A confidential Trump administration budget document obtained by The Cancer Letter called for a 40% budget cut to NIH and a restructuring of the 27 existing NIH institutes and centers down to just eight. But what else is in it?
This episode is available on Spotify and Apple Podcasts.
In this week’s episode, Paul Goldberg, editor and publisher of The Cancer Letter, and Jacquelyn Cobb, associate editor, talk about other ways the 64-page budget document may impact cancer research. (The Cancer Letter, April 18, 2025)
It seems that the cut to FDA was very small, Paul said. However, the budget would zero out the 21st Century Cures Act.
“If that indeed happens, FDA will not be able to hire people at salaries that were never competitive anyway, but at least they were kind of getting towards competitive,” Paul said. “But compare it with the salary of a dean somewhere, and you’re getting into like 30% of what somebody like that earns. So, it becomes kind of a very difficult place to go work.”
The other, more concerning potential impact of the budget? CDC’s grants for state cancer registries is nowhere to be found.
“I am not seeing something that kind of freaks me out, which is I’m not seeing the grants for cancer registries grants to states,” Paul said. “Now, the United States has what is viewed as one of the world’s greatest, if not the world’s greatest, cancer statistics/cancer epidemiology/data gathering apparatuses anywhere.
“This was built since roughly about 25 years ago, when states started receiving these grants. It covers about 97% of the country. And I’m not seeing that in there. This is something that CDC operated, so what does that mean? I don’t know yet. I hope to find out.”
Other stories mentioned this week include:
- The Directors: Louis Weiner and Taofeek Owonikoko on keeping up morale amid uncertainty—“We are resolute. We are committed to continuing to move the work forward.”
- RFK Jr. urges FDA staff to resist “agency capture” by special interests and resist “deep state”—Whistleblowers will be “honored”
- TIL + pembro regimen achieves 24% response rate in solid epithelial tumors, marking a step forward in immunotherapy research
- What would Mary do? Trump’s actions call for Lasker-style advocacy
This episode was transcribed using transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on the Cancer Letter Podcast:
Jacquelyn Cobb (00:00): This week on The Cancer Letter podcast…
Paul Goldberg (00:05): It’s highly unusual for an NCI director to be gone from the previous administration because they usually go from administration to administration because not really, I mean, it is a political appointment, but there, these are not political people. Or shouldn’t be.
(00:21): But most of them really would be very comfortable working for any administration because they’re about cancer. Politics doesn’t cure cancer, although political actions can make the cure happen, such as the National Cancer Act. And this is really important, because it’s been shown in over 52 years that bullshit does not cure cancer.
Jacquelyn Cobb (00:46): You mean literally?
Paul Goldberg (00:47): Literally. Bullshit does not cure cancer. It has no impact on it whatsoever.
Jacquelyn Cobb (00:52): Yep.
Paul Goldberg (00:53): That’s been shown. I’m willing to defend this point of view anytime.
(01:15): You are listening to The Cancer Letter Podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of the Cancer Letter,
Jacquelyn Cobb (01:30): And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter. We’ll be bringing you the latest stories, groundbreaking research, and critical conversations shaping oncology.
Paul Goldberg (01:40): So, let’s get going.
Jacquelyn Cobb (01:50): Good morning, Paul. How’s it going?
Paul Goldberg (01:52): Good morning, Jacquelyn. How are you?
Jacquelyn Cobb (01:54): Good. We’re starting at 9:00 a.m. today instead of 10. So I might look a little more tired than normal, but I have my coffee, so, I’m ready to go.
Paul Goldberg (02:01): That’s all that matters.
Jacquelyn Cobb (02:04): I’ll jump right in and take us through last week’s headlines.
(02:08): Our cover story was a story about the latest episode of The Directors, which is a special segment of The Cancer Letter Podcast. In that episode, Taofeek Owonikoko, the executive director of the University of Maryland, Marlene and Stewart Greenebaum Comprehensive Cancer Center, and Louis Weiner, director of Georgetown University’s Lombardi Comprehensive Cancer Center, talked about keeping up morale at a time when many cancer researchers are reconsidering their career choice.
(02:33): I wrote a story about RFK Jr.’s off-the-cuff remarks given to FDA in an all-hands meeting. He urged FDA employees to resist “agency capture” by special interest and “the deep state.”
(02:47): I also had the opportunity to write a science story, which is so exciting. I think probably the first proper science story I’ve written since Trump became president, and it was about the results of a phase II trial of tumor infiltrating lymphocytes plus pembrolizumab in solid GI cancers. I was able to sort of dive into the history of TILs in various cancers and how the developers, including Steven A. Rosenberg, have incrementally improved response in broader and broader indications.
