At first glance, the administration appears to have made choices. The National Cancer Institute is essentially spared, rising slightly from about $7.34 billion to $7.35 billion. Meanwhile, the National Center for Advancing Translational Sciences, which helps move discoveries toward treatments across diseases, would fall from about $942 million to $873 million.

That can look like cancer research is being protected while savings are found elsewhere.

The problem is that biomedical research does not respect government budget categories.

After more than 15 years in oncology research and drug development, I have learned how misleading disease boundaries can be. A future cancer treatment may depend on discoveries in immunology, genomics, cell biology, imaging, or engineering that were never confined to a cancer-specific research program.

Cancer immunotherapy illustrates the point. Foundational discoveries behind today’s checkpoint inhibitors emerged from basic research into how the immune system works. Scientists identified molecular brakes that restrain T cells and later discovered that blocking those brakes could help the immune system attack tumors. Research that did not begin as a cancer medicine ultimately helped transform cancer treatment.

The lesson is not that Washington must fund everything. Taxpayers are entitled to ask what they are getting for their money, and programs that cannot demonstrate biomedical or strategic value should face scrutiny.

But deciding where to cut requires understanding what is actually being protected.

Protecting the National Cancer Institute does not necessarily protect every scientific capability on which the next generation of cancer medicines will depend. A federal budget category is not the same thing as a biomedical research boundary.

That distinction also matters for America’s position in the world.

China has made biotechnology and biomedicine strategic priorities and continues expanding its research capabilities. If U.S. biomedical capacity erodes, some discoveries may simply move elsewhere. Others may never be made at all.

There is nothing inherently wrong with Americans benefiting from discoveries made abroad. Science has always crossed borders. The strategic risk arises when the U.S. loses the domestic capacity to generate critical discoveries and translate them into medicines, becoming increasingly dependent on capabilities developed elsewhere, including in countries it considers strategic competitors.

If America is going to spend less, it should first determine what it cannot afford to lose.

Congress and the administration should identify foundational research capabilities that meet three tests: they support progress across multiple diseases, private companies are unlikely to finance them adequately on their own, and they would be difficult or slow to rebuild once lost.

That could include fundamental biological research, shared genomic and data resources, translational research networks, critical infrastructure, and programs that train the next generation of biomedical researchers.

Pharmaceutical companies can take promising discoveries and develop them into medicines. They cannot recreate a national biomedical research ecosystem on demand after laboratories have closed, expertise has dispersed, and young scientists have built their careers elsewhere.

FROM $1,000 TO $149: TRUMP JUST UNLOCKED THE BIGGEST DRUG PRICE DROP IN 60 YEARS

America cannot fund everything.

But before Washington decides what biomedical research to stop funding, it should know what future medicines it may be giving up.

David Adler, M.D., is a senior pharmaceutical leader in oncology clinical drug development and translational medicine with more than 15 years of industry and academic leadership experience. He spent a decade in senior leadership at Bayer AG’s Global Oncology Clinical Development organization and currently serves as chief scientific & medical officer of the PATHORA Institute of Pathology & Tissue Medicine. He also holds academic appointments at the Hebrew University of Jerusalem, Ben-Gurion University of the Negev, and the University of Bonn.