for the Research of Tomorrow
Over the years, the National Institutes of Health has grown alongside the nation's investment in biomedical research. As it expanded, NIH adapted its research portfolio to advances in science and emerging health concerns, responding in a dynamic fashion to new challenges like mapping the human genome. But with the pace of scientific discovery quickening and its reliance on interdisciplinary collaboration increasing, concerns have been raised that NIH's decentralized structure may no longer be able to adapt adequately.
NIH's current configuration of 27 different institutes and centers makes it very difficult for the agency to marshal resources to confront strategic, crosscutting issues, says a new report from the National Research Council and Institute of Medicine. Dramatic changes in the number of institutes and centers are not the remedy, however. "A wholesale consolidation could undermine the social and political coalitions that have been central to NIH's success," said Harold T. Shapiro, chair of the committee that wrote the report, and former president and current professor of economics and public affairs at Princeton University. "But given the changing nature of the scientific enterprise, NIH needs to make major organizational changes that give it the ability to respond as a whole. "
In particular, the report says NIH needs a new mechanism for mobilizing resources to address immediate strategic objectives that are of interest to multiple institutes but cannot be pursued efficiently by any one. Each institute and center should commit 5 percent, and eventually as much as 10 percent, of its budget to its participation in "trans-NIH" research that results from strategic planning. The committee cited fields such as obesity and proteomics -- the study of how proteins change, perhaps triggering a disease, when genes are turned on and off -- as good examples of research that could fall under the new trans-NIH initiative.
The committee also suggested that the NIH research portfolio has become too risk averse. Noting that highly innovative, "risky" research is not being adequately funded through the traditional peer-review grant process, the committee called for such research to be supported via a new special projects program -- modeled after the Pentagon's Defense Advanced Research Projects Agency. The program should receive a separate budget of $100 million the first year, rising to $1 billion within five.
The trans-NIH research and special projects proposals are among many recommendations aimed at increasing the authority and flexibility of the NIH director. "We think that giving the director greater influence in the development of strategic initiatives will prove more practical than simply combining institutes," Shapiro noted.
Although the report does not call for a major restructuring, it does say that a formal public process should be established to review whether institutes should be added, dropped, or combined with others, and the committee recommended a couple of mergers with which to begin: uniting the drug- and alcohol-abuse institutes, and folding the human genome institute into the general medical sciences institute. Clinical research programs also should be consolidated in an effort to improve collaboration and data sharing, and the special status granted to the National Cancer Institute, which largely runs outside the control of the NIH director, should be re-examined.
The report also suggested a number of changes related to personnel, including up to two six-year terms for the presidentially appointed director and two five-year terms for heads of the institutes and centers. In addition, any effort to consolidate or outsource administrative functions as part of the "One HHS" initiative should be carefully reviewed before being applied to positions inextricably tied to NIH's scientific mission, such as grants-management personnel.
-- Bill Kearney
Enhancing the Vitality of the National Institutes of Health: Organizational Change to Meet New Challenges. Committee on the Organizational Structure of the National Institutes of Health, Board on Life Sciences, Division on Earth and Life Studies; and Board on Health Sciences Policy, Institute of Medicine (2003, approx. 137 pp.; ISBN 0-309-08967-0; available from the National Academies Press, tel. 1-800-624-6242; $31.00 plus $4.50 shipping for single copies).
Harold T. Shapiro, president emeritus and professor of economics and public affairs, Princeton University, Princeton, N.J., chaired the committee. The study was mandated by Congress and funded by the National Institutes of Health.