The calm before the chainsaw at HHS.
DOGE’s delay in cutting 10,000 HHS jobs provides a moment to take stock of what we’ve lost and what we are about to lose.
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Last week, the Trump administration announced that DOGE would terminate around 10,000 HHS employees, including thousands at the CDC, FDA, and NIH. The move stands to be the most sweeping attack on the US public health workforce in modern memory, and yet the details remain murky at best. Rumors have been flying about what will get cut, but little is certain. Among the dozens of HHS employees that I communicate with regularly, only one had any direct knowledge of what those cuts might entail—and even that individual would not say much.
Termination notices were expected Friday and over the weekend. Most never came. According to Politico, the delay stems from cronyism and infighting at DOGE. The reprieve offers an opportunity to review and scrutinize some of what we’ve lost and what more is at stake…
Indeed, the cuts that are coming to HHS are unlikely to be well-considered or thoughtful ones. The reason is that leaders at the agencies themselves have apparently had little say in any of this. Many of these leaders have ample experience so that if thoughtful but tough cuts had to be made (and let’s face it, this whole effing thing is optional), you’d want their considered input. And yet, Politico reported that when some terminations started to occur at the end of last week, “department heads and senior leadership were learning about expected layoffs from news reports.” That was not popular.
It should bother us that thousands of job cuts are being determined by shady DOGE operatives who have likely never darkened the doorways of most of our public health agencies. It’s also clear that nobody has taken the time to study carefully and seriously the difference between projects that are complementary (and that are necessary) and others that are truly redundant (and might actually be okay to cut or consolidate).
The harms of cuts are not always immediately apparent.
The problem, of course, is that the negative effects of job cuts and funding cuts are not immediately apparent. Former CDC Director Dr. Tom Frieden stated it well on LinkedIn: “It's hard for many people to see the importance of what CDC does because when it succeeds, there isn't an outbreak. Your neighbor doesn't overdose. Your cousin stops smoking or your child doesn't start. Your grandmother doesn't develop cancer. Cuts to this work would put us all at greater risk.”
Another way to say this is that if you cut funding for road upkeep, you feel smart on day one. No more spending, and everything seems to be holding up well. Over time, though, potholes start causing problems. Eventually, roads become unsafe. When we start discovering the potholes in our public health system, it won’t be pretty.
What we are about to lose, both logistically and philosophically.
Here is some of the fallout that we can expect as we continue to bear witness to the Trump administration’s reckless and short-sighted cuts.
Job losses and economic consequences everywhere. This dashboard by Dr. Joshua Weitz and his team at the University of Maryland shows the economic effects from just the proposed 15% NIH cap in “indirect research costs” in every US county. These figures will be far worse once updated to include terminated NIH grants, including cuts in research on everything from pandemic preparedness to cancer.
A brain drain. In a poll of US scientists conducted by Nature, 75% of respondents said they were considering leaving the country, including for Europe and Canada. I can add that in my own research, I have been particularly fortunate to have worked with several brilliant scientists from China who, trust me, we really want to stay here. Remember, America is great because we attract the best and brightest. Turning away from that is just about the least American thing I can imagine.
The politicization of science. Yes, science has always been political to some degree. But the idea that all NIH “calls for research” will now have to be cleared by DOGE is absolutely chilling, and an order of magnitude more political than what we’ve seen before. This alone may contribute to a brain drain, even if research funding cuts end up not being as deep as feared; scientists don’t want to be told by government stooges what topics are verboten.
Meanwhile, cronyism seems to be a growth industry in this administration. According to Politico, one of the reasons that the HHS cuts were delayed in the last few days is that the HHS DOGE lead, Brad Smith, was playing favorites. Apparently, Smith wanted to make deep cuts across HHS except at the Centers for Medicare and Medicaid Services (CMS), the agency where he just so happens to have previously worked. This was pretty interesting to me; one of my sources mentioned to me last month that CMS had conspicuously been the one agency whose staffers had been asking reasonable questions to stakeholders about how to make things better in the future. Now we can guess why: Gee, it’s almost as if people over at CMS thought they were immune from dreaded HHS cuts and, therefore, they could set out to investigate some changes and improvements that might actually make sense.
