This cross-sectional study assesses National Institutes of Health (NIH) data from fiscal years 2016-2025 comprising annual counts of principal investigators funded through research grants and fellowship grant recipients, stratified by self-reported sex, race, ethnicity, and disability status.
Science Journals
In the Review titled “Prepregnancy Care and Counseling: A Review,” published in the May 19, 2026, issue of JAMA, a reference was incorrectly cited and another reference was inadvertently omitted from the article. In the fifth paragraph of the Cardiovascular Disease section of text, the sentence “Testing may include electrocardiography, echocardiography, exercise testing, electrophysiology studies, and genetic evaluation for conditions such as Marfan syndrome, long QT syndrome, and hypertrophic cardiomyopathy” was revised to cite reference 74. Additionally, in the Cannabis subsection of the Substance Use section of text, the sentence “A systematic review and meta-analysis (51 studies; 21 146 938 patients) reported that cannabis use during pregnancy was associated with increased odds of low birth weight (OR, 1.75; 95% CI, 1.41-2.18; 20 studies), preterm birth (OR, 1.52; 95% CI, 1.26-1.83; 20 studies), small for gestational age (OR, 1.57; 95% CI, 1.36-1.81; 12 studies), and perinatal mortality (OR, 1.29; 95% CI, 1.07-1.55; 6 studies)” should have cited the following study: Lo JO, Ayers CK, Yeddala S, et al. Prenatal cannabis use and neonatal outcomes: a systematic review and meta-analysis. JAMA Pediatr. 2025;179(7):738-746. doi:10.1001/jamapediatrics.2025.0689. Because of this additional study, the seventh sentence in the Methods section was revised to “This Review includes 119 articles, consisting of…16 systematic reviews and meta-analyses…” and references 114-118 were renumbered to 115-119. This article was corrected online.
Seldom are health policy decisions guided solely—or even primarily—by evidence from clinical trials. Indeed, there may be an inherent mismatch between the broad scope and rapid speed of most policy decisions and the deliberate specificity and methodical pace of traditional trial research. Policymakers often adopt or fund interventions for broad populations based on incomplete information, and under time pressure, budgetary constraints, and competing political demands. Clinical trialists, in contrast, may focus on generating internally valid answers to highly specific questions under carefully controlled conditions, a process that can take years of planning, data collection, and analysis. Not surprisingly, policymakers may perceive that the evidence generated by trials is too limited and arrives too late to guide many of the real-world decisions they make, while trialists may lament that sweeping policy actions are taken without robust experimental evidence demonstrating their effects.
To the Editor A recent study reported that higher caffeinated coffee and tea intake was associated with lower dementia risk and modestly better cognitive performance in participants from the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). In adjusted models, participants in the highest vs lowest quartile of caffeinated coffee consumption had a hazard ratio (HR) of 0.82 (95% CI, 0.76-0.89) for dementia, with the most pronounced difference at a moderate intake of approximately 2 to 3 cups per day. We propose that, in addition to neurobiological effects of caffeine, part of this association may reflect more socially active lifestyles among regular coffee drinkers, which themselves protect against dementia.
In Reply We thank Dr Schiappacasse and colleagues for their thoughtful comments on our article, and for raising the potential role of social engagement as a confounder or mediator of the observed associations. In our original analyses, we did not adjust for social engagement because comprehensive data on this construct were collected after each study’s baseline, specifically, beginning in 1992 in the NHS and in 1988 in the HPFS compared with baseline in 1980 and 1986, respectively. Including these variables would have substantially reduced follow-up duration and statistical power; therefore, we adjusted for marital status and living arrangements, which were available in the original baseline data.
My mother measures wellness in motion. She calls from the South, steady in static. Did you eat, sleep, pray, she asks. I say I am fine, surgical, sealing a container. She raised me on proof, beans roasted to shine, the jebena warmed until it hums. Before school, she packed injera in foil, warm against my palm, a quiet kind of love. Now the season returns. I hide small failures. A toothbrush dry at noon. Food cools because chewing feels like labor.
Poetry is inherently expressive and often subjective, making it a useful complement to stoically objective medicine. A reader may experience one viewpoint within a poem or even two or more perspectives living within the same verse. Because it can accommodate such divergences, poetry can help reconcile conflicting narratives, as may arise during clinical care. In particular, clinicians must often engage cultural beliefs that differ widely from their own; yet cross-cultural humility is often not adequately taught during medical training, resisting typical didactic approaches as not problems to be solved but worlds to be entered. The poem “Two Languages” illustrates what cannot be reduced to abstract statistics or checklist stereotyping, as the speaker grapples with depression amid rounds in the emergency department, ironically treating patients with depression while receiving unscientific, culturally based advice from his mother on how to best alleviate his own symptoms. Medication and other clinical interventions are set beside religiousness and home cooking. Data collide with the cultural differences inscribed upon the speaker’s illness experience, with its roots in war, displacement, and food insecurity in a distant country with another language. Yet a conversation that honors a “quiet kind of love” between mother and child provides a lifeline, through a poetry that ultimately informs the speaker’s dedication to, and empathy for, his patients. “She sends care the only way she knows…Mom, be beside me,” he says, lines reaching across cultural dissonance to show healing connection can triumph, even without completely shared ideologies.
Decision analysis is a quantitative approach to decision-making under conditions of uncertainty that uses explicit statistically based methods to compare alternative strategies based on their expected outcomes. Cost-effectiveness analysis is a form of decision analysis that compares resource use and health outcomes of competing strategies. The cost-effectiveness analysis by Lee et al in this issue of JAMA estimates that adding 1-time Helicobacter pylori stool antigen testing (HPSA) to fecal immunochemical testing (FIT)–based colorectal cancer screening programs could yield greater life-years and lower costs than FIT alone due to reductions in gastric cancer mortality.