(03:20): We also had a guest editorial by Kevin J. Cullen, which said that President Trump’s actions require Mary Lasker style advocacy. And there’s some really fun art with that story. So, definitely check it out on the web or on the PDF.
(03:33): And today we’re going to dive into Paul’s story about the Trump administration’s proposed budget documents—the sort of soft budget. So, I’ll pass it over to you, Paul, to explain what was in those documents and what they said.
Paul Goldberg (03:49): I know you guys make fun of me for being non-linear, but can we kind of curve, kind of go back a second? Because The Directors really is becoming more and more important, at least in my view as an editor, because, you know, the cancer program has leaders, and the leaders are the directors of cancer centers. Right now, there is no NCI director, so there’s a whole lot of other leaders, and it’s very important to have their voices heard and to bring them out to the very front of what we report.
(04:28): The other bit is something you said that struck me as fascinating, which was that this is the first time since Trump’s inauguration when you were able to write a proper science story. And that is a microcosm of where we are.
(04:44): We’re focusing on policy, we’re focusing on survival, we’re focusing on existential threats, but science…
Jacquelyn Cobb (04:51): Mm-hmm.
Paul Goldberg (04:52): Where’s the science? Gee. So, I think it’s really, I applaud you for having made that story happen, because I was one of those people who said, “Well, can we just sort of focus on more policy?” And I hate this.
(05:07): I mean, I wish we could write about nothing but science, but that requires policy.
(05:11): So the other bit I felt that I really loved was Kevin Cullen’s piece. It was really a hoot because what he did was he took Mary Lasker’s ads that she placed in newspapers all over America in the run up to the National Cancer Act, and the ad read “Mr. Nixon, you can cure cancer.” And he produced, or we helped him produce—he wrote it—we produced a very similar ad that says, “Mr. Trump, you can cure cancer.” Yeah—you can cure cancer. You can do a lot more than Nixon could, for sure, because he is standing on the shoulders of the giants who have been for 50 years doing the science of the sort that you’re now writing about, like Steven Rosenberg, for example. And you know, because we’re spending all this time on policy and, and now I can actually address your question, which I still remember.
Jacquelyn Cobb (06:14): Excellent!
Paul Goldberg (06:16): So, the OMB presented its budget blueprint for for HHS. And that involved a cut of about 40% to NIH, bringing it down to $27.3 billion. So, it’s, you know, like to a decade ago. And then when you subtract the inflation, we’re back God knows where—somebody needs to sit down and figure it out. This was so massive.
(06:57): And by the way, NIH has and can—and has objected to this. So, a 40% cut is completely, totally devastating. Oh, plus of course, it includes, not surprisingly, a 15% ceiling on on indirect [costs]. So, that’s going to hurt everyone.
Jacquelyn Cobb (07:22): Yeah.
Paul Goldberg (07:23): And you know, why are they doing it? But the most interesting thing here is that I was able—I had only one day to put this together, because I got the 64 page document and I had to plow through it.
(07:41): It involves cutting the NIH institutes and centers down from the current number of 27 to just eight. NCI remains upright. However, if it gets a proportional part of of the cuts, then it gets cut by 40%. We don’t know what anybody thinks, but I mean, the way it usually works is if there are cuts, the the sort of the larger entity decides how to distribute them. So, it could be 40%, it could be 0%. Who knows? But NCI is standing upright. There are parts of this document that I was unable to figure out in the time allotted. One of them was CDC and another I didn’t look very deeply at—FDA. Let me dispense with that.
(08:37): First, to be non-linear, with FDA, the cut was very small and most of it had to do with the drug side. The cut was very small. But we don’t know the implications of the… they did zero out the Cures [Act], which is what is used to even out the salaries. So, FDA will, if that indeed happens, FDA will not be able to hire people at salaries that were never competitive anyway, but at least they were kind of getting towards competitive. So, NIH, same thing. So, basically the top salary under Title 42 is Cures is going to be in the $230s [$230,000]. The top salary for the top compensation for the officials of the FFRDC, which is Frederick [National Laboratory for Cancer Research], is at $400,000. Which is interesting because it’s a public-private partnership, so it should be more competitive, but it’s now topped at $400,000. $400,000 is the salary of the U.S. president. So, I think it has to be $399,000. But compare it with the salary of a dean somewhere, and you’re getting into like 30% of what somebody like that earns. So, it becomes kind of a very difficult place to go work. And the part that I have not been able to look at, so I didn’t really look very deeply at the implications of the Cures. I’m just telling you what I’m going to look at this week.
Jacquelyn Cobb (10:38): Yeah. Yeah.
Paul Goldberg (10:39): I mean, this is just, this was the time allotted.