Research in progress flushed down the toilet. The idea that this administration does not want to fund certain science that it fears and that offends its snowflakey sensibilities is more than merely pathetic, but it’s also myopic and foolish. But as the Atlantic reported, among the most reckless moves the administration has made is suddenly cutting clinical trials that were already underway. This is literally the antithesis of efficiency (thanks, DOGE) because large amounts of money and other resources will have been spent, but we will not reap the scientific and medical benefits from the eventual results—to say nothing of the harm to patients who enrolled in these studies. Indeed, as Art Caplan and Lisa Kearns wrote in MedPage Today, “Who Will Volunteer for Clinical Trials Now?” Scientific and medical progress often relies on good clinical trials. These actions may undermine good science for a generation.
Compromising American safety. While we do not yet know the exact nature of the HHS cuts, CBS reported that deep cuts to NIOSH (the National Institute for Occupational Safety and Health) are anticipated. Meanwhile, Stat News reported that the Agency for Healthcare Research and Quality is likely to be cut by 80%–90%. AHRQ does a lot on a relatively small budget, including administering PSNet (whose shuttering was first reported here in Inside Medicine) and other projects like the National Healthcare Safety Dashboard, which monitors the government’s goal of reducing patient and healthcare workforce harms (like post-operative complications and workplace infections) by 50% by 2026. I must have missed the “Make America Less Safe Again” bumper stickers.
Reform is fine. Reckless destruction is not.
While HHS Secretary Robert F. Kennedy Jr. says that these cuts are designed to decrease redundancies and make things better, it’s hard to square that with the gleeful chainsaw massacre of valued public health assets like USAID and the sudden cessation of billions of dollars in NIH grants we’ve witnessed in the first two-plus months of this administration.
I agree with former FDA Commissioner Dr. Robert Califf (and Inside Medicine reader) who wrote on LinkedIn that he didn’t have a problem with the notion of reorganizing HHS, if it were done well. But that’s a big if, as he wrote…
“I'd wager that everyone who has worked in the HHS environment has thought about different org[anization] structures that would be more effective and efficient—so it deserves some time before judging. I hope this is carefully thought through and that employees will be treated with the respect they deserve and will be attuned to the ethics of patient care and research—major flaws in DOGE efforts so far that should be unacceptable to the public. If done poorly there will be real human suffering and death from something this big.” —Dr. Robert Califf.
While I appreciate Dr. Califf’s level-headed perspective, it is hard to see how what has been happening (and what is coming once the 10,000-employee cuts move ahead) is anything but a combination of retribution for prior Trump/Musk grievances and a voraciously anti-scientific bent. (Note: On March 28, the administration rescinded the Scientific Integrity Policy of the National Institutes of Health, which had four main goals: “Foster an organizational culture of scientific integrity; Protect the integrity of the research process; Communicate science with integrity, and; Safeguard scientific integrity.” Who needs any of that?!)
Is the US government too big? Maybe. I don’t know. That’s not my lane. But, if the federal government is too big, one thing is clear: HHS is not the problem, nor is DOGEing it and the science it supports the solution. Remember, to manage the American public health system and to advance and support all of our medical and scientific safety and progress, HHS currently has around 82,000 full-time employees. Meanwhile, the Department of Defense and Department of Veterans Affairs have around 1.2 million employees combined.
Misery loves company…
Since January, I have been describing the Trump administration’s various destructive actions—from its attempted obliteration of USAID to deep funding cuts to our research infrastructure—as a “war on US public health.” Yesterday, nearly 2,000 members of the National Academies of Sciences, Engineering, and Medicine published an open letter decrying the administration’s “wholesale assault on U.S. science.” I’m glad they agree with me.
