First Annual President’s Address to the NAM Membership by Monica M. Bertagnolli, MD
Delivered October 19, 2026
My heroes have always been scientists and clinicians. When I was a young girl, my hero was my Uncle Pierre, a primary care physician who practiced in rural Wyoming. Delivering babies, responding to highway trauma and farming accidents, making sure all the kids were vaccinated and everybody’s blood pressure was controlled — he did it all. He was, in so many ways, the single most important person in his small rural community. He saved lives. In junior high school, I read Rachel Carson’s book Silent Spring. The part that really hit me was that chemicals widely used in agriculture could be a cause of cancer. My beloved grandmother had died of cancer and I immediately knew I also wanted to be not just a doctor taking care of people but also a researcher so that I could also help find cures or — even better — prevent cancer in the first place. And today, here I am in a room filled with my heroes. The feeling is the same as it was way back then — of fascination with the beauty and drama of science, of excitement over the potential to accomplish goals that are so important, and of a responsibility to use the opportunity I have been given to make a real, meaningful difference by working with all of you.
The National Academies Hold a Special Place in Our Society
The NAM’s mission is to achieve human health, equity, and well-being, and to do this by advancing science and the evidence base, informing decisions and policymaking, and catalyzing action. The National Academy of Sciences (NAS) (the founding organization of the National Academies) holds a very special place in our society. It is an institution established by Congress for the purpose of providing independent advice to the federal government. Specifically, the National Academies have a responsibility, when asked by the federal government, to investigate, examine, experiment, and report on any subject of science. This obligation is unusually broad, covering a wide range of scientific and technical questions brought by government departments over the past 163 years.
While we provide important services to the federal government, we are not a federal agency. Our statutory authority gives us the independence to establish our own governance and elect our own members, instead of having them appointed for us.
Our 1863 charter from Congress embodies a fundamental principle: the federal government should have access to the best available scientific evidence, but the scientific judgments informing government decisions should remain independent of political influence.
The Need to Adapt Our Institutions to a Staggering Pace of Change
Today, our society is undergoing change at a staggering pace, and change is never easy. One of the biggest changes shaking the foundations of science and medicine — let alone the rest of society — is artificial intelligence (AI). Machines have become increasingly capable of analyzing information and generating solutions, which means that scientifically grounded human judgment, creativity, and ethical reasoning become more important — not less.
Although scientific and technological advances are creating extraordinary opportunities, access to their benefits remains unequal — and for health care, the gap between what is possible and what is available to many is growing. Finally, the global interdependence of our challenges is increasingly recognized. Climate change, food supply, economic stability, and national security — all of these are related to health, and none of these can be addressed as isolated problems.
Our institutions ground us; they provide the base from which we deliver progress. One of the reasons we all feel so uncertain today is that the pace of change is exceeding our institutions’ ability to adapt. Government, universities, health systems, and regulatory agencies are all under stress as they manage the updates to their structures and practices demanded by new technologies. They must also deal with shifting government funding priorities creating uncertainty concerning what might come next. A pressing need to adapt to change is leading our nation to confront questions with profound implications for our institutions. These include the proper use of federal research funding, the independence of our academic institutions, the integrity and trustworthiness of scientific advice, and our government’s response to complex challenges in health, technology, and the environment.
Preserving Independent Scientific Judgment at the Federal Level
The National Academies recently weighed in on a matter that speaks directly to the role for which we were created. On May 29, 2026, the White House Office of Management and Budget (OMB) published in the Federal Register a proposed rule titled “Regulation for Federal Financial Assistance.” This rule would substantially revise the Uniform Guidance governing federal grants and cooperative agreements, formalizing an additional stage of review by senior political appointees, and explicitly incorporating presidential priorities into decisions about discretionary awards.
This proposed rule raises a question that the National Academies were explicitly created to address: How can the federal government retain legitimate authority and accountability over public research expenditures while preserving the independent scientific judgment and sustained investment that have historically made American biomedical research so successful?
In early July 2026, just as I arrived as NAM president and Neil Shubin took over as president of the NAS, we responded to a call for input on OMB’s proposed rule. NAM Council members and our elected officers worked together to produce a response that pushed back strenuously on elements of the proposed rule that would introduce damaging instability into a system whose predictability and scientific independence has allowed it to produce tremendous benefits for our nation and the world over more than seven decades. We argued that the proposed rule weakens the practical influence of scientific peer review and increases the risk that research proposals will be rejected for politically motivated reasons unrelated to their scientific merit. That distinction is particularly important for basic biomedical research, where a project with strong scientific value may not appear to have immediate relevance to an administration’s policy objectives.
