Michael Crow, president of Arizona State University, has an opinion piece in Nature this week arguing that the NIH needs to be revamped. He points out that the although the NIH budget is 30 billion a year, there have relatively few recent benefits for public health. He argues that the problem is that there is no emphasis on promoting outcomes beyond basic science. Right now the NIH consists of 27 separate institutes (I’m in NIDDK) with little coordination between them and great redundancy in their missions. For an intramural principal investigator such as myself, the walls are invisible when it comes to science and collaborations but very apparent when it comes to regulations and navigating the bureaucracy. Crow uses the obesity pandemic as an example of the NIH’s ineffectiveness in combating a health problem. This point really hits home since the NIH Obesity Research Task Force, which is spread out over 27 NIH components, is largely unaware of the novel work coming out of our group – the Laboratory of Biological Modeling. Crow’s solution is to drastically reorganize the NIH. An excerpt of his article is below.
Nature: What if the NIH were reconfigured to reflect what we know about the drivers of innovation and progress in health care?
“A new NIH should be structured around three institutes.”
This new NIH should be structured around three institutes. A fundamental biomedical systems research institute could focus on the core questions deemed most crucial to understanding human health in all its complexity — from behavioural, biological, physical, environmental and sociological perspectives.
Take, for instance, the ‘obesity pandemic’. In the United States, medical costs related to obesity (currently around $160 billion a year) are projected to double within the decade. And by some estimates, indirect spending associated with obesity by individuals, employers and insurance payers — for example on absenteeism, decreased productivity or short-term disability, exceeds direct medical costs by nearly threefold8. The NIH conducts and supports leading research on numerous factors relevant to obesity, but efforts are fragmented: 27 NIH components are associated with the NIH Obesity Research Task Force, a programme established to speed up progress in obesity research.
Within a systems research institute, scientists could better integrate investigations of drivers as diverse as genetics, psychological forces, sedentary lifestyles and the lack of availability of fresh fruit and vegetables in socioeconomically disadvantaged neighbourhoods.
A second institute should be devoted to research on health outcomes, that is, on measurable improvements to people’s health. This should draw on behavioural sciences, economics, technology, communications and education as well as on fundamental biomedical research. Existing NIH research in areas associated with outcomes could serve as the basis for expanded programmes that operate within a purpose-built organization. If the aim is to reduce national obesity levels — currently around 30% of the US population is obese — to less than 10% or 15% of the population, for example, project leaders would measure progress against that goal rather than according to some scientific milestone such as the discovery of a genetic or microbial driver of obesity.
The third institute, a ‘health transformation’ institute, should develop more sustainable cost models by integrating science, technology, clinical practice, economics and demographics. This is what corporations have to do to be successful in a competitive high-tech world. Rather than be rewarded for maximizing knowledge production, this institute would receive funding based on its success at producing cost-effective public-health improvements.
This kind of tripartite reorganization would limit the inevitable Balkanization that has come from having separate NIH units dedicated to particular diseases. Indeed, such a change would reflect today’s scientific culture, which is moving towards convergence — especially in the life sciences, where collaboration across disciplines is becoming the norm, advances in one field influence research in others, and emerging technologies are frequently relevant across different fields.