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Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

NIH EXTRAMURAL CENTER PROGRAMS

Criteria for Initiation and Evaluation

Committee for Assessment of NIH Centers of Excellence Programs

Board on Health Sciences Policy

Frederick J. Manning, Michael McGeary, Ronald Estabrook, Editors

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the National Institutes of Health through Contract/Grant No. N01-OD-4-2139, TO#117. The views presented in this report are those of the Institute of Medicine Committee for Assessment of NIH Centers of Excellence Programs and are not necessarily those of the funding agencies.

Library of Congress Cataloging-in-Publication Data

NIH extramural center programs : criteria for initiation and evaluation / Committee for Assessment of NIH Centers of Excellence Programs, Board on Health Sciences Policy ; Frederick J. Manning, Michael McGeary, Ronald Estabrook, editors.

p. ; cm.

Includes bibliographical references.

ISBN 0-309-09152-7 (pbk.)

1. National Institutes of Health (U.S.) 2. Medicine—Research—Government policy—United States. 3. Medicine—Research—United States—Evaluation. 4. Medicine—Research—United States—Finance. 5. Federal aid to medical research—United States.

[DNLM: 1. Financing, Government—economics—United States. 2. Health Policy—United States. 3. Program Evaluation—United States. 4. Research Support—economics—United States. WA 540 AA1 N691 2004] I. Manning, Frederick J. II. McGeary, Michael G. H. III. Estabrook, Ronald W. IV. Institute of Medicine (U.S.). Committee for Assessment of NIH Centers of Excellence Programs.

R854.U5N535 2004

610′.72′073—dc22

2004004828

International Standard Book Number 0-309-53028-8 (PDF)

Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2004 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Adviser to the Nation to Improve Health

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

COMMITTEE FOR ASSESSMENT OF NIH CENTERS OF EXCELLENCE PROGRAMS

RONALD ESTABROOK, (Chair), Professor of Biochemistry and Chair, Department of Biochemistry,

University of Texas Southwestern Medical Center at Dallas

SUSAN E. COZZENS, Professor and Chair,

School of Public Policy, Georgia Institute of Technology, Atlanta

IRWIN FELLER, Senior Visiting Scientist,

American Association for the Advancement of Science, and

Professor Emeritus of Economics,

Institute for Policy Research and Evaluation, Pennsylvania State University, University Park

CHARLES K. FRANCIS, President,

Charles R. Drew University of Medicine and Science, Los Angeles, California

RONALD G. GELLER, Senior Associate,

Health Research Associates, Gaithersburg, Maryland

DAVID G. KAUFMAN, Professor and Vice Chair of Pathology and Laboratory Medicine, Professor of Biochemistry and of Toxicology,

School of Medicine, University of North Carolina, Chapel Hill

J. RICHARD LANDIS, Director, Division of Biostatistics, Vice Chair,

Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia

STEPHEN MCCONNELL, Vice President,

Advocacy and Public Policy, Alzheimer’s Association, Washington, D.C.

RUTH MCCORKLE, Professor and Chair, Doctoral Program, and Director of the Center for Excellence in Chronic Illness Care,

Yale University School of Nursing, New Haven, Connecticut

NICOLA C. PARTRIDGE, Professor and Chair,

Department of Physiology and Biophysics, Robert Wood Johnson Medical School, Piscataway, New Jersey

MICHAEL SAAG, Professor of Medicine and Director,

1917 AIDS Outpatient Clinic, University of Alabama, Birmingham

S. LEONARD SYME, Emeritus Professor of Epidemiology,

Division of Public Health Biology and Epidemiology, University of California, Berkeley

