This debate cuts to the heart of a critical question: can the U.S. government fund the next generation of medical breakthroughs without suffocating them in red tape? Stuart Buck, writing alongside Aishwarya Khanduja, challenges the prevailing narrative that venture capital is the superior model for scientific discovery, but the real story here is the rebuttal from Dr. Jeremy M. Berg, a former director of the National Institutes of Health (NIH). Berg doesn't just defend the status quo; he dismantles the myth that federal funding is rigid, using decades of insider experience to argue that the system is far more agile than critics claim.
The Myth of Bureaucratic Rigidity
The central tension in this exchange revolves around the flexibility of government grants versus the perceived agility of private capital. Buck and Khanduja suggest that the federal process is too slow to adapt when a researcher's initial hypothesis proves wrong. Berg, however, draws on his tenure as an institute director to correct this misconception. He writes, "But you do not have amend anything! You pursue the science and describe whatever changes in approach in your annual progress report." This distinction is vital. It reframes the narrative from one of bureaucratic obstruction to one of misunderstood protocol.
Berg illustrates this with the landmark work of Thomas Cech, who discovered that RNA could splice itself without proteins—a finding that contradicted his original grant proposal. "He was able to pursue this discovery, focusing on the requirements for this RNA-driven process, without contacting NIH or amending his grant in any way," Berg notes. The study section's response was simply, "Cool. That's even better." This anecdote is powerful because it exposes a gap between the public perception of government funding and the actual day-to-day reality of scientific inquiry. Critics might argue that while Cech's success is real, it represents an exception rather than the rule, yet Berg's experience suggests such flexibility is standard practice for program officers who understand the nature of discovery.
"As is almost always the case in medicine, it is essential that one arrive at the right diagnosis before deciding on a treatment."
The Incentive Structure and the Nobel Prize Paradox
A significant portion of the original argument by Buck and Khanduja focused on the lack of incentives for government program officers. They posited that bureaucrats face "perverse incentives" where failure is punished but success goes unrewarded. Berg pushes back hard on this, arguing that it misreads the motivation of public servants. "Program officers are public servants who are not motivated much by money but rather by helping science advance," he asserts. He points out that during his directorship, there was "no special compensation to a program officer whose grantee received a Nobel Prize," yet the staff remained proud of their contribution to such breakthroughs.
This reframing is crucial for understanding the institutional dynamics at play. The argument shifts from a critique of individual greed or laziness to a defense of public service ethos. However, the discussion of Katalin Karikó introduces a necessary counterpoint. While Berg acknowledges her struggle to secure funding, he attributes her eventual success to a timeline spanning over 15 years, noting that "venture capital-style funders would have the patience necessary for these long and uncertain timelines." This highlights a fundamental difference in risk tolerance: private capital often seeks quicker returns, whereas the NIH can sustain long-term, high-risk projects that may not yield immediate results but are essential for foundational science.
Venture Capital vs. The Public Portfolio
The piece also delves into the limitations of venture capital (VC) in driving pure scientific advancement. Berg shares his experience serving on the boards of VC-backed companies, observing that the model often prioritizes marketability over discovery. He describes a scenario where investors would wait until a company was "on the verge of financial failure" before stepping in to replace leadership with a focus on selling the company rather than developing technology. "My experience was that the venture capital approach was to hear lots of ideas and pick a small number on which to focus, based on their potential marketability in the short or, at best, the medium term," Berg writes.
This critique suggests that while VC is excellent for commercialization, it may be ill-suited for the early, uncertain stages of basic research. Berg uses the analogy of a financial portfolio manager to describe the NIH's role: balancing investments in "solid, dividend-paying established companies" against "start-ups that might flame out but might lead to the 'next big thing'." He argues that the NIH already has mechanisms for this, such as the Director's Pioneer Program, which he helped run. "They might need tweaking and expansion, but they were thoroughly evaluated in the past... and were deemed to be successful," he concludes. This suggests that the solution isn't a radical overhaul of the funding model, but rather a better understanding of the existing tools.
Bottom Line
The strongest part of Berg's argument is his ability to correct the record on how the NIH actually functions, replacing anecdotal fears of bureaucracy with concrete examples of flexibility and long-term support. The biggest vulnerability in the counter-argument lies in its assumption that the current system is broken by design, rather than acknowledging that it is a complex, evolving ecosystem that already accommodates high-risk research. As the debate continues, the focus should shift from dismantling the NIH to ensuring its high-risk programs receive the sustained attention and resources they need to replicate the success of discoveries like mRNA technology.