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Report recommends major changes at the NIH

NAS panel suggests organizational modifications to improve NIH efficiency

By | July 30, 2003

The National Research Council and the Institute of Medicine of the National Academies of Science (NAS) on Tuesday (July 29) recommended that the National Institutes of Health (NIH) make major, comprehensive organizational changes. The culmination of a year of discussion and study, their report titled, "Enhancing the Vitality of the National Institutes of Health: Organizational Change to Meet New Challenges," was drafted at the request of Congress amid concerns that the growing size of the NIH has made the organization too unwieldy to address new biomedical research challenges.

The NAS committee chose not to recommend a large-scale consolidation of institutes and centers in order to improve NIH's efficiency. "We think that the basic structure of the NIH is not unreasonable," committee Chair Harold Shapiro told The Scientist. Shapiro, a professor of economics and public affairs at Princeton University, told attendees at a briefing in Washington, D.C., Tuesday that the costs of consolidation, including possible loss of support from key constituencies, outweigh the benefits.

Rather than wholesale consolidation, the committee suggested that all institutes and centers be required to devote a certain percentage of their budgets—5% the first year, growing to 10% or more within 4 or 5 years—toward trans-NIH research.

However, the committee did suggest that Congress and NIH advisory committees review the ideas of merging the National Institute on Drug Abuse (NIDA) with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and of merging the National Institute of General Medical Sciences with the National Human Genome Research Institute (NHGRI). "Nothing should be locked in stone forever," committee member Alan Leshner told The Scientist.

Leshner, chief executive officer of the American Association for the Advancement of Science and former director of NIDA, added that merging institutes was certainly feasible and would encourage "better synergies," for example, in the case of NIDA and NIAAA, by combining efforts focused on compulsive and addictive behaviors.

NHGRI Director Francis Collins could not be reached for comment, but said in a prepared statement, "the idea of merging some of the current institutes was one of the inspirations for convening this distinguished group, so it is not surprising that they considered this quite seriously. As the committee states, such mergers will require a period of thoughtful public discussion before implementation."

The NAS committee also recommended that several intramural and extramural clinical research programs be combined into a new entity called the National Center for Clinical Research and Research Resources.

In order to encourage the funding of "risky, cutting-edge" research, the committee also called for the establishment of a "special projects" program along the lines of the US military's Defense Advanced Research Projects Agency. Shapiro said that such a program might still include peer review but would do so with a "different charge" in mind. The committee suggested that the program be funded with new money provided by Congress: $100 million in the first year, growing to as much as $1 billion per year.

The length of terms served by the NIH director and heads of institute and centers also deserves a second look, according to the NAS committee. They suggested that the NIH director serve a 6-year term unless removed sooner by the president. This, said Shapiro, would allow the director to "transcend changes in administration." The committee recommended that directors of institutes and centers be appointed to 5-year terms with the option to serve a second and final 5-year term. Shapiro told hearing attendees that this was, in part, a response to the perception that the appointment of directors had become "politicized," and that this is a "growing problem," though he had no concrete evidence that that was the case.

The committee also reviewed the special status of the National Cancer Institute, whose director is appointed by the president and whose budget is determined by Congress, separately from the other institutes and centers. "This strikes us as an anomaly," said Shapiro, adding that this special treatment is a problem if the NIH is to determine and demonstrate its intent to be one entity.

Shapiro and the panel also expressed concern regarding the "One HHS" initiative, a project that would consolidate, streamline, and standardize administrative programs throughout the Department of Health and Human Services (HHS). The panel advised that any attempts to centralize or outsource things like personnel recruitment and aspects of grant management should be carefully reviewed to "determine how it may affect NIH's special mission of scientific and medical discovery," said Shapiro.

The NAS report comes a day after the NIH announced the formation of a new steering committee, composed of a rotating group of institute and center directors, that will consider NIH's direction and trans-NIH initiatives.

"We've had tremendous growth in size and complexity of the organization over the last several years," NIH Deputy Director Raynard Kington told The Scientist. "And that has made it more apparent that we need to develop a transparent and more effective and efficient mechanism for making trans-NIH a policy and decision-making." Kington, who pointed out that the new NIH steering committee had been contemplated for several years prior to Congress's requesting an evaluation from the NAS, said the committee will provide a forum for considering many of the recommendations in the NAS report.

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