Medical Research and the Government: Debates in Funding and Research Ethics

Graphic by Allison Chin

At the root of scientific discovery is the accumulation of thought, skill, and work of people and communities everywhere — research. However, regulating this multibillion-dollar industry requires both financial and ethical infrastructures. In terms of medical research, federal infrastructures like the National Institutes of Health (NIH) and other substructures, like Institutional Review Boards (IRBs), exist to regulate these aspects of medical research. But, what happens if they lose funding? 

This question becomes increasingly relevant in the context of current events under the Trump administration. On February 7, a proposed policy was announced that made the NIH limit the indirect funding capacity for each research grant to 15% — meaning that, at maximum, only 15% of a grant a research lab obtains can go towards indirect funding [1]. Indirect funding goes towards the facilities that each lab uses, such as the building’s maintenance, other laboratory supplies, and salaries [2], which are all essential for adequately supporting a lab and a project. The rationale for such budget cuts comes down to increasing “government efficiency” by minimizing any spending deemed “unnecessary” [1]. Similar cuts have been made to other governmental departments, such as the Department of Education and the Department of Health and Human Services [3].  This new NIH policy means that research labs and facilities across the nation will need to cut back on the number of projects, scholars, and utilities that they use, stagnating scientific progression, and medical discovery. 

With this NIH budget cut, there will be fewer federal donations being supplied by facilities towards research. Therefore, this places a significantly higher financial burden on the universities and institutions that carry these labs — a burden that they cannot currently sustain [4]. Duke themselves has commented that the proposed policy would deprive them of about $194 million USD, causing significant stalling in their research and cease initiatives for discovery [5]. With this unstable financial responsibility, facilities are left to turn to additional, external funding sources. However, when their primary sources of research funding turn away from the government and to private enterprises, this can convolute a fundamental sentiment of all research: to avoid a conflict of interest. Private donors are easily able to target certain medical interests and avoid others that they deem unnecessary, potentially shifting the landscape of research in a biased way. Therefore, this financial burden on research-inhabiting facilities has the potential to complicate research ethics in an unforeseen way.

Introducing additional funding sources can also convolute the idea of “beneficence” in medical research. In an abstract sense, beneficence in research can be defined as minimizing harm to any research participants, something that is typically screened through IRBs, but also as maximizing “benefits to participants and society” [6]. However, with more potential financial partners in play, these societal benefits are increasingly ill-defined — what is beneficial, and what is of interest? Moreover, what is actually being done with the research would progressively be in the hands of other associates, rather than just the government and the university/institution. This additional dynamic adds another perspective of what deems a certain project as beneficial as it inherently introduces another interest. This complication of “beneficence” becomes even more relevant in projects that do not require the screening of an IRB. 

It is further likely that many institutions will simply cut the number of projects they support [4], inherently increasing the selectivity of projects proposed by individual laboratories or researchers. How does one deem which project is more worthy of another if they pertain to two different fields entirely? While these questions and complications are always present, they are highlighted and intensified in light of recent events and pose interesting ethical questions regarding not only research itself but its relationship with the government as a multibillion-dollar industry.   

Reviewed by Sanjana Anand

References 

[1] Guardian News and Media. (2025, February 8). Trump administration to cut billions in medical research funding. The Guardian. https://www.theguardian.com/us-news/2025/feb/08/trump-administration-medical-research-funding-cuts 

[2] Direct costs vs. indirect costs. University Research. (2015, April 23). https://vpresearch.louisiana.edu/pre-award/building-your-budget/direct-costs-vs-indirect-costs 

[3] Kinnard, M. (2025, February 19). A comprehensive look at Doge’s firings and layoffs so far. AP News. https://apnews.com/article/doge-firings-layoffs-federal-government-workers-musk-d33cdd7872d64d2bdd8fe70c28652654 

[4] Badger, E., Bhatia, A., Cabreros, I., Murray, E., Paris, F., Sanger-katz, M., & Singer, E. (2025, February 14). How trump’s medical research cuts would hit colleges and hospitals in every State. The New York Times. https://www.nytimes.com/interactive/2025/02/13/upshot/nih-trump-funding-cuts.html 

