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This Is How Trump’s Budget Cut Would Harm Medical Research

The 20 percent cut to the National Institutes of Health in 2018 will close labs, end careers, and, most importantly, deprive the public of the medical research benefits scientists are working toward.
(Photo: snre/Flickr)

(Photo: snre/Flickr)

Among the many potential casualties of the Trump administration’s proposed budget is medical research. President Donald Trump’s recent budget blueprint includes a 20 percent cut to the National Institutes of Health, the federal agency that supports the vast majority of the biomedical science conducted in the United States. By taking $6 billion from the NIH in 2018 (and funneling that money into the Department of Defense, supposedly to fight ISIS), the Trump administration would set the agency’s budget back 15 years, below its 2003 level. Such a drastic cut would not just reduce the amount of science done by U.S. scientists — it would harm our scientific workforce and infrastructure in ways that would take years, if not decades, to recover from.

Fortunately, Trump’s proposal is already meeting bipartisan resistance, and it is unlikely to pass in its current form. Even so, it’s critical to examine what is at stake in order to understand the full scope of the harm that Trump seems willing to inflict. A 20 percent cut to the NIH budget would be unprecedented. According to an analysis by the American Association for the Advancement of Science, “no administration has attempted NIH cuts as large as these since AAAS began formally monitoring the budget process in 1976.” However, as the AAAS points out, we do know what happened after a much smaller NIH cut. As part of the budget deal between the Obama administration and the Congressional GOP known as “sequestration,” the NIH budget was reduced by about 5 percent in 2013. As a result, the funding rate for NIH research grants — meaning the fraction of submitted proposals that were actually funded — dropped to its lowest level in 20 years.

Trump’s budget could force the NIH to reduce the number of new proposals by a jaw-dropping 88 percent in 2018.

If Trump’s plans for the NIH were realized, grant funding rates would almost certainly reach a historic low. There are different ways that the NIH could handle the situation, but one possibility is that the agency funds hardly any new biomedical research projects in 2018. According to an analysis by the American Society for Biochemistry and Molecular Biology, based on a model by former NIH official Jeremy Berg, Trump’s budget could force the NIH to reduce the number of new proposals by a jaw-dropping 88 percent in 2018.

The reason for this is that, in any given year, most of the NIH budget goes to pay for ongoing research projects continued from previous years. (The average NIH research grant lasts four years.) Only a minor portion of the budget, about 20 percent, is therefore available for new proposals each year. Currently, the NIH awards between 9,000 to 10,000 new proposals per year. With Trump’s cut, according to the ASBMB’s analysis, that could fall to just 1,200 new proposals in 2018.

That’s probably a worst-case scenario, but any severe, immediate reduction in the NIH funding rate would cause lasting damage to U.S. science. To see why, it’s important to understand the role that NIH grants play in biomedical research. Most scientists who conduct this research are employed by universities. But universities — even the wealthiest ones — don’t have the resources to pay for most of the research performed by their scientists. In order for scientists to actually do any science, they need outside money. Some of this money comes from private sources, like the March of Dimes, the American Cancer Association, or, in some cases, biotechnology and pharmaceutical corporations. But private philanthropy — even when it comes from some of the world’s wealthiest individuals — can’t match the scale of the NIH budget, which in 2015 alone funded nearly $21 billion in research grants.

This means that, in order to run their labs, virtually all biomedical scientists at U.S. universities must obtain NIH grants at some point in their careers. Newly hired scientists are usually given some money by the university to start their labs, which leaves them about six to seven years to bring in their first NIH grant. After that, young scientists either get tenure or lose their jobs. Even tenured scientists need these grants — without them, their labs will close, their staff will be laid off, and their students will have to start new research projects with other professors. Just one bad year of budget cuts at the NIH is enough to end research careers — not because particular scientists were doing a poor job, but because they happened to need a new grant in a year when the agency was forced to drastically scale back new proposals.

No wonder Trump’s budget has so many scientists on edge. To see how these cuts would play out in individual labs, I asked some of my scientific colleagues how they would be affected if cuts made it almost impossible to get an NIH grant next year. Younger scientists with new university positions, even those with money from private foundations but no NIH grant, all told a similar story: “lab closed, research over, trainees gone.” Scientists who are just finishing their training are rethinking a career in research, asking themselves, “Should I quit now?” Some established scientists, with a record of years of successful science, have expiring grants; to keep their labs open, they need to obtain new grants in the next year or so. “To say I am concerned about this would be an understatement,” an established University of Utah scientist told me.

Even scientists who already have multi-year grants that might outlast the Trump administration would be affected, because the NIH would also have to reduce its funds for existing grants as well. For scientists, this would mean scaling back their work, laying off lab members, and, as one neuroscientist put it, “not testing bold new ideas, only ‘safe’ ones.” It would also mean that, rather than actually doing science, researchers would spend even more time writing proposals, hoping that one gets funded.

Trump’s proposed NIH cuts would not only have an indiscriminate effect on individual scientists; they would also affect progress on a broad range of biomedical science topics, including basic research on laboratory animals, cancer genetics, clinical trials for neuromuscular diseases, and Zika.

Tara Smith, an associate professor at Kent State University, is an established, productive scientist who works on one of our most pressing medical problems, antibiotic resistance. Smith studies antibiotic-resistant bacteria that infect humans and livestock, especially on U.S. farms. Even though she’s successfully obtained research grants for nearly a decade, she has several expiring grants, and needs to secure new funding by the end of next year to keep her lab running. If that doesn’t happen, a research associate in her lab would have to find a new job, the dozen or so undergraduate and master’s degree students who train in her lab each year would have to find new research projects, and the U.S. would lose a lab focused on a top medical priority.

Beth Prusaczyk is finishing up her graduate work at Washington University in St. Louis. (Full disclosure: This is also my employer.) She will begin a post-doctoral fellowship at Vanderbilt University this summer, where she will continue her research on how to translate research findings into better medical care at actual clinics. Her work focuses on how to help doctors, nurses, and hospitals adopt new research findings that would improve the care they give their patients. She’s passionate about better medicine. “It takes, on average, 17 years for a new clinical discovery to make it’s way into routine practice and to me that’s unacceptable,” she says. To continue her research career, she’s aiming to secure NIH funding for her post-doctoral work within the next year or two — which will be much more difficult if Tump’s budget plan is enacted.

Some researchers feel awkward complaining about budget cuts, because scientists at U.S. research universities aren’t exactly the first people who come to mind in discussions of who will be hurt by Trump administration policies. “It’s hard to complain when I am in academia,” says Sadie Ryan, an assistant professor at the University of Florida. Ryan is a medical geographer who studies the transmission of diseases like malaria and Zika, and how the risk of transmission is best communicated to the decision-makers who must choose where to focus resources to prevent and combat disease. Her research is also threatened by potential NIH cuts. While losing this funding would affect her personally, Ryan also believes it would affect society. “I won’t grandstand about the importance of the science I do,” she says, “but people like knowing where Zika will be, and how and where prevention methods work for it and other vectorborne diseases.”

The cumulative effect of thousands of stories like these would last for years as scientists scaled back, labs closed, and people left their fields altogether. This potential effect cannot be easily reversed, especially since the cuts would hit younger scientists hard. If an incoming generation of researchers can’t do their work, or even keep their jobs, America’s leading role in science will inevitably be diminished. If that happens, more than prestige is at stake: Our economy will lag, and our nation’s health will suffer.

The Trump administration called its proposal a “Budget Blueprint to Make America Great Again.” It’s an unintentionally ironic title for a plan that would casually discard the science and scientists who, for more than half a century, have made America one of the world’s greatest producers of medical research.