:
Reform
of the National
During the past 40 years the National Institutes of Health have proven to be one of the federally constituted organizational successes of this nation and, for that matter, the rest of the world. The NIH was conceived and executed as a partnership between government, the scientific and medical community, and the public. Accountability and benefit have been delivered to the public who have funded the NIH and its sister research institutes in ADAMHA [Alcohol, Drug Abuse and Mental Health Administration]. Organized in a unique, non-corporate, and decentralized fashion, the NIH has been a model of success in no small part because the essential leadership has been external and the administrative management internal. The scientific leadership at large has provided the insight to recognize the origins of creativity and nurture the ingredients of success through the NIH. The research supported by this decentralized organization has resulted in a productive ferment in which life scientists and physicians have revolutionized the very fundamentals of biomedical knowledge, application to the prevention and eradication of disease, and modern delineation of the nature of health. In nurturing this endeavor there has evolved one of the foremost economic and social promises for the future of this nation. Funding of biomedical research by the NIH resulted in disease prevention and diminished suffering due to improved therapy, knowledge that has been translated to effective savings in health care, and birth to an understanding of human biology. In addition, it has produced the molecular biology revolution, modern cell biology, an integrated understanding of human physiology, as well as a detailed knowledge of the basis of disease and rational intervention. The promise defies the imagination and has given birth to a daughter enterprise the biotechnology and new pharmaceutical revolutions that may save this nation by providing opportunities for worldwide economic leadership. Currently afoot is a proposition that this remarkable multidimensional organization, which has served the nation so well, should be modernized (1). This has been interpreted to mean reform NIH in accord with a more conventional “corporate” mold with well-identified executive roles for implementation vested in the IDCs (institutes, divisions, and centers). We are informed that the current NIH model, be it of 1952 design and therefore rather obsolete if not worn, is no longer adequate. The implication is that it may not be fuel-efficient, environmentally proper, and politically correct. In the spirit of the automobile industry (a metaphor that fails to inspire confidence and seems more of a bad joke), it has been suggested that we should reform the NIH in the modern “corporate” mold with well-delineated central management “top down” corporate style; firmer control and direction by the managerial class to assure product delivery; and a characteristic absence of deterministic or participatory authority in the hands of those most expert and qualified to provide the primary leadership, which I pose is now, as in the past, resident in the research institutions of this nation. I would like to suggest that what is needed is a more powerful engine (dollars), one sufficient to propel the current model (or for that matter even a new more fuel-efficient model, if that is indeed the result) down the road to success. Whereas an image of the new model may be improved in some circles, I doubt it will lend substance. In a moment of reflection I have come to suspect that perhaps the present democratic organization of NIH is not sexy enough. Perhaps it is difficult to sell to the powers that be. Perhaps it is both politically unwieldy and lacking in opportunity for today’s managers. In addition, it is “different” and not entirely adaptaVol.
6
September
1992
Institutes
of Health
ble to political purposes. The result is that the NIH has become grist for the reform mill, subject to changes along more responsive lines with a pod of corporate psychologists and the like, dreams of conversion to a revenue-generating government business or some variation thereof. However, as scientists seldom shy from an investigative opportunity nor physicians a diagnostic one, I will share a perception that is neither personal nor isolated. Our managerial colleagues on the NIH campus have unleashed a debate of unprecedented magnitude. Perhaps that is as it should be. The debate is bringing heat to the topic. Hopefully, some light may be shed as well. The question that we should be asking is whether the current NIH with its provincial organization around disease entities, responsiveness to Congress, lack of real authority vested with the Director of NIH, and decentralized leadership is an anachronism or not? Does NIH serve its purpose well? Should there be analysis and reorganization? The scientific community should take common cause to assure that the appropriate questions are asked and objectively answered in a constructive manner. After all is said and done, however, there remains a single essential criterion upon which to judge NIH: Does NIH recognize and foster the pursuit of excellence in the life sciences? Yes, and across the national campus it has yielded a wealth of knowledge and fostered the application to human benefit. A greater yield can be realized through greater funding of the current system. Can it be achieved through other types of organization? In the absence of a better model elsewhere, I suggest that the proposed reform fails to be convincing. Other organizations have used the corporate model where it has been useful in generating products. The Framework for Discussion of Strategies for NIH (2) delineates a “top down” corporate management approach, and the need for a corporate culture. What about leadership? Just ask the gurus of the business world to learn that the corporate model has been found deficient in leadership. John Kotter (3) has informed us that “Most U.S. corporations today are overmanaged and underled?’ The proposed model for the reform of NIH is similarly lacking. Management exists to execute the policy and directives of leadership, not to usurp leadership. We must assure appropriate leadership. This might be accomplished through an Executive Committee for the NIH, one composed of the most expert and accomplished of the life scientists and the Director of NIH. Leadership is required in addition to advice as provided by the Advisory Committee to the Director and the Councils. Rather than reform NIH, the Administration might do better to recognize the importance of the youngest, most challenging and most promising science. Add a seat on the President’s Science Council for the life sciences. It is a legitimate partner in the future of this nation. Thomas S. Edgington, M.D. Department of Immunology The Scripps Research Institute 10666 N. Torrey Pines Rd. La Jolla, CA 92037, USA REFERENCES 1. Healy, B. (1992). Is this your father’s NIH? And other strategic questions. Science 257, 312, 313, 414, 415 2. Framework for discussion of strategies for NIH. (1992) National Institutes of Health, Department Health and Human Services 3. Kotter, J. P. (1990) What leaders really do. Harvard Business Review, pp. 103-107
EDITORIAL
3027
w.fasebj.org by Iowa State University Serials Acquisitions Dept (129.186.138.35) on January 13, 2019. The FASEB Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNum
Reform
