Daily Archives: November 25, 2024

Trump’s promise to reinstate travel bans has scientists deeply concerned

On the heels of Donald Trump’s presidential election victory, MIT issued a note of caution to its international students: Assess your winter break travel plans.“The new administration will be sworn in on January 20, 2025, and new executive orders that may impact travel and visa processing may be implemented,” the director of the university’s international students office wrote in a Nov. 12 message posted on its website. “Any processing delays could impact students’ ability to return to the U.S. as planned.”advertisement

The University of Massachusetts Amherst issued a nearly identical travel advisory to its students, staff, and faculty. 

The warnings reflect already palpable concern that Trump will make good on a campaign promise to reinstate — and expand — travel restrictions put in place during his first stint in office. That prospect has members of the life sciences community bracing for policies that could bar the entry of researchers from countries deemed security threats to the United States, as well as measures that would make entering the country tedious, time-consuming, and expensive.

The exact nature and scope of any restrictions is for now unclear, and Trump has at times paradoxically said he’d incentivize foreign graduates to stay in the country. Yet scientists, biotech leaders, and immigration experts told STAT they fear the incoming administration will send a message to international researchers that they’re not wanted here, an outcome they warned would undermine the United States’ position as a scientific powerhouse and discourage vital collaborations.advertisement

What could Trump mean for the business of health? Scenarios for an RFK Jr. HHS

“Science is a global endeavor,” said Stefano Bertuzzi, CEO of the American Society for Microbiology. “When there is a health crisis, it’s never a good time to start exchanging business cards with our scientific counterparts outside of the country. You want to have built those relationships over time.”

Researchers from outside the United States play a growing role in driving early-stage scientific discovery. The share of new biomedical Ph.D. grads who were internationals on temporary visas rose from 8% in 1978 to 24% in 2023, according to data from the National Science Foundation. Similarly, the proportion of foreign scientists working as postdoctoral researchers shot up from 36% in 1980 to 54% in 2022.

Travel limitations on international researchers could further stress the academic workforce, which is experiencing an unprecedented exodus of early-career life scientists, many of whom are ending postdocs early or avoiding them altogether to take lucrative jobs in private industry. That trend has already caused some projects to slow or stall, with hypotheses going untested and grant dollars unused. 

“It’s very hard to find postdocs. And now, if we’re further limited in the countries that we can get postdocs from because of bans or different policy changes, it’s going to be even more challenging,” said Elvisha Dhamala, a neuroscientist at the Feinstein Institutes for Medical Research whose lab consists entirely of international researchers.  “That’s just going to slow down scientific progress as a whole.”

She’s bracing for a repeat of what happened in 2017, when, a week after taking office, Trump signed an executive order prohibiting nationals from seven majority-Muslim countries from entering the United States. That same day, the State Department quietly revoked visas of travelers from Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen.

The impacts were felt almost immediately, as researchers who’d planned to work in the U.S. or present at scientific conferences suddenly weren’t able to enter the country. And while the order was quickly challenged in court, it was replaced with subsequent orders and proclamations that maintained some restrictions on travelers from many of the originally named countries, with new nations later added to the list.advertisement

President Biden reversed those restrictions in a proclamation issued on his first day in office. Trump repeatedly vowed to bring them back during his campaign for a return to the White House.

“Under the Trump administration, we imposed extreme vetting and put on a powerful travel ban to keep radical Islamic terrorists and jihadists out of our country,” he said at a rally in Iowa last year. “When I return to office, the travel ban is coming back even bigger than before, and much stronger than before.”

The president-elect reiterated that message at a conference of the Israeli-American Council in September. Trump has said he’d govern by the motto of “promises made, promises kept,” and he has selected Stephen Miller, architect of the original travel ban, as his deputy chief of policy.

Some scientists were already bracing for a return of travel bans even before Trump’s victory — and taking steps to reduce the impact of any restrictions. Dhamala told STAT that she has been directly involved in the planning of two scientific meetings that won’t be held in the U.S. due in part because of travel concerns, including one conference that usually draws 3,000 to 4,000 attendees.

“The approach has sort of been to ideally avoid the U.S. as much as possible until what would be expected to be the end of the Trump presidency,” said Dhamala, who declined to name the meetings because of the sensitive nature of those discussions.