Each of the three Academies issued its own response to the proposed rule, and the three presidents together issued a joint public statement underscoring our shared concerns about the proposal and the importance of protecting independent scientific judgment. This outcome allowed different perspectives from each of the three Academies to be voiced — but produced one unified conclusion: the National Academies oppose any actions that threaten the independent scientific judgment and sustained federal investment that have historically made American biomedical research so successful and supported critical public health infrastructure and delivery of essential services.
In a bipartisan action in September 2026, Congress temporarily blocked OMB from implementing its proposed rule changes until after December 11. Congress has not permanently rejected the rule, so we remain concerned that this action may still take place.
Beyond the Federal Government: The Complex Science and Health Ecosystem
Scientific independence gives the National Academies the ability to decide what we believe are the most important questions and issues to be investigated, examined, experimented, and reported on. And if not asked by the federal government to weigh in on these questions, then we still use our ability to convene across all disciplines and institutions relevant to science, engineering and medicine — engaging not only those who contribute expertise and lived experience, but also those who have the ability to effect change. Not everything that needs to change requires action at the level of the federal government.
For me, having recently served as director of a large federal agency — the National Institutes of Health (NIH) — the difference that the NAM’s broad mandate brings is profound. My task as NIH Director was to ensure that public dollars were spent on research that most effectively advanced the health and well-being of all people. At the NAM, the job is very different. The job is to work to achieve human health, equity, and well-being by harnessing the talent, creativity, and generosity of our members and volunteers, and also that of the many institutions forming the complex ecosystem underlying health and health care who also look to the National Academies for guidance and support.
This is a job that requires rallying all forces around shared goals. Since being named as the new President of our Academy, I have been contacted by many who have expressed a desire to participate more actively in the NAM’s work. I am so grateful for the support you have given me as I enter this new role. This includes generous and very welcome advice from many of you, and considerable time and effort from those who have responded to a call for input or action. I am also grateful for the support of our donors and sponsoring organizations, which makes it possible for our work to extend to many concerns that require the multi-sector approach that the National Academies can uniquely provide.
The National Academies, like every other institution today, need to adapt to current realities. It is clear we have a critical role during these challenging times and must expand our ability to drive positive change. I still have a lot to learn and relationships to build with people and organizations who support our work. But I’m off to a brisk start thanks to the talented and dedicated National Academies staff, and to our outstanding and highly responsive NAM Council. What is very clear is that there is great desire among our members to do more. And when I consider who our members are, and what institutions they represent, the potential for progress is tremendous.
Areas Where the NAM Is Uniquely Able to Drive Progress
Ensuring That Scientific Advances Deliver More Public Health Benefit
Our biomedical research enterprise has produced remarkable progress, with exciting advances in immunology, gene editing, single-cell analysis, artificial intelligence, and more that have transformed our scientific toolkit. We now have the ability to move clinical medicine from predominantly standardized, disease-based treatment toward increasingly individualized, molecularly informed, digitally enabled care. However, our nation’s capacity for progress stalls at a critical point — when we need to test new discoveries in clinical trials, and also when we use the data together with new analytics now at our disposal to learn from the real-world clinical care setting. The slow pace of progress and high cost of clinical research in the United States, compared to that of other nations — notably Australia and China — illustrates not just differences in our regulatory environment, but in the efficiency and expense of our health care system.
Stated another way, there is a disconnect that I believe not only stalls progress but also contributes significantly to anti-elitism and even distrust in science. Our scientific capability has advanced more rapidly than the systems responsible for delivering its benefits equitably. Today, although medicine can accomplish things that were almost unimaginable just a decade ago, far too many people struggle to obtain timely, affordable, coordinated, and trustworthy care.
Our priorities are clear. We need our researchers and innovators to continue to produce new therapies, diagnostics, and decision-support tools that enable more effective disease prevention and treatment. But just as urgently, we need to re-center health care delivery on the patient’s personal health goals and ensure that every clinician and every patient has the best evidence available to guide health decisions, together with the resources and support required to achieve a patient’s health goals. There is a growing crisis in the increasing cost of health care, with far too many people unable to afford what they need. We must eliminate waste from health care spending by incentivizing health care delivery systems to measure what matters and then apply those data to optimize health outcomes for all people while maximizing care efficiency and minimizing cost. And in the public health arena, we need to make sure that individual people and their communities have the knowledge and resources they need to be healthy and that they are valued partners in both the delivery of health care and the research required to achieve a better future.
