Disclaimer: The views here do not necessarily express the views of my employer or sponsors.

The point of this essay is to provide an accessible summary of one of my papers. This is the first summary in what I hope to be a series I do for my first author and senior author papers going forward. While a lot of my budding following here are academics, I also hope to reach audiences outside of my of my academic bubble.

Many people talk about communicating research in a way that makes it more accessible. I think this matters. Something that I think matters even more is that research tends to have a life of its own once it goes into the world. Following up my first author and senior author papers with a complementary essay here allows me to control my own narrative a bit. It is also a helpful look-back on the trajectory of my work.

One of my dissertation papers was published today in Circulation: Population Health and Outcomes (formerly Circulation: Cardiovascular Quality and Outcomes). This is the journal of the American Heart Association’s Council on Quality of Care and Outcomes Research.

My main study takeaway is that in the overall sample, discrimination was associated with higher risk of heart attack or stroke. This association persisted when we accounted for an array of sociodemographic factors (namely wealth, marital status, insurance status, education), and health status (namely chronic health conditions and a history of these events). This finding is an interesting signal showing that how people feel in these spaces can serve as a marker for risk.

A media headline for this study would be something scary like “RACISM IN HEALTHCARE LINKED TO HIGHER HEART ATTACKS AND STROKES” which is a scary assertion and a misrepresentation of the work. Even though it is a misrepresentation, it is not an unfair assumption to someone who skims the paper. Below is the first figure from this paper. The red line shows those who reported discrimination in healthcare and the blue line shows those who did not report it. This figure shows that those who report discrimination in healthcare are more likely to have a heart attack or stroke over time.

The scale of the risk in between groups is not huge. There are two different ways this could be reported.

1. A hazard ratio tells you how much a single factor increases someone’s risk of having an event. In my study, Table 2 shows the hazard ratio is 1.44 for discrimination in healthcare for all adults. A hazard ratio of 1 means no difference, and anything above 1 means higher risk. So a hazard ratio of 1.44 for discrimination means people who reported discrimination were 44% more likely to have a heart attack or stroke. That assertion without context is scary, but it also is a bit misleading because something like elevated blood pressure (hypertension) is considerably more harmful. We have many tools at our disposal to mitigate those more harmful risk factors (e.g. cheap drugs, lifestyle interventions like exercise, clear dietary guidance) that are much more consequential. Also examining increased risks of events that are (ideally) rare might not amount to health outcomes being noticeably different. The harmful consequences of high blood pressure is a finding repeated across so many studies and has been so consistent in research that clinical guidelines now incorporate it as a major healthcare factor that needs to be addressed. Discrimination in healthcare is nowhere near that level.

2. In the supplemental file of the paper, you can find the adjusted event rates. Over the 10 years of follow-up, you can see that those who did not report discrimination had a 9.97% stroke or heart attack rate, versus a 12.09% stroke or heart attack rate for those who did report discrimination.

For discrimination in healthcare to gain broader recognition as a risk factor for health, findings like the ones in my paper need to show up consistently through repeated studies in different contexts with the same results, be built from well-defined measures of discrimination, and hopefully point toward actionable targets and interventions.

The juiciest (and perhaps most perplexing) finding is illustrated in Figure 2 below.

The way you read this chart is: if the point and confidence interval bars sit to the right of the 1 line, discrimination is a risk factor for that group. If they fall to the left of the 1 line, discrimination appears “protective”. If the group’s confidence interval cross the 1 line, it is not a statistically significant finding.

Through 2, 5, and 10 years of follow-up discrimination was a statistically significant risk factor only for White men, both before and after adjustment for the factors we considered. For White women it was a statistically significant risk factor through 2 years of follow-up but not through 5 or 10-years. Again thinking of how my work could be taken out of context this figure could lead to another scary headline of “RACISM IS ONLY HARMFUL FOR WHITE MEN” which would certainly get clicks but is again a misrepresentation of the study.

My research focuses on discrimination in healthcare, and one of the most visible forms of discrimination comes from recent discourse on racism in healthcare. This is also what people often assume I care about most when they see me, a Black man, or hear about my family’s negative experiences. Racism is a phenomenon which can be more elusive (e.g. someone is denied for a bank loan which they are qualified for, but the determining factor was they were Black). Discrimination in my view is a more overt action (e.g. someone is told that they cannot eat in a restaurant because of some type of attribute). Both can be consequential, we can measure both, but the recording of both and attribution of harm is contested. That assumption might make someone’s eyes glaze over if they are opposed to reckoning with the past and present racial issues in America. It galvanizes a group of people who want to attribute racism as the primary driver of all health disparities. Both viewpoints can lead to blind spots in other forms of mistreatment. My initial hypothesis was that healthcare discrimination reported by self-identified underrepresented racial and ethnic minority adults would be associated with increased risk of stroke or heart attack.

For my analysis, I used two complementary approaches for considering other factors that could contribute to how I interpret any connection between discrimination in healthcare and stroke or heart attack: model adjustment and sample weighting. Model adjustment accounts for specific factors we know are important to consider, like age, smoking status, or prior heart events. Weighting addresses the fact that people who report discrimination may differ systematically from those who do not in ways that could bias our results. By reweighting the sample, we create a comparison that more closely resembles what we would see if discrimination were randomly experienced. Using both together strengthens the analysis because if either approach is slightly off, the other can compensate. Our analysis included around 17,000+ people who answered the question on being unequally treated in healthcare settings, which is a large sample for this type of longitudinal study (a study that follows people over a prolonged period).

Why did I not find what I hypothesized? Maybe it is because there are only a few thousand self-identified racial and ethnic minority individuals in my sample. The longitudinal data in the Health and Retirement Study are powerful, but participating in a survey assumes willingness, availability, and ability to participate. Some might say that discrimination not showing a significant association with risk of heart attack or stroke for Black adults or Hispanic adults means that perceived mistreatment for these individuals does not matter. In my view this makes me want to understand what surrounds these individuals even more. In American healthcare we famously are one of the few nations in the global north without universal healthcare, our social safety net is also notoriously poor and shrinking. However, I would also argue that our interpersonal treatment of individuals today is far better than times such as slavery or the Jim Crow era. There is room to grow because of the high rates of reported unfair/poor treatment (often upward of 30%), but something like a microaggression is a more nuanced phenomenon with subtler health implications than, say, burning someone’s house down. I think we need to measure both, and understand the implications for both.

One explanation from my study’s findings is that for Black adults, high awareness or the consequences of systemic racism could override the negative health effects of interpersonal discrimination (especially in areas where you spend less time like the doctor’s office compared to something like work or school). Being overtly disenfranchised through less access to insurance, healthy foods, medical services, etc. could also overcome any nuanced consequence of discrimination. When discriminatory treatment is anticipated, some could follow protective coping strategies for managing those experiences and en route still get the care they need. Some White adults who may not carry that same day-to-day awareness of something that looms as large as systemic racism may find not find discrimination normal. Therefore, ageism, classism, or religion-related bias may land as more unexpected when it happens to them. Through my analysis, it is unclear whether the reported discrimination is directly harmful (e.g. causation). My view is that reported mistreatment can signal poor quality care, even in the event that someone receives excellent care for their physical issues. If the culture of a healthcare setting is not emotionally or culturally welcoming, that experience can still drive a patient away.

In the future I would love to have more data available with more participants. If I can access more representation in my data and also ensure the questions capture consistent responses across populations, I can dig deeper into the consequences of discrimination in healthcare. My study also warrants more investigation into the reasons discrimination is reported. In my data, there are variables which allow participants to describe why they think the discrimination happens to them. However, those attribution variables only apply to the larger Everyday Discrimination Scale, which captures discrimination across many settings outside of healthcare. For example, let’s say someone says police or restaurants treat them poorly because of their race, but hospitals treat them poorly because of their weight. You cannot disentangle these attributions. For my future work, I think it is important to understand not only the source of the discrimination, but also the attributed reason, so that we can understand how it affects health behavior. This shows why discrimination in healthcare is an important issue for all people, especially in our American system where so many people are dissatisfied with their care.

Disclaimer: The views here are my own and do not necessarily reflect the views of my employer or sponsors.

Today, I start a position as a Postdoctoral Research Fellow in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. If you told me a few years ago that I would land a position at one of the premier public health schools in the globe, at a research institution like Johns Hopkins, I would not believe it.

My position is supported by a National Institutes of Health F99/K00 award. This is a grant designed to support a promising PhD student through their dissertation and into a postdoctoral position in which they establish the foundation for an independent research career. It is something I was only able to pursue because I was in a privileged position to wait through very long periods of uncertainty.

Waiting is a part of life. So is uncertainty. But the context around your life determines how long you can afford to wait and live in uncertainty. Privilege is not a skill, and often it is an inherited trait instead of an earned one. Despite claims of emphasizing merit and competition in science from senior government officials and their supporters, it is quite clear to me that the most valuable trait right now is the privilege to wait. This essay will highlight evidence demonstrating that claim.

Waiting Timeline

After submitting my grant application in October 2023, I spent 11 months waiting to receive the funds for my pre-doctoral fellowship. After submitting my Postdoctoral Transition Plan in October 2025, I spent another 5 months waiting to receive funds for my postdoctoral fellowship. In normal times, this kind of waiting is routine. You wait because the process works, and the NIH had credibility when it came to honoring its commitments.

These are not normal times. Over 2.5 years, my grant was assessed once by a scientific study section, in February 2024. I was asked twice to fundamentally rewrite my science after that review was already complete to comply with ideological demands from the NIH Director and Deputy Director. There were also two government shutdowns in the middle of my transition process.

Here is what that looked like:

October 2023: Applied for my F99 grant.

• Waited 4 months to receive my score.

February 2024: Received my score.

• Waited 7 months to receive my Notice of Award.

September 2024: Received my Notice of Award.

July 2025: Submitted my Year 1 Progress Report. One week later, received a notice that my award needed to be “renegotiated.” One-week deadline.

• Waited 1.5 months.

August 2025: Received my Year 2 Notice of Award.

October 2025: Submitted my K00 Transition Plan, in the middle of a government shutdown.

• Waited 3 months then got another renegotiation request.

January 2026: Received a request to “renegotiate” my K00 plan. One-week deadline.

January 2026: Submitted my revised K00 Transition Plan.

• Waited 2.5 months.

March 2026: Received the Notice of Award for my K00 Transition. I can finally start my postdoc, 5 months after sending NIH the detailed plan outlining work I first described in brief in October 2023.

Two years and five months after my initial submission in September 2023, I transitioned to my postdoctoral position in April 2026. The entire purpose of the National Institute on Aging F99/K00 is to “transition a pre-doctoral student to aging research.” Through this award the latter part of my PhD and now my postdoctoral work focuses squarely on aging research. By the program’s own description, the mission was accomplished.

Earning this award was mentally taxing. It was taxing because of policy decisions that inflict real harm on early-career researchers. It was taxing because NIH staff were put in a position where they could not offer guidance on timelines for reviewing and administering awards. Unclear timelines undermine science. Unclear guidance on whether an award will even be delivered holds you in professional and personal limbo. You do not get to select for the best and brightest candidates when you create these conditions. You also do not get the benefits of innovative research, because you are building an environment so hostile that any rational person would consider doing their work elsewhere.

A funeral and a renegotiation

The second request to renegotiate my grant was particularly painful. The one-week deadline I was given overlapped with my grandfather’s funeral. The deadline for resubmitting my “renegotiated” grant was the exact day of his funeral. There is no process to request an extension for this forced renegotiation.

My grandfather died of congestive heart failure. His experience navigating healthcare (and many of my other family members) was the main reason I decided to pursue a career in health research focused on systemic issues. It is deeply ironic that I was instructed to strip the foundation of my work, work that was built on a body of scientific evidence and rooted in personal experience. I was told to remove the words that described why this research matters to me, and to the communities I study, under the premise that it was unscientific.

The grievances driving these policy changes are built primarily on anecdotes and a set of assumptions about health that ignore structural realities. The idea that health outcomes are principally a matter of individual choices, that people simply need to eat better, exercise more, and make smarter decisions, has a long history. It is the comfortable position. It also does not survive contact with the data. My grandfather did not die of congestive heart failure because he lacked willpower. He died in a context shaped by decades of limited access to quality preventive care, by the neighborhoods available to him, by the clinics that served those neighborhoods, and by how he was treated when he walked into those clinics. That is what my research studies. And that is what I was told to scrub from my grant. There is no evidence that removing this kind of research improves health outcomes, or scientific rigor, or the return on taxpayer investment. There is no published analysis showing that the termination of 977 NIH grants representing $1.7 billion in funding has advanced any of the goals that were cited as justification. There is no before-and-after comparison. There is no data. There is only an assertion that this research is ideological, made by people who have offered no scientific standard for that identification of “DEI” beyond their own preferences.

We know what arbitrary scientific standards look like in practice because we have seen it applied elsewhere. When the Department of Government Efficiency (DOGE) operatives arrived at the National Endowment for the Humanities last spring to identify grants for termination, they did not conduct a substantive review. According to court documents reported by the New York Times, two DOGE employees acknowledged in depositions that they had no background in the humanities. They fed grant summaries into ChatGPT with the prompt: “Does the following relate at all to D.E.I.? Respond factually in less than 120 characters. Begin with ‘Yes’ or ‘No.’” The results flagged a documentary about Jewish women’s slave labor during the Holocaust as DEI because it risked “amplifying marginalized voices.” An effort to digitize the papers of a British general from the American Revolution was flagged for “promoting inclusivity and diversity in historical research.” Nearly every active grant made during the Biden administration was terminated. This is the rigor behind the ideological claim. When I was asked to renegotiate my own NIH award, I received similarly opaque instructions with no clear criteria and no precedent. Again, I ask: what is the rigorous standard here that prioritizes merit?

The privilege of patience

I was privileged enough to wait out the uncertainty of my renegotiation period. While I am not where I want to be financially, I had enough wiggle room. I went without a paycheck, aside from a part-time bartending job, and without stable health insurance for January, February, and March. By privilege, I mean this concretely: having no dependents, some financial cushion, and the personal circumstances to unexpectedly go three months without a full-time paycheck or health insurance. Many people who would be tremendous assets to this field cannot do that. Forcing trainees to demonstrate resilience during one of the most vulnerable periods of their lives is a fundamentally different value proposition than selecting for merit. As Jim Olds, former head of NSF’s Biological Sciences Directorate, has written, the compensation for graduate students and postdoctoral researchers is staggeringly low, and prolonged periods of poverty-level wages justified through “training” dramatically limit the type of person who can play this waiting game. This is compounded by the fact that NIH’s budget, when adjusted for inflation using the Biomedical Research and Development Price Index, has never recovered to its 2003 peak. In FY2025, the inflation-adjusted NIH budget was nearly 9% below that level. Scientists are expected to produce more innovative work with less money, higher personal costs, and intensifying competition.

