National Institutes of Health

Based on Wikipedia: National Institutes of Health

Every single drug approved by the United States Food and Drug Administration between 2010 and 2016 owes something to research funded by a single government agency. Not some drugs. Not most drugs. Every drug. That agency is the National Institutes of Health, and if you've ever taken a medication, received a vaccine, or benefited from modern medicine in any way, you've been touched by its work.

The National Institutes of Health, commonly known by its initials N-I-H, is not one institute but twenty-seven. It's not just an American institution but the largest biomedical research organization on the planet. And at roughly fifty billion dollars in annual activities, it represents one of the most significant investments any nation has ever made in understanding human health.

Yet most people have never heard of it.

From Marine Hospitals to Medical Behemoth

The story begins, surprisingly, with sailors. In the late 1800s, the United States operated a network of Marine Hospitals to care for merchant seamen. These hospitals eventually expanded beyond just treating sick sailors to investigating why they got sick in the first place. In 1887, a small laboratory was established on Staten Island, New York, dedicated to studying bacteria. They called it the Hygienic Laboratory.

The name sounds quaint today, almost comically Victorian. But this modest facility would grow into something extraordinary.

The laboratory bounced around Washington for years, eventually landing at the site of the Old Naval Observatory. By 1930, Congress passed the Ransdell Act, which gave the renamed National Institute of Health—singular, at that point—three quarters of a million dollars to construct proper facilities. In 1938, the institute made its final move to Bethesda, Maryland, where it remains today.

The shift from singular "Institute" to plural "Institutes" happened in 1948, reflecting a new reality. As Congress poured more money into biomedical research, specialized institutes sprouted like mushrooms after rain. The National Cancer Institute came first. Then institutes dedicated to heart disease, aging, mental health, infectious diseases, and eventually two dozen more.

How the Money Flows

Understanding the N-I-H requires understanding two fundamentally different ways it operates.

The first is called intramural research—"intramural" meaning "within the walls." About ten percent of N-I-H funding goes to scientists who work directly for the agency, primarily at the sprawling Bethesda campus and satellite facilities scattered across the country. As of 2013, this included over twelve hundred principal investigators and four thousand postdoctoral fellows. When researchers discover something in an N-I-H lab, they're government employees making that discovery.

But the intramural program, despite being the largest such research operation in the world, represents only a fraction of what the N-I-H does.

The vast majority of money—more than eighty percent—flows outward through the extramural program. This is research grant funding, the lifeblood of university medical research across America. By 2003, the extramural arm was providing twenty-eight percent of all biomedical research funding spent annually in the United States, approximately twenty-six billion dollars.

Think about that proportion. When you read about a medical breakthrough from Harvard or Stanford or the University of Michigan, there's a better than one-in-four chance the N-I-H helped pay for it.

As of 2018, the agency was awarding approximately forty-seven thousand grants per year to about twenty-seven hundred different organizations. These aren't just universities—small businesses must receive a certain percentage under laws designed to foster innovation. The ripple effects extend throughout the economy. One study estimated that every ten million dollars invested in N-I-H research generated two to three new patents.

The Discoveries That Changed Everything

Lists of accomplishments can feel dry, but some discoveries are worth lingering over because they reveal how fundamental this research has been.

In 1908, a researcher named George McCoy figured out that rodents were reservoirs for bubonic plague—the Black Death that had killed perhaps a third of Europe's population centuries earlier. Knowing where diseases hide is the first step toward controlling them.

In 1924, researchers developed a vaccine against Rocky Mountain spotted fever, a tick-borne illness that had terrified inhabitants of the American West. The name "Rocky Mountain" is somewhat misleading, by the way—you can catch this disease in almost any state, and it remains potentially fatal even today without prompt treatment.

The 1940s and 1950s brought breakthroughs in cell culture, the technique of growing human cells in laboratory dishes. This might sound mundane, but it revolutionized medical research. Before cell culture, scientists had to experiment on whole animals or wait for human volunteers. After cell culture, they could test theories on human cells directly, speeding research enormously.

One discovery from this era deserves special mention. Julius Axelrod identified a previously unknown class of enzymes called cytochrome P450 monooxygenases. If you've never heard of them, that's understandable—the name is a mouthful. But these enzymes are fundamental to how your body processes medications. When your doctor asks if a drug might interact with something else you're taking, cytochrome P450 enzymes are often the reason for concern. Axelrod's discovery eventually earned him the Nobel Prize.

The 1960s produced the first effective treatment for Hodgkin's lymphoma, a cancer of the lymphatic system. Before this breakthrough, the diagnosis was essentially a death sentence. The treatment combined multiple drugs in specific sequences—an approach called combination chemotherapy that would become the standard for treating many cancers.

