President Trump's recent push to send federal health care dollars directly to individuals, rather than insurers, reflects a broader demand for transparency and effectiveness in how public funds are used. Government-funded medical research, which forms the foundation of much clinical care, also requires such scrutiny.

In recent years, academic medicine has advanced a nebulous theory of “structural racism” that echoes the 19th century “miasma” theory, which blamed disease on “bad air.” Despite scant evidence, studies attempting to validate this vague framework have multiplied, often funded by largely unaware taxpayers. Refocusing federal research dollars on rigorous science and evidence-based care is essential to correcting this trajectory.

The incentives were clear: Few researchers — early-career or established — would decline funding in an area where the NIH was investing heavily.

How did this happen? The construct of “structural racism” was virtually absent from medical literature until a decade ago. Since then, it has become the default explanation in academic medicine for differences in health outcomes across racial and ethnic groups. Its rise accelerated during the 2020 anti-racism craze, which swept through corporate boardrooms and university administrations while also becoming a core ideological pillar of Black Lives Matter and other political movements.

Academic medicine was no exception. This philosophy quickly gained favor in medical education, academic health centers, elite journals, and professional associations, eventually influencing federal agencies that distribute research funding.

The result: a surge of grant-funded studies built on the premise that racism causes health disparities. Of the nearly 2,300 articles indexed under the term “structural racism” in PubMed, the U.S. National Library of Medicine’s database of leading biomedical and health journals, 95% were published after Jan. 1, 2020. In 2025 alone, PubMed lists 400 such papers — nearly four times the total published before 2020.

This proliferation has been supported by a tsunami of federal taxpayer dollars coming from the National Institutes of Health. From 2020 to 2025, an NIH database search found nearly 750 projects mentioning “structural racism” in their abstracts, totaling almost $533 million in funding. More than 70 of those projects were funded in 2025 at just under $40 million — significantly down from more than 220 projects in 2024 totaling $150 million, but still far above 2020, when only 12 projects received a little over $12 million in the aggregate. Before 2020, the NIH had funded just 10 such projects at a combined cost of $4 million.

Funding patterns across NIH’s 27 Institutes and Centers from 2020 to 2025 make clear that ideology, not medical science, drove much of this growth. The largest investments came from the National Institute on Drug Abuse ($147 million in total funding), National Institute on Minority Health and Health Disparities ($70 million), and National Institute on Aging ($57 million), each pouring substantial resources into “structural racism” research.

In 2025, for example, NIDA supported a project under the Healthy Brain and Child Development National Consortium that identified “structural racism” as a risk to babies before and after birth, alongside more recognizable factors like maternal health, toxic exposures, and child abuse — thereby conflating an abstract, ill-defined, and ideological social theory with measurable, scientific variables as a threat to child development.

Also in 2025, NIMHD funded the Clinical Research Scholars Training program, a “health-equity focused” initiative created in part due to NIH calls for research on “the impact of structural racism and discrimination on health disparities.” Eligibility for this program was limited to those deemed “underrepresented in biomedical research.” All others need not apply.

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And just last year, a NIA-funded project invoked “interrelated systems of structural racism” and “race-specific stress” as risk factors for Alzheimer’s disease and cognitive decline, diverting attention and resources away from well-established contributors such as genetics, medical conditions, lifestyle and environmental factors, and core biological mechanisms like amyloid plaques and tau tangles.

Unfortunately, a commitment to science gave way to ideology years ago. Under Francis Collins, the NIH “acknowledged and committed to ending structural racism,” without even defining the concept itself. “Structural racism” was accepted despite its questionable validity and lack of explanatory power.

With vague boundaries and mechanisms difficult to measure, claims of “structural racism” far exceeded the empirical evidence. Nevertheless, the idea was accepted wholesale and used to justify a wave of DEI initiatives, effectively recasting the NIH as an “anti-racist” institution in the Ibram X. Kendi mold. Objective science was no longer sufficient; the agency was expected to take an activist stance.

Proponents embraced this shift, seeing an opportunity to move health research from “individual-level risk, health behavior, and functioning” to “structural level concepts” with “structural racism” named specifically. Research dollars supported tools like the Structural Racism Effect Index to “guide policies and investments to advance health equity.”

The incentives were clear: Few researchers — early-career or established — would decline funding in an area where the NIH was investing heavily, especially when that support could provide a path to publication in top journals.

Yet the instruments used to quantify “structural racism” expose a basic flaw: They don’t measure racism.

The SREI’s nine dimensions, for example, largely track socioeconomic conditions — wealth, income, housing, employment. In practice, a high score identifies communities facing poverty. Even researchers linking SREI scores to hypertension, obesity, smoking, and low physical activity concede they “cannot make causal inferences.”

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These health risks may result from poverty, contribute to it, or arise from entirely different causes. Labeling them as products of “structural racism” adds no explanatory value, miscasts economic hardship as race-based, and downplays individual responsibility. It overshadows far more consequential drivers of outcome disparities, including access to care, personal choice, medical comorbidities, and genetics.

Nonetheless, no alternative explanation for health disparities has received anywhere near the same attention in leading medical journals — such as the New England Journal of Medicine, Lancet, and JAMA — as “structural racism.” This concept has been treated as settled fact, with disparities alone offered as proof: If disparities exist, racism must be the cause. Likewise, many medical organizations have reinforced this view through policies and position papers that embed an anti-racism framework into scientific inquiry.

But change is in the air. The NIH’s recent miasma-like fixation on “structural racism” is finally clearing. Under Director Jay Bhattacharya, the agency is refocusing on its core mission of funding rigorous, evidence-based science rather than ideology-driven research. This shift will direct scarce taxpayer dollars toward work grounded in medical science and its practical application — research that can genuinely improve health rather than feed political currents.

This course correction is timely, and while sustained effort in 2026 will be needed to fully restore the NIH to its rightful mission, taxpayers can take comfort: America’s leading biomedical and medical science research institute will once again prioritize their dollars and their health.

Editor's note: This article was originally published by RealClearPolitics and made available via RealClearWire.