Restructuring NIH

Beyond cutting out waste, it has been obvious for decades that NIH should be reorganized. Institutes are organized according to 19th century notions of disease, and the 27 institutes and centers create duplication and institutional barriers to collaboration.

By themselves, reducing duplication on infrastructure or administration may not be a huge money saver. But reducing duplication in research efforts would be, and getting rid of the research silos could allow much faster propagation of biologic insights from one disease to another that are separated by organ system but united by molecular pathology.

Institutes and centers are created by Congress, often in response to lobbying by patient groups who want more research funding dedicated to their disease. Eliminating or consolidating them has proven much more difficult.

For example, it has taken many years and a Herculean effort to merge the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), two institutes with missions that so obviously overlap that even members of Congress should understand the benefits of combining them.

The task was proposed in a joint report by the National Research Council and the Institute of Medicine in 2003. It likely won't be completed until 2014.

As this pace, it could take two decades to organize NIH according to modern ideas about the molecular basis of disease. Austerity could be the driver that sets the process in motion sooner than later.

- Susan Schaeffer