This is not about burning down the house. It’s about rebuilding it with better architecture, clearer lines of accountability, and a foundation that can actually support the weight of the science it claims to carry.
From Siloed Bureaucracy to Systems-Driven Strategy
The NIH’s current structure reflects a legacy era: rigid divisions, compartmentalized disease focus, and fragmented funding streams. But the modern scientific frontier doesn’t fit in those boxes. Chronic illness, neurodevelopmental disorders, immunological collapse—these don’t operate in silos.
The future is convergence. Research must be organized not around symptoms or legacy institutions, but around underlying systems. We need a Convergent Systems Division that fuses toxicology, immunology, metabolism, and neurology. It’s time NIH caught up to the reality that complexity is the new normal.
Fixing NIH isn’t about defunding. It’s about refactoring. We need a structural audit that maps disease burden and progress— the deltas - against funding flows—not by disease name. Instead, by causal networks—environmental exposures, inflammation, mitochondrial dysfunction, and endocrine disruption. Then we reweight accordingly.
Programs that are non-reproducible, overtly commercialized, or dependent on proprietary platforms, or outdated get a second look. Not from ideology, but from forensic accounting of opportunity cost. Funding is finite. Priority must be earned.
Strategic Reform Without Institutional Self-Sabotage
Legacy researchers should not be discarded—they should be deployed. The path forward involves co-authoring transition frameworks with senior figures who know the terrain. Reform will not survive if it is mistaken for revolution alone. #RevolutionaryReform in Fiscal Year 1 must become #EvolutionaryReform by Fiscal Year 3, or we are behind schedule.
We turn critics into custodians. We build prestige pathways into reform leadership. That’s how institutional sabotage is pre-empted, and reputational continuity is preserved. The only advocacy we should reward is for obvectivity in science and measureable ROI in terms of improved health outcomes. Translational Research must become Transformational Research.
Reform is not declared. It’s embedded, one strategic alliance at a time.
Bioethics as Embedded Infrastructure
NIH must stop treating ethics as a final checkbox. Ethics must be engineered in from the start. Every funded study should answer not just “Can we?” but “Should we?” — with defensible metrics.
We implement a forward ethics framework based on epistemic soundness, public benefit, and independence from extractive motives. This isn’t moral theater. It’s structural integrity under operational pressure.
If someone were to ask me what gives NIH the right to exist in the first place, I’d point to Article I, Section 8 of the Constitution: to promote science and the useful arts.
But “promotion” does not mean protectionism. It does not mean regulatory capture. It does not mean soft power wielded without oversight.
NIH must function as a public trust, not as a semi-private instrument of biopolitical influence.
Research priorities must be transparent, legally tethered, and publicly accountable. This is not optional. It is constitutional stewardship.
Strategic Risk Rebalancing
Not all science deserves equal investment.
Gain-of-function research with ambiguous benefit and unbounded risk must be constrained. Meanwhile, iatrogenic disease, metabolic disorder, mental health, and autoimmune conditions, with eyes on systems toxicology, environmental medicine, and developmental epigenetics—fields with high public impact and low commercial reward—must move from margin to center.
The rule is simple: fund what impacts. Not what flatters quarterly returns.
Reproducibility as a First-Class Objective
The replication crisis isn’t a footnote. It’s an indictment. NIH must embed replication into its funding DNA. That means:
Dedicated validation tracks
Elevation of null results
Incentives for methodological rigor over media value
Study of reproducibility of data analysis plans.
We cannot expect to earn trust if we don’t pay for evidence.
Executive Competence: Curating Judgment, Not Commanding Compliance
NIH leadership must evolve from command-and-control to a model that curates judgment across disciplines rather than issuing top-down mandates and picks the winners. That means:
Building cross-disciplinary advisory teams
Empowering structured dissent
Translating complexity across legal, scientific, and public dimensions
I don’t lead from ideology. I lead from system integrity—and with full awareness of the reputational, legal, and political terrain NIH must now navigate.
Deliverables, Not Declarations
The goal of reform is not better messaging. It’s coherence. It’s verifiability. It’s outcome accountability.
We aren’t here to inspire belief. We’re here to make the data clean, the portfolios functional, and the public interest legible again.
This isn’t about trust in science. It’s about restoring science to a place that’s worthy of that trust.
And that work begins—not with headlines, not with postures—but with the next deliberate, rigorous step forward.
Quietly. Accountably. Unshakably.
Like Secretary Robert F. Kennedy is doing for all of us at HHS.