Increasing concerns about research funding for the NIH and wokeness of medical and basic science journals
One thing is certain: funding from the National Institutes of Health (NIH) will change for all of medicine- and that is not necessarily a bad thing. The way NIH has been allocating its grant money has increasingly drawn criticism from experts. Two criticisms appear most relevant:
1. A significant portion of the agency’s budget goes to in-house research. In other words, NIH staff awards grants to itself, - obviously never a good idea for fostering quality research.
2. The habit of the NIH of favoring established investigators over younger investigators, even though everybody knows that most of us significantly loose creativity as we age.
But there was nevertheless, the expected outcry from NIH staff upon receiving pink slips after having been convinced for the longest time to that their positions were lifetime. And, at least for some time, the granting process came to a standstill. Then, of course, started the lawsuits, with some terminations temporarily stopped by federal judges or. Ultimately, two major changes can be expected to become permanent with very high probability: The NIH will significantly cut so-called overhead costs to institutions, which are payments hospitals, universities and other entities receive to cover their indirect overhead costs if the research a grant supports is conducted at an inhouse location (1).
Why are we so sure of this cutback? Because on February 7, 2025, the NIH announced its intention of cutting overhead payments to most universities and research centers. Meaning, all overhead costs will be subject to cuts including: facility costs, equipment uses, utilities, and maintenance. Most smaller institutions receive for a project a ca. 30% indirect cost rate, which means that 30% of the total grant payment is not part of the investigator’s budget, but goes to the university or another “landlord.” 30% overhead is, however, nothing in comparison to what leading academic institutions charge and currently receive. In places like Harvard or Rockefeller University indirect costs can exceed 80% of the grant amount. On some occasions institutions have even charged in excess of 100%.
According to the aforementioned Healio article, the NIH spent over $35 billion (with “b”) in fiscal years on almost 50,000 grants, of which 26 billion involved direct costs, but $9 billion went to institutions for indirect costs. Rumor has it that indirect costs will be capped at 15%, which could yield over $ 4 billion in savings for the NIH.
Whether institutions will agree with those cuts is questionable; but who knows? Everybody knows that many of the most prominent schools (with the biggest – tax -exempt -endowments) would likely, have a hard time maintaining their research facilities and research faculties with only 15% overhead costs. But then what are their billion dollars endowments then really for?
The University of Pennsylvania offered a statement to Healio, suggesting that its NIH funding would annually decline by $250 million, adversely affecting its research enterprise. And interestingly, Sean Tipton, MD, chief advocacy and Policy officer of the ASRM, called on the American public to contact President Trump and Congress to demand that this announced “misguided” policy be reversed. As if NIH (as noted above) really ever supported much infertility research!
Recently, a medical journal published a quite unprecedented article, “an anonymous voice within the U.S. federal research system” -whatever that may mean- offered in the BMJ their feelings of “anger, despair, and defiance,” about the changes taking place in the U.S. federal research system (2). This person, did not hold back, claiming for example that this, “digital genocide will undo decades of progress toward informed and appropriate care and (disproportionally affect) those that are female, non-white, poor, and living in Republican states.”
That many individuals in academia may in these days hold such extreme opinions is no surprise and is expected. And they, of course, are entitled to them and should be protected in expressing them. But like the use of “anonymous sources” in journalism, the use of information and/or opinion from such anonymous sources should be minimal and carefully considered. After all, how do we know what the qualifications are of this anonymous individual in expressing their opinion? Moreover, it is easy to make accusations when one does not have to consider possible consequences.
That an esteemed medical journal, like the BMJ, was willing to publish this article – in its anonymity likely a precedent, is astonishing and yet another demonstration of the wokeness, that has taken over editorial offices in the medical world, especially in the U.K. As repeatedly noted before in the The Reproductive Times, The Lancet is, of course, the prime example, though the U.S. and some of this country’s leading medical journals don’t lag very much behind.
