During his testimony before the Senate Committee on Health, Education, Labor and Pensions hearing on Wednesday, Jay Bhattacharya, President Donald Trump’s nominee to run the National Institutes of Health, seemed to side with the president’s plan to cut billions of dollars from the nation’s scientific research budget, most of which is controlled by the NIH.
“I have a background as an economist as well as being a doctor,” Bhattacharya told the committee. This helps him “understand that every dollar wasted on a frivolous study is a dollar not spent. Every dollar wasted on administrative costs that are not needed is a dollar not spent on research. The team I’m going to put together is going to be hyper-focused to make sure that the portfolio of grants that the NIH funds is devoted to the chronic disease problems of this country.”
Some of Trump’s cuts have already been made, including the firing of over 1,000 “probationary” workers, and the blocking of this year’s grants through a bureaucratic loophole. The Trump administration also wants to stop paying indirect costs for building space, expensive equipment, and oversight of medical research, though so far that has been stopped by a judge’s temporary order.
What should we make of these cuts? Are they a sensible way to make medical research even more efficient? Or will they threaten the development of cures that could save millions of lives?
We asked two oncologists we trust to debate this important issue.
David Andorsky is an oncologist in private practice who believes that these cuts will be disastrous. “I spend my days with patients who’ve been saved by miraculous treatments that were invented by scientists working at labs, primarily academic ones, funded by the NIH,” he said.
Vinay Prasad, a frequent contributor to our pages, is also an oncologist as well as a professor at the University of California, San Francisco. But he has a different view—that paring back the NIH’s research budget can be healthy, forcing the agency to make better choices about what it should, and should not, fund.
Here are David and Vinay:
David Andorsky: Vinay, I have a lot of respect for you—I’ve listened to your podcast and heard a talk you gave for the U.S. Oncology Network a few years ago. But I can’t imagine another oncologist saying that these sorts of sledgehammer research funding cuts are a good thing. My perspective comes from my own experience as a clinician. I spend my days with patients who’ve been saved by miraculous treatments that were invented by scientists working at labs, primarily academic ones, funded by the NIH. I see patients every day who would be dead without these medical advances.
We can quibble about whether the NIH could be more efficient. But the cuts proposed by the Trump administration would create budget deficits of many millions of dollars at every medical research institution in the country.
Vinay Prasad: David, thanks for coming to that talk. Just to clarify my position: I support Trump’s proposal to cut indirect costs. When the NIH gives a grant to universities, it pays some money directly to researchers and their teams, and some to the university as overhead or indirect.
Currently, if a researcher gets $100,000—the university can get an additional $50,000 or $65,000, or even $90,000—that is the indirect. At some places like Salk and Scripps, two research institutes, indirect rates are up to 90 percent. Trump has proposed capping indirects at 15 percent.
Indirect costs don’t go to researchers, they go to universities, often the dean, and are unaccounted for—some of these funds support mandatory trainings and a vast administrative state.