Category: Blog

The Politicization of Research: NIH Cuts, DEI Litigation, and the Future of Health Equity Research

Under the Trump administration, hospitals, medical schools, and academic research centers have faced an increasing wave of legal and regulatory challenges to diversity, equity, and inclusion (DEI) initiatives. What began as coordinated complaints to the U.S. Department of Health and Human Services Office for Civil Rights quickly expanded into a massive wave of National Institutes of Health (NIH) grant cancellations.  

According to a Congressional Research Service review of HHS data, as of November 28, 2025, the department had terminated 977 NIH grant awards, representing approximately $1.7 billion in obligated funding, pursuant to a presidential memorandum. As noted in a dissent authored by Justice Ketanji Brown Jackson, NIH grant terminations have been historically rare. From 2012 to January 20, 2025, the NIH terminated fewer than 6 grants midstream in the 13 years. However, starting in February 2025, the administration took a drastic departure from that when they terminated $1 billion in NIH grants focused on disparities research. In the termination letter from the NIH, researchers were informed that their grants were ended because the projects allegedly “harm the health of Americans,” “offer a low return on investment,” or “fail to improve health, extend or reduce disease.” Many researchers felt that their research “was not evaluated on its merits, but nixed because words like ‘race’ or ‘gender’ were in the project’s title or description.” Additionally, in August, the NIH Director, Dr. Jay Bhattacharya, announced a new unified strategy for research priorities, stating that “research based on ideologies that promote differential treatment of people based on race or ethnicity, rely on poorly defined concepts or on unfalsifiable theories, does not follow the principles of gold-standard science.”

In June 2025, two lawsuits filed in federal court in Massachusetts challenged actions by the Trump administration and resulted in the restoration of more than 2,000 previously terminated grants. In August, the Supreme Court held that the lower court likely lacked the jurisdiction to review the termination of research grants focused on disfavored topics and populations, but declined to block the district court’s ruling. In December 2025, an additional agreement with the plaintiff required the administration to reconsider certain DEI-related research proposals, leading to the release of over 100 grants whose reviews had been on hold, and stated that decisions on additional grants would be made in the coming weeks. However, in remarks on a podcast in December last year, NIH Director Jay Bhattacharya suggested that the reinstated June grants may only offer temporary relief and could be terminated in 2026. He stated that “when it comes to renewal, those grants no longer meet NIH priorities. . . So when they come up for renewal over the course of the year, we won’t renew them.”

Physicians and academic researchers worry that the NIH cuts may slow down innovation and ultimately undermine patient care. The Association of American Medical Colleges (AAMC) has argued that these developments threaten biomedical research and academic medicine more broadly. AAMC warns that the termination of NIH grants could risk access to treatment for clinical patients and slow scientific progress. Beyond immediate funding losses, legal scholars note that the uncertainty surrounding grant renewals, shifting research priorities, and ongoing litigation has created a chilling effect within academic medicine, prompting institutions to reevaluate compliance frameworks, research portfolios, and DEI-related programming to mitigate enforcement risk. 

According to recent coverage, the researchers have now moved to remove terms related to DEI and health disparities from research grants. Additionally, organizations have compiled lists of diversity-related language based on manual reviews of grant materials, which have since been circulated among research institutions and online forums frequented by scientists. Other reports have described researchers as self-censoring their language around diversity to secure grant funding. Experts have also stated that the termination of grant programs that support students from underserved backgrounds “could close off scientific careers for individuals who wouldn’t otherwise have access to research opportunities.”

From a legal perspective, these changes represent both regulatory and funding risks. According to the AHLA Fraud and Abuse Practice Group, board and compliance officers now have toevaluate DEI programs not only under Title VI and Section 1157 frameworks, but also in light of the sustainability of the research portfolio. Compliance Officers must now review all federally funded programs to ensure eligibility requirements and documentation are in place. They must ensure that disparity-focused research is framed in scientifically and population-neutral terms. They must also closely monitor NIH statements and funding guidance updates and develop contingency plans for non-renewal scenarios. 

