Fix the NIH to Fix American Science

Perspectives from 8VC about how to reform America's scientific research behemoth

The National Institutes of Health (NIH) is ostensibly the crown of American biomedical research. It commands an annual budget of nearly $50 billion. Most medical research in the US depends on it. Yet for all this spending, our nation’s health and biotech outcomes are faltering. Chronic diseases still ravage millions — with little scientific attention. Breakthroughs for conditions like Alzheimer’s and many cancers remain elusive despite considerable, sustained commitments.

In too many ways, the NIH embodies the Soviet model that should have been left to die in the 20th century: centralization, top-down ideological control of processes, and an extreme conviction by the bureaucrats that they know better than anyone about everything. This has real consequences. 

The NIH, unfortunately, is functioning as welfare for underperforming labs and scientists. Administrators at both the NIH and individual universities fund safe, incremental work by popular professors while transformative ideas from young innovators struggle to get serious monetary support. At its worst, it is engaged in political nonsense that has nothing to do with science — and which clearly siphons money away from research that matters for our civilization. 

At its best, though, the NIH can be one of the crown jewels of science in the history of the world: an institution that underwrites the best innovators and produces the most public good on behalf of the taxpayers who fund it. For all who believe America can lead a new golden age of innovation in health and biotech, this should be a rallying cry. We did it before, and we can do it again. But first, we must be honest about what’s broken. 

What is Broken

Today, the NIH epitomizes the dysfunction that inevitably arises when bureaucracy and entrenched interests overshadow merit and innovation. Far too many resources are funneled toward scientists whose primary strength lies in navigating institutional politics, rather than producing groundbreaking insights. Perhaps most troubling is NIH's recent drift away from pure scientific inquiry toward politicized messaging, squelching dissent and poisoning scientific credibility. Increasingly dollars are allocated through internal academic politics and political meddling.  Instead of empowering pioneering researchers, NIH dollars thus fuel mediocrity, supporting projects that please committees but fail to deliver meaningful scientific progress or solve problems. 

As a result, the most talented researchers, frustrated by layers of red tape and academic politics, increasingly turn their backs on NIH funding altogether. They opt instead for forward-thinking private institutes—ventures like Arena Bioworks—where the best science tackling the biggest problems wins. Others still remain in academia, yet deliberately choose more meritocratic funding avenues, whether through private foundations, philanthropies, biotechs or venture capital. These alternative sources, with even lower indirect rates than the historical NIH rate, prove more attractive precisely because they reward ideas based purely on merit rather than connections. 

To repair the NIH requires an earnest commitment to excellence, transparency, and meritocracy, principles that are compromised today. Below, we outline five critical reforms to realign the NIH around these foundational principles. Robust basic and clinical research funding remains essential; every dollar invested returns at least 2.5 times its value directly, with broader societal returns even greater. Nearly every drug approved in America can trace its roots back to NIH-funded science. The stakes are too high to let inefficiencies persist.

To supercharge real scientific breakthroughs and the benefits from them, we must slash wasteful spending and redirect those resources to researchers tackling the big, bold problems. Cutting bureaucratic fat and political nonsense effectively gives us an instant funding boost for meaningful science—without spending a single extra taxpayer dollar than we already spend.

Why does basic research matter? History has repeatedly proved the transformative power of seemingly bizarre basic research: genomics emerged from studying bacteria in hot springs; today's life-saving gene-editing treatments trace back to obscure bacterial defense studies; and blockbuster drugs like Ozempic owe their existence to studies on the venom from a Gila monster. Aspirin, insulin, detergent enzyme technologies—each began as oddball science without obvious applications. To secure future breakthroughs, America must double down on NIH-backed basic research.

Tomorrow’s scientific winners could possess genetically enhanced soldiers, civilians who think faster and live longer, and cures developed by reprogramming human cells—like Umoja’s groundbreaking in vivo cell therapies which are already in trials. Efforts are already underway by our geopolitical rivals to engineer enhanced humans that can sleep less, run faster, and have better overall health.

