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Yes, yes, reform the NIH. But while we’re in the finger-pointing mode, why not mention the waste in money and time stemming from the way biotech finance works? Beauty contests, herding around fads, billions of dollars wasted on courting KOLs for treatment that will never be approved. It’s all there…

So, here is a last-minute Hail Marry request that I hope someone will respond to. I run an introductory course on clinical trials at UMBC (BTEC668). Today at 6pm EST we have a patient/caregiver panel where I talk to a few people on why they did or didn’t participate in trials. We may have a last-minute cancelation from a panelist, so if a patient or caregiver has 90 minutes to spare this evening it would be much appreciated! Do email or DM if interested.

The same week Alexey Guzey proposed abolishing the NIH, two more essays popped up:

• Distinguishing the real from invented problems with the NIH, from Sasha Gusev, himself an NIH-funded geneticist
• The NIH Needs Reform: Here are 10 Sensible Suggestions from Joseph Marine, a cardiologist

A few things came to mind:

• You can clearly see the difference in backgrounds. Gusev’s essay is an “insider-y”, show-me-what-we’re-doing-wrong approach. Marine’s is outward-looking-in, dealing more with perception of the NIH.
• Marine makes several immediately actionable proposals which are the policy equivalent of politicians kissing babies but since these days any politician seen kissing a baby would be called a creep (or worse) I suspect that even those modest proposals would become divisive.
• Neither states conclusively what the NIH is for. Is its mission to give out grants? Advance biomedical science? Or help people live longer and/or better? I’d say it’s that last one and that everything else is means to that end.
• So if we see the NIH as a grant-giving machine, I guess we could give it a passing grade. The awardees certainly seem happy! But in the last 30 years we saw several massive public health crisis, from the obesity epidemic to the opioid murders to the bungled response to the pandemic so from that standpoint at least there is room for improvement.
• Gusev’s essay does not at all consider the opportunity cost of the current system. He lists length of grant proposals as an “invented problem” and unironically writes (emphasis mine):

The last NIH proposal I submitted was about ~150 pages which might indeed seem daunting. But only ~12 pages of that was dedicated to science and will be the focus of study section reviewers (and I can also assure you that I wish I had more than 12 pages to work with). The remainder was some combination of budgets, resumes for all of the personnel involved, descriptions of the data and resources, and contractual language between the NIH and my institution. Nearly all of it was handled by experienced grants administrators in my department who can put these documents together in a matter of hours.

• You don’t have to be an expert in probability and statistics to see how this “invented problem” leads to a winner-takes-all system, the winner being a handful of investigators in a handful of institutions. This is an incredible systemic risk that can lead to billions of dollars wasted and set back an entire field of study by decades.
• I want to read something from Adam Mastroianni on the topic of NIH reform.

Abolish the NIH is an unnecessarily divisive title but the core idea is interesting: sunset extramural NIH funding over 10–15 years through natural expiration of grants and, in parallel, set up alternative mechanisms which otherwise would have no room to breathe. Worth considering.

Judging from the number of new follows BlueSky is becoming a new hub for MDs. So, it was time for a new profile pic. And because I cross-post from micro.blog to BS (which is how I will henceforth call it, just because) this… ugh… skeet will make for an interesting loop.

📺 Slow Horses, Season 4 has reached a plateau, in that it is “only” as brilliant as the previous season. Which is to say, it continues to be the best live-action show of the decade. Has there been a better TV character than Jackson Lamb as played by Gary Oldman?

Gravity Falls (2012–2016) is the king of our household, but if there were ever a contender to replace Dipper and Mable it could only be Over the Garden Wall (2014). Well, November 3–7 were the 10-year anniversary of it coming out on Cartoon Network, and there is a stop motion short voiced by the original cast to commemorate. It’s been a busy few weeks so I only saw it now, but it made my day (and will quite possibly be the highlight of my week). (ᔥwaxy.org)