young people are getting sicker earlier and staying sicker and older people are getting sick but holding on to some remnants of health longer and most of the treatments are geared toward the older population is that true yeah that's true that's exactly right that's a terrible situation because it essentially is not preparing for the future right so what we have is a system as a sick care system the advances we've made have allowed people to say sick longer it hasn't translated a longer life right it just it's there was a hope I think when I first started doing research in 2001 there in population aging there was this idea of a compression of morbidity that is you live long a long life and the time you spent really sick and disabled was was compressed at the very end of your life rather than spending a long time disabled and sick and you you you die die after having spending like a decade or more very sick the idea was that that that we're uh which we have advances in our culture has produced results so that you uh you live a long life and you only spend you know a few months really sick at the end of your life um that hasn't panned out right that is in fact we have uh uh very little increase in life expectancy and for many many people unfortunately a very long period of time in in a in a state where they're uh their the quality of life is not that high not that good right dementia uh chronic disease leading to uh you know say diabetes leading to all kinds of of you know kidney failure macular degeneration you you name it peripheral peripheral vascular disease heart disease um you end up with a situation where all of these amazing biomedical advances that we've had over the last decades have not translated to actually improving the health and well-being and longevity of the american people um i think that uh that the biomedical infrastructure research infrastructure of the country has to translate over for results for regular for real for real people for the american people otherwise people can ask us what why why are we having these why why are we doing what we're doing it can't just be that we we're doing cool things i mean not that we're not doing cool things a lot of cool things are getting done but if they don't somehow eventually translate over uh i don't again i don't mean to distinguish basic science work i think basic science work is really important but eventually it has to translate over or else people will say why have we made these vast investments the key the key thing is um if we're not actually improving health as a result of the research we do then we haven't accomplished our mission right that's the and um the research agenda of the nih as we've talked about it's very it's like we talked about uh you know international relations as determining in part what scientists work on it you know for drug pricing um we talked about how politics determines the the agenda that scientists work on right so you talked about hiv right so the the political focus on hiv led to the vast investments the nih has made in hiv with some positive effect actually a lot of positive effect um and then also the sociology professions the scientific profession determining these are all complicated things that result in the portfolio but if the portfolio ultimately doesn't meet the health needs of the american people then it's not doing what it's supposed to be doing part of my job is to make sure that that it does meet those health needs the the make america healthy again movement um that's what it's asking for that the health institutions of this country actually meet the health needs of the people where they are uh and um in the large part we've not successfully done that in this country for decades uh otherwise we wouldn't have this major major chronic disease crisis we're currently facing um and so that's you know it's a complicated question it's not like you know it's not just solved by funding one grant or making the specific decisions it's about the incentive the system at large to focus on on on it uh and in uh on on uh on to create incentives to for the so that scientists turn their ingenuity toward those health needs rather than rather than just advancing their careers incrementally