As NIH and NCI funding is negotiated in Congress, Paul W. Thurman felt compelled to crunch some numbers. He compared the U.S.’s cumulative funding for NCI to the funding slated for ICE—the latter of which vastly outweighs the former—and asked whether the funding priorities of the federal government are properly representing the nation’s mortality.
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“I think the way a government or the way a people spends its money talks not only about its priorities, but about its morality,” Thurman says in this episode of In the Headlines. “And I would argue that perhaps we’re losing a bit of our moral compass by appropriating in this disproportionate way towards something that does not cause nearly the death and destruction and psychological damage that a disease does. And when you start reducing the number of cancer researchers that can be hired…”
Thurman is a professor of management and analytics at the Joseph L. Mailman School of Public Health of Columbia University Medical Center appeared on the podcast as a special guest to discuss the editorial he wrote for last week’s issue.
In this episode of In the Headlines—the first since The Cancer Letter’s August publication break— The Cancer Letter’s editorial staff talks about the three major events covered in last week’s jam-packed issue:
- The House subcommittee on Labor, HHS, Education and Related Agencies reported out its version of the spending bill for FY26, which would provide $46.9 billion for NIH’s base, representing a $99 million (0.2%) increase over the FY25 level of $46.8 billion,
- The appearance of HHS Secretary Robert F. Kennedy Jr. before the Senate Finance committee, where he was questioned about his changes at the CDC, and
- The meeting of the National Cancer Advisory Board, at which NIH Director Bhattacharya made a rare appearance and fielded questions from oncology leaders about funding, political oversight in scientific grant review processes, and DEI.
In the podcast, Paul Goldberg, editor and publisher of The Cancer Letter, Jacquelyn Cobb, associate editor, and Claire Marie Porter, reporter, debrief about what these events mean for the oncology community.
Stories mentioned in this podcast include:
- Bhattacharya fields NCAB’s questions about funding, political involvement in grant review, DEI, animal testing
- House committee’s FY26 spending bill increases NCI funding by $48M, NIH by $99M House joins Senate in rejecting Trump’s proposed 40% NIH cuts
- Lowy: Forward-funding policy forced NCI to drastically reduce RPG awards funded for FY25, 10% of NCI staff has been lost
- With CDC in free fall, RFK Jr. faces bipartisan rebuke at Senate hearing Kennedy calls CDC “the most corrupt agency at HHS and maybe the government.”
- Curing cancer or curbing immigration: A question of national morality and priority
- Knight Cancer Institute receives record-setting $2B gift from the Knights—and self-governance within OHSU Brian Druker returns to executive role as president of the new Knight Cancer Group
- The departure (and return) of Vinay Prasad
This episode was transcribed using AI 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: This week on the Cancer Letter Podcast…
Paul Thurman: If we go with the hypothesis that there’s a lot of criminals and a lot of murders and a lot of crime that’s being committed by illegal immigrants that we want to now remove from the country, that number is statistically insignificant.
Hey, no, we don’t want anybody to die in anyone’s hands. Okay. And I’m not here to say that this is necessarily an either-or argument. Namely, we should fund cancer and not fund Border Protection. We want strong borders and we want protection, and we want people to be in the country legally. But if you look at the, in business terms, the return on investment, with far less money, the war on cancer is saving more lives and putting a bigger dent in death, if you will, than other expenditures.
Oh, and by the way, just in case you’re curious, I told you what the ICE budget is of roughly 28 billion a year with this infusion of another 168 billion. The National Cancer Institute budget for this year is $7.2 billion, and under the current proposal by the president and the fiscal budget for 2026, that number will reduce by 37%.
Paul Goldberg: 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: 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: So, let’s get going.
Jacquelyn Cobb: Hello, guys. How’s it going?
Claire Marie Porter: Hi.
Paul Goldberg: Hi. How are you, Jacquelyn? How are you, Claire?
Claire Marie Porter: Really good.
Jacquelyn Cobb: Good. We are all back from our three-week-long August publication break. I assume you all had a wonderful time. I have heard snippets already, but any highlights that you all want to share?
Claire Marie Porter: We went to Maine, which is a familiar territory for you, but it was first time for my family. So we drove up there in our little Fiat, and we parked it and took a shuttle to a ferry and a ferry to an island, and had a really wonderful time. Didn’t get to do as much as I wanted, but still saw a satisfying amount of wildlife, and yeah, ate a lot of good food.
