Grant Applications Due Soon to the National (Root Causes) Institutes of Health
Thousands of scientists fired, programs stopped, & threats to the mission of NIH and CDC continue - what comes next, framed as research into root causes, is even worse.
Just “Trimming the Fat”
Even now, certain people will tell you that the NIH and CDC needed to be reformed even if initial steps taken by the Trump administration have been mishandled. Others will tell you that things will get better once the administration is done with these initial cuts. Perhaps they are scientists tired of all the administrative time-wasting, having spent too much time filling out forms and not enough time in the lab. Perhaps they are from the business world (some operating with large government contracts themselves) and wonder why the government ‘subsidizes’ universities. Perhaps they are folks who have been ‘inadvertently’ impacted by cuts to American programs and services both here and abroad.
Cognitive dissonance is real.
What type of reform agenda abruptly shuts review panels, silences scientists, tries to rip up terms of negotiated contracts associated with billions of dollars of awards that will devastate America’s leadership in biomedical research nationwide, interrupts clinical trials of potentially life-saving drugs, and fires thousands of employees within NIH and CDC, including the entire incoming cohort of the Epidemic Intelligence Services?
Is this reform? Is this good intentions mishandled? No.
Unlike what certain people tell you, what comes next will not be the necessary correction that they hoped for. The White House may share talking points justifying cuts to HHS as methodical. In fact, the NIH and CDC are being gutted.
The money ‘saved’ by slashing and burning mission-critical programs and firing thousands of employees won’t turn into more grants for basic and translational science – at least not the kind that actual scientists with decades of experience recognize and practice. Instead, without action now this initial phase is almost certainly a prelude to something even worse: an administration that appears intent on ushering in a golden era of pseudoscience.
NCRI Launch & Request for Proposals: mid-2025
Press Release (Summer 2025, draft version): The National Root Causes Institute (NCRI) is dedicated to improving human health by getting to the root causes of why Americans are getting sick. The NCRI will work transparently and eliminate conflicts of interest to advance the Make America Healthy Again agenda by improving the quality of food we eat, enabling lifestyle changes, and focusing on disease prevention – especially chronic childhood disease. Created in Summer 2025, the National Root Causes Institute (NCRI) is part of the National Institutes of Health (NIH) within the Department Health and Human Services (HHS). Special emphasis panels and Council members will be announced soon on the NCRI home page. NCRI encourages applications from industry and institutes committed to the goals of prioritizing innovative root cause research and interventions.
This seemingly anodyne announcement (albeit satirical) is one of our potential futures. It would mark a moment of imminent collapse of the reputation and standing of America’s biomedical research ecosystem. To an insider who understands what science is, what scientists do, and how hard it is to make fundamental advances in understanding the principles of how living systems work – this type of call should raise alarm bells. The prioritization of ‘root causes’ is code for something else: reducing investment in the study of infectious and opportunistic diseases, including HIV/AIDS, TB, influenza, COVID, hepatitis, malaria, dengue, fungal infections, and drug-resistant bacteria (e.g., pathogenic E. coli and MRSA). Alone, drug-resistant bacteria are estimated to infect more than 3 million and kill approximately 50,000 Americans annually. We can’t afford to give infectious disease research ‘a break’.
But, I can imagine that many people outside of science & medicine might hear about the new ‘NCRI’ (or similar initiatives whatsoever they are called) and applaud the decision. Root causes are important and the federal government should link food quality, lifestyle choices, and environmental effects to disease prevention.
Spoiler alert: the NIH, CDC, FDA already do precisely this.
As but one example, since 2013, the NIH and FDA have invested in a long-term study to explore the relationship between lifestyle choices and health – ‘The Population Assessment of Tobacco and Health (PATH)’. The PATH study includes nearly 50,000 participants from across the US, integrating health outcomes and surveys conducted yearly, leading to more than 800 scientific papers and related policy recommendations. How does firing doctors scientists, nurses, technicians, and support personnel advance health goals? It doesn’t, but that is by design.
We Face A Tipping Point
Universities, medical research institutes, pharmaceutical companies, and insurance companies may decide to weather the storm or, in some cases, take ‘advantage’ of favorable circumstances in the short-term to certain industries – supplements, vaccine alternatives, and other non-FDA approved aisle miracle cures (remember: invermectin). If they remain silent, then taking a haircut this year won’t be enough. Universities with endowments might be able to backfill some of the funds, but the vast majority – including the national system of flagship state universities and medical schools – will not. Ironically, an attack that DOGE framed as laser-focused on the Ivies and Ivy-adjacent private universities (which in and of itself is backwards and destructive in its own right) will hit public institutions the hardest.
