Even as the NIH’s budget soared over the past half-century, much of that growth came at a price: a narrowing of NIH’s scientific imagination. Driven by bureaucratic reforms and the need to demonstrate fiscal responsibility, the agency gradually shifted away from large, community-based, longitudinal studies aimed at understanding what keeps people healthy. Instead, it prioritized smaller, faster studies with statistical significance and quantifiable data, but far less explanatory power about how to stay healthy.
In the late 1950s, the NIH was beginning to expand its mission to address chronic ailments like heart disease and cancer. These growing health threats required a fundamentally different kind of science—slower, more complex, and deeply embedded in communities. Early NIH leaders, such as James Shannon, embraced this challenge with a bold vision: government-led, multi-site observational studies tracking large populations over decades. The Framingham Heart Study, launched in 1948, embodied this approach. It aimed to enroll over 5,000 healthy residents of Framingham, Mass., and follow them for at least 20 years to understand how lifestyle factors and social context shaped long-term health outcomes.
Over the next decade, the NIH became the de facto institution for carrying out this sort of bold population-based investigation into health and disease.
But as the 1960s progressed, this vision for the NIH ran afoul of a growing government-wide push for budgetary control. Reforms like Planning, Programming, Budgeting, and Execution and Zero-Base Budgeting demanded that all federal agencies and initiatives define outcomes in advance and justify expenses with quantifiable projections. Large-scale observational studies—by their very nature, exploratory, slow, and expensive—were easy targets for government watchdogs obsessed with efficiency. For example, the Wooldridge Committee, a task force appointed by President Lyndon B. Johnson's Office of Science and Technology to review the federal research enterprise, sharply criticized the NIH in 1965 for failing to provide adequate oversight of its biggest studies
The committee warned that scientific freedom could no longer excuse a lack of fiscal discipline.
The NIH responded, not by defending the long arc of discovery required for understanding the causes of chronic disease, but by adapting. Researchers were asked to project statistical returns on investment. Studies were re-evaluated not just for scientific merit, but for how likely they were to generate measurable results within a budget cycle.
Framingham, once a flagship of public health research, was deemed too open-ended. By 1970, it had lost its privileged status and instead had to compete for grants like any university-based project.