- The Washington Times - Sunday, October 5, 2003

Last week, National Institutes of Health (NIH) Director Elias Zerhouni released an ambitious road map to restructure the agency. Members of Congress and researchers in the field have become increasingly concerned that NIH, with its 27 separate centers and $27.3 billion budget, has become too fragmented and bloated to respond to the ongoing revolution in medical research.Those misgivings and their potential remedies were enunciated in a report this summer from the Institute of Medicine (IOM) and the National Research Center (NRC). Dr. Zerhouni’s plan is responsive to many of the recommendations in the IOM/NRC report.

The goal of the road map is to reduce the time that it takes to turn basic knowledge into tangible benefits. To that end, its 28 initiatives fall into three broad categories: Greater emphasis on the discovery of molecular pathways, greater interdisciplinary and intra-center research, and better-coordinated clinical research. While scientists have identified most of the basic biological building blocks (proteins, nucleic acids and the like), there is still a great deal of uncertainty of how those molecules interact with one another. A drug discarded as useless for one disorder might be the perfect palliative for another, but will not be known as such until the path has been determined. As Dr. Zerhouni pointed out, “Future progress in medicine will require quantitative knowledge about the many interconnected networks of molecules that comprise cells and tissues, along with improved insights into how those networks are regulated and interact with each other.”

Discovering potential therapies will require greater cooperation between scientists in disparate fields and collaboration between seemingly unrelated NIH centers. The road map sets up a variety of interdisciplinary projects which will require the standardization of grant-writing and research requirements. Dr. Zerhouni also plans to get NIH centers more involved with drug development at earlier stages in the process, through greater collaboration between NIH centers and private companies.

The road map isn’t likely to affect funding for Project Bioshield, which is funded through the Department of Homeland Security. The $2.1 billion it will cost to implement over the next five years will come from the budgets of existing centers. Not every member of Congress is convinced that Dr. Zerhouni is taking NIH in the right direction. Sen. Edward Kennedy, the ranking member of the Health Education Labor and Pensions committee, is concerned that partnerships with the private sector could cost more than they are worth. Other legislators are worried that Dr. Zerhouni’s plans to streamline clinical research requirements will result in lax federal oversight. However, the NIH road map also has wide support, ranging from Sen. Arlen Specter to Alan Leshner, the chief executive of the American Association for the Advancement of Science. Dr. Zerhouni intends to begin implementing it next year, although some aspects of it will require congressional sanction. His plans have merit. Congress should give them proper consideration.

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