roles in support of the NIH mission. While none of the roles or elements of the program is unique, the aggregate—comprising research laboratories, a clinical center, freedom from the competition for grants, a large group of scientists working together on a campus that provides opportunities for collaboration and interchange, a site for research training—creates a distinctive research environment.1 Over the years, the intramural program has made large contributions to basic and clinical research, as well as providing training for some of the nation's most distinguished biomedical scientists. A 1969 review of its purposes and objectives noted its contribution to the overall NIH mission by providing ''comprehensiveness of approach, scientific guidance, prestige and an unequalled opportunity for the development of future leaders.''2 But these purposes and accomplishments do not completely illustrate why it is important for a discipline to be represented in the intramural program. To answer that question, one must look at some of the tangible and intangible elements in the relationship between the intramural and extramural programs, and at some of the notions about the intramural program that prevail among NIH staff.

Despite the fact that the administration of extramural grants is kept at arm' s length from the rest of NIH, there is a widely held belief that the coexistence of the two programs, intramural and extramural, at the same location and under the same overall control is vitally important.3 Some commentators cite the benefit that when intramural scientists are ready to leave the laboratory, a few transfer to the extramural program, bringing their knowledge and experience to grants and contracts administration; others note that some intramural scientists go on to become NIH leaders. According to one NIH extramural staff member, the virtually total absence of OB/GYN from the intramural program creates a sense of isolation and a vacuum where important communication should be occurring.*

Another intangible result of being excluded from the intramural program is the sense, reflected both within and outside of NIH, that the excluded discipline is held in low esteem. Some current and former NIH repre-sentatives, however, dispute the notion that this is the case for OB/GYN They point to an attempt in the early 1970s to establish OB/GYN in the intramural program as aa indication that NIH supports the idea of OB/GYN intramural research.**

*  

 Some research in reproductive endocrinology is conducted in the NIH intramural program, and a little OB/GYN-related laboratory research is conducted by visiting fellows from overseas.

**  

Beds for OB/GYN to collect data on normal pregnancy and delivery, as well as a perinatal unit, were designed and constructed in the Clinical Center at NIH, but the beds were never opened Reasons for the failure to follow through on the plans included a lack of needed 24-hour blood bank and anesthesia services, expected problems in patient recruitment, and difficulty in recruiting



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