Some Candid and Scathing Opinions from a Former NIH Insider

Guest article by Jeremy Berg

Introduction by Stuart Buck:

This is a guest column from Jeremy Berg, who is currently Associate Senior Vice Chancellor for Science Strategy and Planning, Health Sciences, and Professor of Computational and Systems Biology, School of Medicine, at the University of Pittsburgh. Previously, he was editor-in-chief of Science magazine and the Science family of journals, and Director of the National Institute of General Medical Sciences (NIGMS), one of the National Institutes of Health, where he oversaw a $2 billion budget supporting basic research.

Berg has some crucial insights into the statutory process for reforming NIH’s structure and organization—insights that would be much-needed in any future NIH reform bill, efforts to improve government efficiency, and the like.

More provocatively, Berg opines that Francis Collins “could be a bully, bordering on a tyrant.”

It is rare to see someone speak so candidly about the leader of a science funding agency. No one wants to bite the hand that feeds them, after all. But it would be a public service if more folks followed Berg’s example by telling their own side of the story.

Finally, we would be willing to print a response from Francis Collins.

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From Jeremy Berg:

I joined the NIH staff as Director of the National Institute of General Medical Sciences (NIGMS) in 2003. While my appointment was under consideration, a report from the Institute of Medicine (now the National Academy of Medicine) was released entitled “Enhancing the Vitality of the National Institutes of Health.”

This report made numerous observations and recommendations about NIH organization and possible reorganization scheme. However, there was no mechanism for exploring or implementing any of these recommendations without initiating immediate political fights.

NIH Director pushed Congress to create the Scientific Management Review Board (SMRB) to provide such mechanisms. I was involved with the SMRB since its inception and have very strong feelings about how it was used, misused, and abandoned. My passion on these issues will undoubtedly show through.

The NIH comprises 27 institutes and centers, 24 of which have grant-making authority. This structure was not arrived at through a rational process, but rather through episodic congressional action based on perceived needs and political pressures.

The National Institute of General Medical Sciences (NIGMS) (which I directed from 2003-2011) was an attempt to slow down the creation of new institutes, with authorizing language that NIGMS was responsible for any disciplines not covered by any institute and those overlapping 2 or more institutes.

NIGMS became focused on basic biomedical sciences as the 1960s became a golden age of molecular biology (with the elucidation of the genetic code, determination of numerous protein structures, and so on). This was largely due to strong leadership from Frederick Stone (1964-70), DeWitt Stetten (1970-74), and, particularly, Ruth Kirschstein (1974-93). Ruth Kirschstein was an amazing person. She was deeply caring, had an incredible work ethic, high standards, and tremendous leadership skills. She was the first woman to lead an NIH Institute and served as Acting Director of NIH twice.

In 2006, NIH (led by Elias Zerhouni) worked with Congress on the NIH Reform Act of 2006. Among other things, this limited the number of institutes and centers to 27, and created the Scientific Management Review Board, a committee reporting to the NIH Director, Congress, and the HHS secretary.

The SMRB (NIH Reform Act of 2006 (Pub. L. 109-482)) provides organizational authorities to HHS and NIH officials to:

• (1) Establish or abolish national research institutes;

• (2) reorganize the offices within the Office of the Director, NIH including adding, removing, or transferring the functions of such offices or establishing or terminating such offices; and

• (3) reorganize, divisions, centers, or other administrative units within an NIH national research institute or national center including adding, removing, or transferring the functions of such units, or establishing or terminating such units.

I was pleased to be one of the founding members of the SMRB. The first working group I participated in was focused on "Deliberating Organizational Change and Effectiveness.”

We wrote a report (available on the Wayback Machine) that was also called "Deliberating Organizational Change and Effectiveness," which was very straightforward. We noted that NIH Institutes and Centers have various stakeholders. Wholesale reorganization of NIH could be extremely messy but incremental changes (e.g. merging institutes) could be beneficial. This would, however, require consultation with various stakeholders, careful budget consideration, and so on.

Our report was submitted and accepted. Other working groups starting working on substance abuse and addiction and on translational medicine and therapeutics.