of the National
During the past 40 years the National Institutes of Health have proven to be one of the federally constituted organizational successes of this nation and, for that matter, the rest of the world. The NIH was conceived and executed as a partnership between government, the scientific and medical community, and the public. Accountability and benefit have been delivered to the public who have funded the NIH and its sister research institutes in ADAMHA [Alcohol, Drug Abuse and Mental Health Administration]. Organized in a unique, non-corporate, and decentralized fashion, the NIH has been a model of success in no small part because the essential leadership has been external and the administrative management internal. The scientific leadership at large has provided the insight to recognize the origins of creativity and nurture the ingredients of success through the NIH. The research supported by this decentralized organization has resulted in a productive ferment in which life scientists and physicians have revolutionized the very fundamentals of biomedical knowledge, application to the prevention and eradication of disease, and modern delineation of the nature of health. In nurturing this endeavor there has evolved one of the foremost economic and social promises for the future of this nation. Funding of biomedical research by the NIH resulted in disease prevention and diminished suffering due to improved therapy, knowledge that has been translated to effective savings in health care, and birth to an understanding of human biology. In addition, it has produced the molecular biology revolution, modern cell biology, an integrated understanding of human physiology, as well as a detailed knowledge of the basis of disease and rational intervention. The promise defies the imagination and has given birth to a daughter enterprise the biotechnology and new pharmaceutical revolutions that may save this nation by providing opportunities for worldwide economic leadership. Currently afoot is a proposition that this remarkable multidimensional organization, which has served the nation so well, should be modernized (1). This has been interpreted to mean reform NIH in accord with a more conventional “corporate” mold with well-identified executive roles for implementation vested in the IDCs (institutes, divisions, and centers). We are informed that the current NIH model, be it of 1952 design and therefore rather obsolete if not worn, is no longer adequate. The implication is that it may not be fuel-efficient, environmentally proper, and politically correct. In the spirit of the automobile industry (a metaphor that fails to inspire confidence and seems more of a bad joke), it has been suggested that we should reform the NIH in the modern “corporate” mold with well-delineated central management “top down” corporate style; firmer control and direction by the managerial class to assure product delivery; and a characteristic absence of deterministic or participatory authority in the hands of those most expert and qualified to provide the primary leadership, which I pose is now, as in the past, resident in the research institutions of this nation. I would like to suggest that what is needed is a more powerful engine (dollars), one sufficient to propel the current model (or for that matter even a new more fuel-efficient model, if that is indeed the result) down the road to success. Whereas an image of the new model may be improved in some circles, I doubt it will lend substance. In a moment of reflection I have come to suspect that perhaps the present democratic organization of NIH is not sexy enough. Perhaps it is difficult to sell to the powers that be. Perhaps it is both politically unwieldy and lacking in opportunity for today’s managers. In addition, it is “different” and not entirely adaptaVol.
6
September
1992
Institutes
of Health
ble to political purposes. The result is that the NIH has become grist for the reform mill, subject to changes along more responsive lines with a pod of corporate psychologists and the like, dreams of conversion to a revenue-generating government business or some variation thereof. However, as scientists seldom shy from an investigative opportunity nor physicians a diagnostic one, I will share a perception that is neither personal nor isolated. Our managerial colleagues on the NIH campus have unleashed a debate of unprecedented magnitude. Perhaps that is as it should be. The debate is bringing heat to the topic. Hopefully, some light may be shed as well. The question that we should be asking is whether the current NIH with its provincial organization around disease entities, responsiveness to Congress, lack of real authority vested with the Director of NIH, and decentralized leadership is an anachronism or not? Does NIH serve its purpose well? Should there be analysis and reorganization? The scientific community should take common cause to assure that the appropriate questions are asked and objectively answered in a constructive manner. After all is said and done, however, there remains a single essential criterion upon which to judge NIH: Does NIH recognize and foster the pursuit of excellence in the life sciences? Yes, and across the national campus it has yielded a wealth of knowledge and fostered the application to human benefit. A greater yield can be realized through greater funding of the current system. Can it be achieved through other types of organization? In the absence of a better model elsewhere, I suggest that the proposed reform fails to be convincing. Other organizations have used the corporate model where it has been useful in generating products. The Framework for Discussion of Strategies for NIH (2) delineates a “top down” corporate management approach, and the need for a corporate culture. What about leadership? Just ask the gurus of the business world to learn that the corporate model has been found deficient in leadership. John Kotter (3) has informed us that “Most U.S. corporations today are overmanaged and underled?’ The proposed model for the reform of NIH is similarly lacking. Management exists to execute the policy and directives of leadership, not to usurp leadership. We must assure appropriate leadership. This might be accomplished through an Executive Committee for the NIH, one composed of the most expert and accomplished of the life scientists and the Director of NIH. Leadership is required in addition to advice as provided by the Advisory Committee to the Director and the Councils. Rather than reform NIH, the Administration might do better to recognize the importance of the youngest, most challenging and most promising science. Add a seat on the President’s Science Council for the life sciences. It is a legitimate partner in the future of this nation. Thomas S. Edgington, M.D. Department of Immunology The Scripps Research Institute 10666 N. Torrey Pines Rd. La Jolla, CA 92037, USA REFERENCES 1. Healy, B. (1992). Is this your father’s NIH? And other strategic questions. Science 257, 312, 313, 414, 415 2. Framework for discussion of strategies for NIH. (1992) National Institutes of Health, Department Health and Human Services 3. Kotter, J. P. (1990) What leaders really do. Harvard Business Review, pp. 103-107
EDITORIAL
3027
w.fasebj.org by Iowa State University Serials Acquisitions Dept (129.186.138.35) on January 13, 2019. The FASEB Journal Vol. ${article.issue.getVolume()}, No. ${article.issue.getIssueNum
