From 1996 to 1999, the U.S. food and Drug Administration approved 157 new drugs and from 2006 to 2009, one decade later, the agency approved a mere 74. Of those approved in the latter period, none were cures, or even meaningfully effective treatments, for Alzheimer's disease, lung or pancreatic cancer, Parkinson's disease, Huntington's disease, or a host of other afflictions. From 1998 to 2003, the budget of the NIH—which supports critical research at universities and medical centers as well as within its own labs in Bethesda, Md.—doubled, to $27 billion, and is now $31 billion. With so few cures making it through what has been called the valley of death, this article explores the barriers to exploiting fundamental discoveries.

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