February 14, 2025 • 31 mins
We've seen many health policy changes coming out of HHS in the past couples of weeks. It's honestly felt hard to keep up. So this week, Drs. Alicia and Stephanie Rolin do their best to summarize some of those changes & outline some potential impacts.
This is not intended to be medical advice, and the content is solely the responsibility of the authors and does not necessarily represent the official views of their employers or funders
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Episode Transcript
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(00:00):
Today is February 13th. It's 450 APM.
(00:09):
And the date and the minute matter because it feels like health policy changes are coming
so fast that we're getting whiplash.
I feel like by the end of this recording, it might be outdated. We might have a bunch
of notifications on our phone that, you know, everything that we've talked about has been
overhauled.
(00:29):
That is true, but probably not RFK Jr.'s appointment to lead HHS, which was confirmed today.
Robert Francis Kennedy Jr., I learned something, has officially been confirmed as Secretary
of the Department of Health and Human Services.
And that's starting today. But even before he's taken over, we have seen a lot of changes
(00:52):
at HHS already in the past couple weeks of this new administration.
A lot of changes, some of which have made our day to day jobs more difficult, some of
which has made everyday families lives more difficult, some of which have made health
care more difficult.
It's so true.
So today we're going to talk about how recent policies passed by the current administration
(01:16):
has led to some censoring of scientific and health information, how new departments of
the government that are reducing inefficiencies have maybe created some inefficiencies in
the government.
And we're going to talk about the concerns about undermining science and this spreading
of mistrust of health care professionals.
(01:36):
So let's get right to it.
One of the things that I've been really concerned about the past few weeks has been the CDC
website. So when we've taped episodes before, like our episodes about bird flu, we always
refer people to the CDC website where they can see the latest numbers.
But in the past few weeks, those numbers stopped being reported.
We've been seeing the effects of a communication pause, the words that have been used.
(02:02):
There's been a communication pause between the Department of Health and Human Services
and the general public.
And that means that places like the CDC are no longer updating their weekly reports about
outbreak numbers. And that includes bird flu, influenza in general, pertussis, norovirus,
(02:25):
all of these illnesses that you can get.
They're just not reporting how many people are sick or where they're sick.
This also includes the CDC's weekly publication called the Morbidity and Mortality Weekly Report.
The MMWR.
Historically, the MMWR has been published every single week without fail since the 1960s.
(02:48):
It is one of the most reputable and most used sources of data and it has nearly 150,000
electronic subscribers every week.
It has continued through government shutdowns.
This is a highly cited scientific journal that is released once a week and it reports
how many people are sick with certain diseases.
(03:10):
These are things like bird flu and tuberculosis.
These are illnesses that the government really wants to track closely to prevent large outbreaks.
That's right.
The government tracks them so they can put in preventative measures in advance to prevent
it from spreading more than it already is.
Like Alicia said, this is a highly regarded medical journal.
(03:32):
One of my proudest moments early in my career when I worked with the CDC was part of a team
that published an outbreak investigation in the MMWR.
On the basis of the executive orders and this communication pause, the MMWR was not released
for more than two consecutive weeks.
And when it was finally published, it was a truncated very short MMWR that included
(03:56):
only two brief reports on the health effects of wildfires in the setting of the wildfires
in LA, but there were no full reports included.
So not updating the numbers and also not publishing these investigations that are so needed for
public health decisions.
There were full reports on bird flu that had been prepped and that were ready for publication
(04:18):
in the MMWR and they were ultimately not included.
We know this because there was a technical glitch that resulted in a table from one of
the studies being published accidentally and then having to be taken down.
And these reports that were published and then taken down, they indicated that bird
flu is spreading more in the United States than we were aware of before.
(04:43):
And so there were some very specific and technical studies about how bird flu was spreading between
cats and dairy workers and some studies of veterinarians.
But overall, the takeaway message was that we should be worried about bird flu.
And the admission of these three full reports really raises concern about the extent of
(05:03):
the executive branch's power and their ability to censor scientific research.
The New England Journal of Medicine is one of the leading scientific journals and you
sent me a commentary that was published by three former editors of the MMWR who worked
for the CDC overseeing the MMWR for decades.
(05:24):
The commentary is called The Consequences of Silencing the Voice of the CDC and they
raise concern about, and this is a direct quote, the CDC's ability to disseminate scientific
data and analysis of public health information in a timely manner in the setting of all of
these recent changes.
And I think that's powerful.
That's a powerful statement.
When you sent it to me, I really just sat with that for a moment.
(05:47):
And we're both people who have worked with the CDC before and it has been hard to see
them silenced in this way.
It's called a pause, but essentially we're not getting the public health information
that we need while there's a looming pandemic threat coming our way.
And it's not just the MMWR.
We've been seeing take down of a lot of websites.
(06:09):
If you are on a lot of the Health and Human Services websites and you're clicking links,
a lot of those links are broken and you get to like this page is not found.
I've been working on a grant that's due this week and in grant writing, I use so many of
these public websites to look at census data or to look at published studies.
(06:30):
And it feels like every other site that I go to disappears, is gone, is missing.
And it's made it really hard for me to do my job of accessing good scientific information.
Cases that were taken down secondary to a lot of the executive orders have included
clinical practice guidelines.
(06:52):
They've included data sets, they've included published studies, and they've covered a lot
of different areas ranging from HIV to pregnancy, transgender health care.
And not only is that affecting individuals causing research, it affects me every day
in the emergency department.
(07:12):
I use a lot of clinical guidelines given by the CDC that poof, all of a sudden disappeared.
It's so scary to think about all of these medical resources that millions of taxpayer
funded money has gone into developing so that we have a guide for what is the best science,
what is out there and they were just taken down.
(07:35):
And then before they came back, it seems like they've been edited.
