381: The future of American science and a dispatch from ASH

What It Covers

The Readout Loud examines disruptions to American biomedical research under the Trump administration, including NIH funding cuts and scientist layoffs. The episode also covers breakthrough data from the American Society of Hematology conference, featuring Terns Pharmaceuticals' chronic myeloid leukemia drug and new obesity treatments showing unprecedented weight loss with significant side effects.

Key Questions Answered

• •CML Drug Development: Terns Pharmaceuticals presents data for a chronic myeloid leukemia drug that appears superior to Novartis's Semblyx, a three to four billion dollar peak sales drug. This represents the latest evolution in targeted therapies since Gleevec transformed CML into a chronic disease in 2000, with patients cycling through generations of treatments as older drugs lose efficacy or cause intolerable side effects.
• •Multiple Myeloma Treatment Progress: Johnson and Johnson's two-antibody combination shows an eighty-three percent reduction in tumor progression compared to standard multi-drug treatment in second-line multiple myeloma patients. The dramatic efficacy gap between treatment and control arms prompted audible reactions from researchers, though high infection rates required mitigation procedures and raise questions about positioning against CAR-T therapy in treatment sequencing.
• •Obesity Drug Tolerability Concerns: Eli Lilly's triple-hormone GGG drug achieves 28.7% weight loss in patients who complete treatment, but high discontinuation rates from nausea, vomiting, and perceived excessive weight loss drop overall efficacy to 23.7%. This pattern of substantial weight loss paired with poor tolerability appears across multiple next-generation obesity candidates, raising questions about whether pushing for rapid, extreme weight loss serves patient needs.
• •NIH Research Ecosystem Disruption: Forty percent of US scientists surveyed in November 2025 consider moving abroad within two years, primarily seeking freedom to pursue their research without political interference. The broken trust between researchers and federal funding agencies threatens US scientific leadership as China and Europe increase competition, with PhD enrollment in life sciences flatlined after years of steady growth following administration uncertainty.
• •FDA Evidence Standard Changes: The FDA plans to require only one clinical trial for new drug approvals instead of two, though regulators maintain discretion to require additional studies. Agency sources and external experts express confusion given existing flexibility policies for impractical situations, worrying the blanket change unnecessarily lowers evidence standards for efficacy and safety without addressing specific problems requiring reform.