I Was an NIH Program Official. Here’s What a Peer Reviewer Doesn’t See.

In a June 18 opinion piece in MedPage Today, Anthony LoSasso, PhD, a health economist who served on NIH study sections for 12 years, took issue with a recent New England Journal of Medicine (NEJM) editorial that criticizes the Office of Management and Budget (OMB) proposed Federal Financial Assistance rule.

His complaints against the NEJM editors were threefold. First, he argued they romanticized NIH peer review, ignoring that funding decisions have always involved judgment, discretion, and imperfection. Second, he accused them of hyperbole for invoking the Soviet agronomist Trofim Lysenko, implying the comparison to politicized science crowded out the opportunity to argue for a more balanced middle ground. Third, he cites the “Unified Strategy” from NIH Director Jay Bhattacharya, MD, PhD, as an example of thoughtful reform, calling on the NEJM editors to approach this issue with humility as Bhattacharya has done. But his characterization of what the Unified Strategy actually is and what has been happening at NIH is incomplete.

Each of these complaints deserves a direct response. But taken together, his argument inadvertently obscures rather than illuminates what the administration is actually doing.

On Peer Review and Funding Decisions

LoSasso is correct that NIH peer review is not a purely mechanical process. Priority scores matter enormously, but they are one input into a larger deliberative system. What he appears not to know — because study section members don’t see it — is what happens after the scores are assigned.

I spent 22 years as a scientific program official at NIH. Program officials are responsible for reviewing every peer review outcome. We read every summary statement. We listen to the reviews. We know when reviewers have missed the mark, when an assigned reviewer imposed their own methodological preferences, or when a junior investigator got an unlucky panel draw. And when that happens, we advocate. I did this many times, making the case to branch chiefs, division directors, advisory council members, and institute directors that an application with a suboptimal score deserved a second look. The system LoSasso describes as opaque is in fact a layered, accountable process staffed by career scientists, exercising scientific judgment on behalf of the public.

LoSasso calls this “political discretion.” That framing is wrong. The Public Health Service Act of 1944 deliberately placed funding authority in the hands of scientists, not politicians. These decisions are informed by detailed discussions with study section members, advisory council members, institute leadership, and program staff to arrive at scientific consensus. Scientific judgment exercised by career civil servants, vetted through multiple layers of peer accountability, is categorically different from political discretion exercised by appointees whose job is to advance the President’s priorities. Conflating the two may be useful to those who want to replace the former with the latter.

He also complains that NIH study section members are never told which applications ultimately receive funding. Those decisions are a matter of public record, available to anyone through NIH Reporter, searchable by study section, institution, or investigator. Perhaps he just never looked.

On Lysenko

LoSasso says the NEJM editors reached for Lysenko as a rhetorical shortcut. But the comparison is not hyperbole. It is a structural description of what is currently happening at NIH. Lysenko replaced legitimate science with a politically acceptable alternative, enforced by the state, and destroyed the careers of scientists who practiced disfavored methods.

That structure is precisely what the data show happening today.

The National Institute of Allergy and Infectious Diseases (NIAID), historically central to pandemic preparedness, has undergone significant reorientation without congressional input and against scientific recommendation. Staff were directed to remove references to “biodefense” and “pandemic preparedness” from institute materials, and NIAID leadership have all been fired, reassigned or stepped down.

I have documented on my Substack that 110 NIH funding announcements have been canceled since January 20, 2025, spanning HIV vaccine and cure research, health disparities science, biodefense programs, and career development pipelines for early-stage investigators from underrepresented communities. These were targeted eliminations of specific categories of science, carried out without scientific review.

I also found a psychedelics research announcement that had sat in NIH’s approval queue for 316 days cleared in 11 days after a presidential executive order, while an HIV vaccine consortium funding call entered the same queue at approximately the same time and was formally killed. Meanwhile, NIH has terminated or frozen thousands of research grants since January 2025 — grants that had already been approved and funded. The cancellations were disproportionately concentrated in infectious diseases research, vaccine research, and health disparities work.

That is a system operating on political instructions. The NEJM editors were not being hyperbolic. They were drawing on historical lessons: highlighting the close parallels between the historical record of Lysenko and what is happening today.

On the Unified Strategy

This is where the incompleteness of LoSasso’s characterization becomes critical. He cites Bhattacharya’s call for a “more unified funding strategy” as an example of thoughtful reform — an example of the humility he advocates for. But his description of what the NIH Unified Strategy actually is and what it actually does omits essential facts. Upon examining the strategy in full and then observing its implementation, a different picture emerges.

The Unified Strategy was issued by Bhattacharya on August 15, 2025, 8 days after the executive order “Improving Oversight of Federal Grantmaking,” which called for the requirement for pre-issuance review of all NIH grants. The Unified Strategy operationalizes the executive order at NIH; the proposed OMB rule would make it permanent through federal regulation. The Unified Strategy is the document through which political appointees will define what research aligns with “agency priorities,” the filter applied to grant applications after peer review is complete.

The document’s careful language emphasizes balance, scientific rigor, and continued commitment to multiple research areas. Yet, the actual cancellations show what has happened under the Unified Strategy: health disparities research examining structural factors has been eliminated, gender-related science restricted, international collaborations curtailed, and mRNA vaccine development abandoned. The gap between the document’s stated commitments and the systematic cancellations reveals the document’s actual function: to provide rhetorical cover for political policy.

The Unified Strategy also eliminated paylines — the objective score thresholds that once determined which grants were funded. Previously, applications scoring above the payline had a strong likelihood of funding based on peer review merit. This structural change removed the objectivity that once helped protect meritorious science from political override.

By characterizing Bhattacharya’s approach as thoughtful reform based on calls for “transparent” weighing of scientific merit alongside other factors, LoSasso accepts Bhattacharya’s language at face value. But he ignores what has actually occurred under his leadership: the systematic elimination of disfavored research behind the language of continued support and scientific rigor. This is not reform. It is redirection through administrative action.

What Isn’t Mentioned

LoSasso focused his entire critique on the pre-issuance review provision. He said nothing about the OMB rule’s authority to terminate funded grants at any time without cause, which would allow politicians to cancel ongoing clinical trials mid-enrollment. He said nothing about the rule’s severe limits on foreign research collaboration that would sever the international partnerships essential to pandemic preparedness and global disease surveillance.

These are not peripheral details. They are the core of what makes this rule dangerous.

The NEJM editors had it right. The fundamental choice is between a system where scientists make scientific judgments through accountable deliberative processes and one where political appointees make those calls instead. The NEJM editors understood precisely what was at stake. And the stakes are high.