So there's been some investigation throughout the internet, you can look up different studies,
different reports, but it seems like some of the language has been changed, some of
the information is missing.
And it's really unclear how much information remains missing and what information has been
modified.
(07:55):
But we've seen changes of things like the terms pregnant people have been changed to
pregnant women.
And it's just really unclear how much has changed, how much is still missing.
Links are definitely still broken.
This just feels like it's contributing to a censoring of scientific information.
Instead of allowing data and information to be available to the public, it's being changed,
(08:22):
edited, deleted in order to conform to policy.
It's affecting both of our lives in the way that we practice medicine, but it's also directly
affecting patients not only through how I'm able to prescribe medicines, but it's also
taking down a lot of websites that are intended for patients and families about different
(08:43):
diseases, about their care, about what's safe or not safe.
And these websites matter because when your family might be facing a new diagnosis, it's
easy to get on Dr. Google and look for it.
And there's so much scary information on the internet that is not evidence-based.
And these government websites matter because they've been a trusted source that you can
(09:06):
go to for the scientific facts so that you're not reading about apple cider vinegar as a
cure for cancer, but instead of getting the real data about what's happening.
We've talked on this podcast before about the importance of trusted sites and have referenced
the CDC website specifically with bird flu saying that this is the most trusted resource.
(09:27):
Because it's concerning, like is the CDC censoring information?
Is the CDC censoring science?
And is this a trusted reference?
And I don't know what the answer to that question is.
And I think that's what scares me most of all.
It's been a really hard time.
We both work for institutions that have changed the way that they practice medicine in response
(09:53):
to these evacutive orders, regardless of what is right in health care.
And it's been really hard to work for institutions that are restricting the ways that we can
practice.
Another place that we've seen changes in HHS even before RFK Jr. has come to power,
come to the leadership role, has been a whole discussion about inefficiencies.
(10:18):
Government inefficiencies.
So many government inefficiencies.
So many that we must have a new government department just to talk about inefficiencies,
also known as DOJ, or the Department of Governmental Efficiency.
President Trump, while speaking to reporters earlier this month, has claimed that DOJ has
(10:38):
already identified, quote, tens of billions of fraud, waste, and abuse.
But really, tens of billions?
So the numbers really don't add up.
Shocking.
And there is no documentation that they provided for any of this.
But the numbers that have come out through investigative journalism is about $6 billion,
(11:02):
not $500 billion.
There's a big difference between $6 billion and $500 billion.
And the majority of that $6 billion come from this new change to the National Institute
of Health.
So we really went into detail about the NIH and what they do in the second episode of
this podcast.
It funds a lot of biomedical research at institutions, universities, across the country, and internationally.
(11:28):
It's the largest funder of biomedical research in the world.
And research is expensive.
Research is complicated.
So for all of the research that you do, there's something called indirect costs.
So the direct cost of research is paying for the study.
It's paying for the people running the study.
It's paying the participants.
(11:50):
It's paying for specific equipment that you need to run that study.
But it's not paying for everything involved in that study.
For example, it's not paying for the office you might sit in, the electricity you need
in order to plug in your computer, the light bulbs that you have lights.
Do you want to sit in a chair?
(12:11):
Not included.
These are all known as indirect costs.
It's electricity to run all of your fancy scientific equipment.
It's electricity to run your very fancy special freezers that are preserving your samples.
It's the cost that it takes to keep the animals alive in your animal models.
It's the cost of the environmental service worker that's cleaning the lab.
(12:33):
There are so many costs involved in running a research project that are not directly involved
in the research.
Do you want toilet paper?
What's the cost?
This all gets calculated in what's called an indirect cost, an amount that the NIH adds
to a research grant.
(12:54):
There's an audit process through the NIH where they go to every institution.
They carefully calculate what those costs are across an institution.
For example, I don't do animal research, but my colleagues do.
All together, the costs of that are shared, that is the indirect cost rate, the IDC, that
(13:14):
they add on to a grant.
It averages across all institutions at about 30%.
One of the things that happened this week was DOGE, in an effort to reduce inefficiencies,
decided that they were just going to reduce the maximum IDC rate from what had previously
(13:34):
been audited and agreed upon with the NIH.
Whatever that number was, they were reducing it to 15%.
That is a huge change.
It sounds like a small change, but it is having huge repercussions.
It can have huge repercussions on research institutions.
They've claimed that these high indirect cost rates are an example of inefficiency, despite
(14:00):
the fact that the NIH has carefully audited and accounted for all of the costs.
They keep calling it administrative overhead, and it's not just money that institutions
are pocketing.
There is so much that money goes for, and that's why it's carefully accounted for.
This dramatic reduction to just across the board 15% sent shockwaves through the medical
(14:22):
research community, and consequences are already being felt.
For example, the University of Iowa temporarily blocked submissions of all new grants.
We're currently in a grant cycle.
Grants are all due this week, next week.
University of Iowa said no new grant submissions because they did not think that they would
be able to afford to continue research with all of the overhead costs that a grant requires
(14:46):
without being paid for it.
Other places like Columbia University has now instituted a hiring freeze.
They have restricted travel where all their researchers are not able to travel, whether
for research or conference purposes.
They are not allowed to purchase new equipment.
(15:06):
They're really reducing how researchers can use grants that they've already received.
And this is what DOJ claims is reducing inefficiencies.
They've saved the government $4 billion by reducing what they think is inefficient.
And this is really sad because this isn't just about biomedical researchers being harmed.
(15:28):
This is about the progress that comes from biomedical research.
And a person I think who can really speak to this is the architect of Project 2025 and
the new director of the Office of Management and Budget, a person who has advocated for
this indirect cost reduction is Russell Vogt, and he's the parent of a child with cystic
(15:54):
fibrosis.
Cystic fibrosis is a genetic illness that can lead to respiratory issues, many infections,
worsening lung function, and often leads to death.
