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Vol. LVII, No. 23
November 18, 2005

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Zerhouni Assures NIH 'Stakeholders' About Agency's Future

On the front page...

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
"town hall.

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, intelligent medicine.

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 century."

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 reason."

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."