Austerity at What Cost? NIH Cuts Could Jeopardize Children’s Lives
Vidya Chidambaran MD, MS, Rita Agarwal MD, FAAP, FASA, Myron Yaster MD
Donald Trump and the Republican party won sweeping victories in fair and square eclections last October. As we and the rest of the world are learning elections have very real consequences. We are only beginning to see how devastating the new policies that are unfolding are having on world politics and the American health care system. In today’s PAAD, I asked Dr. Vidya Chidambaran, the Director of Perioperative Pain Management and Professor of Anesthesia at Cincinnati Children’s Hospital and a frequent contributor to the PAAD to briefly describe how the cuts taking place at the the National Institute of Health are affecting the future of pediatric research and health. Over the next few weeks I will be posting more information in the PAAD about how these cuts at NIH as well as cuts at the Centers for Disease Control will affect you in your every day practice and lives. Myron Yaster MD
"Investment in knowledge pays the best interest." – Benjamin Franklin
For over 130 years, the National Institutes of Health (NIH) has been the driving force behind life-saving medical breakthroughs—fueling cancer therapies, deep brain stimulation for Parkinsonism, and combating the opioid crisis with naloxone and buprenorphine. These investments have benefited every American family and transformed anesthesia and pain management through rigorous, unbiased research. Unlike industry-sponsored studies, NIH-backed research prioritizes scientific integrity over profit motives, ensuring advancements that directly benefit adult and pediatric patients. Moreover, NIH funding sustains the next generation of physician-scientists, securing the future of biomedical innovation.
The scale of NIH’s Impact is impressive - in 2022, NIH funded 50,000 grants supporting 300,000 scientists at 2,500 institutions across the U.S. NIH research contributed to 568,585 jobs and generated $96.84 billion in economic activity, with a return on investment of $2.64 per $1 spent[VC1] . Needless to say the benefits are far reaching and across political divides.
Pediatric research alone receives $5.7 billion annually, driving critical studies in rare diseases and genomics. pmc.ncbi.nlm.nih.gov. Among key pediatric anesthesia/pain research investments, the HEAL KIDS Pain Program (2023) funds clinical trials for pediatric pain treatment (NIH HEAL). We personally know of many pediatric anesthesiologists and physician scientists including ourselves (VC, MY) who have benefited and been supported by NIH R01 and K23 grants enabling studies on post-surgical pain, genomics, the molecular basis of acute and chronic pain, opioid use, anesthesia effects on brain development, and pain disparities. Thus, NIH funding is the backbone supporting research at pediatric institutions. For example, in FY23, Cincinnati Children’s Hospital (CCHMC) secured $304.7 million in external research funding and 80% were from federal sources (CCHMC Science Blog).
A Dangerous Policy Shift: Slashing NIH Indirect Costs
Recent federal policy changes have capped NIH indirect cost reimbursements at 15%, a drastic cut from the previous 30-70% range (The Guardian). Indirect costs cover lab facilities, utilities, IT support, and administration—essential services enabling research. The administration claims this cut will redirect $4 billion annually toward direct research costs. However, this approach overlooks the reality that research cannot function without operational support. As an analogy, imagine a pediatric surgeon fully prepared to operate—but without nurses, sterile instruments, or a functioning OR due to budget cuts. NIH layoffs: On February 16, 2025, 1,165 NIH employees were laid off due to funding constraints (reuters.com). However, the effects don't stop there.
The Ripple Effect: Freezes, Layoffs, and Program Closures
To present an example again, the department of anesthesia at CCHMC aims to maintain at least 50% of said support from extramural funds. This amounted to around $3.3M in 2023, And also helps support the availability of non clinical time for academic anesthesiologists. As in many institutions, research is subsidized through clinical revenues and institutional support. With indirects being slashed by more than half, and Medicaid reimbursement challenges impacting most pediatric institutions, there is really no buffer to enable research support in anesthesia. When institutions face the double jeopardy of reimbursement cuts and NIH cuts, we can guess who will face the consequences:
· lack resources to sustain research infrastructure is expected to lead to hiring freezes, job losses, and reduced clinical trial capacity. Major pediatric centers like MD Anderson and Baylor College of Medicine have openly been discussing the severe financial strain this adds to their running expenses. (houstonchronicle.com
·As Mary Lasker famously said, “If you think research is expensive, try disease." The Cost of Inaction can especially negatively impact our patients. For example, pediatric pain will continue to be a Hidden Epidemic and research derailments will increase delays to reach the clinical arena. And yes, compare this to the cost of untreated pain which has a staggering economic burden of $19.5 billion annually (PubMed). Without federal funding, large-scale clinical trials, unbiased research, and technological advances in pediatric anesthesia will be severely compromised.
· The Financial Times highlighted on February 17, 2025, that such cuts could undermine critical healthcare research and deter young scientists from pursuing careers in the field. ft.com
A Glimpse at the Bigger Picture
This isn’t the first time shortsighted budget cuts have crippled progress. The early 2000s saw stagnation in HIV/AIDS research due to federal funding reductions, delaying vaccine development and draining expertise from the field (reuters.com). We are now seeing history repeat itself: NIH recently laid off 1,165 employees (6% of its workforce) as part of a broader cost-cutting reorganization (theguardian.com).
The global implications are just as concerning. The National Science Board projected in 2022 that China would outspend the U.S. on research and development by $200 billion annually by 2030. NIH’s budget represents a tiny fraction of U.S. government spending, yet these cuts will have devastating consequences for scientific leadership, pediatric healthcare, and the future of American medicine.
What Can Pediatric Anesthesiologists Do?
Protecting NIH funding isn’t about politics—it’s about the children we serve, the future of pediatric pain management, and the scientific progress that benefits all Americans. If we do not advocate for the preservation of pediatric anesthesia research, we risk losing an entire generation of breakthroughs that could transform children’s lives. The scientific community has expressed deep concern over these developments. Experts warn that reducing funding for indirect costs could severely disrupt ongoing research projects, delay clinical trials, and hinder future medical advancements. The Financial Times highlighted on February 17, 2025, that such cuts could undermine critical healthcare research and deter young scientists from pursuing careers in the field. ft.com
Action is critical. Legal challenges have also emerged in response to these funding cuts. A coalition of 22 states filed a lawsuit against the NIH, arguing that the abrupt reduction in indirect cost funding is "flagrantly unlawful" and jeopardizes essential research infrastructure. In response, a federal judge in Massachusetts temporarily blocked the cuts, as reported by The Guardian on February 11, 2025. theguardian.com
Pediatric anesthesiologists are uniquely positioned to fight for the future of pain research. If we remain silent, these cuts will not just impact research labs; they will affect the children who depend on us for innovative, effective, and compassionate pain management solutions. Advocacy efforts at institutional, state, and federal levels can help protect funding for pediatric research. Organizations like SPA, ASA, and USASP play vital roles in amplifying these concerns. Diversifying funding sources—including federal agencies like the Department of Defense (DOD), philanthropic foundations, and industry partnerships—can help mitigate risks, though conflicts of interest must be carefully managed.
Finally, a glimpse of hope lies in the Executive Order on Feb. 13, 2025, establishing the “Make America Healthy Again” Commission aims to restructure federal healthcare policies (White House). By highlighting the growing burden of childhood chronic disease, redirecting NIH funds to preventive solutions is definitely commendable but cost-cutting “efficiencies” impacting research is not a viable solution.
Send your thoughts and comments to Myron who will post in a Friday reader response.