The National Institutes of Health commands nearly $50 billion annually — more than the gross domestic product of many nations — and its importance to biomedical research has historically been prized by both political parties.
Since Covid however, the NIH has been criticized for a lack of full transparency and accountability, particularly about the research it was sponsoring in Wuhan, China. While these criticisms were largely about one specific issue (virology), the new administration has doubled down on cutting the NIH in numerous ways — cutting the proposed budget by some 40%, cutting grants in progress, and cutting more than 1,000 employees.
In the end, these cuts are likely a bad idea. We all benefit from a well-functioning and well-funded NIH that supports biomedical research looking for cures for cancer, heart disease, Alzheimer’s, and other diseases. However, there are many potential reforms that would make the NIH stronger, not weaker. As President Trump and Department of Health and Human Services Secretary Robert F. Kennedy Jr. pursue their Make America Healthy Again agenda, they should focus on these productive reforms.
The crisis of scientific reproducibility
American taxpayers deserve research they can trust. Yet large-scale reproducibility projects have shown that many experiments are questionable. For example, in a project I funded while in philanthropy, replication experiments in cancer biology returned results that were 85% smaller than the original studies, with only 46% of findings successfully replicating.
The replication problem isn’t surprising. Publication bias favors exciting, positive results over the null findings that are equally crucial to scientific understanding. Meanwhile, academic fraud can lurk undetected for decades: The NIH’s own director of Alzheimer’s funding was recently fired for falsification, discovered not through systematic oversight but by amateur online sleuths.
The NIH has the power and budget to make huge headway against these problems: It should mandate fully transparent reporting of null results, and should dedicate at least 1% of its current budget — that is, in the neighborhood of $500 million — to systematic replication studies and fraud detection. Such an investment could restore credibility to the entire research enterprise.
Breaking the bureaucratic stranglehold
Federal surveys reveal that NIH-funded scientists spend nearly half their time on bureaucratic compliance rather than actual research. That’s an average, and I have spoken to university researchers who estimate that they spent up to 70% of their time on paperwork, leaving almost no time for actual science. Although most bureaucratic requirements are well-meaning (like an attempt to exercise oversight over federal dollars and prevent waste or abuse), the overall effect is a waste of human talent and taxpayer dollars.
The NIH should lay out an ambitious goal to slash the administrative burden to 20% of researcher time within three years. This requires ruthless elimination even of well-meaning requirements, while maintaining essential oversight. For example, we could reduce the number of progress reports detailing how researchers spend their time. Instead agency staff could use AI tools to track the progress of research and ask for additional details only when needed.
Dismantling outdated organizational silos
The NIH’s 27-institute structure is likely inefficient and reflects several decades of bureaucratic accretion rather than any systematic strategy for how to address human biology and disease. After all, why maintain separate institutes for drug abuse and alcoholism when these conditions share both mechanisms and treatments? Why organize around body parts like hearts and eyes when modern medicine recognizes systemic, interconnected pathways?
Both congressional Republicans and the new administration have proposed reorganizing the NIH. While potentially controversial, the NIH reorganization should not be a partisan issue. Indeed, Clinton-appointed NIH director Harold Varmus wrote in 2001 that the NIH’s structure creates “administrative redundancies” and places many areas of crucial research “at a disadvantage.” His proposed reorganization into six major offices or institutes, with a focus on broad biological systems rather than narrow disease categories, remains relevant today. In 2006, Congress created the Scientific Management Review Board, which was designed to advise the NIH director on the optimal structure of the agency given ever-evolving science and medicine. Unfortunately, the board was left dormant for several years, until revived in November 2024 at the behest of Congress.
Whatever the optimal structure of the NIH, it’s worth having the discussion and using the mechanism that Congress already created in 2006.
Experimenting with revolutionary funding models
The NIH’s peer review system likely discriminates against the most innovative research, as shown by the Nobel winners who say that their groundbreaking work wouldn’t get funded today. The current process demands “preliminary data” that essentially proves experiments will work, creating a perverse cycle in which most researchers seek funding only for work that they’ve already completed. Indeed, one top neuroscientist told me candidly, “If I have a great idea, I don’t propose it to NIH, because they will never fund it. I propose a modest and careful idea that they will fund, and then I use part of the money to explore the better idea.”
Such a system of winks and nods makes no sense. The NIH should eliminate preliminary data requirements and instead experiment with alternative review mechanisms. What if study sections gave higher scores to proposals where reviewers strongly disagreed with one another, which might be a signal of a genuinely novel idea? What if a line of grants specifically funded scientists who were switching fields, thereby introducing fresh perspectives across disciplines?
Indeed, the NIH’s scale would allow a truly unprecedented level of experimentation with funding models. The agency should establish a dedicated Center for Experimentation and Innovation to pilot and test ideas at scale. This includes randomizing grant sizes and durations, testing different review committee compositions, and measuring outcomes against traditional approaches.
Expanding cross-cutting research
The NIH Common Fund, established in 2006 for interdisciplinary research, has stagnated at $600-700 million annually. Given the inherently cross-cutting nature of challenges like nutrition, aging, and chronic disease, this fund should triple to $2 billion.
Nutrition research exemplifies the problem. Despite affecting the entire human body and numerous diseases, nutrition lacks a natural home within the NIH’s disease-specific structure. The result is that nutrition gets scattershot funding across multiple institutes whose research is of highly-varying quality. An expanded Common Fund could enable more systematic research into nutrition (including microplastics, endocrine disruptors, and industrial seed oils), while supporting well-controlled studies of related issues like exercise and sleep.
The path forward
These reforms don’t require congressional approval and can be implemented through existing administrative authority. The NIH director and the HHS secretary have broad reorganization powers, while individual institute directors can modify grant processes and review procedures.
The obstacles are political and cultural, not legal. Yet the stakes are too high for incremental change. Public trust in scientific institutions has eroded. Fundamentally, the current system fails the patients whose lives depend on research breakthroughs that bureaucratic dysfunction can delay or prevent.
The government’s goal shouldn’t be to cut science funding, which will only incentivize researchers to engage in more fraud and irreproducibility. Instead, the Trump administration has a unique opportunity for transformative NIH reform. By prioritizing scientific integrity, reducing bureaucratic burden, and experimenting with innovative funding models, America can reclaim its position as the world’s undisputed leader in medical research.
Stuart Buck is the executive director of the Good Science Project and a longtime advocate for improving science.
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