Take a look at their well-written and important letter, and please share it.
TO THE AMERICAN PEOPLE
We all rely on science. Science gave us the smartphones in our pockets, the navigation systems in our cars, and life-saving medical care. We count on engineers when we drive across bridges and fly in airplanes. Businesses and farmers rely on science and engineering for product innovation, technological advances, and weather forecasting. Science helps humanity protect the planet and keeps pollutants and toxins out of our air, water, and food. For over 80 years, wise investments by the US government have built up the nation’s research enterprise, making it the envy of the world. Astoundingly, the Trump administration is destabilizing this enterprise by gutting funding for research, firing thousands of scientists, removing public access to scientific data, and pressuring researchers to alter or abandon their work on ideological grounds.The undersigned are elected members of the National Academies of Sciences, Engineering, and Medicine, representing some of the nation’s top scientists, engineers, and medical researchers. We are speaking out as individuals. We see real danger in this moment. We hold diverse political beliefs, but we are united as researchers in wanting to protect independent scientific inquiry. We are sending this SOS to sound a clear warning: the nation’s scientific enterprise is being decimated.The administration is slashing funding for scientific agencies, terminating grants to scientists, defunding their laboratories, and hampering international scientific collaboration. The funding cuts are forcing institutions to pause research (including studies of new disease treatments), dismiss faculty, and stop enrolling graduate students—the pipeline for the next generation’s scientists.The administration’s current investigations of more than 50 universities send a chilling message. Columbia University was recently notified that its federal funding would be withheld unless it adopted disciplinary policies and disabled an academic department targeted by the administration. Destabilizing dozens of universities will endanger higher education—and the research those institutions conduct.The quest for truth—the mission of science—requires that scientists freely explore new questions and report their findings honestly, independent of special interests. The administration is engaging in censorship, destroying this independence. It is using executive orders and financial threats to manipulate which studies are funded or published, how results are reported, and which data and research findings the public can access. The administration is blocking research on topics it finds objectionable, such as climate change, or that yields results it does not like, on topics ranging from vaccine safety to economic trends.A climate of fear has descended on the research community. Researchers, afraid of losing their funding or job security, are removing their names from publications, abandoning studies, and rewriting grant proposals and papers to remove scientifically accurate terms (such as “climate change”) that agencies are flagging as objectionable. Although some in the scientific community have protested vocally, most researchers, universities, research institutions, and professional organizations have kept silent to avoid antagonizing the administration and jeopardizing their funding.If our country’s research enterprise is dismantled, we will lose our scientific edge. Other countries will lead the development of novel disease treatments, clean energy sources, and the new technologies of the future. Their populations will be healthier, and their economies will surpass us in business, defense, intelligence gathering, and monitoring our planet’s health. The damage to our nation’s scientific enterprise could take decades to reverse.We call on the administration to cease its wholesale assault on U.S. science, and we urge the public to join this call. Share this statement with others, contact your representatives in Congress, and help your community understand what is at risk. The voice of science must not be silenced. We all benefit from science, and we all stand to lose if the nation’s research enterprise is destroyed. The views expressed here are our own and not those of the National Academies or our home institutions.
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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Thank you for this clear-eyed, comprehensive, and urgently needed post. You’ve laid out not only the scale of destruction being wrought on our public health and scientific institutions, but also the quiet, long-term damage that many may not recognize until it’s too late. This isn’t just mismanagement—it’s a wholesale assault on the foundations of evidence, safety, and progress. Posts like this help preserve both clarity and resolve in a time when both are badly needed.
They apparently were sent out late last night/early this morning, in some sort of sardonic April Fool's prank. FDA employees didn't find out, until this morning as they were denied entry into their offices, as their building access cards had been turned off. Rumors are that all across the CDC, emails have been received for people in Occupational Safety and Health, Birth Defects, Injury, Environmental Health, Global HIV and TB, Communications, and Immunization Policy.