Misguided Brushes of a Pen Continue to Dismantle and Destroy Biomedical Research in the United States: We Can No Longer Afford Complacency and Fear. We Must All Act Now!

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Editorial| April 29 2026

Steven E. Kahn ; Steven E. Kahn

1Editor in Chief, Diabetes Care

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Cheryl A.M. Anderson; Cheryl A.M. Anderson

2Deputy Editor, Diabetes Care

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John B. Buse ; John B. Buse

2Deputy Editor, Diabetes Care

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Elizabeth Selvin

Elizabeth Selvin

2Deputy Editor, Diabetes Care

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Diabetes Care 2026;49(6):901–905

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The opinions expressed in this editorial are the personal views of the authors (S.E. Kahn, C.A.M. Anderson, J.B. Buse, and E. Selvin) and do not represent those of the American Diabetes Association or the authors’ employers. The American Diabetes Association had no role in the development or writing of this manuscript. The authors declare that they receive honoraria from the American Diabetes Association for serving as editors of Diabetes Care and are recipients of grant awards from the National Institutes of Health. There are no other relevant conflicts of interest. Just a year ago, in these very pages, we highlighted the many threats the current U.S. administration posed to the health of our nation (1). Since then, there have been actions by the administration that have caused grave health consequences, and their current approach will continue to do so. The numerous measles outbreaks and associated avoidable deaths have resulted in part from hyping disproven theories of harm rather than publicizing the effectiveness of the measles vaccine (2). Plugging the concept that diabetes is curable by “changing the food source” (3) simply ignores the large body of work that has demonstrated that it is not merely a disease of poor nutrition and the immense challenges of reinventing the food industry. Peddling conspiracy theories represents failures by officials of the Department of Health and Human Services (HHS), whose primary goal is to protect our health. These two examples represent just two of the broken promises made by the current HHS leadership during their confirmation hearings (4,5). And, despite promising oversight, representatives on Capitol Hill have shirked their responsibility and have allowed the country to continue along misguided paths that even they recognized as irresponsible (4). We are not only naysayers; we do wish to give credit where credit is due. Both Republicans and Democrats loudly and firmly rejected the White House’s proposed nearly $18 billion reduction in National Institutes of Health (NIH) funding for fiscal year 2026.

The result was a 1% increase in the total appropriation over that of fiscal year 2025, amounting to $47.5 billion. This signaled that the value of biomedical research is not lost on our elected representatives. We appreciate their steadfastness and resistance to surrendering to what would have destroyed decades of American advances in biomedical discovery and translation. While one would think that this congressional action to preserve the NIH budget was a clear repudiation, it has not stopped President Trump from requesting a 2027 budget that now seeks a $5 billion reduction to NIH (6). These proposed cuts would eliminate the National Institute on Minority Health and Health Disparities, which they claim “is replete with DEI [diversity, equity, and inclusion] expenditures,” the Fogarty International Center, which is responsible for funding degree programs in foreign countries that benefit the health of all, including Americans, and the National Center for Complementary and Integrative Health, whose charge includes supporting research and offering information about complementary health approaches in the setting of whole-person health. Other vital cores of the NIH that would be scaled back are the National Institute of Allergy and Infectious Diseases and the National Library of Medicine; the latter’s charge includes providing searchable access to the worldwide medical literature for scientists, clinicians, and patients around the world. Threats to the U.S. biomedical research infrastructure are easy to understand when they involve reductions in appropriated dollars and cents. However, serious negative consequences arise when administrative changes are made without congressional approval or oversight. We have been witnessing significant changes imposed on NIH since the start of this administration. The changes seem to be accelerating and occurring across the whole of NIH, without exception, thus impacting biomedical innovation in diabetes care and across every disease. From our perspective as investigators who have received federal research funding, these changes have and will continue to have detrimental effects on the NIH research infrastructure, with significant adverse trickle-down implications for universities and investigators. These radical modifications have included a marked reduction in the NIH workforce, changes in medical advisory councils, a reduction in published notices of funding opportunities, and an ill-advised multiyear funding policy.

Early in 2025, the new administration implemented unplanned and haphazard “reductions in force” that targeted not only NIH scientific staff but also many behind-the-scenes personnel in each institute who were responsible for policy, compliance, and communications. It is very clear to many of us that this reduction in key staff has fractured the NIH infrastructure, leaving a huge void such that the NIH is failing to communicate with the general public, universities, and the investigators they serve. At an administrative level, each NIH institute has a medical advisory council responsible for providing oversight and guidance to its staff. Each institute’s advisory council represents a second level of peer review and acts as the ultimate arbiter for the agency’s scientific and legal integrity. Each institute’s advisory council also provides approval for “concept clearance,” which is required to launch new research initiatives. Further, these medical advisory councils have a fiduciary responsibility to ensure the American public’s tax dollars are properly expended by reviewing and approving each institute’s grant funding pay plan, thereby ensuring funding of the most innovative and impactful basic, clinical, and translational research. Membership on these committees, which comprise subject matter experts from academia and nonprofit organizations, has finite terms, after which members are either reappointed or replaced. In the past year, neither has occurred, allowing the Trump administration to impose its political agenda with few questions asked. Since mid-2025, observations suggest the appointment process, which has included traditional nonpartisan vetting, is taking a worrisome turn and is now transitioning to more direct oversight by HHS leadership. This transition is leading to significant and likely intentional delays in appointments, resulting in some institutes’ councils operating at only one-third capacity and many councils with massive backlogs in completing their responsibilities. In addition, the administration appears to be shifting membership expertise away from an academic and scientific focus to reflect broader administration priorities and including political appointees who frequently have no subject matter expertise. A consequence of these changes is that the grant cycle is significantly slower and oversight of grant funding is no longer a required administrative step; it is now a deliberate policy alignment tool to ensure new research closely mirrors specific administrative political interests. As a result, meritorious scientific projects that aim to improve the lives of all Americans are not being funded. All of this is in line with what Dr. Francis Collins recently said: “Mix politics and science, you get politics.

You kind of lose everything else.” (7). Another new tactic is starting to severely hamper the ability of the NIH’s institutes to foster high-impact science. The plan, which is currently being instituted, reduces the number of Notices of Funding Opportunities (NOFOs) being issued. Over the first 13 months since Donald Trump’s return to the White House, NIH has issued only 84 NOFOs, compared with 787 the year before (8); this represents an 89% reduction. Examination of funding activity using NIH RePORTER data from the start of the current fiscal year on 1 October 2025 to the end of February 2026 reveals a truly troubling trend. This report, issued by the Association of American Universities, compared this fiscal year 2026 period to that of each of the first 5 months of 2021–2024 (9). It identified that the current number of grant awards has been reduced by about 66%, from nearly 3,000 to less than 1,000. In turn, this has reduced the research money provided to investigators by 54%, from just over $1.3 billion to about $600 million. Why is this consequential for science overall and for diabetes research? NOFOs, an umbrella term that includes Program Announcements and Requests for Applications, encourage investigators to submit applications for a particular subject matter determined to be high priority by an institute’s scientific staff. Aside from the impact of the concerns of reduced grant funding laid out above, there are other significant core issues and implications for fewer NOFOs that include efficient oversight and scientific progress as prime examples. Further, and enormously important, while these calls for NOFOs used to be approved by each institute’s medical advisory council, approval now rests in the hands of the NIH Director’s office and HHS, the NIH’s parent agency, resulting in severe delays or even disapprovals. Furthermore, with fewer specific NOFOs being approved, more researchers are funneled into general pools, providing fewer opportunities to focus on specific gaps and needs identified by NIH.