Michael Lyon talks with Dr. Ann Anderson Berry, executive director of the Child Health Research Institute, a pediatric research partnership between the University of Nebraska Medical Center and Children’s Nebraska. They start at the beginning: what medical science actually is, how a question becomes a treatment, and why it takes so long to reach a bedside.
Transcript
Transcribed automatically and lightly corrected.
[0:02] Michael Lyon: This is Heartbeat, conversations about medical science, research, and the discoveries that touch all of our lives in collaboration with the University of Nebraska Medical Center. Together we'll explore how science works, why it matters, and how today's research could shape tomorrow's care. I'm Michael Lyon. My guest today is Dr. Ann Anderson Berry, Executive Director, Child Health Research Institute at UNMC. Welcome. Hello. Let's talk about the big picture here, and we're starting right at the beginning with the big question that I'm sure if you asked the average person on the street they would have a whole variety of answers for. So the question is,
Ann Anderson Berry: what is medical science? Medical science or medical research is a systematic way of asking questions to better understand what's going on with the health of humans. It's a very simple place to start, and of course it can get a lot more complicated from there.
Michael Lyon: And it's different from medical care because of course that has to do with diagnosing and treating patients, but medical science is would you say the foundational research that sort of informs those practices?
Ann Anderson Berry: Absolutely. The majority of what we do in medical care is based on what we've learned from medical science. We call that evidence-based medicine, and you want your care teams to be practicing evidence-based medicine, then you know you are getting the most current, most effective treatment for whatever ails you.
Michael Lyon: We hear about research all the time, and whether that comes from reputable sources or from social media posts, medical research, the evidence of it at least, is everywhere. Why does it matter in everyday life? Well, it matters for
Ann Anderson Berry: just the reasons we were talking about, that your medical care is based on good quality research. There's a lot of different interpretation of the evidence, as you mentioned in social media, as compared to medical journals, as compared to what you would get from advice from your health care provider. And so the source of interpretation around medical research also matters very, very much. If you have the wrong interpretation or a misrepresentation, skewed medical research, then we can get into big trouble with receiving inadequate or incomplete care.
[2:30] Michael Lyon: Now, has medical science already changed the way we live?
Ann Anderson Berry: Oh, medical science has changed the way we live since the development of penicillin. We have four hundreds of years. We have been benefiting from the questions asked around how the human body functions, how we can intervene to make it function better, how we can try to augment things that are going well or change things that are going poorly. We have to start with a question. We call that a hypothesis. And so if we have a clinical situation, and most medical biomedical research starts with a clinical question. What's going on at the bedside or with a population that we would like to not be happening? Say that is in my field, babies delivering too early. Well, that's a problem. And then let's try to figure out how often that happens. That's an epidemiologic question. So we can look at the population and see is this really happening frequently? Is it happening more frequently in 2026 than it was in 2020? And then we can go from there. So we've got to start with a hypothesis.
Michael Lyon: There are many questions that continue to be asked medically about how we deal with one condition, illness or another. And there are some questions that have been asked for years and years and years and research is still ongoing. Is there sort of any burnout with that among the research community? Because funding is still available for those things, but isn't funding also available for new and exciting technologies that can have a very quick payoff?
[4:12] Ann Anderson Berry: Yeah, funding is a key part of successful research. So I lead the Child Health Research Institute at UNMC in collaboration with Children's Nebraska and the investigators that I support across both campuses are constantly looking for funding to do important work in child health research. Big part of funding historically has been the National Institutes of Health. That's federal funding, NIH funding. That's what we hear about a lot in the news. Cuts and NIH funding, each priorities and swings in those priorities can dramatically impact how one investigator can ask questions and get money to fund that and how other investigators might not have a priority area of interest, but it's still important to those patient populations. So then we have alternative sources, so there can be foundations like the Kidney Foundation or the Diabetes Foundation, so the American Heart Association that also provides significant amounts of funding for researchers. So as researchers, we have to get creative in looking for funding sources to do important work, particularly as priorities shift, but
Michael Lyon: creative researchers always find a way to get things done. Okay, so you mentioned the Child Health Research Institute, and I believe Mary Woolley, president and CEO of Research!America, said at a 2024 lecture there that at a time when federal research funding has dipped and public confidence in research appeared to be slipping that the four most important words for scientists are, I work for you. What did she mean by that? Oh, she she is brilliant,
[6:02] Ann Anderson Berry: and I was at that lecture, and I believe every scientist works for the citizens. So when we say we work for you, it means that we are working using all of our expertise and resources to solve problems that affect the public's daily lives. If you think about any medicine you or a family member takes, that's the result of medical research. If you think about any surgery that anyone in your circles have had, that's the result of medical research. If you use a device, say an insulin pump or a continuous glucose monitor, that's the result of research. So everything a researcher does, whether we're in a wet lab working with cells, or whether we're doing electronic health records, we're working for you to make your life better through biomedical research.