We’re encouraged by the direction this administration’s HHS leadership is headed. Jay Bhattacharya is exactly the kind of bold choice needed to lead the NIH—an accomplished scholar unafraid to speak hard truths and genuinely committed to advancing American science. But meaningful progress won’t happen unless Jay shatters some glass. He needs fearless operators and contrarian minds around him, people willing to weather inevitable blowback for taking the risks necessary to drive real breakthroughs. In science, big bets sometimes pay off enormously—and sometimes fail spectacularly. That’s simply the cost of innovation.

We urge Bobby Kennedy and the President to stand firmly behind Jay, encouraging him to push boldly ahead and ignore the predictable outcry from bureaucrats determined to protect the comfortable status quo, as well as from media voices that reflexively defend mediocrity. Donald Rumsfeld said it best: “If you’re not criticized, you may not be doing much.” Let's back real change.

Five Pillars

1. Overhaul the NIH grant system to embolden visionaries while rooting out politics, special interest, and fraud

2. Experiment with new NIH funding models

3. Streamline the NIH through targeted cuts to re-focus the agency on real results

4. Ensure publicly funded science, and its data, exists for the public benefit and in service of America’s strategic interests

5. Keep the best and brightest scientists in America, we shouldn’t educate our adversary’s workers for free!

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This is the third in a series of federal health policy pieces we’ve published this year. You can read the others on the FDA and HHS!

1: Embrace Radically Important Science and Scientists while Rooting Out Politics, Special Interests, and Fraud

The NIH grant process has become infested with biases, political mandates, and regulatory capture. To unleash real innovation, NIH must enact bold, targeted reforms:

1a) Eliminate political mandates from NIH grants

The US must strip away all political and ideological mandates from NIH funding criteria—DEI quotas, corporate favoritism, woke narratives, or any other political litmus test from any side of the political spectrum. These agendas poison merit-based science. Funding decisions must rely solely on scientific rigor, originality, and real-world potential to solve scientific problems. The costs of such distractions are real. As City Journal reported:

Consider several of NIH’s funded projects, which began under Trump and endured under Biden. The agency allotted $3 million to Columbia University, for example, to use Twitter “to enhance the social support for Hispanic and Black dementia caregivers” and to study the “ethical use of minority detection algorithms.” Remarkably, this award funded the creation of a “Black Tweet detection algorithm” to help curate posts “tailored to Black and Hispanic dementia caregivers.”

In one instance several years ago, the NIH actually created a DEI grant program specifically targeted at scientists who could not obtain a grant through the regular NIH process. The epitome of meritless grants. 

Many of the arguments about funding levels seem to ignore the serious situation with what is actually being funded. We citizens can disagree about the total funding number. But first we must appreciate that the processes are more broken than we realize, leading to major grants like the one described above — for which Columbia would have collected over a million dollars in overhead costs. Stuff like this must be turned off, plain and simple, and re-directed to merit-based science. 

1b) Cut Red Tape—Don’t let FACA Stop the Best Minds from Reviewing Grants

Today's NIH grant-review panels are crippled by outdated rules imposed by the Federal Advisory Committee Act (FACA), forcing committees to include reviewers who often lack the appropriate subject matter expertise. Bureaucrats with no skin in the game appoint reviewers more concerned with checking demographic or geographic boxes than backing bold, groundbreaking research. The consequence? Risk-averse committees that reward incremental mediocrity over genuine innovation.

It doesn’t have to be this way. Congress already experimented successfully with streamlined, innovation-focused review processes back in 2006—but limited these reforms to a fraction of NIH's activities. It's past time to scale this up. Congress must eliminate bureaucratic mandates and diversity quotas that dilute genuine expertise. Science doesn’t care about geography or demographics—it cares about breakthroughs. Grant reviewers should be selected solely for their ability to recognize and champion bold, transformative research. The stakes are too high to let political correctness dictate who sits in judgment of America's most promising scientific ideas.

