Posted with permission from STAT

President Trump's proposed budget chops $6 billion, about a fifth of the total budget, from the National Institutes of Health, a move that could decimate biomedical research in a number of areas and stagger academic institutions around the country that depend on NIH grant money to keep their scientific research programs afloat.

Research funding at the Department of Energy and the Environmental Protection Agency would also take steep cuts under the budget blueprint, released early Thursday.

The budget for the National Science Foundation isn't specifically listed but it likely falls under the category of miscellaneous agencies targeted for across-the-board cuts of nearly 10 percent.

As for the pharmaceutical industry: Trump has repeatedly promised drug makers he'll make it easier and cheaper for them to bring new medicines to market, but he's also counting on them to pay more for their regulatory reviews. His budget calls for hiking the fees that industry pays the Food and Drug Administration to review medical products, arguing that companies "can and should" pay their fair share. Trump aims to bring in  $2 billion from these user fees in 2018, approximately double the current level.

Funding for the NIH has been a bipartisan priority for years; one of Trump's key advisers, former Representative Newt Gingrich, has long championed that cause. It was just two years ago, in fact, that Gingrich called for doubling the NIH budget, calling health spending both a moral and a financial imperative. "It's irresponsible and shortsighted, not prudent, to let financing for basic research dwindle," Gingrich wrote then.

But Trump's $1.1 trillion budget reflects new priorities in D.C.: The Pentagon, Department of Homeland Security, and Veterans Affairs would all get significant boosts in funding, offset by sweeping cuts across other domestic spending. The EPA and the State Department would be hardest hit, with each taking cuts of about 30 percent.

The Department of Health and Human Services comes in for a cut of more than $15 billion, or nearly 18 percent - a figure that includes additional funds for "program integrity and implementing the 21st Century Cures Act."

Trump has talked often about the need to address the opioid crisis; his budget calls for a $500 million increase in spending to increase access to treatment and recovery services.

Trump's budget proposal, which is slim on details, is just a blueprint; the details will be negotiated with Congress, and top Republicans have already made clear that they're not on board with all the cuts. Just this month, Representative Tom Cole, who chairs a key appropriations committee, told STAT he hoped to boost NIH funding by as much as $2 billion this year. (The agency got its first significant budget hike in years, of $2 billion, in late 2015.)

And within hours of the blueprint's release, Senator Roy Blunt (R-Mo.), who has also called for increasing NIH spending, issued a statement calling the president's plan just the "first step" in a long a process. "There are many concerns with non-defense discretionary cuts," Blunt said.

Senator Bernie Sanders went further, calling the budget "morally obscene."

Advocates for scientific research, too, fired off sharp criticism. The proposed budget would "cripple" science and technology "through short-sighted cuts," said Rush Holt, CEO of the American Association for the Advancement of Science.

"Biomedical research is not something you can toggle on and toggle off," said Dr. Landon King, executive vice dean of the Johns Hopkins School of Medicine. "The disruption and uncertainty this introduces into the progression of existing work or the initiation of new work is extraordinarily threatening."

Though the details are sure to change, the budget document is important nonetheless in laying down a marker of the president's priorities.

At the NIH, for instance, the plan calls for a "major reorganization" of the 27 institutes and centers that make up the agency. It outright abolishes the Fogarty International Center, which spends $69 million a year to support research on global health and encourage collaboration between health research institutions in the US and in other nations.

The Fogarty center pushed back immediately on Twitter with a link to a page that lays out its funding for everything from Alzheimer's research in Colombia to HIV treatment in South Africa to an effort to model the spread of infectious diseases.

Trump's budget is quite vague on other spending targets in the realm of health and medicine.

There are no specifics listed for the Centers for Disease Control and Prevention, for instance, beyond a pledge to create a $500 million block grant fund to help states respond to their specific public health challenges. It's not clear if that's new funding or if it would be reallocated from elsewhere within the CDC. The budget also talks about unspecified investment in "mental health activities" such as suicide prevention.

Also mentioned in the document, without specifics: A plan to create a "federal emergency response fund" to address public health emergencies such as Zika.

The plan calls for "consolidating" the Agency for Healthcare Research and Quality, which among other things provides evidence-based guidelines for clinicians. It's not clear whether, or how, the agency's work would continue.

The budget doesn't mention specific funding levels for Medicare and Medicaid, though the Republican health care bill moving through Congress would enact significant cuts to Medicaid spending.

Among the few specifics in the HHS budget blueprint: Trump would eliminate $403 million in funding to train health professionals and nurses, calling the program ineffective.

It proposes a modest increase, of $20 million, in the Department of Housing and Urban Development budget to mitigate health hazards such as lead-based paint in homes.

Dylan Scott and Megan Thielking contributed reporting.

Correction: A previous version of this story misstated the budget for the Fogarty International Center.