It’s hard to escape the din of the nation’s prognostication industry coming to terms with its wrongness today, with so many teeth to gnash and garments to rend.
But here in the world of science and medicine, the election of Donald Trump has left many trying to make sense of the vagaries, reversals, and red herrings that have marked his rhetoric on key issues from research funding to drug pricing.
Here are five questions we have about what the Trump administration will mean for science.
1. What’s he going to do with the NIH?
The National Institutes of Health is still recovering from the deep cuts of sequestration in 2013, and China, paper tiger of many Trump talking points, is slated to outpace the US in science and technology R&D spending this decade, according to the Organization for Economic Cooperation and Development.
And yet Trump has said little of consequence about the issue. He told ScienceDebate.org that while “there are increasing demands to curtail spending and to balance the federal budget, we must make the commitment to invest in science, engineering, healthcare and other areas that will make the lives of Americans better, safer and more prosperous.” How he would strike that balance remains a mystery.
At the same time, Trump has been close to former House Speaker Newt Gingrich, who last year called on Congress to double the NIH’s budget. So there’s that.
But the next president apparently takes a dim view of the NIH as a whole. Last year, when conservative talk radio host Michael Savage offered to take over the roughly $32 billion operation, Trump deemed it a “great” idea that would bring “common sense” to the institution. “Because I hear so much about the NIH,” he said, “and it’s terrible.”
2. What becomes of the Obama-era science projects?
The BRAIN Initiative, the Precision Medicine Initiative, the cancer “moonshot”—President Barack Obama made the world of science a major focus of his second term. But it’s unclear whether those projects will have a champion in the White House over the next four years.
Greg Simon, head of the moonshot project, said last week he had yet to hear from the Trump transition team but still sounded optimistic about the future of the project.
“I’ve been in Washington since 1985, and I have never been associated with a program with more bipartisan support,” he said.
But Trump remains a wild card. He could side with Republicans like Tennessee Senator Lamar Alexander and Michigan Representative Fred Upton, who have advocated for federal investment in scientific research.
Or he could lean toward the House Freedom Caucus, a populist group of Republican lawmakers who have called for cutting federal spending across the board.
3. How will he address the opioid crisis?
Trump spent much of the campaign saying his long-promised wall on the southern border would stem the flow of illegal drugs into the US. He expanded on that a bit last month, promising to crack down on prescription drug abuse while offering help to those struggling with addiction.
But his plan was characteristically light on detail. He promised to incentivize states to handle the issue but offered no explanation as to how. (Clinton, by contrast, proposed a program through which the government would provide matching funds to states with plans for treatment and education.)
Trump also called on the Food and Drug Administration to speed up the review of new painkillers meant to be deter abuse, something that would require the intervention of Congress. He promised to increase the number of patients doctors can treat for opioid addiction, which the Obama administration has already done.
All the while, the number of US deaths from opioid overdose has roughly quadrupled since 1999, reaching a record of more than 28,000 in 2014, according to the Centers for Disease Control and Prevention. The problem is especially desperate in the rural corners of the Rust Belt, where Trump support proved strong on Tuesday.
4. Who’s going to run Health and Human Services?
The coming weeks will be consumed by speculation about the makeup of a Trump cabinet, which is reportedly going to be heavy on private-sector membership. Of key importance to the world of science and medicine is Health and Human Services, which presides over the FDA, the NIH, the CDC, and the Centers for Medicare and Medicaid Services, among other agencies.
Dr. Ben Carson — who has assailed the Affordable Care Act, called for the overturning of Roe v. Wade, and disputed the theory of evolution — is an oft-cited candidate. So, too, is Gingrich, a friend of the drug industry who has also crusaded for broader research into Alzheimer’s and dementia. Also mentioned is Rich Bagger, a longtime biopharma exec who took a leave of absence from his role at biotech giant Celgene to serve as executive director of the Trump transition team under his friend New Jersey Governor Chris Christie.
HHS departments like the FDA and NIH have long been considered essentially apolitical. But partisan fighting over drug prices and scientific appropriations could thrust those agencies into an uncomfortable spotlight. And whoever Trump picks to take over for current HHS Secretary Sylvia Mathews Burwell will play a key role in shaping science and medicine policy.
5. And what about drug pricing?
Biopharma stocks rallied on Tuesday morning because Trump is widely perceived to be less hawkish on the issue of drug prices than his opponent. Equities research firm Evercore ISI surveyed its investor clients and found that 80 percent expect major pricing reform to be effectively off the table in a Trump presidency.
But that assumes the sort of business-as-usual Republican administration that values free markets and shies away from imposing new regulations on industry. Trump rides into office with a populist message that might make dyed-in-the-wool fiscal conservatives nervous, and parsing his admittedly sparse statements on the issue paints a murkier picture for the drug industry. He has called for Medicare to be able to negotiate directly with drug companies on price and has argued for allowing drugs to be imported from other countries, two ideas well outside Republican dogma.
For now, which way he goes is anyone’s guess.