Recommendation 3
Institutes focused on particular diseases, organs, or symptoms, as are current ICs, have considerable merit, but increased understanding of biology and disease has made clear that defects in a particular biological mechanism or pathway can cause distinct diseases that cross those categorical boundaries. For example, failure to produce a functional cellular structure called a primary cilium can result in disorders ranging from kidney, liver, lung or pancreas dysfunctions, retinal degeneration, loss of smell, various brain anomalies, polydactyly (extra fingers or toes), to infertility. Thus, a conceptual or technological break- through in an IC pursuing one of these defects could well benefit research or increase understanding in several others. Siloing of research, researchers, and research findings into separate NIH ICs can be problematic, inspiring many proposals over several decades to reduce the number of institutes and categorize them more “rationally”. Indeed, one such proposal was put forth as part of a “Framework for Discussion” in June 2024 by the House Energy and Commerce Committee, which authorizes NIH. While the current institute structure involves a certain amount of inefficiency, reconfiguring the IC org chart risks simply creating a new set of silos that complicate or inhibit in different ways the capacity to recognize and react to emerging areas of potential cooperation and synergy. As a more efficient and flexible alternative, we recommend a major expansion of the Common Fund, a mechanism enacted through the 2006 Congressional comprehensive reauthorization of NIH for up to 5% of the NIH budget, in which the NIH Director provides funding for emerging or under-explored scientific opportunities or knowledge gaps, to be pursued jointly by at least two ICs. Any two or more ICs would be encouraged to co-design funding opportunities that leverage resources and programs currently isolated within those ICs. By jump-starting successful “perforation of silos”, this program will motivate further inter-IC coordination and interaction. Such success could be extended in the future to interactions across agency boundaries, such as those needed in Recommendation 2 for development of ML/AI technologies for biomedical research and health. A substantial increase in the current Common Fund appropriation, from $672M in FY24 to $1B in FY25 and expanding in later years to the level authorized by Congress in 2006, while still elevating the IC appropriations, would have a significant impact by accelerating IC interactions and synergies.
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