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From crosswords to cancer research

Rebecca Goldstein applies similar problem-solving and pattern-finding skills to immuno-oncology drug discovery that she uses to create crossword puzzles in her spare time

March 12, 2026

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zoomed in crossword puzzle graphic with photo of Merck scientist Rebecca Goldstein in a lab coat

Rebecca Goldstein is an accomplished crossword puzzle creator, but her most challenging puzzle is the one she’s dedicated her career to solving: how to cure cancer. Working in drug discovery, Goldstein, Ph.D., finds that her passions for tackling diseases and creating crossword puzzles reveal surprising parallels. 
 
“While seemingly significantly different, they both require ingenuity, agility and strategic critical-thinking and problem-solving skills,” said Goldstein, senior principal scientist at Merck.

She began creating crosswords in 2020 during the pandemic when her wife suggested she find a hobby. Since then, Goldstein’s published nearly 300 crosswords, including in The New York Times, where she’s created seven (and counting) Sunday puzzles.

“It’s really satisfying when things make sense. In both science and crosswords, I’m trying to find those ‘aha moments,’ those times when things really come together,” said Goldstein. 

Cancer drug discovery  

On average, it takes about 10 years to develop one new medicine. The first part of that process is discovery. Goldstein is focused on immuno-oncology discovery, seeking new ways to harness the immune system to kill tumors.  

“We’re trying to identify the target — a specific protein on a cancer cell — and then develop a drug-like molecule to hit that target and stop the cancer’s progression,” said Goldstein.  

And while designing a crossword is much quicker, she sees similarities in the process.  

Finding the patterns

For Goldstein, both science and crossword puzzles begin with pattern recognition. 

“When creating a crossword, I first work on a theme, which involves looking for patterns that could connect a series of answers,” she said. “In the lab, I’m also looking for patterns — for example, how and where proteins are expressed on cells and tissues. We’ll then screen hundreds of molecular candidates to find the one that we think will hit the target best. It’s similar to sifting through hundreds of words to identify which ones fit my crossword theme.”

Iteration and refinement drive progress  

Iteration is central to both pursuits for Goldstein. In research, that may mean adjusting molecules based on results of experiments. In crosswords, it means determining where to put each word, the best placement for the black squares and how to formulate a layout that makes the puzzle fun and challenging.

“At the end of the day, I want solvers to enjoy it, to feel accomplished and that their time was well spent,” Goldstein said.   

Putting patients first  

In the lab, Goldstein always puts patients first. It’s a mindset that was deeply embedded early in her career when some of the first molecules she helped discover proceeded to clinical trials.  

“It’s humbling to realize that something you worked on has the potential to help people,” Goldstein said. “Clinical trial participants are making an important contribution for science. As scientists, we need to approach this work with a careful eye and be very good at what we do.”

Collaboration strengthens ideas and outcomes 

This includes collaboration, as breakthroughs rarely happen alone.  

“Having other minds and perspectives can really elevate an idea,” said Goldstein. “People have different backgrounds and areas of expertise, which are helpful in running the best experiments with the best controls.”

She said the same is true even when she has a solo crossword byline: “I’ll ask one of my fellow crossword creators questions similar to those we ask in the lab, ‘Hey, does this make sense to you? Am I stretching too far? Does it really work?’” 

When it clicks: breakthrough moments 

Although it takes a lot of work to get there, Goldstein savors the moment when everything suddenly comes together.   

She recalls one of those times in the lab when data from multiple teams aligned: “We took the totality of the data and everything lined up. The whole thing just made beautiful sense. It was like a perfect study.” 

Goldstein said crossword inspiration comes from similar “aha moments” in her everyday life — in conversation, in TV dialogue, at work and even in solving other crosswords. She builds on the moment to create a puzzle that appeals to the widest audience. 

“I want to open the tent and make room for more people to come in and enjoy the puzzle — the more likely people are to find something that represents them or that they can relate to, I’m all for it,” said Goldstein.  

And, in case you’re wondering, Goldstein is also an impressive crossword puzzle solver. Her personal best on a Sunday New York Times crossword is under six minutes! 

icon of a salt shaker tilted over with salt coming out

When crosswords meet chemistry

Goldstein sometimes weaves scientific themes or words into her crosswords. In fact, the theme of her first ever New York Times puzzle was “salt shaker” and included rebuses — a word or group of letters written inside a single square — of anagrams of NaCl, the chemical name for salt.