MYRON L.WEISFELDT, Professor of Medicine and Director,

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

Board on Health Sciences Policy Liaison

MICHAEL LOCKSHIN, Director,

Barbara Volcker Center for Women and Rheumatic Disease, and

Co-Director,

Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York, New York

Study Staff

FREDERICK J. MANNING, Study Director

NATASHA DICKSON, Senior Project Assistant

BENJAMIN HAMLIN, Research Assistant

Institute of Medicine Staff

ANDREW POPE, Director,

Board on Health Sciences Policy

MELVIN WORTH, Scholar-in-Residence

TROY PRINCE, Administrative Assistant,

Board on Health Sciences Policy

CARLOS GABRIEL, Financial Associate

Consultant

MICHAEL MCGEARY

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

Independent Report Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

John S. Greenspan, University of California, San Francisco

Steven Hyman, Harvard University

David Korn, Association of American Medical Colleges

Edward D. Miller, The Johns Hopkins University

Jordan S. Pober, Yale University

David Roessner, SRI International

Joan L. Samuelson, Parkinson’s Action Network

Brian L. Strom, University of Pennsylvania

Terrie Wetle, Brown University

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions

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Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by William N. Kelley, Professor of Medicine, Biochemistry, and Biophysics at the University of Pennsylvania Medical School, appointed by the Institute of Medicine, and Floyd E. Bloom, Chairman, Department of Neuropharmacology, The Scripps Research Institute, appointed by the NRC’s Report Review Committee. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

Preface

Research in the biomedical sciences in the United States is recognized to be at the pinnacle of success. This reputation is due in large part to the generous federal support for research provided by Congress, which appropriates the budget required to carry out the multitude of activities directed by the National Institutes of Health (NIH). This commitment by Congress over the last years is evidenced by ever increasing budgets for biomedical research. Increased funding has resulted in the ability of the scientific community to expand the portfolio of diseases studied while simultaneously developing and applying new techniques of experimentation. As a result, the biomedical sciences carried out in the United States are acknowledged to be at the forefront of major advances essential for extending the health and wellbeing of the general population.

NIH serves as the critical hub of this success. The wisdom and guidance of leaders at NIH together with the mechanisms developed over the years for selecting for support the very best ideas generated by scientists, principally in academic institutions, provide an unbeatable mix. The major share of support for research has been dedicated to funding ideas proposed by individual investigators and evaluated by a critical peer review system. However, biomedical science is changing. As our understanding of biology increases, the conduct of disease-oriented science is becoming more complex. Scientists with differing expertise and skills are now required to function as multidisciplinary teams to bring new approaches to solving complex issues. Further, the translation of basic science findings to clinical application requires unique settings where cross-disciplinary interactions and meth-

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

odological sharing can occur. It is this “team approach” to problem solving that one anticipates will dominate the future direction of biomedical research and thus lead to new discoveries and new therapies.

In the early 1960s the NIH established the General Clinical Research Centers program to provide loci for facilitating the cross-fertilization of scientists and clinicians that would foster the translation of fundamental science to patient care. As the years progressed the wisdom of this approach was evidenced by the establishment in the 1970s of Cancer Centers and Specialized Centers of Research for cardiovascular research. Today we note a multitude of centers that encompass a wide range of topics related to disease processes. However, support of centers is frequently expensive because of their multi-disciplinary structure and application to clinical care.

The success of centers supported by NIH has attracted the attention of members of Congress, many of whom have been urged by disease-oriented advocacy groups to seek similar funding for research in their special interests. This situation presents a dilemma for Congress and for NIH, because there is the temptation “to rob Peter to pay Paul” when dividing up the designated funding available for the support of biomedical research. Congress asked the Institute of Medicine (IOM) to carry out a study that would provide guidance to both Congress and the NIH in deciding which diseases warrant additional financial support by the establishment of new “Centers of Excellence” programs at NIH and which research areas are adequately supported by the present arrangements.

