WASHINGTON -- Once upon a time, it was called the National Institute of Health. Not institutes, but institute -- singular.
That was 1937, when the US biomedical bureaucracy had barely been invented.
Today, the NIH contains 27 institutes and centers, each focused on a particular ailing body part, class of disease, or inevitable aspect of life such as aging -- and each with its own budget, support staff, and committee of expert advisers.
Now Congress is thinking about pruning that Bethesda bramble by reauthorizing the agency -- a process that gives legislators an opportunity to make structural and administrative changes beyond those they make indirectly through the budgeting process.
At a hearing last week, several members of a House subcommittee pressed NIH director Elias A. Zerhouni to concede the $28 billion agency needs a makeover.
''Unfortunately, NIH has grown like topsy-turvy," said House Energy and Commerce chairman Joe Barton, Republican of Texas, stopping short of pointing any fingers of blame given Congress' widely recognized role in most of that expansion. ''While the motivation behind this explosive growth has certainly been sincere, the individual organizations were created arbitrarily, usually without benefit of systemic analysis or review of the efficiency of this structure."
Health subcommittee chairman Nathan Deal, Republican of Georgia, echoed those thoughts, saying NIH would benefit from ''much-needed reform in the agency's administrative structure."
Zerhouni agreed that certain efficiencies could be attained by combining some of the boxes on NIH's crowded organizational chart. He also noted that to solve some problems arising from box proliferation he was creating a new box for the chart -- the Office of Portfolio Analysis and Strategic Initiatives. That office is to coordinate the increasingly interrelated missions of NIH's various centers and institutes.
''What we have is a hand with 27 strong fingers, but I'm not sure the palm is strong enough to coordinate all that," Zerhouni said. The new office, set to open this fall and budgeted for $2 million for fiscal 2006, would bolster a trend toward ''cross-cutting" research and interinstitute collaboration that Zerhouni has championed since his arrival in 2002.
Despite several starts, Congress has not reauthorized NIH since 1993, and there is no guarantee it will succeed this time. Under the Public Health Service Act of 1944, NIH has an authority to conduct research that never expires, Zerhouni said, so the agency has not had to undergo a comprehensive reauthorization process before getting its annual appropriations approved.
Hill watchers said the effort could be successful this term. One reason is that Congress has completed a five-year doubling of the agency's budget, a process that has inspired closer oversight on Capitol Hill. Also, congressional trust in the agency has not been helped by recent revelations that some NIH scientists broke agency rules regarding the disclosure of outside consulting activities with drug and biotechnology companies.