Jacquelyn Cobb: What wildlife did you see?
Claire Marie Porter: Well, I really wanted to go whale watching or puffin watching, or any of those other excursions that you can do from Portland, but we just couldn’t fit it in. I did see just a ton of pelicans and loons, and we caught a bunch of hermit crabs and regular crabs, and probably more that I’m forgetting. But yeah, it felt like very unlike the beaches I’m used to going to the New Jersey beaches, they were so wild. And there was always something under a rock. It was really, really fun for us. Yeah.
Jacquelyn Cobb: Yep, yep. Being familiar with both New Jersey beaches and Maine beaches at this point, I can definitely confirm.
Claire Marie Porter: Very different.
Jacquelyn Cobb: Yeah. Yeah, different. And both of those very different from Florida beaches. Just-
Claire Marie Porter: Yeah. Never been there either. Can’t compare.
Jacquelyn Cobb: … wow. Well.
Paul Goldberg: And the journalists, of course, were superbly trained to look under rocks.
Jacquelyn Cobb: True.
Claire Marie Porter: Well, and I started out more in environmental journalism, so I’m especially trained to look under rocks and logs. And I do. A lot. Even when I’m not on the clock.
Jacquelyn Cobb: I’ll have to pick your brain, Claire, because I went on a run yesterday and I saw this crazy orange, bright orange mushroom that I’m… But they were little dots everywhere. I’m going to have to ask you about it and show you pictures, because-
Paul Goldberg: I can tell you what it is.
Jacquelyn Cobb: Yeah. Bright orange. Bright orange.
Paul Goldberg: Oh, no. I can give you the Russian name for it, which is Mukhomor, which is, actually, I think also an English name for it. And I do believe that… I wouldn’t recommend it to anybody, but that might be hallucinogenic and it’s used that way.
Jacquelyn Cobb: Wow. All right.
Paul Goldberg: Might also kill you. So I have no idea.
Claire Marie Porter: Yeah.
Jacquelyn Cobb: As mushrooms go, it seems to be the way. I’ll have to do more research. Maybe go back.
Paul Goldberg: In Vermont, which is where I was. So we were all in New England. It’s really interesting. I was trying to pick mushrooms, as I always do, and I’ve done this for decades and many more than I care to admit. My mother taught me when I was six or seven, so I’m pretty good in North Woods. And this is the first time in Vermont that there were almost no mushrooms.
Jacquelyn Cobb: Really?
Claire Marie Porter: Too cold?
Jacquelyn Cobb: Why is that?
Paul Goldberg: I have no idea. It was a very dry summer. You need a lot of water and so for moisture and for the mushrooms. But yeah, I couldn’t find any mushrooms.
Jacquelyn Cobb: None? Not any at all this-
Paul Goldberg: None.
Claire Marie Porter: Wow.
Paul Goldberg: I had enough to one time to sort of save up to make a mushroom and barley soup, but I supplemented it with dry mushrooms from last year.
Jacquelyn Cobb: Okay.
Claire Marie Porter: Wow.
Paul Goldberg: Never seen this before. I mean, places where there were always more mushrooms, tons of mushrooms. There weren’t any.
Claire Marie Porter: And it’s not a case of over foraging. Like, no one’s in those woods? You’re not sure.
Paul Goldberg: I’ve never seen anyone who had been in those woods.
Claire Marie Porter: That’s strange.
Paul Goldberg: Well, lots of people in those woods. Not lots. Some people in those woods, but most of them have no idea what kind of a mushroom is going to kill you and what kind of a mushroom-
Jacquelyn Cobb: Yeah. Yes. So, they should not be foraging, though they might be anyway.
Claire Marie Porter: What about you, Jacquelyn? What did you do? I don’t think I’ve had a chance to catch up with you yet.
Jacquelyn Cobb: Yeah, I really did not much of anything. I read a lot and laid in my house in Portland, which is still new for me because right after we moved in, we went to Peru. So now it’s almost fully decorated, and it just has a lot of outdoor… We have a porch and a little deck thing. So I literally just laid in the sun for most of the month.
Claire Marie Porter: Nice.
Jacquelyn Cobb: So, it was very needed. It was like a nervous system reset after the crazy year. And then as a transition anyway, we came back to a doozy of a week. I think for me, I was thinking back to a week that was crazier than last week, and I think it was only the Marathon ODAC can compare to what happened last week. That was insane. So I’ll take us through the headlines, but there are a lot of them, so bear with me.
Really, what drove the craziness was that it was a shortened week, obviously, and then also there were two pretty major events happening on Thursday morning. And I’m sure most listeners would know, but we publish on Friday morning. So we had a lot of copy to write and a lot of stuff to digest and get re-familiarized with, as after the break, to write and publish on Friday within 12 hours. So it was a sprint instead of a marathon this time. But yeah, so the two major events were the NCAB meeting, the National Cancer Advisory Board meeting. It was the second one since Trump was inaugurated. And it had NIH director Jay Bhattacharya as a speaker, which is apparently an incredibly rare event to have the NIH director speak and importantly hold an open Q&A session at this event. So that was our lead story was focused in on that Q&A mostly, and sort of almost like a roundup of recent policy changes at NIH through that Q&A. So focused, obviously, on oncology.
Our second story was about the house spending bill that was reported out last week. It was a huge signal for the oncology community and for NIH more broadly that the house is sort of on track to join the Senate in rejecting President Trump’s budget proposal that would cut NIH by $18 billion. So both the Senate and the House bills give modest increases to both NIH and NCI. We also reported on NCI acting director Douglas Lowy’s remarks at the NCAB meeting, which included some important sort of how the House… Well, not even just the house, but how the Congressional budget news is affecting NCI and how the institute plans to prepare for forthcoming news events from Congress.
And finally, Claire wrote a story about the RFK or Robert F. Kennedy Jr. hearing before the Senate Finance Committee. Just in case listeners aren’t aware, that is the HHS secretary. And that was a really highly charged event. I will let Claire talk about that later in the podcast, but that is definitely a juicy story to read when you have a chance. And then, yeah, Sara, our fellow, she, because we were all, she took on a lot of the cancer policy stories, which is really more than we would normally expect for a fellow. And she really took it in stride. She also was going over, or she also produced the backlog of the month of briefs that we had missed. So somehow she managed to get a… I don’t even know how to put it in words, how much work she got done. So really just an incredible team effort last week to get everything done. And we didn’t even have that late of a Friday, so we made it work.
And then, yeah, the last thing I’ll mention is that one of our stories, we actually published it in our issue, was a special report from the August break featuring Brian Druker of Knight Cancer Institute, who returned to his executive role as president of the new Knight Cancer Group. So you can definitely check that out. That is also a podcast as well. So you can find that on Spotify or in our issue from last week.
But yeah, so that’s a lot. Obviously, there’s more to talk about. Like I said, cancer policy was packed. We had in the archives and the briefs were huge as well. But yeah, if we want to dive into probably some more of the details, all four of our main stories last week were really worth diving into. So I would probably start with story one, just to keep it chronological.
Paul Goldberg: I would actually suggest that we start with story two, because I think that’s really fundamental. I generally keep my mouth shut on these choices, but I think story two is where things are crucial. I think it’s important to talk about Congress. You and I wrote that story, mostly you. What does it say about Congress?
Jacquelyn Cobb: Yeah. I mean, I think the major thing is that bill is sort of getting mixed reviews from various communities. Take out oncology. Take out even biomedical research. There’s lots in that bill, obviously. But for our readers and our particular focus, for NIH and NCI, it’s a pretty great news, or pretty good news, I guess I would say more conservatively, because like I said, it sort of signals that the House is joining the Senate in rejecting Trump’s major cuts.
Specifically, I can give you the numbers. Basically, it includes a 46.9 billion budget for NIH’s base, which represents a 99 million or 0.2% increase over FY ’25 levels. And NCI, specifically, would receive 7.3 billion, which is a boost of 48 million or 0.7% above FY ’25 levels. So I think I’ve heard some people say that with inflation, that’s almost kind of like flat funding. It’s nothing crazy. But again, compared to what we were fearing when we saw the president’s budget proposal, this, like the Senate bill, is great news. It’s wonderful.
Paul Goldberg: Yeah. And it’s not just that. That bill… The President’s budget request proposed consolidating a bunch of institutes and cutting a bunch of them out, completely destroying them. And here, NCI is getting the largest increase of them all. The institutes are being kept as they are. And by the way, a couple of years ago, a year ago actually, the House Energy and Commerce suggested the blueprint where they really originating the idea of consolidating a bunch of institutes. Also, wouldn’t you say that there is something really interesting with the fact that the Office of Minority Health?
