The National Institutes of Health (NIH) is the world's pre-eminent biomedical research agency. The annual NIH budget ($40B+) is an order of magnitude larger than peer institutions (CIHR in Canada, MRC in the UK) in nominal terms, and commensurately the NIH is responsible either directly or indirectly for a plurality of the world's impactful biomedical research each year.
One reductive but instructive data point on the impact of the NIH is the number of Nobel Prize recipients with NIH funding. NIH-funded scientists have received >10% of all Nobel prizes in history. If we subset to the Nobel Prizes for Physiology and Medicine (110 total prizes) or Chemistry (111 prizes) where all but two NIH-funded scientists received their awards, NIH-funded scientists have received a shocking 42% of all prizes. This is especially notable given that the NIH has only existed since 1930 and the Nobel's began in 1901.
In just the 2010-2016 period, NIH funding can be traced to scientific breakthroughs that supported the development of 210 new drugs. (It's important to note that NIH funded basic discovery is but one component of the vexing, arduous path to drug discovery.)
From even a cursory glance, it's apparent that the NIH is responsible for a non-trivial fraction of human progress in both biology and medicine. I've long been fascinated by the NIH as an institution: how did it come to be; how does it prioritize abstract, long-term goals; and how might we improve the funding mechanisms of the NIH to accelerate biological discovery.
Given that the NIH funds such a large portion of discovery in one of the most rapidly advancing scientific fields, it seems that we can learn a great deal about scientific progress by investigating the NIH's political origins and operational decisions.
It strikes me that the NIH's mandate is much more radical than most presentations of the institutions long history suggest. The NIH fundamentally takes taxpayer dollars, bequeathed by all, and uses that revenue to fund exploratory, high risk basic research. In the language of venture capital, the NIH is black swan farming, but rather than risking the funds of wealthy limited partners, the NIH invests with the public purse.
I believe this arrangement has led to almost unquantifiable good for humanity, but nonetheless, it's a shocking proposition to include in a political speech.
Imagine the pitch: "I would like to take tax dollars, disperse them widely on a number of individuals with interesting but inherently difficult to justify ideas, and then we'll cross our fingers and hope for the best."
But the pitch worked! And so did the science!
How did this happen?
Victoria Harding presents a step-by-step account of the NIH's political origins in Inventing the NIH, with a strong focus on the role of non-governmental organizations and lobbying groups. She eloquently outlines how the NIH blossomed from much smaller beginnings into a high-growth scientific juggernaut. While insightful, Harding's text is written for the academic historian and a bit difficult to consume for leisure. I've tried to extract some of the main insights below in a briefer form.
The NIH was not created anew from whole-cloth in a single legislative text. Rather, it was built upon existing institutional foundations, created for related but distinct purposes.
The deepest origins of the NIH connect back to the Marine Hospital Service, a network of hospitals specifically created to treat ill seamen, funded by a tax on their wages. In a way, we can think of this network as a form of integrated health insurance similar to Kaiser Permanente in modern California. The Service was originally run within the precursor to the US Coast Guard, but was given independent management after the Civil War within the Department of Treasury. This change in management led to the development of distinct class of public health civil servants within Hospital Service.
Crises and external circumstances began to expand the Hospital Service's initial mission. Beginning with management of quarantines for incoming ships, Congress and the executive branch began asking the Hospital Service to manage and investigate various other public health problems.
It seems like the logic here was roughly: Who has the personal to deal with problem X? That weird marine worker insurance program? Sure, give it to them.
Germ theory developed in the late nineteenth century, representing one of the great conceptual advances in modern biology. As part of the growing list of demands from Congress, the Hospital Service came to employ a few students of this new doctrine, including a direct trainee of Robert Koch himself, Joseph Kinyoun. Kinyoun was placed in charge of establishing what we would now recognized as a basic research facility, termed the Hygienic Laboratory in keeping with the nomenclature of the time. This laboratory was fairly small by modern standards (< 200 employees), but it was the first time federal funding was used to support ongoing basic research.