1c) Strengthen independence in study sections

The NIH must dramatically strengthen study section independence by removing direct peer-review conflicts. Today, researchers hesitate to criticize flawed or weak proposals for fear of retaliation—especially when influential senior academics have friends or former students on review panels. We have personally heard feedback from academics on study sections that they cannot deny grants to certain senior Principal Investigators for fear of retaliation; despite these reviewers knowing that the senior PI’s work won’t replicate or has fatal flaws. Nepotism and entrenched interests frequently protect poor-quality proposals, while truly innovative or contrarian ideas are blocked by academic “mafias”enforcing dogma. This damages scientific integrity and stifles innovation.

The NIH should mandate that over half of reviewers on each study section commit to 10 years of ineligibility for NIH or federal science funding following their service, bringing in impartial experts from academia, government, industry, retired researchers, students, post-docs, patients and others. Reviews must be double-blind, preventing reviewers from knowing whose grants they're assessing. The NIH should also regularly rotate reviewers amongst sections to prevent entrenched thinking. These measures would create genuine accountability, reduce conflicts of interest, and prioritize scientific merit over academic politics.

1d) Fund bold vision with NIH grants, not incremental projects

Today’s NIH frequently funds incremental projects. Partially driven by a lack of courage in administrators and also driven by rules designed for mediocrity. An example: each NIH institute / center sets a single overarching payline for all of their grants regardless of the importance of each area. This means that grants for obscure topics such as “Cancer Communication in the New Information Ecosystem” are funded at the same rate as grants in extremely important topic areas such as the “Biology of Bladder Cancer”. This must change. The NIH must embrace bold visions and focus its funding on the basis of where massive scientific problems exist, not the best way to text a patient about potential carcinogens (which ought to be part of the surgeon general’s remit not the NIH’s in any case). This will require courage on the part of the new NIH director, to partially (or fully) cancel grant areas that are merely functioning as welfare for academics who in many cases not only fail to work on major problems but also fail to publish high-impact research papers and instead operate as a giant money sink. 

1e) Streamline and Modernize Grant Reviews—Less Paperwork, More Breakthroughs

NIH grant reviews currently consume countless unpaid hours from America’s best scientists—precious time better spent discovering cures than buried in paperwork. To fix this, the NIH should radically simplify its grant process. Set a strict 30-day deadline for funding decisions to eliminate unnecessary delays. Every day that is lost reviewing proposals instead of funding research delays cures and treatments patients urgently need.

In order to meet this sort of pace the NIH can leverage advanced analytics and AI to root out inefficiencies, detect duplicate applications, identify fraudulent or recycled data, and highlight genuinely novel proposals. AI-driven platforms can streamline this burden, freeing top minds to innovate instead of navigate bureaucracy. 

Next we recommend simplifying the grant submission & review process itself. Instead of cumbersome paperwork, start with concise, 1–2 page executive summaries submitted through a rolling application system. Researchers should immediately receive clear, actionable feedback, allowing quick adjustments before investing time in a full proposal. This approach swiftly eliminates weak applications, saving reviewers valuable time. Additionally, deploy AI-powered tools to capture reviewer discussions and generate transparent, precise notes for applicants. Today's vague, overly polite rejection letters waste everyone’s time by encouraging repeated resubmissions of weak proposals. Clear feedback means fewer wasted hours and more groundbreaking research.

1f) Break the dominance of super-PIs to ensure more diversity in academic viewpoints and approaches to science

Currently, so-called “super-PIs” with massive labs monopolize funding, disadvantaging smaller, innovative teams at less prestigious institutions. The top 1% of researchers capture nearly 10% of all NIH funding while studies have shown that researchers with lots of grants are actually less productive than their peers with fewer grants. Capping submissions would ensure a fairer playing field, rewarding great science—not administrators who oversee sprawling research empires. Based on these studies, a cap of 2 - RO1 grant-equivalents per PI would result in a fairer playing field and more efficient researchers: a win-win for efficiency and science overall.