Jacquelyn Cobb: Yeah. That stays flat, which I kind of expected it to be cut, considering… And yeah, that stays flat. That’s still there. The Make America Healthy Initiative did get $100 million, but it did not, or the bill did not actually establish the administration for a Healthy America, which was in the Trump’s proposed budget. The Fogarty International Center is still there. The National Institutes for Nursing Research, the National Center for Complementary and Integrative Health, all these were slated to be cut in the Trump proposal, but are still there. Again, albeit flat funding, but they’re still there in the house spending bill.
Yeah, I mean, from what I could see, the main cuts on the NIH or HHS side are for ARPA-H, the Advanced Research Project Agency for Health, which got a $555 million cut, which was 37%. So that seems to be a big chunk of where they got this spending money. And the bill also eliminated the funding for Agency for Healthcare Research and Quality, although I don’t actually off the top of my head right now know how much that was, like the dollar amount.
But yeah, it is surprising all around. There’s not too much. I mean, I will say, and this sort of ties into Claire’s story, the bill does include a, what is it, a 7.4 billion… It includes 7.4 billion for CDC, which is a cut of 1.7 billion below 2025 level, which is sort of its whole other news beat, I would say, CDC specifically. And that’s obviously receiving a lot of not so great reviews and feedback from the community as well.
Paul Goldberg: It’s interesting because the lobbying that occurred was aimed at, I believe, at moderate Republicans in the House and Senate. And it seems to have worked. It’s really probably an unprecedented lobbying campaign or at least of unprecedented effectiveness. Lots of people were working together on this and there was strategic thinking happening, which just kind of creates an interesting thing because Democrats aren’t really happy about the House bill.
Jacquelyn Cobb: Yeah. Yeah.
Paul Goldberg: It’s kind of a war between Republicans. It’s a new kind of situation… But should we talk about CDC or should we talk about HHS, or should we talk about the Kennedy hearing or should we go to NCAB?
Jacquelyn Cobb: Lots of them.
Paul Goldberg: You decide. I decided on one. You decide on the other.
Jacquelyn Cobb: I would say, why don’t we take the CDC path to RFK? That would be my choice. If you want to talk a little bit about it, Claire.
Claire Marie Porter: Thursday morning, Kennedy appeared before the Senate Finance Committee for the first time since May, I believe. Meaning, this was the first time that senators had the opportunity to question him about the upheaval and chaos at CDC. So he has effectively fired and replaced the Vaccine Advisory Committee. Susan Manares’ ouster happened while we were on break, followed by three other CDC, top CDC folks. So there’s a lot of feelings. It was probably one of the longest and most contentious… I’ve sat through, I think, all of the Senate and House hearings since the beginning of the year, doing the Lord’s work. And I think this was the longest and most stressful across party lines. Everyone had a bone to pick with Kennedy, it seemed, at this particular hearing.
And vaccines, as they usually do with him, are the focal point. There were some very angry Republicans. Bill Cassidy among them, who was his deciding vote in his confirmation. Kennedy’s deciding vote who had kind of been on the fence and hesitant to cast that vote because of Kennedy’s stance on vaccines. Kennedy, I guess on and off camera, reassured him that he would not make it more difficult for people to take vaccines. Cassidy’s take is that, that commitment has not been upheld and that it is indeed harder for a lot of people to get the COVID vaccine in particular, and he’s worried it’s going to get harder. He submitted documents showing that he has proof of that happening. What else? John Barrasso of Wyoming, Ron Johnson of Wisconsin, both Republican senators, were also a pretty upset and kind of challenging Kennedy on his commitments and his inconsistencies on vaccines.
Right now, it’s kind of a wait and see. Is Trump going to let this go on? His response to reporters, I believe, in the Oval Office and then again at a dinner, was that he didn’t watch the hearing. That he’d heard a lot about it. And that Kennedy’s position is kind of a tough stance on vaccines. His quote was, “You have some vaccines that are so incredible. And I think that you have to be very careful when you say that some people don’t have to be vaccinated.” Which is interesting, because one of the talking points that kept coming up was Operation Warp Speed, which Trump was obviously behind and a big part of.
