For years, critics have argued that the U.S. National Institutes of Health favors clinical research over fundamental science. A new analysis of more than 2.2 million grant applications suggests they may be right—and indicates that the shift has been driven less by an increase in clinician-scientists pursuing research than by administrative decisions at the agency.
The comprehensive study, spanning fiscal years 1986 through 2017, shows that while support for curiosity-driven research through the traditional R01 grant remains prominent, NIH has increasingly channeled funding through alternative types of grant mechanisms. Although many of the new mechanisms theoretically support the entire spectrum of biomedical research, in practice, awarded applications have increasingly pursued translational and clinical science.
Key Findings
The research team, led by Woodley Park Institute founder and former NIH program official Dr. Kristine Willis, found that:
• Funding opportunities expanded dramatically: Non-R01 funding announcements increased more than twenty-fold between 1986 and 2017, while R01-based opportunities plateaued in 1995.
• Applications followed suit: Scientists responded strongly to these new opportunities, with applications for certain mechanisms like the R21 increasing over 150-fold during the study period.
• Research outputs became more clinical: Publications acknowledging NIH support showed increasing clinical orientation, as measured by analysis of terminology and article classifications, with solicited non-R01 grants driving this trend.
• Physician workforce remained stable: Despite the shift in research outputs, the percentage of NIH-funded investigators with medical degrees stayed relatively constant throughout this period, hovering around the thirty-year mean value.
Implications for Biomedical Research
The findings suggest that funding structures themselves play a powerful and underappreciated role in shaping the direction of scientific inquiry. Rather than reflecting growth in the pool of clinician-scientists pursuing laboratory work, the gradual but significant shift toward clinical research appears to be an expression of agency priorities.
Questions for Future Study
The authors emphasize that while their analysis identifies clear portfolio-wide trends, it raises important questions about the optimal balance between fundamental and clinical research. They call for continued monitoring of funding trends and additional analyses to determine whether different funding structures are more effective at delivering biomedical advances.
Read the paper:
A thirty-year trend of increasing clinical orientation at the National Institutes of Health bioRxiv, December 2025
https://www.biorxiv.org/content/10.64898/2025.12.16.694423v1