Almost nothing about how the United States government funds health research was chosen. The National Institutes of Health (NIH) began with leftover penicillin money and a letter to medical school deans. The decision to fund projects rather than people came from a foundation protecting itself during the Depression. The paperwork came from a congressman who was annoyed in 1962.

Michael Lauer spent nearly two decades at the NIH, serving as Deputy Director for Extramural Research from 2015 until 2025. He joins Salma to trace how these accidents hardened into a system that leaves scientists dependent on grants for their salaries, concentrates most of the money in a small number of hands, and does not grant most researchers independence until their mid-forties. They discuss what could be done differently, and the question that has gone unanswered since the 1940s: who should decide what science gets done.

Dr. Lauer suggests that the current situation being faced by the NIH and researchers is the result of these structural problems and highlights that while there is a crisis, it is also an opportunity to restructure funding and research incentives.

This episode asks whether the current inflection point in research funding might be the opening needed to rethink a system that was never quite designed to work.

Notes:

Acronyms used in this episode include:

• CTSA = Clinical and Translational Science Awards
• IACUCs = Institutional Animal Care and Use Committees
• IRB = Institutional Review Board
• MIRA = Maximizing Investigators' Research Award
• NASA = National Aeronautics and Space Administration
• NCI = National Cancer Institute
• NHLBI = National Heart, Lung, and Blood Institute
• NIAID = National Institute of Allergy and Infectious Diseases
• NIGMS = National Institute of General Medical Sciences
• NIH = National Institutes of Health
• NSF = National Science Foundation
• PCORI = Patient-Centered Outcomes Research Institute
• R01 = Research Project Grant

Fact checks:

• Glenn Seaborg was Chancellor of the University of California at Berkeley between 1958 and 1961

About the guest:

Michael Lauer is a cardiologist and physician-scientist who served as the Director of the Office of Extramural Research and the Deputy Director for Extramural Research at the National Institutes of Health (NIH) between October 2015 and February 2025. As Director for Extramural Research he led the NIH funding processes for universities, medical schools, and research organizations outside of the United States government.

Useful resources:

• Bush V. Science, The Endless Frontier - 75th Anniversary Edition. National Science Foundation. Published online 2023. https://nsf-gov-resources.nsf.gov/2023-04/EndlessFrontier75th_w.pdf
• Kratsios M. Science, A New Golden Age. Office of Science and Technology Policy; 2026. https://www.whitehouse.gov/science/

Host: Dr. Salma Abdalla

Editors: Catalina Melendez Contreras

Marketing: Kinkini Bhaduri

Music: Eden Avery / Melting Glass from Epidemic Sound https://www.epidemicsound.com/track/2fqOXWpHab/

The views and opinions expressed by the guest in this episode do not necessarily reflect those of their institution, the funders, or the podcast team.