The United States is still the global leader in medical research. For now. Francis Collins, director of the National Institutes of Health, is sounding the alarm, warning that other countries are “setting out to eat our lunch” and take the top spot the U.S. has held for decades. China, he says, is looking to dethrone the U.S. in spending on medical research, not just as a percentage of GDP but in total spending within five years. As global competition increases, Collins says immigration reform—specifically, modifying the visa system—is key to our ability to stay out in front. “We’re not handling this in the way that you would want to if what you wanted to be was an ongoing magnet for the best and brightest to come to our shores,” he said.