The New York Times - November 11, 1986
Lawrence K. Altman, M.D.

Today we know this experiment as the National Institutes of Health. The Staten Island laboratory, since moved to Bethesda, Md., is now arguably the world's foremost biomedical research center. Nobel Prize-winning experiments are done there. The institutes' $6.2 billion budget finances most of the research conducted by non-Federal scientists in more than 1,200 hospitals, medical schools and private laboratories elsewhere. The N.I.H. has shaped the practice of physicians by bringing a more scientific approach to the bedside and by developing treatments and preventions.

The N.I.H. helped bring the United States dominance in biomedical science, making the agency's laboratories and hospital a magnet to foreign scientists. On any day, more than 1,100 visiting foreign scientists work along with the more than 13,000 employees of the National Cancer Institute, the National Heart, Blood and Lung Institute and the 10 other institutes that make up the complex.

Few would call it anything but a huge success. Yet its phenomenal growth and the political pressures accompanying it have brought their own problems. Some wonder if it can sustain its successes and ask how the institution that has put its brand on American medicine for much of the last century can adapt to lead the country into the next.

N.I.H. funds have transformed research from a private philanthropic effort often carried out as a hobby by wealthy physicians to a public institution offering full-time professional careers to all qualified investigators. Thus, the United States has a cadre of highly qualified scientists unmatched by any other nation.

Rare would be the American Nobel Prize winner in medicine whose path to that coveted award was not supported by N.I.H. funds. Foreign laureates have benefited as well. But the record has not been perfect. The National Academy of Sciences' Institute of Medicine, while praising the N.I.H. for making rapid advances in the battle against acquired immune deficiency syndrome, criticized the agency last month for "inadequate Federal coordination" of development of an AIDS vaccine.

There is increasing criticism of N.I.H. procedures for choosing research projects and awarding grants. Some scientists say the procedures have contributed to excessive emphasis on quantity not quality in scientific publications and to "grantsmanship" and voluminous paperwork.

Others, including several researchers who judge grant proposals, assert that the N.I.H. favors experiments that are sure to yield data, even if they are of questionable significance, and is reluctant to take a chance on novel or radical ideas that might produce cures or alter basic thinking about a disease. Some even assert that the competition for N.I.H. funds has contributed to scientific fraud.

In response, the agency is trying to increase the number of longer-term grants and is asking the academy's Institute of Medicine to study the problem of dishonesty in research.

Most researchers believe that the strength of the institutes lies in the proposals initiated by investigators who follow their scientific noses and that such work is the most likely to bring crucial scientific discoveries.

Debates continue about the proportion of research funds that should be aimed at specific diseases. Many scientists express concern that if too much of the budget is spent in this way, creativity could be strangled. Over the years N.I.H. and other scientists have opposed proposals of new institutes devoted to specific disease categories - the recent creation of an arthritis and an eye institute are two examples. But many opponents of such moves now acknowledge that they have produced substantial scientific, financial and political benefits.

Meanwhile, although the N.I.H.'s budget has grown to $6.2 billion this year from $577 million in 1961, many political leaders and N.I.H. officials have been concerned that too few Americans know about it. So it has begun a yearlong centennial celebration aimed at describing not only what the institutes mean to the country but also how program cuts could threaten further improvements in the health of Americans and the dominance of American science.

There are few green patches left between the 40 buildings put up on the Bethesda farm to which the institutes moved in 1938. The growth was slow until just after World War II. Then, in what many have described as a Government love affair, Congress poured money into biomedical research, at times more than the research community said it could wisely use. As a result, many date N.I.H.'s origins to World War II, not to Staten Island.

Its director, Dr. James B. Wyngaarden, acknowledged in an interview that the institutes "can't claim credit for all the health benefits in the last century." The decline in incidence of many infectious diseases, for instance, is due to improvements in housing and sanitation as well as to the discovery of antibiotics and application of epidemiological methods.

Still, its impact extended far beyond the Bethesda campus. In recent decades, the agency was the dominant source of money for biomedical science, particularly that conducted in universities. However, since 1982, industry has taken the lead. In 1985, for example, industry will spend 39 percent and N.I.H. 37 percent of the $12.8 billion spent on health research.

Along the way, the agency acquired one component, the National Library of Medicine, that was 50 years older than itself. The library's 3.5 million volumes are the most comprehensive such collection in the world, one vital to medical practice. Through a computerized system, a physician treating a patient in a rural area can get instant answers to tough questions.

Though most scientists profess otherwise, politics has always been a major factor in the running of N.I.H., and the nature of N.I.H. politics has changed significantly.

"Initially, the politics centered on convincing the public to support biomedical research," Dr. Gert Brieger, a medical historian at Johns Hopkins Medical School in Baltimore, said. But, Dr. Brieger went on, "As N.I.H. got bigger, more bureaucratic, more cumbersome and more was at stake, you began to have rivalries and internal political pressures. That's the kind of politics that did not exist in the beginning and it can do a lot more damage in the next century."

Dr. Wyngaarden cited two other areas of "potential harm" he said had tarnished the image of the N.I.H. and the rest of the biomedical community: a growing number of instances of scientific fraud and lapses in concern about animal welfare. Although such abuses have been few, Dr. Wyngaarden said, "they are more widespread than we would like to admit." Congressional questioning has been more probing, he said, adding, "The reflex support of N.I.H. is not as strong as it once was."

The difficulty of medical research is that no one has developed a fool-proof formula to make the next great breakthrough. To Dr. Lewis Thomas, the essayist, who has received many N.I.H. grants, progress is less apt to come from detailed plotting of experiments on paper. More often, Dr. Thomas said in an interview, "It is made by getting to work, waiting for something surprising to turn up, and then by capitalizing on surprise."

N.I.H. has been praised for helping to make the post-war period the Golden Age of medical research. But to Dr. Wyngaarden, the harvest from the public investment in research is only beginning. "The Golden Age is still ahead of us," he said.

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