1g) Reform the Financial Mechanics of NIH Grants—Increase Accountability, Slash Waste, and Drive Results

The administration’s recent steps to rein in excessive overhead rates at universities are spot on. Universities often charge outrageous overhead rates—far beyond what private foundations, for-profits or nonprofits pay—without meaningful accountability. Overhead funds, intended to support essential resources and core facilities, too often become administrative slush funds, diverted away from the intended scientific research to powerful professors' pet projects. Even worse, universities regularly exploit “tuition reimbursement,” billing the NIH over $50,000 for graduate students who haven't set foot in a classroom in years while often requiring graduate students to contribute free labor as class teaching assistants. This system isn’t just wasteful—it’s unfair to researchers and taxpayers alike.

The NIH should continue to cap overhead rates at 15% on all new grants, clearly allocating 14% for general university overhead and reserving 1% explicitly for commercialization support (such as patents) directly tied to funded research. Reducing overhead rates will empower researchers to directly invest grant dollars into genuinely valuable facilities and resources relevant to their work, rather than subsidizing unrelated campus initiatives. Universities should also be prevented from manipulating overhead internally to favor certain researchers, ensuring fair, transparent distribution of resources.

Importantly, this reform should not mean cutting total grant award sizes. Rather, grants like a typical RO1 award ($1 million direct funding plus another $700k to $1 million in overhead) should keep their total funding constant, shifting excess overhead funds into direct research expenditures and targeted commercialization. In parallel, allow professors greater flexibility to use direct funding on critical resources such as core facilities, equipment, or lab space. After a few years of detailed accounting and oversight, the NIH can further adjust funding allocations, cutting administrative bloat and politically-driven spending from grants entirely, while ensuring researchers and students aren’t unfairly harmed.

Finally, the NIH should follow DARPA’s proven approach by shifting many grants to milestone-based funding. Today’s interim reports are bureaucratic box-checking exercises rarely reviewed seriously, incentivizing unrealistic project goals. Instead, funding increments should depend strictly on achieving concrete, researcher-defined milestones that are independently validated by reviewers. DARPA’s milestone model creates urgency and accountability, driving researchers to deliver tangible scientific progress rather than paperwork. Bringing this results-oriented model to NIH will accelerate breakthroughs, ensuring taxpayers get real returns from their scientific investments.

2: Experiment with new NIH Funding Models

Today’s NIH funding relies on methods from the mid-20th century. While peer-reviewed grants have delivered valuable results, it's past time to explore fresh approaches. The NIH must experiment with new funding strategies—such as investigator-focused grants, lotteries for high-risk proposals, or distributed funding models—to ensure bold, innovative ideas aren't stifled by bureaucratic inertia. If America wants groundbreaking science, our funding methods must match the creativity we seek to support.

At the core of our new strategy must be competition. A singular vision at the NIH is debilitating for science, because anything that doesn’t conform to that singular vision gets crushed. Science is a process of discovering new things. So, different perspectives really matter. We must set things up in a way so that when there is a conflict, no one organ can crush a new idea. There need to be multiple pathways for an idea to succeed — as there are in any sound market (say, when one investor passes on an idea but another makes an investment). 

2a) Learn from Bold, Innovative Funding Models Outside Government

The NIH must urgently look beyond its bureaucratic walls and study successful alternative funding methods. Foundations like Damon Runyon consistently identify and back exceptional young talent by empowering veteran scientific leaders to make decisions, while the Arc Institute and Arcadia Science excel at supporting contrarian and high-risk ideas. In the for-profit world, Altos and Arena Bioworks blend groundbreaking basic research with rapid commercialization, swiftly moving science from the lab to patients.

