WASHINGTON--Concerns that pressure from advocates for specific
diseases and congressional mandates have skewed research priorities
at NIH led Congress to request a report from the Institute of
The IOM report, "Scientific Opportunities and Public Needs,"
focuses on the NIHs need to strengthen its analysis and use of
health data in setting research priorities, and to increase the level
of public understanding of these criteria and how they are
implemented. Data used to set priorities include burdens and cost of
diseases, as well as data relating to the impact of research on the
Second, the panel urged that the priority setting process be opened
to broader public participation, to reduce the influence of advocacy
groups for specific diseases. The panel acknowledged that advocacy
groups have played a vital role in promoting biomedical research,
while also creating "a contentious environment for those trying
to set research priorities, be it Congress or the NIH."
Leon E. Rosenberg, MD, of Princeton University, chair of the
19-member committee, cited some "celebrated examples in which
very effective and vocal lobbying and political pressures have
affected research allocations--breast cancer and AIDS being two
The panel also noted that Congress has felt compelled at times to
mandate the creation of new centers or offices at NIH and to specify
funding for pet research projects, although Congress generally lacks
the expertise to judge scientific opportunities.
The IOM committee called for strengthening the office of the NIH
director. "We believe that the NIH director needs more authority
to help ensure a unified, agency-wide planning process, and to
coordinate research that cuts across institutes," Dr. Rosenberg said.
The committee further urged that:
Directors of all the institutes and centers should provide the NIH
director each year with multiyear strategic plans, including budget scenarios.
The NIH director should establish an office of public liaison;
strenthen existing liaison offices in its various institutes,
centers, and divisions; and create new ones where necessary. The aim
is to broaden outreach to the general public beyond the advocacy
groups. [See also the interview with Eleanor
Nealon, director of the NCIs Office of Liaison Activities.]
Public membership of NIH policy and program advisory groups should be
selected to represent a broad range of public constituencies.
Congress should use its authority to mandate specific research
programs, establish levels of funding for them, and implement new
organizational entities only when other approaches have proven inadequate.
Congress should increase the funding needed to manage research so NIH
can implement improvements in the priority-setting process, including
stronger analytical planning and interaction with the public.