IOM: NIH needs big strategy, not fewer institutes. (Perspectives).

Publication: Medicine & Health

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An Institute of Medicine panel tells Congress that lawmakers shouldn't worry much about the recent proliferation of new organizations within the National Institutes of Health. Policymakers should concentrate on helping NIH administer its research portfolio; engage in more big-picture thinking and high-risk; big-payoff projects, and maintain independence from politicized and single-constituency influences.

No question: NIH has sprouted plenty of new organizational buds over the past decade. In the midst of all this activity, senators questioned--in a fiscal year 2001 appropriations report--whether "the proliferation" of entities raises "concerns about coordination" in the 21st century world of science.

The answer, released in a new report from an IOM panel, is twofold: On a procedural note, conversations with interested parties suggest that the process of achieving even a modicum of consensus on how to reorganize could take approximately forever.

More substantively, the report finds that "the vitality of NIH is only modestly dependent on its formal administrative and organizational structure." There is "no compelling argument for major structural alterations at this time."

While that may sound like unadulterated good news, it isn't. Many factors imperil NIH's ability to do its best work, panel members said at a July 29 briefing. But what might look to be a quick and easy change of structure isn't the fix. Instead, NIH, with Congress' authorization, must change its way of doing things, not its organizational chart, and that, too, could be a very tough job.

* A little bit, not a lot, of consolidation recommended. The committee does list a handful of organizational changes under the heading "opportunities for mergers," adding that "undoubtedly" others "might be studied."

Periodically, lawmakers have questioned the...

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