New: Trump-controlled NIH begins targeted purge of LGBTQ+ research.

Citing "agency priorities," some grants were terminated on Friday, leaving researchers with uncertain futures.

Hi everyone, A colleague alerted me to some important news over the weekend that I haven’t seen written about elsewhere.

So, today’s Inside Medicine is dedicated entirely to that story and two scientists you’ll read about below who are bravely sharing their unfolding stories with all of us.

That means I didn’t get to other key stories I intended to update you on. A list and brief description of those topics can be found at the bottom of today’s newsletter.

Reminder: If you are employed by the government (or were recently let go) and you want to speak to me informally, please email me or find me on Signal at "InsideMedicine.88." I promise to maintain your confidentiality.

Let’s get to our main story…

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The first specific and targeted defunding of LGBTQ+ science under Trump has begun.

A grant termination notification received by NIH-funded researchers on Friday.

On Friday, University of Nevada, Las Vegas associate professor Dr. Jason Flatt received notification that two of his NIH-funded grants had been suddenly terminated. The grants had been active for years and supported dozens of researchers and support staff.

Across the country, over at Vanderbilt University, associate professor Dr. Tara McKay received a nearly identical notice, though the letter was signed by a different NIH staffer, also within the National Institute on Aging.

The scientific research that Drs. Flatt and McKay led “no longer effectuates agency priorities,” the letters said. “The NIH is obligated to carefully steward grant awards to ensure taxpayer dollars are used in ways that benefit the American people and improve their quality of life. Your project does not satisfy these criteria.”

The problem with their research? “Transgender issues: Research programs based on gender identity are often unscientific, have little identifiable return on investment, and do nothing to enhance the health of many Americans. Any such studies ignore, rather than seriously examine, biological realities.”

These Friday afternoon grant terminations, and probably others like them, appear to represent the first targeted attempts to defund specific research that offends the Trump administration’s oh-so-delicate sensibilities. Previous moves made by the Trump administration’s obsessive campaign to censor and silence specific views—what it calls “woke ideology”—were broader, including the banning of certain words and phrases from CDC and NIH websites and a pause on all federally funded grant research payouts (both of which were halted by legal challenges). These grant terminations, however, were intended to be surgical strikes, supposedly, albeit not convincingly, justified by “agency priorities.”

Is it legal to just randomly cancel an ongoing grant?

One of the disturbing features of the Trump administration’s attack on our nation’s public health and biomedical science assets has been its attempt to stop funding immediately, rather than adjusting priorities for future grants, which would at least allow people ample time to adjust their plans to stay afloat (or keep people from dying of malaria, polio, or HIV/AIDS). The scorched-earth approach favored by the Trump administration has created not only chaos but death.

The question here is different from previous battles over the future of US-led scientific progress, covering an array of issues ranging from indiscriminate terminations of HHS employees to halting USAID programs. Here, the NIH grant apparatus includes an existing specific termination clause that might permit such draconian moves “if an award no longer effectuates the program goals or agency priorities.”

Indeed, while NIH-funding recipients aren’t exactly in positions to negotiate such clauses when receiving highly coveted awards, that’s not the end of it. Whoever wrote the termination notices that Drs. Flatt and McKay received—and we’ll get to him later—felt compelled to specifically spell out that “transgender issues” were the reason that their work would no longer be funded. In other words, the author of the grant termination notices knew that the sudden shifts had to be justified.

And yet, even a trivial analysis would conclude that the writer failed in his mission (yes, it’s a he). It’s entirely unclear how work that studied LGBTQ+ populations would necessarily fail to reflect the priorities of the National Institute on Aging, nor was any specific argument even attempted. It was simply stated without any real support.

In the notices Dr. Flatt and Dr. McKay received, the NIH informed them that their studies “are incompatible with agency priorities, and no modification of the project could align them with agency priorities.” Importantly, this was the written justification for terminating these grants, rather than suspending them (which is “generally” what the NIH does when considering what it calls “corrective actions”).

And yet, it took me approximately five seconds to come up with an argument that falsifies that naïve contention. To be clear, no modifications are actually needed. Even if one were to believe that understanding the reasons behind aging-related health disparities among LGBTQ+ populations is not a worthy goal unto itself—a point that no serious scientist would concede—it seems to me that all that would be needed to “save the grant” would be the most superficial clarification of how epidemiological research works. Specifically, understanding why aging LGBTQ+ populations experience worse health outcomes will almost certainly help researchers understand factors that accelerate age-related illnesses for all people, regardless of their gender or sexuality. For example, one of Dr. McKay’s studies was an evaluation of social networks—which have been shown to have impressive effects on stroke (and other) outcomes in the general population; One of Dr. Flatt’s studies examined risk factors and protective factors for cognitive impairment (including Alzheimer’s disease and other forms of dementia)—the lessons of which would almost certainly provide insight for other populations.

Done and done.

