By N. Adam Brown, MD, MBA

I recently wrote about the slow dismantling of the U.S. medical and scientific infrastructure. And just two weeks later, I'm sad to report it is about to get worse. Much worse.

On August 7, President Trump signed an executive order that could fundamentally restructure how federal research grants are awarded. On the surface, this change may sound like a small, bureaucratic procedural shift, but procedure is policy and, in this case, policy is politics. In fact, this order is a direct power grab that threatens to undo decades of scientific progress.

How so? The order directs a move to take away final decision-making authority for federal grant approvals and awards from scientific review boards and hand it to people appointed by Trump to serve at these agencies. (The chief qualification for these political appointments appears not to be expertise, but rather loyalty to a party or president.) The order will affect grants and awards from the NIH, CDC, and other critical scientific institutions.

This order is not just a step backward. It is a back flip off a cliff.

Science as a Political Tool

Let me be clear: this move is about politics and nothing more.

President Trump's Republican Party is just under 15 months out from a very difficult midterm election. History is not on its side -- the party that holds the White House historically loses seats in both the House and Senate during midterm elections. And the GOP's signature domestic policy "achievement," the One Big Beautiful Bill Act, is deeply unpopular.

With razor-thin margins in both chambers of Congress, the president needs to solidify support from certain parts of his base -- religious groups, vaccine and climate change skeptics, and others who are skeptical of "experts." This order is red meat for these groups.

Instead of awarding grants for HIV research, climate change mitigation, or pandemic preparedness, this order (if carried out) could enable the president to redirect taxpayer dollars to projects that fit his preferred political narrative, regardless of science. Goodbye hypothesis testing and peer-reviewed trials, and welcome to the land of taxpayer-sanctioned kickbacks, scientific censorship, and manufactured consensus.

Would conservatives be comfortable knowing a Democratic political appointee had full authority to approve or deny research grants? Would they be okay with a Democratic administration defunding cancer research that does not align with progressive ideals? Of course not.

This erosion of trust is not just political; it is existential.

The End of Peer Review

Historically, research grants from institutions like the NIH undergo a rigorous and transparent peer review process. Independent experts and scientists at the top of their fields evaluate proposals based on merit, feasibility, impact, and the strength of the proposed science. This process ensures that federal taxpayer funds go to projects that are the most likely to advance health and scientific understanding.

President Trump's executive order explicitly says: "Nothing in this order shall be construed to discourage or prevent the use of peer review methods to evaluate proposals for discretionary awards or otherwise inform agency decision-making, provided that peer review recommendations remain advisory and are not ministerially ratified, routinely deferred to, or otherwise treated as de facto binding by senior appointees or their designees."

In other words, the advice of experts should be considered optional.

Optional?

This is not how good science works. This is how propaganda is formed. When we turn our back on peer review, we turn our back on the very mechanism that keeps science honest, rigorous, and impactful.

President Trump may not realize it, or acknowledge it, but while this move may fit his political agenda, the result will be to diminish our country's standing in the world and our global leadership in healthcare innovation.

A Global Opportunity for Everyone But Us

Other countries are watching. Closely.

As the U.S. defunds vaccine research, delays pandemic readiness initiatives, and enables political ideology to infect grantmaking, Europe, China, and even Russia see an opening. They see the fall of what was once the world's gold standard in biomedical research as their opportunity to take the lead -- to recruit the brightest minds, to attract investment, and to become the home of next-generation innovation.

If President Trump was upset about the latest monthly jobs report, just wait until he sees the economic destruction this order will generate.

Scientific research is a massive economic engine. With an annual budget of more than $47 billion, NIH funding generated an estimated $92 billion in economic activity in fiscal year 2023 alone. This activity supported hundreds of thousands of jobs, spurred the creation of startups, and helped maintain U.S. leadership in global biopharmaceutical development.

Undermining federal grantmaking is not just bad for science, it is bad for jobs, bad for business, and bad for our economy.

A System Designed to Fail

This order has the potential to replace merit with obedience and corruption. It would eliminate transparency, reduce accountability, and turn grantmaking into political patronage and dealmaking. It would open the door for Big Pharma, Big Tech, and other industries to use campaign contributions as leverage for preferential treatment. It would incentivize universities and researchers to align with ideology instead of evidence, not because they want to, but because they have to in order to survive.

It also sends a message to every U.S. scientist and medical professional: your expertise does not matter. Your years of research do not matter. The only thing that matters is political loyalty.

The Government Accountability Office and federal courts have said efforts to withhold NIH funding were illegal. But that has not stopped this administration, and we should not assume the courts will protect scientific rigor.

The responsibility now falls on us -- clinicians, scientists, healthcare leaders, and voters -- to make it clear that this order is not acceptable; that it is not about efficiency, reform, or cutting red tape. It is about control.

If we allow this power grab to stand and we let political appointees decide the future of U.S. science, we will be complicit in the death of one of our nation's greatest strengths: independent, trusted scientific innovation.