That medical journals have not yet caught up to the general anti-wokeness sentiment that has been gaining popularity in the country, was recently again quite apparent in several articles – mostly of course personal opinions – published in some of the leading U.S. medical and science journals. Here are some examples: Unsurprisingly, The New England Journal of Medicine, excelled in this regard: It started with a group of U.S. authors in a Perspective article arguing that “the deluge of legislative and policy attacks on diversity, equity, and inclusion efforts threatens the integrity of the health care workforce and will ultimately worsen the health of the populace” (3).
Making similar point are two Stanford University faculty members in another Perspective article in the same medical journal lamented that, “a study of a health equity curriculum was stopped in its tracks by the ban on diversity, equity, and inclusion efforts in federal agencies, with the study’s leaders seeing the sudden halt as a call to action” (4), and sine in medicine we believe that everything happens in threes, a third Perspective article in the same journal issue claimed that the voice of the CDC was “silenced” because one issue of the MMWR went unpublished in time (5) (the MMWR, of course, one week later was published again). To quote, “for more than 60 years, the MMWR has published life-saving information on U.S. public health crises. The Trump administration’s pause on health communications has disrupted that essential mission.”
Seriously?! The rhetorical exaggeration in all of these declarations is, of course, only too obvious and not only counteracts the potential credibility of expressed concerns, while also discouraging any serious engagement with the arguments made. But that also did not appear to be the intent of the editors of The Journal because – as has been customary for too long – they, despite three basically unanimous opinion papers on the subject declaring the end of the world as we knew it, did not find it necessary to also invite in balance a less emotional and more fact-based opinion on the subject.
The editors of The Journal quite obviously felt that even a 3-to-1-ratio would have been unacceptably unfair for the woke crowd which, of course, is always intolerant to any alternative opinion. Maybe a better way to say the same thing is that woke arguments, in principle, can never stand up to really good and unbiased arguments!
How woke medical journal editors have become these days was also well demonstrated by an Opinion article the still relatively new editor-in-chief of the BMJ co-authored, in which the two authors of the article expressed the opinion that, “medical journal editors must resist a recent CDC order and anti-gender etiology” (6). What the article referred to was a rather ridiculous order by a temporary CDC leadership that instructed CDC employees to retract and/or withdraw papers that contradicted the Executive Orders from the Trump White House that there existed only two sexes, female and male – and that gender-transition treatments for children and young adults till age 19, were inappropriate. Can a reasonable person really argue that in a democratic society government has the right of withholding from parents the right – without a court order – to withhold health care decisions regarding health care, including sex assignment, of their children?
Since when is it a medical journal’s editor’s right to be so political as to argue in favor of depriving parents of this most basic right, as California state law mandates when, for example, precluding school officials from informing parents of their children’s alleged desire to switch their gender assignment (7)?
And to demonstrate how political the BMJ, indeed, has become under its new editor-in-chief, it published an paper by four U.S. writers from Baltimore (who probably couldn’t place their Opinion piece in a U.S. journal) in which they make the claim that, “the elimination of protections against immigration action in health care facilities risks patient care, public health, and moral injury to providers” (8). This is likely the same crowd that argued that the Israeli army going after murderous Hamas terrorists in permissive hospitals endangered their function as hospitals.
References
1. HEALIO. February 11, 2025. https://www.healio.com/news/hematology-oncology/20250211/discussion-about-nih-research-funding-cuts-requires-data-time-and-careful-evaluation
2. Anonymous. BMJ 2025;388:r294
3. Guerra P, et al., N Engl J Med 2025. DOI: 10.1056/NEJMp2500489; Online ahead of print.
4. Wang SXY, Chi K, N Engl J med 2025; DOI: 10.1056/NEJMp501471. Online ahead of print.
5. Rasmussen et al., N Engl J Med 2025; DOI: 10. 1056/NEJM2501622. Online ahead of print.
6. Clark J, Abbasi K. BMJ 2025;388:r253
7. Atkinson G. Alliance Defending Freedom. October 2, 2024; https://adflegal.org/article/california-safety-act-would-codify-reckless-disregard-parentalrights/#:~:text=Misleadingly%20named %20the%20%E2%80%9C SAFETY%20Act,gender%20identity%2C%20or%20gender%20expression
8. Page KR, et al., BMJ 2025;388:r304