The NIH should also allow internal competition, empowering its institutes to adopt these or other innovative models and prove their effectiveness. A dedicated team (akin to an NIH SWAT team) within the NIH director’s office should rigorously measure outputs—publications, patents, real-world therapies—to identify what truly works. Experiment boldly, drop failing approaches swiftly, and prioritize proven methods that reward creativity and deliver breakthrough results.

2b) Test Crowdfunding Models—Let the Public Drive NIH Innovation

NIH’s current funding cycles move at government speed—slow and out-of-step with today’s rapidly changing world. Meanwhile private sector crowdfunding platforms, like Experiment.com, quickly funnel millions into innovative projects that align closely with public interests. NIH should aggressively experiment with similar crowdfunding methods to boost public engagement and streamline research funding. In particular, this would provide the greatest benefit to areas where the NIH is years behind what is important to the public: areas such as natural peptides, stem-cell therapies, endocrine disrupting chemicals from plastics or psychedelics for mental health treatment. 

Three specific crowdfunding models could make NIH funding much more responsive to changing public needs:

First, establish a publicly driven grant platform, enabling the public to vote on and select promising projects for direct NIH funding. Implement straightforward ID verification to keep voting legitimate.

Second, create a charitable crowdfunding platform allowing individuals and companies to support specific research with tax-deductible contributions, matched dollar-for-dollar by NIH, effectively doubling their impact.

Third, launch a commercialization-focused platform, where contributors fund projects with strong commercial potential. NIH would again match contributions dollar-for-dollar, but funders would share in the commercial success, receiving a 20% stake in resulting innovations or intellectual property—mirroring proven models at pioneering institutions like Arena Bioworks.

Crowdfunding can transform NIH funding into a faster, more responsive, and publicly engaging engine of innovation.

3) Streamline NIH for Impact—Cut Bureaucracy, Refocus on Real Results

With 27 different institutes and over 18,000 employees, today's NIH is overly fragmented, inefficient, and unfocused. NIH must be aggressively streamlined, consolidating around clear, realistic, and impactful goals.

3a) Separate grant-making functions from other functions and reorganize the NIH for efficiency

Most NIH funding is awarded externally—yet bureaucratic confusion persists because internal NIH operations and external grant management are unnecessarily tangled together. Splitting these roles decisively sharpens accountability and streamlines effectiveness. Once separated, the NIH director must aggressively audit every institute. Centers serving primarily as mere pass-through funding vehicles, without significant internal research contributions, should be swiftly dissolved. The NIDDK, NIDCD, and NINR stand out as immediate candidates. Take the NIDDK: tasked with critical areas like diabetes and kidney disease, yet embarrassingly behind the innovation curve on breakthrough treatments like GLP-1 agonists and SGLT-2 inhibitors—predictable failures given their lackluster internal research record. These critical grant areas belong under a revamped NHLBI, positioned to holistically tackle cardiometabolic diseases instead of outdated, bureaucratic silos separating kidneys, pancreas, and heart. Similarly, folding NINR into NCATS and the NIH Clinical Center would create a powerhouse for clinical excellence, while merging NIDCD with NINDS would unify research on hearing loss, neurological disorders, and genetic therapies—fields increasingly interwoven by cutting-edge science. America’s biomedical enterprise demands nimble, meritocratic institutes—let’s build them.

