The Demise of Scientific Medicine? Responding to the Challenge of Populist Medicine and Institutional Mistrust

The U.S. federal government has undertaken an unprecedented dismantling of core institutions related to health research, policy, and services.Beyond politicizing issues of health and social welfare, these actions have revealed conflicting positions about what counts as evidence for health and what knowledge should be accepted as science.After President Trump signed executive orders to ban diversity, equity, and inclusion, "woke gender ideology," foreign aid, the "green new deal," and funding for "nongovernmental organizations that undermine the national interest" in January 2025, federal agencies paused operations, terminated thousands of awards, vetted scientific grants, and removed public databases pertaining to race, gender identity, and sexual orientation (Mervis, 2025a).An April 2025 proposal from the Trump Administration planned a 50% cut to the National Science Foundation's (NSF) budget, a 37% cut to the National Institute of Health's (NIH) budget, a 30% cut in the DHHS budget, and consolidation of the 27 institutes of the NIH into eight (Looi, 2025; Science News Staff, 2025).To comply with the newly created Department of Government Efficiency, political appointees eliminated grant spending and scientific personnel in May 2025 by more than 50% across the NIH and NSF (Malakoff, 2025), including leaders at both agencies (Thompson & Kozlov, 2025).The DHHS announced that it would terminate 10,000 employees in 2025, with more terminations expected in 2026 (Tollefson et al., 2025).As of January 2026, researchers estimate that 5,843 NIH and 1,996 NSF grants have been disrupted, amounting to US$724 million and US$697 million, respectively, in lost scientific funding (Grant Witness, 2026).On January 13, 2026, the Trump Administration terminated nearly US$2 billion in grant funding for mental health and addiction services through the Substance Abuse and Mental Health Services Administration, a decision that was reversed less than 24 h later after 100 U.S. Congressmen across political parties "furiously" lobbied to restore funding (Hoffman, 2026).These moves damage research pipelines, academic careers, medical infrastructures, and the capacity to respond to the unmet needs of