In a 412-page document released on May 29 — into the lull of a summer weekend news cycle — the White House budget office proposed a drastic overhaul of the rules that govern every federal research grant. The proposal would give political appointees unprecedented control over the future of more than $50 billion of medical and health services research, affecting the lives of patients and families across America, and the global standing of American scientific inquiry. The rule covers all federal grant-making agencies, including the National Institutes of Health, the world’s largest funder of biomedical research.
The proposed changes are of critical importance because the grant-making process decides which questions are asked about our health and the way we deliver care. Whether the next cancer drug gets tested, whether anyone studies what actually works for the prevention of Alzheimer’s and other dementias, whether there is evidence behind the Medicare decisions that will shape your or your parents’ last decade: nearly all of it is paid for with federal money, and the proposed rules will change how the decisions are made.
Until now, political appointees have had wide-ranging authority to administer agency programs and set priorities according to the administration’s policy agenda, but they did not do political evaluations of individual studies. Under the proposed rules, political appointees would get final approval over which studies the government funds, and the scientists who currently make that call through peer review would be demoted to advisers. The proposal gave the public 45 days to comment, an unusually short window relative to other proposals of this significance and complexity, and the rule is written to take effect at the start of the 2027 fiscal year on October 1, 2026.
The administration says that the measures are necessary to improve “transparency, accountability, and oversight” for how federal grants are awarded, and to prevent “wasteful spending” and “misuse or mismanagement of federal funds.” The document points to spending during the Biden presidency, when the Trump administration claims federal awards were often used to promote a “woke” policy agenda. The proposed changes to the grant-making process come on the heels of sharp cuts to the NIH budget, workforce and existing grants since President Trump took office in January 2025.
Scientists, public health researchers and clinicians have expressed alarm about the dismantling of a grant-making process designed for the slow, long-horizon work of scientific questions that may not fit a specific political agenda. “In science, we are planning for the patients we will be treating in 10 or 15 years, but politics operates in two- and four-year cycles,” said Dr. R. Sean Morrison, Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai Health System in New York. “The treatments that will benefit my future patients require research that has to start now, and it can’t be subject to the whims of whoever is in office.”
“The treatments that will benefit my future patients require research that has to start now, and it can’t be subject to the whims of whoever is in office.”
The proposal has three teeth. First, political appointees will have the ability to override scientific peer review scores for proposed research using their own “independent judgment,” based on a number of broad criteria. Appointees are instructed to prioritize awards that “demonstrably advance the President’s policy priorities,” while vetoing research awards that may be used to “fund, promote, encourage, subsidize or facilitate” any of the following: DEI policies or practices, “gender ideology,” or any other initiatives that “promote anti-American values.” Second, existing grants can be ended at will, at the agency’s discretion. And third, new limits would restrict international collaboration, conference travel and even federal support for publishing results.
The United States has built the world’s most respected scientific research enterprise on the idea that federal dollars should fund the best science, as determined by independent experts in a competitive and transparent process. Scientists warn that the administration’s proposals put these decisions into inexperienced hands. Scientific peer review is considered the gold standard for these decisions because reviewers understand the underlying science and have developed expertise in designing research studies of their own. A grant application in molecular neuroscience to advance our understanding of diseases such as Alzheimer’s or Parkinsons is unreadable to anyone without years in the field. Judging whether a study’s methods are sound, its aims plausible and its budget honest is specialist work.
“No political appointee, regardless of their qualifications, can replicate that judgment.”
“The merit review system is a carefully constructed, legally and scientifically defensible process through which thousands of the nation’s best scientists evaluate the quality, innovation, and feasibility of proposed research,” wrote former NIH program officer Elizabeth Ginexi, in a public comment responding to the proposals. “No political appointee, regardless of their qualifications, can replicate that judgment.”
Researchers acknowledge that the peer review system works imperfectly. It is slow and expensive, and reviewers are notoriously inconsistent, with frequent disagreements over whether a given proposal deserves funding. The system also typically leans conservative, rewarding safe, established names and institutions over risky or innovative work, and it has never been much good at catching fraud. But its faults are visible and can be corrected by other means: scientists say that putting these decisions in the hands of political appointees is the wrong solution. As one researcher told the Aging Almanac, asking even our most earnest political appointees to approve or kill a neuroscience grant based on their “independent judgment” is akin to asking them to land a loaded jumbo jet. The instruments are unfamiliar, the stakes are other people’s lives, and good intentions are no substitute for attending flight school.