It's a very sad illness that affects children.
There is a new medication on the market called Trikafta.
(16:15):
The Vogt family has been very vocal about how Trikafta has changed their daughter's
life and has significantly improved her life expectancy and her lung function.
And it was backed by a $2.9 million grant from the NIH.
Wow.
So these are the exact tweets.
Oh, yes.
Come with the receipts.
(16:36):
His wife, Mary Vogt, today's the day our little one starts hashtag Trikafta.
Beyond grateful for this miracle drug.
So then later says, quote, we're extremely grateful to live in a nation that leads the
way on medical innovation.
She said that in 2021.
And now in 2025, I don't know, we just got to do across the board cost reductions.
I mean, he's targeting the exact Institute that largely saved his daughter's life or
(17:00):
at least develop the cutting edge treatment that she's benefiting from.
As a researcher, I am so happy that this NIH funded work has created positive outcomes
in the world, like the advancements and the improvements that his daughter has experienced.
That is all I want with the work that I do.
As an NIH funded researcher, I'm also really concerned that he's advocating cutting my
(17:23):
budget by this amount, because the reality is these cuts have been called a double edged
sword.
They are going to reduce the amount of money that can actually go to research by taking
overhead out of the research budget now.
And so it is really going to limit what researchers like us are able to do and the treatments
that we're able to put forward in the future.
(17:45):
I am worried about medical advancements over the next four to 10 years.
If there is a stifling of research at the NIH, it's going to have long lasting impacts
and we will see less innovation, less progress, less cutting edge research if we can't fund
it.
But these are the inefficiencies, Alicia.
(18:07):
So the numbers that are adding up, let's go back to the numbers.
Do the math.
So investigative reporting has said that they've saved about $6 billion, $4 billion of which
come from the reduction of indirect costs.
The other $2 billion largely come from ending DEI, diversity programs, or climate change
programs.
(18:27):
And so whether that constitutes waste, fraud, and abuse, I think depends on what your definition
of waste, fraud, and abuse is.
I might have a different definition.
But those are the $6 billion that they've saved.
Those are the only receipts that we found.
And meanwhile, as they're claiming that these indirect cost rates are an example of administrative
bloat and inefficiencies, there's also been a complete halt at the NIH related to this
(18:53):
communication pause where grants can't even be reviewed.
Grants are reviewed in cycles by a large group of people.
All grants are peer reviewed and scored.
So the fun part of this is that a lower score is better.
So you want to be the lowest scored study.
The lowest scored study end up being funded.
(19:14):
And a large group of people review all the grants, then they meet together and they talk
about it, and then they decide officially the scores.
And they do this in cycles.
There's only a couple of weeks a year that these study sections are happening.
And this is one of those times.
So they have to convene all these scientists with different levels of expertise, get them
together, either in person or via Zoom, and really sit down and review these studies.
(19:38):
And it's hard to coordinate the schedules of this many busy scientists.
And these meetings have been canceled across the board with very little notice.
There are people who are scheduled for a meeting and look at a notice that morning saying study
sections canceled, no plans on when to be rescheduled.
And this is going to lead to a delay of funding of studies.
(20:00):
And this is an inefficiency that we should be worried about.
It's unclear if any of these reviews have happened since the new administration has
come on board.
I have not heard of any study sections happening.
It's possible that some have, but I've only heard of study section over and over and over
again being canceled.
And each of those is going to require so much time to reschedule.
(20:24):
And it's going to lead to a delay in the delivery of these funding dollars to the researchers
who need them in order to advance medicine.
So one of the things that RFK Jr. has proposed or has indicated that he would like to do
as the new officially confirmed Secretary of Health and Human Services is that he would
like senators to approve NIH studies before they get funding.
(20:49):
And so he has said during his confirmation hearing with the Senate Health, Education,
Labor, and Pensions Committee, quote, I will commit to you here today prior to approving
any study at NIH to allow you to approve the protocols and the researchers.
I would love input from this committee on any study that we do.
There are many ways that studies are flawed and you can correct those at the outset in
(21:12):
a lot of ways.
What does this even mean?
I mean, there are so many NIH grants.
I just think I've responded with like an open jaw when he said this.
I was like, do you understand what you were saying, sir?
I am not sure that he did.
I mean, Alicia, we're going to have senators review NIH grants.
(21:33):
If you just take this for what it is.
So he says there are many ways that studies are flawed and you can correct those at the
outset in a lot of ways.
I don't think that's a wrong statement.
If studies are flawed, you can correct them before the study starts.
Are the senators that have no background in statistical methods, in study design, and
biomedical research, are they the ones who are going to identify the flaws and be the
(21:53):
best ones to correct it?
Or is it going to be the peer reviewed scientists that are now not allowed to meet?
Are they going to be the ones to best identify what is a flawed study, what is not a flawed
study, and provide the best feedback?
I just feel like we should go with the scientists.
I'm going to go scientists on this one.
And if you just take it at face value, I don't think they understand how many grants the
(22:16):
NIH reviews a year.
But how many grants does the NIH review a year?
So the NIH, as we've said, is the largest biomedical funder in the world.
They have 27 institutes and centers.
So a lot.
And they fund nearly 60,000 grants a year.
Okay.
And that ranges from all sorts of things, cancer, infectious disease, human genomes,
(22:36):
some like weird cell that you've probably never heard of.
I mean, the senators are really going to need to learn a lot of science.
Lot of science.
I could not review...
I can review outside of my area.
Outside of my institute.
Even many things in my institute.
So they fund nearly 60,000 grants a year.
Let's just say an average 30% success rate of funding.
It's not like every single study that's applied is funded.
(23:00):
So if you just say, back in the envelope calculation, 60,000 grants, 30% success rate, maybe, I
don't know, 200,000 grants that they need to review a year.
Yep.
200,000 grants.
I'm with you.