And the senators challenging Kennedy on whether or not Trump deserves a Nobel Prize for Operation Warp Speed. And he said that he did believe he deserves a Nobel Prize. So it was kind of this catch-22. So if you believe he deserves a Nobel Prize, but you’ve also said that the COVID-19 vaccine is the deadliest vaccine of all time. What is the truth? What do you really believe? And Kennedy, the whole time, in kind of in attack mode. And yeah, it was contentious.
Paul Goldberg: Yeah, it was a brawl. Covering a brawl. It’s interesting that your beats, two of them are Vinay Prasad and RFK Jr.
Claire Marie Porter: I didn’t ask for this life. It happened to me.
Paul Goldberg: I’m glad you’re leading this life.
Claire Marie Porter: Yeah, it’s interesting stuff. It’s definitely kind of a fun trajectory to watch. I feel very invested in these people’s lives. So Vinay is back, too. I don’t know if people saw that, but he’s back.
Paul Goldberg: Yeah, you wrote that story.
Claire Marie Porter: That story as well. It’s in Cancer Policy.
Paul Goldberg: Yeah. Yeah. So, more brawls to come. Will keep you entertained [inaudible 00:20:32] this. But Kennedy, I think, is… There’s more to be seen with Kennedy. It’s not over. I just don’t feel like it’s… I don’t know, I would not bet more than $5 on him being here next year.
Jacquelyn Cobb: Yeah.
Claire Marie Porter: Yeah.
Paul Goldberg: I might bet. $3.
Claire Marie Porter: It feels like a boiling point. Maybe, yeah, a boiling point. Or maybe the boiling point has passed and now the pot is boiling over a little bit. That’s what it seems like. That’s what it felt like. I’m not a political analyst, but intuitively that’s what it felt like.
Paul Goldberg: Yeah, that’s all we’ve got is our intuitions.
Claire Marie Porter: Yeah.
Paul Goldberg: Yeah. Maybe we should talk about now the lead story. Because to me, the most interesting thing was what Bhattacharya said in response to question from one of the NCAB members, Dr. Boxer of UCLA. He said, nope, it’s not going to happen. The 40% cut’s not happening. That to me was a highlight. It’s not going to happen.
Jacquelyn Cobb: Yes.
Paul Goldberg: What worries you guys the most about what is happening? Would they actually spend the money the way Congress intends it, or spend it on some research that NIH doesn’t necessarily want? What would be your guess?
Jacquelyn Cobb: Yeah. I guess I could say I’m a little concerned. Again, not a political analyst and still a very young reporter in this field, but something that’s sort of made the hair on the back of my neck stand up a little bit is the sort of next level of grant review or an additional level of grant review at NIH by Trump-specific political appointees. And I think we’ve covered that. Again, there’s a lot of news going on, so I forget in how much depth we’ve covered it, but some people are saying that it’s a little bit concerning that an additional level of potential politicalization can be introduced into a very scientifically rigorous process.
On that note, and again, this is sort of like things are all happening at the same time-ish, but Bhattacharya said that one of his new priorities, which he laid out some of them in his remarks, and then he spoke to some of them in response to the questions that were asked. So in his prepared remarks for the NCAB, Bhattacharya actually talked about a new unified grant funding policy. I haven’t seen this reported before. I’m not sure if this was the first time he ever spoke about this. I’ll have to double-check moving forward. But basically, it would move NIH on the whole away from a payline-based funding model.
He did say that about half of the institutes and centers already do this, but he basically said that NCI is going to have to introduce a new variable when considering which grants to give funding to, which grant applications. Basically, he said, quote, “Paylines are no longer the primary driver of funding decisions.” And it asks NCI to introduce… Basically, the variable is how well a grant aligns, quote, unquote, “aligns” with the strategic vision of the institute. So it introduces a less scientific objective metric into the grant review process.
So, yeah, I mean, we’ll have to keep a close eye on that. But basically, it allows NCI or its institute and center directors, but NCI director, of which we do not have one, to basically make these grant decisions or supersede these grant decisions that are based entirely on scientific merit and add in this, again, alignment with NIH’s priorities, research priorities.
Paul Goldberg: Well, also to me, it was interesting to see on the NCAB side, Doug Lowy’s comments. To me, the headline is what’s going to happen to grants next year as NCI transitions to a new system, where they fund grants for their entirety as opposed to… So what does it do to the payline? Not that payline is any longer a payline.
