WESTPORT, CT (Reuters Health) Mar 08 - The US National Institutes of Health (NIH) has too many institutes, which threatens its ability to function effectively, says former NIH director Dr. Harold Varmus.
In an editorial published in the March 9th issue of Science, Dr. Varmus, now the president of the Memorial Sloan Kettering Cancer Center, in New York, points out that many call the NIH the crown jewel of the federal government.
"But considerably less attention has been given to its shape than its price," he argues. "New facets are being added without much thought to overall design, providing a superficial sparkle that may be pleasing to the few, but threatening to the functional integrity of the entire gem."
The new National Institute for Biomedical Imaging and Bioengineering is the latest example, Dr. Varmus says. He comments that its creation was prompted by the lobbying of a few bioengineers and radiologists, approved by Congress without hearings or public debate, and signed into law by President Clinton "without appreciable objection or fanfare." Dr. Varmus wonders how well NIBIB will collaborate with the disease-specific NIH institutes — and how support for NIBIB will affect the budgets of the other institutes.
"Having more institutes also means less flexibility, less managerial capacity, and more administrative burden," he notes.
The solution is to restructure the NIH into six units, each about the same size with about the same budget, Dr. Varmus says. Five units would be dedicated to groups of diseases: the National Cancer Institute, the National Brain Institute, the National Institute for Internal Medicine Research, the National Institute for Human Development, and the National Institute for Microbial and Environmental Medicine.
The sixth unit, NIH Central, would be headed by the director of NIH and would be, among other things, responsible for all policies across NIH, peer review and scientific infrastructure, and "thematic coordination."
This suggestion is only one of many possible solutions, Dr. Varmus acknowledges. His emphasis is the need "to establish some general principles by which the NIH should be organized, and attempt to use those principles to decide how it can, in practice, be reorganized even if reorganization occurs in slow stages."
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