[5] Brinn, L. (2025, February 13). Information about changes to NIH indirect cost reimbursement rates - Duke University: Office of the president. Duke University | Office of the President. https://president.duke.edu/2025/02/13/information-about-changes-to-nih-indirect-cost-reimbursement-rates/ 

[6] Mondragón Barrios, L., Martínez Levy, G. A., Díaz-Anzaldúa, A., & Estrada Camarena, E. (2022, September 30). Rethinking benefits in Health Research, reflections of an Ethics Committee. The Yale journal of biology and medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC9511940/

IVF and the Political Dilemma: Balancing Reproductive Rights, Ethics, and Accessibility

Graphic by Eugene Cho

In vitro fertilization (IVF) has become a focal point of political unrest, especially, because the procedure raises a series of complex and nuanced ethical questions that cannot be easily categorized in binary terms, as some politicians may suggest. IVF, one of the most effective fertility treatments, is one in which doctors collect mature eggs from a woman's ovaries, fertilizing them with sperm to create embryos, and then freeze many of those embryos for future use (1). The embryos are stored by replacing the water in their cells with a protective fluid and freezing them using liquid nitrogen (4), a procedure that is highly controversial over its morality. Since the overturning of Roe v. Wade, opposition to IVF has gained traction, with some anti-abortion groups questioning the ethics of embryo creation and destruction. This division highlights the broader moral dilemma facing lawmakers: balancing the potential benefits of IVF in helping individuals start families against the ethical concerns surrounding embryo creation and destruction.

In February 2024, the Alabama Supreme Court ruled that "embryos are children under law," a decision that threatened the accessibility of IVF (2). In response, many Republicans began to take a stance supporting the procedure, a surprising shift from their previous positions on reproductive rights. These Republicans defended IVF as a “pro-life issue,” but struggled with reconciling this stance with their opposition to abortion. The central dilemma lies in the idea that, as proponents of “life beginning at conception” argue, IVF involves the creation of embryos that may ultimately be discarded—raising ethical concerns about the destruction of potential life (2). Florida Senator Marco Rubio captured this tension, acknowledging that “the ethical dilemma is that, in order to create life, you have to destroy life because you’ll create embryos that are not going to be used” (3). Some, like Emma Waters, a Senior Research Associate in the DeVos Center for Life, Religion, and Family at The Heritage Foundation suggest the U.S. adopt policies limiting the number of embryos created to reduce this ethical conflict. She explains that Republican lawmakers need not be boxed into a strict "binary" choice of fully supporting or opposing IVF (3). While Alabama's legislature has passed a bill protecting IVF providers from legal liability, the legal and ethical questions from the state court's ruling remain unresolved.

IVF treatments typically cost between $12,000 and $25,000 per round, and insurance coverage for the procedure is often inconsistent (5). Many businesses only extend coverage to individuals with infertility, while others, including coverage under Medicaid, often limit fertility treatment access or exclude certain groups, such as LGBTQ+ couples and single women (4). This inconsistency in coverage creates a divide, limiting IVF access to those who can afford the treatment out-of-pocket. During his campaign, Donald Trump promised that IVF would be made free for families, either through insurance coverage or government funding. President Trump, aiming to address the growing concern around the high cost of IVF, signed an executive order on February 18th, 2025, in which he tasked the assistant to the President for domestic policy with providing a list of recommendations to protect IVF access (4). However, Senators like Patty Murray (D-Wash.) have criticized his recent executive order, calling it a "PR stunt" due to the lack of concrete policy action (5). They point to the history of Republican resistance to legislation that would make IVF more affordable and accessible. Senate Democrats, including Senator Tammy Duckworth, argue that if Trump is serious about making IVF free for all, he should urge Senate Republicans to back the "Right to IVF Act," which would require insurance plans to cover the procedure (6). The bill has been blocked by Senate Republicans for over a year due to concerns that its language could be used to justify abortions.

Ultimately, Trump's executive order only requests recommendations to make IVF more affordable but does not guarantee direct action. This cautious approach reflects the complex position Republican lawmakers find themselves in, balancing support for IVF with their anti-abortion stance. As the debate continues, it remains to be seen whether Trump will take more definitive action on IVF accessibility. Until then, the political conversation surrounding IVF will remain deeply divided, with ongoing ethical debates over the potential benefits of wider access to fertility treatments versus concerns over the moral implications of destroying human embryos in the process.