Each grant, I don't know, 125 pages.
Yes.
The grant that I'm submitting this week is 125 pages.
It is my shortest grant yet.
(23:21):
My last one was 156 pages.
So that's 25 million pages a year.
That is so many pages.
There are 23 senators in the help committee.
So even if each study was only read by one, that's over a million pages per senator.
I don't even know how to respond to theater that they're going to read a million pages
(23:43):
of science, especially because when we're talking about NIH grants, we use half inch
margins and 11 point font.
So you can fit so much on one page.
And they are dense.
That is dense science.
I feel like these are going to be 23 year old staffers that are going to be tasked with
reviewing NIH grants on top of their other full time jobs.
(24:05):
So senators aren't getting a break from their other jobs in order to review a million new
pages, literally a million new pages on science.
How many pages of science?
A very, very, very dense science, very dense, very medical science about structuring studies,
about statistical methods, about how to power a study.
(24:29):
Things I'm not sure the majority of senators are really that well versed on.
Or I don't really think they should be that well versed on.
I don't think that is an important part of their job.
You know, I feel like we're just going to lead to a new indirect cost rate that's going
to be reimbursing senators for their time for reviewing these.
(24:51):
Talk about government inefficiencies.
So we're in this place where, you know, DOGE is just dramatically cutting costs at the
NIH, claiming that that's inefficient, but then they're not reviewing studies and letting
things go forward and are suggesting review methods that seem like they'd be way more
inefficient.
So like, who's inefficient now?
(25:11):
I'm worried about this massive delay in research.
If we're now pausing review by peer reviewed experts.
Let's call them what they are, experts.
So we're pausing reviews by experts, and then we're suggesting that non-experts need to
read a million extra pages a year.
I just can't even.
Like that could lead to massive delays in research, not only like changing science,
(25:36):
censoring science, what's going forward.
If the Senate is now deciding what we're funding, what we're not funding, what does that mean
for science?
Totally separate.
But on top of that, like, how are we going to fund anything and how long will it take
and how many delays are we going to have causing not only issues with delays in medical advancement,
delays in biomedical research, but also delays in things that people are relying on, salaries
(26:02):
on having a job.
And we're laughing about it because so much of this, I mean, what can you do but laugh?
Because the reality is that HHS is here in order to support the health of American families.
And we see that through the advances that have been made in cystic fibrosis care or
(26:23):
in care for sickle cell or certain types of pediatric cancers.
We have seen families be able to experience better health and better outcomes because
of the investment in HHS and at a time where all of a sudden information coming out of
HHS is being censored and new inefficiencies are being introduced into the way that science
(26:49):
has worked.
It's something that although I'm laughing, I want to cry.
We're seeing an all time high right now in physician mistrust.
We're seeing an all time high in science mistrust.
I spend a large portion of my day talking about vaccines with family.
It is a high of vaccine hesitancy.
(27:11):
And I'm worried about where we are right now with policy coming first and science coming
second.
And even before RFK Jr. takes power and leadership of HHS, the policy changes that we've seen
so far have really served to undermine science and to spread mistrust.
(27:32):
And it's a time where we really need science.
We've talked about the looming pandemic threat of bird flu.
We're currently at an all time high, a big surge of influenza A. We're also at a high
of pertussis or whooping cough, which is a vaccine preventable illness.
And yet we're seeing a really high number of cases.
(27:55):
And there's a tuberculosis outbreak in the Midwest.
There's just a lot of infectious diseases that are being transmitted right now that
I don't know how well we're tracking if the CDC isn't updating.
And we really need a science first attitude.
That's how we're going to help families and that's how we're going to save lives.
(28:16):
And it will be interesting to see how this evolves with a lot of the ongoing lawsuits.
A lot of the executive orders and policies have been temporary blocked, unblocked, reblocked,
unblocked.
So who knows?
I feel like it's minute by minute.
And parents, they need science they can trust.
And with these lawsuits, these executive orders, this whiplash that you're talking about, it's
(28:39):
hard to know where information is coming at you from.
And it's hard to know what sources are reliable when we're talking about censoring the most
reliable sources.
These have historically been our most reliable sources.
The government websites are no longer the first place that I go to to learn about what's
happening with bird flu.
And that's a scary, uncharted territory for me as a physician and as a parent.
(29:03):
That's an optimistic note to end on.
We're really seeing that science is being censored and undermined with policy coming
first.
That is also a very positive note to end on, Elise.
It has been a hard week to be a physician and a grant funded researcher.
I will say I've had moments that I felt really overwhelmed with the news that was coming
(29:28):
my way.
I would say it's been a hard six weeks.
Yeah, it's been a hard couple.
It's been hard.
It's been hard.
But we're committed to being here and trying to unpack this as it's all happening to us
at the same time.
We are the Rollin Forward podcast.
I'm Dr. Elisey Rollin.
I'm Dr. Stephanie Rollin.
(29:48):
We are on all the socials.
You can follow us.
You can like and subscribe.
You like our content, please share it with someone you know.
We really want to help people have access to science that they can trust.
And you can always shoot us an email at RollinForwardShow, R-O-L-I-N, forward show at gmail.com.
(30:10):
Let us know what you want us to talk about.
Let us know your thoughts.
Thanks for your time and we look forward to tuning in with you next week.
Do you know what's one of the craziest things I've heard?
Tell me.
Someone told me that on Epic.
(30:31):
I'm scared.
You can no longer access growth charts.
No, no, no, that can't be true.
Because growth charts are based on the WHO.
That's so stupid.
That's like really actually dumb.
So like 50th, 75th, 95th percentile.
I guess we're not part of the WHO anymore.
They come from the WHO.
And so because we're withdrawing from the WHO, we can't access growth charts anymore.
(30:53):
How are we going to know if kids are growing?
So there is a CDC growth chart, but they're not the standard in the MRI right now.