Check out her latest New York Times puzzles, published Feb. 15 and March 20.

 

Innovation

We’re teaming up with Eisai to help fight cancer

How we're leveraging each other’s unique strengths to help advance cancer research

March 12, 2026

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Combining two ambitious research teams to form a united front to help people with cancer

It’s sometimes said that the whole is greater than the sum of its parts. That’s why in 2018 we teamed up with Eisai, a global pharmaceutical company headquartered in Japan, to work together to advance cancer research.

“Combining Merck’s leadership in oncology with Eisai’s strengths in small molecules allows us to advance combination approaches that have the potential to help more people living with challenging cancers,” said Dr. Gregory Lubiniecki, vice president, global clinical development, Merck Research Laboratories.

“There’s still an unmet need for many patients with cancer. These patients and their families are in need of more treatment options, and this remains at the forefront of our collaborative efforts.”

  • Dr. Takashi Owa
    Head of external innovation, Deep Human Biology Learning (DHBL), Eisai Co., Ltd.

Together, we’re striving to drive cancer science forward, and this shared vision has led to multiple clinical trials investigating the companies’ combination treatment options in various tumor types.

Through this comprehensive approach, we’ve been expanding our clinical research to help as many cancer patients as possible.

Why did you decide to go into oncology research?

“My decision was very personal,” said Owa. “At the age of six, my grandmother passed away from gastric cancer. I couldn’t fully process what had happened to her at that young age. It wasn’t until I entered junior high school that I began to understand the toll cancer had taken on her, which motivated me to learn about cancer and find my passion in cancer research.”

Lubiniecki’s experience was also very personal.

“Watching my mother recover from breast cancer while I was in high school exposed me to the challenges patients face when battling cancer. These experiences inspired me to ultimately pursue oncology,” he said. “Oncology clinical research offers an opportunity to impact the practice of medicine greatly.”

Looking to the future

“I’m proud of what we’ve been able to accomplish together in our pursuit to investigate additional options for patients across a broad range of cancer types through our robust clinical research,” said Lubiniecki.

Owa is optimistic about the progress the two teams have made together. “We’ve already seen encouraging anti-tumor activity in several difficult-to-treat cancers, which has led to multiple milestones to date,” he said. “As we continue to enhance our knowledge and scientific evidence through our ongoing clinical research efforts, together, we aim to give patients and their families hope.”

Lubiniecki believes that collaborations are important to continuing to advance cancer research and improve the outcomes of people with cancer.

Dr. Greg Lubiniecki smiling

“A collaborative approach is key to advancing science and making strides in drug discovery and development.”

  • Dr. Gregory Lubiniecki
    Vice president, global clinical development, Merck Research Laboratories

“Working with others driven by the same patient-centric goals can yield innovations and is imperative to continued progress in improving patient care,” said Lubiniecki. “I’m thrilled to be a part of this collaboration as we continue to advance and expand our clinical research.”

Health awareness

Notes of resilience: A musician’s journey with head and neck cancer

One singer-songwriter found the strength to keep going after his head and neck squamous cell carcinoma diagnosis by accepting help and embracing love and music

March 10, 2026

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In 2023, Jon Michaels was happily balancing the joys and routines of life – from his publishing job and his passion for music as a singer-songwriter to cherishing moments with his wife, Jeannie, and their daughter, Jennings.

One day, Michaels noticed a painless lump in his neck. Since it didn’t affect his ability to sing, talk, eat or drink, he initially dismissed it. When the lump persisted, he was urged to see a doctor who conducted a biopsy and surgically removed the lump. Then came the news that changed his life forever – Michaels was diagnosed with head and neck cancer. He now had to face the impact of this diagnosis on his life, his loved ones – and his music.

“I was wondering, ‘How would I react if I were to be diagnosed with cancer?’” he said. “That day, I found out.”

What is head and neck cancer?

Head and neck cancer describes tumors that develop in or around the throat, larynx, nose, sinuses and mouth. In 2022, there were more than 947,000 cases of head and neck cancer worldwide. These data include cancers of the salivary glands, hypopharynx, oropharynx, nasopharynx, larynx, lip and oral cavity. Michaels’ diagnosis, squamous cell carcinoma of the head and neck, is the most common type of head and neck cancer and begins in the flat, squamous cells that make up the thin mucosal lining of the head and neck.