The Consolidated Appropriations Act, 2026 (P.L 119.75) rejected the Trump administration’s proposed 40% NIH cuts, instead providing an increase of $210 million. The legislation also included a provision blocking the Office of Management and Budget’s multi-year funding proposal, which contributed to 2,000 fewer NIH grants being awarded in 2025. This represents a promising sign for medical research, but it does not fully resolve the instability surrounding NIH priorities, grant renewals, and administrative overhaul. Whether courts ultimately constrain the executive branch’s authority to deprioritize entire categories of research remains unsettled. The central question moving forward is not only whether DEI-related programs will remain legally defensible, but also whether the nation’s biomedical research can continue to address documented disparities amid shifting political priorities.

Overcompensation?: The FDA Nixes Boxed Warnings for MHT Drugs

The U.S. Food and Drug Administration (FDA) recently removed boxed warnings for six menopausal hormone therapy treatments (MHTs), drugs that reduce the uncomfortable side effects of reduced estrogen levels. These are the FDA’s highest level of warnings that appear on drug packaging in bold print and warn users of serious adverse reactions or important dosing restrictions. For MHT, the boxed warning informs consumers that MHT increases the risk of cardiovascular disease, breast cancer, and dementia.

Although this may look at first glance like another one of the current administration’s attempts to flip food and drug law on its head, a closer look at the scientific findings that prompted the boxed warning indicates it’s not so simple. Originally, the FDA mandated boxed warnings for MHT drugs after the Women’s Health Initiative (WHI) conducted a study in 2002, finding coronary heart disease and invasive breast cancer as primary adverse outcomes based on largely observational data. After the warning was implemented, usage dropped 22% for menopausal women from 1999 to 2020.

However, the safety and long-term risks of MHT have been debated by scientists, particularly because of the WHI study’s controversial design. The study had two main design flaws: it included women with an average age of 63, and the study tested synthetic hormones that are not the same as MHT drugs on the market today. The average age of participants was problematic because women generally experience menopause around age 51.5, but women around 63 years old are more likely to have preexisting cardiovascular issues. Furthermore, the use of synthetic hormones in this study means the adverse health outcomes are not necessarily attributable to the MHT treatments currently on the market. Additionally, modern MHT treatments use lower doses of estrogen and can be delivered through the skin may further reduce the likelihood of adverse events.

FDA panelists were urging the removal of boxed warnings specifically for vaginal estrogen because it poses the lowest risk of adverse effects. When this route of MHT treatment is taken, less estrogen is absorbed in the patient’s bloodstream, which lowers the risk of blood clots, stroke, and cancer. However, the FDA ultimately chose to remove boxed warnings for all estrogen-containing MHT treatments.

Under the Federal Food, Drug and Cosmetic Act, drug labeling must reflect current and accurate science-based evidence without misleading consumers. There is a risk that removing these warnings about increased risks of cardiovascular disease, breast cancer, and dementia for all estrogen-containing MHT treatments was premature, despite the shortcomings of the WHI study. If labels understate risks of MHT treatment, companies may risk facing claims of misbranding drugs under the Act, even though the FDA no longer requires the boxed warning for six current MHT drugs.

Women deserve a better solution than an outdated, poorly designed study for MHT drugs. Instead of risking liability or debating whether the WHI study is accurate enough to make the FDA require boxed warnings about serious adverse effects, the government should provide a grant for a new study on MHT drugs in menopausal women with a younger average age than the previous study.

The Future of Equal Protection for Transgender Youth in School Sports

On January 13, 2026, the Supreme Court heard oral arguments for West Virginia v. B.P.J. and Little v. Hecox. These two cases challenged state laws that banned transgender girls and women from joining girls’ and women’s sports teams at public schools and colleges. In West Virginia v. B.P.J., 15-year-old Becky Pepper-Jackson challenged West Virginia’ state’s 2021 law that prohibited her, as an 11-year-old transgender girl, from joining her middle school’s track and cross-country teams. In Little v. Hecox, college runner Lindsey Hecox sued Idaho over its 2020 “Fairness in Women’s Sports Act,” which similarly bans transgender women from women’s sports and authorizes invasive sex testing practices. Together, these cases test whether the categorical exclusion of transgender girls from girls’ sports violate Title IX and the Equal Protection Clause.