Oh my gosh.
Okay.
So much science.
It's like the stupidest thing.
It's so dumb.
It's so dumb.
Type, type, type, type, type, type, type, type, type, type.
Research.
Today is February 13th. It's 450 APM.
(00:09):
And the date and the minute matter because it feels like health policy changes are coming
so fast that we're getting whiplash.
I feel like by the end of this recording, it might be outdated. We might have a bunch
of notifications on our phone that, you know, everything that we've talked about has been
overhauled.
(00:29):
That is true, but probably not RFK Jr.'s appointment to lead HHS, which was confirmed today.
Robert Francis Kennedy Jr., I learned something, has officially been confirmed as Secretary
of the Department of Health and Human Services.
And that's starting today. But even before he's taken over, we have seen a lot of changes
(00:52):
at HHS already in the past couple weeks of this new administration.
A lot of changes, some of which have made our day to day jobs more difficult, some of
which has made everyday families lives more difficult, some of which have made health
care more difficult.
It's so true.
So today we're going to talk about how recent policies passed by the current administration
(01:16):
has led to some censoring of scientific and health information, how new departments of
the government that are reducing inefficiencies have maybe created some inefficiencies in
the government.
And we're going to talk about the concerns about undermining science and this spreading
of mistrust of health care professionals.
(01:36):
So let's get right to it.
One of the things that I've been really concerned about the past few weeks has been the CDC
website. So when we've taped episodes before, like our episodes about bird flu, we always
refer people to the CDC website where they can see the latest numbers.
But in the past few weeks, those numbers stopped being reported.
We've been seeing the effects of a communication pause, the words that have been used.
(02:02):
There's been a communication pause between the Department of Health and Human Services
and the general public.
And that means that places like the CDC are no longer updating their weekly reports about
outbreak numbers. And that includes bird flu, influenza in general, pertussis, norovirus,
(02:25):
all of these illnesses that you can get.
They're just not reporting how many people are sick or where they're sick.
This also includes the CDC's weekly publication called the Morbidity and Mortality Weekly Report.
The MMWR.
Historically, the MMWR has been published every single week without fail since the 1960s.
(02:48):
It is one of the most reputable and most used sources of data and it has nearly 150,000
electronic subscribers every week.
It has continued through government shutdowns.
This is a highly cited scientific journal that is released once a week and it reports
how many people are sick with certain diseases.
(03:10):
These are things like bird flu and tuberculosis.
These are illnesses that the government really wants to track closely to prevent large outbreaks.
That's right.
The government tracks them so they can put in preventative measures in advance to prevent
it from spreading more than it already is.
Like Alicia said, this is a highly regarded medical journal.
(03:32):
One of my proudest moments early in my career when I worked with the CDC was part of a team
that published an outbreak investigation in the MMWR.
On the basis of the executive orders and this communication pause, the MMWR was not released
for more than two consecutive weeks.
And when it was finally published, it was a truncated very short MMWR that included
(03:56):
only two brief reports on the health effects of wildfires in the setting of the wildfires
in LA, but there were no full reports included.
So not updating the numbers and also not publishing these investigations that are so needed for
public health decisions.
There were full reports on bird flu that had been prepped and that were ready for publication
(04:18):
in the MMWR and they were ultimately not included.
We know this because there was a technical glitch that resulted in a table from one of
the studies being published accidentally and then having to be taken down.
And these reports that were published and then taken down, they indicated that bird
flu is spreading more in the United States than we were aware of before.
(04:43):
And so there were some very specific and technical studies about how bird flu was spreading between
cats and dairy workers and some studies of veterinarians.
But overall, the takeaway message was that we should be worried about bird flu.
And the admission of these three full reports really raises concern about the extent of
(05:03):
the executive branch's power and their ability to censor scientific research.
The New England Journal of Medicine is one of the leading scientific journals and you
sent me a commentary that was published by three former editors of the MMWR who worked
for the CDC overseeing the MMWR for decades.
(05:24):
The commentary is called The Consequences of Silencing the Voice of the CDC and they
raise concern about, and this is a direct quote, the CDC's ability to disseminate scientific
data and analysis of public health information in a timely manner in the setting of all of
these recent changes.
And I think that's powerful.
That's a powerful statement.
When you sent it to me, I really just sat with that for a moment.
(05:47):
And we're both people who have worked with the CDC before and it has been hard to see
them silenced in this way.
It's called a pause, but essentially we're not getting the public health information
that we need while there's a looming pandemic threat coming our way.
And it's not just the MMWR.
We've been seeing take down of a lot of websites.
(06:09):
If you are on a lot of the Health and Human Services websites and you're clicking links,
a lot of those links are broken and you get to like this page is not found.
I've been working on a grant that's due this week and in grant writing, I use so many of
these public websites to look at census data or to look at published studies.
(06:30):
And it feels like every other site that I go to disappears, is gone, is missing.
And it's made it really hard for me to do my job of accessing good scientific information.
Cases that were taken down secondary to a lot of the executive orders have included
clinical practice guidelines.
(06:52):
They've included data sets, they've included published studies, and they've covered a lot
of different areas ranging from HIV to pregnancy, transgender health care.
And not only is that affecting individuals causing research, it affects me every day
in the emergency department.
(07:12):
I use a lot of clinical guidelines given by the CDC that poof, all of a sudden disappeared.
It's so scary to think about all of these medical resources that millions of taxpayer
funded money has gone into developing so that we have a guide for what is the best science,
what is out there and they were just taken down.
(07:35):
And then before they came back, it seems like they've been edited.
So there's been some investigation throughout the internet, you can look up different studies,
different reports, but it seems like some of the language has been changed, some of
the information is missing.
And it's really unclear how much information remains missing and what information has been
modified.
(07:55):
But we've seen changes of things like the terms pregnant people have been changed to
pregnant women.
