancing health through genome research. The Institute led NIH’s contribution to the Human Genome Project, which was successfully completed in 2003 ahead of schedule and under budget. Building on the foundation laid by the sequencing of the human genome, NHGRI’s work now encompasses a broad range of research aimed at expanding understanding of human biology and improving human health. In addition, a critical part of NHGRI’s mission continues to be the study of the ethical, legal and social implications of genome research.

National Institute on Aging (NIA) — Est. 1974 NIA leads a national program of research on the biomedical, social, and behavioral aspects of the aging process; the prevention of age-related diseases and disabilities; and the promotion of a better quality of life for all older Americans.

National Institute on Alcohol Abuse and Alcoholism (NIAAA) — Est. 1970 NIAAA conducts research focused on improving the treatment and prevention of alcoholism and alcohol-related problems to reduce the enormous health, social, and economic consequences of this disease.

National Institute of Allergy and Infectious Diseases (NIAID) — Est. 1948 NIAID research strives to understand, treat, and ultimately prevent the myriad infectious, immunologic, and allergic diseases that threaten millions of human lives.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) — Est. 1986 NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases.

National Institute of Biomedical Imaging and Bioengineering (NIBIB) — Est. 2000 The mission of the National Institute of Biomedical Imaging and Bioengineering (NIBIB) is to transform through engineering the understanding of disease and its prevention, detection, diagnosis, and treatment.

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) — Est. 1962 NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all.

National Institute on Deafness and Other Communication Disorders (NIDCD) — Est. 1988 NIDCD conducts and supports biomedical research and research training on normal mechanisms as well as diseases and disorders of hearing, balance, smell, taste, voice, speech, and language that affect 46 million Americans.

National Institute of Dental and Craniofacial Research (NIDCR) — Est. 1948 NIDCR provides leadership for a national research program designed to understand, treat, and ultimately prevent the infectious and inherited craniofacial-oral-dental diseases and disorders that compromise millions of human lives.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Est. 1950 The mission of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is to conduct and support medical research and research training and to disseminate science-based information on diabetes and other endocrine and metabolic diseases; digestive diseases, nutritional disorders, and obesity; and kidney, urologic, and hematologic diseases, to improve people’s health and quality of life.

National Institute on Drug Abuse (NIDA) — Est. 1974 The mission of the National Institute on Drug Abuse (NIDA) is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health. 

National Institute of Environmental Health Sciences (NIEHS) — Est. 1969 The mission of the National Institute of Environmental Health Sciences is to discover how the environment affects people in order to promote healthier lives.

National Institute of General Medical Sciences (NIGMS) — Est. 1962 The National Institute of General Medical Sciences (NIGMS) supports basic research that increases understanding of biological processes and lays the foundation for advances in disease diagnosis, treatment and prevention. NIGMS-funded scientists investigate how living systems work at a range of levels, from molecules and cells to tissues, whole organisms and populations. The Institute also supports research in certain clinical areas, primarily those that affect multiple organ systems. To assure the vitality and continued productivity of the research enterprise, NIGMS provides leadership in training the next generation of scientists, in enhancing the diversity of the scientific workforce, and in developing research capacities throughout the country.

National Institute of Mental Health (NIMH) — Est. 1949 NIMH provides national leadership dedicated to understanding, treating, and preventing mental illnesses through basic research on the brain and behavior, and through clinical, epidemiological, and services research.

National Institute on Minority Health and Health Disparities (NIMHD) — Est. 2010 NIMHD has a long history, beginning in 1990 as an Office and later designated a Center in 2000. The mission of NIMHD is to lead scientific research to improve minority health and eliminate health disparities. To accomplish its mission, NIMHD plans, reviews, coordinates, and evaluates all minority health and health disparities research and activities of the National Institutes of Health; conducts and supports research in minority health and health disparities; promotes and supports the training of a diverse research workforce; translates and disseminates research information; and fosters innovative collaborations and partnerships.

National Institute of Neurological Disorders and Stroke (NINDS) — Est. 1950 The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. To accomplish this goal the NINDS supports and conducts basic, translational, and clinical research on the normal and diseased nervous system. The Institute also fosters the training of investigators in the basic and clinical neurosciences, and seeks better understanding, diagnosis, treatment, and prevention of neurological disorders.

National Institute of Nursing Research (NINR) — Est. 1986 The mission of the National Institute of Nursing Research (NINR) is to lead nursing research to solve pressing health challenges and inform practice and policy—optimizing health and advancing health equity into the future.

National Library of Medicine (NLM) — Est. 1956 NLM collects, organizes, and makes available biomedical science information to scientists, health professionals, and the public. The Library’s Web-based databases, including PubMed/Medline and MedlinePlus, are used extensively around the world. NLM conducts and supports research in biomedical communications; creates information resources for molecular biology, biotechnology, toxicology, and environmental health; and provides grant and contract support for training, medical library resources, and biomedical informatics and communications research.

NIH Centers

NIH Clinical Center (CC) — Est. 1953 The NIH Clinical Center, America’s research hospital, provides a versatile clinical research environment enabling the NIH mission to improve human health by investigating the pathogenesis of disease; conducting first-in-human clinical trials with an emphasis on rare diseases and diseases of high public health impact; developing state-of-the-art diagnostic, preventive, and therapeutic interventions; training the current and next generations of clinical researchers; and, ensuring that clinical research is ethical, efficient, and of high scientific quality.

Center for Information Technology (CIT) — Est. 1964 CIT incorporates the power of modern computers into the biomedical programs and administrative procedures of the NIH by focusing on three primary activities: conducting computational biosciences research, developing computer systems, and providing computer facilities.

Center for Scientific Review (CSR) — Est. 1946 CSR is the portal for NIH grant applications and their review for scientific merit. CSR oversees and implements peer review for over 75% of the more than 88,000 applications submitted to NIH each year, as well as for some other components of HHS. The mission of CSR is to see that NIH grant applications receive fair, independent, expert, and timely scientific reviews — free from inappropriate influences — so NIH can fund the most promising research.

Fogarty International Center (FIC) — Est. 1968 FIC promotes and supports scientific research and training internationally to reduce disparities in global health.

National Center for Advancing Translational Sciences (NCATS) — Est. 2011 The mission of NCATS is to catalyze the generation of innovative methods and technologies that will enhance the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions.

National Center for Complementary and Integrative Health (NCCIH) — Est. 1999 The mission of NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.

This page last reviewed on July 12, 2023

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