In September, the prestigious journal JAMA Pediatrics published and editorialized about a comprehensive study reviewing NIH funding for pediatric diseases: "Correlation Between National Institutes of Health Funding for Pediatric Research and Pediatric Disease Burden in the US," by Rees, et al. (doi:10.1001/jamapediatrics.2021.3360.) Its goal was to determine the correlation between NIH funding and disease burden for pediatric conditions.The study analyzed 14 060 disease-specific pediatric grants awarded by the NIH
from 2015 to 2018 in the US. Funding for pediatric research was correlated with pediatric disability-adjusted life-years (DALYs), deaths, years lived with disability, and years of life lost. They analyzed 157 disease conditions, including some mental illness diagnoses. They noted "There was substantial overfunding and underfunding of certain conditions."
However, no where in the article or in their classification of disease states was any mention made of child abuse or neglect trauma. In fact, for the past 50 years NIH has continuously and repeatedly underfunded research into child maltreatment and associated harms. This prompted our protest to the Editor which was published December 28:
National Institutes of Health Funding Priorities
To the Editor
The analysis by Rees et al1 and the accompanying Editorial provide a valuable and insightful evaluation of crucial current pediatric research priorities and policies. While the
lists of diseases (Figures 1, 2, and 3) included some mental health morbidities (eg, bipolar disorder, self-harm, and anxiety and depressive disorders), and the Editorial noted omission of the challenge of βfactoring in determinants of cognitive,behavioral, and physical health outcomes for children that are not captured in disorder categories,βneither publication explicitly mentioned existing or needed research into the pediatric
pandemic of child maltreatment or the importance of childhood trauma and adversity in the development of mental and physical disease and behavioral morbidities (eg, domestic
violence, homelessness, criminality, mass shootings, and unemployment) across the life course. Existing research has documented changes in genetic, epigenetic, neuroanatomic,
neuroendocrine, immunologic, and inflammatory systems associated with child maltreatment, discovering possible pathophysiologic mechanisms, but much more research is necessary to prove that these changes directly cause or mediate specific disease states. The NIH's deemphasis on funding for child maltreatment research
for several decades has hindered an entire generation of career scientists who might have contributed some important knowledge on child maltreatment, identification, treatment, prevention, etc. While increasing attention ($51 million in NIH grants to child maltreatment in 2021, (in addition to some National Institute of Mental Health funding) is being
given to the pathological effects of adverse childhood experiences, trauma, and stresses, and increasing associations are being made with a panoply of childhood and adult pathologies, research into pathophysiological mechanisms warrant more investigation. As advocates for research into a pathology that does not yet have patient or family media advocacy organizations, we recognize it is very difficult to take resources away from well-funded problems with well developed constituencies or to garner new resources. In addition to the disparities documented in these publications, it is urgent to recognize the need for research into this pediatric pandemic, as the morbidity and mortality associated with child maltreatment are on par with those associated with pediatric cancer and heart disease.
Jeoffry B. Gordon,MD,MPH; David Corwin, MD
The letter speaks for itself. PACEsConnection is in a position to advocate in the public square like the March of Dimes, or the Jimmy Fund, St Jude's or ACTUP for redress in this matter. The original articles are attached.
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