And it's just really unclear how much has changed, how much is still missing.
Links are definitely still broken.
This just feels like it's contributing to a censoring of scientific information.
Instead of allowing data and information to be available to the public, it's being changed,
(08:22):
edited, deleted in order to conform to policy.
It's affecting both of our lives in the way that we practice medicine, but it's also directly
affecting patients not only through how I'm able to prescribe medicines, but it's also
taking down a lot of websites that are intended for patients and families about different
(08:43):
diseases, about their care, about what's safe or not safe.
And these websites matter because when your family might be facing a new diagnosis, it's
easy to get on Dr. Google and look for it.
And there's so much scary information on the internet that is not evidence-based.
And these government websites matter because they've been a trusted source that you can
(09:06):
go to for the scientific facts so that you're not reading about apple cider vinegar as a
cure for cancer, but instead of getting the real data about what's happening.
We've talked on this podcast before about the importance of trusted sites and have referenced
the CDC website specifically with bird flu saying that this is the most trusted resource.
(09:27):
Because it's concerning, like is the CDC censoring information?
Is the CDC censoring science?
And is this a trusted reference?
And I don't know what the answer to that question is.
And I think that's what scares me most of all.
It's been a really hard time.
We both work for institutions that have changed the way that they practice medicine in response
(09:53):
to these evacutive orders, regardless of what is right in health care.
And it's been really hard to work for institutions that are restricting the ways that we can
practice.
Another place that we've seen changes in HHS even before RFK Jr. has come to power,
come to the leadership role, has been a whole discussion about inefficiencies.
(10:18):
Government inefficiencies.
So many government inefficiencies.
So many that we must have a new government department just to talk about inefficiencies,
also known as DOJ, or the Department of Governmental Efficiency.
President Trump, while speaking to reporters earlier this month, has claimed that DOJ has
(10:38):
already identified, quote, tens of billions of fraud, waste, and abuse.
But really, tens of billions?
So the numbers really don't add up.
Shocking.
And there is no documentation that they provided for any of this.
But the numbers that have come out through investigative journalism is about $6 billion,
(11:02):
not $500 billion.
There's a big difference between $6 billion and $500 billion.
And the majority of that $6 billion come from this new change to the National Institute
of Health.
So we really went into detail about the NIH and what they do in the second episode of
this podcast.
It funds a lot of biomedical research at institutions, universities, across the country, and internationally.
(11:28):
It's the largest funder of biomedical research in the world.
And research is expensive.
Research is complicated.
So for all of the research that you do, there's something called indirect costs.
So the direct cost of research is paying for the study.
It's paying for the people running the study.
It's paying the participants.
(11:50):
It's paying for specific equipment that you need to run that study.
But it's not paying for everything involved in that study.
For example, it's not paying for the office you might sit in, the electricity you need
in order to plug in your computer, the light bulbs that you have lights.
Do you want to sit in a chair?
(12:11):
Not included.
These are all known as indirect costs.
It's electricity to run all of your fancy scientific equipment.
It's electricity to run your very fancy special freezers that are preserving your samples.
It's the cost that it takes to keep the animals alive in your animal models.
It's the cost of the environmental service worker that's cleaning the lab.
(12:33):
There are so many costs involved in running a research project that are not directly involved
in the research.
Do you want toilet paper?
What's the cost?
This all gets calculated in what's called an indirect cost, an amount that the NIH adds
to a research grant.
(12:54):
There's an audit process through the NIH where they go to every institution.
They carefully calculate what those costs are across an institution.
For example, I don't do animal research, but my colleagues do.
All together, the costs of that are shared, that is the indirect cost rate, the IDC, that
(13:14):
they add on to a grant.
It averages across all institutions at about 30%.
One of the things that happened this week was DOGE, in an effort to reduce inefficiencies,
decided that they were just going to reduce the maximum IDC rate from what had previously
(13:34):
been audited and agreed upon with the NIH.
Whatever that number was, they were reducing it to 15%.
That is a huge change.
It sounds like a small change, but it is having huge repercussions.
It can have huge repercussions on research institutions.
They've claimed that these high indirect cost rates are an example of inefficiency, despite
(14:00):
the fact that the NIH has carefully audited and accounted for all of the costs.
They keep calling it administrative overhead, and it's not just money that institutions
are pocketing.
There is so much that money goes for, and that's why it's carefully accounted for.
This dramatic reduction to just across the board 15% sent shockwaves through the medical
(14:22):
research community, and consequences are already being felt.
For example, the University of Iowa temporarily blocked submissions of all new grants.
We're currently in a grant cycle.
Grants are all due this week, next week.
University of Iowa said no new grant submissions because they did not think that they would
be able to afford to continue research with all of the overhead costs that a grant requires
(14:46):
without being paid for it.
Other places like Columbia University has now instituted a hiring freeze.
They have restricted travel where all their researchers are not able to travel, whether
for research or conference purposes.
They are not allowed to purchase new equipment.
(15:06):
They're really reducing how researchers can use grants that they've already received.
And this is what DOJ claims is reducing inefficiencies.
They've saved the government $4 billion by reducing what they think is inefficient.
And this is really sad because this isn't just about biomedical researchers being harmed.
(15:28):
This is about the progress that comes from biomedical research.
And a person I think who can really speak to this is the architect of Project 2025 and
the new director of the Office of Management and Budget, a person who has advocated for
this indirect cost reduction is Russell Vogt, and he's the parent of a child with cystic
(15:54):
fibrosis.
Cystic fibrosis is a genetic illness that can lead to respiratory issues, many infections,
worsening lung function, and often leads to death.
It's a very sad illness that affects children.
There is a new medication on the market called Trikafta.
(16:15):
The Vogt family has been very vocal about how Trikafta has changed their daughter's
life and has significantly improved her life expectancy and her lung function.
