Study suggests NIH could benefit from reorganization

The National Institutes of Health, fresh off a five-year doubling of its budget, could benefit from some organizational changes-including giving its director significantly more authority and funding, and merging some of its 27 institutes and centers, according to a study released Tuesday by the Institute of Medicine.

"NIH has never been administratively reorganized in any substantial way, only added on to, despite vast changes in the landscape of science and the nation's health concerns during the last half century," said the report, ordered by Congress as part of the fiscal 2001 Labor-HHS appropriations bill.

Among the IoM's top recommendations is one to create a formal process to consider changes to NIH's organizational structure. That process should be used, said the IoM committee, to consider two mergers-one between the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, whose missions overlap substantially; and another between the National Institute of General Medical Sciences and the National Human Genome Research Institute. The latter institutes both focus on basic research.

The IoM panel, chaired by Harold Shapiro of Princeton University, also suggested several changes in the way NIH is led. It recommends that the NIH director be appointed to a six-year term, with a second six-year term possible, and that he or she be given authority to hire, fire and review annually the individual institute directors, who are currently appointed by the HHS secretary.

The panel recommends that Congress order the NIH director to "lead a trans-NIH planning process to identify major crosscutting issues and their associated research and training opportunities and to generate a small number of major multi-year, but time-limited, research programs." Such trans-NIH research could consume 10 percent or more of NIH's budget within five years.

The committee also recommended that the director be given a "special projects" budget, initially $100 million, but rising to as much as $1 billion "to fund risky cutting-edge research that offers a high potential payoff for society in terms of cures or improved medical treatment."