Advancing the Learning Health System
In response to the need for a much deeper evidence base for medical decision making, Institute of Medicine (IOM) president Harvey Fineberg invited Michael McGinnis in to help explore approaches for the IOM to help. Together, they formed an IOM Roundtable on Evidence-Based Medicine, and, in anticipation of substantial opportunities to generate knowledge from practice, embedded in its 2006 Charter the notion of a continuously Learning Healthcare System. Later that year, the IOM Annual Meeting focused on those opportunities.
In 2006, an important aim was to address the fact that less than 50 percent of clinical decisions were estimated to be based on the best available evidence, but even more challenging was the level of evidence that didn’t exist at all. There needed to be new ways of producing better evidence faster. The Roundtable set a stretch goal of 90 percent of clinical decisions based on accurate, timely, and up-to-date evidence by 2020.
It’s fair to say that transforming the U.S. health care system has proven to be more difficult than anyone anticipated — not only because of the inherent challenges of fragmentation and adverse system incentives, but also because the pace of innovation in diagnosis and treatment has far outpaced innovation in evidence development. Although we’re nowhere near meeting that 2020 goal, the NAM’s Learning Health System Initiative continues to engage a broad coalition of public and private organizational leaders to align science, incentives, informatics, and culture to improve the nation’s health. Today, in response to increasing need and the arrival of exciting new data technology, the initiative has evolved considerably. Its many partners, now including leaders in the application of AI in medicine and research, are working together to develop and implement a systems engineering approach — measuring what matters to patients, achieving data transparency and use in ways that build trust and accountability, using data and feedback to take action toward important goals and finally, making sure that positive change is sustained by integrating what is learned into the system itself.
Just one of many programs underway in the Learning Health System Initiative is the Clinicians Forum on AI in Health and Medicine. This Forum addresses a major challenge facing health care: AI capabilities are advancing faster than the health professions’ ability to evaluate them and integrate them safely into practice.
Led by Helen Burstin and Suzanne Miyamoto, and operating through the initiative’s Digital Health & AI Action Collaborative, the Forum brings together professional organizations, AI developers, health systems, patients, and others — including the Food and Drug Administration, the NIH, and other federal agencies. Its purpose is to ensure that artificial intelligence is introduced into health care in ways that improve patient outcomes while supporting clinicians, protecting safety, and promoting continuous learning.
Sustaining the Biomedical Workforce
Think back, everyone, to a time when you were a medical student, a postdoc, or a junior faculty member yet to receive funding for your work, or when you were approaching graduation and looking for a job. Remember how hard you worked to be ready and how you depended on institutions to give you a professional home and mentors to help you succeed? The damage to the U.S. biomedical research enterprise created by recent changes to government funding for research and new federal demands on academic institutions has hit hardest on those in the early stages of their careers — those who we all depend upon for our future. Of the many harms created by recent disruption, this is the most concerning.
Last year, the NAM held a workshop in collaboration with the American Junior Investigator Association that resulted in a forward-looking discussion whose proceedings were published in May 2026. The workshop was supported by Burroughs Wellcome Fund, the Lasker Foundation, and the American Society for Clinical Investigation, and included Robert Lefkowitz, Jay Bhattacharya, Rob Califf, and many other leaders from academic medicine, philanthropy, government, and industry.
The workshop identified six priorities:
- Restore rigorous basic science in medical education.
- Protect research time for clinician-scientists who face increasing pressure to generate clinical revenue.
- Improve early-career funding.
- Strengthen mentorship.
- Develop alternative funding models.
- Create a compelling national narrative — make the case to the American people for why clinician-scientists are essential for our future success.
This workshop established the basic principles, and its publication is a call to action — but we need to do much more to put these recommendations into action. Eva Feldman and Karen Antman are now co-chairing a multi-sector initiative convening leaders across academia, government, industry, and philanthropy to develop actionable strategies to strengthen career pathways for physician-scientists. The initial focus is on two critical and complementary priorities: strengthening mentorship and advancing sustainable financing to sustain career pathways. Other established programs within the National Academies, including the Science and Engineering Education and Workforce Program Area and the standing Board on Higher Education and Workforce also provide important multi-disciplinary focus for this work. This work must continue for the foreseeable future, and it needs new support to continue — support for the NAM to lead the charge on behalf of the biomedical research workforce, and for all who need the skills and talents of the National Academy members of the future.