And it was backed by a $2.9 million grant from the NIH.
Wow.
So these are the exact tweets.
Oh, yes.
Come with the receipts.
(16:36):
His wife, Mary Vogt, today's the day our little one starts hashtag Trikafta.
Beyond grateful for this miracle drug.
So then later says, quote, we're extremely grateful to live in a nation that leads the
way on medical innovation.
She said that in 2021.
And now in 2025, I don't know, we just got to do across the board cost reductions.
I mean, he's targeting the exact Institute that largely saved his daughter's life or
(17:00):
at least develop the cutting edge treatment that she's benefiting from.
As a researcher, I am so happy that this NIH funded work has created positive outcomes
in the world, like the advancements and the improvements that his daughter has experienced.
That is all I want with the work that I do.
As an NIH funded researcher, I'm also really concerned that he's advocating cutting my
(17:23):
budget by this amount, because the reality is these cuts have been called a double edged
sword.
They are going to reduce the amount of money that can actually go to research by taking
overhead out of the research budget now.
And so it is really going to limit what researchers like us are able to do and the treatments
that we're able to put forward in the future.
(17:45):
I am worried about medical advancements over the next four to 10 years.
If there is a stifling of research at the NIH, it's going to have long lasting impacts
and we will see less innovation, less progress, less cutting edge research if we can't fund
it.
But these are the inefficiencies, Alicia.
(18:07):
So the numbers that are adding up, let's go back to the numbers.
Do the math.
So investigative reporting has said that they've saved about $6 billion, $4 billion of which
come from the reduction of indirect costs.
The other $2 billion largely come from ending DEI, diversity programs, or climate change
programs.
(18:27):
And so whether that constitutes waste, fraud, and abuse, I think depends on what your definition
of waste, fraud, and abuse is.
I might have a different definition.
But those are the $6 billion that they've saved.
Those are the only receipts that we found.
And meanwhile, as they're claiming that these indirect cost rates are an example of administrative
bloat and inefficiencies, there's also been a complete halt at the NIH related to this
(18:53):
communication pause where grants can't even be reviewed.
Grants are reviewed in cycles by a large group of people.
All grants are peer reviewed and scored.
So the fun part of this is that a lower score is better.
So you want to be the lowest scored study.
The lowest scored study end up being funded.
(19:14):
And a large group of people review all the grants, then they meet together and they talk
about it, and then they decide officially the scores.
And they do this in cycles.
There's only a couple of weeks a year that these study sections are happening.
And this is one of those times.
So they have to convene all these scientists with different levels of expertise, get them
together, either in person or via Zoom, and really sit down and review these studies.
(19:38):
And it's hard to coordinate the schedules of this many busy scientists.
And these meetings have been canceled across the board with very little notice.
There are people who are scheduled for a meeting and look at a notice that morning saying study
sections canceled, no plans on when to be rescheduled.
And this is going to lead to a delay of funding of studies.
(20:00):
And this is an inefficiency that we should be worried about.
It's unclear if any of these reviews have happened since the new administration has
come on board.
I have not heard of any study sections happening.
It's possible that some have, but I've only heard of study section over and over and over
again being canceled.
And each of those is going to require so much time to reschedule.
(20:24):
And it's going to lead to a delay in the delivery of these funding dollars to the researchers
who need them in order to advance medicine.
So one of the things that RFK Jr. has proposed or has indicated that he would like to do
as the new officially confirmed Secretary of Health and Human Services is that he would
like senators to approve NIH studies before they get funding.
(20:49):
And so he has said during his confirmation hearing with the Senate Health, Education,
Labor, and Pensions Committee, quote, I will commit to you here today prior to approving
any study at NIH to allow you to approve the protocols and the researchers.
I would love input from this committee on any study that we do.
There are many ways that studies are flawed and you can correct those at the outset in
(21:12):
a lot of ways.
What does this even mean?
I mean, there are so many NIH grants.
I just think I've responded with like an open jaw when he said this.
I was like, do you understand what you were saying, sir?
I am not sure that he did.
I mean, Alicia, we're going to have senators review NIH grants.
(21:33):
If you just take this for what it is.
So he says there are many ways that studies are flawed and you can correct those at the
outset in a lot of ways.
I don't think that's a wrong statement.
If studies are flawed, you can correct them before the study starts.
Are the senators that have no background in statistical methods, in study design, and
biomedical research, are they the ones who are going to identify the flaws and be the
(21:53):
best ones to correct it?
Or is it going to be the peer reviewed scientists that are now not allowed to meet?
Are they going to be the ones to best identify what is a flawed study, what is not a flawed
study, and provide the best feedback?
I just feel like we should go with the scientists.
I'm going to go scientists on this one.
And if you just take it at face value, I don't think they understand how many grants the
(22:16):
NIH reviews a year.
But how many grants does the NIH review a year?
So the NIH, as we've said, is the largest biomedical funder in the world.
They have 27 institutes and centers.
So a lot.
And they fund nearly 60,000 grants a year.
Okay.
And that ranges from all sorts of things, cancer, infectious disease, human genomes,
(22:36):
some like weird cell that you've probably never heard of.
I mean, the senators are really going to need to learn a lot of science.
Lot of science.
I could not review...
I can review outside of my area.
Outside of my institute.
Even many things in my institute.
So they fund nearly 60,000 grants a year.
Let's just say an average 30% success rate of funding.
It's not like every single study that's applied is funded.
(23:00):
So if you just say, back in the envelope calculation, 60,000 grants, 30% success rate, maybe, I
don't know, 200,000 grants that they need to review a year.
Yep.
200,000 grants.
I'm with you.
Each grant, I don't know, 125 pages.
Yes.
The grant that I'm submitting this week is 125 pages.
It is my shortest grant yet.
(23:21):
My last one was 156 pages.
So that's 25 million pages a year.
