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Chapter ~
INTRODUCTION
The National Institutes of Health (NIH) has earned a reputation
for excellence in the support ant conduct of research to improve the
health of the American people. It has maintained its leadership
position in the international scientific community even in the face of
considerable changes in its political ant social environment. But
pressure continues to mount for change in the mission and organiza-
tional structure of NIH. The future success of NIH depends on it and
the rest of the Public Health Service adopting a more unified and
coordinated approach to meeting the nation's health research needed
The Mission of NIH
Any study of the organizational structure of the National
Institutes of Health must begin with its mission. The simplest and
most complete statement of that mission can be found in one of its own
publications:
The mission of the National Institutes of Health (NTH) is
to improve the health of the people of the United States by
increasing our understanding of the processes underlying human
health and by acquiring new knowledge to help prevent, detect,
diagnose, and treat disease.
NIH accomplishes this mission by:
supporting research in universities, medical
schools, hospitals, ant research institutions in
this country and abroad;
conducting research in its own laboratories and
clinics;
supporting Braining for promising young researchers;
helping to develop and maintain research resource
-lo;
identifying research findings that can be applied to
the care of patients, and helping to transfer such
advances to the health care system;
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.
promoting effective ways to communicate biomedical
information to scientists, health practitioners, and
the public; and
developing and recommending policies related to ache
conduct and support of biomedical research.!
Efforts by NIH to fulfill this mission have brought it recognition
as an extraordinary national resource. In every recent session of
Congress, however, bills have been introduced to change the
organizational structure of NIH. Proponents of such changes see them
as a way to enhance research in neglected areas. Opponents see them as
administratively costly and scientifically ineffective. They fear that
these changes, combined with funding limitations, could diminish the
agency's flexibility to respond to emerging research opportunities.
The mission of NIH demands that its leaders pursue two principal
objectives: (1) to be responsive to health needs, achieving reductions
in the burden of illness by capitalizing on Scientific opportunities,
and (2) to promote basic Science and maintain Standards of scientific
excellence. Although it sometimes seems that these two objectives are
contradictory rather than complementary, such is not the case. Both
must be pursued with equal vigor, creative leadership, and hard work if
the NIH is to continue its successful record.
The task of this committee, as we see it, is to provide guidance
for the pursuit of these two objectives. This report examines
procedures and institutional patterns to meet these objectives and
recommends criteria to guide the organization's further evolution.
The Organizational Structure of NIH
The genius of the institution in shaping scientific excellence to
health needs is found in the interplay between the categorical research
institutes and the disciplinary Study aectiona. A complete description
and analysis of this structure appear in Appendix B. None of the
research organizations that we have investigated in the United States
or abroad has a more effective structure for mobilizing scientific
research against disease.
"Categorical" refers to the fact that most of the research
institutes at NIH are focused on a category of disease or health
problem and have both clinical and basic research components.
Because of their association with diseases, the institutes provide for
two-way communication with Congress and the public. They enable
Congress to appreciate the accomplishments of the institutes and to
understand and support their further goals. At the same time, the
structure enables Congress to express public concerns and priorities
about the need for research on current health problems. One important
exception to this categorical organizational plan is the National
Institute of General Medical Sciences, which has the vital
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responsibility for supporting basic biomedical sciences, such as
molecular biology and genetics, that do not fit fully into any of the
categorical ins t itutes .
The other part of the organizational plan is a set of disciplinary
study sections , independent from the institutes, that review research
grant applications for scientific merit, as described in Appendix B.
The peer review study sections ensure that the best available
scientific talent and ideas are brought to bear on the problems
identified through the categorical institutes, and that the source of
future scientific resulte--basic research--is continually repl enished .
In many ways, the study sections are the glue that horde the
categorical system together.
In addition, NIH has a strong intramural research program that is
managed by the categorical instituter with effective NIH-wide
coordination ant scientific communication. This program complements
the categorical/disciplinary extramural program of the institutes and
provides attractive opportunities for scientists in basic and applied
research, thus enabling NIH to recruit and retain the best scientists
and scientific managers. NIH also relies on advice from highly
qualified external scientists, especially those on the study sections
and other advisory committees. These scientists and menage re transfo.=
a structure that would appear unwieldy to a management analyst into an
effective means for simultaneously furthering scientific excellence and
being responsive to the needs of society.
This gamut of research notwithstanding, NIH is repeatedly
confronted by those who seek more research results that will have
practical applications. In the past four years alone, there have been
proposals for at least eleven new institutes at NIH, with three of
there proposals introduced as legislation.2 There also have been at
least four legislative proposals to transfer existing agencies into
NIH.3 And Congress continues to consider modifications of the
legislative basis of the NIH mission and authority.
Recommendat ions
In order to preserve ant enhance an effective and appropriate
organizational structure the committee makes recommendations in three
areas. Chapter 2 analyses the effect of major organizational changes
in the past and recommends both a process ant a set of criteria to
guide future changes. Chapter 3 explores the NIH relationship with the
rest of the Department of Health and Human Services and with Congress
and the public, and describes a mechanism to ensure that NIH and the
other agencies of the Public Health Service are making adequate
contributions to the nation's health research effort. Finally, Chapter
4 analyzes the internal organization of NIH, including structures for
dealing with issues that cross institute lines, and suggests a series
of measures to ensure a manageable structure for NIH and its overall
responsiveness to health needs ant scientific opportunities.
Representative terms from entire chapter:
scientific excellence
