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NIH Record

Final Meeting as NIH Director
Varmus, Advisors Discuss Budget Growth, Construction at 79th ACD

By Carla Garnett

On the Front Page...

With the ink not yet dry on NIH's fourth-straight large budget increase, Dr. Harold Varmus presided over his 13th and final meeting of the advisory committee to the NIH director (ACD) on Dec. 2. President Clinton had signed just a week earlier the FY 2000 omnibus spending bill that represented another step closer to the goal of some advocates to double the agency's appropriation by 2004.


The ACD meeting agenda was chock-full of presentations and discussions about concrete ways — particularly construction projects both intramural and extramural — to spend the latest and any future largesse. As is customary, Varmus spent the opening minutes of the meeting giving his advisors a summary of events since their last gathering. He welcomed several new official ACD members including Phillip Williams, retired vice chair of the Times Mirror Co., who had served previously as an ad hoc ACD member; and Dr. Don Wilson, vice president for medical affairs and dean of the University of Maryland School of Medicine. Varmus also announced a few appointments within NIH: Dr. Stephen Straus as director of the National Center for Complementary and Alternative Medicine, Dr. Allen Spiegel as NIDDK director and Sue Quantius as NIH associate director for budget.

Finally, upcoming departures were acknowledged: NIDCR director Dr. Harold Slavkin will leave NIH in June to head the University of Southern California Dental School; Dr. Norman Anderson, director of the Office of Behavioral and Social Sciences Research, leaves in March for a professorship at Harvard University's School of Public Health; and Varmus himself moved on, ending his sixth year as NIH director to take the reins of New York City's Memorial Sloan-Kettering Cancer Center in February. Also noted was the departure of Rep. John Porter (R-Ill.), who left Congress last year. Varmus hailed Porter — longtime chair of the House of Representatives committee that oversaw NIH — as "one of the great champions of NIH" and credited him for being instrumental in acquiring via legislation the tremendous prosperity the agency has enjoyed in recent years.

Construction On Campus and Off

"In view of NIH's prosperity and the number of projects in progress and projected both here and around the country," Varmus said, "I thought it would be useful to think about how NIH supports construction and renovation, and what more we ought to be doing. We're developing our 2001 budget and planning for 2002. This seems like an auspicious time to consider whether the ways we currently support infrastructural needs are sufficient, or whether we should be pressing for even greater increases in the amount of money we can supply to extramural institutions' construction activities or to projects we can carry out here on campus."

Updates on several intramural building projects were presented, including the Clinical Research Center, the Louis Stokes Laboratories Bldg., and the Vaccine Research Center. In addition, a new project was proposed to occupy what is currently Bldg. 35.

Institute directors Dr. Gerald Fischbach of NINDS and Dr. Steven Hyman of NIMH recommended the formation of an "integrated neuroscience research" program that could be housed by 2004 in a 200,000-square-foot Neuroscience Center on campus. The new center would bring together researchers from several institutes including NINDS, NIMH, NIAAA, NIDA, NIDCD and NIA.

Taking for example the molecule dopamine — which has implications in NINDS's Parkinson's disease research, NIAAA's and NIDA's drug addiction and reward research, and NIMH's emotion and mood disorder research — Hyman explained, "It's patently ridiculous to divide investigators who are interested in the action of this molecule into different buildings — even different intellectual universes — by virtue of the accident of where we divided up the clinical sciences years ago. It will lead to enormous progress both in terms of the basic science, but also in terms of the translation of discovery into clinical therapeutics by bringing these scientists together. We would like to create a model that goes from molecule to behavior to clinical application."

Citing the cost of renting off-campus lab space coupled with the need for scientists to interact with those doing similar work, Hyman continued, "There are other benefits that are less intellectual and lofty and more financial. There is this broad intellectual vision, but there is also a very practical aspect to this."

"I think this was the most exciting thing that I have read about in all the time that I have been involved with this group," enthused Dr. Shirley Tilghman, a professor in Princeton University's department of molecular biology and ACD member. "This is really spectacular. The spirit of cooperation that [Varmus has] obviously been able to incite here is exactly what this problem is going to need in the future."

Attendees also heard from three presenters about planning and budgeting for extramural building projects: Dr. David Kaufman, president of the Federation of American Societies for Experimental Biology, gave a needs assessment for research institutions; Quantius offered a legislative proposal for NIH's support of such needs; and Dr. Wendy Baldwin, NIH deputy director for extramural research, explained the role of NIH funding in outside construction matters.

Issues in the News

Two other topics that were discussed during the ACD meeting coincidentally were also being covered in the media that day: NIH had released the first-ever proposed guidelines for stem cell research on Dec. 1; and the annual meeting of the recombinant DNA advisory committee (RAC) was scheduled for the next week. The RAC would be reviewing issues related to the death of a young man taking part in an NIH-supported clinical study of gene therapy at the University of Pennsylvania. The safety, and successes and failures of gene therapy clinical trials, as well as what oversight roles NIH and the Food and Drug Administration should have in the conduct of such studies were all concerns slated to be discussed at the RAC meeting.

"The NIH is in a difficult situation in that it is not inherently a regulatory agency," Varmus explained. Regulation is handled by FDA, he continued. "Gene therapy is one of a variety of therapeutic modalities, all of which have risks. NIH continues to believe it has a very important role in maintaining the public discussions of novel developments in gene therapy research," he said. "Recent events require that NIH take a closer look to ensure that we are doing everything that can be done to minimize the dangers of gene therapy...I believe gene therapy has promise despite the unfortunate events and that we need to take a longterm outlook."

Health Disparities Addressed

Another issue that merited special mention in the 2000 appropriation was the marked difference in health status between minority and majority populations in the United States and the world.

"The administration has taken a very firm position on reducing disparities in health status," Varmus said. "It's important that those of us who are charged with seeing technological improvements in medicine not lose sight of the fact that public health goals are paramount. In the 2000 budget, one of our key areas of emphasis is health disparities, both domestic and international. There are more than 50 new initiatives across NIH addressing various aspects of health disparities."

NIH is supporting a bill currently in Congress that would strengthen NIH's Office of Research on Minority Health by giving the office grantmaking authority, Varmus said. While "the fate of that bill is still unclear," he continued, "I will be taking specific administrative action before I leave to implement many of the ideas within the legislation. It doesn't include everything in the bill that I'd like to see — I can't establish a loan repayment program or award grantmaking authority — but I can do a number of other things that will be in this administrative directive."

One thing Varmus's directive will do is activate an annual strategic plan that will be formulated by institute directors, the NIH Office of Research on Minority Health and the NIH director.

The next ACD meeting is scheduled for June.

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