That is so many pages.
There are 23 senators in the help committee.
So even if each study was only read by one, that's over a million pages per senator.
I don't even know how to respond to theater that they're going to read a million pages
(23:43):
of science, especially because when we're talking about NIH grants, we use half inch
margins and 11 point font.
So you can fit so much on one page.
And they are dense.
That is dense science.
I feel like these are going to be 23 year old staffers that are going to be tasked with
reviewing NIH grants on top of their other full time jobs.
(24:05):
So senators aren't getting a break from their other jobs in order to review a million new
pages, literally a million new pages on science.
How many pages of science?
A very, very, very dense science, very dense, very medical science about structuring studies,
about statistical methods, about how to power a study.
(24:29):
Things I'm not sure the majority of senators are really that well versed on.
Or I don't really think they should be that well versed on.
I don't think that is an important part of their job.
You know, I feel like we're just going to lead to a new indirect cost rate that's going
to be reimbursing senators for their time for reviewing these.
(24:51):
Talk about government inefficiencies.
So we're in this place where, you know, DOGE is just dramatically cutting costs at the
NIH, claiming that that's inefficient, but then they're not reviewing studies and letting
things go forward and are suggesting review methods that seem like they'd be way more
inefficient.
So like, who's inefficient now?
(25:11):
I'm worried about this massive delay in research.
If we're now pausing review by peer reviewed experts.
Let's call them what they are, experts.
So we're pausing reviews by experts, and then we're suggesting that non-experts need to
read a million extra pages a year.
I just can't even.
Like that could lead to massive delays in research, not only like changing science,
(25:36):
censoring science, what's going forward.
If the Senate is now deciding what we're funding, what we're not funding, what does that mean
for science?
Totally separate.
But on top of that, like, how are we going to fund anything and how long will it take
and how many delays are we going to have causing not only issues with delays in medical advancement,
delays in biomedical research, but also delays in things that people are relying on, salaries
(26:02):
on having a job.
And we're laughing about it because so much of this, I mean, what can you do but laugh?
Because the reality is that HHS is here in order to support the health of American families.
And we see that through the advances that have been made in cystic fibrosis care or
(26:23):
in care for sickle cell or certain types of pediatric cancers.
We have seen families be able to experience better health and better outcomes because
of the investment in HHS and at a time where all of a sudden information coming out of
HHS is being censored and new inefficiencies are being introduced into the way that science
(26:49):
has worked.
It's something that although I'm laughing, I want to cry.
We're seeing an all time high right now in physician mistrust.
We're seeing an all time high in science mistrust.
I spend a large portion of my day talking about vaccines with family.
It is a high of vaccine hesitancy.
(27:11):
And I'm worried about where we are right now with policy coming first and science coming
second.
And even before RFK Jr. takes power and leadership of HHS, the policy changes that we've seen
so far have really served to undermine science and to spread mistrust.
(27:32):
And it's a time where we really need science.
We've talked about the looming pandemic threat of bird flu.
We're currently at an all time high, a big surge of influenza A. We're also at a high
of pertussis or whooping cough, which is a vaccine preventable illness.
And yet we're seeing a really high number of cases.
(27:55):
And there's a tuberculosis outbreak in the Midwest.
There's just a lot of infectious diseases that are being transmitted right now that
I don't know how well we're tracking if the CDC isn't updating.
And we really need a science first attitude.
That's how we're going to help families and that's how we're going to save lives.
(28:16):
And it will be interesting to see how this evolves with a lot of the ongoing lawsuits.
A lot of the executive orders and policies have been temporary blocked, unblocked, reblocked,
unblocked.
So who knows?
I feel like it's minute by minute.
And parents, they need science they can trust.
And with these lawsuits, these executive orders, this whiplash that you're talking about, it's
(28:39):
hard to know where information is coming at you from.
And it's hard to know what sources are reliable when we're talking about censoring the most
reliable sources.
These have historically been our most reliable sources.
The government websites are no longer the first place that I go to to learn about what's
happening with bird flu.
And that's a scary, uncharted territory for me as a physician and as a parent.
(29:03):
That's an optimistic note to end on.
We're really seeing that science is being censored and undermined with policy coming
first.
That is also a very positive note to end on, Elise.
It has been a hard week to be a physician and a grant funded researcher.
I will say I've had moments that I felt really overwhelmed with the news that was coming
(29:28):
my way.
I would say it's been a hard six weeks.
Yeah, it's been a hard couple.
It's been hard.
It's been hard.
But we're committed to being here and trying to unpack this as it's all happening to us
at the same time.
We are the Rollin Forward podcast.
I'm Dr. Elisey Rollin.
I'm Dr. Stephanie Rollin.
(29:48):
We are on all the socials.
You can follow us.
You can like and subscribe.
You like our content, please share it with someone you know.
We really want to help people have access to science that they can trust.
And you can always shoot us an email at RollinForwardShow, R-O-L-I-N, forward show at gmail.com.
(30:10):
Let us know what you want us to talk about.
Let us know your thoughts.
Thanks for your time and we look forward to tuning in with you next week.
Do you know what's one of the craziest things I've heard?
Tell me.
Someone told me that on Epic.
(30:31):
I'm scared.
You can no longer access growth charts.
No, no, no, that can't be true.
Because growth charts are based on the WHO.
That's so stupid.
That's like really actually dumb.
So like 50th, 75th, 95th percentile.
I guess we're not part of the WHO anymore.
They come from the WHO.
And so because we're withdrawing from the WHO, we can't access growth charts anymore.
(30:53):
How are we going to know if kids are growing?
So there is a CDC growth chart, but they're not the standard in the MRI right now.
Oh my gosh.
Okay.
So much science.
It's like the stupidest thing.
It's so dumb.
It's so dumb.
Type, type, type, type, type, type, type, type, type, type.
Research.
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