Congress attached a long string to its 1994 appropriations for NIH—a directive that NIH appraise the size, quality, and cost of its entire intramural program.

The first order of business was an NIH-wide scan by a committee headed by Paul Marks (Memorial Sloan-Kettering Cancer Center) and Gail Cassell (University of Alabama). The next level of scrutiny fell on individual institutes, and the first institute to go under the microscope was NCI, which, under a new director, has been undergoing extensive reorganization since the report of the ad hoc working group to review the NCI IRP was delivered in June of 1995.

Now a second institute has been dissected. After 10 months of deliberations, including soliciting and reviewing confidential letters from IRP scientists and staff of NIMH, a 17-member outside panel—chaired by Herbert Pardes, dean of the faculty of medicine and chairman of psychiatry at Columbia University College of Physicians and Surgeons and a former NIMH director—has delivered its report.

Called Finding the Balance, the report opens in no uncertain terms: "Faced with an explosion in knowledge, rapid changes in technology, and increasing complexity of research questions. the infrastructure and organization that has served the [NIMH] IRP so well in the past are no longer sufficient to guarantee high quality science."

Nonetheless, the panel found a "powerful rationale for [NIMH's] continued existence . . . provided the research is of the highest quality" and offered 77 recommendations. Salient among them are the need to recruit a permanent scientific director, emphasize more translational and clinical research, and foster a greater spirit of cooperation and collaborative research among the various components without stifling the autonomy of independent investigators.

Neither the overall NIMH budget nor the proportion devoted to the intramural research program would need alteration to respond to the recommendations, the panel determined, but it advises that teh scientific director have a discretionary fund, that resource distribution within the IRP be more firmly rooted in scientific merit rather than "history," and that the fees the IRP pays to use the Clinical Center be reduced. A summary follows.

Leadership

NIMH, which has not had a permanent scientific director since 1993, must fill that position with an individual with outstanding credentials and track record. The permanent scientific director, together with a newly recommended ad hoc planning group should develop a long-term agenda—and then restructure the IRP to fulfill that agenda. The scientific director should have a discretionary fund to facilitate shaping the IRP's scientific directions.

In what some early responses to the report suggest is one of its more eye-catching recommendations, the

panel advises that a portion of that fund be allocated to laboratory and branch chiefs to enable them to "encourage thematic integration" within their group. The chiefs should coordinate, rather than direct, individuals ands groups of researchers. This approach, the panel suggests, would correct past shifts in the balance toward the particular scientific interests of the chief.

Only rarely should a basic scientist be placed in a clinical laboratory, and then with extreme care, lest the basic scientist become isolated. Collaboration among basic and clinical scientists is not dependent on their residing in a common lab, the panel maintains.

Quality of Science

The panel calls for rigorous BCS review of chiefs and independent investigators as critical to the restoration of high-quality science in the IRP and advises an "arm's-length relationship" between the scientific director and the BSC. The recommended components of the "stewardship" evaluations of the scientific director and lab and branch chiefs are quality of science, scientific vision, relevance of projects to the laboratory or branch overall and to the IRP mission, and use of special IRP resources, as well as mentoring and administrative abilities.

There should be two distinct sets of recommendations by the BSC in each chief's review: one regarding resource allocations based on the review of the science, the other regarding the status of the individual (reappointed, promoted, demoted) based on the stewardship review. There should also be set procedures for downsizing or closing labs with severe deficiencies. Appeals of negative reviews ought to be handled within the current review cycle.

Recruitment, Retention, and Retirement

Regarding recruitment, the panelobserves that a marked preponderance of "homegrown" IRP scientists has led to "insularity" and "fiefdoms," a situation that should be corrected by efforts to recruit externally and by encouraging individual research pursuits.

Regarding retention, the panel faults the IRP for not exploiting available incentives to retain valued tenured scientists, noting, for instance, that although retention bonuses of up to 25 percent of base salary are possible, "only one tenured scientist at NIMH is currently receiving a retention bonus."

The panel outlines several mechanisms for shifting senior scientists out of positions for which others become better suited—so-called "graceful exit pathways."

Training and Mentoring

The report presents quotes from the confidential letters of IRP staff solicited by the panel during its review. Perhaps the most scathing published comments accompany the panel's deliberations on the issue of mentoring: "Young scientists are being employed as pawns in the game of obtaining recognition, resources, and influence instead of being mentored."

The panel's detailed recommendations to upgrade the quality of the IRP fellowship program reflect its concern that NIH overall, as well as NIMH in particular, be competitive in attracting excellent postdoctoral candidates; that the focus of fellowships be on training, rather than technical support; and that the training, including experience in "teaching and grantsmanship," equip fellows to be competitive in their search for positions after they leave NIH.

Recognizing that intensified mentoring will necessarily cut into the research time of the mentors, the panel suggests that mentors be rewarded with more fellows or more flexibility in hiring support staff.

Clinical Research

"Revitalization of clinical research efforts is critical," the panel says, and should be a "special focus of the NIMH IRP, particularly since clinical research is threatened in the extramural community."

Noting that NIMH is the third largest institutional contributor to the Clinical Center budget (after NCI and NHLBI), expending about 22 percent of its own budget for use of the Clinical Center, the panel points to a "growing consensus . . . that the charges to the NIMH IRP are excessive." It recommends lowering them to reflect lower utilization by NIMH clinical research patients of such high-cost services as surgery and intensive care.

The panel advocates the consolidation of all NIMH clinical research programs, which, in practical terms, would mean bringing onto the Bethesda campus the clinical neuroscience program now housed at St. Elizabeth's Hospital in Washington.

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