Pace of N.I.H. Funding Slows Further in Trump’s Second Year

NIH is not okay.

@nytimes.com highlights how grant-making & ability to obligate funding is at risk from staff shortages and time consuming screening processes designed to censor research to align with the administration's political ideology.

www.nytimes.com/2026/04/22/s...

Some highlights:

Pace of N.I.H. Funding Slows Further in Trump’s Second Year

New York Times article about the slow pace on NIH grant making as well as enforcement of political constraints.

[Gift Link]

www.nytimes.com/2026/04/22/s...

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Welcome! You are invited to join a webinar: IGHS Grand Rounds with Bibhav Acharya. After registering, you will receive a confirmation email about joining the webinar. Welcome! You are invited to join a webinar: IGHS Grand Rounds with Bibhav Acharya. After registering, you will receive a confirmation email about joining the webinar.

Join in person in San Francisco or on zoom: ucsf.zoom.us/webinar/regi...

Event flyer for a UCSF Grand Rounds IGHS Connect! talk. A headshot of Bibhav Acharya, a young man in a suit smiling, appears alongside the talk title: "Addressing Social Drivers in Global Mental Health: Lessons from an Intervention for Intimate Partner Violence in Rural Nepal." Event details: May 4, noon to 1 p.m., Mission Hall-1407. More info at tiny.ucsf.edu/GrandRoundsAcharya. Hosted by the UCSF Institute for Global Health Sciences.

What if we could prevent domestic violence instead of waiting until a crisis?

I’m sharing our experiences and results during Grand Rounds at @ighsatucsf.bsky.social

We'll talk about tackling intimate partner violence and mental health in rural Nepal + lessons we can draw for programs everywhere

Behind the Seen: Searching for Peace in a House With Violence | Annals of Internal Medicine

In this short story (published in @annalsofim.bsky.social) I wrote about what I tried, what didn’t work, and what ultimately worked:

www.acpjournals.org/doi/10.7326/... (subscription needed but free with HINARI in LMICs). If you still can’t get access, please let me know.

...just on the woman but also on her environment. What’s hurting and more importantly, what can help?
- Don’t rely just on formal systems and professional roles but also on (non-professional, informal) family/social relationships that can support her.

- If the woman says she can’t leave, don’t keep insisting she should.
- You’re not in her shoes; she is. Try to see the world the way she does.
- Look for others nearby who don’t have violence. What are they doing differently?
- Don’t focus...

Screenshot of an article in the Annals of Internal Medicine. Title: Behind the Seen: Searching for Peace in a House with Violence The house is unremarkable: thatched roof over walls of compacted clay. She’s sweeping the porch with a twig broom. On the hike to her home in rural Nepal, I had mulled options for her severe depression: new antidepressants, intensive therapy. “Namaste, Devi,” I announce. “I’m a doctor of the mind. I teach at the local clinic. Your regular doctor asked me to see you.” She produces a joyless smile to gesture welcome. We sit on straw mats on her porch as Devi’s six-year-old daughter steers her toddler brother from chasing the chickens in the yard. Every night her husband drinks...

I felt helpless when she told me her husband hits her every day. I had nothing to offer other than saying she should leave. But she couldn’t leave.
So, I stepped back and learned from women who did NOT have violence at home. The common link was surprising and taught me many things:

Paul Farmer on my mind

Link to the tribute: nepalitimes.com/latest/paul-...

“Should I even do global health?” I’m hearing this from the young generation. I get it. Funding slashed, worries about unequal relationships, and now the common refrain: “why are we helping abroad when people suffer here?” Global health was supposed to reduce suffering by breaking down the artificial distinction between “there” and “here.” It made some progress but failed a lot. But Paul Farmer pointed out the fundamental problem: “the idea that some lives matter less is the root of all that is wrong with the world.” I started by running brief “health camps” in high school, became disillusioned. Worked in established non-profits, saw exploitation. Co-founded Possible to run hospitals long-term, saw local elite capture as we handed over the hospitals to the government. Worked on finding innovative solutions to complex problems, and saw funding removed. Some lives matter less. As I wrote in this tribute to Paul, each step was a course-correction rather than a retreat. That’s where we are in global health now. A course-correction. Focus on what you uniquely bring to reduce suffering. Never accept that some lives matter less. So yes, do global health. Do it better than the previous generation.

“Should I even do global health?”

I’m hearing this from the young generation. I get it. Funding slashed, worries about unequal relationships, and now the common refrain: “why are we helping abroad when people suffer here?”