Prior to the current disruption, research was already a cutthroat environment where dollars drove the science. The disruption has made it worse. Schools of medicine and public health now have a smaller and less stable pool of money to attract and retain faculty. I have colleagues who are extremely well-qualified by every traditional measure (20+ quality publications, teaching experience, mentoring experience, clear paths to funding) who cannot get an interview for jobs that 5 years ago someone with half their experience could easily land. When I entered my program in 2021, postdoc positions stayed open for months and departments struggled to attract candidates given low salaries and relocation costs. Now, positions fill almost immediately, and young scholars have no negotiating power because so many people are simply looking for a place of employment.

The consequences are already measurable. A Boston Globe survey, the first of its kind to poll NIH-funded researchers about the impact of federal cuts, found that over two-thirds now recommend their students consider careers outside academia. 40% said their institutions had rescinded offers to students, staff, or postdoctoral researchers. 61% said postdocs or staff had been laid off. At UMass Chan Medical School, biomedical PhD enrollment dropped from 73 to 15 in a single year. As Nicholas Lemann, a staff writer at the New Yorker, detailed in a recent investigation, NIH grants to universities are down more than 90% this fiscal year, and the National Cancer Institute has not made a single new grant at the time of their article in March. Meanwhile, as the Guardian reported, young researchers are leaving the country for positions in Europe and beyond, with more than 10,000 postdoctoral experts lost from the federal scientific workforce last year alone according to Science magazine. European universities are openly recruiting American scientists for what they are calling “scientific asylum.”

Many people were not given the opportunity to survive

The experience of Jahn Jaramillo, a PhD candidate at the University of Miami studying HIV prevention in the Latino immigrant community, illustrates how the system is failing researchers who play by every rule. According to STAT News, the NIH terminated 405 F31 awards meant to fund doctoral students, and most were “diversity” awards. Jaramillo’s grant, which had received a perfect peer review score, focused on HIV in the Latino immigrant community. His work aligned directly with the Trump administration’s own stated initiative to end the HIV epidemic, and Miami is a high-priority area for that initiative. His grant was terminated anyway.

These “diversity” NIH grants were reviewed in the same study sections as all other awards. The applications were evaluated on the same criteria of scientific merit. Jaramillo scored the highest possible score. Still, his work was cut. His ability to engage research participants from a community that had never participated in research before, an asset enabled precisely by his identity and language, was turned into the reason his funding was pulled. Something that, by any honest measure, makes rebuilding trust in research harder.

This pattern is not isolated. Data reported by the blogger Drug Monkey (an anonymous biomedical scientist who has tracked NIH funding disparities for nearly two decades) and confirmed in a STAT News story shows that new fellowship awards to Black PhD students fell by 40% in FY2025. Awards to White trainees dropped by 9% over the same period.

The raw numbers make the scale of this undeniable. New fellowship awards to Black trainees dropped from 205 in FY2024 to 122 in FY2025. That is 83 fewer early-career Black scientists receiving funding in a single year. White trainees, by contrast, receive roughly 75% of all NIH fellowship awards in any given year, about 2,500 to 3,000 awards annually according to NIH Data Book figures. A 9% drop in a pool that large means roughly 250 fewer awards, spread across a population of thousands. A 40% drop in a pool of 205 turns a small pipeline to a trickle. While underrepresented minority researchers are disproportionately losing existing awards through terminations, and others like me are being forced to renegotiate, the odds of receiving a new award are simultaneously shrinking.

Science is shrinking for all. In FY2024, 3.7% of NIH research project grant PIs were Black. By FY2025, that number had dropped to 3.5%. A 0.2 percentage point decline may sound small. It is not. That figure is a trailing indicator, reflecting grants that were largely in motion before the full effect of the current disruption hit. The leading indicators are far worse: a 40% collapse in new fellowship awards to Black trainees, the termination of hundreds of diversity fellowships and awards that were specifically designed to build the pipeline from postdoc to independent investigator. There have been targets placed on “DEI” research topics, population health, health disparities, community-based work, that minority scientists disproportionately study. Add to that the moral injury of being told that your lived experience, is itself disqualifying. What should we expect the 3.5% of Black PIs to be by 2028?

The public conversation around DEI has been weaponized as though it is all about admissions slots at elite universities or corporate board composition. We now see a kitchen-sink approach targeting early-career minority researchers for whom even the standard of “merit,” the metric their critics claim to champion, confirms they belong. Researchers with the highest-scoring projects, including on topics that had nothing to do with their minority identity, are being told that science is not the place for them.

What comes next

I am living to fight another day. I also recognize that I am just one researcher. Researchers who were told between 2020 and 2024 that their voices and ideas matter, that their institutions would address deficiencies in their research programs and the composition of their staff, are now being picked away. Meanwhile, many of those same institutions are looking the other way.

On March 28th, I stood outside the NIH headquarters in Bethesda, Maryland, and spoke to about a thousand people who gathered as part of the nationwide “No Kings” protests. I shared a stage with Bill Bien, a lymphoma survivor whose life was saved by NIH-funded research at the National Cancer Institute. I spoke alongside Jeanne Marrazzo, the former Director of the National Institute of Allergy and Infectious Diseases, who was placed on administrative leave and ultimately fired for resisting cuts imposed by NIH leadership. And I spoke alongside doctoral students whose research has been upended by this administration’s policies.

I told the crowd what I have written below (you can also watch the full speech on YouTube here):

“I became a researcher because I saw the needs of my family members not being met. I study discrimination in healthcare, and while I care about discrimination against Black adults because of my own experiences, no form of discrimination is acceptable because it stops people from seeking care in our health system. Apparently, studying whether people of any background feel listened to or welcome in healthcare settings is a topic so sinister that my career needed to be thrown into a prolonged state of uncertainty.”

I talked about trust, because that is what my research is about. I have heard the NIH Director talk about how his main goal is to restore trust within the NIH. But I told the crowd that his version of trust looks nothing like mine:

“The best science has always come from democratic processes: open competition, agencies honoring their prior commitments, and transparent criteria

…

What I see instead is one person trying to run science like a king, deciding which research is acceptable based on political ideology rather than scientific merit.

…

Trust does not come from going on podcasts claiming that it is important to you. Trust comes from clear processes and integrity. Trust comes from not letting your partisan beliefs ensure that thousands of scientists lose their jobs or get pushed out of the field.”

Institutional leaders need to reckon with the fact that the recent policy changes have not produced evidence that they are improving scientific outcomes. Congress increased the NIH’s FY2026 budget and rejected the proposed 40% cut and expansion multi-year funding scheme that contributed to 2,000 fewer grants being awarded in FY2025. The courts have repeatedly ruled on actions against science. And yet the instability continues. Institutional leaders have the data. They have the resources. What they lack is the willingness to demand accountability from the people dismantling the system they depend on. From my vantage point, you are being actively harmed whether or not you are silent. It is hard to ask your employees to keep doing their jobs if you do not fight for the policies that determine whether those jobs exist.

The incentive structure of academic research has been reshaped in a way that rewards the ability to endure uncertainty, which is a function of privilege, not merit. Incentives determine outcomes. Media tours about science do not lead to structural changes. My question for institutional leaders is this: come 2028 and 2029, what will you say to the next cohort of researchers who are supposed to join whatever iteration of university research exists then? What pipeline will be left? What trust will remain?

Planning for that future needs to happen today. Urgently. Because every month of passive policy is another researcher who did everything right and still could not afford to stay.

My Situation

I was awarded an F99/K00 fellowship from the National Institute on Aging (NIA) in August 2024. This award is one of the most competitive pre-doctoral fellowships the NIH offers across all institutes: both U.S. citizens and non-citizens are eligible to apply. Only 69 individuals have ever received it at NIA. It provides up to six years of funding and is specifically designed to give early-career scientists a runway to pursue new research areas.

My grant focused on studying whether patient-reported discrimination in healthcare settings is associated with cardiovascular and cognitive health outcomes. It was peer-reviewed, scored competitively, and awarded through the standard NIH process.

In July 2025, at my yearly progress report, NIH told me my grant needed to be renegotiated to remove what they called “DEI activities.” They gave me one week to rewrite 70+ pages of work. I asked for specifics on what had been flagged as “DEI-activities”. I received none. So, I removed references explaining why the mistreatment Black adults report in healthcare settings is consequential. I did not change my methods at all, just the proposal framing. The grant was approved for year two of the project in August 2025.

In October 2025, I notified NIH that I wanted to start my postdoc in January 2026. On January 7, 2026, a day after what should have been my start date, I was told the grant needed to be renegotiated again. Based on an analysis I wrote in a previous substack post, of the 69 recipients of this award at NIA, I am the only one who has ever had to change the content of their grant.

There’s a concurrent issue here – it is complicated to explain but important. Recent reporting has confirmed that NIH funding is being held up even though Congress appropriated a higher level of scientific spending for 2026 compared to 2025. The simplest way I can explain it: Congress wrote the check, the NIH deposited it, but the White House and the Office of Management and Budget placed an indefinite hold on the funds. You cannot pay researchers with money on hold, just like your bank will not let you make a purchase with funds that have not cleared.

Why I Asked My Question

Given how opaque this process has been, I thought the most productive use of this platform was to ask for clarification on what a “DEI activity” is. Twice I was told my research qualified. Twice no one defined the term “DEI activity”. In previous settings, DEI grants were defined as programs where only some people were eligible to receive funding. My award was not one of those; anyone could apply. Instead, I assumed my grant was flagged as “DEI” due to its mention of discrimination, black adults, etc.

At first glance, my grant could appear to be about race because I wrote about Black adults and their experiences in healthcare (justified because of documented disparities in heart disease). But in the application itself, I clearly outlined how I planned to test potential consequences of discrimination across the full sample. The language that I believe sparked the “DEI” censorship were statements about poor treatment of Black adults in healthcare settings, but the scientific design was always inclusive of all groups.

My question came from lived experience and good faith. I did not ask it to embarrass Dr. Bhattacharya. I asked it because I genuinely do not know what a “DEI activity” is. That label and lack of clarity has temporarily cost me my income, my health insurance, and months of my early career.

What I Said

Below is the transcript (sourced from the page) from my question that was aired on the 2/26/26 episode of the “Why Should I Trust You?” podcast, which was recorded the same day. In the footnote I have attached the uncut clip of my recording that I sent to Brinda (sorry Brinda for yapping so much).

Michael Green 50:10

My name is Michael Green. I recently finished my PhD in Population Health Sciences at Duke University, and I’m a recipient of an F99/K00, award from the National Institute on Aging. That program is designed to support early career scientists with their PhD and into a postdoc. I’m a black man in his late 20s who come from a family where a lot of people stopped going to their doctor for preventative care because they felt like they weren’t being listened to. By the time they came back, it was often too late. My grant focused on studying how patient reported discrimination in healthcare settings is associated with cardiovascular and cognitive health outcomes. It was peer reviewed score competitively and awarded in August of 2024. In July 2025 NIH told me my grant needed to be renegotiated to remove what they called DEI activities. They gave me a week to rewrite 70 pages of work. I asked for specifics on what was flagged, and I received none. So I [re]moved the word black from my grant and references to evidence on why black adults report feeling mistreated in healthcare settings. I didn’t change my scientific approach at all, just the language. I didn’t have a learning moment from the process, because I still don’t know what a DEl activity is.

[In] The context of my grant, no one told me. It’s now late February. I’m unemployed. I have no health insurance. I haven’t received a paycheck since I graduated in December 2025, and out of the 69 recipients of this award at NIA, I’m the only one who has ever had to change the title of their grant beyond punctuation and [spelling]

Brinda Adhikari 51:42

Okay, so Jay, what would you say to Michael Green in that situation?

What He Said, and What He Got Wrong

Jay Bhattacharya 51:47

I’d say that he didn’t take advantage of the opportunity to rethink his grant. Like, we gave him the opportunity, and he didn’t take advantage of it, right? So he again, I didn’t know this grant specifically, but, like, I’ll tell you, like, based on the title, what I hear is a grant where it has as a premise, something that, in principle, couldn’t have a control group.

And so its bad science….

Brinda Adhikari 52:09

So what would have made us better?

Jay Bhattacharya 52:11

Just okay for let me just finish Brinda. So I think if, if I say that, I provisionally, because, again, I’ve not read his grant so, but based on that 90 second snippet, he had the opportunity to be more specific about his hypotheses, make them actually scientific, give them give make arguments for control groups. We gave him that opportunity, and he didn’t take it. That’s what I’d say.

What the NIH Director missed: Around 80% of the people in my study sample reported never experiencing discrimination in healthcare. That is the comparison group. That is the control. The study examines differences in health outcomes between those who reported discrimination and those who did not. This is a straightforward, well-established epidemiological design and a reasonable one for a PhD dissertation project. The methods I used were novel for exploring the consequences of discrimination experienced in healthcare, which I believe is part of the reason why the grant was scored competitively and was awarded.

The Deeper Contradiction

After this statement, Brinda asked a direct question:

Brinda Adhikari 52:35

Let me ask you, you know, is it worthwhile? Because I know that one of the things you have talked a lot about is improving health outcomes. Do you believe that there is scientific merit to studying the role that discrimination plays in health outcomes?

Jay Bhattacharya 52:56

What do you mean by discrimination?

In an interview with Ross Douthat from New York Times Opinion on January 29, 2026, Dr. Bhattacharya said that free speech is a moral and ethical imperative for science. On February 26, 2026, he evaluated my funded, peer-reviewed grant he had never read and called it “bad science” based on its title. He used this to justify forcing me to rewrite my work. His support of free speech and his rejection of my scientific aims cannot coexist.

Every NIH Director has the right to set new scientific priorities. But if the label “DEI activity” can be applied retroactively to funded, peer-reviewed research without a clear definition, then any label can. Three or four years from now, a new NIH Director could decide that grants classified as “MAHA activities” need to be renegotiated. The precedent is the same. The process, or the erosion of it, is what should concern everyone regardless of where they sit on the political spectrum.

Dr. Bhattacharya claims to want to encourage innovative ideas from a new coalition of researchers. Many of my peers who are interested in his stated priorities have reached out to me, not to disagree with his version of science, but to tell me they have little faith in his leadership and claimed support for early-career scientists. I am still waiting for an answer to my original question and also have 3 clarifying questions that everyone deserves an answer to.

1. What is the definition of a “DEI activity,” and how is it being communicated to NIH staff so they can determine whether a grant qualifies?

2. What would your reaction be if a future NIH Director decided to force all grants considered “MAHA activities” to be renegotiated three to four years from now?

3. How does the current instability at the NIH positively impact the careers of early-career researchers?

Footnotes:

Link to the unedited clip I sent to the podcast.

Disclaimer: As always, the views I share in this post are my own. They do not necessarily represent the views of my employer or research sponsors.

I am awaiting a notice after the renegotiation of my K00 award. If the NIH approves my K00 Transition plan and I successfully start a post-doctoral research position, I will write another blog and link it here. I submitted a comprehensive proposal that outlined my post-doctoral plan in early October 2025 (notably in the middle of the 1^st government shutdown). I requested a January 1^st, 2026 start date, and in the middle of January 2026 I received a request to renegotiate the scope of the proposal.

