Misguided Views about NIH and Recent Funding Cuts Hurt Us All
It's time to debunk some of the negative hype and expose misguided assumptions.
The Trump administration’s slash and burn approach to cost reduction lays waste to essential, vital services and research. Recent layoffs and funding cuts within the NIH (National Institutes of Health) have devastated the agency, leaving uncertainty and an attack on the very foundation of scientific study in their wake.
But negative hype about the NIH, coupled with criticisms from the Trump administration, characterize this federal biomedical research funding agency as the reckless purveyor of bloated government spending — leading some to view the changes as justified.
My experience was quite different, though, when I was a principal investigator on an NIH grant proposal (described below). Contrary to the negative hype, the NIH, past and present, is meticulous in determining when to award funding.
What the NIH actually does
The NIH identifies as the “the largest public funder of biomedical research in the world,” whose mission is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability.”
NIH grants are not dispensed indiscriminately. Applications are scrutinized by a discerning body of highly trained scientists and researchers who are selective to a fault. Research grants are offered only to the deserving few who meet critical standards — approximately 20% of applicants.
In fact, “no project can receive NIH funds without first being vetted by multiple panels of experts in the field, who judge each proposal based on criteria such as the lead scientist’s track record, the rigor of the study’s design, and the project’s likelihood of addressing a pressing biomedical-research issue,” health journalist Katherine Wu explained in The Atlantic.
In a summary of what the NIH funds, public health policy advocate Marquisha Johns from the Center for American Progress describes the following:
“NIH-funded research spans more than 300 health topics, including substance use, chronic conditions, injuries, mental health, aging conditions, genetic disorders, health disparities, social factors influencing health, and more. In addition, NIH is integral to vaccine development and the availability of new drugs on the market: NIH funding contributed to research for roughly 99% of drugs approved between 2010 and 2019.”
The NIH is housed under the Department of Health and Human Services (HHS), and since the Trump administration took office, both HHS and NIH funding have taken a hit. Staff have been fired and their research halted. A long list of recently cancelled HHS and NIH research is compiled here through TAGGS (Tracking Accountability in Government Grants System), a database tracking tool of HHS grants.
(For an update on recent HHS cuts, see this overview from Substack’s Inside Medicine here.)
NIH funding cuts affect all of us
Slashing research funding that impacts the public’s health and well-being will have far-reaching consequences. Essential research on medical and mental health conditions, medication safety and effectiveness, and new treatment approaches will be stalled indefinitely. Medical recommendations every patient receives from their doctors are based on rigorous scientific findings; when this pipeline of research stops abruptly, every patient will be deprived of the latest information.
Patients participating in now-cancelled clinical trials, for example, will be tossed aside, sometimes without guidance about how to taper off their medication. “The federal government’s disregard for clinical trials is one of the most direct illustrations yet that the nation’s new leaders have abandoned people’s health,” Wu wrote.
Funding cuts are also personal, affecting NIH research staff as well as the patients they serve. Talented scientists, research assistants, and administrative staff are now unemployed, and will likely endure economic hardship. When universities lose funding that supports research, it affects monies available for students, faculty, and the businesses within these communities. In fact, every U.S. state is at risk of losing funding and experiencing increased job loss, wrote Johns.
And those universities, businesses, and communities in rural or underserved areas will suffer the most, cautioned University of South Carolina immunology and toxicology researchers Prakash and Mitzi Nagarkatti in The Conversation. The researchers point out the following:
“While we believe such cuts will be detrimental to the entire country, they will disproportionately hurt states that traditionally have received very low levels of NIH funding, the majority of which are red states that supported Trump’s election to a second term. This is because such states lack resources to develop advanced research infrastructure necessary to compete nationally for NIH funding.”
The public’s distrust toward science may escalate, especially as private companies pick up the slack and conduct sometimes questionable research, given their financial stake in the outcome. It appears that political views (rather than scientific standards) are the catalyst for determining whether a particular study is no longer a priority or violates the new administration’s stance on topics such as Diversity, Equity, and Inclusion (DEI). And many NIH scientists decry the insertion of political opinions and grievances in determining a study’s merit, according to Wu:
“Decisions about which grants to cut have been made seemingly without regard to scientific legitimacy… The cuts have variously targeted studies on LGBTQ populations, DEI, health equity, and vaccine uptake; projects in foreign countries; grants that happen to have been housed at universities the Trump administration is sanctioning for other reasons; projects that make mention of COVID-19. This blitz has also hit grants less focused on those topics: Projects on antibodies, genetics, and dementia have been cut simply because — as far as scientists and NIH officials can tell — their titles or descriptions mention words such as diversity.”
