Politics. “Administrative questions are not political questions. Although politics sets the tasks for administration, it should not be suffered to manipulate its offices,” wrote Woodrow Wilson in 1887, introducing the idea of the administrative state in the June edition of Political Science Quarterly.
Wilson, the son of a Presbyterian minister, simply could not abide the messy, incoherent federal workforce populated by people whose sole credential was political and financial support of the current occupant of the White House.
President Wilson, along with the original advocate of civil service, President Theodore Roosevelt, would be mighty disappointed if they still haunt the halls of official Washington.
It is their own fault. They never considered the possibility that the bureaucracy would become so influential that over 100 years later it has become difficult to say who is manipulating whom.
Long time Washingtonians accept that the operations of high-profile departments like State, Defense and Treasury must align with the priorities of the president. These departments pull the levers of soft power at home and abroad.
Did Wilson ever consider a time when civil service protection meant a director at the National Institutes of Health could deftly skirt around a 2014 White House prohibition on risky research on viruses? Or that the Food and Drug Administration would eschew the advice of its AdComms – a key tool for (mostly) balancing the interests of the drug industry against that of public health?
Wilson, like Theodore Roosevelt before him and Franklin D. Roosevelt after him, counted on public servants to be government’s version of the household staff.
“Self-government does not consist in having a hand in everything, any more than housekeeping consists necessarily in cooking dinner with one's own hands. The cook must be trusted with a large discretion as to the management of the fires and the ovens ...”
Even with the Gilded Age fading fast, Wilson made no provision for a time when people of his ilk would no longer naturally summon respect based on the intangibles of reputable genealogy, good manners and sterling education.
Those things mostly absent among the political class, America’s bureaucracy joined the cooks of Fifth Avenue and Hyde Park in seeking new masters. They have found them in the pharmaceutical industry, university research departments and cable news outlets.
Wilson’s science of administration has yielded the very thing he hoped to prevent.
Policy. It seems almost inevitable that the National Institutes of Health, the Food and Drug Administration and the Centers for Disease Control will be called upon to explain their behavior these last two years.
It is that inevitability that has given rise to the months-long Twitter war of words. On the one hand, scientists like Richard Elbright at Rutgers have advocated for a full and open inquiry into, not just the origins of the SARS-CoV-2 virus, but the events and activities that created the polarized view of the topic.
On the other hand, Kristian Anderson at Scripps and others have argued against such an effort fearing, in part, regulatory oversight that might put the kibosh on virus research.
The same lines have formed over the safety and efficacy of the COVID-19 vaccines. Eric Topol, also at Scripps, has been a constant supporter of the CDC’s research and policies. Meanwhile Tracey Hoeg at UC Davis and Vinay Prasad at the UCSF have pointed out its shortcomings especially as it relates to cardiac complications.
You might expect such debates via the usual research-publication-peer review cycle instead of Twitter but apparently there is no time for that. There probably isn’t much funding for it either. The National Institutes of Health controls virtually all the medical and scientific funding in the U.S., and they have made it clear no one is to bring them bad news.
Most days it is hard to say anything nice about the cursed website that is Twitter, but SciTwit allows the dissension that was once considered mandatory for the scientific process to find its way to political leaders and policymakers, 140 characters at a time.
Power. The growing dissatisfaction with the Big Science NIH represents is long time in developing, but is now clearly on public display. All the Institutes that make up the agency send billions each year to just a small sub-set of American research universities.
In FY 2021, a third of the $36B in research grants were awarded to 25 universities including Johns Hopkins that perennially reliable bioterror panic machine, Duke and Stanford. Land grant schools also received about a third of NIH funding in FY 2021, but it was split among 203 research centers.
The concentration of NIH grant awards on which many large universities depend for operations, has led to the group think that gave us Aduhelm. Only applications that fit the confirmation biases of grant authorizers make it through the research organizations’ committees. It is a safer passage.
Fortunately, NIH is not science’s only wallet. States are offering alternatives. First New York, and now Tennessee, have established their own mechanisms to facilitate clinical trials through collaboration with hospital systems across the state. Supported in part by state appropriations, these networks are designed to support clinical research at small research departments that would never see an NIH grant.
No threat to NIH but loads of promise for researchers that prefer science over politics.
Emily Evans
Managing Director – Health Policy
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