Travel restrictions instituted during Trump’s first term drew criticism not only from academics and scientific societies, but from more than 150 biotech executives and investors who slammed the policy as misguided.

Rand Paul plans to investigate Covid-19 origins from his new perch leading a key committee

“If I’m in biotech or pharma and I’m trying to recruit the best of the best, I’m not necessarily biased toward where a person came from,” said Richard Heyman, one of the letter’s signatories and an investor with ARCH Venture Partners. “I’m looking for the best talent.”

Notably, the Biotechnology Innovation Organization (BIO) and Pharmaceutical Research and Manufacturers of America (PhRMA), the industry’s top two trade groups, did not comment on the restrictions. That silence continues. BIO did not respond to requests for comment from STAT, and PhRMA offered a statement from CEO Stephen J. Ubl that said the group wants to work with the Trump administration to strengthen the industry but that did not address the travel issue. advertisement

The first-term restrictions also created issues for high-profile medical centers that lost out on revenue from foreign patients willing to pay full price for care. Between 100,000 and 200,000 people visit the country for medical services each year, according to the U.S. International Trade Commission, roughly 8% of them from the Middle East.

In some moments, Trump’s campaign was marked by mixed messages on immigration. During a taping of the “All-In” podcast earlier this year, Trump said he’d like to offer green cards to any foreign student who graduates from a U.S. university so they aren’t forced to leave the country due to visa issues. But campaign press secretary (and incoming White House press secretary) Karoline Leavitt quickly walked back that comment.

“President Trump has outlined the most aggressive vetting process in U.S. history, to exclude all communists, radical Islamists, Hamas supporters, America haters and public charges,” Leavitt said in a statement issued hours after the podcast posted. “He believes, only after such vetting has taken place, we ought to keep the most skilled graduates who can make significant contributions to America.”

In addition to outright bans, immigration experts noted there are more subtle ways Trump could stymie the entry of foreign researchers. Elizabeth Goss, an immigration attorney in Boston, pointed out that about half of non-immigrant visas are issued without an in-person interview. If the Trump administration were to do away with interview waivers, she said, that would immediately put securing a visa out of reach for many internationals. Appointment wait times for a visa interview are as long as a year or more in some countries as is.

“You can just wear people down. It’s death by 1,000 paper cuts versus some dramatic spectacle,” Goss said. “You ask a lot of questions. You make people work much harder. You make it more expensive. You make it more tiresome.”

Goss and others — including graduate students and officials at scientific societies who requested anonymity to speak freely — added that making it more difficult for foreign researchers to enter the U.S. could push some scientists to seek opportunities elsewhere. By some estimates, that would be costly. An analysis from the National Foundation for American Policy, a nonpartisan nonprofit, calculated that blocking foreign Ph.D. students from working at American universities could lead to billions in lost revenue from discoveries they would have patented.advertisement

It’s stories like Forough Habibollahi’s that worry the U.S. science community. Travel issues snared the Iranian student after she applied for graduate school in 2017. She was accepted into a Ph.D. program at Northeastern University in Boston, where she planned to study neuroscience. Habibollahi couldn’t believe her luck — her partner had been accepted into the same program, too.

“We were very excited to go. We even bought our flight tickets,” she told STAT. “We chose our seats.”

But the pair started having second thoughts. Like many Iranian students, Habibollahi was issued a single-entry visa, meaning that if she were to visit home before the end of her graduate program, she wouldn’t be able to come back to the U.S. without applying for a new visa. Her safest bet would be not to return home for the six years it would likely take her to complete her degree, even though she and her partner had aging parents.

That worried Habibollahi. So did stories from friends who’d traveled to the U.S. only to be stopped mid-transit and forced to return home due to Trump-era travel restrictions. So about 10 days before the start of her graduate program, and with her bags partially packed, she told her would-be Ph.D. adviser she wouldn’t be coming to the U.S. after all.

Habibollahi instead went to Australia to earn her Ph.D. She now works in Melbourne as a data scientist at Cortical Labs, a synthetic biology startup. She says that while she still hopes to visit the U.S. on occasion, she and her partner plan to settle and work in Australia long-term.

“We love living here,” she said.