Threats to Health That Transcend National Borders
Threats to health have never been contained by national borders. Pandemics, forced human migration, climate change, artificial intelligence, and national security — these all represent concerns that demand international collaboration. Like everything else in science and medicine, today’s global health landscape is changing — shifting toward greater emphasis on locally led research, sustainable national capacity, and international scientific partnerships, rather than major reliance on traditional donor-supported programs and support from the U.S. government. This changing financing environment raises important questions about which global health functions — such as disease surveillance, research infrastructure, scientific training, and rapid response capabilities — should be supported as enduring public goods.
The National Academies have long held a global perspective, and the NAM has contributed by catalyzing important international partnerships and leadership initiatives. An example of this is the Healthy Longevity Global Grand Challenge. Launched as a major international initiative in 2019, its goal is to transform how societies approach aging by focusing on human healthspan — the number of years people live in good physical, cognitive, and social health — rather than simply extending lifespan. This Global Grand Challenge employs scientific research, technological innovation, public policy, and financial incentives to improve health and well-being as populations age. A worldwide competition has identified and funded bold ideas across the globe and the Grand Prize has been awarded.
Another NAM effort, the Climate Grand Challenge, seeks to make human health a central consideration in global climate policy, and in the related scientific research, health care delivery practices and economic development strategies that can address this ongoing threat. In addition to developing a roadmap for progress at the global level, this effort engages Academies of Science and Medicine across the world to provide independent scientific advice, share evidence, and help governments implement practical climate-health solutions.
The NAM’s programs in global health are complementary to boards and committees across the National Academies. A notable example is the Forum on Microbial Threats, created in 1996 at the request of the Centers for Disease Control and Prevention and the NIH. This Forum provides ongoing discussion and scrutiny of critical, and sometimes contentious, scientific and policy issues related to infectious disease research and public policy. For example, as the world recovers from COVID-19, understanding how pathogens first spill over into human populations is critical to prevention efforts. In January 2025, a convening by the Forum examined how ecological and social factors shape the emergence of new infectious diseases in humans. Speakers addressed gaps in understanding disease emergence with a focus on the human-animal interface and laboratory biosafety.
Conclusion: Working Together for Progress in Health and Science
The National Academies were created for circumstances just like the ones we are experiencing today. Our charter was granted by the U.S. Congress during the Civil War — a time of national crisis and partisan divisiveness in the extreme. Our purpose then was very clear and remains the same today: we are the institution created to provide the federal government with guidance based on the best available scientific evidence, and to ensure that the scientific judgments informing government decisions remain independent of political influence.
There is so much at stake today, and what we do now will make a great difference to future generations. Will they live in a physical and social environment that allows them to thrive, or will they struggle with chronic disease, or a health care system that doesn’t care for them?
I’ve barely scratched the surface of all that is underway at the NAM and the National Academies — just listed a few areas of high priority among so many other programs achieving important progress because of the time, talent, and resources contributed by our members and sponsors.
Since 1970, when the Institute of Medicine was founded, and over the past 11 years in its role as an independent National Academy of Medicine, we have become a community — now made up of over 2,500 outstanding individuals who have devoted their life’s work to improving the health of all people. Our members and many volunteers belong to powerful institutions that define the entire health ecosystem, including a growing number of organizations that engage people with lived experience in our work, allowing us to earn the trust that is essential for progress. The potential for achieving better health for all people by coordinating the collective action of our community is tremendous.
We need to lead the nation through a time of difficult but exciting change. We need to introduce evidence into so many discussions that lack this critical element so that wise decisions can be made on issues of grave importance to society and individuals.
Most of all, when our evidence points to actions that can promote health, we need to follow through. We need to use the collective power of our broad community to put into action the directions that become clear as we deliver on the requirements set out in our charter to investigate, examine, experiment, and report upon matters of science relevant to health.
I remember so clearly the feeling of great pride and accomplishment when I was elected to the membership of the NAM. And now, as your president, I can’t wait to work with all of you to see our work amplified — because what we can achieve together is so much more powerful than what any of us can accomplish alone. If not us, then who will?
Thank you.
