We Spend $ and Then Hear About Success and Breakthroughs But they Don't Reach Us
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Dr. Carroll is a pediatrician and the president and chief executive of AcademyHealth, which tracks the cancellations of Agency for Healthcare Research and Quality research grants.
New York Times
This is Adam Gonzalez : Just to add one of those breakthoughs reached their way to Trump during Covid19 and After He was secretly Taken to the Hospital a few months back. It is said he got some treatment by IV not available to the public. It might be what keeps him alive. To top t all off Trump and his crazy doctor RKennedy have fired countless of scientists working on all type of diseases.
Almost every doctor has a tragic story that sticks with them. For Dr. Suchitra Rao, a pediatrician in Colorado, it was a teenager with a congenital heart defect and a weakened immune system who got a flu vaccine each year. One year, a stretch of medical visits and hospitalizations crowded out that routine care, and the vaccine got missed. The child caught influenza, the virus led to a secondary bacterial infection, and he died.
This wasn’t a failure of medical discovery; it was a failure of medical delivery. Flu vaccines have been around for many decades. The health care system that shuffled this child from specialist to specialist just never gave the shot.
There’s a whole field that studies how to turn research into practice: how to get the right vaccine into the right child, the right antibiotic to the right patient, the right asthma plan into the right household. It’s always gotten short shrift because it isn’t glamorous. No one wins the Nobel Prize for figuring out how to remind a hospital to give a child a flu shot.
The United States spends more than $5 trillion a year on health care. It funds the most productive biomedical discovery engine in the world. But the most effective treatment in the world does nothing for the patient who doesn’t receive it.
The collection of sciences that focus on how care is delivered, whom it fails, how disease is prevented and what actually improves it is sometimes called health solutions science. It includes my own field, health services research. Everything Americans hate about health care — the high cost, how it’s hard to access and how disjointed it feels, with test results that never follow you — falls under its scope.
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You can see how these sciences are neglected in the national budget. The National Institutes of Health received roughly $47 billion this year, overwhelmingly to find new treatments and test how well they work. The Agency for Healthcare Research and Quality, the lead federal agency for health solutions science, received less than 1 percent of that money — $345 million — to figure out how to make care safer and ensure those treatments get to the patients who need them. The bet embedded in that ratio is that discovery is the hard part and delivery takes care of itself.
And yet by one famous estimate, it takes 17 years for research evidence to make its way into everyday practice. This spring, The Times reported that half of people with metastatic lung cancer receive no treatment at all, decades into the era of therapies that can extend their lives.
Now, even that 1 percent is being dismantled. It’s still there on paper; the Agency for Healthcare Research and Quality was appropriated close to its usual amount in the 2026 budget. But because of mass layoffs and departures, it has lost roughly 75 percent of its staff and has awarded no new grants since April 2025.
Dr. Rao built her research around the type of failure that killed that teenager. With funding from the agency, she created a randomized controlled trial across 11 health systems to test whether hospitals could reliably identify high-risk children, like the one who died, and vaccinate them against the flu before sending them home, rather than counting on busy outpatient care to catch up later. It is extraordinarily hard to plan, fund and run such a study across so many settings, but she persevered, and the trial was in its third year of a planned five.
In July, the federal government discontinued its funding, along with that of more than 100 others, with no warning. The work, the time, the sacrifice, the participation of so many children, families and clinicians — all of it goes to waste.
Dr. Michelle Kelly of Wisconsin was testing what might happen if parents of hospitalized children had easier access to their children’s medical notes in the electronic health record. When left to find them on their own through the hospital’s patient portal, less than 10 percent of families read their children’s medical notes. In an early pilot study, which offered real-time note access on a bedside tablet, 96 percent did, and about one in five families who read them found a potential medical error or safety concern. After enrolling 150 families, the full trial was abruptly ended.
Dr. Valerie Vaughn of Utah was leading a study to reduce unnecessary antibiotic prescriptions for patients being sent home from the hospital. Unnecessary antibiotics cause side effects and increase antibiotic resistance, making some infections harder to treat for everyone. The study was canceled midstream.
Every administration gets to set research priorities. But when Dr. Kelly and Dr. Vaughn were informed that their trials had been canceled, the explanation was strange. In letters to the researchers, the Agency for Healthcare Research and Quality said it had chosen not to continue the studies to focus on other priorities — the ones it listed included “patient safety” and “preventing antibiotic resistance.” Other areas the Trump administration cited in the letters as key priorities were telehealth, artificial intelligence, nutrition and autism; it also canceled studies testing telehealth for children with asthma and digital tools to improve autism diagnosis and care.
Stopping a study midway doesn’t make the question disappear. It means we may never get the answer, even after taxpayers have paid millions toward finding it.
I can’t tell you Dr. Rao’s trial would have worked. One child’s death, however tragic, can’t tell us whether prioritizing vaccinating children in the hospital saves lives at scale, or how hospitals could reliably do it.
Normally I’d end an essay like this by calling for a study to answer those questions. But that trial existed. It was in year three. The government stopped it.
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