Trump’s promise to reinstate travel bans has scientists deeply concerned

On the heels of Donald Trump’s presidential election victory, MIT issued a note of caution to its international students: Assess your winter break travel plans.“The new administration will be sworn in on January 20, 2025, and new executive orders that may impact travel and visa processing may be implemented,” the director of the university’s international students office wrote in a Nov. 12 message posted on its website. “Any processing delays could impact students’ ability to return to the U.S. as planned.”advertisement

The University of Massachusetts Amherst issued a nearly identical travel advisory to its students, staff, and faculty. 

The warnings reflect already palpable concern that Trump will make good on a campaign promise to reinstate — and expand — travel restrictions put in place during his first stint in office. That prospect has members of the life sciences community bracing for policies that could bar the entry of researchers from countries deemed security threats to the United States, as well as measures that would make entering the country tedious, time-consuming, and expensive.

The exact nature and scope of any restrictions is for now unclear, and Trump has at times paradoxically said he’d incentivize foreign graduates to stay in the country. Yet scientists, biotech leaders, and immigration experts told STAT they fear the incoming administration will send a message to international researchers that they’re not wanted here, an outcome they warned would undermine the United States’ position as a scientific powerhouse and discourage vital collaborations.advertisement

What could Trump mean for the business of health? Scenarios for an RFK Jr. HHS

“Science is a global endeavor,” said Stefano Bertuzzi, CEO of the American Society for Microbiology. “When there is a health crisis, it’s never a good time to start exchanging business cards with our scientific counterparts outside of the country. You want to have built those relationships over time.”

Researchers from outside the United States play a growing role in driving early-stage scientific discovery. The share of new biomedical Ph.D. grads who were internationals on temporary visas rose from 8% in 1978 to 24% in 2023, according to data from the National Science Foundation. Similarly, the proportion of foreign scientists working as postdoctoral researchers shot up from 36% in 1980 to 54% in 2022.

Travel limitations on international researchers could further stress the academic workforce, which is experiencing an unprecedented exodus of early-career life scientists, many of whom are ending postdocs early or avoiding them altogether to take lucrative jobs in private industry. That trend has already caused some projects to slow or stall, with hypotheses going untested and grant dollars unused. 

“It’s very hard to find postdocs. And now, if we’re further limited in the countries that we can get postdocs from because of bans or different policy changes, it’s going to be even more challenging,” said Elvisha Dhamala, a neuroscientist at the Feinstein Institutes for Medical Research whose lab consists entirely of international researchers.  “That’s just going to slow down scientific progress as a whole.”

She’s bracing for a repeat of what happened in 2017, when, a week after taking office, Trump signed an executive order prohibiting nationals from seven majority-Muslim countries from entering the United States. That same day, the State Department quietly revoked visas of travelers from Iran, Iraq, Libya, Somalia, Sudan, Syria, and Yemen.

The impacts were felt almost immediately, as researchers who’d planned to work in the U.S. or present at scientific conferences suddenly weren’t able to enter the country. And while the order was quickly challenged in court, it was replaced with subsequent orders and proclamations that maintained some restrictions on travelers from many of the originally named countries, with new nations later added to the list.advertisement

President Biden reversed those restrictions in a proclamation issued on his first day in office. Trump repeatedly vowed to bring them back during his campaign for a return to the White House.

“Under the Trump administration, we imposed extreme vetting and put on a powerful travel ban to keep radical Islamic terrorists and jihadists out of our country,” he said at a rally in Iowa last year. “When I return to office, the travel ban is coming back even bigger than before, and much stronger than before.”

The president-elect reiterated that message at a conference of the Israeli-American Council in September. Trump has said he’d govern by the motto of “promises made, promises kept,” and he has selected Stephen Miller, architect of the original travel ban, as his deputy chief of policy.

Some scientists were already bracing for a return of travel bans even before Trump’s victory — and taking steps to reduce the impact of any restrictions. Dhamala told STAT that she has been directly involved in the planning of two scientific meetings that won’t be held in the U.S. due in part because of travel concerns, including one conference that usually draws 3,000 to 4,000 attendees.

“The approach has sort of been to ideally avoid the U.S. as much as possible until what would be expected to be the end of the Trump presidency,” said Dhamala, who declined to name the meetings because of the sensitive nature of those discussions.

