An Ungovernable Foe

Winner, 2024 Choice Outstanding Academic Title

In American politics, medical innovation is often considered the domain of the private sector. Yet some of the most significant scientific and health breakthroughs of the past century have emerged from government research institutes. The U.S. National Cancer Institute (NCI) is tasked with both understanding and eradicating cancer—and its researchers have developed a surprising expertise in virus research and vaccine development.

An Ungovernable Foe examines seventy years of federally funded scientific breakthroughs in the laboratories of the NCI to shed new light on how bureaucratic organizations nurture innovation. Natalie B. Aviles analyzes research and policy efforts around the search for a viral cause of leukemia in the 1960s, the discovery of HIV and the development of AIDS drugs in the 1980s, and the invention of the HPV vaccine in the 1990s. She argues that the NCI transformed generations of researchers into innovative public servants who have learned to balance their scientific and bureaucratic missions. These “scientist-bureaucrats” are simultaneously committed to conducting cutting-edge research and stewarding the nation’s investment in cancer research, and as a result they have developed an unparalleled expertise. Aviles demonstrates how the interplay of science, politics, and administration shaped the NCI into a mission-oriented agency that enabled significant breakthroughs in cancer research—and in the process, she shows how organizational cultures indelibly stamp scientific work.