The most effective government role in innovation is to act as a catalyst for high-risk, foundational R&D (like DARPA creating the internet). Once a technology is viable, the government should step aside to allow private sector competition (like SpaceX) to drive down costs and accelerate progress.

The 'safety first' mandate in drug development is flexible. For cancers like leukemia with high cure rates, highly aggressive therapies with severe side effects are deemed acceptable. The risk-benefit calculation shifts dramatically when a cure, not just management, is the goal.

The Orphan Drug Act successfully incentivized R&D for rare diseases. A similar policy framework is needed for common, age-related diseases. Despite their massive potential markets, these indications suffer from extremely high failure rates and costs. A new incentive structure could de-risk development and align commercial goals with the enormous societal need for longevity.

CZI set an audacious goal to cure all disease. When scientists deemed it impossible, CZI's follow-up question, "Why not?" revealed the true bottleneck wasn't funding individual projects, but a systemic lack of shared tools, which then became their core focus.

A medically-proven hangover cure doesn't exist mainly because the economics are unviable. The high cost of clinical trials, potentially hundreds of millions of dollars, is prohibitive for a product that would likely be low-margin and based on non-patentable ingredients, offering no clear path to profitability.

Renowned gene therapy pioneer Jim Wilson was forced to spin out ultra-rare disease programs into a new company after his initial venture failed to attract VC funding. This demonstrates that even elite scientific leadership cannot overcome investor disinterest in this segment without powerful, predictable government incentives like transferable priority review vouchers.

The fastest, cheapest path to drug approval involves showing a small survival benefit in terminally ill patients. This economic reality disincentivizes the longer, more complex trials required for early-stage treatments that could offer a cure.

Developing an antibiotic is costly, but its use is short-term and new drugs are held in reserve, making them unprofitable. This market failure, not a lack of scientific capability, has caused pharmaceutical companies to exit the space, creating a worsening global health crisis.

Diseases like Ebola and malaria, which primarily affect poor countries, lack market incentives for vaccine R&D. The Ebola vaccine only progressed because it was briefly on a U.S. bioterrorism list created after 9/11, highlighting how market failures require creative, sometimes accidental, incentives to overcome.