I have academic freedom, and NIH data is publicly available, so I decided to ask the question: what has the history of the National Institute on Aging (NIA) F99/K00 award been to date? Currently, NIH staff are producing less public communications, and I believe that as a scientist, understanding how NIH programs function matters since many of our careers are attached to that infrastructure. Selfishly, my own experience drove this as well. I suspected within the extramural grant portfolio of the National Institute on Aging; my award was the only F99/K00 they had asked to renegotiate. Singularity is incredibly rare in research, so instead of feeding my own delusion about my status, I decided to dive into the data (spoiler: based on my analysis I am correct).

My methods are described below:

Dr. Jeremy Berg, posted a tutorial on analyzing NIH grant data, which is publicly available. The NIH introduced the F99/K00 program at National Cancer Institute, and a few other institutes have since adopted it. The National Institute on Aging (NIA) introduced the program in 2019 and issued the first awards in 2020. I queried NIH Reporter data and imported it into RStudio. I found 69 unique individuals with the F99/K00 award from NIA. Below you can see the breakdown of the awards by NIH fiscal year. For those unfamiliar with NIH grants, the NIH issues awards as “new awards” in year one. That indicates someone who applied for the grant received it. The NIH also issues continuations, which traditionally means another year of funding for that grant. There are a bunch of other categories for continuations, but for this program, the options are limited. In the grant proposal, you outline your multi-year plan. Annually you communicate your progress to NIH staff, and your award is renewed/continued. For “transition” or “boomerang” awards (e.g. the F99/K00 or the more common K99/R00), you have the added benefit of another award at a different career stage. Below, I indicated the “new” awards in dark blue and the first year of the second phase of the award in dark orange.

For the pre-doctoral fellowship award (F99), you get 1-2 years of support and during that period, you request the second phase (K00) of the award. The post-doctoral phase is 3-4 years. You get the 4th year of funding if you apply for a career development (K01, K22, K99) award. A career development award in theory would support your transition to a faculty position if awarded.

In many ways, this program supports an individual researcher. It also thoughtfully provides a pathway to a faculty position. This pathway is in touch with the present-day reality in which biomedical researchers are hired both on their research productivity and grant-writing ability. A common talking point of current NIH leadership is that they want to support individuals. In fact, the NIH Director came to my Ph.D. institution for a Zoom fireside chat in January (the first of a series to celebrate 30 years of the Duke Clinical Research Institute). I watched it in its entirety, and he mentioned that he would like to focus on supporting early career researchers. He claimed that he wanted to redo the entire K award process because he felt that it was not currently suited to support early career people. I agree; currently, most institutions are on soft-hiring freezes and can only bring in faculty who have their own funding. Revamping the K-award process would, in theory, change this prospect. The source of the soft-hiring freeze at schools of medicine and public health nationally is largely because of the changes and threats of change at the NIH the past year. So, how much money is coming in and how the NIH administers awards has changed, but the incentive structure where universities depend on their researchers bringing in grant money has remained intact.

Back to the F99/K00 program, a program centered on individuals. The whole purpose is to provide a pathway for doctoral students to have their dissertation work and post-doctoral training paid for. In simpler times, a student would be in high demand with this award for a post-doctoral position because they are bringing money for their salary and career development funds. This candidate would even be in a position to negotiate for more compensation. Given the contraction of university (and in turn faculty) budgets, this is a less reasonable ask. It is still a way better situation than those without a grant. Below, I pulled together a graph looking at the outcomes of the NIA F99/K00 awardees. Each year is the total number of new awards. The first three years (2020-2023), only 4 out of 30 did not advance to the K00 phase. I did some LinkedIn sleuthing, and those individuals appeared to have started a tenure track job or a job outside of academia. I would classify those outcomes as successful under the described goal of the F99/K00 award. Since 2023, there has been no other attrition, but there are 15 individuals whom we still do not have data for since they are not outside of the 2-year window from their award start date in 2024.

My hypothesis was that some of the awardees had to deal with renegotiating their award. I thought the simplest way to test this was seeing if any of the awardees had to change the title of their grant to remain compliant with “anti-DEI” initiatives from the NIH. Across all 69 individuals, I found 4 awards that had changed their titles mid-phase. 2 of them were changes in spelling/punctuation, 1 was indicating an extension of the award, and the final one seemed to be a meaningful change in the scope of that award (another spoiler: that last one is me).

Some might consider the F99/K00 program a success because the early career researchers who have gone through this program are both making it to the next career stage and are also relatively unscathed from political backlash against “health equity” topics (e.g. no awards have been terminated). This is a fair assertion for now.

My new question is: why make scientific reviewers, NIH staff, and many more review these grants and move the goalposts of what is a worthy award midstream? As an early career researcher, I love the idea of supporting individuals. From my view the F99/K00 award, which is an investment in individuals, is a great opportunity to learn from existing programs. Reviewing the NIH extramural grant portfolio, reviewing the and outcomes of researchers, and investing in the awards that allow people to advance their careers makes sense but is not happening. Treating staff well and humility about the tools at your disposal would also go a long way. Talk does not mean much to people who have the ground shake beneath them every day. All early career researchers feel the ground shaking beneath them, but are being told that people care about their work and their future. The ramifications of program instability might be affecting the “health equity” researchers most acutely, but all universities are feeling the contraction. Even worse, a new administration could easily unravel any researcher’s proposed ideas that are aligned with the “new administrative priorities” just as cruelly as the health equity work was unraveled.

Investing in individuals is a great idea, for me that has so far meant missing a January paycheck and possibly missing a February paycheck. I do not have children or others depending on me so I have been able to manage that, it for sure is less than ideal coming out of earning the institutional minimum Ph.D. stipend for 4.5 years. If we want to think about supporting new ideas, this is another bottleneck which is widely out of touch with bringing more researchers from different backgrounds and perspectives into our figurative tent.

We need to strive for better. The tools are at our disposal to do so. At NIA, the F99/K00 program is currently expired. The only NIH institute that is actively accepting F99 applications is National Institute of Child Health and Human Development (NICHD) and it is only for projects focused on Down Syndrome Research. An investment in early career researchers would involve expanding programs like the F99/K00 to all institutes and cutting red tape for people at the beginning of their careers. Neither happened.

When reading the article I was struck by the fact that he did it with little to no ability to code, and the website was designed purely with code. Before attempting to redesign my website with Claude Code, I had never written a line of code outside of RStudio and Stata. Many skilled programmers would scoff at me even calling the analysis and data wrangling I do there coding. That makes me a fair barometer for the viability of a product like Claude Code raising the “floor” of technical ability for researchers like me.

I have tried most of the frontier lab AI products (ChatGPT, Gemini, Claude) because I think the capabilities for tech-related tasks are great. While I am still uncomfortable using them for any consequential interpretation of data or creative writing, these are tools that came out of Silicon Valley and are clearly ready today to be used for the tasks they center their lives around (creating apps, creating websites, writing code). As a researcher outside of a highly technical field like computer science, these are all “last-mile” tasks. I have transformed quite a bit on the prospect of using AI as a researcher, but not in the sense that it will take over my job. This is not a permission slip to make all of your writing AI, your writing is a core part of your work and it to me is one of the easiest ways to convey your own style. Whenever I see a social media post, essay, or marketing material that is obviously AI-generated, it feels inauthentic. This can be inconsequential for some use cases, but in many places you want to convey that you are willing to take a step back and be thoughtful about how you present your ideas.

When I say “last-mile” I mean using AI for the things that AI companies are building these tools to excel at. We have seen AI misused to complete exams and essays, which wastes the opportunity to gain foundational knowledge education is designed to provide. Using AI for the last mile means doing all the work that is core to you and your values first, then implementing AI where one of the Silicon-Valley centered tasks would improve the use case of your work. For researchers, this means the intellectual labor (forming hypotheses, interpreting data, developing theory) stays with us, while the technical delivery tasks (building a website, formatting visualizations, writing code for routine processes) become candidates for AI assistance. There is a lot of rhetoric about AI ushering in an era where it replaces all work. That is a scary assertion, but I think that as someone who has tested a lot of these tools, AI is on a path where it replaces all mediocre work.

We are in a period of contraction for research, a period where less resources are available and the infrastructure we depend on is dramatically shifting. This blog post by Elizabeth Ginexi (former NIH Program Officer of over 20 years) is a great overview of this contraction from an NIH-centric lens (the lens most academic medical centers hold). While we are contracting, I think it could be worthwhile for researchers to use some of these tools for last mile tasks. You do not need to be a web developer to host a polished website that shows your work and can answer some of your frequently asked questions. For example, Mark Dredze, a computer science researcher at Hopkins, is one of the first people I saw with a FAQ section on his website (Dr. Dredze’s section is titled “Prospective Students”). This kind of feature handles the repetitive communication, providing quick answers instead of sending him a simple email that might get lost in hundreds of emails professors get weekly.

I have a more nuanced take on where AI falls in my research toolbox. I think that the center of our value proposition as a researcher is our brain. Secondarily it cannot replicate our human relationships. I am comfortable using AI tools for tasks like debugging code and improving data visualization because that is more of a last mile task. Again, I was paying SquareSpace $21 monthly and have been a subscriber since 2021. This was a monthly deposit to Squarespace to host my own digital business card. None of the content was sensitive, the personalization was fairly limited, and now they are consistently marketing new AI tools to enhance my website.

I am impressed by what I was able to create with Claude Code. I was somewhat satisfied with my template portfolio from SquareSpace that I held for about 5 years. You can view my new website at my domain that I used to host it on for Squarespace here (michaeldgreen.phd). I put some pictures of my old website below for comparison.

I believe the computational power of AI tools is clearly on a transformational trajectory. What does appropriate use of AI in health research actually look like? I think cardiovascular data science offers a useful illustration. From a research perspective, there are a ton of ready-made applications for AI. For example, if you have big data that is consistently available, I think it could be one of the most appropriate tools. I have seen this first hand at the American Heart Association Scientific Sessions. Dr. Rohan Khera’s Cardiovascular Data Science (CarDS) Lab at Yale has used big data from health systems and wearables to move forward detection of cardiovascular conditions and markers of health. This is a great use of AI and machine learning. For back-to-back years, Dr. Khera’s team did live workshops at Scientific Sessions for QCOR Day. They had a room of mostly clinician-scientists open Google Colab to see how the models and products of his team are trained. The code is available to everyone, which is common practice in computer science. As a population health scientist, sharing methods seems to be a bit more gate-kept. Pre-printing your work, making data and code accessible for replication, and other open science principles are not norms for us like they are in other fields.

I research discrimination faced by individuals. Whenever I submit a paper surrounding the topic of discrimination in healthcare it is often viewed from a race-based lens. I work with survey data and we are often forced to use purely cross-sectional information. The limitation here for AI is fundamental: if the training data does not adequately capture the phenomena I study (which tend to be underreported, context-dependent, and subject to measurement challenges that even human researchers struggle with), then AI tools will not help and may actively mislead. The most disparate circumstances are less often captured in the datasets that would train these models.

My own research operates under different constraints that make AI adoption less straightforward. As a population health scientist focusing on different social determinants and drivers of health, I am highly skeptical about the completeness of data on discrimination for deployment in AI solutions. With current attacks on research exploring contested social topics, I am concerned restricting this work means the development of AI tools on these topics will lag behind other areas of health research).

I do not see value in AI use in tasks which are core to your professional identity (e.g. writing a first draft of a cover letter, formatting emails) - it can waste time and comes off as inauthentic. On the other hand, I benefitted from AI for redesigning my website, saving money and making my research mission clearer and more personal. Would I delegate my statistical analysis plans over to AI? No. My research hypotheses and question formations? Not that either, considering that is a big part of my identity and why I wake up every day. But for technical tasks where I had a very real skill gap that prevented me from effectively reaching my target audiences, AI was helpful. It can open a new set of tools for disseminating our work without requiring us to hand over the parts of research that make it ours.

A sentiment that I think is admirable right now, not everyone has to be a subscriber or Substack reader, but it clearly is a communication tool that can matter.

As Colette noted in the below BlueSky post, she had launched the newsletter on a platform without an integrated network and had fewer than 100 subscribers over the course of 5 months. At this time, the Science Fight Club has 298 subscribers and is #4 “Rising in Science” after being live for 3 days. That is impressive growth, and the amount of money going to Substack’s bottom line in my view is inconsequential compared to the hopefully positive good that Colette could achieve through the platform. To provide a salient example on dollars going to Substack, let’s say that 50 of the current subscribers (conservative estimate) are paying the $5 subscription and Substack takes 10% fees from subscriptions. That is $250 of gross monthly revenue and $25 of that is going to Substack

There are 3 actions I see for people who are considering supporting someone who chooses to write on Substack but are concerned about the platform’s moderation. 1) You can subscribe for free and get direct emails to your inbox through the platform (and inherently never have to deal with push notifications from the app or targeted emails). 2) You can subscribe and choose to pay creators directly for content and maybe they get enough resources to leave and/or have more impact outside of an email newsletter (this is one way to pledge your support, but as many people note there is no way for that money to not transact through that platform). 3) Finally, you can choose to not support the mission at all. It is within everyone’s right to choose not to support a mission based on platform. As scientists we all have limited time and our primary jobs are not communicators. We also have limited time and energy to disseminate our work. Because of that, our choices for where we spread our work matter.

I do not use Twitter/X to promote my science. In my view, sharing science on that platform is counterproductive for both the authors and audience. Even more frighteningly, the in-house AI product in X (Grok) was explicitly developed to mirror a specific ideology that I disagree with. The AI product built into X had a newsworthy moment when it called itself “MechaHitler”. Since AI products respond based on their training data and an array of curated instructions, this is a clear warning signal about the desired culture on that platform. Now take the example of Substack posts and publications centering Nazism and other forms of dehumanizing hate-speech. People thinking that any group are a social underclass and should be killed is terrible. People feeling comfortable enough with these views to the point that they can build a monetizable following is also terrible. A society that allows this is problematic and I vehemently disagree with the views espoused in those posts/newsletters. I raise these two points (on Substack vs X) because they center the same terrible speech pattern. In the case of Grok, xAI is training the model to speak in a way that is ‘anti-woke’—embedding a particular ideology into how the algorithm interprets and presents information. The promotion of views that have a central message of hate speech and dehumanization is sad and harmful.

