WASHINGTON, DC—Amid various investigations into allegations of financial conflicts of interest at the National Institutes of Health (NIH), a congressional panel yesterday (June 2) questioned senior officials over how the agency sets priorities for conducting research. Legislators plan to examine these priorities in greater detail during a reauthorization process of NIH's 27 institutes and centers planned for later this year.

"The priority-setting process at NIH and its centers and institutes has drawn questions, God knows, from members of Congress, patient advocacy groups, and others," said Rep. Michael Bilirakis (R-Fla.), chairman of the House Energy and Commerce Subcommittee on Health. "I believe much of this criticism is because the priority-setting process is extremely complicated, especially the grant approval process, and because NIH lacks transparency in many of its processes."

Rep. Joe Barton (R-Tex.) noted that NIH Director Elias A. Zerhouni "doesn't have a lot of control" over the 27 institutes and centers that have "grown up serendipitously" over the years. The NIH director directly controls only 2% of the total NIH budget, and current legislation prohibits him from transferring any amount of $1 million or more among programs or institutes without approval from the chairman of the House Appropriations Committee.

"Most of the programs in NIH have not been reauthorized in years," Barton said. "Let's see if we can't work on a bipartisan basis to come up with legislative reforms that make it easier for NIH to do its functions." Ranking committee member Sherrod Brown (D-Ohio) said NIH and Congress both "walk a fine line in terms of how much influence to exert" on setting research priorities. But if NIH is not sufficiently responsive to the public, "it doesn't matter how the agency sets its priorities. Those priorities will always be wrong."

Zerhouni told the subcommittee that the current process for allocating research priorities directly to disease, organ, or special population-based institutes and centers "has served NIH and the public well."

"But science is changing, driven by new technologies and discoveries," Zerhouni said. New areas of research are often best conducted by interdisciplinary teams whose expertise cuts across different NIH institutes and centers. "Genomics, proteomics, and molecular engineering serve all fields of endeavor and cannot be pigeonholed according to specific diseases," he said. "I believe we cannot be static."

Testifying with Zerhouni were Andrew C. von Eschenbach, director of the National Cancer Institute (NCI); Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID); and Nora D. Volkow, director of the National Institute of Drug Abuse. NCI and NIAID together received one third ($9.2 billion) of NIH's $27.7 billion for fiscal year 2004.

The growth in NIAID's budget—from $214 million in 1980 to more than $4.4 billion this year—reflects efforts to combat a changing priority of life-threatening infectious diseases, from AIDS in the 1990s to bioterror agents since 2001, Fauci said.

Referring to last year's highly publicized controversy over NIH funding of research grants to study human sexual behavior, two Democrats on the subcommittee—Henry Waxman and Lois Capps, both of California—complained that Republican lawmakers had "interfered" with the NIH peer-review process for ideological reasons. But Rep. John Shimkus (R-Ill.) said: "It helps us in rural America if the grants pass the 'common sense' test. Can you bring some sense or explanation for those that don't?"

Zerhouni agreed, noting that since the controversy, he has required every extramural grant to include an explanation of its benefit and relevance to society "in plain language."

"We depend on the support of all the taxpayers," Zerhouni said.