Instead of a haircut, the basic science and biomedical research innovation ecosystem will run further into the red as grants run dry. Panels will be shut and funds reduced even further. There simply won’t be grants to apply for in areas of legitimate scientific need, because the Trump administration and incoming HHS Sec. Robert F. Kennedy Jr have repeatedly expressed what it is they value: ineffective and often dangerous ‘cures’ and what they want to undermine: the products of America’s innovation economy, including life-saving vaccines.
In this version of America’s future, NIH and CDC grant review panels that were once convened by experts and subject to peer review will become quaint vestiges of a prior era in which scientists could complain about process, administrative burden, and paylines on social media and in private conversations. Grumbling about decisions of a study section matters less if the study section no longer exists and the lab is already closed.
Don’t think it’s possible. Let’s face facts. They want it all, but there is a window to act.
Cracks have already appeared in what Andrew Sullivan described as a “shock and awe” period carried out by whom David Brooks calls “French revolutionaries in red hats.”
How does it benefit the people of Pennsylvania if the Trump administration destroys a nation leading center for biomedical research in Pittsburgh? How does it benefit the people of Alabama if the Trump administration destroys one of the leading cancer research institutes in Birmingham? How does it help the people of Texas if the Trump administration undermines a network of world-class science, biomedical, and clinical care universities and research institutes in Houston?
This is not trimming the fat. This is nihilism.
The Bottom Line
Firing people and cutting off the flow of federal investment in basic and translation research will short-circuit pathways to the next drug therapy and lead to economic pain now. Job losses mean folks have less money to spend in their communities. Small and large businesses that work with the federally funded research ecosystem across the science supply chain will face significant setbacks. Students will miss out on opportunities to launch the next stage of their careers. The ripple effects are devastating and transcend party and region.
But it requires help for any of this to happen.
In the past week, a series of principled U.S. attorneys resigned rather than implement what they viewed as unlawful orders to enact an alleged quid pro quo to drop corruption charges against Mayor Eric Adams of New York City. Those who said no defied significant pressure to comply. Not all will say no. This story has a lesson for the world of researchers in the basic, translational, and biomedical sciences.
Building an alternative science infrastructure requires people willing to do the work and Governors, businesses, and institutional leaders that are willing to play along. The pressures are real. Mortgages due, rent to pay, and health care to cover. Already groups of scientists, physicians, and economists (e.g., the members of the ‘Journal of the Academy of Public Health’) have begun to form the blueprints of an upside-down, copycat world of science-like journals and academies that could provide cover for an administration seeking to argue that it is building a research paradigm focusing on root causes that has the backing of the scientific community. Unlike ‘predatory journals’, these groups have far greater ambitions.
In the late 1800s, Louis Pasteur and Robert Koch formulated what we now term ‘the germ theory of disease’. Microscopic organisms made us sick and could kill us – not miasma. Understanding how things actually work can lead to effective prevention, treatment, and cures. Vaccines, drugs, therapeutics, and improvements in clean water, sanitation and hygiene have extended the life expectancy of Americans from 40 years for those born in 1885 to nearly 80 years for those born in 2020. There is much to improve in the US science and biomedical research ecosystem. But, destroying the NIH, CDC, FDA and NSF won’t make us healthier or better off. It turns out that ‘just asking questions’ has consequences.
In the end, the search for supposed ‘root causes’ may precipitate a vast, costly, and misguided effort that undermines evidence-based interventions we have in place already and diverts our attention from discoveries we have yet to make.
It is time to change paths – now – and restore actual expertise and experts in HHS.
Why does the federal government need to pay for all these things? Are there no other sources of funding for important medical research? Are the companies in the industry so capital-poor that they can't share some of the funding burden?
The above are sort of snarky questions, but they're also honest - how did we get here, where everyone depends on the federal government, which is by its nature fickle and subject to radical change from time to time, for funding?
The "trickle down" effects are already happening. Pre-med students are telling me that they are getting emails following their applications to the NIH Summer Internship Program that say the program is being halted. The NIH SIP website says " Summer Internship Program: The NIH Intramural Program has paused the recruitment of IRTAs, CRTAs, and Visiting Fellows in all training programs pending guidance from Health and Human Services. Check back daily for updates."
If students can't get research experience, they will have a more difficult time getting into and succeeding in medical school. This will have major impacts on the US supply of doctors which will impact everyone's health.