The Trump Administration’s “Terrifying” Cuts to U.S. Cancer Research

HARI SREENIVASAN: Christiane, thanks, Jonathan Mahler, thanks so much for joining us. You wrote a piece in the New York Times magazine recently, and it’s titled “Trump is Shutting Down the War on Cancer.” And you take so many different approaches in this piece. Let’s, I guess start with first, what do you mean by this? Give me the scale of the war on cancer and what he’s shutting down.

JONATHAN MAHLER: Yeah. So I mean, the War on Cancer is, is something that we started — launched in this country, you know, back in 1971. President Nixon actually signed the legislation, the National Cancer Act. And really what it was, was a commitment to make a sustained, large investment in treating cancer and improving our treatment of cancer. And over the decades that investment has grown steadily. 

And now we’ve reached at — a moment where, where, you know, we’re poised for, for even greater breakthroughs at the very moment that the Trump administration has decided that we’re spending — apparently decided that we’re spending way too much money trying to cure cancer. (02:19): And the, the, you know, the war on the war on cancer it’s, it’s happening both in terms of the cancellation of individual grants, so individual projects that were, you know, dedicated to, to, to discovering kind of new, new treatments or, or, you know, kind of adapting new treatments. It’s happening in terms of, of freezes in funding to research universities that depend on NIH money to keep their labs running, are suddenly finding that money frozen, not appearing. 

And then it’s happening in an, in an on a kind of a larger, even larger scale. And this is something that’s still a little bit, you know, to be determined, but the president’s proposed budget for next year, which is, you know, still, still before Congress, is calling for a 38% cut to our cancer research budget, which is, you know, $3 billion. I mean, it is, this is a lot of money. 

In addition to that, the administration is, is trying to lower the, the reimbursement rate that research universities get for their overhead expenses. So, you know, universities that are conducting this research they, they have scientists who are doing the work, but they also have to keep the labs running. They have to you know, employ people to, to you know, to, to, to administer the grants. They have to pay for the electricity, et cetera. They’re, they’re able to, to,  to expense some of those costs. And the, the administration wants to dramatically lower the reimbursement rate for universities. So it’s really a, a kind of a 360 degree attack on, on on this funding system.

SREENIVASAN: Give me an idea — or give our audience some perspective here and set the level. Okay, this has been happening for decades. How successful has that “war” been? I mean, you know, we’re spending billions and billions of dollars every year. I get that, but like, is there a way that you can measure what a dollar gets us?

MAHLER: Yeah, so I mean, my favorite statistic is — which, which was published recently in the Journal of Clinical Oncology — is that about every every $300 that the government spends on cancer research extends someone’s life by one year. So that feels like a pretty modest investment to me as you know, as someone who, who lost his mom to cancer seems to me, you know, pretty worth it. 

To say nothing of the fact that there are enormous economic benefits to this investment, too. I mean the, the the, the biotechnology industry, the pharmaceutical industry, all of these and, and all the investors in these companies have all made an enormous amount of money off the research that began on this basic biological level funded by our government.

SREENIVASAN: And so, when somebody gets a cancer today versus perhaps our parents’ generation, what is the likely outcome? Are we more likely to survive it? Are there fewer cancers that are kind of untreatable?

MAHLER: Our ability to treat cancer has been, you know, dramatically transformed, particularly since the 1990s. So really, if you, you think about how this, this whole war on cancer has unfolded, the first, you know, 20 plus years were, were really a period where scientists were mostly grappling with how, how much more complicated this disease was than they, than they had realized. It’s, it’s not a single disease. It’s, it’s hundreds of thousands of diseases. And each one behaves differently in everyone’s, on every organ and in everyone’s body. And really beginning in the late nineties, you know, what, what had been basically the only options historically had been, you know, surgery really. And then, you know, chemotherapy came along and radiation as well. (06:45): But these were, you know, all — both radiation and chemotherapy are enormously toxic. And, and, you know, not always effective.

But what, what the, the really, the biggest innovation and, and the innovation that we’re still really, scientists are still really building on is what’s known as immunotherapy. And immunotherapy is essentially the, the, the use of one’s immune system to, to the stimulation of, of an immune system to detect the mutant cancer cells and fight the cells itself. So your immune system does the work that otherwise these toxic chemotherapy chemicals would be doing, which people tolerate much better — so their quality of life during treatment is much better — and it’s also much more effective. 

So this is a new — you know immunotherapy  is, is relatively new. We’re talking about, you know, 15, 15 years or so. And and there’s still a lot of cancers where they’re just beginning to, to, to understand how to use immunotherapy.