In both examples, the central difference is intent. One group specifically created a piece of technology that consistently demonstrates a problematic ideology. The other promoted harmful content on their app and doubled down a stance against content moderation (which is an action protected by Section 230). Corrective actions behind the intent are different in my view. With Grok, the ideology is not a byproduct of lax moderation but rather an intentional design choice—xAI leadership has explicitly trained the model to be “anti-woke,” making the AI itself a vehicle for a particular worldview. This is fundamentally different from Substack, where problematic content exists because the platform allows broad speech (even speech that I view as hate speech) but does not actively engineer that content into its core product. The chatbot Grok is integral to X’s user experience in a way that a newsletter you never subscribe to simply is not. Also, the risk that your audience is susceptible to harm are dramatically different. On Twitter/X (as well as BlueSky, Threads, etc.) you can read 100s of posts in a short period of time. Curating your feed is also far more difficult, which is why I think the company’s stance on content moderation is even more important. Whenever I sign up for a new app, I unsubscribe from all promotional emails and push notifications because all apps are trying their hardest to command more of my attention. Turning off notifications and only seeking out creators you respect (ideally outside of the platform) is a lot simpler to self-moderate compared to algorithm-based social media optimized towards engagement enragement.

I am on Substack because people I respect use it as their platform of choice for disseminating their newsletters. I subscribe to several creators because they have subscriber only content I would like to pay for (namely , because I am a die-hard Chargers fan and I trust his opinions on the Chargers given the level of access he has as the Athletic’s team reporter).

I struggle a bit with having science-focused subscriber-only content on Substack. If you are offering a course or access to something novel, then maybe you should sell it on this platform if that is the best means of distribution. In that case I could understand harsh criticism maybe if your mission is so compromised by the lack of moderation stance of the Substack team. If giving your personal dollar to Substack is a moral quandary, not pledging money to the platform is a good idea. Perhaps you can only subscribe to the people that you wish to see and open their emails in your email instead of on the Substack app itself (while unsubscribing to all the marketing emails from them alongside their push notifications). Finally, perhaps someone making the choice to post their newsletter on a platform which has allowed bad ideas to be present should make you walk away from an organization entirely. This is also within your rights, and I respect your choice even though that is not my personal path. Although Section 230 is your main adversary here, not an individual organization or creator. I would suggest that more energy is spent on structural change criticizing Section 230 instead of criticizing scientists trying to ensure their field survives.

I am of the view that deplatforming individuals in the current internet landscape does not take away their microphone but rather emboldens them in less visible platforms. Research supports this concern: after Parler was deplatformed following the January 6th Capitol attack, a study found overall activity on fringe social media did not decrease as individuals migrated to Gab, Rumble, and Telegram. Similarly, during the height of the COVID-19 pandemic, deplatforming conspiracy theorists from Facebook had limited long-term impact. The barrier to entry for secondary accounts is low and bad-actors can be diversified across alternative platforms where counter-narratives became even harder to deliver. Walking away from good people who are doing good work because they are on Substack does hurt that creator, and maybe they will learn from it. At the same time the people who are in our opposition continue to grow power and capitalize on an engagement-based media environment. Again, I think there are levels to harmful platforms. Just this week, Grok was caught allowing users to digitally undress women and minors from photos posted on the platform through an image-editing feature that displayed altered images right under the original post. xAI admitted to ‘lapses in safeguards’ as governments in India and France opened investigations.

As a population health scientist, I witnessed firsthand the unraveling of our public health infrastructure. I believe a mistake of the time was attempts to deplatform ideas (even though those ideas are inherently dangerous, and often explicitly disproven by empirical research). Those ideas need to be combatted with better communication strategies. Deplatforming simply makes identifying and dismantling antagonists harder, and fringe ideas can become even more enticing to others. Open up Tik Tok, Instagram, YouTube, you are bombarded with ads and misinformation. This can happen by seeking out misinformation, or even leaving a video on auto-play. I believe Substack subscribers are technologically savvy enough to work with a foreign platform and manage the road bumps that come with it their own content moderation. As people gain widespread notoriety for their work, it likely is both more financially lucrative and they have more control if they move away from Substack. In the interim, growing an audience and reaching more people who can easily support a mission is imperative.

For my own blog, it is free because I do not want to take any money for a personal blog. This gives me a bit of freedom in terms of the content I produce and ensures it stays a hobby (for now).

Why are you writing about your Ph.D. experience, you have not accomplished anything substantive yet?

I by no means see myself as someone with all the answers, but I view my Ph.D. experience as a net positive. Because of this, I wanted to write a blog to reflect a bit on my experience and why I think I was able to make it to the end.

I first spoke to my dissertation chair and Ph.D. advisor when I was a rising junior in undergraduate at Dartmouth College in the summer of 2019. One of the things he told me in this phone call is generally only a third of the PhD students who enter a program finish and receive their degree. He asserted that a third cannot handle the coursework, a third cannot finish the dissertation, and the final third get their degree. While I am unsure if these proportions are entirely accurate and reflect today’s graduation rates, I think the sentiment about milestones where you can slip up are accurate. On that call and throughout my application process, he reinforced how important it is that I convey a level of clarity and understanding of why I want to pursue a Ph.D. that would put me in a position to make it through the big bottlenecks of a Ph.D. program. Now on the other side of it, I am incredibly grateful for his insight on this. The initial clarity around why I want to pursue a Ph.D. provided a reference for me during points when it was difficult to be motivated to complete an assignment or I was rejected from something. Rejection even for the most successful scholars is a universal experience, so having clarity in the source of my desire helped maintain my fortitude. My advisor emphasized the importance of clearly articulating my motivations for pursuing a Ph.D., believing it’s crucial for reviewers to understand if those desires aligned with the training program and resources available. However, I firmly believe that my own comfort and conviction in this decision were even more important. Pursuing a Ph.D. is inherently challenging and lacks immediate rewards, and it is essential to understand why you want to pursue one.

There is a lot of rhetoric about a Ph.D. being an enormous opportunity cost for individuals (and their families if they have them). Conventionally, this is true. Opportunity cost permeates throughout so many spheres of life. Some choices you make in your personal life stick with you and how you are perceived. Like your personal habits, who you spend time together with, if you decide to have a family, when you decide to have a family if that is something you desire, and more. Some choices will prevent you from being able to accomplish or see things that you want in the short term. Delayed gratification is a big part of choices on opportunity cost. I am not frugal, I am not really depriving myself of a ton, but I also have a realistic view of things that I want long term. By choosing to pursue a Ph.D. there is a ton of inherent delayed gratification in that choice. I think that for most people a Ph.D. is a very overrated pursuit. A lot of people choose this path to impress their parents and peers. Some people pursue a Ph.D. when what they really need is the level of respect, knowledge, and domain expertise that comes with working in an industry for 10 years. For some people, a Ph.D. makes a ton of sense and the sometimes unquantifiable returns that experience will have for you are spectacular and unique to that path.

I will break this blog post into 3 overarching sections. First, I will speak about the good. This section will overview highlights of my Ph.D. experience, which I think provide context but are not worth over-analyzing. Second, I will speak about the bad experiences. Whether that be for unintentional missteps or choices I thought would be good but were not (this is probably the most important section). People who are candid about what they did wrong in a measured way are both self-reflective and often secure enough to desire you to learn from their mistakes. Finally, I will speak to a part of my experience which was not a focal point but I believe it is important to continue to work on. In each of these sections I will also provide some resources I think were relevant for my experience, helped me make it through, and could possibly help you. This is by no means an exhaustive list. I plan to point people here as a starting point when they ask me for advice (again which you should always take cautiously).

The Good

Grants

This is probably the most (relative) impressive part of my CV, and in many ways I think only 10-20% of this success is just attributed to me. My first grant was an NIH Diversity Supplement which is a program which no longer exists. It was tremendously impactful for me by giving me protected time (time to pursue research and training that I was the primary designer and leader for), but the proposal writing process was fairly straight forward given I set aside around 6 months to write it and I had a clear idea of a research question that fit in the scope of my Mentor’s project.

Description of Diversity Supplements from the (Old) NIH:

“Funding Opportunity Description

The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) hereby notify all Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) holding research grants with activity codes listed in “Part 1 Overview Information” that funds are available for administrative supplements to recruit and support high school, undergraduate and graduate/clinical students, postdoctorates (including health professionals), and eligible investigators. Administrative supplements must support work within the scope of the original project…

This administrative supplement is designed to provide support for research experiences for individuals from diverse backgrounds throughout the continuum from high school to the faculty level. Continuation of this program in the future will depend on the evaluation of the career outcomes of the supported individuals as well as continuing assessments of the diversity of the scientific workforce.

In all cases, the proposed research experience must be an integral part of the approved, ongoing research of the parent award, and it must have the potential to contribute significantly to the research career development of the candidate.

Receiving a Diversity Supplement was great for me because it also provided me the chance to pursue a topic that was related to health equity. A misconception of the Diversity Supplement program was that people only pursue topics under this umbrella. The stated intent of the program was:

From (Old) NIH:

“Enhancing Diversity

Fostering diversity in the scientific research workforce is a key component of the NIH strategy to identify, develop, support and maintain the quality of our scientific human capital NOT-OD-20-031.

Every facet of the United States scientific research enterprise from basic laboratory research to clinical and translational research to policy formation requires superior intellect, creativity and a wide range of skill sets and viewpoints. NIH’s ability to help ensure that the nation remains a global leader in scientific discovery and innovation is dependent upon a pool of highly talented scientists from diverse backgrounds, including those from underrepresented groups, who will help to further NIH’s mission.

NIH’s ability to help ensure that the nation remains a global leader in scientific discovery and innovation is dependent upon a pool of highly talented scientists including those from underrepresented groups, and others who will help to diversify the workforce to help further NIH’s mission.

Research shows that diverse teams working together and capitalizing on innovative ideas and distinct perspectives outperform homogenous teams. Scientists and trainees from diverse backgrounds and life experiences bring different perspectives, creativity, and individual enterprise to address complex scientific problems. There are many benefits that flow from a diverse NIH-supported scientific workforce, including: fostering scientific innovation, enhancing global competitiveness, contributing to robust learning environments, improving the quality of the research, advancing the likelihood that underserved or health disparity populations participate in, and benefit from health research, and enhancing public trust…”

I noted the purpose of the program because I want to emphasize that the program itself did not force individuals to pursue a topic that was related to their lived experience. Diversity in the topics that people selected is different from diversifying the workforce. One of my more provocative opinions is the backlash against DEI and other programs targeted at improving the diversity of workforces, education, etc. are successfully being dismantled because in many ways they funded work and people who were forced to fit into the same systems and structures that opposed people and created inequity to begin with. As a result, the trainees and early career scholars who were told that their new perspectives were valued must rapidly pivot in a world where them simply existing and following instructions now comes with a label that their work “has less merit”. I mourn the loss of these programs, but I also want to see a future where new programs are put in place that not only find diverse voices but uplift them in a way so that their disruptive ideas can make more change.

My second grant was an National Institute of Aging/National Institute of Health F99/K00 pre and post-doctoral fellowship award “Transition to Aging Research for Predoctoral Student” which was far more complicated to write. Part of the reason I said it is only 10-20% my own success I attribute to receiving these grants is because NIH fellowship awards depend so much on the institutional environment (e.g. which university you go to, and to some degree what department), your mentor (having a successful mentor is good on paper, but not all mentors are incredibly supportive and transparent like mine was), are you perceived as successful (even if you have a great idea, does your publication record and coursework signal someone who is impressive but also needs more training), and of course skilled writing (are the reviewers going to deem your proposal worthy of a vote and high impact score). Now my CV reads as someone who had 4 consecutive years of NIH extramural funding which is impressive for a predoctoral student, but in practice I was also incredibly lucky. The core interest for why I wanted to pursue a Ph.D. is one of the banned words amorphous health equity topics. I like many others have been asked to renegotiate my award terms and am grateful to still have a little autonomy in what I do because of extramural NIH support. Many were not lucky and lost their awards in an abrupt, unprecedented, and cruel fashion which is awful and consequential for their careers and sometimes their day-to-day finances. Especially if you are in a school of public health or medicine, grants are essential to funding the operation. I am curious how that changes in the future, but from my understanding of what that looks like today with new rules and general instability at the NIH, researchers are casting a net even wider for where they receive funding. Nevertheless grants were important for me because it first provided me time to think for myself while at the same time having structured time with my mentor. They also provided me a way to signal that I have good ideas because my proposal was scored high enough to receive the grant. Who knows if that is a real indicator of future success, but previous analysis shows that getting grants increases your likelihood to receive more funding in the future. Time will tell if that holds.

Resources: There was not a magic guide that I can attribute directly to my grant success. Things are changing as I noted above. What I do not think is changing is the value of taking time to carefully craft a proposal and conveying your ideas to multiple people to see if your ideas make sense. Have a good idea, read the directions of the grant, reach out to the decision makers after reading the directions thoroughly if they allow you to contact them, and give yourself time to work on the proposal. A lot of people have requested me walk through my writing process for my fellowship. Once the second part of my F99/K00 award is approved I plan on doing a deep dive on my writing for those for whom it will be helpful.

Mike Lauer, the former Deputy Director of Extramural research at the NIH recently won the Quality of Care and Outcomes Research (QCOR) Council Outstanding Lifetime Achievement Award at the American Heart Association (Disclosure: I am a member of the early career committee of QCOR) and he delivered a great lecture at the American Heart Association Scientific Sessions about chaos on the infrastructure that supports research alongside general mistrust of science. He has a forthcoming book on his time at the NIH, and I think it could be interesting read for thinking about the direction that supporting research could go.

Analytics

In my program, we have a methods sequence which overviewed many of the different type of analysis we would encounter. After that overview, I made the most growth working alongside my mentor to execute the type of analysis that was relevant for both the questions that I was interested and the data at my disposal. I gained proficiency in group-based trajectory modeling, survival analysis, and mixed-models. These are all prospective analysis techniques I never executed or really understood prior to entering my program. Connecting my analytic toolbox to the questions that I wanted to ask were important because it stretched me as a scientist. It keeps my gears turning about how my analytic toolbox could help me answer questions and inform solutions on what I want to change in the future. It is great to get knowledge from coursework, but application of the techniques has been most fruitful for me.

Resource: I think that enrolling in methods courses are helpful and finding a good instructor through word of mouth is also critical. At the same time doing things like workshops at your school can also be a great use of your time and allow you to get an overview of a topic thematically. For example, this summer I went to the Duke Health AI – Machine Learning Summer School which had intensive sessions on neural networks and clinical prediction models that expanded my thinking about future applications.

Networking

One of the underrated parts of being in a Ph.D. program is the protected networking time. Being a student is a drag because you are not at the level where you can lead a large national lab or whatever other operation you consider large scale impact. At the same time, as a trainee you can approach people from the perspective of being a learner in an environment where the core missions are generating and teaching ideas. For me, being in this position has led to many great collaborations and mentors. At the same time, there are many people who never respond or meetings go poorly. Take these instances as learning opportunities, but at the same time do not take them personally

Resource: I highly recommend listening to Dr. Kemi Doll’s podcast episode (Spotify and Apple Music) on how to properly reach out to people for informational interviews. Even though I am an early-career researcher, over the past couple of years I have started getting an overwhelming number of requests for advice and guidance. Some are more appropriate requests than others, and I endorse Dr. Doll’s advice on how to make a “cold call” style email more productive than others.

