The war on health science

Sharp cutbacks to NIH "indirect" research support and at EPA will sharply reduce basic health science research and drive major universities further into the arms of industry.

Who will get hit hardest by the Trump administration’s order on Friday to cut overhead support budgets to a maximum of 15% for all National Institutes of Health research grants? Here’s a list of the top universities with the most NIH grants, most of which also have high overhead costs (some as high as 50-60%):

What do they have in common? They are the backbone of the government-funded medical research enterprise in the U.S., which was the source of almost every medical breakthrough since the end of World War II.

If the pharmaceutical industry doesn’t lend its weight to helping universities reverse these cuts, it will essentially be endorsing a policy that eats its seed corn. Recent research showed that NIH-funded basic and applied science research grants contributed to every single new drug approved between 2010 and 2019.

It will also cost them a lot of money. Major research universities (and virtually every state has at least one) are also the organizers of critical clinical trials, especially when they involve unproven new technologies and rare and hard-to-treat diseases. While pharmaceutical and biotechnology firms are the largest funders of clinical research, much of their trials involve collaboration with major university-based medical centers. Those university-based contractors depend on the infrastructure funded by NIH.

Indeed, the only reason why Big Pharma firms, start-up biotech firms, and medical support foundations enjoy lower overhead costs when they collaborate with major universities is that they are subsidized by government payments for infrastructure. Overhead grants for NIH-funded research, which cover rent, electricity, lab equipment, support staff, administration and more, average 26-27%. News reports suggest private sector contracts pay around 15% or less. It is just one more way that federal tax dollars are used to subsidize a private sector that is unlikely to make up the difference when government support is withdrawn.

Pushback coming

How will universities respond? There are numerous reports that cutbacks are already underway. “We’re not going to close, but it will require a hard look at our research and what we can afford,” an administrator at Weill Cornell Medical School told STAT News. “We would unquestionably have to make cuts in what we do. We have 400-500 Ph.D. students on campus, and another 400-500 postdocs. Likely, that is going to diminish.”

This will drive budding young scientists into the arms of industry. They may make more money, but their research interests will be channeled into what is most commercially useful, not what is most medically or socially necessary. The basic and applied research that is driven by investigator passion, entirely funded by government and private foundations, will decline. Inevitably, so will future innovations.

The universities do have other options. They could raise private sector overhead fees. The could cannibalize other parts of the university (goodbye humanities?). They could raise tuition and fees for students. They could slim down administrative costs, but I suspect that would only provide minor savings.

The least likely outcome will be private universities liquidating some of their endowments to pay for current expenses. That latter option is only available to the largest private universities like Harvard, Yale and Columbia with huge endowments.

For a complete primer on the significance of cutting overhead spending at universities and how they will be forced to respond to this unprecedented assault on the U.S. intellectual enterprise, I recommend this substack column by Delip Rao at the University of Pennsylvania.

Two of his key takeaways:

Institutions may scale back participation in NIH-funded trials as a result. Trials in areas like pediatrics, rare diseases, or public health – which are scientifically important but not big money-makers – could be hardest hit…

This shift could reduce the number of investigator-initiated or public health trials.

Corporate beneficiaries

That latter point, I suspect, is the real reason why Russell Vought, the new head of the Office of Management and Budget, and Elon Musk, anointed chief executioner of the government capability, want to reduce government science funding. The other major agency slated for major cuts in its scientific budget is the Environmental Protection Agency.

The NIH and the EPA are the primary funders of research into the medical, social and environmental impact of industrial products and processes. This research provides the scientific basis for government regulation.

Government-funded research (with only a sliver of help from foundations) provides the only counter to industry-employed scientists who claim their products (food, drugs, cosmetics, chemicals, fertilizers, building materials, etc.) and processes (air and water emissions, hazardous waste disposal, employee protections, etc.) are safe.

Sometimes government-funded science is the only science in these areas because industry does none at all — or none that has been made public (see Tobacco Industry and Oil Industry for examples of covering up internal research showing long-term harms from their products). Though the Toxic Substances Control Act has been on the books since 1976, only 20% of the more than 80,000 chemicals used in industrial products and processes have ever been tested for safety. Under TSCA, which wasn’t amended to require safety tests on new chemicals until 2016, the EPA has banned only a dozen or so chemicals in the past half century.

One of the biggest debates in the scientific literature today involves the relationship between man-made chemicals like perfluoroalkyl (PFAS) and rising incidence of ADHD and autism. PFAS is used in many household products and industrial applications and resists environmental breakdown for centuries. Most of the latest research involves large epidemiological studies that have shown a correlation between exposure and harm, but not necessarily direct causation.

A public safety approach would encourage (or force) industry to substitute alternatives to forever chemicals in the short term while conducting further research to come up with more definitive science. Indeed, Robert F. Kennedy Jr.’s pronouncements over the years on chemical additives would lead him to take such an approach.

However, as I’ve opined before, RFK Jr. is a foil. Or perhaps I should amend that to useful fool. The oligarchs running the Trump administration plan to replace the old saying, “What you don’t know won’t hurt you,” with “If it hurts you, you won’t know about it.”