(10:42): When you’re seeing an NIH cut of about 40%, bringing it down to $27.3. That’s billion. That’s obvious, the number, but it was less [obvious], some of the things in the FDA piece were somewhat obvious. So, that’s in there, but I wouldn’t look deeper. The place where I did not look, because I really didn’t know how to begin, because that requires an audit of the budget proposal. And that is CDC. And there, I am not seeing something that kind of freaks me out, which is I’m not seeing the grants for cancer registries grants to states. Now, the United States has what is viewed as one of the world’s greatest, if not the world’s greatest, cancer statistics/cancer epidemiology/data gathering apparatuses anywhere.
(11:51): This was built since roughly about 25 years ago, when states started receiving these grants. It covers about 97% of the country. And I’m not seeing that in there. This is something that CDC operated, so what does that mean? I don’t know yet. I hope to find out.
(12:21): That’s one of the things, but there is a new agency that’s being built in accordance with the RFK Jr.’s plans. And it’s an Agency for a Healthy America—correct me if I’m getting the language wrong,
Jacquelyn Cobb (12:37): Let me double check.
Paul Goldberg (12:38): Yeah, please. Because I don’t want that to stand. Agency to make America…
Jacquelyn Cobb (12:44): Administration for Healthy America.
Paul Goldberg (12:45): Administration for Healthy America. So, it’s getting like bits and pieces of various agencies. And it’s just very difficult to figure out what goes where. CDC gets carved up pretty well; you know? Pretty thoroughly. So, it’s very hard to figure that one out. So, that’s what I’m… that’s my work.
Jacquelyn Cobb (13:08): That’s what you’re gonna be doing for the next three days, four days.
Paul Goldberg (13:10): Yeah. So, if you don’t see it in next week’s issue, that means I failed miserably.
Jacquelyn Cobb (13:15): Or you just need more time to figure it all out.
Paul Goldberg (13:18): Yeah. I just need to get some help on this, because there’s almost no way to make sense of it right now. What is being proposed, and also, you know, it’s kind of late in the planning stage, but it’s it’s still in the planning stage. I mean, the president has not presented the budget proposal to Congress, and Congress hasn’t really looked at it yet.
Jacquelyn Cobb (13:47): Yeah.
Paul Goldberg (13:47): In the past, something like that would be dead on arrival.
Jacquelyn Cobb (13:53): Yeah.
Paul Goldberg (13:53): But I don’t know what that means now, whether Republicans are going to do anything about it. I think they will. That’s my prediction, because everybody has an academic institution or a cancer center or medical institution of some sort. And, in some places, they’re the largest employer in the state.
Jacquelyn Cobb (14:20): Yeah. So, and you know, health research can be bipartisan. I know it’s often not at this point, but at least cancer research has, you know, we’ve quoted this many times, enjoyed bipartisanship throughout its history.
Paul Goldberg (14:38): Well, it’s better than that. Republicans have been better.
Jacquelyn Cobb (14:40): Yeah, yeah. True. They’ve been actively supportive. Right.
Paul Goldberg (14:44): Yeah. So, I have no idea. What’s going to happen now? I don’t think they want you to have any idea.
Jacquelyn Cobb (14:53): Yeah.
Paul Goldberg (14:53): Because anything that Republicans are doing now, they’re doing kind of in secret, under the cloak of not being found out by Mr. Musk who could then throw a few tens of millions to have them primary. And I really do not understand what is happening, or I have no idea what Congress is going to do. I don’t think anybody does. And it does depend on Republicans.
Jacquelyn Cobb (15:29): Yeah, absolutely. Before we get too lost in the terribleness of the world right now, we can I think… Paul, you’ve literally anticipated all of my questions and it was crazy, because it was actually in the order that I was going to ask them of you. So, linear or not, we’re thinking the same way.
Paul Goldberg (15:45): Oh my God. That’s, that’s really scary. That’s the scariest thing that Jacquelyn, I’ve heard you say and you should have interrupted me.
Jacquelyn Cobb (15:54): No, no, you were on a roll. If I ask one question and you go off, so be it. I’m happy to let you go off. I think, honestly, we covered everything. Is there anything else we want to include? I think that this is great. I’m really looking forward to reading your next story about this. Hopefully, if it all works out.
Paul Goldberg (16:09): Well, thank you. And I’m looking forward to yours. You know what, I do have a question. Can you talk about the science story?
Jacquelyn Cobb (16:18): Well, I tried to get as much as I could in our little intro because I knew that that wasn’t the story we were focusing on this week. But yeah, I mean, just not necessarily even about that story, but I really enjoy writing about more mechanisms of action, really, like biological molecular bio, stuff like that. And how that affects patients.
(16:41): Like I am craving—you must be too, Paul—I am craving covering an ODAC. I miss ODAC so much.