The Equal Protection Clause prohibits states from treating individuals differently on the basis of sex unless the distinction is substantially related to an important government interest. In these cases, West Virginia and Idaho argue that their laws are intended to protect fairness and safety in girls’ sports, asserting that transgender girls have an inherent advantage over cisgender girls. Yet, Idaho’s and West Virginia’s sweeping restrictions prohibit transgender girls from participating in noncompetitive and recreational teams, while allowing transgender boys to join boys’ sports teams. The result is categorical exclusion of transgender girls in sports regardless of medical transition or athletic context.

During the oral argument, Justice Sotomayor raised sharp concerns about whether these bans truly serve fairness or instead discriminate on the basis of sex, calling them a “clear sex classification” that must survive intermediate scrutiny. She acknowledged the long-settled norm of separating sports teams by sex under Title IX, a practice no one contests. Yet, she drew a key distinction: excluding a transgender girl, who lives and competes as female after medical transition, is based on her transgender status intertwined with her sex, making it “by its nature sex discrimination,” and thus subject to heightened constitutional scrutiny that states cannot sidestep by redefining who counts as female.

Justice Jackson pressed Idaho’s lawyer on this question too, asking why medically transitioned girls, who have lost male-typical muscle and strength after hormone therapy, aren’t similarly situated to cisgender girls, undermining the state’s blanket premise that girls who are transgender have an inherent advantage. Justice Kagan also flagged the overbreadth of the statute, exposing how these policies target transgender identity over any evidence-based logic. While the Court held in Bostock v. Clayton County that discrimination against transgender individuals is sex discrimination, it has not squarely decided if Title IX’s unique context allows greater leeway to address sports-specific concerns.

Since 2020, 27 states have passed similar laws as West Virginia and Idaho to prohibit transgender girls from participating in school sports. Many of these bans similarly authorize invasive forms of sex testing that put all female student-athletes at risk by allowing anyone to dispute a girl’s sex and force medical exams on her reproductive anatomy, genetics, or hormones. Such laws subject girls, especially those perceived as “too masculine,” to dangerous and humiliating surveillance, which has triggered coerced procedures, stigma, and career-ending harm worldwide.

The outcomes in these cases will impact over 380,000 transgender youth nationwide, with more than 50% living in states that restrict their participation in school sports. Although the conservative majority is expected to uphold the ban in some capacity, procedural quirks of the case may allow the Court to avoid setting broad precedent about transgender youth in sports for now. As the country awaits, transgender students, their families, and their allies continue showing up to insist that every child belongs in sports.

Artificial Intelligence Is A Threat To Public Health And Universal Programs Are The Only Solution

Under the best case scenario, AI may present novel opportunities for disease surveillance, diagnostics, and drug-development, but relatively little attention has been paid to the emerging, cataclysmic public health crisis it will cause. The costs are mounting. The noise and air pollution caused by data centers, AI psychosis, and ChatGPT encouraging a teenager to commit suicide are just the start. Aside from the high likelihood of worsening climate change and the existential risks from AI misalignment, the biggest danger no one is prepared for is AI’s potential to rupture the social contract and exacerbate existing crises. 