Michaels’ painless lump is a common symptom of this disease. Other symptoms may include a sore in the mouth that won’t heal, coughing up blood and pain when swallowing.

The power of support in Michaels’ cancer fight

After his diagnosis, Michaels and his wife discussed a treatment plan with the doctor.

“He started by saying, ‘I have good news and bad news. The good news was that we can treat your cancer, with surgery, radiation and chemotherapy. The bad news is that it will be tough,’” Michaels said. “That was hard to process.”

As Michaels started treatment, he was concerned about how it may affect his ability to pursue music.

“That worried me, as music was so much a part of my life,” he said.

Michaels faced both physical and emotional challenges during his treatment, reaching a point where he almost wanted to give up.

However, his wife refused to let him. She inspired him to remain strong and encouraged him to accept help during this difficult time. Even his therapist advised him: “Let the people who love you, love you.” Those words taught Michaels to accept support from his neighbors, friends and family.

“My support group were the real heroes in this experience,” he said.

While others handled life’s daily tasks for him, such as sending meals, mowing the lawn, helping with chores and transportation to appointments, Michaels focused on fighting this disease.

These acts of kindness got him through his toughest days, allowing him to recover and channel his emotions into music, even writing a song to reflect on his cancer experience.

SEE ALSO: Supporting colleagues with cancer

Strengthening our commitment to patients with cancer

Stories of support, like Michaels’, underscore why patients are our inspiration as we continue to pursue the fight against cancer. His journey is an important reminder to turn to a supportive network during trying times.

“The most rewarding part was the overwhelming love shown by my family, friends and strangers,” he said. “Trust in the care and fight when they tell you to fight.”

Health awareness

How collaboration can help enable early detection of lung cancer

Learn about our work with the American Cancer Society

February 18, 2026

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Through our Mission Lung Cancer initiative, we’re bringing together our efforts to break down barriers that stand in the way of early lung cancer detection. Our approach is rooted in strategic collaboration, scientific insights and innovative technology.

One program that’s part of Mission Lung Cancer is the American Cancer Society’s Get Screened initiative. Since 2020, we’ve worked with the ACS to help advance early detection for breast, cervical and colorectal cancers through Get Screened.

In 2024, our involvement in this collaboration expanded to include a focus on early detection of lung cancer. Through this initiative, Merck supports the ACS’s efforts to provide screening navigation services, mobile screening units and access to free or low-cost screening options for eligible people* who are uninsured or underinsured.

“Together with the American Cancer Society, we’re focused on supporting initiatives that elevate the importance of early lung cancer detection and helping eligible individuals get access to screening. We’re proud to support efforts to raise awareness around this disease that impacts millions of people each year.”

  • Josette Gbemudu
    Associate vice president, patient health innovation

The Get Screened campaign is already making an impact, with more than 362,400 additional breast, cervical, colorectal and lung cancer screenings conducted. The ACS also aims to raise $30 million to further expand access through outreach, technology and infrastructure.

We joined the Get Screened campaign to help increase cancer screening rates in the U.S., and recently focused specifically on lung cancer, as it’s the leading cause of cancer-related death worldwide.**

However, in the U.S., only 18.2% of those eligible underwent lung cancer screening in 2022. Alongside screenings, knowing the signs and symptoms of cancer can potentially help increase the chance of finding the disease before it spreads.

“This work highlights the power of collaboration between advocacy and industry. Together, we’re helping to build a path for the future where every person at risk receives timely information and resources, empowering them to lead healthier lives.”

  • Shane Jacobson
    CEO, American Cancer Society

Our collaboration with the ACS is one of several initiatives under Mission Lung Cancer, all to advance our mission to help enable early detection of lung cancer to help ensure patients get timely care.

Learn more about Mission Lung Cancer.

*per the U.S. Preventive Services Task Force screening guidelines
**World Health Organization – GLOBOCAN 2022


Innovation

How wearable technology powers patient-focused drug development

Our scientists are exploring the use of sensor-based technologies and digital clinical measures to improve disease understanding

February 10, 2026

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Sensor-based digital technologies like smartwatches and other wearables have surged in popularity in recent years. People are easily and conveniently tracking physical activity, sleep and other health-related data — including information that’s helpful for scientists developing new medicines.