By this point, President Obama had been elected and Francis Collins had replaced Elias Zerhouni as NIH Director. The substance abuse and addiction working group was focused on the underlying science of addiction and overlaps between institutes. They made the recommendation that the National Institute of Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) should be merged into a single entity. This had been recommended by various groups for years and many (including me) regarded this a test case.

The translational science working group examined possible structures. There were reports that Collins wanted to take all clinical and translational science out of the institutes into one structure. Needless to say, directors such as Harold Varmus (NCI) and Tony Fauci (NIAID) were not supportive.

Before the translation working group reported, Collins announced at an Institute Directors meeting that he was recommending to the HHS Secretary that the National Center for Research Resources (NCRR) be abolished. NCRR supported infrastructure, including clinical research. I was extremely surprised and upset.

After the SMRB had codified a thoughtful process for considering such changes, I did not understand why he would make this recommendation without any transparent process. It did not make any sense on its face. I walked back to my office thinking that surely other directors would push back and force such a change to go through the statutory process.

I spent the weekend before the SMRB meeting regarding the translational working group report (which was to recommend the creation of a new translational center) on the phone. Everyone I could reach agreed (at least to my face) that hastily abolishing NCRR was a bad idea.

The next day (and before the SMRB meeting) Francis Collins called a meeting to say that they would go through some process after the recommendation. I did not find this the least bit convincing or comforting. I was very anxious about the SMRB meeting, but thought I still had some allies.

The SMRB meeting occurred, and the translational science report was presented. The abolishment of NCRR was never explicitly discussed. I raised a question about whether the working group had considered NCRR as a home for translational science. The chair said "yes", but other members said they never did.

I tried to continue the discussion, but no one else stepped up. The vote was called, and the vote was 12-1 (with me as the sole dissenter). I was extremely disappointed and frustrated with my colleagues and my inability to be more effective.

NIH did go through a pro forma process about NCRR (1 hour calls with 40 minute presentations and time for 3 or so questions). NIH and Collins then broke up NCRR with some programs going to NIGMS and other institutes and some to an "Interim Infrastructure Office" in the NIH Director's Office.

I was not shy about my disagreements with the process. I felt the need to document what had occurred and why it was a very bad precedent. Thus, this article in Science.

After the addiction working group recommended merging NIDA and NIAAA, NIH studied this merger in an appropriate way. However Collins, apparently in part due to pressure from the alcoholic beverage industry, backed off and decided on "functional integration" instead.

To me, this signaled that NIH (at least under Collins) would never try to rationalize NIH structure without some other agenda. The SMRB had been made completely ineffective, and they subsequently stopped meeting in 2015 (although they were not officially disbanded).

Congress eventually noticed this and asked NIH what was going on. The SMRB just met again for the first time in November. The recent meeting set the stage for future action. Time will tell.

I think the SMRB was a thoughtful and strategic idea. I hope that Collins' abuse and neglect of the SMRB will not lead to too high a price. If Congress and the new administration allow it to work, that will be a healthy development.

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A few final thoughts on this:

During public discussions on NCRR, NIH Deputy Director Larry Tabak said that "you would not create NCRR if you were designing NIH from scratch." I disagreed vehemently. NCRR was like The Department of Public Works. You need a team with expertise to manage roads, sewers, libraries, etc.

Why did Collins want to do away with NCRR? Congress had limited the number of institutes and centers to 27. Thus, to create a translational center (NCATS), one would need to get rid of something. Collins repeatedly denied that this was a factor, but I repeatedly asked him why. He said that other institute directors thought NCRR was not well run. I asked who he was referring to so I could examine their concerns. He did not respond until I pushed again and again. He finally said, "You have to remember that I used to be an Institute Director."

Collins could be a bully, bordering on a tyrant, but delivered with an "aw shucks" style. He would often push through social cues that would restrain others in the NIH leadership. I was very concerned that no one else spoke up in defense of NCRR at the SMRB meeting. Some told me essentially, “Francis is going to this anyway so we will just make it more painful for everyone if we oppose it.” In my view, such capitulation in advance is a very dangerous rationalization that will lead to bad outcomes and the undermining of key structures.