Traditional Academic Productivity

When I applied to Ph.D. programs 5 years ago in November 2020, I had 1 publication (which was a first author original research manuscript) and had received two research awards to support my time as a research assistant. I also applied for a grant to support my anthropology honors thesis. Often, publication record alone is emphasized as a way to signal potential as a Ph.D. student. At the time of applying to programs I had “enough” to be a compelling candidate, but “what is enough?” is an unfair question because the content of your CV and what resources are available to you dramatically vary by applicant. I applied to MPH and Ph.D. programs and was admitted everywhere I applied. I selected my program because the stipend was highest, because of cost of living the dollar would stretch even more, and I felt I would have the best mentorship fit. Lastly, the program was new and I was told that they would be flexible with me. Many people speak poorly about their Ph.D. program and experiences. Unfortunately I rarely have heard someone refer to their Ph.D. program as a great time in their life. This can be compounded by poor mentorship fit or unclear expectations, which is why program culture matters as much as prestige. Also want to reiterate how my mentor was incredibly generous with his time, expertise, and resources.

At the time of graduating, I have 13 published manuscripts, 11 under review at various stages from 1^st submissions to 2^nd revisions, and 3 in preparation that I hope to get under review in a month or so. 9 of those are lead author manuscripts and 2 are senior author manuscripts. When I applied to the program, there were a ton of people who had more productivity than me and a ton with less, this still applies to my post grad status. Publishing timelines are incredibly different across disciplines. Some places you need to collect all your data and in others, having one paper under review by the end of your PhD is impressive. And in some disciplines you would be lucky to get a job with under 30 papers. I left this section last because if you are pursuing a Ph.D., you do not need me to tell you publishing is important. That is clear through the composition of the faculty and how they filter through prospective candidates on the job market, but the former 3 sections I think were far more critical to my own development and what I think was valuable from my experience.

Resources: “Writing Science” by Joshua Schimel is a book that I read for a scientific writing class in undergrad. It was incredibly helpful and helps a lot with how I think about conveying ideas to scientific audiences. I took two scientific writing classes in undergrad and also a class on data visualization in grad school. Although I am nowhere near an expert, I have found that the time spent working on both writing and visualization have been incredibly helpful for my comfort with my work for academic audiences.

The Bad

Personal struggles

Like almost any 4–5-year period in your life you are bound to have personal struggles. I think that being in open dialogue with your friends and family members about mental health is important. In the low moments of my program, I had a great network of people who picked me up and did not judge me when I failed. At the same time, it is important to note that it is hard to have a village if you are not also working on maintaining relationships. So when you are having good moments, try to show up for your people. That does not necessarily mean trying to keep score or create IOUs, but relationships and friendships are a beautiful thing and it is one of the things that makes life worth living and gives you some purpose outside of your career.

Resource: “Rest” by Alex Soojung-Kim Pang was a great book I read the weekend of my 25^th birthday at the end of my 3^rd year of my program. It was a great way to kick off my quarter life crisis.

The unpredictable nature of the world

This year has been rough for a lot of people pursuing academic research. During the COVID-era when I felt everyone would say times are “unprecedented” the attitude around the nature of change was entirely different. The pandemic was acute in terms of the lives lost, the measures taken to mitigate the spread of illness, and the way it impacted our health physically and socially. The current attacks on higher education, academic freedom, and our overall research enterprise have forced many of us to reconsider what security means in academic careers and how to build resilience beyond any single institution or research sponsor. I feel I would be unwise to guess the future and tell you what exactly will be the next great crisis moment. Because of this uncertainty, it is incredibly important to remain grounded and do what you can do with the resources at your disposal.

Resources: For academic commentary, I have enjoyed Professor Don Taylor’s Substack blog.

Another book on my reading list is “The Uncontrollability of the world” by Hartmut Rosa which is about this topic. We often are very good at attributing our successes and failures to things that are within our control. Sometimes this is the case where our reality is based on our effort, but often it is a combination of our actions and circumstances.

I think it is important to get your news from journalists who cover the topics you care about. This year, I subscribed to STAT News because they investigate topics I care about (student discounts are found here). I would also recommend reading and supporting your local news sources while also seeking out other media platforms. A healthy news diet can keep you informed on what is happening in your space, and instead of falling into dread it has kept me sober about the reality of what is and is not in my control right now. There is a lot of information noise, and finding a way to focus on what will directly impact your decision making is crucial.

Interpersonal professional conflicts

Disagreement, questioning, and feedback are all core tenets of the scientific process. If there was 100% consensus on an idea, there would not be a point in investigating it. While now I think a lot of ideas that are close to a strong majority and have been well tested that are being opened for debate, I am amenable to a lot of the scientific process being a process where people must justify their assertion (even to bad faith actors). As I mentioned earlier, I was in the first cohort of my program and we did not have a handbook or structure that applied to our different milestones consistently every year. There are benefits and drawbacks to this. In practice, Ph.D. programs should have a degree of flexibility because it is not a cookie cutter degree. At the same time, it is difficult to have clear guidelines for mentees and advisors to know what adequate completion of various milestones. This is especially true in an interdisciplinary program where the mentees have different goals and the mentors trained at a different time. Throughout the process, I have felt some general animosity that I had to learn not to take personally when someone belittled me, demeaned my work, or criticized my motives. I have an affinity and appreciation for many of the people from my program. Even in points of friction, I try to give people I disagree with the benefit of the doubt. Despite this, it is imperative that students are responsive to feedback and transparency in standards continue to be a core part of the process. With potentially more stressors coming for academia in the United States of America, understanding what is expected of you and how to demonstrate that is a two-way street.

Resource: Taking a deep breath and not taking anything too personally. Remain aware of disrespect but try not to let it derail what you set out to do.

Future Direction

Scientist-Citizen Training

Health communication is something I think is at odds with Ph.D. training. We are hammered to learn about the limitations of our work and methods. As a scientist that is important because your words and claims have consequences and different standards than non-experts. We live in a landscape where the barrier to entry to communicate ideas is cheaper than ever. Creating a social media account, blog, or YouTube channel is as simple as a few clicks. Speaking in a tone that is like an expert is also a few clicks away with the proliferation of free and/or cheap AI tools. It is becoming easier by the day to appear as an expert but effective communication in the hands of well-intentioned scientists can be empowering. Speech is even more democratized in terms of access, but the quality and filtering that is possible through normal gate-keeping mechanisms is harder. I say all this collectively because I think I was the least prepared in my program was around science communication (this is not a program specific issue in my view, rather a systemic one). At a recent conference, one of the plenary speakers said everyone should become more of a Scientist-Citizen, which is a play on words for “Citizen-Scientist”. We need to take Scientist-Citizenship seriously. That means encouraging researchers to think about how their work connects to the communities they serve, and it means promoting people who do this well. Universities talk constantly about broader impacts and public engagement, but the incentive structures rarely support scientists spending paid time on this as a part of their research responsibilities. If we believe knowledge production serves the public good, then communicating that knowledge should be a core part of the academic mission, not a nice-to-have.

This is a stand-alone section because I think that not everyone should be a science communicator in public spaces, and from observations the people who do this the best do so through their own journey. While effectively communicating ideas can be bolstered with tools, coursework, and coaching, I think that a good amount of the competency that people can get comes from being authentic. Authenticity comes from an understanding of oneself and conveying authenticity includes a lot of time listening. Instead of feeling the need to comment on any and everything, if you understand yourself, you will know what is worth your voice and what is not.

While it is important to communicate effectively regardless of who you are, and every scientist needs to be able to disseminate their work through journals and the venues for your job. What happens when you give someone who is not approachable, relatable, or measured in their speech a microphone? I think people must learn how to navigate non-academic communication channels, and the individuals who are trained and talented in this must be adequately compensated and promoted accordingly.

For example, if a scientist gets a paper in Nature, Cell, the New England Journal of Medicine, etc. that will stand out very clearly on their CV and recognition is more simply quantified and valued. In the same sense, if someone is speaking on a podcast that has national recognition, I think the value of their communication skill could also be recognized. The path towards being a nationally recognized science communicator involves many dud podcast appearances and media appearances which garner tens of views instead of thousands or millions. Similar to how early scientific experiments are not Nobel Prize winning work, talent in Scientist-Citizen tasks is developed through iteration. The cynical take is that the public has already made up its mind about scientists and no amount of thoughtful communication will change that. I do not think apathy is a good enough reason to abandon the effort to promote the value of being a Scientist-Citizen. I also do not think that people are static in their value of expertise and good information, they often have for one reason or another not understood the value of aspects of the scientific process. Even if the impact of emphasizing being a better Scientist-Citizen is smaller than we hope, the alternative—ceding the conversation entirely to people who speak confidently but inaccurately—seems worse.

What’s next

I started this blog in January 2025, and this is my 13^th post of the year. I planned to write 10 posts this first year so I am ecstatic to have made it past my goal. Next year I hope to double that goal and complete 20 blogs. As the blog currently exists I want to keep it free, but I am curious about opening options in 2027 to produce paid content so that I could explore more cool science communication avenues. Despite that, I think that viewing the content should be free and the part that will eventually be limited is personal access (e.g. via comments and chats), that way I can be hands on with moderation of discourse while still allowing those who value these blogs to read them. To improve as a “Scientist-Citizen”, I am going to try to work on disseminating work through my various social media channels at least once a week in 2026.

Instagram for this blog and me professionally are: @notbeinggreen and @michaeldgreenphd

BlueSky Accounts are: @michaeldgreen.phd and @notbeinggreen.com

Appreciate your follows and support as always!

-Michael D. Green, Ph.D.

While some values of the Make America Healthy Again (MAHA) movement, such as increasing food quality, have merit, that is as far as it extends. The promotion of vaccine misinformation and health research skepticism outweighs any benefits of the MAHA movement on public health. In fact, the destruction of government infrastructure combined with widespread misinformation will set back chronic disease care for decades to come.

Chronic disease, and healthy lifestyle research is possible because of the enormous progress in the control of infectious disease. A slogan-driven theory of change poses a deeper problem. When policymakers follow culture-war logic instead investing in solutions, progress stalls. The current policy and government infrastructure changes are in line with culture war ideologies rather than legislation that align with health management.

Despite promises to make America healthier, leaders of health agencies like the NIH have dismantled what they incorrectly deemed are “DEI programs and research activities”; they are constantly being sued over the termination of awarded peer-reviewed grants. They have diverted public funds from health-promoting action to legal battles. At the same time, they channel concern about ultra-processed foods into narrow fights over food dyes and oils, areas with limited consensus, instead of advancing comprehensive policies that can improve diet and activity. Instead of listening, assessing the situation, and changing the future direction; they swiftly cancelled programs they did not fully understand.

If you believe DEI is unscientific, present the data, create a plan, and then act. If you believe vaccines are unsafe, present credible studies, create a plan, and then act. If you oppose fluoridation of water, show your analysis, create a plan, and then act. Let policy follow evidence, not the other way around. The speed and decisiveness on display are striking - even enviable at an operational level - but leaders deploy them to destroy programs instead of finding solutions.

In recent years of building up DEI programs, progress was gradual and incremental. People were told to engage with their past, expand hiring practices, think about inclusivity. If DEI expansion had followed the actions of what the current leadership is doing, it would take money from all departments because they do not have adequate representation of race, ethnicity, and gender. That did not happen. There is no equivalence between the 2020-2024 changes to increase diversity to current changed that are causing mass layoffs, dramatically changing funding practices, and disrupting public services.

Institutions, especially elite ones, will do whatever is necessary to preserve themselves. Collective action is needed here, but it is even more important to preserve our individual values. Instead of focusing on destroying the other side, I am eager to hear what solutions people will present in this moment. It is clear that healthcare and healthcare research will be a lot different going forward. Solutions are possible, but they must be implemented in alignment with clear priorities and a robust plan. We must set up public heath infrastructure that is resilient throughout various political climates. Investment in health promotion and quality research is no longer bipartisan, and we must prevent further erosion of the means at our disposal to enact change.

On Friday afternoon, August 8th, a 30-year-old gunman from the suburbs of Atlanta opened fire at the CDC headquarters. He shot hundreds of rounds, and killed the security guard. There are reports that he did this because of his fixation on the coronavirus vaccine, something that he directly attributed to his own physical ailments. His actions are not reflective of everyone (and I believe the majority) in the anti-vaccine movement. I can empathize with the frustrations of this group. Public health interventions are straightforward on paper, you make choices to bolster disease prevention and set the floor for the health of the public. In practice, we sometimes must make sacrifices that are not communicated clearly, or the ideas we have might not get the full public support and buy-in we would need to be successful. Success is also broadly defined from person to person. Much like how figuring out one unknown variable in a math equation is a simple algebra task, figuring out a bunch of unknown variables is complex. People right now are angry, but anger should never lead to violence, it should lead to solutions. If you really care about disease prevention, you do not open fire on government buildings; you find solutions for these issues.

I am big fan of the "Why Should I Trust You" podcast

( on Substack). Their mission is:

We hear from people who are wary about public statements, recommendations and studies coming from what they view as an elitist and conflict-riddled scientific establishment. And we hear from those in this establishment who fear the consequences of what they see as a dangerous trend towards anti-expertise. And then somehow, we will seek a path through all this!

The episode they released right after the shooting at the CDC had representatives from the MAHA movement (whom I disagree with on the merits of their proposed solutions but I understand their frustrations). I was incredibly pleased to hear them at the start of the podcast acknowledging that violence is never the answer. Unfortunately, many of the most prominent proponent’s of the movement like RJK Jr. have a leadership style that is not built on either accountability or scientific evidence. I was not in the head of the shooter and cannot draw a causal link between just one thing that was said and his inevitable choice to attempt to kill many federal workers (and success in killing one). What I can say is that explosive rhetoric not supported by scientific evidence is easier to access than ever, and accountability for spreading anecdotal evidence opposed to causal evidence is a common theme for anti-scientific movements.

Dissent is important for the scientific process, but dissent without evidence is a bad faith argument. Unfortunately, instead of desiring to have a stronger standard of evidence, we have an unequal platform that is leaning more into rhetoric-based arguments instead of evidence-based ones. If the new leaders of HHS, CMS, NIH, EPA, etc. all made research practices more transparent and required everyone to have stronger evidence standards, I would welcome it. I have not seen any solutions thus far that have systemically increased standards for transparency and evidence generation.

Sarah Gollust, a professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health, has an excellent invited commentary essay where she outlines the importance of protecting the public health workforce from threats and harassment. This piece was published on July 29th, 2022. She states:

We are in an environment where there are on-going threats to scientific infrastructure from the top down (through massive funding cuts, wide-scale layoffs, and banning the investigation of certain topics). Jerome Adams, the Surgeon General from 2017-2021 (appointed during the first Trump Administration), also had a great piece arguing that the CDC shooting is a wake-up call that leaders of federal health organizations need to work harder to protect the missions of their organizations and the very people who are employed to execute said mission. One of the most chilling parts of that opinion piece:

"One particularly telling — and troubling — comment came from Vinay Prasad, a high-level FDA official handpicked by Kennedy. (He recently left his position only to return weeks later.) After being asked whether Americans should forgive public health figures for their missteps, Prasad responded: 'I don't believe in forgiveness because in my opinion these pieces of shit are still lying.' This raw, venomous language from a senior public official doesn't just reflect deep frustration — it helps fuel a culture of dehumanization that may instigate real-world violence."