At Merck, scientists in our digital clinical measures group are using these sensor-based tools in clinical trials to collect objective measurements which were previously difficult or impossible to obtain. Now, measurements from patients outside the clinic, including at home and work, can provide data that’s more reflective of their everyday lives — deepening our understanding of disease and enabling more efficient and patient-centric drug development.

What are digital clinical measures, and why do we use them?

Digital clinical measures are specific, objective measures of biology, health, behavior or treatment response that are generated via sensor signals from digital technologies processed with algorithms. These measures can be derived from data collected during active task-based assessments, such as timed walk or hand-turning tests performed with wearable sensors, or through passive monitoring, where data are captured continuously as part of everyday activities like walking or sleeping.

Unlike some traditional clinical study endpoints that require lengthy in-clinic exams or patients or caregivers to remember symptoms over days or weeks, sensor-based technologies can objectively and remotely track metrics of health, behavior and treatment response over time. They can also provide more precise measures compared to traditional clinical rating scales.

“Digital clinical measures can augment traditional study endpoints and allow us to collect richer, more frequent data that better reflect how patients live and function day to day.”

  • Marissa Dockendorf, Ph.D.
    Head of digital clinical measures

“In addition to using digital health technologies — or DHTs — to enhance the data we capture in clinical trials, we’re focused on developing more objective and precise measures from these technologies,” added Dockendorf. “These advancements can enable us to understand more quickly, or with fewer clinical trial participants, whether our drug candidates are working, which ultimately can support our ability to deliver medicines to patients faster.”

Collaborating to advance the field of digital measures

We’re working with partners including the Critical Path for Parkinson’s Consortia, the Digital Medicine Society, the University of Oxford and Koneksa Health to advance development of digital clinical measures. These collaborations focus on furthering the digital endpoint field as well as identifying promising digital measures that may improve how we assess disease progression in patients with Parkinson’s disease and, potentially, how we evaluate the efficacy of investigational therapies.

“Digital endpoints hold tremendous promise to transform how we measure and understand health in clinical research,” said Dockendorf. “To fully realize that promise, collaboration is essential as we lay the important groundwork needed to develop measures that are valid, reliable and capable of making a meaningful impact in drug development.”

Digital clinical measures in action in Parkinson's disease

Our researchers are exploring the use of digital health technologies to measure motor function in clinical trials for Parkinson’s disease. Wearable sensor arrays — devices equipped with multiple sensors worn on the body to capture comprehensive data — can provide a wide range of motor function measures, such as gait and turn speed. Collecting data from these technologies over time may provide a clearer understanding of how motor function changes over time and with treatment as compared to traditional endpoints based on categorical rating scales.

Innovation

Our Q4 and full-year 2025 financial results

February 3, 2026

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Merck’s (NYSE: MRK) Q4 and full-year 2025 sales performance reflects strength across oncology and animal health, as well as increasing contributions from new launches. Our company announced Q4 worldwide sales of $16.4 billion. Full-year 2025 worldwide sales were $65.0 billion.

“In 2025, we continued to advance leading-edge science to deliver transformative medicines and vaccines that are improving health outcomes for patients around the world,” said Rob Davis, chairman and CEO. “Our business benefited from demand for our innovative portfolio, including for KEYTRUDA, increasing contributions from new launches in cardiometabolic and respiratory as well as vaccines, and strong performance of Animal Health. The transformation of our portfolio, bolstered by the acquisitions of Verona Pharma and Cidara Therapeutics, is well underway, and momentum is building as we continue to execute on our strategy. Our progress positions us to continue delivering on our purpose for patients and creating durable value for shareholders.”

Merck anticipates full-year 2026 worldwide sales to be between $65.5 billion and $67.0 billion.

4Q and full year financial highlights for Merck

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Innovation

5 ways we’re transforming artificial intelligence into impact

We’re applying AI across our company to help us work smarter and faster so we can reach patients sooner

January 9, 2026

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At Merck, we’re in the business of knowledge, insights and innovation — rooted in intelligence.

Today, artificial intelligence (AI) — or what could also be “automated”, “accelerated” or “augmented” intelligence — lies not only in software and computer systems, but in the data, development and delivery of these intelligent tools to achieve better outcomes for patients.

Here are five ways we’re using AI to drive our purpose of saving and improving lives around the world.

01.

