“The Triological Society continues to use resources to provide research funding support to help augment otolaryngology research programs where we can,” he said. “I want to emphasize that our grant programs remain available, and we look to partner with otolaryngologists, especially at early career stages, as much as we can to help provide research support and mentorship.”
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September 2025He said that at Duke, in light of the uncertain environment, the university has examined its spending and looked at how to expand its portfolio of funding.
“The approach that leadership at our medical center took was just one of caution, mainly asking people to proactively essentially slow spending where we can and to prepare for the worst, hope for the best kind of thing,” Dr. Goldstein said.
He said the prospect of major cuts is a reason to make changes that would be prudent in any budgetary environment.
“I think those of us in academia tend to view federal funding, NIH funding, as kind of the gold standard when we talk about medical research, but the reality is that we should have a diversified funding portfolio at a department and institution level,” he said. “Pragmatically, I think there are major challenges in making up for the amount of funding that can be provided by federal programs like NIH. It’s very unlikely that any foundation support is going to completely make up for a canceled grant program.”
Emily Boss, MD, MPH, director of pediatric otolaryngology at Johns Hopkins University in Baltimore, said the cuts could put at risk lines of research that might not be as high profile as trials on therapeutics, but are nonetheless clinically important, such as research on decision making for surgery. She wrote a piece for the university’s HUB publication, recounting how communication used in the conversation between her and the family of a six-year-old girl helped them through decisions involving tracheostomy placement (HUB. https://tinyurl.com/5n77shem).
“What does the layperson or politician view as critical research? They’re going to view, appropriately, research focused on curing cancer, life-saving disease interventions, as key priorities, as they should be,” she said. “But if practice-related health services research is defunded, what we will miss is a lot of research that really reflects real-world practice and healthcare delivery, and outcomes like how patients experience care. Ironically, this type of research has the potential to more immediately and broadly impact how surgical care is delivered and received in the U.S.”
The communication behind decision making is especially crucial in otolaryngology, because often the choice of whether to proceed with surgery is not clear, she said.
“Otolaryngology is composed of more than 70% of elective surgical care,” she said. “These cases are the bread and butter of our specialty.”
She and a colleague also recently wrote a commentary expressing concern about how the Make America Healthy Again commission report characterized research on adenotonsillectomy and tympanostomy tube placement (STAT. https://tinyurl.com/mwu8j754). The report, they wrote, mistakenly concluded these procedures cause harm without benefit, while ignoring findings of improved sleep, behavior, hearing, and speech.
Dr. Boss added that examining NIH indirect costs is wise in principle, but the effects need to be understood.
“Just to be clear, I think some indirect rates are too expensive, and there’s probably a lot of opportunity to make costs more project-specific, which makes rates truly reflect the resources that are indirectly required to complete the research,” she said. “But no matter what, any cut in research funding, particularly to this degree, restricts the overall resources that we have to continue conducting rigorous science.”
In the spring, Jonathan Overdevest, MD, PhD, assistant professor of rhinology and skull base surgery at Columbia University, had funding stopped for his study to understand how olfactory dysfunction in COVID-19 patients is associated with neurocognitive and neuropsychiatric symptoms and development. The grant cessation was tied to both Columbia’s broad loss of funding and to the withdrawal of money for COVID-19 research, although post-COVID-19 olfactory dysfunction was simply a model for smell loss.
“Given the uncertainty, the decision was made to wind down the time frame for which we were following individuals,” so that part of the study has come to a close, he said. Rather than following patients for five years, the follow-up will be three years. When they were told they would no longer be followed, some patients clearly showed that they were invested in the research, asking who they could contact to restore funding or whether they should begin their own fundraising efforts.
In the study, patients were followed clinically, with biospecimens taken to examine how virally mediated olfactory dysfunction relates to other long-standing neurodegenerative populations, with the idea that this dysfunction could be a helpful, supplementary biomarker that can be assessed non-invasively.
“That funding was going to be paramount to facilitate that connectivity, whereas without it, we’re left scrambling for other sources of funding to complete the experiments,” he said. The research team is now trying to do assessments in a “piecemeal” way and pull it all together later, rather than in the more seamless fashion in the original plan, he said.
Facing the unknown has been difficult, he said.
“I think the imposition of uncertainty is the biggest challenge for these academic centers,” Dr. Overdevest said. “It affects the ability to sustain and maintain our core research infrastructure, all the research coordinators, post-doctoral students, and graduate students. These are all groups that need some level of certainty when determining what they’re going to be doing for the next months, years of their life.”
The uncertainty has prompted discussions among him and his colleagues about their futures in academic medicine.
“The conversations are absolutely happening. You run into colleagues, and it’s like, ‘What are you going to do about this?’ And nobody really knows.”
The research infrastructure that is required to do these sorts of complex studies requires a huge team. And if you lost funding from your lab, that team’s got to go. And once that thing shuts down, it’ll be years to recreate what currently exists. —Lawrence Lustig, MD
Sad, but true.
As a former clinical assistant professor, I had an agreement to have protected time to perform research in 2008. Due to illness and a change in staffing, I lost that protected time. My clinical services were needed, and my research time was taken away. I resolved to make my teaching and clinical services my priorities. When the affected individual returned to work later in 2009, my reward was that I was given more teaching responsibilities and no time or funding for research. As I scrambled for grants and contacted industries to help support funding after the economic downturn of 2008 and 2009, I came to realize that the likelihood for funding was gone. Without prior research or publications, no funding was available to support time off from clinical work for independent research. This did not stop me from continuing my clinical work and research, once I left the world of academia. I became self-funded by dedicating a percentage of my salary to research purposes.
I believe that self-funding is the way to go. If Universities will not use their endowments to invest in research at their institutions where their review boards approve the research, then why should the janitorial staff that cleans the research buildings pay for the research with their tax dollars. If Departments of Otolaryngology-Head and Neck Surgery are dedicated to researchers, then use clinical dollars to support the research that needs to be done. Shift funds generated from ancillary personnel, such as NP’s and PA’s and Fellows, to a core research fund. Researchers need to be held accountable for the costs of their studies for there are no more blank checks.