Congress is looking to an old idea to spur new innovation in healthcare.
As part of the 21st Century Cures Act, Congress may establish the Eureka Prizes Competitions: Retrospective monetary rewards for achieving specific, well-defined technological goals. This idea reverses the usual path to government support for research and development: Prospective grants where federal agencies fund specific researchers in hopes that the money will spur discoveries.
The idea of prizes in lieu of grants reflects several notions.
First, 21st century medicine is an age of discovery whose eventual paths and endpoints are as unknowable as the globe was to Columbus and others during the original Age of Discovery (the 15th-18th centuries). Second, great discoveries often come from unknown people in unexpected places. And third, government funding of science and technology is here to stay, regardless of one's views on the proper role of the state.
Eureka Prizes would resemble the privately funded X Prizes, which offer millions of dollars for specific technological achievements. In 2004, the $10 million Ansari X Prize went to the first private company to fly a three-passenger vehicle 100 kilometers into space twice in two weeks. Currently, the Tricorder X Prize is available to anyone who develops a mobile device that can "diagnose patients better than or equal to a panel of board-certified physicians."
The Eureka Prizes hark back to the most celebrated such prize of all time, the Longitude Act of 1714. At that time, no method existed for ships to determine their east-west longitude, a failing whose cost was many ships and thousands of lives. The British Parliament offered ¢20,000 (roughly $2.5 million in 2016 dollars) for inventions and discoveries leading to a method for ascertaining longitude within half a degree.
In the frenzied race that ensued, the Act established the Board of Longitude, which bestowed smaller awards to contestants whose discoveries would contribute to, but not achieve, the contest's stated goal. Eventually, John Harrison, a self-educated carpenter and clockmaker, won the bulk of the prize money for inventing the marine chronometer, a device that finally solved the problem.
The Eureka Prizes now proposed in Congress grew from earlier prize competition proposals by Rep. Todd Young, R-Ind., Rep. Andy Harris, R-Md., Sen. Roger Wicker, R-Miss., and Sen. Tom Udall, D-N.M., just to name a few. The legislation would empower the National Institutes of Health to create retrospective prizes in biomedical research.
The Eureka Prizes suggest a step toward modesty concerning the relationship between government, science and technology. In 2014, I told an academic conference on technological innovation of my concerns over the ability of governments to anoint discoverers before the fact. My explanation went something like this:
"Not to denigrate myself, but the problem with the grants process is that I am exactly the sort of person whom the government hires to review proposals. I have a Ph.D. and some other degrees. I know a fair amount about technology and the process of innovation.
But I have never started a company, met a payroll, or gambled my life's savings on a dream. I've never invented anything or struggled through the patent and marketing processes. I place great value on my leisure time. I'm risk-averse, preferring precisely two equal-sized paychecks per month. In short, I have very little in common with the people whose grant proposals I would judge and no visceral comprehension of the process they endure en route to discovery."
Before these comments, I told the audience of three inventors: A puppet-maker who invented the 3D-printed prosthetic hand; the actress Hedy Lamarr, who developed a system for ending Nazi jamming of American radio-controlled torpedoes; and my own childhood doctor, who performed the world's first cord-blood transplants on cancer patients in an obscure small-town hospital. None of these people, I noted, could ever have won a federal grants competition.
The Eureka Prizes, in contrast, could well go to puppet-makers, clockmakers, actresses, teenage computer jocks, country doctors, and garage tinkerers of all manner. If the prizes come to pass, the results will be fascinating to watch.