SREENIVASAN: To illustrate what’s happening kind of in the research ecosystem, you help kind of personalize it by looking at Rachael Sirianni, a Professor at the University of Massachusetts. Her research focuses on an aggressive form of pediatric cancer known as Medulloblastoma. Tell us her story and how it’s indicative of what’s happening to other researchers, people who are facing grants.

MAHLER: She’s working on basically a new way to deliver a drug, to deliver drugs into the interior of the brain to attack this very aggressive form of pediatric brain cancer, which, you know, kills hundreds of kids every year, medulloblastoma. And so she’s been working kind of steadily on this for, for, you know, 10 years now. And she’s, she, she had three NIH grants to do this work, was making great progress. Her grants were just because they, you know, they only last for, for five years or so, coming up in 2025 and 2026. So coming into this new year and the new presidential administration, she was aware that she needed new grants to keep her research going. (09:24): You know, she runs a lab of, of, with, with seven researchers and technicians, and it’s expensive and, and time consuming work, running, you know, running all these studies. 

She had submitted two grant applications to keep her work going to the NIH. And days after the, the inauguration she was informed that the meetings where her grants were gonna be considered had, had been canceled. And so months now went by, she, she had to start laying people off in her, in her lab. She had to cancel one of her most promising studies.

And then she was informed that they, they in, in June, that they, they were not, that neither project was gonna be funded. 

So now she’s, she’s faced with this, this decision of, well, you know, what am I gonna do? I’ve been, this is, this is this important work that I’m devoted to, that I’ve been doing for years now, and I’m making great progress. And and she’s come to this decision now that, that she — for the moment at least, she can’t really focus on this work any longer, because pediatric brain cancer work is very expensive. It’s expensive because it requires a very specific kind of lab mouse. 

 So now she’s, she’s decided she’s gonna have to just pivot away from it and start working in, in some other fields, you know, which is obviously, you know, tragic. I mean, this was a woman who was making great strides in, in, in helping children with brain cancer survive. And, and it’s hard to imagine a, you know, some, something more worthy to, for our government to be investing in. And yet, you know, here she is having to, having to move to other fields.

SREENIVASAN: So, you know, we’re in a period now where you said that in the mid seventies, America’s five-year cancer survival rate sat at 49%. Today it’s 68%, that’s startling. Considering how relatively new immunotherapy is, and perhaps some of the work that’s happening with mRNA research that could impact cancer. Is this a productive time for cancer research?

MAHLER: Many people whom I spoke with said that this is, this is one of the most productive moments, if not the most productive moment in the history of cancer research, because we have all of that accumulated knowledge. We have all of this new technology. We have artificial intelligence. There’s, there’s so much, so many sort of forces coming together. There is, as you say, there, there are cancer vaccines, mRNA vaccines, and other cancer vaccines being developed. There are new studies now to detect a cancer in, in the bloodstream years before, before, before you have any symptoms. So, so the ability to, to begin to treat cancer before it even appears. 

There, there’s a new radiation treatment in development, it’s a flash of radiation that’s literally a microsecond. And that’s it. And so rather than a prolonged radiation treatment, which causes all sorts of damage to the surrounding tissue, it just hits the, the, the spot. And, and just in an instant and you’re done. So, and, and as I was was telling you before, immunotherapy is this incredibly promising area. So there is, there is there’s so much going on right now. It’s a, it’s a really exciting time for cancer research, but of course, it’s also a terrifying time for cancer researchers.

SREENIVASAN: So let’s talk a little bit about kind of the politics and the motivation of the president’s cuts on this. I mean, even, you know, as you describe, if the NIH stopped taking meetings well before kind of DOGE came in, this seems like part of an sort of an orchestrated plan on what to do.

MAHLER: This was a, a very deliberate and premeditated campaign. And it’s not an easy thing to do because the NIH and the NCI, the National Cancer Institute — which is, you know, part of the NIH, which kind of oversees a lot of the cancer research in this country — they were, they were built to be insulated from politics for, for obvious reasons. So, so if you wanted to make, you know, a sort of politically-motivated assault on, on these institutions, you know, it was gonna require some forethought.

And, and, and that’s, that’s, that’s what happened. I mean, this administration came in and, and they knew exactly what to do and how they were gonna do it. And it, and, and they, they started freezing grants — I mean, it’s, it’s, it, you know, it was, it’s unprecedented for active research grants to be, to be canceled. I mean, truly unprecedented. And you know, and, and it was happening by, you know, by the hundreds. It’s unprecedented for, for universities to have their funding frozen. 