Travel restrictions instituted during Trump’s first term drew criticism not only from academics and scientific societies, but from more than 150 biotech executives and investors who slammed the policy as misguided.

Rand Paul plans to investigate Covid-19 origins from his new perch leading a key committee

“If I’m in biotech or pharma and I’m trying to recruit the best of the best, I’m not necessarily biased toward where a person came from,” said Richard Heyman, one of the letter’s signatories and an investor with ARCH Venture Partners. “I’m looking for the best talent.”

Notably, the Biotechnology Innovation Organization (BIO) and Pharmaceutical Research and Manufacturers of America (PhRMA), the industry’s top two trade groups, did not comment on the restrictions. That silence continues. BIO did not respond to requests for comment from STAT, and PhRMA offered a statement from CEO Stephen J. Ubl that said the group wants to work with the Trump administration to strengthen the industry but that did not address the travel issue. advertisement

The first-term restrictions also created issues for high-profile medical centers that lost out on revenue from foreign patients willing to pay full price for care. Between 100,000 and 200,000 people visit the country for medical services each year, according to the U.S. International Trade Commission, roughly 8% of them from the Middle East.

In some moments, Trump’s campaign was marked by mixed messages on immigration. During a taping of the “All-In” podcast earlier this year, Trump said he’d like to offer green cards to any foreign student who graduates from a U.S. university so they aren’t forced to leave the country due to visa issues. But campaign press secretary (and incoming White House press secretary) Karoline Leavitt quickly walked back that comment.

“President Trump has outlined the most aggressive vetting process in U.S. history, to exclude all communists, radical Islamists, Hamas supporters, America haters and public charges,” Leavitt said in a statement issued hours after the podcast posted. “He believes, only after such vetting has taken place, we ought to keep the most skilled graduates who can make significant contributions to America.”

In addition to outright bans, immigration experts noted there are more subtle ways Trump could stymie the entry of foreign researchers. Elizabeth Goss, an immigration attorney in Boston, pointed out that about half of non-immigrant visas are issued without an in-person interview. If the Trump administration were to do away with interview waivers, she said, that would immediately put securing a visa out of reach for many internationals. Appointment wait times for a visa interview are as long as a year or more in some countries as is.

“You can just wear people down. It’s death by 1,000 paper cuts versus some dramatic spectacle,” Goss said. “You ask a lot of questions. You make people work much harder. You make it more expensive. You make it more tiresome.”

Goss and others — including graduate students and officials at scientific societies who requested anonymity to speak freely — added that making it more difficult for foreign researchers to enter the U.S. could push some scientists to seek opportunities elsewhere. By some estimates, that would be costly. An analysis from the National Foundation for American Policy, a nonpartisan nonprofit, calculated that blocking foreign Ph.D. students from working at American universities could lead to billions in lost revenue from discoveries they would have patented.advertisement

It’s stories like Forough Habibollahi’s that worry the U.S. science community. Travel issues snared the Iranian student after she applied for graduate school in 2017. She was accepted into a Ph.D. program at Northeastern University in Boston, where she planned to study neuroscience. Habibollahi couldn’t believe her luck — her partner had been accepted into the same program, too.

“We were very excited to go. We even bought our flight tickets,” she told STAT. “We chose our seats.”

But the pair started having second thoughts. Like many Iranian students, Habibollahi was issued a single-entry visa, meaning that if she were to visit home before the end of her graduate program, she wouldn’t be able to come back to the U.S. without applying for a new visa. Her safest bet would be not to return home for the six years it would likely take her to complete her degree, even though she and her partner had aging parents.

That worried Habibollahi. So did stories from friends who’d traveled to the U.S. only to be stopped mid-transit and forced to return home due to Trump-era travel restrictions. So about 10 days before the start of her graduate program, and with her bags partially packed, she told her would-be Ph.D. adviser she wouldn’t be coming to the U.S. after all.

Habibollahi instead went to Australia to earn her Ph.D. She now works in Melbourne as a data scientist at Cortical Labs, a synthetic biology startup. She says that while she still hopes to visit the U.S. on occasion, she and her partner plan to settle and work in Australia long-term.

“We love living here,” she said.

