NEWS

Committee Recommends Against Complete NIH Reorganization

Charles Marwick

As the premier supporter of the funding of biomedical research and training, the National Institutes of Health is a successful enterprise that makes a useful response to the demands made upon it. But if it is to meet coming challenges, some organizational changes are needed to enable the NIH as an whole to respond effectively, concludes a new report from the National Research Council and the Institute of Medicine.

At the same time, the report stated, there is no need to consolidate or reduce the number of the present 27 separate institutes and centers, a step that already had been proposed.

Congress asked the NRC and IOM to examine "whether the current structure and organization of NIH is optimally configured for the scientific needs of the 21st century." A 21-member committee, chaired by Harold T. Shapiro, Ph.D., an economist and president emeritus at Princeton University, Princeton, N.J., drafted the final report.

Among the 14 recommendations the committee made are the following:

· The NIH director should have the authority to hire and fire institute directors. At present, this is in the hands of the Secretary of Health and Human Services.

· The NIH director needs an enhanced ability to fund, develop, and carry out highly innovative special projects that would support promising research involving high-risk but high-potential payoffs—an attempt to deal with a peer review system that tends to fund only projects that seem likely to succeed.

· The NIH director should be limited to a 6-year term, with an option to renew one time for a further 6 years. Likewise, individual institute directors should be appointed for 5 years, again with an option to renew one time for a second 5-year term.

· Congress should charge NIH with developing an enhanced ability to develop strategic research initiatives that would cut across many, if not all, of the disease-oriented institutes—a move bound to be controversial with institute directors who may be protective of their turf.

· A call for more emphasis on clinical research by forming a National Center for Clinical Research and Research Resources, in effect an expansion of the existing National Center for Research Resources.

· Finally, in a step that has already sparked considerable controversy (see story below), the committee recommended a re-examination of the present status of the National Cancer Institute. The NCI director is a presidential appointee and this, along with the fact that NCI’s budget is not under the control of the NIH director, is a situation not conducive to good management, said Shapiro. The NCI’s budget constitutes about 17% of the overall NIH budget.

In its report, the committee made an effort to deal with the point that, with the sheer number of institutes and other units being formed in recent years, NIH is becoming unmanageable, an argument also put forth by former NIH director Harold Varmus, M.D., now the president of Memorial Sloan-Kettering Cancer Center in New York.

Consolidating or eliminating NIH institutes would be a lengthy, uncertain process and would outweigh any likely benefits, Shapiro said. "We thought that the benefits and goals advocated by the proponents of a major consolidation could be achieved more quickly and effectively through organizational changes other than restructuring." But, he added: "We do not expect NIH’s organizational structure to remain frozen. Business as usual is no longer appropriate at NIH." Indeed, the committee recommended combining two institutes: The National Institute of Drug Abuse and the National Institute of Alcohol Abuse and Alcoholism.

Shapiro pointed out that with the pace of scientific discovery, some institutes and centers will become more relevant than others, and he recommended that a formal process be established for reviewing whether centers should be added, eliminated, or combined. He pointed out that Congress would still need to authorize any changes in the number of institutes, but the NIH director could start the process.

Currently, there are moves by the Department of Health and Human Services to centralize administrative and management functions at NIH, such as budgeting, finance, and procurement. The committee was critical of these moves as possibly decreasing the effectiveness of NIH and recommended that they be considered only after careful study. "A studied and structural approach should be used to assure that centralization would not undermine NIH’s ability to identify, fund, and manage the best research and training proposals and programs," the committee wrote in its report, which is available at http://www.nationalacademies.org.

NIH considers the report a starting point for self-analysis, said Raynard S. Kington, M.D., Ph.D., deputy director of NIH. "We see this report as the beginning of a process that will allow us to take a look at the broad array of recommendations," he said. "It’s appropriate for an organization like ours, which has increased in size and complexity in recent years, that we take a look at how we do things."



             
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