I still remember the day my father and I sat in his oncologist's office and first heard the words, “stage 4 pancreatic cancer.”
I'm a physician, so I understood what that meant. Pancreatic cancer is one of the most deadly cancers we treat. By the time it's diagnosed, it's typically very advanced — and the conversation is often limited to some basic questions: What can be done now? How much time is left?
As a daughter, I heard those words differently. I watched my father sitting next to me in that exam room, suddenly transformed from the person who raised me into a patient. I knew what his scans showed and I knew the statistics. At the same time, I felt the heartbreak of loving someone who was very sick.
But then the conversation took a turn I wasn’t expecting.
The oncologist told us that my father carried a specific gene mutation which made him eligible for a newer class of medications called PARP inhibitors. These drugs work by disrupting the way in which certain cancer cells repair and replace damaged DNA. For some patients, they can slow the progression of disease and offer something medicine cannot always give: more time.
During my medical training less than a decade earlier, this treatment simply did not exist. Progress happens slowly; it shows up quietly in labs and in grant proposals, in failed experiments, in patients who volunteer for clinical trials, in researchers who keep asking questions many years before others know whether they'll matter.
And that day, in that room, the answer mattered to us.
For patients, medical breakthroughs can feel sudden, even miraculous. Your doctor mentions a new medication, an immunotherapy, a clinical trial. With those words, a door opens where there had previously been only a wall.
In our case, and for others like my dad, the miracle here is not only the drug. It’s that the treatment was waiting when the patient needed it.
Every therapy we rely on today has a hidden history. Before a pill reaches a pharmacy — before an oncologist makes a recommendation and a family lets itself hope — there are decades of work we never see. There's a scientist studying a cellular pathway in a lab far from anyone’s bedside. There's a team designing an experiment that may fail. There's a grant reviewer asking whether the scientific work is rigorous enough to move forward. There are patients volunteering for clinical trials, because they want to help someone they'll never meet.
Somewhere near the beginning of this long road to discovery is the decision to provide funding for scientific research. This may sound bureaucratic, but in reality, it's one of the quiet places where the future of medicine is made.
Historically, federal research funding has relied heavily on review by experts. Seasoned scientists and physicians assess whether the research question is important, if the methods are appropriate, if the team can complete the research, and if the knowledge generated will advance the field. The system is far from perfect: Some excellent ideas don't receive funding, and many great ideas are not supported because they're too ambitious. But expertise matters.
The Office of Management and Budget has proposed rewriting the rules for billions of dollars in federal grant funding in a way that would make them more restrictive — and far more subject to White House control. Today, research grants are generally evaluated by agencies with scientific and technical expertise, often through a peer-review process. Under this proposal, grants across health, science, education, housing, and other areas would have to first clear a political review and show that they advance the president’s policy priorities. The government could also block or terminate grants it decides are not in the “public interest,” and researchers could face new limits on what they study, where they collaborate, and how they share their work. This proposal is complex, but for patients and families, the central questions are straightforward:
Who decides which ideas are allowed to move forward?
Can a project that has already begun suddenly lose support because priorities changed?
Can researchers freely share what they discover with other scientists, physicians, and the public?
These questions may seem abstract for someone awaiting test results, starting chemotherapy, or caring for a parent with dementia. But they're critical in determining whether the next treatment exists in time.
Somewhere, a young scientist is studying a pathway that may one day cure Alzheimer’s disease.
If political appointees have the power to remove expert oversight, scientific merit risks becoming secondary to ideology or convenience. Important work could be stalled because it asks an uncomfortable question. And in medicine, the uncomfortable questions are often the most necessary. Does air pollution harm children’s lungs? Can a new targeted approach help patients whose cancers have stopped responding to treatment? Why are some women more likely to die in childbirth than others? These answers serve all of us, no matter how we vote.
If grants are terminated early, years of research effort can be lost. Science can’t be easily put on pause. Trials depend on staff, enrolled patients, data systems, and trust. When resources disappear, the people move on. Experiments end. Patients who gave their time and hope may never see that sacrifice become knowledge.
If it becomes more difficult for researchers to publish their work and share their findings with peers, science becomes quieter. Research becomes useful when it is tested, challenged, shared, and later translated into care.
I understand that discussions about federal grant funding and policies may seem mundane. I know that when I sat with my father in the oncologist's office, I had no thoughts about the importance of grant review processes or the Office of Management and Budget cost allocation rules.
I thought about time: Time for him to celebrate another birthday. Time to ask the questions that suddenly felt urgent. Time made possible by people my father would never meet.
The PARP inhibitor was available for my father that day because years of research survived long enough to become medicine.
That's what worries me now. Somewhere, a young scientist is studying a pathway that may one day cure Alzheimer’s disease. Somewhere, a team is trying to understand why a rare cancer no longer responds to chemotherapy. Somewhere, a clinical trial is testing an idea that may fail, or may become the reason someone else’s father gets more time.
The patient who needs that discovery may not be sick yet. She may be out walking her dog, packing a school lunch, booking a summer trip, ignoring a symptom that she hopes is nothing. Years from now, she may sit in an exam room while her doctor shares what options are available.
What will be waiting for her?
Public comments on this OMB proposal are open until July 13th. Anyone can submit one as a patient, a caregiver, a parent, a cancer survivor, or a person who takes a medication that did not exist a generation ago. You can tell the government why independent science matters. You can ask OMB to withdraw the proposal. You can contact your elected representatives and tell them that the future of medical research should not depend on political preference.
As a doctor, I know there are limits to what medicine can do. As a daughter, I know that even when a cure isn't possible, time can still mean everything. As both, I believe we owe it to the patients we have not yet met, and to the families who'll one day sit beside them hoping for one more option. We cannot know whose life the next breakthrough will change. But we do know this: If we fail to protect the science today, we may close the door on the hope someone will need tomorrow.
Shoshana Ungerleider, MD is board-certified, practicing internal medicine physician at General Medicine. She is the founder of endwellproject.org, a nonprofit focused on making the end of life part of life and the host and producer of TED Health and Before We Go podcasts.