Jacquelyn Cobb: Yeah, seriously. Yeah. So, I mean, we reported a couple of weeks ago that NCI published their sort of funding policy document, and that said that the payline will be up to the fourth percentile, which is a historic low. We’ve covered that in the past. But this, what, Paul, you’re referencing is this upfront funding or forward funding, multi-year funding. There’s a couple different words for it. But basically, the Trump administration is asking NCI and other NIH institutions and centers to give grants their entire funding upfront rather than basically spreading it out over four or five years.
And so if you have this RPG, research project grant, pool of money, and you’re used to spending, I think… What was it? It was… I forget exactly the numbers, but a certain amount of it is… I think it might be… What is it? It’s like 80% or something, Paul. A huge chunk of it, right?
Paul Goldberg: It’s a chunk.
Jacquelyn Cobb: A huge chunk. I think it would be more than half, is dedicated to paying off previous year’s grants.
Paul Goldberg: About 80. Yeah, yeah. The mortgage.
Jacquelyn Cobb: Yeah, the mortgage. I heard that for the first time last week when you said that. And so when you’re expecting to use this 20% to fund new grants, but then you’re also having 80%, or whatever the percentages are, but this huge chunk going to last year’s and the previous year’s multiple grants. And then the Trump administration comes in June and says, actually every new grant you give out… Or I think it’s 50% at this point. But ultimately, every new grant you give out has to be given out entirely upfront. That drastically reduces the number of new grants you can give out, of course, because there’s limited money. Larger payment of grants means lower number of grants.
So basically he said, and we did some digging. There’s a little bit of specifics being a little bit in the weeds, but Lowy did say that through this process, specifically with R01, and I believe it’s R37 grants, they expected to give out 700 awards in 2025. But after this new policy basically came down, and they are required to do 50% of their new grants to be upfront funded, they’re only going to be able to give out 400 of these grants. So it nearly halving… Halving. It’s nearly halving. Halving. Halfing.
Paul Goldberg: Halving, it’s a dessert. It’s halva.
Jacquelyn Cobb: Halva. Yeah. That’s where I thought you were going, but I wasn’t sure.
Paul Goldberg: Yeah. This is not a dessert. This is something else entirely.
Jacquelyn Cobb: The opposite. Yep. The opposite bitter pill instead. So yeah, it’s not good. I mean, I think the interesting part of all of this is that even if Congress says funding stays flat, indirect costs are fine as they are, there’s no cap on indirect costs. The Trump administration’s actions still have fiscal impact on the institute that can hurt researchers. And so I think it’s important to just sort of scale back a little bit sometimes when we’re covering like spending bills and stuff like that. That’s like there’s other stuff going on that is negatively impacting the field.
Paul Goldberg: Well, thank you. This is an amazing summary.
Jacquelyn Cobb: Yeah. It might be one of our longer podcasts, but there’s a lot to say, so we got to get it done.
Paul Goldberg: Yep, yep. I guess the moral of the story, we should never take a publication break anymore and just keep working around the clock all time.
Jacquelyn Cobb: It seems like. Yeah, the whole year. The whole year. We can’t take the, what is it, the Congressional recess?
Paul Goldberg: Yes. We [inaudible 00:29:05]-
Jacquelyn Cobb: Anymore.
Paul Goldberg: No recesses. Just work, work, work, work.
Jacquelyn Cobb: Thanks, Donald Trump.
Paul Goldberg: Yeah. Hey, thank you. So, also, this week we had a fantastic guest editorial by Dr. Paul Thurman of Columbia. Dr. Thurman is a professor of management and health management, and he looked at the priorities that this country has been exhibiting, and spending more on ICE than on cancer research and kind of looked, taking more of a historical view of it.
And Dr. Thurman, how did you come up with this idea of doing this calculation?
Paul Thurman: Well, first of all, Paul and the rest of The Cancer Letter team, thank you for having me on. It’s a delight to be a part of the conversation. I appreciate you mentioning the editorial.
I got interested in this, having some conversations actually with some colleagues of mine, both here at Columbia and at the National Cancer Institute where I do a bit of teaching to their research fellows. And when the articles started coming out with the numbers around what parts of the big, beautiful bill would be spent on immigration or on border enforcement, we simply asked the question, hey, how much are we spending on cancer research? And how much are we spending on the NIH in general? And what are those orders of magnitude? And it turned out that not all of us knew any of the numbers. What was the ICE and border number? What was the NIH or the NCI numbers?