What the science says creatine supplements can, can’t and might do

Creatine has long been popular with male athletes and bodybuilders for building strong muscles. More recently, the supplement has caught the attention of a broader audience.Growing evidence shows that taking creatine also benefits muscle strength in females and older adults. And it might help improve memory, among other possible health benefits.Here’s what the science says.What is creatine?Creatine is a natural substance produced by our kidneys, liver and pancreas. Most of it (95 per cent) is stored in skeletal muscle; about 5 per cent is in the brain. Diet also contributes to our body’s creatine stores. It is found in animal foods, especially red meat, chicken and certain fish such as tuna, salmon, cod and herring.Creatine is used to generate adenosine triphosphate (ATP), a compound that provides on-demand energy for cellular processes, including muscle contraction. During intense exercise, muscles use up ATP very quickly, in just a few seconds. The rate at which the body regenerates ATP, however, isn’t fast enough to allow a person to continually perform high-intensity exercise.Taking supplements to increase muscle creatine stores can, therefore, help you give near-maximum effort for a little longer before fatigue sets in.Performance and muscle gainsSince the early 1990s, a wealth of evidence has established that creatine supplementation, combined with exercise, improves athletic performance.It is effective for activities that involve fast, powerful movements (i.e., bursts of intensity) such as weightlifting, sprinting, jumping, rowing, mountain biking, swimming, soccer, football and basketball. It offers little or no benefit for lower intensity exercise.Since creatine supplementation can allow you to lift heavier weights and do more repetitions, it can help increase muscle mass and muscle strength. Taking it may also improve recovery from intense exercise.Creatine doesn’t work for everyone, though. People with naturally high muscle creatine levels, for example, may not respond to extra creatine the same way those with lower levels do.Most research on creatine and exercise performance has involved young healthy male adults. There is mounting evidence, however, that females can also benefit. Studies show that, together with resistance training, creatine is effective for increasing muscle mass, muscle strength and athletic performance in pre- and post-menopausal females.Creatine supplementation may also counteract sarcopenia – age-related muscle loss – and by doing so improve balance in seniors. Studies conducted in adults aged 65 and older who participate in resistance training have demonstrated that those who take creatine experience greater gains in muscle mass and strength compared with those who do not.Creatine may have cognitive benefitsOur brain is the most ATP-demanding organ. Creatine can help brain cells generate energy, and it may protect the brain by reducing inflammation and oxidative stress.Findings from a review of 16 randomized controlled trials, published in 2023, suggest that the supplement has positive effects on both memory and attention time. It appeared to be more beneficial for females and those aged 18 to 60 years.Creatine is also being studied for its potential beneficial effects on bone density, mood disorders and managing blood glucose in type 2 diabetes, but it’s too soon to draw conclusions.How to take creatineCreatine supplements are typically sold as powders. Look for creatine monohydrate, one the most well-studied supplements overall. (Scientific support for other variations is lacking.)It can be taken by starting with a “loading” dose of 20 grams for five to seven days to quickly saturate muscle stores. A daily dose of three to five grams is then taken to maintain levels.Alternatively, you can simply take three to five grams of creatine a day without loading. This method is equally effective at increasing stores but takes a little longer to do so.A five-gram dose of creatine monohydrate typically costs between 35 and 70 cents, depending on the brand. That’s similar to many multivitamins.Safety, side effectsCreatine monohydrate is considered generally safe and well tolerated. Studies conducted in adults have lasted up to five years. (There’s limited evidence about the safety of creatine supplements in children and adolescents.)Side effects such as bloating, digestive upset and diarrhea may occur initially during the loading phase.People with kidney disease, high blood pressure or liver disease should not take creatine. (It does not harm kidney function in healthy individuals when used at recommended doses.)If you have an underlying illness, consult with your doctor before taking creatine.Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