Accelerating the discovery of new medicines

Drug discovery remains an endeavor where only about 1 in 10 drug candidates that enter clinical trials ultimately receive regulatory approval. We’re working to change that by enabling scientists to use AI and machine learning (ML) foundation models to enhance and build upon their existing approaches to drug design before experimental testing and clinical trials.

We recently developed two foundation models which uncover patterns in disease to find better drug targets, allow faster molecular design and rapidly test small molecules, including cyclic peptides, for efficacy and toxicity before going into the clinic.

By unlocking patterns within vast datasets, these AI models enable our scientists to accelerate the discovery of leading therapeutic candidates —  a process that normally takes 10 years — allowing us to potentially get therapies to patients faster without compromising scientific rigor.

illustration of cup

02.

Optimizing clinical trials

Enrolling people in clinical trials and keeping them engaged once they’ve signed up remains a significant challenge across our industry, with approximately 20% of activated sites failing to enroll a single participant. We’re addressing this by using AI to help improve site selection, patient matching and retention. For example, predictive models can flag patients at higher risk of dropping out, enabling targeted interventions that improve retention and keep trials on track.

03.

Automating workflows to improve productivity

Our enterprise-wide training program helps employees understand the latest digital technology, including generative and agentic AI, and learn how to use it responsibly. Our proprietary AI platform — which more than 80% of our workforce uses — applies large language models to enable employees to automate, simplify and digitize processes that historically took more time, freeing us up to prioritize more impactful work.

Illustration of  people looking at workflow chart

04.

Modernizing manufacturing

Generative AI helps protect our supply chain when potentially disruptive events like natural disasters or port delays occur. Our systems can produce event-based risk assessments in under 30 minutes — allowing us to quickly see which products and sites are affected and act to avoid or reduce shortages and delays.

In vaccine manufacturing, we’re using computer vision — another form of AI — to inspect vials and syringes for defects. This results in less waste, lower costs and higher production speed.

05.

Streamlining education and engagement with health care providers

We’re using AI to streamline information for providers and patients to ensure we deliver the right details to the right people when it matters most.

We’ve embedded AI across the content life cycle — from conception through medical, legal and regulatory review — so that we can organize messages more intelligently. The result: higher quality, personalized content that gets to health care providers faster.

Supporting this is our generative AI-powered chatbot for our field representatives. It summarizes relevant insights and helps us respond in real time to provider needs.

It all starts with data

Data powers AI. We have a vast repository of proprietary and secure data, but for it to be usable, it must first be structured and organized.

We’re continuously working to create a frictionless data flow so AI can reliably and accurately drive faster, more targeted and personalized outcomes.

Data is critical to our business strategy and to our pipeline. When our data is high-quality, well-manicured and organized to support powerful insights, we can make more accurate and intelligent predictions — and move faster to deliver the medicines and vaccines patients are waiting for.

Read more about how we’re using data science, AI and machine learning.

Health awareness

Acting early in cancer detection

Diagnosing cancer early, before it has spread, may potentially lead to better outcomes

December 10, 2025

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Time is important with a cancer diagnosis. People with cancer may have the opportunity for better outcomes when the disease is detected early. And with increases in routine cancer screening (e.g., mammograms, colonoscopies, lung cancer screenings, Pap smears, etc.), more cancer cases can be diagnosed before metastasis — before the disease has spread to other parts of the body.

“We’ve seen incredible progress in the fight against cancer in recent decades, driven by advances in early detection and the availability of new treatment options,” said Dr. Gregory Lubiniecki, vice president, oncology clinical research. “This progress makes me optimistic for a future where cancer is detected and treated as early as possible, giving patients the greatest chance to live cancer-free. We can’t rest now — I’m hopeful that we’ll continue to build on what we’ve learned about helping people with earlier stages of disease.”

But important work remains to continue to improve care and diagnose cancer early.

What is early-stage cancer?

After someone is diagnosed with cancer, doctors will try to figure out how much cancer is in the body and if their disease has spread — this process is called staging, which can help guide treatment decisions. Different cancer stages have different treatments and possible outcomes, and they’re associated with different odds of recurrence. 

The stages of cancer

animated GIF of the four stages of cancer
  • Stage 0: Cancer is localized to where it started.
  • Stage 1: Cancer has not grown deeply into nearby tissues.
  • Stage 2 and 3: Cancer has grown more deeply into nearby tissues and may involve lymph nodes, but has not spread to distant parts of the body.
  • Stage 4: Tumor cells have spread to other organs or distant parts of the body.