So I did a little bit of digging and discovered that there’s a lot of money that’s being set aside for ICE and for border enforcement, and actually a potential decrease from an already small number for the National Cancer Institute for cancer research.
Paul Goldberg: So when you look at the numbers, cumulative numbers of spending on NCI from 1971, which is, ’72, really, is what we should look at on, but these are small numbers in ’71, and compare it to what’s in store for ICE. I love those numbers. That was the thing that jumped out at me in that piece you wrote.
Paul Thurman: Well, and thank you. Not only did they jump out at me, just the fact that one of them has an extra digit or two than the other.
Paul Goldberg: Right.
Paul Thurman: And that they’re so different is what sort of urged me to write the editorial. If we go all the way back to President Nixon, which my first memories of television were the Watergate trials, just as a side note, but if we go all the way back to when he declared war on cancer in ’71 and then the appropriations were made in ’72, that’s when the head of the National Cancer Institute became a presidential appointee, just like the head of the National Institutes of Health. If you look at how much money’s been spent in those 54 years since the NCI was founded, since the war on cancer was started, perhaps they should have called it the Department of War on Cancer back then or something.
Paul Goldberg: Nice. Right.
Paul Thurman: But if you look at the numbers in nominal terms, so if you just add up the dollars without accounting for inflation, you get to about $180 billion that have been sent on the National Cancer Institute. If you adjust that for inflation since the early ’70s, you get to about 322 billion in real terms. So inflation-adjusted numbers, 322 billion over 54 years.
Now, if you compare and contrast that to some of the ICE numbers and Border Protection numbers that have come out, the big, beautiful bill, the big reconciliation package that was just passed by both houses of Congress, ICE and Border Protection, and these numbers are coming from the New York Times and the Cato Institute and other sources, the annual ICE budget, annual ICE budget in today’s dollars will increase from about 8 billion to 28 billion. So a 20 billion increase. That’s an annual budget, by the way. That’s one year.
And the government will also create over a five-year period, an additional infusion of roughly a total of, I believe, 168, 170 billion. So you get 28 billion a year, and you get a sort of a kicker over five years of 168 billion. So if you do the math on that in current dollars… Remember, total over 54 years for the NCI is about what I said before in terms adjusted for inflation, 322 billion. Now, compare that to 168 billion one time and 28 billion a year. In just a few years, ICE and Border Protection will have been appropriated as much money in just a few years as the National Cancer Institute has had in this entire history.
And that’s okay. We’ve spent certainly a lot of money on defense, and we’ve spent money on other priorities. But let’s think about the real impact of that investment, and that’s where things started to get very interesting. You can trace just about any drug, particularly a cancer drug, back to some National Cancer Institute funding, whether it was research that was funded at the NCI itself or funded extramurally to a university like Columbia, the NCI giving us grants to do drug development and clinical research and clinical trials. So if you look over those 54 years, there’s been a bit more than 100 anti-cancer drugs developed all with explicit ties back to that $322 billion over 54 years. Okay. And by the way, those drugs have saved a lot of lives. They’ve extended the life.
We’ve actually cured some cancers. We don’t have germ cell or testicular cancer really anymore, if you think about the Lance Armstrong cancer. A lot of childhood leukemias, we don’t worry about. Hodgkin’s lymphoma has pretty much been eradicated. So there’s been a lot of cures, and certainly quality of life extensions, thanks to those medications. On the other hand, so that’s the improvements, but now look at the costs in terms of lives. Let’s excuse the dollars for a moment. Let’s just look at lives. The number of lives that have been saved by cancer medications and by the research that the NCI has done. We’ve roughly cut the death rate of cancer by 34% over that time period. So that’s a lot of lives saved. Now, just to be clear, there’s still a lot of people affected by cancer even since that war began. About 27 million lives have been lost to cancer in those 54 years. And every year, about 600,000 people die.
That’s cancer, and cancer being very broad. All forms of cancer. Cancer is going to affect one in three Americans in their lifetimes. That doesn’t even include the families that are affected by those deaths or by that disease. I’m sure all of us know somebody, either a personal friend, an acquaintance, a family member that’s been affected by cancer in some way. So that’s sort of the battle we’re fighting, the true war that we’re fighting in some sense of the casualty rate. Let’s compare that now to something that is similarly funded in a fraction of the time, ICE and Border Protection. If we go with the hypothesis that there’s a lot of criminals and a lot of murders and a lot of crime that’s being committed by illegal immigrants that we want to now remove from the country, that number is statistically insignificant.