What the science says creatine supplements can, can’t and might do

Creatine has long been popular with male athletes and bodybuilders for building strong muscles. More recently, the supplement has caught the attention of a broader audience.Growing evidence shows that taking creatine also benefits muscle strength in females and older adults. And it might help improve memory, among other possible health benefits.Here’s what the science says.What is creatine?Creatine is a natural substance produced by our kidneys, liver and pancreas. Most of it (95 per cent) is stored in skeletal muscle; about 5 per cent is in the brain. Diet also contributes to our body’s creatine stores. It is found in animal foods, especially red meat, chicken and certain fish such as tuna, salmon, cod and herring.Creatine is used to generate adenosine triphosphate (ATP), a compound that provides on-demand energy for cellular processes, including muscle contraction. During intense exercise, muscles use up ATP very quickly, in just a few seconds. The rate at which the body regenerates ATP, however, isn’t fast enough to allow a person to continually perform high-intensity exercise.Taking supplements to increase muscle creatine stores can, therefore, help you give near-maximum effort for a little longer before fatigue sets in.Performance and muscle gainsSince the early 1990s, a wealth of evidence has established that creatine supplementation, combined with exercise, improves athletic performance.It is effective for activities that involve fast, powerful movements (i.e., bursts of intensity) such as weightlifting, sprinting, jumping, rowing, mountain biking, swimming, soccer, football and basketball. It offers little or no benefit for lower intensity exercise.Since creatine supplementation can allow you to lift heavier weights and do more repetitions, it can help increase muscle mass and muscle strength. Taking it may also improve recovery from intense exercise.Creatine doesn’t work for everyone, though. People with naturally high muscle creatine levels, for example, may not respond to extra creatine the same way those with lower levels do.Most research on creatine and exercise performance has involved young healthy male adults. There is mounting evidence, however, that females can also benefit. Studies show that, together with resistance training, creatine is effective for increasing muscle mass, muscle strength and athletic performance in pre- and post-menopausal females.Creatine supplementation may also counteract sarcopenia – age-related muscle loss – and by doing so improve balance in seniors. Studies conducted in adults aged 65 and older who participate in resistance training have demonstrated that those who take creatine experience greater gains in muscle mass and strength compared with those who do not.Creatine may have cognitive benefitsOur brain is the most ATP-demanding organ. Creatine can help brain cells generate energy, and it may protect the brain by reducing inflammation and oxidative stress.Findings from a review of 16 randomized controlled trials, published in 2023, suggest that the supplement has positive effects on both memory and attention time. It appeared to be more beneficial for females and those aged 18 to 60 years.Creatine is also being studied for its potential beneficial effects on bone density, mood disorders and managing blood glucose in type 2 diabetes, but it’s too soon to draw conclusions.How to take creatineCreatine supplements are typically sold as powders. Look for creatine monohydrate, one the most well-studied supplements overall. (Scientific support for other variations is lacking.)It can be taken by starting with a “loading” dose of 20 grams for five to seven days to quickly saturate muscle stores. A daily dose of three to five grams is then taken to maintain levels.Alternatively, you can simply take three to five grams of creatine a day without loading. This method is equally effective at increasing stores but takes a little longer to do so.A five-gram dose of creatine monohydrate typically costs between 35 and 70 cents, depending on the brand. That’s similar to many multivitamins.Safety, side effectsCreatine monohydrate is considered generally safe and well tolerated. Studies conducted in adults have lasted up to five years. (There’s limited evidence about the safety of creatine supplements in children and adolescents.)Side effects such as bloating, digestive upset and diarrhea may occur initially during the loading phase.People with kidney disease, high blood pressure or liver disease should not take creatine. (It does not harm kidney function in healthy individuals when used at recommended doses.)If you have an underlying illness, consult with your doctor before taking creatine.Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