These isolated statements cannot be drawn as a causal link for the violent actions, but collectively allowing this rhetoric will cause more problems than solutions. I mourn for the CDC workers who have to go back to work with a heightened sense of fear. Many feel their leaders do not have their backs. Public service involves sacrifice, but their job description never included evading bullets because of rhetoric amplified by your bosses.

DEI programs and other inclusion initiatives were dismantled swiftly due to a lack of genuine support. In contrast, work that is truly deemed mission-critical is not easily dissolved. As a researcher, I feel it is my duty to provide evidence for what happens in the world. If there’s a backlash against DEI, particularly if people claim that it’s not important or that our objectives have been achieved, I would like to see the evidence to support those assertions. I am a senior author on a pre-print that evaluates reporting of race and ethnicity and the diversity of study participants using data from the largest registry of clinical trials. Our main finding was that most clinical studies and trials do not report the race and ethnicity of participants to the registry. Reporting to this space would facilitate easier evaluation of diversity. If DEI was truly important, why would over half the studies not report the race, ethnicity, and other sociodemographic factors to the registry?

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A similar analysis was published in 2022 in The Lancet Regional Health: Americas examining US-based interventional clinical trials registered through 2020. These trials are foundational evidence for evaluation of safety and efficacy for drugs that are commercially available. The racial categories in this paper were aligned with the US Census and Department of Health and Services Guidelines. In this analysis they found that US-based drug trials also lagged representation of all racial and ethnic minority groups compared to their proportions in the 2010 Census as shown in the figure below.

In our pre-print, we used the NIH Office of Management and Budget Race and Ethnicity Categories. Clinicaltrials.gov is managed by the National Library of Medicine. Given the significant reductions in the US federal healthcare workforce, monitoring this data could influence the willingness of sponsors to report or potentially even what can be reported without fear of persecution. Nevertheless, our pre-print is an analysis from 2009 to 2024 data and offers a perspective on an evolving environment. It can serve as a comparative example after the on-going dramatic disinvestment in federal research support and infrastructure in the United States in 2025.^1-4

We conducted this analysis with the initial intent to assess the current state of racial and ethnic diversity in clinical research. Complete reporting of participant race and ethnicity is necessary to accurately interpret diversity. The national and social context of these results must always be presented when interpreting race and ethnicity. While completeness of data is important, ensuring that appropriate context is provided for results is equally important, given the potential consequences of misinterpretation. Among studies registered clinicaltrials.gov we have knowledge of well over 70% of studies with reported results. The way that those categories are reported and timeliness of reporting can all be improved. As this project continues, I am excited to provide evidence to assess assertions about who is involved in clinical research.

There should be concerns about the maintenance of this registry. In this July 2025 correspondence piece in The Lancet, the authors documented evidence of manipulation of US Federal Government health-related data. This past Friday after a below expectations jobs report, the White House fired the labor official primarily responsible for this report. Selection bias occurs when the data we analyze do not reflect the people we claim to study, and efforts to track diversity in research exist to address this problem. The most flagrant form of selection bias happens when investigators suppress or highlight results simply because they fit their agenda; withholding race and ethnicity data leaves us unable to see who is involved in research and makes conclusions less trustworthy.

This problem is not just theoretical, recent reporting at STAT shows it unfolding in real time at the highest levels of U.S. biomedical research. In this article they overview how the current NIH Director has a career where he has touted his work studying vulnerable populations and health disparities. Now under the well-documented unraveling of health disparities research at the NIH (which is being conducted under the false guise of calling it DEI/diversity science despite the documented unequal prevalence and prognosis of diseases) an environment has been created where researchers and institutions are incredibly hesitant to confront the role that race plays in documenting and evaluating disease burden. One thing I am certain of, despite the lack of willingness to acknowledge that race and other socially constructed concepts matter for the prevalence and prognosis of suffering, unequal suffering will persist without solutions that acknowledge lived experiences. Telling people that their experiences and identities do not matter will not make them irrelevant.

References:

1. Cutler DM, Glaeser E. Cutting the NIH—The $8 Trillion Health Care Catastrophe. JAMA Health Forum. 2025;6(5):e252791-e252791. doi:10.1001/jamahealthforum.2025.2791

2. Sommers BD. The Public Health Damage—and Personal Toll—of Federal Worker Layoffs. JAMA Health Forum. 2025;6(5):e252652-e252652. doi:10.1001/jamahealthforum.2025.2652

3. Galea S. The Potential Consequences of Disinvestment in Health in the US. JAMA Health Forum. 2025;6(4):e250803-e250803. doi:10.1001/jamahealthforum.2025.0803

4. Sinclair AH, Harris MJ, Andris C, et al. NIH indirect cost cuts will affect the economy and employment. Nature Human Behaviour. 2025/06/02 2025;doi:10.1038/s41562-025-02238-x

During this especially challenging time in healthcare research, I am trying my hardest to take inventory of what is in my control, what is out of it, and trying my hardest to funnel energy into goals and activities which feel actionable. This also involves me funneling my energy away from activities which feel like they center circumstances incredibly out of my control. A balanced and clear-eyed perspective is incredibly important for this assessment. Achieving a goal is a combination of talent and luck, but the opportunities that come your way are easy to overlook if you do not pay attention.

Empathy is connected to our understanding of luck. Many people overestimate how much of what they value is a result purely of their hard work, and not the circumstance you are born into and opportunities you have been presented. That lack of acknowledgement compounded with insecurity can lead to a personality that I really dislike, someone who is both incredibly proud and uninformed. Although disliking this combination of traits is core to who I am, I suppose that I also need to be conscious of what it is like to be born into a situation where the tailwinds behind you are so strong you might struggle to ever feel what it’s like to be in a downward spiral. That safety-net could be outside of someone’s control, just as much as a lack of opportunity is outside the control of another.

Luck, circumstances, and opportunity all can work together, and can be amplified by hard work. I think that making this easier to understand requires the right incentives to reward empathy. For example, we raise money for government programs through taxes, which are something a lot of people hate. When we take essential things for granted, it can create a disconnect between the public benefits of a functioning tax system and the immediate impact revenue has on people. This disconnect can lead to discontent. Many people would not like to build their a municipal water system on entirely on their own dime, but when things work well it is easy to take them for granted. Entering a time where there is a lot more rhetoric around the inefficiencies and lack of benefit of government programs, I am eager to see the solutions that are proposed. I hate the idea of promoting a “scarcity mindset” to put us on a path towards progress, because only a select group of people can insulate themselves well enough from the public to not have to work alongside their neighbors to get the resources they need.

Our future (complicated) problems will take more collaboration, and that collaboration will take even more empathy in the face of more inequity. Understanding the importance of luck and privilege is key to this.

I applied to my Ph.D. program in 2020 during the apex of the response to a once-in-a-century global pandemic. For everyone in healthcare, it was a formative (and traumatic) time. In broader society, everyone was forced to learn about our healthcare system either through loss, disruption, change in routine, or all of them combined. Entering my first year of my Ph.D., I hoped that the importance of healthcare would be seen through the vast loss of life and disruption globally. In many ways, the importance of healthcare was highlighted, but that highlighting provided the opportunity for people to emphasize failures and promote different methods for change. Many of these different methods were not evidence based, but were still gaining prominence through new medical officials’ communications. This figure by Katrine Wallace, Ph.D. (Dr. Kat), an epidemiologist at the University of Illinois at Chicago, demonstrates that revenue of the wellness industry is far greater than pharmaceuticals.

There have been many people who cry out asking for more wellness remedies to fix our nation’s health issues, citing the amount we spend on pharmaceuticals and treatment opposed to disease prevention. I understand that cry. Drugs are complex, as are the processes for testing, approval, distribution, administration, acquisition, and taking them. But we DO spend a ton nationally on wellness. Increased spending on wellness, without supporting safety and monitoring, (and uplifting researchers who can investigate if health is improving) will create an environment where there is even more dramatic loss in our nation’s health progress. Make no mistake, our healthcare system right now centers on treatment opposed to prevention. That is a problem. I believe to fix this problem we must prioritize population health centered approaches that involve collective action opposed to individualism. I prefer an environment that requires evidence-based plans, as opposed to hoping for the best. Those plans take resources and knowledge that is not available quickly or cheaply, and burying our heads in the sand hoping for the best will not protect us.

One of the many reasons people seek out alternatives to our traditional medical options are because of the inability and/or unwillingness for experts to communicate with people in an accessible manner. I have greatly appreciate the work of Dr. Robert Califf, a former FDA commissioner whom has been very vocal about the implications of unraveling of the scientific environment. He’s spent his entire career trying to make progress in through his social media and the news outlets to promote accessibility of information. Lizzy Lawrence, an FDA Reporter at STAT News highlighted a presentation Dr. Califf had at STAT’s Breakthrough Summit West. Dr. Califf stated,

“I don’t know how the policies are going to be enacted in the right way without the people to actually do the work that it takes to get it right”

The voices of all scientists from trainees to advanced investigators like Dr. Califf are incredibly important right now.I also commend his willingness to start his own personal blog titled “Califf’s Commentary” his first post is here.

In this moment, we have an unraveling of biomedical research infrastructure that not only is impacting my own training and research ability, but the future of scientific research. Many of the conversations I’ve had recently are about pivoting research focus. If I could go back into the future to newly admitted Ph.D. student Michael Green, the most straight forward advice would be to pursue something “non-controversial” so he could position himself for a career to pursue science that the current administration deems “non-controversial”. Avoiding controversy is not why I decided to pursue a Ph.D. in Population Health Sciences focusing on how people are socially treated in health systems. The definition of controversy is also constantly changing, so if avoiding controversy is your guiding framework, your target will be very unstable.

I am pursuing this path because I have lived experience where my family members suffered because they feel like they were mistreated and/or unwelcome in healthcare spaces. In this moment, their experiences and trust in health systems are even more fractured than before. Simply pivoting from that work would not help them, so I cannot pivot from the greater mission, given that mission is core to my identity. Science is centered on controversy, we ask questions, run experiments, and make claims based on those experiments. Despite the pivot in how we support (or choose not to support) healthcare research, since I believe the new chaos will not work, we still need people in place to propose new solutions. I am concerned about people who hap-hazardously pivot from their alleged principles. At the same time I understand that the compensation you get in academia is well under corresponding positions in industry or another field. If the mission driven nature of academia is lost, and your ability to choose what you pursue based on your principles is lost, weathering the storm is a lot easier in places where you will make far more money or have less conflict. Hopefully people who are fighting for change are able to weather this storm, but sustaining yourself not only takes financial resources, but also mental fortitude.

Making big decisions in moments of crisis is hard. That’s why I really try to work on my relationships during times when there is not crisis so that I hopefully have a firm floor of support. In past 4 years of my Ph.D. program, I’ve had my host of swings in my family life, romantic life, friendships, professional life, all with the full range of wins and losses in all those areas. Even with these swings my abilities have objectively grown; I entered my program with a single peer-reviewed article, and at the time of writing this I have 19 total articles that have been published or are under review. This is accompanied by a research portfolio supported through an ~$90,000 NIH diversity supplement grant and ~$90,000 through a NIH fellowship grant. I have no papers in “top-tier” high-impact factor journals, but I by no means think that my experience and training has been unsuccessful. In academia there is always more to grasp for, it would be cool to get another grant, it would be cool to have double the number of papers I have now, it would be cool to start a company, it would be cool to get a faculty offer straight out of my program in my dream city, and, and, and, and…

There will always be a new achievement to fixate on, but the path to that achievement is not always dependent purely on effort. We all get lucky, and successful people at the training stage often have a support system that provides a floor for many opportunities that lead to success. Some people will be put into positions to succeed because they were in the right place at the right time. At the same time, some people are extremely talented but are shunned. I recently read the new book “Abundance”. In a section on scientific innovation by Derek Thompson from the Atlantic. He highlights how the technology for the COVID-19 vaccine, a mRNA vaccine, was a technology that never received federal funding and led to Katalin Karikó one of the scientists who pioneered it to eventually being pushed out of academia until some scientists indicated interest in her work at a biotech company called Moderna around 2013. She eventually won the 2023 Nobel Prize in Physiology or Medicine, alongside Drew Weissman, for this technology. Having decades of feeling like a failure are not a part of my path right now, but in science many of the most innovative careers and ideas have come from getting little to no real gratification for major parts of their career.

Many people might look at my life up to year 26 and say they wish to have what I have. At the same time, many believe I am someone who simply got lucky because of the opportunities and fortunes I have been put into because of a stellar mentor team, “name-brand” educational opportunities, and few external obligations like a family or large financial liabilities. I hope to approach my career with a level of awareness of what I have been granted through luck and skill, all while acknowledging that many of the key components of life surround both. In this moment it feels clear to me that the health equity centered research I want to pursue is going to be more challenged. The NIH, NSF, and other US federal research funders already had challenges where it favored feasible research and universities with a history of receiving grants. Even with these challenges, an area it was a global leader in and had immediate impact on lives was by facilitating a ton of advanced scientific training. There might be ways to supplement the lack of project centered research dollars though foundations, industry, and other areas. However, scientific training has been facilitated through a consistent investment from the government at a scale that not only will be hard to replicate, but it losing it will have a chilling effect on the amount of collaborators and people I can work with in the future.

Despite these headwinds, I reflect on this 26^th birthday and declare that the work must go on. The moments I experience big scientific “wins”: a paper at a journal getting accepted, getting into a program, getting to speak places, getting grants - all have meaning for my CV and my career trajectory. However, the day-to-day activities are still mundane. There certainly might be less of those wins in the near term, but even when that success comes, the process is more rewarding than the outputs. I find myself reflecting on the great relationships and people that I have met along my journey. Cheers to 26, hopefully I can stay healthy in the face of a ton of actions that will also make that more challenging!

“The Sirens’ Call” does an excellent job explaining the dynamics of the attention economy—the modern landscape where capturing and maintaining attention is a primary economic driver. Chris clearly describes how attention has become essential currency, providing numerous compelling examples of how companies, advertisers, and political groups constantly compete for our attention. A central idea he explores is the widely recognized concept: "If you are getting something for free, you are probably the product.” Chris effectively demonstrates how our attention is not only monetized but also manipulated to influence our choices and behaviors. The information overload caused by this intense competition often overwhelms us, making it challenging to identify high-quality content and engage in meaningful interactions. The book is particularly relevant in today’s overwhelming news environment. We are constantly bombarded with significant events, ranging from legal battles and ethical controversies to wars and public health crises, which all relentlessly demand our attention. Chris accurately portrays this reality, highlighting how the attention economy exacerbates feelings of anxiety, confusion, and fatigue among the general public.