Reviewed by Leya Edwards-Headen

References

[1] “In Vitro Fertilization (IVF).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 Sept. 2023, www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716. 

[2] Schapitl, Lexie. “How IVF Is Complicating Republicans’ Abortion Messaging.” NPR, NPR, 16 Mar. 2024, www.npr.org/2024/03/16/1238966404/how-ivf-is-complicating-republicans-abortion-messaging. 

[3] “IVF as an Election and Policy Issue .” KFF, 9 Oct. 2024, www.kff.org/quick-take/ivf-as-an-election-and-policy-issue/. 

[4] Ungar, Laura. “Trump Has Signed an Executive Order on IVF. Here’s What You Should Know about the Procedure.” AP News, AP News, 18 Feb. 2025, apnews.com/article/ivf-vitro-fertilization-trump-executive-order-65972cc1b10151bf1a0d9390fe5754d9. 

[5] Simmons-Duffin, Selena, and Diane Webber. “Trump Wants to Lower the Cost of IVF. New Executive Order Seeks Ideas to Do That.” NPR, NPR, 19 Feb. 2025, www.npr.org/sections/shots-health-news/2025/02/18/nx-s1-5301201/trump-executive-order-ivf-in-vitro-fertilization. 

[6] O’Connell-Domenech, Alejandra. “Trump’s IVF Order: Democrats Allege ‘PR Stunt’ as Anti-Abortion Groups Bristle .” The Hill, The Hill, 19 Feb. 2025, thehill.com/policy/healthcare/5154154-trump-ivf-order-criticized/.

Fueling Change: Dietary Interventions in Epilepsy Treatment

Epilepsy is a disease that affects approximately 50 million people worldwide and is characterized by recurrent seizures. These seizures cause involuntary movement in parts of the body or the entire body and can lead to a loss of consciousness. Although antiepileptic drug (AED) therapy stops seizures in most individuals, studies estimate that 30% to 40% of patients become resistant to treatment with AEDs, a condition known as drug resistant epilepsy (DRE). While the exact cause for DRE is unknown, one potential treatment that has been explored is dietary therapy.

Dietary therapy, used in conjunction with seizure medications, improves the therapeutic effects of AED treatment. It can also be used as a management option for those suffering from DRE. One common diet used for epileptic dietary therapy is the ketogenic diet. The ketogenic diet is a high fat, low carb diet that can be prescribed by a physician and is usually monitored by a dietician. In this diet, the body relies on the breakdown of fats rather than carbs for energy. These fats are metabolized into ketones and ketone bodies, which are able to cross the blood-brain barrier and enter the brain where it can be used for energy. Some food choices specific to this diet include butter, heavy whipping cream, mayonnaise, and oil (e.g., canola or olive). However, this diet is more commonly recommended for children, as it is more difficult for adults to follow such a strict diet plan. 

Despite the difficulty in maintaining the diet, it has proven to be extremely effective. Research has shown that the  ketogenic diet typically reduces the number of seizures by 50% or more in half of patients. This occurs because epilepsy, and seizures in general, are often caused by higher levels of glutamate and GABA—excitatory neurotransmitters—in the brain. However, the ketogenic diet reduces the amount of glutamate in the brain and lowers the production of GABA. The exact mechanism by which this occurs remains an active area of research, but it opens the door to a compelling question: what other diseases might be effectively treated or cured through dietary therapy?

Reviewed By: Ashley Gutierrez-Torres

Citations:

“Drug Resistant Epilepsy.” Epilepsy Society, 3 Aug. 2023, epilepsysociety.org.uk/about-epilepsy/drug-resistant-epilepsy. 

“Ketogenic Diet.” Epilepsy Foundation, www.epilepsy.com/treatment/dietary-therapies/ketogenic-diet. Accessed 30 Nov. 2024. 

“Epilepsy.” World Health Organization, World Health Organization, www.who.int/news-room/fact-sheets/detail/epilepsy. Accessed 30 Nov. 2024. 

Wnuk, Alexis. “How Do Ketogenic Diets Help People with Epilepsy?” BrainFacts.Org, www.brainfacts.org/diseases-and-disorders/epilepsy/2018/how-do-ketogenic-diets-help-people-with-epilepsy-081418. Accessed 30 Nov. 2024.