While Dr. Flatt told me that he would appeal, he was clear that he would not abandon the people in his study. “There are transgender people in my studies. I am not comfortable erasing them. I am going to hold to the science and to the value of this work.”

And yet, as above, the rationale in the termination notices were so incredibly flimsy that he and other researchers in the Trump administration crosshairs may not even have to.

Who is really behind all of this?

While the two termination notices I saw were sent by NIH officials, the nearly identical verbiage suggests another “silent” author. And indeed, the metadata of the PDF notifications that both Drs. Flatt and McKay received indicated that the author of the letter was one “JoshuaAHanley.” A directory search did not find anyone by this or a similar name employed by the Department of Health and Human Services (though searches for the two women who ostensibly signed the PDF documents did; neither replied to my inquiry emails yesterday). There does, however, appear to be a Washington, D.C.-based lawyer named Joshua A. Hanley who, it bears mentioning, co-authored a Supreme Court amicus brief in January 2024 that levied a powerful defense of free speech, whether for people in favor of gun control or against it Because it is so on the nose, I am reproducing language from that brief here:

“And as different as those targets may be, the First Amendment protects each of them from government-compelled blacklisting based on their advocacy…. Most of the amici disagree with the NRA’s political positions. But free speech is bigger than political differences. The government may not coerce private entities to disassociate from speakers with whom the government disagrees.”

And yet, here is “JoshuaAHanley”—either the same one or a different one—informing researchers that the government intends to do exactly that (especially in the case of Dr. McKay, who works at a private institution).

Regardless, is the author of these notices a federal employee? A contractor? Just who is doing the bidding of Elon Musk, Project 2025, and, I guess, President Trump? It’s not obvious. There’s no transparency in DOGE.

What’s next and what’s at stake?

Both Dr. Flatt and Dr. McKay seemed dismayed but unsurprised by the grant terminations, but had not yet fully plotted their next moves. The NIH has an appeals process.

“I don’t know what I can do because they think my research does not reflect all Americans,” Dr. Flatt told me. (This standard, by the way, is an absurd one disconnected from reality. A great deal of research is done to understand problems or diseases that “only a few people” experience, and that exact fact drives a lack of interest in such issues within the private or for-profit research sector. Conversely, ideal use cases for government-funded studies include problems or diseases that don’t affect many people, as industry researchers don’t sense a downstream market for their work.)

Moreover, the NIH obviously felt otherwise right until Trump ideologues took over. One of Dr. Flatt’s grants received the highest-possible marks on its final review. “Twenty peer reviewers gave it a perfect score. So, they believed it had merit.”

UNLV told Dr. Flatt to appeal the decision. However, the university has not offered him any legal assistance yet. “I’m not sure I can afford that on my own.”

Meanwhile, the clock is ticking. The NIH pays UNLV, which in turn pays researchers like Dr. Flatt. How long the institution will keep the money flowing is unknown. “At some point, I have to lay off most of my team.” That can’t happen overnight, nor should it. “We have a process.”

Dr. Flatt knows he is not alone, but it’s early. “Most of this happened on Friday. So far, we are sharing experiences.”

Both Dr. Flatt and Dr. McKay are clear on what’s at stake.

“The scientific loss will be substantial,” Dr. McKay said. “Ultimately, this will widen disparities in evidence-based care recommendations for LGBTQ+ people.” The sudden pulling of funding also incensed Dr. McKay because she has been collecting data from study participants for years. Stopping now means that much of those efforts could be wasted. “Rare longitudinal health data [] cannot be recreated retrospectively.”The yanked funding would have a similar effect on Dr. Flatt’s studies.

“Terminating these projects now sends very concerning signals about the ongoing persecution and erasure of LGBTQ+ people in the US,” Dr. McKay said. It perpetuates the invisibility of LGBTQ+ older adults in public health initiatives and resource allocation, and it undermines efforts to address documented health disparities through targeted interventions.”

Nor are LGBTQ+ people the only ones who stand to lose from the termination of grants like these, Dr. Flatt pointed out. “If they are coming for LGBTQ+ people now, who is next?”

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Five other stories we’re following and will catch-up on soon…

Covering the story of Dr. Flatt and Dr. McKay was important and I’m sure you agree. Below are the five stories I was going to write about today but didn’t get to. I’ll provide more analysis of these stories in upcoming Inside Medicine issues.

• RFK Jr.’s half-hearted endorsement of measles vaccines, and his weird focus on vitamins.

• PubMed temporarily went down over the weekend. Nobody knows why, but it was something that had been feared. We don’t know if anything is missing.

• A readout on a massive slowdown in new NIH grants since President Trump took office.

• New estimates of excess deaths from HIV and tuberculosis that are anticipated to result from the sudden end of PEPFAR and USAID funding.

• Plus, we didn’t get a Supreme Court ruling on the USAID case over the weekend, so I’m expecting that as soon as today. We’ll be watching and waiting for news.

That’s all for now! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.

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