Expertise is only half the problem; the other half is incentive. A scientist’s standing rests on getting the science right, while a political appointee’s rests on pleasing the administration that hired them. Downgrading peer review to a mere advisory process lets political appointees block grants that would normally be funded, and steer money toward projects that align with political priorities but would not survive the scrutiny of peer review. This is a concern under any administration —Democrat or Republican — as the political winds of change would direct the progress of scientific discovery.
One researcher who spoke to the Aging Almanac on condition of anonymity said that political appointees are already overriding peer review scores to block grants, before the new rules are codified. This researcher’s grant proposal -- to investigate the effect of health insurance decisions on patient outcomes — achieved a peer review score that in prior years would have virtually guaranteed funding, even when accounting for recent budget cuts and changes to accounting for multi-year grants. But the researcher was informed the study was unlikely to receive funding because the agency was deprioritizing studies on questions of “health policy.” The irony is hard to miss: an agency that exists to give policymakers the evidence to make good decisions refusing to study whether those decisions actually help patients. Ruling “health policy” off-limits does not take the politics out of science — it only guarantees that policy gets made without knowing what works.
Morrison points out that needed research is often politically unpalatable. When HIV/AIDS emerged in 1981, for example, it was concentrated in two groups with little political standing: gay men and injection drug users. While the Reagan administration’s response to the epidemic was lackluster, the NIH funded the research that identified the virus, produced the first drug to treat it, and by the mid-1990s contributed the therapy that turned a near-certain death sentence into a condition that people can manage for decades. “The science may be politically inconvenient for an administration, but that’s why the NIH exists,” says Morrison. “Their role is to work on inconvenient questions, using the best possible science, so that based on that understanding, policy makers can make good policy decisions.”
Science is slow and deliberate, meaning that scientific discovery runs on longer timelines than any political administration’s policy priorities, and political interruptions to studies in-progress can be disastrous. A dementia study enrolls patients over the course of several years, follows them for more, and only yields its answer long after the officials who approved it have moved on. Under the current proposals, grants could be ended at the agency’s discretion, at will, with no appeal beyond the political appointee who signed the order. When funding is pulled without warning, the science suffers: patients scatter, staff leave, samples spoil, and the thread connecting one year’s data to the next is cut.
The impact of at-will funding termination can be wasteful even if it is later reversed on appeal. In late March 2025 the NIH cancelled a nearly $36 million study run by Charles DeCarli, director of the Alzheimer’s Disease Research Center at UC Davis, on the grounds that it served a “DEI” agenda. The title of the study was flagged because it included the word “diverse” to describe the study population: “The Clinical Significance of Incidental White Matter Lesions on MRI Amongst a Diverse Population with Cognitive Complaints.” Roughly $10 million of the grant was unspent. DeCarli had to start dismantling the study, spread across more than 30 sites with some 1,700 participants, while his lawyers wrote an eighteen-page appeal over three weeks. Clinical partners rang hundreds of patients to tell them the study was over. Then, on 11 April, the NIH reversed itself, and the same partners had to ring the same patients back to say it was on again. (1)
The disruption to the study wasted time and money in a pattern that was repeated all over the scientific community. Hundreds of other aging research grants were similarly frozen or terminated in the Spring of 2025, only to be later reinstated by appeal. The five largest such grants were worth a total of $265 million of dementia, diabetes and Medicare research, according to data from Grant Witness.
The abrupt termination of research grants is not only felt by scientists conducting trials, but by the patients participating in them. According to a study published in JAMA Internal Medicine, when the NIH stopped paying for 383 studies between late February and mid-August 2025, it cut off more than 74,000 people already enrolled in them. The studies included research into cancer, heart disease and brain disease, as well as work on infectious disease, flu, pneumonia, and covid. Some participants had signed up for studies that then stalled or never opened; others lost the drug they were taking, or were left with an implanted device and no one funded to monitor it. (2)
Patients and families will also suffer from researchers’ inability to ask questions that are politically unacceptable to the administration at that moment. For example, older Black Americans develop Alzheimer’s and other dementias at roughly twice the rate of older white Americans, a gap no one has fully explained. In February 2025 the National Institute of Aging funded a $13 million study to find out why, re-interviewing the participants of the National Survey of American Life, the only nationally representative sample of Black Americans’ mental health, two decades on. By April the grant was terminated as because it was not “aligned with agency priorities.” (3)
The fact that a person’s health is determined by their life circumstances has been well-established. Clinical care accounts for only about a fifth of what determines health outcomes across a population; the rest is socioeconomic, behavioural and environmental. The gap is large enough to map: federal life-expectancy data show a 25-year spread between neighbourhoods in New Orleans, and an 18-year spread across five miles in Dallas, for example. (4) Researchers sometimes say a person’s zip code predicts their health better than their genetic code. Understanding the root causes of these disparities is the precondition for changing it, but the proposed rules would treat that line of inquiry as a “DEI” agenda and screen it out. Public health analysts warn that preventing this research will leave these phenomena unexplained and unresolved, and the populations affected sicker and more expensive to treat.
