ne problem with the NIH is that it emphasizes slow, safe studies focused on basic science rather than high-risk studies that might fail but that also might succeed in creating whole new fields, like the mRNA vaccines. Many studies show that younger researchers tend to break more new ground than more established ones do; Nobel Prize winners tend to make their discoveries in their late 30s and early 40s, not their late 50s and 60s. Yet the average age of first-time NIH-grant recipients has been going up and up, and is now 44 years. Indeed, the proportion of NIH grants going to what it classifies as early-stage researchers plummeted from about 55 percent in 1990 to less than 35 percent in 2020, while the proportion of grants going to older, later-stage researchers has increased from 10 percent to more than 25 percent in the same three decades.

Instead of embracing a diversity of researchers who employ a wide range of research approaches, the NIH’s vaunted peer-review system is inherently conservative. Its proposal-review committees disproportionately include scientists who have succeeded within the current NIH system. These well-funded researchers have no incentive to expand the range of research topics or reward new approaches that might eclipse their own laboratories’ work. That, in turn, leads to gaps in scientific understanding. Francis Collins, the agency’s most recent director, has acknowledged a profound underinvestment in research on human behavior: “I never imagined, a year ago, when those vaccines were just proving to be fantastically safe and effective, that we would still have 60 million people [unvaccinated].”

Moreover, the NIH has mostly retreated from clinical research. By some estimates, the pharmaceutical and medical-device industries now sponsor about six times as many clinical trials as the NIH. In practice, this dynamic narrows the type of clinical-research questions being investigated; only new drugs and other products that can sell on the market receive rigorous scientific scrutiny.