Michael Lyon: And of course this really speaks to the question of how public funding, public health and accountability are connected. What are the biggest challenges these days in obtaining funding for needed research? Is it public opinion, public advocacy for one, along one particular line, or is there more private funding available or
Ann Anderson Berry: more government funding available for certain things? Yeah, that's a great question and it's a complicated answer. So Mary Woolley was right that confidence from the US population is slightly waning in research, but the majority of US citizens still support science and support biomedical research. Their government, the US government, also supports that. Interestingly, despite all of the news that we've heard about NIH funding, the budget for NIH funding this year was slightly positive, 0.09% increase. That's not much. That doesn't buy many reagents, but it's better than a cut. However, here in Nebraska, the state budget cut five million dollars from the tobacco health funds that supported research at our major universities, not only UNMC, but Creighton University and Boys Town. So we are seeing those impacts locally, and those are big impacts. Five million dollars to those three institutions means resources will have to be cut. Scientists won't be hired to come into Nebraska and answer these interesting questions. On a federal level, we did have that slight increase in those federal funds, but what we're seeing this year is that NIH is very slow to move those funds into the hands of investigators. Grant reviews are taking considerably longer. When they have approved an award, a research project, they're not releasing the funds. In general, month over month, we are incredibly slow this year in getting funds into the hands of scientists to do the approved work. So that's a big complication.
[9:03] Michael Lyon: Yes, given all that, can I ask you how changes in funding might affect rural and underserved communities in 2026?
Ann Anderson Berry: Rural and underserved communities have lagged behind bigger population centers. There's clear evidence that the majority of national funding goes to universities on the coasts and in big population centers. So Nebraska has always been an underfunded entity. That being said, I like to say we hit above our weight class in the quality of work that we do. So we have really leaned into developing our early career investigators and supporting them with entities like the Child Health Research Institute. We focus a lot on supporting early stage investigators, helping them write impactful grants and get that funding here to Nebraska. But you have to be incredibly intentful about how you do that. You can't just wait. CHRI and UNMC is working to move research into our rural communities. You may have heard we have a new medical school opening this year in Kearney and associated with that, we've moved some of our research entities out into that space as well. And we are very excited in the Child Health Research Institute to be launching a statewide research project looking at exposures and growth and human development in Nebraska infants called Nebraska Growns. So there'll be more information about that coming soon as well. Our rural citizens are often less healthy and at increased risk because of the types of environmental exposures that they have. And so we really need to focus on how we can improve the lives of every citizen in Nebraska. Right.
[11:07] Michael Lyon: Earlier on you mentioned the question is asked and that introduces a hypothesis about how something may be addressed medically. How does the scientific process then affect what ultimately hopefully would become a medical practice? That is a great question. It's a little bit complicated.
Ann Anderson Berry: So you identify a problem and then you start to hone in on what the actual question is. You might want to define the scope of the problem. I mentioned the epidemiology of it. How many people does it affect? And then you might want to understand those people a little bit better. What associates a person with this problem? So that can be an observational study. You find out, oh well if you are you know six feet tall and you have five fingers on one hand and six on the other you're gonna get this disease. So you associate it and then you say well what's the mechanism of that? What caused that sixth finger on the other hand? And that's where you might start to look at the cellular level or the metabolism of the cells or enzymes in the cells or even down into the DNA. How the DNA lines up with the code of that is or there's something called methylation. How the DNA has been changed by your environment either before you were born or even before your mother was born or how it's been impacted by your exposures. Did you smoke? Did you drink? Did you breathe? Poor air quality. So there are a lot of different ways to understand mechanism. Once you understand mechanism, then you have to look for the solution. So all of this builds up to saying, okay now we understand the problem. We know who's gonna have the problem and then we have to figure out where the problem occurs, what level cellular DNA organ system. Now what's gonna impact the problem? Do we need a drug? Do we need a device? And then we have to test those drugs and devices develop those. Test them in small populations. Make sure that they're safe. Test them in medium populations. Make sure they're effective. And then test them in large populations. That's where we really find out that they're safe and effective. So those are different phases of our clinical trials and not until we've gone through that entire process for one little question. Can we release something and say, you know, here you have an intervention for this problem?
[13:41] Michael Lyon: And that's certainly not the end of it because obviously an important part of that process falling on from that is peer review. How does that work?
Ann Anderson Berry: Yeah, so peer review happens at all of those different stages. So you'd be publishing a paper at each of those stages, the epidemiology, the associations, the mechanisms, then the interventions, then each of those clinical trials would have a peer reviewed paper as well. So the grant and the funding to get the money to do all of this is also peer reviewed. So science is very collaborative and it's also scientists are very suspicious. They are going to try to poke holes in your hypothesis wherever they can because that's what a good scientist does. They challenge the hypothesis.
[14:30] Michael Lyon: I happen to be a person that is occasionally interested in reading papers from the National Institutes of Health just because those are readily available and they do sometimes speak to things that all of us think about and of course, you know, there may be a great study that you read about and then you find out that there is some criticism of it because nobody else could replicate it. Is that a common problem?
