There can be no doubt that the charge of the NIH is improve human health according to tangible metrics and that the current economic situation in the United States is an opportune moment for belt tightening and critical evaluation of the NIH’s fundamental mission. The “thought experiment” proposed by Michael M. Crow (Time to rethink the NIH. Crow, MM. Nature. 31 March 2011;471:569; link), however, is fundamentally misguided. Crow begins the piece by dismissing out of hand Francis Collins’ proposed new restructuring efforts; it makes for easier editorializing when one need not discuss in real terms the system one is critiquing. Of Crow’s three institutes that would comprise a redesigned NIH, only the first, “Biomedical Systems”, ostensibly concerns itself with discovery, in which Crow suggests that the same institute should examine “genetics, psychological forces, sedentary lifestyles and lack of availability of fresh fruits and vegetables.” A bench scientist is no more qualified to perform ground-breaking research in economic health policy than an economist is to carry out complex basic science experiments, and so it is hard to take this proposal as serious grounds for discussion, even hypothetically. The other two institutes in Crow’s new NIH – “Health Outcomes” and “Health Transformation” – sound great as policy statements but lack scientifically actionable goals and have nothing to do with advancing knowledge.
The purpose of science, and therefore a public agency funding science, is to serve mankind. The United States’ model of bottom-up, investigator-initiated research is founded on independent creativity and competition. In Crow’s new synthesis of theNIH, only the first branch would conduct new research and this would take place according to nebulously defined “core questions deemed most crucial to understanding human health in all its complexity” – who will select these questions is unclear. The $30 billion invested annually (less than a mere 1% of the US’s $3.5 trillion budget) in NIH-sponsored activities is the basis for the advancement of biomedical science in this country. Crow’s proposal argues for making the best out of the knowledge we have rather than generating more. Improving the ability of the NIHto serve the health needs of Americans requires engaging the current system, not working only in the hypothetical.
A better solution is to link individual NIH agency budgets to production of quantitative deliverables in terms of human health, to dissolve or merge agencies to eliminate redundancies, and to re-organize the administration of each individual agency to bridge the divide between basic research and human health.
Tom Vondriska -- April 10, 2011