We had an important conversation today. Also, in case you missed it, you can also watch my interview with former USAID official Jeremy Konyndyk on the US response to Ebola and whether US policy is having a negative impact. (Spoiler: Yes.) That interview is over on MedPage Today.
The New England Journal of Medicine’s editorial board rarely writes as an entity. It also avoids politics, perhaps to a fault. If anything, the journal has been a little too accommodating to the Trump administration, publishing HHS officials’ viewpoints without adequate fact-checking.
So, today, NEJM did something important by releasing an editorial entitled, “The OMB and the Politicization of Science.”
The piece addresses a new rule, proposed by the Office of Management and Budget, that would, among other things, place all grant decisions in the hands of political appointees. From the top, NEJM’s editors invoked Trofim Lysenko, Stalin’s preferred scientist, whose disastrous views led to the deaths of millions in the Soviet Union. That was a strong statement.
Former NIH program official Dr. Elizabeth Ginexi joined me in The Doctors Lounge to discuss this. Dr. Ginexi has been outspoken on this and related topics. (You can find her Substack here.)
Above all, you can make a comment that the federal government must publish.
The landing page for the proposed rule is here. You can read the documents themselves and the >18,000 public comments posted so far.
And if you need a little help, Dr. Ginexi has some instructions and screenshots you can access on her Substack. (She also posted her own comment.)
About our guest expert…
Formerly an NIH Program Official for 22 years. A strategic research and innovation leader who helped build large-scale scientific programs at the intersection of emerging technology, ethics, and public impact.
Below is a summary of our conversation (aided by ChatGPT) with approximate corresponding time codes. Closed captions (㏄) for the video and a transcript option (📄) can be found beneath the video playback control bar above.
Dr. Ginexi’s background. (1:14–2:24):
Ginexi worked at NIH for 22 years as a scientific program official.
She said she left in 2025 after staffing cuts and what she described as increasing political interference in grantmaking.
She reported seeing lists of grants slated for cancellation and being encouraged to consider projects appealing to the MAHA movement, prompting her retirement and subsequent Substack writing.
What is the new OMB proposal? (2:24–12:50)
Ginexi argued that the proposal represents a major expansion of OMB authority:
OMB traditionally issues grant-management guidance and budget oversight.
She said the new proposal converts much of that guidance into regulation, potentially giving political leadership greater control over how agencies spend appropriated funds.
According to Ginexi, the rule would require political appointees to approve or reject grants that have already passed scientific review.
She characterized the proposal as an implementation of ideas associated with Project 2025 and Russell Vought.
Faust argued that OMB historically played a technocratic role rather than a policymaking one and described the proposal as an effort to exert direct political influence over scientific funding decisions.
NEJM editorial: “The OMB and the Politicization of Science.” (12:50–20:00)
Major themes discussed:
Lysenko analogy
The editorial reportedly opens by referencing Soviet agronomist Trofim Lysenko and the politicization of science in the Soviet Union.
Faust called this a striking and unusually forceful comparison.
Ginexi said the analogy is appropriate when scientific decisions become subordinate to ideology.
“Gold standard science”
The proposal repeatedly invokes “gold standard science.”
Ginexi’s criticism:
The term is undefined in the rule.
No objective criteria are provided.
She argued it could become a political rather than scientific standard.
Faust argued that political leaders often use the phrase without demonstrating scientific expertise sufficient to evaluate grant proposals.
Defense of peer review. (17:00–19:30)
Ginexi defended NIH peer review:
Grants are already subjected to extensive expert evaluation.
Study sections are designed to assess scientific rigor, feasibility, and significance.
She argued the current system has produced decades of biomedical advances and helped establish US leadership in science.
Faust emphasized:
US dominance in biomedical research.
High Nobel Prize output.
The role of NIH-supported science in national health and economic competitiveness.
Clinical trials and why interruptions matter. (20:00–25:00)
One of our most concrete discussions centered on clinical trials.
Ginexi explained:
Trials operate on tight timelines and recruitment schedules.
Interruptions can invalidate years of collected data.
Stopping a trial midway often wastes previous investments rather than saving future money.
Trial participants may face risks if treatments are interrupted unexpectedly.
Faust compared trial interruptions to shutting down a factory:
Restarting is far more difficult than simply flipping a switch.
Temporary pauses can permanently damage research programs and eliminate future benefits.
Foreign collaborations. (25:00–32:00)
Ginexi argued the proposal would substantially restrict international scientific partnerships.
Her concerns:
Collaborations with researchers in countries such as Canada, Australia, and the UK have historically been routine.
The proposed rule would require political approval before many foreign collaborations.
She questioned whether political appointees possess the expertise or capacity to evaluate such requests.
Additional points:
International collaborations help maintain ethical standards.
They improve transparency.
Rare-disease research often requires multinational participation because patient populations are small.
Faust argued that engagement with foreign researchers can increase oversight rather than reduce it.
Specific objections Ginexi submitted to OMB. (32:00–35:00)
Ginexi highlighted several provisions she opposes:
Elimination of binding peer review.
Grant termination based on vague “national interest” criteria.
Anti-DEI restrictions that could affect health-disparities research.
Restrictions on foreign collaborations.
Allowing grant competitions without public notice.
Denying grants based on organizational affiliations.
Organizational blacklists. (34:00–38:00)
Ginexi expressed concern that organizations or universities could become effectively ineligible for grants based on political considerations.
She compared the possibility to a modern version of McCarthy-era blacklisting and cited actions against universities such as Harvard University and Columbia University as examples of the broader trend she fears.
NIH governance and legality. (38:00–40:00)
Ginexi argued:
NIH was intentionally structured to keep scientific decisions largely insulated from politics.
Historically only a small number of NIH leadership positions were political appointments.
The proposed rule conflicts with the statutory framework governing NIH grantmaking.
Faust emphasized that bipartisan majorities in Congress have continued funding NIH despite administration proposals for major reductions.
What happens next? (40:00–44:00)
Ginexi outlined two primary avenues for opposition:
Congressional action
Congress could block the rule through a joint resolution.
She acknowledged that currently there is limited Republican leadership support for doing so.
Public comments
She urged viewers to submit comments during the federal comment period.
Her goal is to generate enough public participation to attract congressional attention.
She argued the rule affects not only NIH but also agencies such as the National Science Foundation and NASA, as well as potentially many non-science federal grant programs.
Please share your views in the comment section.