Ann Anderson Berry: It is something that happens not infrequently and it's not unsurprising. Humans are very complicated. We live in complicated systems. We don't all have the same exposures and so when you are doing science, even if you try to design the environment absolutely perfectly, you might not ask the question in a replicatable fashion and so we will often see secondary studies, studies that try to replicate and we'll see them come up with different examples. Some of that can be the duration of the intervention. Some of that can be the timing of the intervention. So I study fat-soluble vitamins like vitamin D. Vitamin D is a perfect example of a substance that's been studied and found to cure cancer and save the world and be absolutely ineffective based on whichever study you read last.
Michael Lyon: Right.
Ann Anderson Berry: I think it's a great example of understanding, well number one, are you vitamin D deficient? Did you pick a population that actually had low vitamin D? If you're vitamin D sufficient, giving more vitamin D really shouldn't impact your body in a positive way. It might impact your body in a negative way. If you're vitamin D deficient, then impacting your health with a dose of vitamin D could be very helpful. If you're early in life when your body's developing really rapidly and incorporating all of the nutrients into building new cells, well that can be a very prime time to supplement nutrients. If you're at the end of life and you have a six-week supplementation, do we really think that that's going to impact outcomes like lung cancer or bone health? Probably not the right period, probably not the right period of intervention time. And so there's a lot of different ways to design a study and that's where peer review comes in is to try to shoot holes in the study design and the hypothesis before you actually spend the money to do the study. But sometimes the studies get done and it's only then that we can see the gaps in the study and then have to point out those, criticize it, and then design the next study with a better study design. And then of course
[17:21] Michael Lyon: we're still not even at the point where clinical trials have been done and hopefully then when those clinical trials are successful there is some medical consensus about a particular
Ann Anderson Berry: treatment. Yes, and that's an important point as well. When we do actually have a definitive treatment, a new innovation that comes from the result of really high quality science, it takes anywhere from seven to ten years to get clinicians to take that intervention to the bedside. And that's where support of something called implementation science is really key. It's saying what do we have that's new in the scientific literature that has shown to be impactful, that has shown to improve outcomes? How can we gather that for any particular condition and bring it to the bedside faster and convince clinicians to change their practice, what they learned in medical school residency or fellowship, and say now in 2026, this is a new and improved way to do this and this is how my patients are going to get the best outcomes. And so even after all of the peer review and after all of the clinical trials and after the FDA approval and all of the hurdles have been
[18:40] Michael Lyon: achieved, there's still the final hurdle of implementation. What sort of medical advances that we've seen today or in recent couple of years do you think will seem very ordinary, 25 years from now?
Ann Anderson Berry: That is a great question. I hope that it is new drugs for pediatric cancer. We have been in a time period where we have had very few drugs developed for that patient population and what we have resorted to is differential dosing of adult drugs and historical drugs to treat these young children. Those drugs are incredibly toxic and Dr. Don Coulter, a colleague of mine who leads our pediatric cancer research group within the Child Health Research Institute, always says, my concern isn't that I can kill these children's cancer, it's that I'll kill the kids with the treatment that I have to give them. And so what I hope is that the work we're doing here at UNMC in Children's Nebraska and in the CHRI will make that obsolete and that we will have effective forms of therapy that don't have these side effects that give these kids
[20:00] Michael Lyon: lifelong injury. I think many of us would echo those sentiments certainly. Researchers are sometimes wrong though, aren't they? How does the scientific process correct what may be going off kilter? Yeah, so researchers can be wrong and
Ann Anderson Berry: many researchers when they find out that they have an error will absolutely print a correction, withdraw a paper and redo their research. That's the acceptable, honorable thing to do as a scientist and that's something that we would expect. We are human, these are very complicated experiments, very complicated questions and so errors can be made even with the most rigorous peer review. And so we have to accept that. We have to look for those erotms or retractions and then we have to learn from that mistake and move forward to answer those questions in an even more rigorous way. The flip side of that coin is when investigators are dishonest intentionally and we've certainly seen that around vaccines and autism and that has been devastating worldwide frankly. False studies, completely fabricated studies have upset such an impactful intervention in childhood vaccines and you know, unfortunately, we live in a society where our children are bearing the repercussions of that falsehood
Michael Lyon: here today in 2026. So we're seeing non ethical actions or behaviors shape medical research, medical findings and that really was actually my final question to you is how should ethics shape medical research?
[22:00] Ann Anderson Berry: Ethics has to be a key part of medical research. We have ethicists on our pediatric institutional review board as well as our UNMC adult institutional review board. So an ethicist looks at every study that's performed through the Child Health Research Institute and at UNMC and we as scientists also have to hold ourselves to the highest ethical standards. Absolutely is the foundational part of science that we are doing. Science that is based on what people need in an ethical way that supports their health and progress moving forward using our research dollars in a fiduciary manner to get the most out of the investment that the federal government, the state government or foundations have given to us. Ethics is
Michael Lyon: absolutely the baseline for everything. My guest today has been Dr. Ann Anderson Berry, Executive Director of the Child Health Research Institute at UNMC. I'm Michael Lyon and this is Heartbeat.