That same decade, N-I-H researchers made an unsettling discovery: tooth decay is caused by bacteria. We take this for granted now, but for most of human history, people assumed cavities were simply the price of having teeth. Understanding the bacterial cause opened the door to prevention, including the N-I-H's earlier discovery that fluoride could prevent tooth decay—a finding that led to fluoridated water and toothpaste.

The Dark Chapter

Not all N-I-H history reflects well on the agency.

In the 1960s, a cancer researcher named Chester Southam conducted experiments at the Jewish Chronic Disease Hospital in Brooklyn. He injected live cancer cells—specifically HeLa cells, the famous immortal cell line derived from Henrietta Lacks—into patients without their knowledge or consent. He wanted to see if healthy immune systems would reject cancer cells differently than sick ones.

Three doctors at the hospital refused to participate and resigned in protest. Their resignations attracted media attention, and investigators discovered something troubling: the N-I-H had been a major funder of Southam's work.

When the agency examined all the institutions receiving its grants, it found that the majority did not adequately protect human subjects. This scandal, combined with other abuses from the era including the notorious Tuskegee syphilis study, led to sweeping reforms. The N-I-H began requiring institutional review boards—committees that must approve any research involving human subjects before experiments can proceed.

Today, these review boards are so embedded in research culture that scientists sometimes complain about the paperwork. But they exist because researchers once injected cancer cells into unwitting patients, and the agency that funded that research decided never to let it happen again.

Following the Money Through Politics

N-I-H funding has always been tangled up in politics, serving as what observers call a "proxy for the political currents of the time."

By 1992, the agency controlled more than fifty percent of all health research funding in America and eighty-five percent of health research funding at universities. That kind of money attracts attention.

Government funding for research in most scientific disciplines has increased roughly with inflation since the 1970s. The N-I-H was different. Through the 1990s and early 2000s, its budget nearly tripled. This wasn't inflation adjustment—it was a genuine explosion of investment in biomedical research, driven by political enthusiasm for curing diseases.

Then it stopped. Since the early 2000s, N-I-H funding has remained relatively flat in real terms. When you account for inflation, this stagnation means gradual erosion of purchasing power. Young researchers today compete for grants in an environment far more brutal than their mentors faced.

The politics can shift suddenly. In January 2025, a new administration imposed an immediate freeze on N-I-H activities—halting grant review panels, travel, communications, and hiring. This affected forty-seven billion dollars worth of research activities, sending shockwaves through the scientific community. Scientists with pending grants faced sudden uncertainty. Research projects ground to a halt overnight.

The Organizational Labyrinth

The N-I-H is not a single entity but a constellation of twenty-seven institutes and centers, each with its own focus area and budget.

At the top sits the Office of the Director, responsible for setting agency-wide policy and coordinating programs across institutes. The Director is a presidential appointee who shapes the agency's priorities and serves as its public face.

Below the Director's office, specialized divisions handle everything from AIDS research to women's health to disease prevention. There's a Sexual and Gender Minority Research Office. There's a Tribal Health Research Office. There's an Agency Intramural Research Integrity Officer whose entire job is investigating allegations of research misconduct.

The main campus in Bethesda, Maryland houses most intramural research, but facilities have sprawled across the country. The Bayview Campus in Baltimore hosts research programs on aging, drug abuse, and genomics. The Frederick National Laboratory in Maryland focuses on cancer research. The National Institute of Environmental Health Sciences operates from North Carolina's Research Triangle.

Perhaps most intriguingly, the National Institute of Allergy and Infectious Diseases maintains Rocky Mountain Labs in Hamilton, Montana—a facility emphasizing work with the most dangerous pathogens, those requiring Biosafety Level 3 and 4 containment. BSL-4 is the highest level, reserved for agents with no known treatment or vaccine. Working in such facilities requires the biological equivalent of a space suit.

The Human Genome and Beyond

By the 1990s, the N-I-H had shifted significant attention to genetics, culminating in its involvement with the Human Genome Project—the massive international effort to sequence all human DNA.

This project, completed in 2003, produced a reference map of the approximately three billion chemical letters that encode human heredity. The implications continue to unfold. Personalized medicine, genetic testing, gene therapy—all trace their lineage to this achievement.

Today, the N-I-H maintains the Database of Genotypes and Phenotypes, a repository linking genetic information to observable traits and diseases. Some information is publicly available; individual-level data requires researcher credentials. The database has proven controversial, with the agency reportedly restricting access to data on politically sensitive attributes like intelligence and educational attainment.

