1/ The funding of scientific research cannot be controlled by a small cabal of insiders at the NIH, many of whom stay in power for decades, acting like presidents in a Banana Republic who never face reelection challenges.
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2/ This allows the likes of Anthony Fauci to exercise undue control over primary investigators and their teams of university researchers, shaping the entire research agenda for a generation or more. There are many potential approaches to breaking up this monopoly.
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3/ I suggest federal block grants to states to fund scientific research, so that each state has their own version of an NIH. Instead of one NIH we could have fifty SIHs—State Institutes of Health. Each state could compete for researchers by offering attractive grants.
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4/4 Or perhaps they could each carve out specific niches within the enormous enterprise of scientific research, focusing on problems or diseases that impact their citizens. Alaska could fund research on hypothermia, Hawaii on sunstroke, and California on mental illness, etc.
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@AaronKheriaty