By NextBestFitIndependent peer review with set-asides for high-risk ideas
Keep funding decisions with scientific peer review, with a fixed share for high-risk research.
Keeps scientists, not politicians, choosing grants.
Review ledgerHow this path connects
This path
Independent peer review with set-asides for high-risk ideas
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Keep peer review
- Set aside funds for high-risk research
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Government chooses which research gets funded
Using scientific peer review for funding decisions insulates research priorities from politics and uses an established approach, while reserving funding for high-risk research.
What it creates or worsens
- Slower access to new drugs and technology
Scientific peer review can be conservative even with funding reserved for high-risk research.
3 paths soften this
Cover new treatments at launch, then reassessSlower access to new drugs and technologyChosenRecycle part of drug savings into researchSlower access to new drugs and technologyChosenRequire timely U.S. launch as a condition of market accessPrice limits can cause shortages, launch delays, or exitsRejected - Takes years, or money up front, before it pays off
Scientific peer review makes research funding decisions slow.
Who's affected
Who gains
- Medical researchers and research institutions
- Government chooses which research gets funded: Government priorities may leave risky or politically disfavored research unfunded.
- People with ongoing or specialist care needs
- Government chooses which research gets funded: People with rare conditions can lose research support for needed treatments.
- Taxpayers and public budgets
- Slower access to new drugs and technology: Strict value assessment lowers payment for new products in the short run.
- Health insurers, brokers, and their shareholders
- Slower access to new drugs and technology: Strict value assessment lowers payment for new products in the short run.
Who loses
- Medical researchers and research institutions
- Government chooses which research gets funded: Well-connected institutions can benefit from politically influenced research funding.
- People with ongoing or specialist care needs
- Slower access to new drugs and technology: Strict value assessment can delay or refuse new therapies.
- Drug and device makers
- Slower access to new drugs and technology: Lower prices reduce research returns for biotech workers and investors.
Where it has been tried
- NIH, ARPA-H: Peer review plus a high-risk agency.
- United States: To fund high-risk, high-reward health technologies beyond traditional peer review, the U.S. established ARPA-H modeled after DARPA, launching with a $1 billion three-year congressional appropriation (2022).