In theory, that's where a lot of individual NIH grants are supposed to do - K level and R level grants. However, NIH people tend to have gotten risk adverse so they look to certain parameter to "vet" whoever gets the money amongst all sorts of applications. The idea is one thing, but also - whose lab you're being mentored in, prior funding success, etc etc play an equal if not more important role.
I think the problem then is...if you have some promising directions from preliminary work, to test an idea in clinical trials, it is not cheap. You have to hire a large army of clinicians, nurses, research people, etc etc to manage all the patients/subjects x 10,000 or 50,000. So there has to be at least some politicking to steer where all the research funds go to. And people who are better at "finessing" scientific review boards tend to bubble to the top
Nobody gets a K award on their own merits. Unless your mentoring committee is well funded and walking lockstep with conventional wisdom, your application is dead in the water.
That's the sad part. Albeit one of my colleagues I know (immensely talented in his own right) is also extremely good is sniffing out who's on the NIH study section reviewing his grants, and networking with them after hours...
Study section rosters are published information. Membership is set for a period of years. Interfering with members is expressly forbidden, though no doubt it happens.
I think the problem then is...if you have some promising directions from preliminary work, to test an idea in clinical trials, it is not cheap. You have to hire a large army of clinicians, nurses, research people, etc etc to manage all the patients/subjects x 10,000 or 50,000. So there has to be at least some politicking to steer where all the research funds go to. And people who are better at "finessing" scientific review boards tend to bubble to the top