Plan would shift power to NIH director

House Energy and Commerce Committee Chairman Joe Barton’s (R-Texas) plan to reauthorize the National Institutes of Health (NIH) for the first time in 12 years could strengthen the panel’s oversight of the agency and profoundly affect how advocates for academic institutions, scientists and patients make their case for more federal money, according to several researchers and former NIH officials.

House Energy and Commerce Committee Chairman Joe Barton’s (R-Texas) plan to reauthorize the National Institutes of Health (NIH) for the first time in 12 years could strengthen the panel’s oversight of the agency and profoundly affect how advocates for academic institutions, scientists and patients make their case for more federal money, according to several researchers and former NIH officials.

Barton’s plan would grant the NIH director unprecedented authority to establish and manage the budgets for the 27 institutes and centers that constitute the NIH and depend on its nearly $30 billion budget. Locating the power to set spending levels within the office of the director also could bolster the influence of the Energy and Commerce Committee after years in which the appropriations committees maintained near-total control over the agency’s annual budget.

Under the current system, the administration specifies budget requests for all 27 components of the NIH and Congress allocates the money as part of the labor-health and human services spending bill. Barton now wants to reduce dramatically the number of NIH budgetary line items from 27 to four: Two would cover the 27 institutes and centers, and two would provide expanded spending authority for the director.

Rep. Nathan Deal (R-Ga.), who chairs  Energy and Commerce’s Health Subcommittee, spelled out one of the panel’s prime objectives for the NIH at a July 19 hearing featuring the agency’s director, Elias Zerhouni.

“In the absence of reauthorizing NIH, this committee basically cedes its jurisdiction to another committee,” Deal said.

The annual appropriations process for the NIH attracts universities, patient groups and other advocates for increased spending.  Reorganizing the budget into fewer, less-specific line items allocated by the director could shift control for the details of NIH funding from the Appropriations Committee to Energy and Commerce.

Without knowing exactly how the authorities of the two congressional committees and the NIH director would interact, representatives of the research community are unsure about the potential impact of the plan. One key consideration is whether Energy and Commerce would authorize specific funding levels, or caps, for institutes and centers. Barton’s spokesman said he anticipated a markup this year.

“It seems to many that, without a target line item … on which to focus their elected representatives’ attention, … that research funding decisions may become the purview of the NIH director,” said Mary Woolley, president of Research!America, an advocacy group.

Another large organization of scientists, the Federation of American Societies for Experimental Biology (FASEB), also is concerned about how the Barton plan will affect the budget-setting process.

“It’s a system that’s worked pretty well, and we’re afraid dramatic change may really throw the baby out with the bathwater,” said Bruce Bistrian, president of the FASEB board of directors and the chief of clinical nutrition at the Beth Israel Deaconess Medical Center at Harvard Medical School.

Ultimately, the appropriations committees will continue to attract the most lobbying regardless of the structure of the NIH budget, said David Moore, a government-relations executive at the Association of American Medical Colleges. “I think advocates would still focus on the appropriators, as they have in the past,” Moore said.
Boston University Assistant Provost Gerald Keusch, who served as director of the NIH’s Fogarty International Center from 1998 to 2003, predicted that streamlining the budgets “would make it a lot easier on the Congress.”
At the hearing, Rep. John Dingell (D-Mich.), ranking member of the Energy and Commerce Committee, argued that the Barton proposal could constrain the ability of health institutes and centers from directly lobbying for what they need and want.

“It may dramatically impact the ability of the constituencies of the 27 research institutes and centers from having a place at the table in the appropriations process,” he said.

Keusch maintained, however, that limiting the influence of research- and patient-advocacy groups could be a positive development for the NIH and for the advancement of science.

“The real question is, should the advocacy groups be out there pushing for budgetary allocations?” Keusch said.

Budgets, he said, have been “driven not by the science or the needs [of society] but by the advocacy groups and their clever use of the political process.”

Political pressure led to the proliferation of institutes and centers at the NIH that focus on specific diseases, bodily organs or segments of the population. Many within the former and current NIH say there are too many components of the agency and that attention, funding and administrative resources are inefficiently spread across the NIH, according to former officials.

The Energy and Commerce Committee’s framework would cap the number of institutes and centers at 27 and permit the director to eliminate or combine existing components or create new ones. Former NIH officials and research advocates are skeptical that any changes will take place.

“The political downside is too large,” said Marvin Cassman, who served at the NIH’s National Institute of General Medical Sciences for 13 years, including nine as director. “You piss off too many people … [and] what do you get out of it?”

Future political interest in new institutes and centers would pit advocates against one another, Keusch predicted. But Moore downplayed the possibility of dogfights over new NIH components.

The “administrative structure” of the agency is unimportant compared to the level of funding itself, Moore said.

“I can’t remember anybody in NIH ever saying, ‘My God, we need another institute!” Cassman added.

Despite all the sound and fury over the possible changes, the research community is largely unconcerned.

“You can’t put it in the hands of the NIH director alone,” Keusch said, adding that the directors of the institutes and centers must continue to be part of the process.

Vesting the authority in the hands of the director might actually increase accountability for NIH spending, Woolley said, because the director is “more visible and more responsible” than the institute and center directors.