Working group chair Dr. William Roper, dean of the school of medicine at the University
of North Carolina, told the board that “it is our unanimous conclusion that the status quo is not ideal.” He pointed out that addiction research at NIH is currently scattered across almost all institutes and centers and that integration is necessary not just at NIDA and NIAAA.
Regardless of whether NIH pursues options deemed “structural” (merger) or “functional,” Roper said NIH would need to undergo “a cultural
|“The reasons for non-merger are not there…it is much cleaner and simpler to merge the two institutes.”
Roper said his 8-person working group “was split, on a good day, right down the middle,”
with 4 preferring merger and 4 favoring functional integration. He said he personally believed that Collins should not pursue a merger
at this time, given other important issues begging the director’s attention, and asked, “Is the juice worth the squeeze right now?”
But the SMRB was not inclined to let the matter
languish. Led principally by NCI director
Dr. Harold Varmus, the pro-merger faction
decided not simply to pass Roper’s two options on to Collins for eventual decision, but to call the question right then and there with a show of hands.
During a brief debate that Roper said characterized
virtually all discussions of the issue, informed voices defended both options in persuasive
Dr. William Brody, president of the Salk Institute
for Biological Studies and former president
of Johns Hopkins University, favored the functional approach, calling it a “slam dunk…If it works, great, and if it doesn’t, we can pursue the nuclear option.”
Varmus objected to what he called “temporizing”
and expressed impatience with “less-than-halfway measures and functional Band-Aids. It’s time to do the right thing.”
Dr. Thomas Kelly, director of the Sloan-Kettering
Institute, also opposed a functional merger: “I view it as postponing the decision.”
Dr. Huda Zoghbi, professor at Baylor College of Medicine, said, “The reasons for non-merger are not there…it is much cleaner and simpler to merge the two institutes.”
Working group member Dr. Richard Hodes, director of the National Institute on Aging, observed that, at the outset of their deliberations,
the group was 6-2 in favor of non-merger. But that viewpoint eroded over time.
Said Dr. Deborah Powell, dean emeritus at the University of Minnesota Medical School, “I don’t think a functional merger would work…This is a major, major enterprise, much larger
than the Neuroscience Blueprint. For me, it’s time to do something definitive, and which offers more benefit to the public, rather than just tweaking around the edges.”
Former NASA administrator Dr. Daniel Goldin
warned that the functional option depended
too much on good intentions unbuttressed by institutional authority: “Unless this agency
shows a little backbone and leadership, no change will occur. You can’t address the problem
of addiction and manage a $3 billion or $4 billion budget on good will.”
Collins acknowledged the knottiness of the issue. “This is not as simple a decision as it might have first appeared,” he said. He noted that the NIDA council was unanimously in favor of merger while the NIAAA council unanimously
opposed it. “I’m not prepared to give a decision,
but I have all I need to do so in the fairly near future.”
Six members of the public were then invited to comment; most had ties to research on alcohol and all opposed the merger.
Then came a two-part vote of the full board. The SMRB unanimously approved a motion to accept the working group’s two recommendations
to Collins, then Varmus, seconded by Goldin, moved to create “a new institute of addiction research.”
NIGMS director Dr. Jeremy Berg interjected that the new entity should also include substance
use and abuse somewhere in the title, and the historic vote was cast.
Concluded Collins, “It feels like we’re living through a bit of a Shakespearean play here, with many acts. I think we got to the climax today.” He said it was up to him to bring the climax to “a worthwhile conclusion.”
The NIH director can, with the concurrence of the HHS secretary, create a new NIH institute. However a variety of procedural hurdles remain once Collins makes his decision, including a public comment period and the formal abolishment
of the preceding entities before establishing
a new one.