ACD Meeting Features Good Grades, Security and Calls for More Resources
By Rich McManus
On the Front Page...
Two years into her acting directorship of NIH, Dr. Ruth Kirschstein had an exemplary Results Act report card to share with the advisory committee to the director (ACD), and progress to report on making human embryonic stem cells available for research. But she also had sobering news to impart on NIH's need to beef up security, and heard calls for more resources from both a panel representing the extramural community, which wants more money for construction, and from a presidential panel on information technology, which urged NIH and HHS to take full advantage of wireless and other computing technologies to propel biomedicine to world leadership in IT.
The 83rd meeting of the ACD began like its predecessors, with a wrap-up of current affairs from the director's perspective. On the personnel front, search committees are in various stages of success in seeking directors for five institutes NIDA, NIMH, NIAAA, NIBIB and NINDS, a state of flux that Kirschstein cautioned was completely normal for IC directors. On the budget front, as of the Dec. 6 meeting, NIH was still operating under a continuing resolution fixing NIH expenditures at the FY 2001 level, but again Kirschstein counseled that "this is not unusual. Last year, deliberations on the budget did not finish until the end of December."
The advisors launched into their first opportunity for debate when Dr. Wendy Baldwin, NIH deputy director for extramural research, reported on NIH's compliance with a request from Sen. Ron Wyden (D-OR) that the Office of Technology Transfer determine NIH's role in developing what eventually became blockbuster (sales of a half billion dollars or more) drugs; Wyden was mainly concerned about drug prices for aged Americans, not in recouping NIH's investment in basic science, explained visitor Dr. David Korn of the Association of American Medical Colleges. Baldwin conceded that tracking NIH's role in the emergence of new drugs "is very difficult to do," and announced that in January NIH will begin monitoring grantee and intramural scientists' invention reports that result in patent issuance and products. But the matter irked some ACD members. "This represents a dangerous attempt to quantify the value of research," warned Dr. Cecil Pickett of Schering-Plough Research Institute. "The expectation of deliverables (following NIH investment) may lead to expectations that can't be met by NIH, which could harm programs and funding." Declared Dr. William R. Brody, president of Johns Hopkins University, "I find this whole discussion very disturbing and dangerous. I understand NIH's responsiveness to Congress, but this is going to drive behavior in a certain way that is against the mission of both NIH and science...This is a path we don't want to go down."
The phrase "NIH has substantially exceeded the goals" characterized the agency's GPRA (Government Performance and Results Act) annual report card, delivered by Hopkins cardiologist Dr. Myron Weisfeldt. The evaluation focused on seven major goals including progress toward an AIDS vaccine by 2007, development of genomic resources, and basic research on stem cells, in addition to advances in disease prevention, diagnosis and treatment. The report was glowing, particularly in Weisfeldt's specialty, wherein the mortality rate for patients with acute cases of heart disease dropped from 25 percent to only 5 percent in the past few years, largely due to NIH-sponsored basic research on statins. "In only 5 years, we went from prescribing digitalis and diuretics (for acute heart disease) to prescribing statins. This is a remarkable achievement."
"This [report] is a remarkable dissertation of achievement," said ACD member Philip L. Williams, former vice chairman of the Times Mirror Co. "There's got to be a way to publicize this to the American people."
NIH's Baldwin updated members on the new stem cell registry and web site, and explained its workings, declaring that the agency's theme is to bring the research quickly into the mainstream of typical NIH research support. "Do these cells grow?" wondered Dr. Thomas Cech, president of the Howard Hughes Research Institute. "When you ask for them, do they come in a form that can be propagated?"
"Some are very readily available, and for some we don't know whether anyone has asked for them yet under NIH support," said Baldwin. "It's not like Amazon.com; the whole field is very variable, but fast-moving and fast-changing." NIGMS director Dr. Marvin Cassman noted that in the spring, NIH will convene a major conference to understand the fundamental biology of human embryonic stem cells, chaired by Dr. James Thomson, the University of Wisconsin researcher who pioneered this field.
Next came tales of flood and terror as Baldwin recounted the harm to studies and research animals that followed the 36 inches of rain that fell on Houston over several days last June. She said a 5-foot wall of water hit the Texas Medical Center, killing some 30,000 animals and ruining whole careers' worth of work at the University of Texas Health Science Center, University of Houston and at Baylor College of Medicine. NIH answered the disaster with major construction awards to rebuild or repair damaged facilities; NIH also extended receipt dates for applications from scientists at harmed programs, and learned to coordinate with the Federal Emergency Management Agency on future disaster response.
Closer to home, Kirschstein reported on campus security in the post-Sept. 11 world, and declared, "Life at NIH will never be the same again as it was before Sept. 11 there's just not any doubt about that." She recounted how, in the past, NIH "had tried, without much success, to have people wear ID badges. Scientists are a very independent group, and some resisted. But Sept. 11 changed absolutely everything." The General Services Administration decides how federal facilities are to be made secure, and NIH has had to comply with its directives, she said.
With obvious reluctance, she said "a perimeter fence will have to be built around this beautiful, open campus. We'll try to make it attractive and not too difficult to manage. It will take some time to do. But there is no question we're an attractive target we're the world's premier biomedical research institution."
She acknowledged traffic delays in the neighborhoods around NIH, and a lack of funds to boost security measures, but emphasized that NIH is coping. "It has been a very big change. It did make use of identification badges mandatory because you're not going to get anywhere if you don't have them. But it's not something that we like. The campus atmosphere was wonderful."
Kirschstein noted that there were two NIH grants active in the World Trade Center, and 27 in close proximity, totalling some $14.6 million. "The people were safe," she reported, "but everything they were doing was lost."
Following the lunch break, the ACD heard calls for more resources in reports presented by the heads of two panels: Dr. Larry Smarr and Hopkins' Brody.
Smarr, who is director of the California Institute for Telecommunications and Information Technology at UC, San Diego, reviewed a report of the President's information technology advisory committee presented last February that stated the U.S. lacks a national vision of how IT will transform health care.
"You're predigital," he said. "Biology and medicine haven't yet fully made the transition to a digital science. There are not enough, by one or two orders of magnitude, cross-trained professionals in public health and information science...IT is still a cottage industry as applied to medicine...I really think that NIH is moving more slowly than it ought to for its own good."
Citing NLM and CIT as bright spots in NIH's IT efforts, Smarr urged the agency "to hire more people as first rate in IT as they are in science and medicine," and concluded by asking audience members to "wave your Blackberrys [palm-size wireless computers], if you have them."
Brody decried the underfunding of "bricks and mortar" for the nation's academic medical centers. The meeting ended with his diagnosis that extramural construction funding needs a boost. "We are tremendously underfunded in capital facilities for the national research infrastructure," he said, estimating a shortfall of $5 billion to $15 billion. "There needs to be a significant investment in research facilities...NIH is going to have to step up to the plate." He offered three recommendations: direct grants, including money for emerging and minority institutions; federal loan guarantees for institutions that borrow money to build facilities; and accelerated depreciation schedules on loans used for construction.
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