Mission-oriented biomedical research at the NIH

The NIH (National Institutes of Health) is the largest single funder of biomedical research in the world. This paper documents tensions between the agency's health and science missions and considers how, in light of these, it has managed to sustain a level of bipartisan political support uncommon in U.S. health or research policy. It highlights the serendipity hypothesis, the presence of “safety valve” mechanisms that allow it to (on occasion) target research at particular diseases and priorities, and a broad and diverse set of constituencies as important to understanding the agency's political success. Through an in-depth look at the NIH allocation process, the paper also provides insights into how demand-side considerations can affect the direction of scientific research.