February
25, 2022 Jackson Hammond
Have
you heard of the internet? What about GPS? Autonomous vehicles? How about the
computer mouse? All of these inventions (and a lot more) were originally
projects at the Defense Advanced Research Projects Agency
(DARPA), the wildly successful government research agency that was founded in
response to the Soviet launch of Sputnik. DARPA was invented to take
high-risk, high-reward ideas and turn them into immediately usable discoveries.
Now, President Biden wants to use this model for health initiatives to find
real, actionable treatments and cures for deadly and rare diseases.
To
that end, Congress has crafted H.R. 5585, the Advanced Research Project Agency
– Health (ARPA-H) Act, and has proposed funding in both the House and Senate
fiscal year 2022 appropriations bills. The House legislation, however, would
make ARPA-H a stand-alone agency in the Department of Health and Human
Services, while both the House and Senate appropriations bills would place the
agency under the National Institutes of Health (NIH). The placement of
the agency has turned into a fight on
the normally bipartisan issue of medical research funding. The
president has repeatedly stated he wants ARPA-H at NIH, and so has his new
science advisor, former NIH Director Dr. Francis Collins. But why does it
matter?
First,
the arguments for placement at the NIH: The NIH is the nation’s premier health
research agency and has contributed greatly to biomedical and scientific
research. The agency has the legal and administrative infrastructure necessary
to host ARPA-H already in place. It is also a well-known entity with routine
bipartisan support in Congress (more on that later). Putting ARPA-H under the
NIH would theoretically allow ARPA-H to build on the work at NIH more
effectively. At first glance, it makes sense to house our next big
health research agency under our nation’s most prestigious health research
agency.
But if ARPA-H was just another targeted research agency, we
wouldn’t need a multi-billion dollar funding package for it. In fact, we probably wouldn’t need it at
all – Congress could just tell the NIH to take bigger risks in its research. As
a quick reminder, the NIH does basic research to lay the groundwork for a wide
variety of health fields; in essence, the research that other research is built
upon. But ARPA-H is not intended to be just another research funding scheme. It
is designed to produce tangible outcomes from its research projects. It takes
massive risks or there’s not much point in having it. Part of the
reason the NIH can’t take such risks is its grant structure: A peer review
committee is set up with outside experts to decide if a project has merit.
These experts are often the people who came up with the “conventional
wisdom,” and approach projects with the question: “How is this relevant today?”
In the “Mean Girls” world
of academic cliques, people without the right connections or background may not
be high on the grant recipient list. Moreover, these peer review boards are far more likely to fund ideas that
they’re already familiar with, ensuring whatever new information comes out of
the project is less likely to be groundbreaking. Fortunately, ARPA-H would be
set up with a project-management-style system, which – if given independence
from political and bureaucratic red tape – prioritizes the ability of a project
manager to find and lead innovative projects over subject-matter expertise.
That “if” part is important.
Four
of the five witnesses at a recent House
Energy and Commerce hearing all agreed (with the fifth being
simply non-committal): The culture at NIH is slow, cautious, and relies on the
conventional wisdom. If you’re looking for an agency to take big, bold risks in
research, that’s the exact opposite of the culture you want. To give us
things like the Cancer Moonshot championed by President Biden, ARPA-H needs a
far less risk-averse culture than the NIH can provide.
Additionally,
the bipartisanship enjoyed by the NIH has come under fire in the last two
years. Senator Rand Paul’s infamous
exchanges with Dr. Anthony Fauci, nominally about the NIH’s
involvement in coronavirus research in Wuhan and generally about the handling
of the pandemic, point to many Republicans’ exasperation with the health
establishment. To quote one Senate GOP
aide: “…Republicans in the House worry ARPA-H will become another
slush fund for Fauci-minded scientists — unchecked scientists who will use more
government money just to curate their public image rather than get
results.” So tying ARPA-H to an agency facing increased scrutiny over
its funding choices is not likely to help its cause.
ARPA-H, if done right, is the exact type of initiative America
needs to remain the world leader in biomedical research. But to do that job right, ARPA-H needs to
be given a clean slate without being weighed down by the current cultural and
political pitfalls at the NIH. Without it, this new body may not give us
the groundbreaking discoveries of the future.
Read more: https://www.americanactionforum.org/weekly-checkup/where-oh-where-will-arpa-h-go/#ixzz7MIsQ2FeL
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