The public health consequences of mass layoffs will be dire. Unsurprisingly, studies consistently find that layoffs worsen health outcomes and lead to premature mortality. The white collar workers AI is already displacing will experience the same devastation neoliberalist economic policy imposed on blue collar workers in recent decades, but their misfortune will cause even more extreme ripple effects, because the US has developed into a white collar service economy where 59% of consumer spending is from the top 20% of earners. The downward spiral has already begun. Block, a financial technology parent company to Square and Cash App, just announced they will lay off 4,000 workers, 40% of their workforce. One-fourth of unemployed Americans have a bachelor’s degree and are spending more time between jobs than their peers with only a high school degree. Recently, when news broke that two CNBC reporters, without a technical background, used AI to replicate Monday.com’s workflow-management platform the company’s stock took a tumble. 

While there is a growing recognition that AI will cause a great upheaval, most of the proposed solutions are confined within the same flawed framework that conditions basic necessities on employment. Retraining and upskilling are not meaningful solutions to the massive wave of job loss that is coming to our shores. Firstly, because existing public retraining programs have mixed efficacy at best. Secondly, because it is nearly impossible to design, much less implement at scale, a program to retrain workers when the future is so uncertain.

The public health community doesn’t just need a plan, it needs an entirely new, universalist vision, to address the universal impacts of this emerging technology. Myriad public policy responses exist, but a universal school meals program and Medicare for All are great places to start because both have strong popular and scientific support. Creating universal programs lowers the barrier to entry and recognizes that in the near-term AI will create mass unemployment across the board, including in white-collar and administrative professions. Both of these proposals are tractable, evidence-based interventions that will ensure access to food during a sensitive developmental window and reduce morbidity, mortality, and healthcare costs. Childhood hunger is associated with worse health and academic outcomes. Conversely, universal free breakfast and lunch have well-demonstrated, positive impacts on behavioral, academic, and health outcomes, such as 17% reduction in obesity and a 29% reduction in morbidity overall. In an August 2025 YouGov poll, 56% supported a universal free breakfast program and 58% supported a universal free lunch program for students. Similarly, life expectancy is longer in countries with publicly funded healthcare systems. Models suggest that if the US had Medicare for All between March 2020 and March 2022, 338,594 lives and hundreds of billions of dollars could have been saved. A 2022 study found that Medicare for All would save about $438 billion dollars in a non-pandemic year. AI is forcing us to reckon with long-standing injustice and inequality embedded in our system. Whatever dangers await us tomorrow, we will be better equipped to face them if we end child hunger and guarantee universal health coverage. 

Denying Medical Care to ICE Detainees: Treating Their Needs as Optional 

In just one year, the number of people detained by Immigration and Customs Enforcement (ICE) has increased by over 75%, with a record 73,000 people held in detention as of mid-January. As anti-ICE protests across the country call attention to detainees, there is an increasing need to understand the questionable, frequently opaque conditions within ICE detention centers. 

There is mounting evidence that demonstrates ICE detention centers lack the infrastructure to provide basic care to those in the custody of ICE. Consequently, detainees are subjected to persistent medical neglect. These conditions, at least in part, persist due to a lack of legal accountability and legal protections. Immigration detention operates in a state of lawlessness, not because no law applies, but because courts have refused to enforce the law that already exists. The result is a system where ICE detainees routinely fail to receive necessary medical care, while the constitutional limits on that failure remain unenforced.

For those in ICE custody, many remain detained for months or years while their immigration cases proceed. During that time, detainees depend entirely on the government, or its private contractors, for their medical care. Yet, reports and court records consistently document delayed diagnoses, untreated chronic illnesses, failures to provide medication, inadequate mental health care, and preventable deaths. These failures are not isolated incidents. They are repeated offenses, and the law’s ability to serve as a tool to fight against these conditions has been strikingly meager. 

The Supreme Court has long made clear that when the government takes a person into custody and deprives them of their ability to care for themselves, it assumes an affirmative constitutional obligation to meet basic human needs, including medical care. In the prison context, the Court held in Estelle v. Gamble that “deliberate indifference” to a prisoner’s serious medical needs constitutes cruel and unusual punishment under the Eighth Amendment. That case established the floor: Once the state confines a person, medical neglect can qualify as a constitutional violation. 

