How to reform NIH…

Recently, I’ve mostly written in this respect about the NSF, but I also spent six years at the NIH, as a staff fellow in the intramural program (the biomedical medical center in Bethesda Maryland). When most folks think about the NIH, they are not really focussing on the intramural program. Rather, it’s the extramural program that gives out grant awards to biomedical researchers at US Colleges and Medical Centers that gets the attention. And I guess that’s fine because the extramural program represents about 90% of the NIH budget.

But, if I were going to magically reform the agency, I would focus on the intramural program. That’s because it has so much potential. With an annual budget north of $4B/year, America’s largest research medical center and thousands of young researchers from all over the world, it has so much potential. If Woods Hole is a summer nexus for life sciences during the summer, the NIH Bethesda campus is that thing on steroids year round.

The special sauce for the intramural program is that ideas can become experiments and then discoveries without the usual intermediate step of writing a proposal and waiting to see if it was funded. When I was at NIH, I could literally conceive of a new experiment, order the equipment and reagents and publish the results several months later. Hence, the intramural program has the structure in place to be a major science accelerator.

But, for some reason, when we think of such science accelerators, we generally consider private institutions like HHMI, the Allen Institutes and perhaps the Institute for Advanced Study in Princeton. What about NIH? On the criteria of critical mass, it dwarfs those places.

To my mind the problem lies in NIH’s ‘articles of confederation’ nature: it’s really 27 (or so) different Institutes and other units that are largely quite independent (especially the NCI), with a relatively weak central leadership. And this weak confederation organization plays out, not only on the Hill or in the awarding of extramural awards, but crucially also on the Bethesda campus, where intramural institute program directors rule fiefdoms that are more insular than academic units on a college campus. And this weak organizational architecture acts in the opposite direction of the science accelerator advantage that I wrote about above.

So here’s a big idea: let’s make the intramural program it’s own effective NIH institute. And have Congress authorize it and fund it separately, as a high risk, high payoff biomedical research program for the country. Does that sound like ARPA-H? Ooops. Well, then maybe we should just give the Bethesda campus to ARPA-H.