Panel proposes changes for national institutes of health

WASHINGTON — A committee authorized by Congress to examine the structure of the National Institutes of Health came out on Tuesday against any wholesale merging of its many branches but suggested making the agency’s director more powerful and re-examining the "special status" of the National Cancer Institute, which now operates semiautonomously.

The committee suggested creating a pool of research money that the director of the health institutes could use to cut across disciplinary lines to push "risky but highly innovative projects." It called for setting aside 5 percent of the National Institutes of Health budget for research into subjects that cross the lines that divide the different institutes, like obesity.

The agency has grown to include 27 institutes and centers. Harold T. Shapiro, a Princeton University professor of economics and public affairs, who was the chairman of the committee, said there were concerns that its sprawling structure "had either fragmented the agency or made it too unwieldy to effectively address the research challenges now emerging on the biomedical frontier."

In particular, the 20-member committee urged the re-examination of the National Cancer Institute. In the National Cancer Act, Congress stipulated that the institute’s director be appointed by the president and allowed for its budget to be set independently.

"It is possible that an unnecessary rift may be created between the goals and leadership" of the cancer institute and the NIH as a whole, Shapiro said in a briefing on the report, which the committee worked on for a year.

Congress set up the study through the National Academy of Sciences, an independent agency that Congress chartered to advise the federal government on scientific matters.

The National Cancer Institute budget represents about 17 percent of the overall NIH budget — $23.6 billion for the fiscal year 2002 — which means, Shapiro said, that "there is one-fifth of the organization that does not have to pay attention to the rest."

John R. Seffrin, chief executive of the American Cancer Society, said his organization would be "very reluctant to see any diminution of the National Cancer Institute."

"We are at a critical juncture where we are poised to see new discoveries," Seffrin said, adding that most of the institute’s research was "basic scientific research that doesn’t mean it only addresses cancer; it may yield benefits in other areas or diseases."

To help the National Institutes of Health be faster on its feet in responding to new research opportunities, the committee recommended setting aside $100 million a year for "risky, cutting-edge research that offers high potential payoff for society in terms of cures or improved medical treatment." That amount should rise eventually to $1 billion annually, Shapiro said.

Sen. Bill Frist, R-Tenn., who is the majority leader and a heart surgeon, said he supported the panel’s recommendation for money directed into what he called "high-risk, high-reward projects."

But the committee also said it would recommend a six-year term for the NIH director and five-year terms for the other heads of institutes and centers.

The committee recommended consolidating the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.

It also recommended combining the National Human Genome Research Institute, which has completed its main task, with the National Institute of General Medical Sciences, which finances basic biomedical research. Congress would have to approve the creation, or the elimination, of an institute.

But the committee said it did not find that "wholesale consolidation is called for at this time because the costs — a lengthy, uncertain process and loss of support from many key constituencies — outweigh any benefits likely to be achieved."