But immigration detainees are not prisoners. Immigration detention is formally civil, not punitive; it is governed by the Fifth Amendment’s Due Process Clause. Under settled doctrine, civil detainees may not be subjected to conditions that amount to punishment. The Court articulated this principle in Bell v. Wolfish, holding that conditions of civil confinement must be reasonably related to legitimate governmental objectives and not excessive in relation to those objectives. If a condition lacks such a justification, courts may infer that it is punitive and, therefore, unconstitutional. The Court reinforced this affirmative duty framework in Youngberg v. Romeo, holding that when the state confines individuals and renders them dependent on institutional care, due process requires reasonable measures to ensure their safety and basic well-being. 

In theory, this constitutional framework could provide greater protection to ICE detainees than to convicted prisoners; however, courts have done the opposite, instead reinforcing executive deference related to ICE detention conditions. COVID-19 litigation exposed this flaw starkly. In cases like Hope v. Warden York County Prison and Fraihat v. U.S. Immigration & Customs Enforcement, federal appellate courts overturned lower-court orders that sought to protect medically vulnerable detainees. The courts emphasized ICE’s institutional competence and its stated detention interests, while declining to meaningfully scrutinize whether conditions had become unconstitutionally punitive. The consequence is that constitutional rights may exist, but they have been functionally unused. 

From a health policy perspective, judicial inaction could delay essential care. When legal obligations are unclear or unenforced, medical care becomes discretionary. ICE detention is not an exception to constitutional governance; it is a test of it. As long as courts treat immigration detention as a zone of exceptional deference, detainees’ health will remain subject to policy choice rather than legal duty. Until courts reckon with this discrepancy, detainees will continue to suffer the consequences. 

Surprise Billing is “Banned”: So Why are Patients Still Being Billed? 

Surprise billing occurs when a patient with health insurance unknowingly or unavoidably receives care from an out-of-network provider and is billed directly for charges not fully covered by their plan. Before the No Surprises Act was passed, patients could be billed for the difference between what a provider charged and what their insurance paid, as well as for additional out-of-network fees. 

The No Surprises Act of  2020 protects individuals covered by group and individual health care plans from receiving surprise medical bills after most emergency services and certain non-emergency care at in-network facilities. Beginning in 2022, the law added additional protections to prevent surprise billing. For privately insured patients, these protections include limits on balance billing and a federal dispute resolution process. For uninsured patients or for those who choose not to use their health insurance for a service, the law requires good faith estimates to be provided before you undertake the service. 

Despite these additional protections, consumers continue to report disputed charges and billing confusion. According to data from CMS, roughly 1.2 million payment disputes were filed by providers and health insurances in the first half of 2025 alone. This was almost 40% higher than the last half of 2024. This increase has drawn attention to the statute’s Independent Dispute Resolution system (IDR), which is a federal arbitration process designed to settle payment disagreements between insurers and out-of-network providers. Under the IDR, insurers and clinicians submit competing payment offers to a certified arbitrator, who must select one amount rather than splitting the difference. Lawmakers adopted this structure to pressure both insurers and providers to submit realistic numbers instead of inflated demands. 

Although the system was designed to keep patients out of reimbursement fights, the large volume of disputes being filed, and surveys suggesting many filed cases may be ineligible under the statute’s terms have raised administrative and enforcement challenges within CMS’s implementation framework. Although the law prohibits balance billing for covered emergency and certain non-emergency services, the continued pace of arbitration filings and associated enforcement work shows that disputes over payment amounts can persist even after protections are in place. 

Patients sometimes receive bills while these payment disputes are pending, and they may not know whether the charge is lawful or subject to dispute, reflecting gaps in implementation and public awareness. This creates a legal issue because the No Surprises Act’s promise of protection depends on the proper operation of the arbitration and complaint processes rather than automatic relief, meaning patients can be left uncertain about their rights unless enforcement and administration keep up with disputes. The continuing volume of arbitration cases shows that the No Surprises Act’s consumer protections depend heavily on administrative systems that are clearly still under strain.