With the visionary language of large federal initiatives like the “Cancer Moonshot” or provocative branding such as “NIH…Turning Discovery into Health®” and the National Institute of Health website further touting “revolutionary ideas often come from unexpected directions,” one might assume an equally ambitious approach is being taken to ensure federal life sciences research is going toward research with the most promise for positive impact and scientific advancement. One of the calls of Vice President Joe Biden’s recent Cancer Moonshot report was urging not to accept a “business as usual” approach. A recent report underscores why that may be a problem at the National Institutes of Health (NIH).