The National Institutes of Health (NIH) claims its research will improve Americans’ health and longevity. That worthy objective and an occasional scientific breakthrough have worked to insulate NIH from budgetary scrutiny. Based on the record through the year 2024, NIH spending has not only been wasted, but it has also harmed progress toward improved health. Beginning in 1960, the annual increase in NIH spending started rising five times more per year in inflation-adjusted dollars than previously. At the same time, the rate of improvement in longevity dropped suddenly by more than half. These perverse results arise from strategic failures by NIH. It has abandoned mission research focused on specific health outcomes in favor of a linear model that spends on “basic” research, a model that has been shown to fail in government agencies and was discarded long ago by successful research efforts in the private sector. Detailed analysis of NIH projects shows substantial funding is spent on projects that clearly have no relationship to improving health and violate basic scientific methods and standards of proof.