Who Could Have Predicted the Attacks on Science Would Go This Far?
Me. I Could Have.
The Trump Administration’s decision to cut NIH indirect cost rates will bring biomedical research to a grinding halt.
It gives me no great pleasure to say, “I told you so” to the leaders of the academic medical center here in my hometown, also known as my former employer, and the place I poured my heart and soul into for about 15 years before I was not-so-cordially shown the curb in 2023. Numerous times on podcasts, during interviews, and in my writing, I have tried to sound the alarm about what happens when the wall between science and politics is breached. That there will be dire consequences if you let partisan, scientifically illiterate electeds dictate what doctors and other scientists can do. Anyone paying attention, who wasn’t blinded by partisan loyalty, who wasn’t primarily motivated by maintaining their relationships with the anti-science far right, could have predicted how bad this would get.
Academic medical center leaders didn’t stand up when it was reproductive rights (because, that’s a woman’s issue and… patriarchy). They didn’t stand up when it was treating gun violence like a public health crisis (because that’s an “urban” issue (please read subtext there re: racism) and… the gun lobby). They didn’t stand up when it was gender affirming care (because damn it's easy to let the little guy get bullied). Keep in mind this is not an exhaustive list. These are just the three most recent examples of academic medical centers abandoning science at the behest of anti-science Republicans. And to be clear, this isn’t just happening in South Carolina, it’s happening in red states across the country.
In each of these instances the science is there, and the science is clear. Evidence tells us what we can do to promote the health of these populations. To reduce the burden of disease and injury. We know what is in the best interest of patients. But instead of doing it, we did what politicians told us to do. Evidence and vulnerable patients be damned. Leaders of academic medical centers (who, by the way, should be the most publicly pro-science among us) did what seemed politically expedient, they did what allowed them to maintain their relationships with Republican elected officials. And they also silenced dissenting voices. They censored public communications. They censored science. They did what they were told. They were complicit.
And now they are in the find out phase. And unfortunately, this affects all of us.
Anyone with any experience with toddlers could have told you that if you give in once, (snacks before lunch, cartoons before nap, letting them sleep in your bed) they are going to realize they have power over you and are going to raise the stakes next time (cookies for breakfast, iPads all day, and total authority over the bedtime routine). And if they don’t get their way they will throw a tantrum. You give them an inch, they take a mile. Please note, I deeply regret having to compare toddlers to Republicans because I really am a big fan of toddlers. And, at this point, it’s an insult to toddlers. But you get my point. You allow bad behavior, you reward bad behavior, and you get…more bad behavior.
It will surprise exactly zero of you when I share that I am not a C-suite gal. Those spaces aren’t for me. I am too loud. Too persistent. Too forthright. Too unapologetically pro-science and pro-child to ever be welcomed there. I am the person who is discussed in the C-suite, not the person in the discussion in the C-suite. So I am not privy to the actual conversations that went down between the South Carolina Freedom Caucus and the MUSC Board of Trustees and executive leadership team over the past few rabidly anti-science years. But I know enough to know that there were MANY missed opportunities to stand up for science and the patients the public university is charged to serve.
I can only assume the leaders thought the anti-science trend wouldn’t escalate to this level. That if they sacrificed women’s health and turned a blind eye to victims of gun violence and threw trans kids under the bus, Republicans would stop short of any action that would hurt them personally, or their bottom line.
Well, the joke’s on them. Except none of this is funny. It’s as devastating as it was predictable. They showed Republicans (over and over again) that science is negotiable and dispensable, that it’s ok to put politics first, and people last. They gave them many inches and the GOP took many miles, and the entire publicly funded biomedical research apparatus as well.
The Trump administration’s decision to slash the NIH indirect cost rate to a level that will decimate the bottom line of MUSC and every academic medical center across the state and across the country is a devastating blow to science and to the health of all Americans.
I made a video explaining how the indirect cost rate cut impacts research at academic medical centers. But for those who aren’t glued to my Instagram stories (you are missing out, btw) here is the high level summary:
Academic medical centers have three missions: Clinical Care, Education and Research and they have to do these three things while also keeping the lights on.
While clinical care is technically revenue generating, the margins are slim due to a myriad of reasons including the high rate of uninsured and underinsured Americans and profit-driven insurance companies and their bloated executives’ salaries.
Education is not a revenue generating activity.
It costs money to conduct research, but investment in research is cost-effective
Researchers apply for grant funding to support their research. Grant applications (including those to the NIH) include incredibly detailed line-by-line budgets for direct costs. Direct costs include items such as partial salary support for the investigators who will spend their time conducting the research, for lab technicians and research assistants who spend their time running the experiments in the lab and enrolling patients in studies; materials like test tubes, and reagents; and the equipment needed to conduct the research that has been proposed. Direct costs do NOT include things like the building the research lab is in, paying the electrical bill to keep the lights on in the lab, the office space for the research staff, and the administrative staff that is necessary to support research infrastructure. All of these costs are covered by the indirect cost rate that is included in the total budget of every NIH research grant application. A rate that, up until last week, has been determined by Congress.
Academic medical centers CANNOT survive without the indirect costs that are distributed in proportion to the amount of NIH research funding an institution receives. Direct costs alone can not support research. Illegally slashing the indirect cost rate will result in biomedical research coming to a grinding halt at every academic medical center in this country (In red states AND blue states). Research staff will be let go. The lights in the labs will be turned off. Diseases win. People lose.
This is pretty much the most devastating financial blow the Trump administration could inflict on biomedical science in America. (#MAHA, right?)
While I haven’t seen the direct financial impact of this rate change on MUSC, I did see that the University of South Carolina School of Medicine is estimated to lose $42 million annually as a result.
But never fear, in an email to MUSC staff about this, leadership said “[we] have been in direct contact with South Carolina’s congressional delegation to communicate the potential impacts of this guidance on MUSC, our three institutions and the State of South Carolina.” I don’t know guys, last time I checked Lindsey and Tim were on Air Force One with Trump on their way back from the Superbowl and Nancy was somewhere screaming into the void about children’s genitals. I am sure those conversations will be productive.
Good thing you all cozied up to the anti-science GOP these last several years. Seems to be working out really well for you… and for us.
I hope RFK Jr. and Dr. Oz can fix this.
Annie, thanks for always being on target and forceful!!!
Great article. Thanks for speaking out on this!