An excellent committee was established by the National Research Council and the IOM, and initial meetings revealed the large number (about 1,200) of centers that are now supported by NIH. The committee soon learned that the portfolio of centers supported by NIH is varied and the mechanisms of selection, evaluation, and initiation are not centralized at NIH. The size and funding for extramural centers supported by NIH are approximately equivalent to the size and funding of the intramural program at NIH. Likewise, the diversity of extramural centers equals the diversity of the intramural research programs supported by NIH. Much of the discussion of the committee at its five meetings was dedicated to understanding better the similarities and differences of the extramural centers supported by NIH. The committee decided at an early stage of its deliberations that a systematic approach was necessary in defining, establishing, and evaluating centers. The committee agreed that once the process of establishing new center programs is better defined and made more transparent, the joint efforts of Congress and NIH in debating the value of new center programs would be facilitated. The committee recognized the value of centers and never questioned the continued usage of this mechanism of support, in particular for translation research. Questions of the future role of centers and the shape and form into which centers will evolve in the next

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

decade, in particular in this period where “team research” is emphasized, remain unanswered. It is our hope that the enclosed report will continue to add to the strength and success of this multidisciplinary approach to research in the biomedical sciences.

Many individuals contributed valuable information and data to the committee through formal presentations, written submissions, or informal contacts with project staff. We are grateful to all of the following for their generous assistance: Paula Allen-Meares, James Anderson, Christine Bachrach, Kenneth Berns, Roger Bulger, Merry Bullock, Elaine Collier, Jacqueline Dunbar-Jacob, Steve Foote, Katy French, Myron Genel, John Haaga, E. Tessa Hedley-White, Kathie Hendrick, Anne Houser, Steven Hyman, Ruth Kirschstein, Steven Koslow, David Korn, Virginia Ladd, Anita Linde, Nita Maihle, Robert Moore, Creighton Phelps, Mona Rowe, John Schwab, Belinda Seto, Charles Sherman, Steven Teitelbaum, Judy Vaitukaitis, Marina Volkov, Gemma Weidlinger, Myrl Weinberg, Marion Zatz, Steven Zeisel, and Joan Levy Zlotnick.

As committee chair I am acutely aware of the contributions that the IOM staff has made to the success of the study. Special thanks and acknowledgment are due to project assistant Natasha Dickson, who made our meetings and travel as comfortable and convenient as possible, provided outstanding secretarial help throughout the study, and painstakingly copy-edited our final product. Michael Lockshin, liaison from the Board on Health Sciences Policy (BHSP), provided invaluable insight from his perspective as a former director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. IOM Scholar-in-Residence Mel Worth and BHSP director Andy Pope provided sage advice from start to finish. I am particularly grateful to study director Rick Manning and special consultant Mike McGeary for their skilled and professional support in shepherding the committee through its task. Finally, I want to acknowledge the individual and collective contributions of the committee members. They represent an admirable example of busy but unselfish professionals volunteering their limited time tending to the scientific “commons” on which we all depend. It was a special opportunity to have worked with this outstanding group.

Ronald Estabrook, Chair

Committee for Assessment of NIH Centers of Excellence Programs

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
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Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
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Acronyms and Abbreviations


ACD

Advisory Committee to the Director

ADC

Alzheimer’s Disease Center

AIDS

acquired immune deficiency syndrome

ApoE4

apolipoprotein E4


BRIN

Biomedical Research Infrastructure Network

BSA

Board of Scientific Advisers


CAM

complementary and alternative medicine

CDC

Centers for Disease Control and Prevention

CFAR

Center for AIDS Research

CJ

Congressional Justification Budget

COBRE

Centers of Biomedical Research Excellence

COSEPUP

Committee on Science, Engineering, and Public Policy

CPEA

Collaborative Programs of Excellence in Autism

CRISP

Computer Retrieval of Information on Scientific Projects

CSR

Center for Scientific Review


DBSB

Demographic and Behavioral Sciences Branch

DHHS

Department of Health and Human Services

DMD

Duchenne muscular dystrophy

DNA

deoxyribonucleic acid

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

EEHSR

education, epidemiology, and health services research

ERC

Engineering Research Center

EXPORT

Excellence in Partnerships for Community Outreach, Research on Disparities in Health, and Training