To the Editor We are dismayed by the number of US adults with uncontrolled blood pressure (BP), as reported in a recent Research Letter. We wish to bring additional attention to the current national quality performance measure target for high BP control of less than 140/90 mm Hg, which has been both outdated and stagnant since 2005. Since 2017, this measure has remained misaligned with national guidelines endorsed by the American Heart Association (AHA) and the American College of Cardiology (ACC), which recommend control for adults with stage 2 and stage 1 confirmed high BP who are at increased risk for cardiovascular disease (CVD).
In Reply We agree with Dr Casey and colleagues that the 2025 AHA/ACC multisociety guideline’s BP goal of less than 130/80 mm Hg should be the national goal. We also agree that the previous BP goal of 140/90 mm Hg, which is included in many national quality metrics, is outdated and that the higher BP levels in quality performance measures may contribute to gaps between evidence and clinical practice. Estimates suggest that achieving and maintaining a BP goal of 130/80 mm Hg among US adults could prevent 500 000 more CVD events nationally during 10 years compared with a goal of 140/90 mm Hg.
This Viewpoint discusses advertising in artificial intelligence (AI)–powered clinical decision support tools and stresses the importance of adopting and policing advertising policies with strong ethical guardrails within these tools.
In Reply We appreciate the interest of Dr Y. Liu and colleagues, Dr C. Liu and colleagues, and Dr Morice and colleagues in our article reporting results of the CORAL study. We showed that patients randomized to receive nalbuphine ER, 54 mg twice daily and 108 mg twice daily, had both significantly lower (vs placebo) measured (objective) cough frequency and patient-reported cough frequency and severity. The nalbuphine ER 27 mg twice-daily dosage significantly improved objective cough but did not consistently improve patient-reported outcomes and was thus determined to be minimally effective.
This cross-sectional study assesses the association of state-level abortion bans with spontaneous abortion management and receipt of mifepristone plus misoprostol among commercially insured individuals in the US.
Ligand-dependent enhancer activation indirectly modulates non-target promoters in a chromatin domain
Transcription activation of genes by estrogen is driven by enhancers, which are often located within the same topologically associating domain (TAD) as non-targeted promoters. We investigated how acute enhancer-driven activation affects neighbouring non-target genes within the same TAD. Using single-molecule RNA FISH (smFISH), we tracked the transcription of TFF1 (enhancer-target gene) and TFF3 (non-target gene) during estrogen stimulation. We observed mutually exclusive expression patterns: TFF1 expression peaked at 1 hr, while TFF3 reached its peak at 3 hr after TFF1 activation had diminished. Chromatin looping data indicated that the enhancer loops with the TFF1 gene but not TFF3, suggesting that TFF3 upregulation is not due to direct enhancer-promoter interactions. CRISPR deletion of the enhancer affected TFF1 transcription more acutely than TFF3. 1,6-hexanediol (HD) exposure suggested that the TFF1 enhancer:promoter undergoes a potential ERα-mediated condensate formation, which sequesters the transcriptional machinery and inhibits TFF3 expression. As estrogen signaling fades at 3 hr, TFF1 expression declines while TFF3 expression increases. Our findings reveal that enhancer-driven activation can indirectly repress neighboring genes within the same TAD, highlighting a dynamic shift in gene expression as signaling progresses.
This JAMA Insights discusses the transmission, diagnosis, management, and prevention of chikungunya.
This Medical News article discusses an investigational fentanyl vaccine that has entered human trials and, if proven safe and effective, could prevent overdose and treat addiction.
This interrupted time series analysis uses Medicare Part D data from January 2021 through December 2023 to measure changes in insulin cost and use after the Inflation Reduction Act $35 cap on out-of-pocket insulin costs, overall and for insulin users with previously high out-of-pocket cost.
To the Editor In the CORAL randomized clinical trial, Dr Molyneaux and colleagues reported that nalbuphine ER reduced 24-hour objective cough frequency in patients with IPF and chronic cough. Higher doses led to more significant reductions compared with placebo after 6 weeks. Although this study addresses a critical unmet need, several aspects require clarification to facilitate its clinical application.
To the Editor In the CORAL randomized clinical trial of nalbuphine ER in IPF, nalbuphine appeared to be a highly effective therapy in individuals experiencing chronic cough.
This JAMA Patient Page describes how chikungunya virus infection is acquired and provides information on the diagnosis, treatment, and prognosis for patients.
Accurate termination of protein synthesis is paramount for the integrity of the cellular proteome, yet the dynamics and fidelity of ribosome termination remain poorly understood. Here, we establish a profiling strategy to capture terminating ribosomes in mammalian cells and reveal a substantial heterogeneity in ribosome pausing at individual stop codons. We identify a sequence motif upstream of the stop codon that promotes termination pausing, a finding supported by massively parallel reporter assays. Unexpectedly, reduced termination pausing increases the likelihood of stop codon slippage, giving rise to proteins with heterogeneous C-terminal extensions. Mechanistically, we show that sequence-dependent termination pausing is consistent with post-decoding mRNA scanning by the 3′ end of 18 S rRNA. We further uncover tissue-specific patterns of termination pausing that correlate with the stoichiometry of Rps26, which potentially modulates mRNA:rRNA interactions. Together, these results suggest termination pausing as a distinct translational signature shaped by mRNA sequence contexts, ribosome heterogeneity, and cell type-specific translational control.
Certain dietary patterns may help women manage weight during menopause, which could improve their long-term cardiometabolic health, according to research published in JAMA Network Open.
Lester S. King, MD
In this narrative medicine essay, an internal medicine resident describes how the visceral pain felt immediately after her father’s death has transformed to a never-ending ache and pressure over time.
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.