So So this administration, you knew they, they knew how to disrupt this system, and they did. And what’s puzzling to me is still is, you know, you can explain this, I think as, Okay, this is part of the war on, on government bureaucracy on what they would say is government — argue is government waste. This is part of the war on research universities that they feel are, are you know, too progressive too too, too left. This is, you know, also important to say this is part of, of, of a kind of attack on the scientific establishment, which of course has you know, lost a lot of a lot of its cred — credibility in many quarters during, during the COVID pandemic. 

I get that, but, but what’s your plan? What, what are you gonna, once you’ve, once you’ve canceled all these grants, once you’ve cut all this funding, what, what are you gonna do? I mean, are we, are, are we just gonna concede the fact that we are going to, you know, essentially surrender the war on cancer? I mean, or, or is there a plan that you just haven’t told the American people about to, to build something in its place? And I — unfortunately, I haven’t seen any evidence of a, of a plan.

SREENIVASAN: You, you have a statement from the Office of Management and Budget. It says “efforts to focus N.I.H. spending will establish a more sustainable and accountable fiscal path for N.I.H., while ensuring that resources are managed effectively and in a manner that best supports America’s biomedical research enterprise.” You lay out kind of one of the critiques by Joe Lonsdale a, a supporter of Elon Musk and the president, and he says, look, this is a, a, a system that’s grown, bloated, and bureaucratic, and it’s not working nearly as fast as it could. And, you know, they wanna change things. So what’s the problem with that critique?

MAHLER: It is very important to recognize that this is not a perfect system by any means. There are, there are, there are criticisms of it both on the left and the right. Any bureaucratic system that has been evolving for, for, you know, more than 50 years now, it is — it has gotten big, it has gotten unwieldy. It has gotten risk averse. There are too many older scientists who are blocking too many younger scientists who have, who have, you know, kind of more, more potentially game changing ideas, who are more familiar with, with new technology, et cetera, that are not able to kind of enter the field. And scientists are spending too much of their time writing grant proposals because it’s gotten so competitive.(22:19): That’s a problem. They should be in the lab. They shouldn’t be spending all their hours, you know, writing 120 page proposals for a grant. 

So that is all true. And, and Joe Lonsdale is, is correct about that. I think the problem is that this, this idea that you can just sort of disrupt this system like you would you know, disrupt the, the technology industry you know, and replace it with, with startup companies, that that’s not how scientific research works. It’s, it’s one scientist in one lab making a, a, a small discovery that another that — and publishing it in a paper and another scientist reading that paper and seeing, oh, that’s interesting. (23:16): I think I might be able to like add a, add a, add a twist to that. I might be able to, to advance that idea a little further. It’s, it’s sort of, it’s collaborative, it’s incremental. It’s very different than, than how the, the Silicon Valley functions. 

So so I would say that, you know, I think he’s, his criticisms of, of the system are, are, are legitimate. I think the idea that it could be replaced by some sort of you know, disruption-centered Silicon Valley style approach seems, seems misguided to me. To say nothing of the fact that, as I mentioned before, we haven’t seen any, any proposal for, for for, for what’s coming next. 

SREENIVASAN: Are people today suffering from the cuts that are coming to cancer research?

MAHLER: Yeah, so there are isolated examples of, of that happening. The chief of surgery at the National Cancer Institute who’s running a clinical trial now to do, to do to, to, to sort of treat a particular form of cancer with immunotherapy — a form that a form of cancer that has not yet been successfully treated with immunotherapy. And he, two of his technicians who, who build, who manufacture the cells he needs to, to inject in his patients, to treat them — and these are late stage cancer patients — these two technicians were laid off. So, so that delayed the treatment of his patients, delayed his clinical trials. So, so, so, yes. 

The bigger issue though is the way, you know, the way this system is structured, the government funds the early stage research, that no no pharmaceutical company or biotechnology company is, is going to invest in because it’s, it’s a, it’s experimental. It’s, it’s, it’s so basic, it’s foundational. When — it’s investigative.  Then you get patents, then you get biotechnology companies, then you get private investment. 

What we’re seeing now is, is will ultimately result in a slowing of that survival rate. Because, because progress at this early stage is what leads to the, the, the great breakthroughs in treatments, the, the great successful clinical trials in humans. But if you take away that foundational research that only the government will pay for, no, no, private industry doesn’t wanna pay for it ’cause It’s, it’s, it’s too speculative. We’re seeing the system kind of being, being attacked at this, at this very, you know, foundational level. And we won’t really know the effects of it for, for you — see the effects of it for, for years to come.

SREENIVASAN: Staff writer at the New York Times Magazine. Jonathan Mahler, thanks so much for joining us.

MAHLER: My pleasure. Thanks for having me