Zerhouni: Cool in the Hot Seat
On March 17, Elias Zerhouni, MD, Director of the National Institutes of Health (NIH), presented testimony before the House Energy and Commerce Health Subcommittee at a hearing entitled, "Setting the Path for Reauthorization: Portfolio Management at NIH." The hearing presented an important opportunity for Dr. Zerhouni to evoke confidence in his leadership and management of NIH issues. The Energy and Commerce Committee is gearing up to produce a bill that would reauthorize NIH. Reauthorization bills, which are produced much more seldom for NIH than for other science funding agencies, present the opportunity to reorganize and reprioritize an agency. During his presentation and the extensive questioning that followed, Dr. Zerhouni walked a narrow path, assuring committee members that he shares their concerns about transparency and accountability, and gently rebuffing suggestions to combine and recombine NIH entities.
Although Health Subcommittee Chairman Nathan Deal (R-GA) chaired the hearing, the full committee chair, Rep. Joseph Barton (R-TX), attended and asked a number of questions. He told Dr. Zerhouni that in his view, an NIH reauthorization bill should accomplish three goals: 1) to give the NIH Director more management authority and budget authority; 2) to align more closely the budget line items with the authorization (not all NIH programs require reauthorization); and 3) to establish new, more transparent reporting systems. Rep. Barton did not make specific suggestions but instead tried to draw Dr. Zerhouni into a discussion of what entities on the complex NIH organizational chart could be combined or eliminated. Dr. Zerhouni kept the discussion on a theoretical level and joked with Rep. Barton that he would gladly accept additional authority.
In his prepared statement, Dr. Zerhouni lauded the NIH peer review system, and mentioned that there are approximately 21,000 outside advisers to NIH whose input helps determine how NIH spends it funds: members of study sections, advisory committees and special strategic planning panels, for example. He assured committee members that NIH takes its responsibilities to the taxpayers very seriously. He cited NIH-produced statistics showing that the NIH budget allocated across the U.S. population would be $96 for each citizen. Of that $96, $16 is contributed by the National Cancer Institute, $10 from the National Heart Lung and Blood Institute, and $15 from the National Institute on Allergy and Infectious Diseases. His point was that he is conscious that the NIH investment on the part of each person needs to reflect, in a broad way, the disease burden that Americans bear, particularly since the average American's health care costs are $5,500 per year.
At least twenty members of the Health Subcommittee were able to question Dr. Zerhouni. He answered questions about NIH's new conflict of interest and open access policies, as well as stem cell research. A highlight was a question asked by Rep. Tammy Baldwin (D-WI) who represents the district containing the University of Wisconsin-Madison. The question was prompted by the work of APA Science Policy staffer Karen Studwell, co-chair of the Coalition to Protect Research. Rep. Baldwin asked:
"We know that six of the ten leading causes of death in the United States are based on behavioral factors, including HIV/AIDS, smoking, violence, diet, and substance abuse and that other behavioral factors are also known to increase individual's risk for disease, disability and early death. And behavior is certainly a factor in the obesity epidemic. While genetic factors play a considerable role in a predisposition towards obesity, environmental and behavioral factors are also strong influences. Obesity is preventable, but more effective methods of encouraging healthy lifestyle choices and reducing the barriers that prevent people from making healthy choices must be discovered. Are we doing enough to ensure that behavioral and social and environmental research is not marginalized in the course of NIH's priority setting and is being fully utilized to solve problems like obesity?"
Dr. Zerhouni agreed that behavioral and social science research is important, and responded that NIH has done a great deal to promote it, including establishing the Office of Behavioral and Social Sciences Research, and that its investment in behavioral and social sciences research has grown to an estimated $2.9 billion for Fiscal Year 2006. He also mentioned that behavioral and social science research is well represented in the Roadmap and in the Blueprint for Neuroscience Research, a trans-NIH initiative led by the National Institute for Neurological Disorders and Stroke.
Representing the proverbial other side of the coin, Rep. Fred Upton (R-MI) told Dr. Zerhouni that he had joined with other colleagues in voting to defund certain NIH grants (dealing with sexual behavior) that he felt weren't quite up to NIH standards. Dr. Zerhouni gave a strong defense of behavioral and social science research on sex, saying that he had personally reviewed the entire portfolio of sexual behavior grants last year and felt confident that all of the projects had strong public health significance. He then said he felt it would be irresponsible for NIH not to fund sexual behavior research that could curb the spread of sexually transmitted diseases.
The APA Science Policy Office is continuing to monitor budget legislation and other bills that may affect NIH, and will continue to bring you information about congressional interest in NIH issues.