3b) Target NIH’s Unique Capabilities to Tackle Big Challenges

The NIH must prioritize its internal research efforts to those that only government-level resources can handle—projects too ambitious, costly, or non-commercial for industry and academia. Large-scale initiatives like the Framingham Heart Study or population-wide biobank research exemplify the strategic advantage the NIH has over smaller entities. Likewise, NIH should lead research on vital but commercially unprofitable topics, such as off-patent drugs, natural peptides, and massive clinical trials. NIH must leverage its unmatched scale, tackling problems no one else can. The NIH should develop internal metrics on its intramural research program to weed out any labs that are working on small incremental projects; easily identified by a lack of high-profile / high-citation articles (e.g. the Framingham Heart study has many thousands of citations). The NIH has already ceded leadership on large scale efforts that would accelerate research. For example it is not the NIH but the Jackson Laboratory (a non-profit) that became the world’s premiere source of rodent animal models, and we are losing to China in developing advanced NHP research models. The NIH must reverse course in all these areas, begin new large scale population studies (partnering with the VA, CMS and other health systems) to discover the causes of disease (similar to this study funded by NINDS which discovered the cause of MS); develop new research tools in AI and develop advanced NHP and other animal models so that we don’t fall behind the rest of the world any further.

3c) Service limits and scientific background checks for NIH positions

Nobody should serve as an NIH institute director for decades—this breeds stagnation and entrenched interests. Enforce strict 10-year maximum service limits to ensure leadership stays dynamic and innovative. Additionally, the NIH must dramatically strengthen its hiring vetting procedures. It is unacceptable for NIH leadership to include scientists linked to fraudulent or questionable research such as the recently fired head of the aging institute. The NIH must implement thorough, mandatory scientific integrity background checks for all senior roles, barring individuals with histories of misconduct from ever holding leadership positions.

3d) Solve the Replication Crisis—Restore Integrity to Scientific Research

Science faces a serious credibility crisis: far too many studies can't be replicated. While many open source efforts (like those at PubPeer) or civic minded groups (like those at DataColada) have done great work in uncovering fake, fraudulent or shoddy work: ultimately the arbiter of science is in replication. If it doesn’t replicate it isn’t science, and it doesn’t really matter why replication failed. Congress should mandate that at least 10% of the NIH budget be set aside for replication.  Only direct, systematic replication can prove whether findings are genuine breakthroughs or merely hype.

The NIH should aggressively deploy these funds towards rigorous replication projects and hold every sub-institute accountable for replicating key studies in their fields. Revitalize the Office of Research Integrity (ORI), empowering it to swiftly investigate suspected fraud or consistently non-replicable work. Scientists confirmed to be engaged in misconduct or whose work results in repeated irreproducible science should be permanently barred from NIH funding. Institutions that tolerate or ignore scientific misconduct should lose their eligibility for NIH grants altogether.

The NIH must also urgently ramp up its technological capabilities to detect fraudulent or shoddy research as well. Partner with open-source watchdog groups like PubPeer and DataColada, integrating their best practices into NIH’s internal processes to proactively spot problematic research.

Finally, after ten years leading a research group, principal investigators should be required to demonstrate independent replication of their key findings as a condition for continued NIH funding. Replication must be conducted externally—by independent labs, CROs, or unaffiliated researchers—to ensure objectivity and credibility.

4) Publicly funded science, and its data, should be for the public benefit and in service of America’s strategic interests

4a) Immediate Public Access to NIH-Funded Research

In 2024, the Biden administration moved to shorten the NIH public access window to zero months, meaning that publicly funded research papers must be made available to the public immediately. The  Trump administration has moved to accelerate the implementation date of the 2024 access policy. Now, it must go further, because there's a critical loophole. Access timing is tied to outdated "final edited manuscripts," not initial publication of a preprint, allowing critical research to remain inaccessible for months or even a year. Preprints have become the new norm in scientific publishing and NIH-funded findings should be publicly available immediately upon their first publication in any form, including preprints. Delays hurt innovation and deny the public timely benefits of taxpayer-funded research. 

4b) NIH Funded Data Should Belong to the Public

Taxpayer-funded data from research shouldn't stay locked behind academic gates forever. NIH must mandate that all funded researchers deposit their primary data—lab notebooks, digital records, and experimental results—into public repositories. Under the current NIH policy for Data Management and Sharing, researchers aren’t required to actually make their underlying lab data available to the public; merely to submit a plan about how they might do so. These plans are rarely enforced or followed-up on for compliance by the NIH. While there are specific databases for data of special interest (genomic data, BRAIN project data) these databases are fragmented. Rather than fragmented and voluntary plans the NIH should instead implement a new regulation requiring NIH-funded data should be deposited at a single repository housed at the NIH. The NIH would then make the data freely accessible to the public, after a reasonable period (perhaps three years, with special protections for protected health or personally identifying data),  empowering open scientific inquiry and fueling future AI breakthroughs.