One aspect of the book that I found less persuasive was Chris’ proposed remedies for negative consequences of the attention economy, such as reverting to simpler technologies like “dumb phones” (devices limited to calls and texts), or increasing reliance on print media. While these solutions may reduce distractions, they overlook the practical realities of the group most affected by the negative consequences of the attention economy. Those who would benefit most from reduced digital engagement often lack either the resources (time or money) or the willingness to adopt these strategies. In cases where individuals are being harmed against their will or, in some cases, within their will but through deception, government intervention or regulatory bodies are necessary. Chris acknowledges the ethical concerns associated with forcibly restricting individuals’ choices and freedoms. In the current moment where regulatory federal government agencies are being torn apart with a hacksaw, it also feels unrealistic to expect any short term restriction for the detrimental side of attention commodification. However, a fundamental problem remains unresolved: the most vulnerable and least informed individuals often lack access to reliable and high-quality information sources, such as subscriptions to reputable news outlets. Even if they had access to subscriptions from renowned journalists worldwide, the reach and influence of individuals attempting to mislead them or exploit their attention often surpasses that of mainstream media outlets. When a reputable news source like the New York Times employs fact-checking and solicits donations, it presents a significantly less productive financial model compared to the rhetoric surrounding the alleged bias of legacy media and the lucrative advertising opportunities generated by divisive content. Divisiveness creates the circumstances to increase engagement, engagement brings more attention, and more attention eventually brings more money. Fact-checking can bring you to a place where the truth is not incredibly divisive or engaging, so the reach and subsequent engagement is often smaller. This issue underscores a critical dilemma: who should be held accountable when negative consequences (like uplifting misinformation or harmful unverified stories without correction) from the attention economy? Platforms often evade responsibility by portraying themselves as neutral entities providing a place for discourse, despite the widespread problems such as misinformation, radicalization, and mental health crises directly linked to their content distribution. Liability debates persist without resolution, with corporations, despite their substantial resources and legal expertise, typically avoiding accountability, leaving individuals unprotected.

Reflecting on why this matters for my field of healthcare research, I recognize the severe consequences of our failure to effectively capture public attention, particularly during the COVID-19 pandemic. Despite the rapid development of some of history’s safest and most effective vaccines, public skepticism towards vaccination and medical authority significantly increased. The guidance provided during the pandemic fluctuated due to the ever-changing nature of scientific research and infectious disease progression, which often requires responding to rapidly evolving targets. Additionally, healthcare professionals tend to be less outgoing and may not communicate as definitively as others, as the scientific process emphasizes elevating expertise and acknowledging the limitations of your process (something that sensationalist new media platforms often do not feel the need to put forward). While there have been past instances of wrongdoing in science and medicine, properly vetting information also takes time, which many people lack. Trust is built on relationships and relatability, and science certainly emphasizes internal relationships and interdisciplinary teams. However, communication to outsiders seems to be a priority during crises but not during the regular day-to-day. While poor communication undoubtedly played a role, the root cause of the post-COVID backlash against biomedicine appears deeper: a systemic failure by healthcare systems to adequately support communities, fostering distrust. People felt that healthcare institutions let them down during the pandemic, reinforcing skepticism towards medicine. We now have a moment where we can think about making regular communication a norm, but we also must think about how to make sure the limitations of claims of others trying to capitalize on their attention are more widely known.

We have an intriguing case study for the nuance that can be present in issues. Observing the impact of outcomes surrounding the substantial expansion of advertising for GLP-1 weight loss drugs (e.g. Ozempic, WeGovy), could provide a real time opportunity for science to think about risk communication. The coverage of impacts and abilities for GLP-1 drugs has been extensive, and I firmly believe they will have some societal impact. However, the parallels between these drugs and vaccines are quite intriguing. A vaccine is a one-time injectable, while GLP-1s require a much higher frequency of administration. Additionally, its important to consider the controversy surrounding advertising versions that have not undergone FDA approval, such as compounding pharmacies that have aired Super Bowl ads alongside misleading Instagram ads. These drugs have undergone far less rigorous testing compared to COVID vaccines, yet they attract significant public attention. Given the vanity effects of weight loss and the invisible impact of vaccination in preventing illness, I would not be surprised if compounded GLP-1s do not elicit a large negative sentiment like the current negative push-back against vaccines. This highlights the substantial influence wielded by those who effectively manage public attention, whether positive or negative. Ultimately, comprehending attention—who controls it, how is manipulated, and its societal impacts—will be crucial in addressing our complex health issues of the future.

I want to share some thoughts about my own application process so we can think more critically about our future when training opportunities are reduced. There is talk of “only uplifting legitimate science,” yet my project—and many others now under scrutiny—meets rigorous standards based on extensive planning and repeated review. My grant is still active as of March 28th 2025, but I consider it naive to think any NIH research is safe if decisions are driven by vengeance rather than by honoring the scientific process. By outlining my experience, I hope you all (especially if you have decision making status for training programs) will consider how to support researchers through this tumultuous period and encourage training for innovation in the research process, rather than dismantle it for personal or political reasons.

My award is from the Funding Opportunity Announcement (FOA) Number: RFA-AG-23-016

Funding Opportunity Purpose

The National Institute on Aging (NIA) invites outstanding graduate students from a wide range of broad research areas who are interested in receiving aging-related postdoctoral training to apply to this Funding Opportunity Announcement (FOA)

…

Successful applicants will be awarded the Transition to Aging Research Award for Predoctoral Students, whose purpose is to recruit and retain emerging investigators in aging research. This two-phase award will allow awardees to complete doctoral dissertation projects and provide a variety of training supports to facilitate the smooth transition of doctoral graduates into competitive, aging-focused postdoctoral positions.

The F99/K00 is a unique award, and the concept is innovative. Many biomedical researchers know the K99/R00 (a postdoctoral-to-faculty transition award). The F99/K00 first appeared in 2016 under the National Cancer Institute, with only 36 awarded, compared to 624 F31 (for PhD students) awards and 516 F32 (for postdoctoral scholars) awards that year. The National Institute on Aging (NIA), the NIH institute which issued my award, began offering the F99 in 2020, funding 15 applicants at first. From 2020 to 2023, NIA awarded 39 of 123 - F99 submissions (31.7% success rate). During that period, NIA funded 73 of 239 - F31 submissions (30.5% success rate), and across NIH overall, 962 of 3448 - F31 proposals (27.9% success rate) received funding. 2 years of support for a PhD student or Post-Doc is great, but the transition awards (F99/K00 and K99/R00) give early career scholars an incredible opportunity to build on ideas for 5 years.

Unlike the F31 and F32, the F99 is open to non-US citizens and supports both the predoctoral and postdoctoral phases. Awardees receive funds for the remaining portion of their PhD, followed by salary and additional support for a postdoctoral position. Because of two part structure of the award, as a prospective post-doc you arrive with a baseline amount of support, making the awardee a more appealing recruit and allowing flexibility in the transition. However, it is not widely pursued relative to the other mechanisms to support individual training because applicants must be at a precise stage of their program—often in the third or fourth year, needing only two years to finish. You essentially get one ideal shot at applying, and although resubmissions are possible, the timeline is tight (applications are due in October with the earliest start date in July). Waiting up to two years to secure this award (if you submit and resubmit a year later) is simply not feasible for many trainees.

The entire purpose of the F99/K00 is to facilitate a seamless shift to a postdoc position, which will cumulatively provide five to six years in total (depending on whether one pursues a career development award) of individual support for training. Yet anyone who has gone through a NIH grant submission knows how far from “seamless” it can be, given the lengthy writing, review, and execution stages.

NIH has often been criticized for being slow, favoring well-resourced institutions and high-profile investigators, and accommodating those with the time or support to submit multiple proposals. Although institutional change and thoughtful disruption might be reasonable, the current state of cancellations does not reflect that. It instead is the dismantling of an established system—driven by cultural or political disagreements—threatening the stability on which scientific research depends on for future innovation.

I have witnessed friends and colleagues lose funding under circumstances that are arbitrary, despite the substantial effort required to secure those awards. Many were locked into well-thought training plans, expecting long-term advantages, only to find themselves vulnerable now. Historically, NIH grants were terminated only for serious infractions like plagiarism or data falsification, yet hundreds of grants have been canceled in recent months because the administration no longer prioritizes those scientific areas. The grants were reviewed by subject experts who volunteered their time, and identified priorities for their space. The terminations were issued by individuals who had no expertise, and did not understand the NIH process.

This BlueSky thread shows one large grant ended for being deemed an “amorphous equity objective.”

The health disparity that is targeted in this grant is well-document as a critical public health issue. That work passed institutional and scientific review, was considered a worthwhile project amongst a panel of experts, and was then abruptly terminated. Innovation in science depends on bold, forward-looking ideas. The issuance of NIH funding was previously considered stable for those who were awarded it, which is one of the main benefits of receiving it to pursue questions with longer time horizons (3-5 years, but likely longer if you consider a full research portfolio which often is 10-15 years cumulatively for more advanced investigators). Dismantling the biomedical research infrastructure removes the foundational support that allows researchers to plan and collaborate effectively.

It is a tragedy, but as an early career investigator, I must look ahead. Elon Musk and his allies are not strengthening scientific innovation, they are unraveling an infrastructure that helps keep personal agendas in check. That approach break a lot, and the pain from that wreckage is on-going. I plan to discuss these broader ramifications in a future piece. For now, the crucial question remains: How do we rebuild? Simply restoring the old system would not address the deeper issues that left us unprepared for this disruption in the first place.

New programs designed to support early-career researchers must not only address the current turmoil but also account for those whose careers have been set adrift by this crisis. If genuine innovation is indeed the goal, then bold ideas need substantial promotion and support. I am eager to see who will rise to the occasion and help create something better.

Most of these blog posts I write start from either a major news event or an on-going dilemma I have had with research. Today’s inspiration is the massive news around many federal grants at Columbia University being unilaterally cut. $400 million in total, with reporting indicating that $250 million of the $400 million are NIH grants. This past weekend I was at a conference and was disconnected from the news while I tried to distract myself with a new city, friends, and fresh science. That headline left a murmur around the poster sessions and transition times between events

This story by Ryan Quinn, a faculty issues reporter at Inside Higher Ed, is a good overview of the aspect of the cuts that I would know most about, the NIH cuts.

“In the federal fiscal year 2024, Columbia University received more than $690 million from the NIH, most of which went to its medical center, according to an analysis of data from the Blue Ridge Institute for Medical Research.

Neither the NIH’s post Monday nor the NIH spokesperson provided information on what the terminated grants were for. The second Trump administration has repeatedly misstated the dollar amount of cuts it has made in the past.”

I believe many people do not fully understand the work and sacrifices people make in biomedical research and the federal government. As a PhD Candidate in a School of Medicine, I work on integrated teams which are upheld by talented staff, students, administrators, and investigators. Many people disagree with the best method or choices, but discourse around the value of science is almost never in question. Maybe people have disagreements about the construction of a program, the path that people should take with their career, or even the appropriateness of investing in new methods opposed to refining the implementation of old ones. What is happening right now in science is not a slight disagreement, it is a widespread reckoning about the worth of any scientific infrastructure supported by the federal government.

People often like to think that government work is useless because they do not directly see its impact on their daily lives. They prefer highlight aspects not useful in their own lives while often ignore the rest. However, this attitude is detrimental to the effectiveness of government systems. While siloed systems emphasize individualism and control, long-term progress often depends on coordinated action—even if it moves more slowly. This is where I believe we need to focus our efforts.

During these challenging times, I find myself trying to laugh with and reflect with the people I am close to. However, I also remind myself to be less punitive and more forgiving of myself and others who are not direct adversaries in my life or the lives of others. It is overwhelming to deal with the current situation, but amidst all the chaos, I believe it is crucial to consider the potential outcomes of this moment. When you lose hope for the future, spiraling into a pit is only a short fall away. It is easy to get caught in a pit of despair, but I am trying to stay focused on planning for the future. I want to find ways to be the change I wish to see and make it through each day. Additionally, I am committed to empowering people and supporting each other in a way that prevents similar backlash from happening. I am leaving these notes as a reminder to myself and others, hoping they can help us navigate these difficult times.

Take the Diversity F31 supplements as an example from my field. These awards require extensive applications (often upwards of 50 pages of materials) and go through the same grading process as the non-Diversity F31 awards. The NIH F31 Fellowship is one of the largest awards available for biomedical doctoral students, providing significant financial support throughout the PhD and signaling a candidate’s potential to secure future funding, which is increasingly critical for a career in health sciences research in academia. The “diversity” mechanism of this fellowship not only supports a firm foundation in research methods and mentorship but also actively broadens the pipeline of scientists from diverse backgrounds. Recently, however, grants submitted months in advance were pulled from the study sections that evaluate them, right alongside the non-Diversity F31s. For many early-career researchers, this was the only opportunity to secure NIH funding to support their work (the timing in your degree where you both have enough experience to assemble this award application while also having enough time in your program left to benefit from the support is fairly narrow usually only a couple year window in 4-6 year degree programs). As of this writing, these applicants have not been given a chance to pivot their hard work to another NIH mechanism. They simply lost their shot without so much as a review. More reporting is here by Usha Lee McFarling and Anil Oza.

This frustrated many people, but few institutions made a large effort to combat this. People who are promising scholars but the most vulnerable in the institutions were hung out to dry, and there was a lack of quick legal challenges.

Esther Choo (an emergency medicine physician, health policy researcher and founding member of Equity Quotient) captured this concern perfectly in a recent BMJ opinion piece speaking to the backlash against research focusing on subgroup differences, which I believe has major parallels to the limitations of not ensuring that there is support for vulnerable groups in scientific training.

She concluded:

“Whatever the new administration intends, stifling our ability to identify and understand specific groups does not make the groups go away. It simply makes our science less insightful and robust. Striking terms like those mentioned above hampers our ability to understand our whole population, in all its inherent heterogeneity, to identify and address when and where existing structures, systems, and therapies are not adequate to ensure health. That is harmful to those already at risk for poor health outcomes; it’s harmful for us all as an interconnected body of people. And sustaining barriers to entering research fields keeps us from our own full potential as a nation of scientific discovery.”

The ideas of people from different backgrounds than the fairly homogeneous scientific training pool are needed. Some of the biggest impact happens at the executive C-suite level and top university leadership positions, and across the nation in biomedical research there is still a striking lack of diversity at these levels. Stifling training now will make sure that this reality remains.

As if that were not enough, the NIH also announced unilateral cuts to indirect funds Friday February 7th: NOT-OD-25-068

I won’t go into the specifics in this post, others have explained it in depth far better than I would, such as Delip Rao here and a fellow Duke colleague, Don Taylor here. The short story is that cutting indirect funds at this scale will devastate biomedical research in the U.S.