Global health was supposed to...

3. 1984: Next in line. May be a little less accessible but the first two books should provide a good foundation. Will see what he thinks.

Any other suggestions?

2. Maus: He accidentally picked this up thinking it was a fun read. I wasn't sure but he is already exposed to WW2 materials so I let him read. Later he told a friend that yes Hitler was bad but so were the people who supported him because Hitler couldn't have personally threatened everyone.

Stack of three books: 1. Ray Bradbury's Fahrenheit 451 2. Maus 3. 1984

Starter pack for raising a tween in 2026:

1. Ray Bradbury's Fahrenheit 451: There is a graphic novel version of this classic. Son was a bit puzzled by the storyline but a few weeks later, made connections with themes in the news...

"screening for food insecurity, or whether people have access to enough nutritious and safe food, as a top priority for medical schools. Mr. Kennedy’s curriculum does not explicitly emphasize the topic.

...Trump administration’s cancellation of the government’s annual survey of food insecurity"

“You’re as healthy as an ox!” Over and over, many doctors said this to me. I tried to explain that I wanted more intensive screening but they said I was lean and didn’t smoke, so the guidelines said I was healthy. I would cite studies showing that South Asians have higher risk of diabetes and heart disease despite being thin and not smoking, but hey, can’t argue with clinical guidelines and “evidence-based” risk calculators, even when they were developed without including S. Asians. I ultimately found a South Asian doctor and she understood immediately. As this article says, all South Asians know someone who had a “surprise” heart attack at a “young age” and so did she. We did deeper screening (Lipo A, ApoB) and had a careful discussion about risks and benefits, and decided to start a low dose statin, even though the calculators said I was low risk. Kudos to Alka Kanaya and her team at University of California, San Francisco for studying this and helping change guidelines. There is still more work to be done (e.g., even in these studies <1% are from Nepal and Bhutan) but I hope South Asian patients will now get receive appropriate screening and treatment for diabetes and heart disease.

“You’re as healthy as an ox!”

Over and over, doctors said this to me. I tried to explain that I wanted more intensive screening but they said I was lean and didn’t smoke, so the guidelines said I was healthy.

I would cite studies showing that South Asians have...
magazine.ucsf.edu/heart-risks-...

Supporting women who cannot leave an abusive relationship Intimate partner violence (IPV) is common worldwide and worsens mental health outcomes such as depression, anxiety, post-traumatic stress disorder (PTSD), and suicidality.1 Although the global prevale...

Link to the article (free): www.thelancet.com/journals/lan...

In public health and medicine, we often focus on what is not working. Which families have domestic violence? What is wrong in the families or communities that is causing this problem? However, we learn a lot by looking at families that do NOT have that problem. While working in rural Nepal, I found that almost all women (including community health workers and nurses) face domestic violence at home. All of them said they could not leave. They lived in multi-generational household/joint families and many, many factors drove violence. It was overwhelming to understand and address each situation. So I looked for women who did NOT have violence. Surprisingly, they had one thing in common: a supportive mother-in-law. “Oh, I get along so well with my MIL. She treats me like her daughter. She will never let my husband treat me badly.” “My MIL will yell at my husband when he tries to hit me. My MIL is great. We make Tiktok videos together!” We (University of California, San Francisco and Possible) are formally testing programs to include MILs in reducing domestic violence and have seen early success (Full randomized controlled trial is underway). In this The Lancet Psychiatry article, Mina Shrestha, Sabitri Sapkota Devkota, and I make a case that if women tell us they cannot leave a violent relationship, we should come up with creative ways to support them. Sometimes, this can include improving the relationship with the mother-in-law.

In public health and medicine, we often focus on what is not working. Which families have domestic violence? What is wrong in the families or communities that is causing this problem?

However, we learn a lot by looking at families that do NOT have that problem.

While working in rural Nepal...

A type II hybrid implementation-effectiveness study of the BECOME intervention: integrating Behavioral Community-Based Approaches for Mental Health and Non-Communicable Diseases delivered by community... Background Common mental health conditions (CMHCs) such as depression and anxiety often co-occur with noncommunicable diseases (NCDs) like hypertension and diabetes, compounding disability and mortali...

Link to paper (free): link.springer.com/article/10.1...