Early-stage is a term that can be used to describe cancer that’s early in its growth, before it has spread to other parts of the body. However, each person’s experience with cancer is unique, and what doctors may define as early-stage can vary by the type of cancer.

When cancer is diagnosed, the goals of treatments are to slow, stop and possibly eliminate tumor growth.

Treatment may be more likely to be successful if it’s started before the cancer has spread, when surgery is a potential option. However, even after surgery, there’s a risk that the cancer may spread to other parts of the body. Additional treatment may help lower that risk. In certain instances, other treatment options can be used before surgery (neoadjuvant) to help to reduce the size of the tumor, and/or after surgery (adjuvant) to lower the chance of the cancer from potentially coming back.

Detecting and treating cancer early may help reduce the risk of recurrence and increase the potential for survival.

Innovation

Exploring the potential use of PET tracers in neurodegenerative disease research

Merck scientists are researching the potential of an investigational alpha-synuclein PET tracer in early identification of Parkinson’s disease

December 9, 2025

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Parkinson’s disease (PD) is a progressive neurodegenerative disease caused by the loss of certain brain cells that are involved with the control of movement. Globally, the prevalence of Parkinson’s has doubled in the past 25 years with global estimates in 2019 showing over 8.5 million individuals living with PD. Most patients with Parkinson’s are diagnosed after experiencing worsening symptoms such as tremors, slow movements and gait abnormalities.

Unfortunately, by the time symptoms become apparent, a large proportion of affected brain cells have already been irreversibly damaged, making therapeutic intervention difficult. Researchers at Merck, along with the broader scientific community, are focused on exploring new ways to identify people with PD earlier in the course of their disease and to measure changes in disease progression.

Alpha-synuclein: A biomarker for Parkinson’s disease

Research evaluating the brains of people with PD has shown that abnormal clumps of a protein called alpha-synuclein form as the disease progresses. Historically, the only way to evaluate the accumulation of alpha-synuclein is by analyzing brain tissue collected after a person dies.

Our scientists then asked: What if there was a way to detect the first signs of these abnormal protein deposits in the brain as a potential way to identify the early signs of PD before symptoms appear? Could we then also evaluate the potential of investigational therapies to slow disease progression?

Exploring noninvasive early detection for neurodegenerative disease

Advanced imaging technologies have helped evolve our understanding of neurodegenerative diseases, in some instances leading to a better understanding of the disease and potential therapeutic options.

In PD, similar imaging techniques offer the potential of early detection and the ability to monitor disease progression. A PET tracer may offer a noninvasive method of detecting alpha-synuclein.

Our scientists are working to evaluate the potential of a PET tracer as a noninvasive way to visualize and measure alpha-synuclein, with the hope that it could lead to earlier detections of Parkinson’s disease.

scientist working in a lab

“A selective PET tracer for alpha-synuclein could have a significant impact on ongoing research by providing a window into what’s happening in the brain in real time,” said Dr. Eric D. Hostetler, executive director and head of translational imaging biomarkers at Merck. “We see the potential for an advanced imaging tool that could contribute to the development of novel treatments by potentially making it easier and more effective to test whether an investigational therapy that targets alpha-synuclein in the brain is working in clinical trials.”

Our research in this area was recognized by the Michael J. Fox Foundation for Parkinson’s Research Ken Griffin Alpha-synuclein Imaging Competition in 2023, and our scientists are continuing important research in multiple investigational PET tracers in the central nervous system space.

“We’re evaluating the potential of this investigational PET tracer to serve as a biomarker to measure disease progression and determine whether investigational therapies are able to slow the progression of Parkinson’s disease,” said Dr. Jason Uslaner, vice president and head of neuroscience discovery at Merck. “It’s all about identifying the right patient at the right time for the right medicine.”

Learn more about our research in neuroscience.

Innovation

Building trust and advancing inclusion: Our approach to clinical trials in Uganda

In Uganda, where women are disproportionately impacted by HIV, our community-based research prioritizes meeting patients where they are

November 24, 2025

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Rebeca Plank, M.D., Ph.D. (right) and Joan Nabawanuka, community liaison officer at MU-JHU Care Ltd., meet with Kibuuka Yahaya Galabuzi, local leader of Katiko Fishing Village in the Mityana district.

