CARNEGIE COMMISSION ON SCIENCE, TECHNOLOGY, AND GOVERNMENT

  

Memorandum . FEB 7 1991 =]

February 3, 1991 ?
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SUBJECT: A Possible Health-Related Commission Study

FROM: Mark Schaefer Uwe,

TO: Joshua Lederberg NG Age ceed
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THRU: David Z. Robinsont }” Ob ~- Uh (eee on ME

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In past Executive Committee and other Commission meetings you
have noted that the Commission is not doing anything in the health
policy area, and you have posed the question of whether or not we
might be missing an opportunity.

Guy Stever and I recently met with Jim Wyngaarden to discuss
issues related to the new Commission Task Force on Establishing and
Achieving Long-Term Goals. In the course of our conversation Jim
mentioned his concern and frustration that the Director of NIH is
embedded in the lower echelons of the Department of Health and
Human Services. He discusses this in part of his letter to Guy
Stever of January 9, 1991 (attached) and indicates that "The NIH
Director has no visible role in science policy compared to that of
the Director of NSF."

Jim also points out in his letter that "two successive panels
have examined the structure of NIH and the role and authorities of
the Director and have recommended major changes. As of today, all
of these recommendations have been rejected by the Secretary's
office."

Because this is an organizational policy issue, it seems
perfect for the Commission. In fact, the situation is somewhat
analogous to that of the President's Science Advisor several years
aqo. Several groups had called for giving the position greater
visibility in the White House, but people did not listen until the
Commission and others pressed for it during a change of
administration.

If the Commission organized a Task Force to examine the NIH
Director issue (and perhaps related issues as well) beginning next
October (FY 92), it could turn around a report in 12 months and
have it ready for presentation at the beginning of the next
administration. It seems to me that this topic is particularly
appropriate for the Commission because it involves organizational
and process questions that can be addressed through clear,
decisive, and practical recommendations.

attachment

cc: Guy Stever
Let me turn now to my second topic that I think also
qualifies as deserving policy attention, namely that of the
receding bureaucratic niche of the NIH in life science policy.

When the modern NIH was created, beginning in about 1947,
the Director reported to the Surgeon General. There was almost
no other bureaucracy involved. The Surgeon General, Leonard
Scheele at the time, charged the Director of NIH to run the
institution as much like a university as he possibly could. When
Jim Shannon became Director in 1955, he did so. He had
substantial autonomy, and was strongly backed by the Surgeon
General. The Department of Health Education and Welfare was
created in 1953, but for the first five plus years of Shannon's
tenure it too left him relatively alone. In addition, he had
tremendous support in the Congress from Fogarty, Hill, Pepper,
Magneson and others. But gradually the bureaucracy proliferated
in replicating layers, and by the end of Shannon's tenure he was
chaffing under it with unconcealed annoyance. First HEW
expanded, then the Office of the Assistant Secretary for Health
was created and the Surgeon General's role began to fade, then
the Fountain Committee pressed for increased accountability, then
after the National Institute of Mental Health received
independent status the cancer lobby tried to achieve the same for
NCI, and nearly succeeded. The cost of keeping NCI within the
NIH structure was considerable relative autonomy, and direct
lines to OMB on their budget. This was followed by a succession
of independent authorities for other institutes, then by an
expansion of the number of Public Health Service agencies, and an
evermore stifling and dense bureaucracy in both HHS (its new
name) and in OASH.

When Shannon was Director he had many conversations with
President Eisenhower and ‘President Kennedy in the Oval Office.
He was in contact with Jerry Weisner at OSTP several times per
week. The contrast today is disheartening. Now the Secretary
speaks for NIH, or occasionally the ASH is asked to do so. The
NIH Director has no visible role in science policy compared to
that of the Director of NSF. The Director can contact OSTP, but
that office wasn't very effective during my NIH tenure. During
my time, I never met with the President or Vice President, and I
had few significant conversations with Secretary Heckler or
Secretary Bowen on the NIH matters, other than on a normal budget
review. Two successive panels have examined the structure of NIH
and the role and authorities of the Director and have recommended
major changes. As of today, all of these recommendations have
been rejected by the Secretary's office. In fact, my successor,
the current Acting Director, was told by the Undersecretary to
accept the fact that NIH is no different from any other Public
Health Service agency, and should expect no special prerogatives.
I don't believe that NIH is just another PHS agency. No
other PHS agency, or for that matter other government
institution, enjoys the international reputation for research and
training that NIH does. A Japanese poll rated intramural NIH the
best research institution in the world in any field. NIH didn't
achieve that status under the present stifling bureaucratic
structure, and probably never would have done so. More and more,-
NIH is being forced to accept the chilling management
restrictions that have so dogged others of our national
laboratories, and that does not auger well for the future.

My own feeling is that the country will not realize the full
potential of the life sciences to contribute to the welfare of
its citizens in health and in inivstry unless the life sciences
are better represented in White House policy affairs, and unless
the NIH Director can play a larger policy role. The Director of
NIH should participate in many White House committees and
councils, as an equal with the Directors of NSF, and NIST, and
rub shoulders with the Secretaries of Energy, or Agriculture, or
Education, as appropriate. Nevertheless, the NIH Director is
never included in any policy discussions at that level. I am
skeptical that such a role can be achieved without major
structural changes. We discussed two models at OSTDP: 1) a free
standing agency, but one retaining the NIH present’ congressional
committee relationships; 2) elevation of the NIH Director to an
Undersecretary position in HHS, a change similar to that recently
accorded NIST in the Commerce Department.

Finally, I think the role of the Life Science Advisor in
OSTP needs to be greatly strengthened. At the present, at the
Director and Associate Director levels there are four physicists
and one life scientist. The Life Science Office has two policy
analysts and a secretary, and such a staff is woefully inadequate
if the life sciences are to be effectively represented.
Incidentally, this allocation of resources to life sciences is
about one third the level provided when Dr. Healy was there with
Dr. Keyworth. During most of the years when the office was really
effective, the Life Science Director, Colin McLeod, or Ivan

Bennett, was the Deputy Director of the office, with substantial
resources.

I_know this letter has touched on many topics, and rambled a
bit. But I have attempted to make primarily two points. The
first is that I think we must increase our investment in
fundamental and applied research in. many areas, not @xcluding the
life sciences, but link this resolve with a broad systems
overhaul of our approach to international competitiveness. The
second is that especially with life sciences addressing many of
the issues of greatest concern to the populous, the time is
overdue for structuring the policy making apparatus of the
administration in such a way that the life sciences, and its
chief agency, the NIH, are more effectively represented.