Medical and health services research is often an international project, as scientists pool patients and expertise across borders to answer some of the hardest questions, including in aging. For example, one of the most revealing forms of Alzheimer’s disease is also among the rarest: inherited, early in onset, caused by a single faulty gene that runs in a few hundred families scattered across the world. No one country has enough people who carry the gene to study them, so for two decades the Dominantly Inherited Alzheimer Network (DIAN) has pooled them: more than 200 families at over 40 sites in 18 countries, tracked from before symptoms appear. The network has produced some of the field’s most important findings about how the disease begins.
The proposed rule’s limits on international collaboration would make projects like the DIAN harder to build and harder to run, isolating American science from the partnerships it depends on. The administration has already shown what that means in practice: when DIAN’s $13 million grant came up for renewal, the NIH rejected it, offered roughly $8 million in bridge funding instead, and cut off every dollar going to the network’s overseas sites. (5)
In addition to the uncertainty and instability of grant funding, new barriers to international collaboration, conference travel and publication of research findings would also threaten American science with a brain drain. Science runs on a supply of young researchers, and many are already making plans to leave American shores after last year’s cuts to funding. In a 2025 Nature poll of 1,600 scientists, 75 per cent said they were considering leaving the United States; among early-career researchers it was closer to 80 per cent. (6) The proposed new limits on conference travel and on publishing results would cut into the work a scientific career is built on. Other countries have noticed an opportunity: the European Union has put €500 million into a “Choose Europe for Science” program, (7) and academic institutions in Canada, France, Belgium, the Netherlands and Spain are all actively recruiting researchers from the United States.
Morrison points to workforce challenges in the field of geriatrics and palliative care in particular, at a time when America’s aging population is escalating demand for specialized care. “For the first time since these fields have existed, we have a very strong pipeline of early-stage scientists tackling problems that are really important to patients and families,” says Morrison. “If we derail those careers, I worry that we’re going to lose the next generation of scientists and, with them, the evidence we need to address pain and symptom management, goals of care, new models of community-based care, and delivery systems that actually work—the kinds of advances we’re already seeing in Europe.”
The administration presents the new rules as good housekeeping: more transparency, more accountability, less waste. Measured against that standard, it fails on each count. The proposal overrides peer review with a single appointee’s “independent judgment,” under which a grant can be killed for opaque political reasons. While the executive branch and Congress are empowered to establish broad research priorities -- that is what they are elected to do -- there are important questions that need to be asked and answered that may not fit the prevailing political agenda, but will help policy makers make better decisions for American lives.
On financial waste, the arithmetic is also unfavorable. The United States already spends 18 per cent of its GDP on its healthcare system — far more than any other country — in exchange for relatively poor outcomes. (8) Delaying or vetoing needed research will keep people sicker and our healthcare system yet more expensive. The Centers for Medicare and Medicaid Services project that by 2033 healthcare spending will outpace overall GDP growth, climbing to more than 20 per cent of the economy. (9) Meanwhile, healthcare research is among the most productive money the government spends: every dollar the NIH awards generates roughly $2.56 in economic activity, and that its grants supported some 390,000 jobs in 2025, according to United for Medical Research. (10) In the absence of the federal government, no one else is positioned to take up the mantle of research funding. Drug companies invest once a target looks profitable, not in the basic biology that finds the target to begin with; while philanthropy is a rounding error against a federal portfolio of more than $50 billion, and rarely pays for decades-long cohort studies, or the health-services research that tells Medicare what actually works.
American medical research has changed millions of lives for the better, says Nancy Said, a long-time caregiver for her father, who lives with multiple sclerosis. Ten years ago her father was facing the progression of his disease; but newer treatments, built on years of federally funded research, slowed it. He has stayed more independent, needed fewer medical interventions and, she points out, leaned less on Medicare than he otherwise would have. “The medical advances that slowed my father’s disease have likely saved substantial healthcare costs while improving his quality of life. Countless Americans with cancer, heart disease, Alzheimer’s disease, MS, and other conditions have benefited from federally supported research in similar ways,” she wrote in a public comment on the proposals. “Reducing the effectiveness of the research enterprise is penny wise and pound foolish.”
In next week’s Aging Almanac, we’ll return to our series on wellness for longevity to look at the effects of loneliness, and the evidence that social connection is a critical pillar of our well-being.
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