Early-career researchers have already felt the sting of these policy changes on a small scale (through their fellowship applications being in an unclear status). Now, the entire field is experiencing a similar shock in the macro sense. There’s been extensive discussions about the need to communicate the value of scientific research more effectively. That has become even more urgent as we lose ground to mounting policy setbacks.

Jeremy Berg (associate senior vice chancellor for science strategy and planning, health sciences, and professor of computational and systems biology in Pitt’s School of Medicine) provided an interesting thought exercise of what an emergency plan to combat this action could look like in a recent BlueSky thread, explaining how institutions could respond to slashed overhead by raising funds in other ways:

Here is how the plan to slash indirects would have looked if immediately implemented for a full year under a round number of $100,000,000.

In these next two images he overviews how money raised can help a short shock to the system like was proposed.

And in this one it corresponds to what maintaining the status quo would look like:

Institutions can pivot, but pivoting in this case without the ability to plan a dramatically different view on how to support biomedical research will have negative cascading effects that by the time they are felt, it will be too late to reverse the damage.

This new perspective on biomedical research from the current administration dramatically eats away at the lead we have in the US. I anticipate that the divide we currently have, where the institutions with the best lawyers, most resources, and most prestige will continue to fight for their positioning and science will continue (at a smaller scale). People will continue to push to be at these places, and opportunities for advancement will be even slimmer than before. Many institutions might shutter their doors altogether, and/or cancel training programs. Science is already an exclusive career where people work and develop ideas and trade off some of the earning potential and simplicity of a job in a non-academic environment to pursue the chance for intellectual freedom in an academic environment. Again, thinking of the early career colleagues I have, over the coming weeks and months more people than ever will ask themselves “Why bother?”.

However, this is not just a problem for academics; it has real implications for public health and medical innovation. Local economies can suffer, since much of this research underpins jobs at hospitals, universities, and biotech startups. In other words, when we fail to invest in science, we end up losing not just the next generation of discoveries, but also the people who innovate and the local environment that is a product of science.

So, what can you do if you are not directly involved in the NIH ecosystem? First, it’s important to stay informed. By following credible news outlets, scientific journals, and community voices, you will get a clearer sense of how research funding impacts healthcare, local economies, and our broader scientific progress. Another practical step is to support science communication efforts. Whether through sharing articles, podcasts, or videos, spreading accessible explanations of why science funding is important can go a long way toward building public momentum. You can also contribute locally. Many nonprofits, labs, and university programs rely on philanthropy, volunteer work, and even a simple retweet or Instagram post to help spread their mission.

Despite all this chaos, I am holding on to a primary source of optimism: the resilience of the scientific community. If we pull together, communicate our value clearly, and keep fighting these regressive policies, we can make room for fresh voices and new ideas. Right now, I am just trying to capture my own thoughts and uncertainty, in hopes of keeping myself and others engaged.

Academics have varying incentives, but promotion and tenure are highly skewed to your scientific output. In some places, scientific output is facilitated through grants; some are allowed to work on research while also teaching. Some have a seat only because of their grant outputs, and when the grants run out, their seat and salary are gone. A key part of this dynamic is this is a system where norms (and being in the know of those norms) are emphasized. For experts these norms are simple to self-police because naturally there are not a ton of people with doctorate degrees whom treat peer-reviewed publication as their primary measure of productivity. Because of that dynamic, predatory publishers arise who do not adhere to ethical peer review and publishing standards and create a pay-to-play environment where individuals can submit their work to get a quick review without the input that other publishers would want you to consider for your work to be published. The fundamental problem with most predatory publishers stem from their exploitation of a system with numerous loose norms. They exploit these loose norms to make money, which is a nuisance. However experts generally disapprove of individuals who engage with these predatory publishers, especially if their entire scientific identity is dependent on them.

When it comes to the public, one of science’s huge issues is the gatekeeping of good information. Articles are often not open access to the public unless the researcher pays for them. Unless you have funding to make the work public, articles go through multiple rounds of expert reviews, and then your work is under embargo for a year (or longer). If you want your study available immediately through a journal, pay a $2000-$7000 Article Processing Charge (APC), and this work is freely available to all with a link. Predatory journals typically undercut some of the top journals’ APCs (Nature, JAMA, etc.), and have quick to no barrier to entry. If you are someone not in this system, it is incredibly easy to not know whether or not a journal is predatory. These journals have similar names to highly regarded ones, and have increasingly deceiving website mimicking non-predatory ones. There are great studies in predatory journals, and there are poor studies in the journals with the most highly regarded reputation, but the whole point of peer-review is having the opportunity for work to be vetted by experts.

Now we have a new predatory journal in my space which goes beyond just a cash grab. this article in WIRED by Emily Mullin and Matt Reynolds overviews troubling aspects of this journal.

From the article:

In a February 5 press release, the Real Clear Foundation calls the journal “revolutionary,” saying it will publish “cutting-edge, peer-reviewed, and open access research from the world’s leading scholars of epidemiology, vaccinology, global public health, health policy, and related disciplines.” In its bylaws, the Academy of Public Health says only members can publish in the new journal. To join, you must be nominated by a current member.

One of the key elements of peer-review journals, which includes most predatory pay-to-play publishers, is that anyone can submit. One might think that if you can only have experts and their networks publish, that journal platform will be great. When the individuals in that space are known for not adhering to standard scientific principles and integrity, that can become a new platform to further trick the public into thinking that their work is legitimate. This is often work that would not ever make it through peer-review (or subsequent requests for retraction/removal) in other spaces .

This new journal, featuring some controversial health scientists, including a few appointees in the new Trump administration who faced significant backlash due to their questionable scientific opinions in response to COVID-19, presents a troubling new perspective. While scientists are not immune to errors, the way they respond to them often reveals their motivations and character. Instead of embracing an open-access model that compensates reviewers for their time and expertise and acknowledges their contributions amidst the vast scientific community, this group chose to establish an exclusive club. By controlling who is invited as reviewers and who can publish, they further narrow the scope of ideas and work shared within their platform.

From the Wired article:

Articles published so far include a review of a paper examining the association between vaccines and asthma, a critique of Covid vaccine trials, and a study that concluded that masks were not associated with lower Covid case rates. The journal also published an editorial from Kulldorf arguing that in some ways scientific journals “are now hampering rather than enhancing open scientific discourse.

I am open to innovative approaches in scientific publishing, such as preprinting, allocating funding for open access journals through grants as part of your publishing strategy, and removing the names of journals from CVs. These efforts encourage scientists to critically evaluate scientific articles based on their merits. While the scientific community can embrace these changes, the public may perceive new journals with prominent board members from prestigious institutions and accolades for their work, leading them to accept this research as high-quality and drawing conclusions accordingly. Unfortunately, this dynamic could further divide the scientific community into partisan networks rather than fostering a level playing field for ethical and reporting standards, allowing the best work to emerge.

Questioning the qualifications of people because they are not in the majority is an experience I have felt frequently. In high school, I went to a school where we had a few students go to highly selective colleges each year, and around half attended a four-year college. So, when I got into Dartmouth College, my dream school, through Early Admissions, I got many congratulations but equally got the same number of responses of “what was your ACT?”, “what was your GPA?”, “Did you get in for sports?”. Which surely takes the excitement away from a 17-year-old who got an achievement that he had envisioned for himself for a while. Those questions of merit were annoying, but I could argue they were fair since test score and GPA are the driving force of college admissions and it is easy to flatten people to a few numbers opposed to having a nuanced conversation about your lived experience. The most troubling statement (which sadly was a frequent one), “well if I was Black, I would have gotten in too”. A double whammy, not only belittling my achievement but also throwing in insight about yourself that I did not ask for.

For those who care, my ACT was within the median range of admitted students at Dartmouth. As were my unweighted and weighted GPAs. I took a ton of the highest courses offered at my school, was the President of our Student Government and National Honors Society as well as on the leadership board of our Black Student Union. I played Varsity Football and Track (but was not good enough to compete at the Division 1 level, so the snarky remarks about being recruited for a sport should be offensive both to me because of this misclassification and the prolific athletes recruited to my alma-mater because I did not have their accolades). I worked on my essay for Dartmouth specifically for well over 8 months and really wanted to go. If I had not gotten in, it would have been disappointing, but it would not slow down the mission of what I wanted to do in life, and I think that is indicative of who I am as a person and my temperament. Some might say that if there were not Affirmative Action and other DEI-related initiatives, my admission into a highly selective school would be more legitimate. Taking away legitimacy and agency from accomplishments is asinine to me, because at no point did I ever delegitimize the accomplishments of people who had more advantage than me, more exposure to opportunities, or other background items that might have elevated their profile. Again, it is a slippery slope to make diversity and merit at odds when the scales for both of those have considerable overlap.

During my time at Dartmouth (and most of its existence, I am sure), there was a large asymmetry between the socioeconomic diversity of America and the socioeconomic diversity that is present at the college. From my knowledge, half of the school did not qualify for financial aid on the approximately $ 80,000 a year cost of attendance. Since Dartmouth is solely a need-based financial aid-granting institution, this is based on your parental income alongside the other tuition needs they are facing at the time. At my high school, I am fairly certain that less than 5 of the around 1,000 people in the school would qualify to receive no aid from Dartmouth. The wealthiest person in my high school would probably be far closer to the median person at Dartmouth, which is not a reflection of the generational and/or top 1% wealth that many peers had in undergrad. While not guaranteed, having resources at that level will provide opportunities that people from places that reflect most of the average American’s lived experience could not even dream of. Merit is not based on equal opportunity, and although DEI is focused on diversity amongst socially constructed groups, throwing out DEI and diversity will throw gasoline on the stark divide in opportunity between individuals with immense resources and those who do not have them.

The reality of the current anti-DEI push is that the people in my position, who are hardworking and have a varying lived experience because of their racial background, have been vilified. At the same time, people who have enormous resources and have been taught about schools like Dartmouth since their early childhood are going to continue to reap the rewards of what privilege has offered. Racial and ethnic diversity programs are not without their flaws, but at the same time, the lack of consideration of socioeconomic diversity will not only make an environment where privilege and nepotism are the strongest currency that can facilitate merit. Underrepresented and historically marginalized groups are beginning to have an opportunity to make an impact at the highest possible level, and vilifying them at this stage prevents advancement.

My first NIH award was a diversity supplement. The diversity supplement program is a program which encourages principal investigators of existing awards to collaborate with underrepresented minority scholars by constructing a sub-question under the scope of the awarded grant that is an enhancement of their on-going work. These awards are available to individuals across all career stages, and in my opinion, the proposition of this helps diversify the biomedical workforce. If your institution does not already have funded investigators, you cannot have diversity supplements. I am fortunate enough to be at an institution where we have many R-level NIH grants (the larger grants that are offered to individual and co-investigators), and on these grants, there is a lot of potential for supporting important science and personnel. Often, places are told that they need to support minority scholars. At the same time, institutions do not provide faculty with the protected time or compensation to properly mentor individuals and while having an incredibly tight timeline for promotion and tenure decisions.

Being on a diversity supplement enabled my mentor to provide me with the necessary resources to support my work with newly acquired grant dollars. Additionally, it granted me the protected time to engage in independent projects that exposed me to new methods and new aspects of the research process. From a broader perspective, the preliminary evidence generated from these projects has the potential to pave the way for my career development and research agenda, ultimately contributing to my progress. I received my supplement in 2022, and since then, it has significantly contributed to my identity and CV. It has directly led to two first-author manuscripts currently under review, two more that I published due to the protected time it provided, and three co-author manuscripts through collaborations. Notably, the preliminary evidence generated by this work ultimately led me to receiving an NIA F99/K00 pre-to-post-doctoral transition award. I will provide more details about the diversity supplement and F99 research in later posts. However, the idea that programs like diversity supplements will be suspended is deeply concerning for those who may not have the opportunity to develop their careers in an environment where the odds are already stacked against them.

Demonizing diversity undermines the very foundation of my work. This sweeping approach to a complex issue is a clear sign of misunderstanding. Even the most well-intentioned opponents of DEI acknowledge the importance of nuance and present solutions and alternatives with depth. I firmly believe that moving away from diversity and in lieu of abstract “merit” is not beneficial; it is a step away from excellence and advancement.

I have a short history in blogging and have always had an interest in reaching people through the internet. People who know me well know I had a brief stint making YouTube videos (shoe reviews), I wrote for my high school newspaper, and blogged for my undergraduate admissions office. I have been skeptical of coming back to blogging mainly because of imposter syndrome (alongside fear of embarrassment). My biggest hangup was grappling with our current state where everyone tries to sell you something. In my view, one of the biggest goals of marketing oneself, ideas, and expertise seems to be so that eventually you hit a point where you can monetize that platform. From Day 1, I’d like to say that I do not view the point of this blog as a future monetization scheme. When you rely on your platform to eventually cash out, your sponsor becomes your editor, and I already have that dynamic in my life. I choose to start this blog with the thought that it would be great to have a place where I can muse a bit and not deal with the constraints of the main place I write, peer-reviewed journals.

I am starting this blog in the end of my 4th year of my PhD program in Population Health Sciences. I currently am on track to complete my degree by the end of the next academic year and think that this space is a great opportunity to collect some of my thoughts at the end of a journey where I am supposed to emerge as an “expert”. There is currently an attack on expertise, which in healthcare is scary but not the first time it’s happened. The ramifications of this attack on expertise are especially pronounced in the current technology and social media age. We are also in an age where controlling the dissemination of work is harder than ever before. The internet is a place where the sharing of ideas and information is supposed to be open. Discovery of new people and places happens through algorithms, and these will emphasize controversy and sensationalism in lieu of expertise. If you are an expert in a hot topic, you might be able to grab onto an audience, but then you are also forced to cater to that audience.

By no means do I consider myself an expert yet, but I do feel like I am at a point where I am more assured in what I do and do not know about my experiences and my research areas. There are quite a few conversations that I have had upward of 20 times with prospective and current graduate students asking me for my advice on things like applying to grad schools, grants, and other aspects of early career academic healthcare research. I will for sure cover those things here, making this blog a resource for people who ask me about those topics. I can also grapple with some of the experiences I had in a long format here, eventually guiding some future choices. Another thing that I want to cover are some behind-the-paper/project blogs where I can discuss the administrative and day-to-day aspects of research that never make it into a peer-reviewed journal article. This is not with the goal of being a how-to guide; rather a way to shine some light on the process of research that does not make it to the headlines.

One of the definitions for “Green” is “(of a person) inexperienced, naive, or gullible.” I am naïve about a lot, so I often seek out and surround myself with people who know more than me. Hopefully people can learn from my mistakes just like I have learned from others, because as many of us know its Not Easy Being Green. With this blog, I have no commitment to frequency, but if a community builds here, I might lean on it a bit for future writing topics. In a lot of spaces, people become beholden to their funders and specific platforms; hopefully, this blog will allow me to take a little bit of agency back. If you made it this far, you probably have a shared desire to consume more long-form content, and I appreciate feedback on this in the future.

-Michael D. Green