From President Biden’s address to Congress in April:
The National Institute of Health — the NIH –- I believe, should create a similar Advanced Research Projects Agency for Health. (Applause.)
And that would — here’s what it would do. It would have a singular purpose: to develop breakthroughs to prevent, detect, and treat diseases like Alzheimer’s, diabetes, and cancer.
This ARPA-H would aim to create the kinds of high-risk, high-reward breakthroughs that have made DARPA itself the most influential agency most people have never heard of since 1958. If successful, it could transform healthcare, advancing science and technology by decades in mere years.
But can it work? I think so, if policymakers and administrators avoid two critical pitfalls.
DARPA’s Outsize Influence
Yesterday I drove home with the help of a hand-held GPS device made possible by DARPA. Today I’m posting these words on a computer network that started as a DARPA project. This year, I’ll buy a car that can drive itself thanks to a series of DARPA-sponsored competitions.
DARPA has made such an outsize impact (at $3.5b, about 1/6 of NASA’s annual budget) because of its single-minded focus on solving tough, well-defined technological challenges on deadline — and leaving operational applications to others.
DARPA’s mission is crystal-clear. As explained to me by then-DARPA director Tony Tether when I interviewed him for my book, The Department of Mad Scientists, it is to both prevent and create technological surprise.
The Eisenhower administration created DARPA in response to the Soviet Union’s launch of the world’s first artificial satellite, Sputnik. Sputnik caught the US by surprise. Eisenhower wanted to prevent that kind of surprise from happening again. And he wanted the agency to create a few surprises of its own.
ARPA-H for Medical Breakthroughs
From what the White House has released regarding a potential ARPA-H, it seems to me that a similar approach could work for healthcare as well.
With an initial focus on cancer and other diseases such as diabetes and Alzheimer’s, this major investment in federal research and development will drive transformational innovation in health research and speed application and implementation of health breakthroughs.
The requested budget of $6.5b would be nearly twice DARPA’s.
So far, so good. But only if the agency avoids a couple of potential pitfalls.
Potential Pitfalls for ARPA-H Success
First, it remains to be seen if the new agency gets enough funding to reach its full potential. By comparison, a similarly DARPA-inspired agency for energy, ARPA-E, has been chronically underfunded at no more than $400m a year.
But money alone does not make for DARPA success. It also takes a laser-sharp focus on a clear, easy-to-articulate mission. Words matter here, as does the intention behind them.
From DARPA’s website:
For more than fifty years, DARPA has held to a singular and enduring mission: to make pivotal investments in breakthrough technologies for national security.
Two key words: “technologies” and “national security.”
According to Tether, DARPA lost its way during the Clinton administration when it attempted to serve more than the military mission. Today, it’s back to its roots, and all of its programs have potential military application.
It’s also not trying to do anything else but to, in Tether’s words, “take the technology excuse off the table” for realizing a given breakthrough.
DARPA’s Focus on Breakthroughs Rather than Applications
DARPA doesn’t commercialize products, manage them after demonstrating they’re possible, or even run the laboratories, test tracks, or launch pads that birth them. DARPA’s program managers and “performers” demonstrate a breakthrough and move on, staying fast and nimble.
In contrast is a June paper in Science proposing a much broader focus for ARPA-H.
Building on DARPA’s mission statement, an initial mission could be: “To make pivotal investments in breakthrough technologies and broadly applicable platforms, capabilities, resources, and solutions that have the potential to transform important areas of medicine and health for the benefit of all patients and that cannot readily be accomplished through traditional research or commercial activity.”
Note the addition of “broadly applicable platforms, capabilities, resources, and solutions.” The paper’s authors argue that “ARPA-H’s focus should be broad—ranging from molecular to societal—because breakthrough technologies are needed and are possible at many levels.”
I don’t argue about the need. Inequities in healthcare kill people, and that’s a societal, not a medical problem.
But DARPA succeeds — and on a shoestring relative to other Pentagon offices — because it doesn’t dilute its focus by trying to mass-produce and distribute the technologies its programs create. Those tough problems are for others to tackle — just as they should be for ARPA-H if it is to achieve anything like the success of DARPA.
Read more about DARPA and how it works in my book The Department of Mad Scientists: How DARPA is Remaking Our World, from the Internet to Artificial Limbs.