The COVID-19 Test

When the COVID-19 pandemic struck in 2020, the N-I-H faced perhaps its greatest challenge and opportunity.

The agency partnered with Moderna, a biotechnology company, to develop what became one of the first effective vaccines against the virus. The final phase of testing began in July 2020, enrolling up to thirty thousand volunteers split between those receiving the actual vaccine and those receiving saltwater injections as a placebo. Scientists waited until approximately one hundred cases of COVID-19 appeared among participants, then analyzed which group they came from.

The results were striking enough that the vaccine received emergency authorization within months—an unprecedented timeline for vaccine development. The N-I-H contributed nearly four and a half million dollars specifically toward the Accelerating COVID-19 Therapeutic Interventions and Vaccines program, known by its acronym ACTIV.

But the pandemic also brought scrutiny. The N-I-H had funded research by an organization called EcoHealth Alliance, which in turn subcontracted some work to the Wuhan Institute of Virology in China. When speculation arose that the coronavirus might have escaped from that very laboratory, the funding connection became politically explosive.

Between 2014 and 2019, the N-I-H had awarded approximately three point seven million dollars to EcoHealth Alliance. About six hundred thousand dollars of that went to the Wuhan lab for a project studying bat coronaviruses—the very family of viruses that includes SARS-CoV-2. Whether this research had any connection to the pandemic remains debated, but the controversy highlighted how tangled international scientific collaboration had become.

The Return on Investment

Does spending billions on medical research actually pay off?

The evidence suggests yes, spectacularly.

In 2000, the Joint Economic Committee of Congress examined N-I-H research, which was then funded at sixteen billion dollars annually. Econometric studies estimated a return of twenty-five to forty percent per year by reducing the economic cost of illness. That's not a stock market return—that's avoided suffering, disability, and death translated into dollars.

Of the twenty-one drugs with the highest therapeutic impact on society introduced between 1965 and 1992, public funding was "instrumental" for fifteen of them. By 2011, N-I-H-supported research had helped discover one hundred fifty-three new FDA-approved drugs, vaccines, and new uses for existing medications over the previous four decades.

And then there's the finding mentioned at the start: one hundred percent of drugs approved by the FDA between 2010 and 2016 benefited from N-I-H funding, either directly or indirectly. The agency's research helped develop the drugs themselves or identified the biological targets those drugs act upon.

This near-universal contribution reflects how foundational government-funded basic research is to pharmaceutical development. Private companies are good at taking promising compounds through expensive clinical trials and navigating regulatory approval. But the initial discoveries—understanding how diseases work, identifying proteins to target, developing the tools to find new drugs—that's often where public money makes the difference.

Nobel Laureates by the Hundreds

One measure of scientific impact is the Nobel Prize, awarded annually for discoveries of "greatest benefit to humankind."

As of 2017, one hundred fifty-three scientists receiving N-I-H financial support had won Nobel Prizes. Another one hundred ninety-five had won Lasker Awards, often called "America's Nobel" and considered a strong predictor of future Nobel recognition.

These numbers reflect both the scale of N-I-H funding and the quality of research it supports. When the largest funder of biomedical research also supports the most Nobel-winning scientists, that's not coincidence—it's evidence that the money is reaching people who can use it productively.

What the N-I-H Means Today

The National Institutes of Health occupies a peculiar position in American life. Almost everyone benefits from it; almost no one thinks about it.

When you take a medication, you're benefiting from N-I-H research. When you receive a vaccine, there's a good chance N-I-H scientists contributed to its development. When your doctor orders a genetic test or prescribes a cancer treatment, the underlying knowledge likely traces back to grants reviewed in Bethesda.

The agency represents a particular bet—that government investment in understanding biology will pay dividends in health outcomes. The evidence suggests this bet has paid off handsomely. But as funding freezes and political controversies demonstrate, continued support is not guaranteed.

Scientists who receive N-I-H grants often describe the funding as essential but precarious. The grant process is competitive, with success rates sometimes below twenty percent. Researchers spend months writing proposals, defending their ideas before review panels, waiting for decisions that determine whether their work can continue.

From the Hygienic Laboratory on Staten Island to the sprawling Bethesda campus, from rodents carrying plague to messenger RNA vaccines against COVID-19, the N-I-H has spent nearly a century and a half asking questions about human health and occasionally finding answers that change everything.

The next time you swallow a pill or receive a shot, consider the invisible infrastructure that made it possible—the grants reviewed, the experiments conducted, the failures endured, the knowledge accumulated. Somewhere in that long chain of discovery, the National Institutes of Health almost certainly played a part.