Paul Goldberg (16:49): Oh yeah.
Jacquelyn Cobb (16:50): So it’s like, just that type of thing. Really diving into… Because I studied oncology a little bit about in college, I’m obviously no expert, but you know, there’s so much for me to learn in this field.
(17:03): I didn’t really know much about tumor infiltrating lymphocytes before this story, besides what we’ve covered in the past. So, it was really fun to get into really the details of how they work. [It is] so fascinating how they come together with with checkpoint inhibitors. I’m not sure I’m going to be able to explain it off the cuff like this, because it’s, like I said, complicated, but you know, they’re two separate immunotherapies—classes of immunotherapies—that are working really well in some cancers and really not working well in some cancers.
(17:35): And you know, it’s not like they’re introducing pembrolizumab to try to treat [the cancers] with pembrolizumab as well. It’s not like a chemotherapy regimen where they’re trying to do multiple things and you get at the cancer in multiple ways. It’s that their TILs express PD-1, and that’s causing an issue with the TILs. It’s not letting them attack the cancer cells. And so, they’re inputting pembrolizumab basically—I might be overstepping here, I’m sorry Dr. Rosenberg if I’m overstepping—but in some ways to, to treat or to get in the way of the PD-1 on the TILs themselves. So, it’s really the pembro and the TILs are coming together to treat the cancer rather than treating the cancer from two different angles. And I thought that was fascinating.
(18:24): I don’t know if that made any sense because I’m not the best at adlibbing about science, but I do love writing about it. So, thank you for giving me the opportunity to nerd out for a second, Paul.
Paul Goldberg (18:35): Well, why don’t we do more of that? We really need to be kind of remembering what this is about and getting into the science of things.
Jacquelyn Cobb (18:44): And patients. That’s the other thing, too. My thing is science, but, you know, the patient side of things is I think very, arguably more, important.
Paul Goldberg (18:53): That’s who’s been missing.
Jacquelyn Cobb (18:54): Yeah.
Paul Goldberg (18:55): Patients have not… We have not heard patient voices at all.
Jacquelyn Cobb (19:00): Yeah.
Paul Goldberg (19:01): And it’s interesting and we need to hear them.
Jacquelyn Cobb (19:04): Yeah.
Paul Goldberg (19:08): I don’t understand why this hasn’t happened yet. We’re ready to publish anything that’s coming from the patient’s perspective. In fact, you know, the sooner that starts happening, the better. And the sooner patients start talking to their elected representatives, the better. Also, the other piece of advocacy that’s missing is there’s no NCI director at the moment. And that needs to happen right now.
Jacquelyn Cobb (19:44): Yeah. Is this any sort of record for how long we’ve been without one?
Paul Goldberg (19:51): Oh, I’m sure not.
Jacquelyn Cobb (19:52): It’s sort of par for the course?
Paul Goldberg (19:54): Yeah.
Jacquelyn Cobb (19:55): Gotcha.
Paul Goldberg (19:56): It’s highly unusual for an NCI director to be gone from the previous administration because they usually go from administration to administration because not really, I mean, it is a political appointment, but there, these are not political people. Or shouldn’t be.
(20:13): But most of them really would be very comfortable working for any administration because they’re about cancer. Politics doesn’t cure cancer, although political actions can make the cure happen, such as the National Cancer Act. And this is really important, because it’s been shown in over 52 years that bullshit does not cure cancer.
Jacquelyn Cobb (20:43): You mean literally?
Paul Goldberg (20:45): Literally. Bullshit does not cure cancer. It has no impact on it whatsoever.
Jacquelyn Cobb (20:50): Yep.
Paul Goldberg (20:51): That’s been shown. I’m willing to defend this point of view anytime.
Jacquelyn Cobb (20:59): Oh my gosh. Okay. Well I think we can wrap up. Katie, our director of operations, is sending me a note in the chat saying that listeners, if you would like to explore the 64-page confidential document for yourself, it’s available for download in the story from last week as a PDF. So, definitely go explore that on your own as well, if you’d like.
Paul Goldberg (21:22): Yeah. It’s quite a document. It makes for quite a reading.
Jacquelyn Cobb (21:28): All right. Well, thank you so much, Paul. See you next week.
Paul Goldberg (21:30): Thank you, Jacquelyn.
Jacquelyn Cobb (21:34): Thank you for joining us on the Cancer Letter podcast, where we explore the stories shaping the future of oncology. For more in-depth reporting and analysis, visit us@cancerletter.com. With over 200 site license subscriptions, you may already have access through your workplace. If you found this episode valuable, don’t forget to subscribe, rate and share together, we’ll keep the conversation going.
Paul Goldberg (21:54): Until next time, stay informed, stay engaged, and thank you for listening.