My foray into writing an NIH grant proposal — a personal account
In my first job after graduate school, I coordinated the psychological component of a multidisciplinary hospital-based obesity treatment program. I loved my clinical work. Sometimes my role as a psychologist was simple, such as running groups that promoted behavior change. Other times, it was more involved, where therapy addressed unresolved trauma or distress over co-occurring medical conditions. I also supervised psychology interns, participated in interdisciplinary program development, and initiated some small-scale research studies.
But I never expected to write an NIH grant proposal as part of my job.
The program’s medical director — an intense man, prone to excesses (including an unhealthy dose of workaholism) — insisted that we devise a study and apply for an NIH grant. We were tasked with designing a study to investigate and compare treatment protocols for clinically obese patients, with the goal of reducing cardiovascular risk factors (e.g., high blood pressure or pre-diabetes). Given the program’s connection with the hospital’s cardiac rehabilitation program, the study seemed feasible, albeit overly ambitious.
The research design and writing were conducted after hours. Late nights of caffeine and pizza were part of the equation as my colleagues (medical, nursing, clinical nutrition, exercise physiology, and clinical psychology professionals) put our collective heads together and agreed on the research design. Each professional discipline devised its own separate study, with the expectation of seamless interconnection across each of our respective disciplines’ investigations. While it was exhausting, collaborating with these talented professionals and hashing out the details was also quite fun.
I never became a psychologist to do research. Yes, the “scientist-practitioner model” is the foundation upon which the profession of clinical psychology was built (which combines both research/social science and psychotherapist training). And yes, I completed the perfunctory research necessary to graduate and even published some studies in peer-reviewed journals. But as the pendulum swings, I was firmly aligned with the practitioner side of the model.
Nevertheless, I was trained as a researcher, so I was open to the challenge: Devise a meaningful, clinically useful, and rigorously detailed study of how cardiovascular risk factors could be reduced. And like many complex endeavors, it took longer than we all expected. Prior to the advent of electronic submissions, a research proposal had to be mailed through the postal system or hand delivered. We lurched toward the submissions deadline, and in dramatic fashion, a research assistant flew to Washington, D.C., grabbed a cab at rush hour, and delivered the proposal to the NIH with ten minutes to spare before offices closed.
The verdict
Several weeks later, the verdict was in: The study was approved but not funded. In other words, peer reviewers determined that the study was worthwhile and well done — but did not warrant grant funding. In their careful determination over where to distribute grant monies, they concluded that our study did not meet their standards.
And they were right.
Our study was credible, elegantly designed, and targeted a serious health condition. But the hospital’s aging infrastructure was likely insufficient to house such an undertaking. And most of us had never written a grant proposal before; the reviewers recognized that taking a chance on us rookies was too great a risk.
But I learned a lot — what it’s like to quickly formulate a research plan, write a proposal, collaborate with a variety of healthcare professionals, and harness inspiration from what I already knew as a psychologist.
I also learned that the NIH is a formidable resource that takes its role seriously.
And over the years, I have spoken with friends, neighbors, and clients who have worked on NIH funded research; the enormous complexity and oversight involved and their dedication was both daunting and admirable.
Bottom line
Recent drastic funding cuts, lay-offs, and elimination of much-needed research create immense uncertainty for our country’s health and well-being. The NIH has been a highly respected organization up until now — funding essential research that enlists rigorous study design and methodology. My hope is that with enough push-back from the public, the medical community, universities, and congress members willing to brave threats of retribution, this necessary channel for federal research funding will survive.
This article is an update of a recent Medium article about NIH funding cuts. It is also part of an occasional series of articles about U.S. policy that impacts mental health and well-being.
For a few additional articles about the state of affairs and mental health impacts, see the following:
Thanks you, Gail, for describing the rigors of the NIH grant funding process and highlighting the importance of agencies like NIH in sustaining the research (and researchers) which have advanced psychology and other health sciences.