4c) NIH IP Licensing Must Serve American Interests

Current NIH intellectual property licensing rules fail to protect America's strategic and economic interests. NIH-funded IP licensing should be restricted exclusively to NATO-based companies, requiring initial ownership by NATO persons and that the majority of product testing or manufacturing occur on NATO soil. Taxpayer-funded innovations shouldn't send critical IP abroad, benefit foreign adversaries or drain expertise to adversaries under the guise of cost-savings in a penny-wise pound-foolish manner. The NIH must ensure American science directly strengthens America's economy and security first.

4d) Rein in Academic Conflicts of Interest—Protect Taxpayers and Researchers

Today, NIH guidelines place virtually no guardrails on academics profiting privately from taxpayer-funded research—opening the door wide to rampant conflicts of interest. Professors routinely leverage their positions over students and staff to enrich themselves, too often resulting in outright scientific fraud and brazen ethical abuses. High-profile scandals grab headlines, but countless others quietly fade away behind closed-door settlements or subtle intimidation tactics, leaving students in impossible conflicts between their educational needs and a professor’s personal financial gain. Disclosure rules alone are toothless—mere box-checking exercises that do nothing to protect students or taxpayers. NIH must step up and impose clear, strict equity limits to dismantle incentives for exploitation: cap individual professors' equity stakes at 7% and group stakes at 15% in ventures commercializing NIH-funded research while enabling the students whose actual work went into the companies to have uncapped stakes. These sensible restrictions ensure taxpayer dollars drive scientific breakthroughs, not the private yachts and vacation homes of ethically compromised academics.

5) Strengthen America’s Scientific Talent Pipeline—Keep the Best and Brightest Here

America spends billions on NIH-funded training for graduate students and post-docs, many from overseas. Yet due to convoluted immigration policies, countless top talents take their American taxpayer-funded skills back to their home countries, benefiting our global competitors rather than the United States.

5a) Require U.S.-Based Work Commitments for NIH-Funded International Researchers

Countries like Singapore smartly mandate that government-funded trainees remain in-country after graduation. NIH should implement a similar policy: international students and post-docs funded by NIH grants must stay and work in America for a minimum period of five years after they complete their training. The requirement should be flexible enough to cover various careers but enforceable enough to ensure that U.S. taxpayers reap the rewards of their investment. Those who leave prematurely should reimburse the full training costs to U.S. taxpayers.

5b) Expedite Green Cards and Visas for NIH-Trained Researchers

To facilitate these commitments, NIH should work closely with Congress to streamline immigration pathways, guaranteeing expedited visas & green cards for NIH-funded students & postdocs. The UK’s “high potential individual” visa program demonstrates how efficiently targeted immigration policies can secure top global talent. Instead of letting other nations poach the elite scientific workforce we’ve trained, America should proactively leverage immigration policy to maintain scientific and economic leadership—especially given aggressive talent recruitment efforts by nations like China. 

Conclusion: America’s research sector is the shining city on a hill

America's biomedical future hinges on our willingness to restore meritocracy, courage, and accountability to the NIH. Bureaucracy and political capture have robbed us of countless medical breakthroughs, but we have the power—and obligation—to demand better. Let’s tear down the walls of academic entitlement, reward genuine risk-takers, and use every dollar wisely to advance American science. Do that—and pair it with the private-sector dynamism we’ve witnessed first-hand—and we’ll replace today’s slow-moving, $50-billion behemoth with a moon-shot factory that unleashes a new era of discovery.