In sub-Saharan Africa, young women are three times more likely than young men to be living with HIV. Now, Merck researchers are part of a coalition of community leaders, academic organizations and NGOs working in Uganda to help ensure that clinical trials for investigational HIV medicines are designed to address this disparity — and to reflect real-world challenges in local communities. By focusing on local voices and expertise, the coalition aims to build trust, improve trial design, address barriers to study participation and engage directly with the community.

To learn more about how these efforts have shaped our HIV clinical trials in Uganda, we chatted with two members of our on-the-ground research team: Ian Bradley-Perrin, Ph.D., and Rebeca Plank, M.D., MPH.

Why is inclusion important in HIV clinical trials?

Plank: People may respond differently to the same medicine based on factors like age, gender, weight or ethnicity. By prioritizing inclusivity in HIV clinical trials, our goal is to develop treatment and prevention options that work for all people affected by HIV.

SEE ALSO: Dr. Plank shares her motivations and hopes for the future of HIV research

Why is it important to include women in HIV clinical research, especially in countries like Uganda?

Bradley-Perrin: Cultural expectations, gender roles and the still-too-common stigma surrounding HIV and sexual health can make it difficult for women in Uganda to take part in HIV prevention trials. Historically, women’s underrepresentation in these prevention clinical trials limited our field’s understanding of how these medicines work specifically for them.

Plank: We’ve made an effort to expand our HIV prevention clinical trials to include pregnant and breastfeeding women because there are limited late-stage data and safety information in those populations. So, it’s important to move in that direction of greater inclusivity in our trials with the goal of driving the research and development of investigational medications to make sure there are options women can access regardless of their plans for pregnancy. Today, many health care providers may be reluctant to prescribe medicines that have not been studied in pregnant and/or lactating women, and pregnant and/or lactating women may be reluctant to take these medicines.

What’s the role of local communities in HIV prevention clinical trials?

Bradley-Perrin: We’ve learned that strong collaboration is essential — and it’s been a real two-way learning process. Partners like the University of Washington’s International Clinical Research Center bring long standing experience running clinical trials in sub-Saharan Africa, and the Gates Foundation is providing strategic partnership and financial support for the operational needs of each clinical research site, including things like experienced research staff, upgraded facilities, and help building new clinics. Equally important is the Global Community Advisory Group: HIV prevention advocates with a country and global perspective who give critical input on trial design, recruitment materials and will advise on study operations throughout the trial. They give us honest feedback about community concerns and help keep us accountable and connected to people’s real lives and priorities.

For example, in Mityana, a rural district west of Kampala, our team collaborated with community leaders to support a local engagement strategy that helped identify locations where women have historically had trouble accessing HIV clinical trials, like fishing villages and gold mining communities.

Plank: By going out to a gold mine that was two hours from the clinic, I better understood the complexities of reaching this community, especially over the duration of a multi-year clinical trial. Transportation was a huge barrier that needed to be addressed to make sure women wouldn’t be hindered from participating because of where they lived or their access to transportation.

What are some other ways Merck is supporting clinical trial participants?

Bradley-Perrin: Along with transportation, we prioritized support services such as child care and, when needed, home visits to help women participate in the trials.

Plank: Thanks to the Gates Foundation, ICRC and our other partners on the ground, the clinical trial team has trained local staff, updated facilities and even helped to construct new research clinics that could be used for new research projects. These practical solutions aim to increase trial participation in geographies that need innovations the most and help address some of the practical challenges participants face.

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  • Godfrey Ssaka and Susan Vaz at lab
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  • Plank and Bradley-Perrin walk with Flavia Matovu Kiweewa, MBChB, Ph.D., principal investigator of MU-JHU Care Ltd.
  • Cyrus Badshah, M.D., Ph.D, Merck senior principal scientist and Joyce Matovu, site hospital liaison coordinator at MU-JHU Care Ltd., tour the Namulanda Mukikadde gold mine community in the Mityana district.
  • A view of Namulanda Mukikadde gold mine area in the Mityana district of Uganda, where innovative clinical trials for HIV are taking place.
  • Godfrey Ssaka, laboratory manager at MU-JHU Care Ltd., shows Susan Vaz, a clinical research manager at our company, around the lab.
  • Merck’s community-based research in Uganda prioritizes fostering trust and creating conditions to encourage inclusive trial participation.