Hopes, fears and uncertainty: life scientists react to Trump’s election victory

Donald Trump will take office on 20 January 2025.Credit: Chip Somodevilla/GettyThe re-election of Donald Trump as US president raises the prospect of big changes in US science, in terms of policy, funding and research. Nature asked six life scientists which priorities they’d like to see the administration focus on once Trump takes office in January next year.AMANDER CLARK: Support education and reproductive careAmander Clark implores Donald Trump to not dismantle the Department of Education.Credit: Don LiebigPolicy promises that president-elect Donald Trump made on his campaign trail stand to affect my professional life greatly — both as a professor at a public university and a principal investigator of a stem-cell laboratory. Now that the election is over, I am eager to learn which of those promises will come to fruition.On the topic of education, I would urge Trump to not dismantle the Department of Education, as he has proposed. Instead, he should consider ways to enable students to attend university without going into debt — for instance, expanding funding for federal Pell grants, which are awarded to students in financial need. At the University of California, Los Angeles, where I work, we are committed to supporting first-generation college students and under-represented populations to provide them with the tools that are needed for success.How the world will weather Trump’s withdrawal from global agreementsOn science funding, I would implore the incoming president to raise funding for the National Institutes of Health (NIH) to a level that is consistent with the cost of doing science. After the last increase to the NIH budget in 2023, funding levels were 1.8% less than they were 20 years ago, when adjusted for inflation (see go.nature.com/3uvk5rr). Asking scientists to do more with less stifles creativity and poses a threat to the United States’ position as a world leader in biomedical research and innovation.And, finally, on reproductive health and science, I urge Trump to support basic research. For too long, federal policies have restricted the ability of scientists to develop technologies that can improve fertility care, and to research ways to expand contraceptive choices, eliminate reproductive diseases and promote healthy reproductive ageing. As a result, individuals and their families remain burdened by unaffordable and inaccessible reproductive treatments, including in vitro fertilization (IVF).In October, Trump recognized the value and importance of IVF to millions of Americans. I hope he will prioritize policies that will expand access to reproductive care and IVF and guarantee that this care is available for all.ERIC TOPOL: Embrace medical AIEric Topol hopes that the incoming administration can provide funding for artificial-intelligence technology to help transform US health care.Credit: Scripps ResearchHealth care in the United States is remarkably inefficient and is plagued by millions of serious diagnostic errors each year. It has a lack of clinicians, pervasive inequities and the worst outcomes of any rich country for life expectancy and maternal and infant mortality.Yet, we are on the brink of a seismic shift. Soon, it will be possible to use multimodal artificial intelligence (AI) to integrate all of a person’s data into one model — their electronic health record, laboratory tests, genome, social determinants of health, environmental exposures and more. The incoming Trump administration should provide financial backing for this technology, to accelerate AI’s transformation of US health care.Scientists must hold President Trump to account with courage and unityUnimodal AI, which analyses just one data type, has already been shown to significantly improve the accuracy with which physicians can interpret medical data, such as scans and pathology samples (E. J. Topol Nature Med. 25, 44–56; 2019). It can also substantially reduce the time that physicians need to spend on administrative work — such as dealing with insurance companies and note taking — so that they have more time to focus on patient engagement and care.Multimodal AI models, which integrate several data types, have the potential to do much more. For instance, it’s hoped that they will enable more-accurate diagnoses. These tools will use technologies such as digital twins — virtual models of a person — to optimize treatments and outcomes. They will be capable of personalized medical forecasting, helping to prevent age-related diseases. These models might also reduce the need for hospital stays by enabling people to be monitored remotely.The opportunities that lie ahead are extraordinary — improved efficiency, productivity, accuracy and outcomes and hugely reduced health-care costs. Still, more testing in real-world medical settings is needed. This clinical research is essential not only to validate AI models and fulfil regulatory requirements, but also to work out how multimodal AI can be used in ways that preserve an individual’s privacy and security, avoid bias and reduce health inequities. The government should make such work a priority.HANK GREELY: Protect patientsHank Greely is concerned that Donald Trump’s proposed budget cuts could decimate biomedical research.Credit: Eleanor GreelyI work on ethical, legal and social issues arising from the biosciences. The Trump administration’s top priority in this area should be to reassure people that the federal government will continue to support bioscience research, while maintaining the regulations needed to avoid exploitation of — and harm to — consumers and people receiving care. Uncertainty about what is to come, fed by statements such as Robert F. Kennedy Jr’s message that the “FDA’s war on public health is about to end,” can cause great damage even if threatened actions are not implemented. It can demoralize those who seek to improve public health, encourage people to retire or change careers and devastate public confidence in scientifically proven medical and public-health measures.