NIH director Dr. Elias Zerhouni held an 80-minute
town hall meeting Oct. 20 in Lipsett Amphitheater, addressing an
audience of NIH "stakeholders" — the network of science-related
societies, advocacy groups, academic medical centers and watchdogs — about
NIH's plans to land softly from the recent budget doubling, negotiate
congressional reauthorization to the agency's best advantage and
survive an era of tight budgets.
Now is not the time for NIH and its supporters to wallow in "post-doubling
guilt syndrome," Zerhouni said. Rather, it is time to take stock
of priorities, maintain momentum and "take advantage of the enormous
opportunities created by the doubling."
||NIH director Dr. Elias Zerhouni
addresses stakeholders at Oct. 20
NIH is "not a broken organization," he said repeatedly. But it
must be more nimble, dynamic and future-oriented in an era of advancing
discovery (notably the Human Genome Project) and high public expectation. "There
is no more important task than to protect our momentum for the
sake of our patients," he said.
The meeting was subtitled "Medical Research at the Crossroads," and
Zerhouni sounded as if the only real failure for the agency is
if medicine 20 years from now is practiced the same as it is today.
It irks him that the NIH budget is seen more often as dollars
spent rather than money saved through improved national health. "How
do we convey the fact that [the NIH budget] is an investment, not
a cost?" he lamented.
Illustrating his case, he asked the stakeholders to consider that
NIH invests a mere $96 per year for every citizen in the country,
while each citizen's health care costs average $6,400 in 2005 (and
will rise to $7,300 in 2006, since costs are rising 8-9 percent
yearly). The National Cancer Institute, he explained, spends about
$16 per capita on a population that faces a 50 percent lifetime
risk of getting cancer. "That's an $800 investment per person in
cancer over 50 years," he stated, incredulously. "How would you
feel" he asked, if so modest an amount was spent on a disease that
has a 1 in 2 chance of killing you? "Probably angrier than victims
of Hurricane Katrina."
But outrage wasn't the flavor of the meeting. Zerhouni wants to
speed up the process of delivering benefits to the public by lowering
barriers to cooperation, eliminating "silos" and "widening dialogue
in areas of synergy." Calling for a "new kind of medicine," he
wants to see interventions before diseases strike and then become
chronic. The recent discovery of a gene associated with the most
common form of blindness impressed him as a prime example of pre-emptive,
|An NIH stakeholder asks Zerhouni
a question during the Q&A session
at the meeting's conclusion.
He pointed to a range of other trans-NIH research goals, including
the Roadmap for Medical Research, the obesity research strategic
plan and the neuroscience blueprint as examples of flattening the
accelerator on improved public health. He said the newly announced
Clinical and Translational Science Awards "have the potential to
create glue between the bench and the bedside" and would result
in "an intelligent fabric across the country.We need to change
our cultural norm, which is rooted in the medicine of the last
Zerhouni then described a new office NIH has created as a kind
of turbocharger for the engine of research — OPASI, or the
Office of Portfolio Analysis and Strategic Initiatives. The metaphors
grew numerous as he explained what it is ("a radar system, scanning
the horizon at all times, detecting what we are doing, and what
we need to do"; "an incubator"; "an opportunity fund") and what
it is not ("a 28th institute"; "a tax on each institute and center").
OPASI's mission, he said, is to "improve the management of large,
complex science portfolios.making NIH more responsive to emerging
scientific demands and opportunities." It will consist of three
divisions, have a director (as yet unnamed) guided by a steering
committee, and will advise the NIH director on how to disburse
a Common Fund paid for by Roadmap money.
"The Common Fund for Shared Needs is not a transfer authority," Zerhouni
explained, "but a set-aside, to invest in synergizing areas of
science." There is a 10-year cap on any initiative emerging from
this incubator, he said. "No more than half the projects funded
by the Common Fund should exist for 10 years with this privilege — after
that, they go back to competing for funds."
The Common Fund would amount to 1.1 percent of the FY 2006 budget,
growing to about 1.7 percent in FY 2008, Zerhouni said. "The fund
has the potential to grow to up to 5 percent of the NIH budget
over time, depending on opportunities and needs."
Why choose 5 percent? "Because science evolves in cycles of about
20 years; that's about how long it takes to bring a new drug to
market, for example," said Zerhouni. "So if you spend 5 percent
each year for 20 years, you reach 100 percent — that's the
The session ended with more than a dozen questions from the audience,
which was chiefly concerned with NIH's deviation from business
as usual. Zerhouni assured them that new investigators and individual
grants remain a top concern for him. But he did caution that a "cultural
change" is ongoing and that there is a need for NIH's components "to
be less parochial about who gets which dollars."