BREAKING NEWS What reproductive biology and reproductive medicine can expect from a Trump 2.0
President-elect Donald J. Trump
With the elections of President and Congress behind us, and a second Trump administration beginning on January 20, 2025, the question asked by many in reproductive biology and reproductive medicine is: what, good or bad, can be expected from this new administration? And while we sense a certain degree of pessimism among some colleagues, we believe, as we will here note, that there really is good reason for optimism.
It was a decisive win for Trump and the Republican party in the November 5 election, and it sent a message. As former President Barack H. Obama once noted, “elections have consequences.” Those consequences may be even more profound if the same party controls the presidency, the Senate and – as of the time of this writing – possibly also may continue to control the House, while in many cases also being able to count on a majority in the decision-making processes of the Supreme Court.
Concerns about funding
One cannot blame colleagues–for example those dependent on federal NIH grants–who are concerned, especially as many already experienced budget cuts to some grants under the Biden administration. Their concerns are further strengthened by Elon Musk’s suggestion that the government could safely cut $2 (1) or $3 (2) trillion in U.S. budgetary spending, as any such efforts, of course, would have to involve NIH budgets.
But at the same time, excess government spending cannot continue unchallenged because even our existing debt as a nation of ca. $35 trillion is already for all practical purposes unaffordable, considering the nation’s annual interest payments on this debt by now exceeds the country’s annual Pentagon budget. Cuts, therefore, will undoubtedly come; but the good news in all of this may be that these cuts will be supervised by Musk, who in taking over Twitter (now renamed X) has demonstrated that he is not only the world’s leading living inventor and business strategist, but also the world’s most effective cost-cutter.
Colleagues worried about their federal funding, moreover, can be assured that any administrative entity overseen by him in cutting national expenses will undoubtedly know how to distinguish between scientific merits of a grant and DEI (diversity, equity, and inclusion)-based funding, which during the Biden presidency – unfortunately – has dramatically increased.
Concerns about restrictions in clinical practice
For several good reasons, it also appears unlikely that a second Trump administration will give in to pressure from the Republican Party’s extreme right and/or religious wing (as Biden unfortunately did to the Democratic Party’s extreme left wing) because after his landslide election victory he is in a much more dominant position within the Republican Party than Biden ever was within the Democratic Party. During his first term he for all practical purposes abstained from any interventions in reproductive biology and the infertility field but, during the recent election campaign, demonstrated significantly more interest, and, clearly, in a positive way, by, for example, supporting in vitro fertilization (IVF) in the strongest terms (3). We therefore see absolutely no reason to expect any adverse activities for the IVF field. Very much to the contrary, Trump very blatantly went on the record in favor of in vitro fertilization (IVF) practice and even proposed a national insurance mandate for IVF (3).
It is also important to note that Trump’s defense of reproductive rights did not only involve IVF practice (i.e., both sexes) but, indeed, also the abortion issue, where Trump very openly (and at the risk of antagonizing abortion opponents in his own party) argued against a complete abortion ban. The abortion issue is, of course, likely the single most important issue for the extreme right in his party. As the election demonstrated, his support of a gestational age-limit for voluntary termination (though not for rape and threat to maternal life) as determined by each state, a stance by now supported by a large majority of the country’s population, proved successful because it apparently defanged the most potent argument of Democrats against the Republican party in the 2022 Congressional election that had ended up so disappointingly for Republicans.
Concerns about research restrictions and, maybe, a new opportunity
We would here, indeed, argue that considering Trump’s public position in favor of IVF, his second term may finally offer an opportunity to get rid of the so-called “Dickey-Wicker Amendments,” so named after Rep. Jay Woodson Dickey Jr of Arizona and Rep. Roger Wicker of Missouri who in early 1996 – in other words in the still very early days of IVF – spearheaded the enactment of two far-reaching Congressional amendments which assured the prohibition of public funding of gun violence research and human embryo research by the CDC and the NIH (4).
Regarding research on human embryos, the language prohibits any federal funds from being used for “the creation of a human embryo or embryos for research purposes” or “research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death.” The consequences have been tragic for IVF practice because it made IVF the only routine medical treatment excluded from all federal research funding in the U.S. It is easy to imagine how much further IVF practice would have evolved over the last almost 30 years, had federal funding been available for IVF research.
And here is why and how the Dickey-Wicker Amendments have survived unchanged for almost three decades: they under the law annually renew by being automatically attached to the appropriation bills of the Departments of Health and Human Services, Labor, and Education.
Considering Trump’s very strong statements in support of increasing utilization and availability of IVF, we see here an opportunity for the new administration to demonstrate its commitment to IVF by finally doing away with the Dickey-Wicker Amendments, at least as they relate to IVF. We would describe the likelihood that the Trump administration would end the prohibitions of federal research funding for IVF – if appropriately advised – as highly probable, and the time to start the lobbying process is now, so that the new administration can include this subject into the list of initial legislative changes planned for the first 30 days.
Concerns about staffing
Who will become the new Health and Human Services (HHS) Secretary will, of course, greatly matter. We have heard considerable concern about Robert Kennedy Jr. (RFK Jr.) being chosen for this position and the concern is primarily based on his very controversial anti-vaccination beliefs. Those views (and his views on climate change) in our opinion make it unlikely that he will get a cabinet post. Instead, we suspect that Trump will use him in a similar function to Elon Musk as head for a specific task involving multiple cabinet departments, in this case charged with improvement of the general health of the U.S. population.
RFK Jr.
Politico recently suggested several other candidates as well for this position (5). They are listed below:
President-elect Trump and Ex-HUD Secretary, Ben Carson, MD
None of these five candidates elicits the same negatives of RFK Jr. We, however, feel that Politico overlooked one serious candidate for the job, and that is Ben Carson, MD, who has remained close with Trump during his exile and as HUD Secretary during Trump’s first administration did an excellent job and would make a superior HHS Secretary.
In summary, contrary to the panic we hear expressed by many colleagues especially in academia and, indeed, also behind the scenes by some professional societies in the field, we feel optimistic about the future of reproductive biology and reproductive medicine during the upcoming Trump 2.0 administration. Making government less controlling can only help!
References
1. The Washington Post. October 29, 2024. https://www.washingtonpost.com/business/2024/10/29/elon-musk-2-trillion-budget-cuts-trump-election/
2. Dennis S. Financial Review. October 29, 2024. https://www.afr.com/world/north-america/musk-wants-3trn-cut-from-the-us-budget-it-d-be-difficult-20241029-p5km44
3. ASRM. Press release. August 29, 2024. https://www.asrm.org/news-and-events/asrm-news/press-releasesbulletins/trump-calls-for-ivf-ca-leg-send-ivf-bill-to-gov/
4. Adashi EY, Cohen LG. JAMA Forum Archive. Published online November 5, 2015. Doi:10.1001/jamahealthforum.20150045. https://jamanetwork.com/channels/health-forum/fullarticle/2760581
5. Politico Staff. Politico. November 4, 2024. https://www.politico.com/interactives/2024/potential-cabinets/trump-second-term-cabinet/