Hey, no, we don’t want anybody to die in anyone’s hands. Okay. And I’m not here to say that this is necessarily an either-or argument. Namely, we should fund cancer and not fund border protection. We want strong borders and we want protection, and we want people to be in the country legally. But if you look at the, in business terms, the return on investment, with far less money, the war on cancer is saving more lives and putting a bigger dent in death, if you will, than other expenditures.
Oh, by the way, just in case you’re curious, I told you what the ICE budget is of roughly 28 billion a year with this infusion of another 168 billion. The National Cancer Institute budget for this year is 7.2 billion. And under the current proposal by the president and the fiscal budget for 2026, that number will reduce by 37%. So 7 billion [inaudible 00:38:33]-
Paul Goldberg: That won’t happen because… I hope won’t happen, but might. Who knows?
Paul Thurman: Right.
Paul Goldberg: We don’t know. But it’s unlikely to happen if Republicans in Congress have their way.
Paul Thurman: Right. And again, I’m not here to say… I’m certainly pro-cancer treatment and pro-cancer research. I’m also pro-immigration. But let’s look at sort of the morality and the prioritization of these things. As I say in my editorial, I think the way a government or the way a people spends its money talks not only about its priorities, but about its morality.
And I would argue that perhaps we’re losing a bit of our moral compass by appropriating in this disproportionate way towards something that does not cause nearly the death and destruction and psychological damage that a disease does. And when you start reducing the number of cancer researchers that can be hired… By the way, to that point, ICE is expanding its ranks to 14,000 employees. The National Cancer Institute right now has about 4,000 employees, probably fewer because that number does not yet account for the Department of Government Efficiency cuts. So you’re talking about-
Paul Goldberg: [inaudible 00:39:55]-
Paul Thurman: … 4,000 cancer researchers and 18,000, excuse me, 14,000 ICE employees. What problem are we really trying to solve here? And which one is going to have a bigger impact on, quite frankly, the health of the United States?
Paul Goldberg: And the world. But it’s also interesting that if you were to take the budgets of the predecessors of ICE, all of the preceding agencies, this would be a Herculean task. And add that up from 1971 up, you would have an even stronger case. But we’re-
Paul Thurman: That’s right.
Paul Goldberg: … doing a little impressionistic numbers, and you still get that. You still get the argument. And I don’t think anybody is suggesting that borders should not be guarded.
Paul Thurman: Agreed. Agreed. We want strong immigration reform and policies that you’re welcome to be in the country as long as you’re here illegally. As long as you’re legally. Excuse me.
Paul Goldberg: Yes.
Paul Thurman: You’re not here illegally is what I’m meant to say.
Paul Goldberg: Right.
Paul Thurman: But we also want to be able to protect you from a disease that affects one in three of us. It’s interesting. There are three of us right now on these panels.
Paul Goldberg: Yeah.
Paul Thurman: Anybody want to flip a coin?
Paul Goldberg: No.
Paul Thurman: And we all know each other. So, now we will know someone, right? So what is the real moral priority and perhaps the economic priority? And I think strengthening one part is fine, but strengthening one part at the expense of potentially allowing a disease to spread more. And this is not without precedent. We’ve seen measles outbreaks. We have the state of Florida that wishes to perhaps have its own vaccine policy, and other states that are perhaps developing their own policies.
So if you start to run numbers and play games like that, we would hope that no matter how we want to make our populace healthy, whether it’s through reducing crime or reducing the incidence of cancer, we should support that. I think that there’s a proportional way to do that. And I would question some of our priorities and our spending habits. I’m not sure if it were my checkbook, I’d be writing checks like this.
Paul Goldberg: Right, right. That’s a very interesting argument. Just seeing it all together to me was, huh, that’s brilliant. So there we are. Thank you very much for joining us, and thank you for writing the piece, and please write more.
Paul Thurman: My pleasure. Thank you. And looking forward to collaborate more with you, not only as a professor and sort of thinker about this stuff, but also institutionally. We at Columbia are delighted to be part of the family, and we’d like to be more so moving forward. So we’ll keep that going.
Paul Goldberg: Oh, yes. That would be fantastic. Thank you.
Jacquelyn Cobb: 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 at cancerletter.com. With over 200 site licensed 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: Until next time. Stay informed. Stay engaged. And thank you for listening.
