NIH’s Scientific Management Review Board Meets, Organizes Working Groups to Address NIH Structural/Management Issues
April 28, 2009
On April 27-28, the National Institutes of Health’s (NIH) Scientific Management Review Board (SMRB) held its initial meeting. Composed of representatives from the NIH and the science community, the SMRB was established by the NIH Reform Act of 2006[P.L. 109-482] to advise appropriate Department of Health and Human Services (DHHS) and NIH officials on the use of its organizational authorities to:
Left to right: SMRB Chair Norman Augustine, Acting NIH Director Raynard Kington, M.D., Ph.D., and Acting NIH Deputy Director Lawrence Tabak, D.D.S., Ph.D. At its request, Dr. Tabak updated the SMRB on the implementation of the $10.4 billion in NIH funding within the American Recovery and Reinvestment Act (ARRA).
The SMRB is to issue a report of its recommendations not less frequently than once each seven years, and must meet at least five times before issuing a report.
- Establish/abolish national research institutes;
- Reorganizing offices within the Office of the NIH Director; and
- Reorganizing divisions, centers, or other administrative units within an NIH national institute or center.
Although the SMRB’s focus was on two major agenda items—a potential merger of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and potential changes to the NIH Intramural Research Program—the Board first heard from two past NIH Directors, Harold Varmus, M.D., who currently serves as the President of the Memorial Sloane-Kettering Cancer Center, and Elias Zerhouni, M.D., who currently serves as Senior Fellow-Global Health at the Bill & Melinda Gates Foundation.
Dr. Varmus proposed in a March 2001 article in Science that the NIH should be reorganized into six comparably sized units, five of which would be organized along groups of diseases (often called “clusters”), as well as the Office of the Director. In his comments at the SMRB, Dr. Varmus recounted his proposal, but added that a number of steps had already been taken through the 2006 reauthorization and administratively within NIH to foster trans-Institute research, meeting many of the goals of his cluster proposal. Dr. Zerhouni did not discuss the cluster issue at length, rather advising that NIH would most benefit from the following: good metrics, which will enable it to make management decision based on data/outcomes; better understanding of the entire research portfolio since science has become so cross-cutting between disciplines; a peer review system that encourages high-risk, high-reward science; attention to the demographics of the scientific workforce; and changes to the Intramural Research program to foster trans-Institute research.
The SMRB also heard from scientists who participated in the development of the last major report on the structure of the NIH—the National Research Council/Institute of Medicine report entitled Enhancing the Vitality of the NIH: Organizational Change to Meet New Challenges, which issued in 2003 [Note: NAEVR Board President Stephen Ryan, M.D., served on this IOM Committee].
In its 2003 report, the IOM rejected Dr. Varmus’ proposal to cluster Institutes, but did note that an NIDA/NIAAA merger could potentially make sense, especially if research efforts to understand the basis of addiction were better coordinated. When the SMRB addressed this issue at the meeting, it encouraged public comment, hearing from several professional societies and patient groups who overwhelmingly opposed the merger, especially since the NIDA has not usually focused on end-target organ research, such as liver research funded by the NIAAA.
The SMRB also discussed a number of recommendations that have been made regarding changes to the Intramural Research program, from the 2003 IOM report and earlier that morning from Dr. Zerhouni.
The SMRB proposed to organize three Working Groups:
The SMRB plans to conduct Working Group meetings during the next few months in preparation for a full Board meeting in the October/November timeframe.
- A “Deliberating Organizational Change” Working Group to develop the underlying principles which would guide SMRB recommendations regarding management and structural changes.
- A Working Group to consider the pros and cons and make a recommendation regarding a proposed NIDA/NIAAA merger, which the SMRB noted could range from no merger to a merger, or some interim action such as more trans-Institute initiatives between these two entities.
- A Working Group to consider/recommend changes to the Intramural Research program.
NAEVR is monitoring the activity of the SMRB, especially the NIDA/NIAAA merger issue, since legislative drafts of what ultimately was passed in December 2006 as the NIH Reform Act of 2006 had contained language that would have clustered Institute and Center budgets into three entities: a cluster that grouped all disease-focused ICs (including the NEI); a cluster of cross-cutting ICs; and the Office of the NIH Director. NAEVR strenuously opposed the budget cluster concept, which was stripped from the final bill, arguing that NEI had been created as a free-standing Institute in 1968 separate from the then-National Institute for Neurological Diseases and Blindness and had flourished, funding more than 60 clinical networks in its nearly 40 year history. NAEVR also argued that a “brain” focused cluster could jeopardize the future of “front of the eye related” corneal research.
NAEVR is not only monitoring the administrative actions of the SMRB, but also any potential legislative activities in Congress related to NIH reauthorization, since the 2006 law reauthorized NIH only for a period of three years. The Congressional Committees of jurisdiction over NIH reauthorization include the House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee.