Panel chief calls for streamlining NIH structure

House Energy and Commerce Chairman Joe Barton, R-Texas, and National Institutes of Health Director Elias Zerhouni offered competing visions Thursday about how to restructure the massive biomedical research establishment.

Zerhouni's appearance before the panel's Health Subcommittee was in anticipation of the first reauthorization for NIH since 1993, which Barton said he hoped to have ready for the House floor in the next two to three months.

"We've been working on reauthorizing NIH longer than some of us have been in Congress," noted Energy and Commerce Health Subcommittee Chairman Nathan Deal, R-Ga.

Barton said the agency's growth "has resulted in an almost random collection of structures in which largely independent institutes and centers are tasked to advance research programs not in cooperation with one another but according to diseases, organ systems or stage of life in which they specialize." While the 27 institutes sometimes work together, he said, "it defies reason to believe they will produce the efficiencies that can be achieved by a logically unified structure."

Barton envisions giving the NIH director more authority -- something Zerhouni readily agreed would help -- as well as streamlining its budget.

Congress has created more than 60 separate research programs, and appropriators fund 26 separate line items. Instead, Barton said Congress should consider "budget clusters" within NIH. He also suggested "a new, more transparent reporting system," to replace frequent congressional mandates for reports on specific diseases.

Zerhouni agreed that NIH must reorganize. With no change, he said, "the cost of practicing medicine ... will become unsustainable." The 21st century, he said, must become a time when doctors intervene before illness strikes, rather than after symptoms appear. But that will require research across institutes, he said.

"Right now we have a hand with 27 fingers, but I'm not sure the palm is as strong as it ought to be," he said.

Zerhouni is proposing an Office of Portfolio Analysis and Strategic Initiatives that he said would look agencywide to identify gaps or redundancies in research.