‘We need to be ready for a new world’: scientists globally react to Trump electionI have three main concerns about the incoming administration’s effects on bioscience and medicine.First, some people in its coalition could attempt to ban or restrict some useful things that they consider to be immoral — including fetal tissue research, embryo research, discarding of IVF embryos, preimplantation genetic testing to select healthier embryos, interstate transportation of abortion pills and more.Second, the administration might decide to protect company profits over the interests of people receiving medical care and consumers, and as a consequence it could gut regulations that protect people by preventing the sale of harmful or ineffective drugs, medical devices, nutritional supplements and a broad range of other unproven practices. The administration has the power not only to change an array of laws and regulations, but also to cripple the agencies, such as the Food and Drug Administration (FDA), that enforce them.Third, it could decimate biomedical research if Trump’s administration really makes huge cuts in the federal budget — even if those cuts fall short of the US$2 trillion that Elon Musk says could be slashed. This would mean a slowdown in the research of life-improving and life-saving innovations — at least in the United States — not immediately, but inevitably, and soon. US health statistics are already bad enough; the new president shouldn’t act to make them worse. I will be (pleasantly) shocked if the incoming administration avoids that result.SALIM S. ABDOOL KARIM & QUARRAISHA ABDOOL KARIM: Prepare for the next pandemicQuarraisha Abdool Karim and Salim S. Abdool Karim urge Trump to fund pandemic prevention.Credit: Elana SchilzThe world has seen first hand how pandemics can affect livelihoods and derail even the best-laid economic plans. In our view, three current epidemics have pandemic potential: AIDS, mpox and antimicrobial-resistant organisms. Respiratory pathogens such as influenza, along with coronaviruses and resurgent, vaccine-preventable measles, are also cause for concern, as highlighted by the World Health Organization (WHO; see go.nature.com/4fvcj22).Combating these pandemic threats will require a worldwide effort, in which the United States should have a leading role. We urge the incoming Trump administration to invest in pandemic prevention, preparedness and response, in the United States and globally.What Trump’s election win could mean for AI, climate and healthFirst, the administration should provide more funding to the WHO, especially its Health Emergencies Programme. This would help the WHO to undertake effective pathogen surveillance around the world, generate information about possible future pandemics and deploy teams that can respond to emerging pandemic threats across the world — a key line of defence.Second, it should support the US Office of Pandemic Preparedness and Response Policy, which was established in 2023 to advise the president and ensure that the United States can respond to a pandemic threat effectively. In practice, this means giving the office the necessary funding, authority and autonomy to develop evidence-based plans.Third, the administration should ensure that the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria are financially supported in their aim of ending AIDS as a public-health threat by 2030 — one of the United Nations’ Sustainable Development Goals. George W. Bush’s administration demonstrated bold leadership in creating PEPFAR in 2003. The programme needs secure support up to 2030, at least, to build on its global gains and complete its mission.The incoming administration has articulated bold economic plans — but these could be at risk if a pandemic emerges. The best time to stop a pandemic is before it becomes one.RAMANAN LAXMINARAYAN: Be smarter with antibioticsRamanan Laxminarayan advocates for improving access to effective antibiotics.Credit: Ramanan LaxminarayanIn Trump’s first presidency, much progress was made in biomedical sciences. NIH funding grew by nearly one-third in nominal terms, for instance — I don’t see funding decreasing significantly in the coming years.And consider Operation Warp Speed. This public–private partnership, initiated in May 2020, incentivized pharmaceutical companies to take risks to expedite the development of vaccines, therapeutics and diagnostics to fight COVID-19.The issue of antimicrobial resistance is particularly close to my heart, owing to my work with the One Health Trust, which is a public-health organization that addresses the interconnected world of humans, animals and environmental health. In my view, the first Trump administration gave this issue no more or less attention than the preceding or succeeding Democratic administrations.This time around, improving access to effective antibiotics — both in the United States and globally — should be the single biggest priority for the incoming administration.Drug-resistant pathogens don’t respect country borders. So it is in the United States’ best interests to ensure that, around the world, antibiotics are used only when appropriate. A programme on the scale of PEPFAR could improve diagnostics, surveillance of antibiotic-resistant microbes and guidance around antibiotic use in low- and lower-middle-income countries in Africa and Asia. Funding for the development of AI and other digital tools could enhance the usability of point-of-care diagnostics, and ensure that the correct antibiotics are used in the correct situations and in the best ways.Financing access to antibiotics globally could help small US biotechnology companies that make these drugs to survive and thrive. This, in turn, will benefit people in the United States who desperately need new antibiotics, because the companies will have more money available for drug development.We sometimes — incorrectly — equate impact with spending. For less than US$1 billion dollars a year, the US government could transform access to existing and new antibiotics worldwide.