As NIH funding cuts drain the pool that has supported drug discovery and development for decades, a vacuum is forming. Although traditional clinical trials will remain the gold standard, can real-world evidence help fill at least part of the gap?

"A collision is coming," said Brigham Hyde, CEO and co-founder of real-world evidence company Atropos Health. "We have all these emerging biotech companies and AI drug discovery forces bringing new targets, new drugs, new everything—but how do we move tens of thousands of new opportunities into clinical trials?"

Brigham Hyde headshot
Brigham Hyde, CEO and co-founder of Atropos Health
Image courtesy of Atropos Health

Like many researchers, Hyde worries about the long-term impact of public funding cuts, but he also sees an opportunity: as one of many private companies targeting the gap left by public solutions, real-world evidence has a chance to prove its value. Along the way, he says, a more robust public-private health data collaboration system could further boost efficiency.

The U.S. Food and Drug Administration (FDA) has in recent years placed greater emphasis on using real-world evidence as clinical data. As industry competition intensifies and regulators tighten budgets, information that can make a drug or clinical study stand out is becoming a valuable asset.

"The capital markets cannot sustain the current approach—what we must do is improve success rates," Hyde said.

"In this country, oncology research is a cause everyone supports, and broad cuts affecting the overall funding pool will not be accepted by the people of this nation."

—Brigham Hyde, CEO and co-founder of Atropos Health

Atropos Health spun out of Stanford University's Green Button personalized medicine project in 2019, initially as a simple question-based tool for physicians, enabling them to conduct a real-world study using existing information within days. Today, the company partners with pharmaceutical giants such as Johnson & Johnson and Merck & Co. to accelerate clinical development.

Hyde noted that as public funding sources dry up for researchers—especially many early-career investigators with limited budgets—real-world evidence could become a lifeline for keeping projects running.

In this interview, Hyde discusses Atropos's work with pharma companies, the limitations of real-world evidence, and the opportunity for public-private data partnerships to thrive amid the current turmoil.

This interview has been edited for length and clarity.

PHARMAVOICE: Can you talk about the work you do for pharmaceutical companies?

BRIGHAM HYDE:The pharmaceutical industry bears a large portion of evidence generation in healthcare. They conduct clinical trials, and under the 21st Century Cures Act, they also make extensive use of real-world evidence data—whether for trial design, epidemiological studies to understand target populations, or publications demonstrating drug value to the clinical community and payers. We have done all of this work, and we help them do it faster. We currently work with eight of the top ten global pharmaceutical companies, using data from dozens of health systems and academic medical centers, with thousands of physicians sending us research requests.

Compared with traditional research, what are the limitations of real-world evidence? How does your work fit into this picture?

At the top of the pyramid are double-blind, placebo-controlled randomized trials. These trials should exist, and we want more of them, but the reality is you cannot run a trial on every patient. Interestingly, in our studies replicating clinical trials, the conclusions of real-world evidence align with trial results roughly to the same degree that different trials align with each other. It ultimately comes down to how trials are designed—they are typically conducted in very limited populations, and about 75% of the patient population is systematically excluded for various reasons. We love trials, but we must acknowledge the gaps. That is where we come in.

Here is an anecdote about this connectivity: Dr. Dylan Dodd at Stanford is a basic science researcher studying the gut microbiome. By altering the gut microbiome, you can actually influence immune diseases. In a gout mouse model, he demonstrated that Bactrim (sulfamethoxazole/trimethoprim), a long-approved antibiotic, is a successful treatment. He came to us to see, based on real-world evidence, what happens if gout patients took Bactrim for other reasons—within days, we completed a study on tens of thousands of patients, and the results were clear in both cases: among those who had taken Bactrim, the incidence of gout was statistically lower than in the rest of the population. Adding this finding to his research elevated the academic value of the paper. This kind of innovation is very exciting, not only because it can be achieved so quickly, but also because it connects basic science with real-world evidence.

How do you think NIH funding cuts might affect your business and the services you provide to researchers and pharma companies?

We have already heard from users or potential customers saying they have to freeze everything because they are unsure about the budget situation. That is real. But at the same time, the efficiency and relative cost advantage of what we produce may push things in our direction in the process. I hope and believe the NIH will still deploy substantial funding, perhaps with a slight shift in direction, and hopefully more toward automation. And we are part of that. I hope this is more of a pause and reshuffle rather than pure cuts. Undoubtedly, the impact is already being felt in the current market—especially in academic medical centers—and I worry about young faculty—they are the ones who need this funding to launch their research. Our hope is to help them during this time. In the coming months, we will announce more about plans to provide our technology free of charge to those in need.

We are very popular with young residents and fellows who do not have large startup funds or budgets—they have to request data access from their institutions or hire three informatics specialists. That could take a year to accomplish. Through us, they can get a publishable answer within a week. For young faculty affected by this funding challenge, it is an excellent way to get their ideas published.

What specific directions of the NIH cuts concern you? What vacuums do you hope to fill?

It is hard to figure out how these cuts were decided. We are all watching the Department of Government Efficiency (DOGE) reports and trying to understand what they mean. I want to emphasize that in this country, oncology research is a cause everyone supports, and broad cuts affecting the overall funding pool will not be accepted by the people of this nation. So I expect this to reverse quickly. I worry about the net impact on support for young faculty, because when you make cuts at large institutions, those are the ones who get hurt.

But we believe the data industry and the NIH can play a more integrated role—we have a vibrant private market in the data space, and if the NIH could bring us together around initiatives they care about, we could go much further. For example, this was part of the promise of the Cancer Moonshot, but it was not fully realized. Now, I hope—just judging from the outlines I have seen—this helps drive that initiative forward and makes resources and tools like ours available to researchers. Everyone in the healthcare data industry wants to see this impact ultimately reach patients and researchers—our roots are in the clinical front lines. So I want more. Let us go further and combine public and private forces, because there is a huge opportunity right now.