More and more people are living with multiple health conditions: high blood pressure, diabetes, depression, and anxiety. Busy doctors prescribe medications, even though counseling and behavior change should be tried first. Our study will answer two related questions: 1. Can community health workers improve health by delivering counseling techniques that are selected based on both simplicity and effectiveness? 2. Can empowering CHWs to use digital technology, having them train doctors, and showcase their work in front of healthcare leaders increase the likelihood of sustaining the program beyond the research grant period? Check out our team’s latest paper outlining the procedures of our 700-person randomized controlled trial of a novel intervention called BECOME. Congratulations to Kripa Sigdel for leading the paper and my co-Principal Investigator Sabitri Sapkota Devkota. Thank you to collaborators at Possible, University of California, San Francisco, Wheaton College, and the municipal governments in Chandragiri and Bardibas in Nepal for this The National Institutes of Health-funded R01 study.

More people are living with multiple health conditions: high blood pressure, diabetes, depression, and anxiety. Busy doctors prescribe medications, even though counseling and should be tried first.

Our latest paper for our 700-person randomized controlled trial of a novel intervention called BECOME

I met a nurse who works two jobs caring for disabled and elderly people. His work is sorely needed in a caregiving crisis that is only going to worsen bsky.app/profile/adri...

Did you look at TrumpRx to find medications? I'd love to hear from you today: melody.schreiber@theguardian.com (please share!)

New York Times home page Nameplate Saturday, January 24, 2026 Today's paper Minneapolis Shooting Just Now U.S. Winter Storm 1m ago [largest headline on the page] Videos Appear to Contradict Federal Accounts of Fatal Shooting LIVE Just Now Agents Kill 37-Year-Old Man in Minneapolis • Democrats condemn shooting as senators prepare to consider funding for ICE. 30m ago • Trump and other federal officials try to put blame on local officials and man who was killed. 45m ago • In Minnesota, citizens with firearm permits can openly carry handguns. 2h ago See more updates › Video Shows Moments in Which Agents Killed a Man in Minneapolis 2 MIN READ other story on page is a local real estate story How a Family of 5 Lives on $140,000 a Year in Morningside Heights New York City is among the most expensive cities in the world. Here is one family's strategy for making it work.

New York Times home page at 4:30 pm (ET)
main story

Videos Appear to Contradict
Federal Accounts of Fatal Shooting

It's very unusual for NYT to publish a video analysis, esp. one contradicting a govt account, so quickly, within 6 hours. But NYT had two of their most capable analysts on it.

Public opinion shifts on ICE as advocates warn of US ‘inflection point’ Amid growing unrest in wake of Minnesota killing, rights observers say US Congress must take action to curtail agency.

The people are saying it loud and clear: ICE is dangerous, violent, and operating with impunity.

Our elected leaders must seize this moment and take bold action to block any more funding of ICE's operations.

UPDATE re SAMHSA:

While the Trump Admin signaled they'll undo the terminations, we don't yet have proof.

On Jan 13, grantees received revised Notices of Award (NOAs) formally terminating their grants. Until they receive *another* new NOA w/ original terms, we assume grants remain terminated.

When governments, private companies, and non-profits focus only on “sick care” (not *health* care), this will replicate the problematic parts of the US system: severe underinvestment in prevention efforts, while most of the healthcare spending goes toward extremely expensive procedures

Advocacy CAN work 👏

Calling your representatives CAN work 👏

(Also, this is no way to run a health system—cut $2B in essential services suddenly and out of the blue, then hear a public outcry, then restore the funding the next day)

Medicaid Is Under Attack. Here’s How to Rebuild It Right. - Science Politics The program has always been underfunded and overlooked. The current crisis is an opportunity to reimagine care for those who need it most.

Thrilled feature Sanjay Basu in @sciencepolitics.bsky.social. I've been influenced by his work for years and it's really a treat to amplify his perspective here. Take a look - it's definitely worth your time if you care about medical care in America.

sciencepolitics.org/2026/01/14/m...

"Every system is perfectly designed to get the results it gets."

--Paul Batalden

"If you have fire hazards, every so often, you will have fire. We have the necessary conditions for this sort of thing to happen and I must emphasize that it will keep happening."

-- Ta-Nehisi Coates

Forensic analysis of objective video evidence. This is how you serve readers searching for clarity.

What happens when you bring the husband, wife, and mother-in-law together to reduce domestic violence?

Improved communication, better relationships, mutual support in household tasks.

And some backlash when women have more freedom.

Our latest paper (free):

link.springer.com/epdf/10.1007...