FDA

Food and Drug Administration

FICC

federal interagency coordinating committee

FY

fiscal year


GDP

gross domestic product

GPRA

Government Performance and Results Act


HESC

human embryonic stem cell

HIV

human immunodeficiency virus


IBD

inflammatory bowel disease

IdeA

Institutional Development Award

IMPAC

Information for Management, Planning, Analysis, and Coordination

IOM

Institute of Medicine

IRPG

Interactive Research Project Grant


MAMDC

Multipurpose Arthritis and Musculoskeletal Disease Center

MDA

Muscular Dystrophy Association

MD-CARE Act

Muscular Dystrophy Community Assistance, Research and Education Amendments of 2001

MIT

Massachusetts Institute of Technology


NCAB

National Cancer Advisory Board

NCCAM

National Center for Complementary and Alternative Medicine

NCI

National Cancer Institute

NCMHD

National Center on Minority Health and Health Disparities

NCRR

National Center for Research Resources

NEI

National Eye Institute

NHGRI

National Human Genome Research Institute

NHLBI

National Heart, Lung, and Blood Institute

NIA

National Institute on Aging

NIAAA

National Institute on Alcohol Abuse and Alcoholism

NIAID

National Institute of Allergy and Infectious Diseases

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

NIAMS

National Institute of Arthritis and Musculoskeletal and Skin Diseases

NIBIB

National Institute of Biomedical Imaging and Bioengineering

NICHD

National Institute of Child Health and Human Development

NIDCD

National Institute on Deafness and Other Communication Disorders

NIDCR

National Institute of Dental and Craniofacial Research

NIDDK

National Institute of Diabetes and Digestive and Kidney Diseases

NIDA

National Institute on Drug Abuse

NIEHS

National Institute of Environmental Health Sciences

NIGMS

National Institute of General Medical Sciences

NIH

National Institutes of Health

NIMH

National Institute of Mental Health

NINDS

National Institute of Neurological Disorders and Stroke

NINR

National Institute of Nursing Research

NORD

National Organization for Rare Disorders

NPEBC

National Programs of Excellence in Biomedical Computing

NRC

National Research Council

NSF

National Science Foundation


OBSSR

Office of Behavioral and Social Sciences Research

OMB

Office of Management and Budget

ORD

Office of Rare Diseases

ORWH

Office of Research on Women’s Health


PA

Program Announcement

PAR

PA reviewed in an institute

PAS

PA with set-aside funds

Ph.D.

Doctor of Philosophy

PHS

Public Health Service

P.L.

Public Law


R&D

research and development

RCMI

Research Centers in Minority Institutions Program

RFA

Request for Applications

RFP

Request for Proposals

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
×

RIMI

Research Infrastructure in Minority Institutions Program

RNA

ribonucleic acid

RPG

Research Project Grant


SCCOR

Specialized Center of Clinically Oriented Research

SCOR

Specialized Center of Research

SIDS

sudden infant death syndrome

SPORE

Specialized Program of Research Excellence

STAART

Studies to Advance Autism Research and Treatment

STC

Science and Technology Center

STD

sexually transmitted disease


VHA

voluntary health association

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
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Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
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Tables, Figures, and Boxes

TABLES

2-1

 

NIH Budget by Mechanism (in millions of current dollars),

 

37

2-2

 

Number of Center Awards by Institute, FY1992-FY2001,

 

38

2-3

 

Funding of Center Awards, by Institute, FY1992-FY2001 (in millions of dollars),

 

40

2-4

 

NIH Extramural Research Mechanisms, FY2002,

 

46

3-1

 

Origins and Intended Purposes of Recent Center Programs,

 

66

FIGURES

2-1

 

Distribution of research center awards by state, FY2002,

 

35

2-2

 

Center and research project grant (RPG) funding as percentage of NIH budget, FY1992-FY2004,

 

36

2-3

 

Center funding as a percentage of the institute’s budget, FY2002,

 

39

2-4

 

Number of specialized, core, and comprehensive center awards, FY1992 and FY2001,

 

42

2-5

 

Funding of specialized, core, and comprehensive center awards, FY1992 and FY2001 (in constant dollars),

 

42

2-6

 

Average size of specialized, core, and comprehensive center awards, FY1992 and FY2001 (in constant dollars),

 

44

Suggested Citation:"Front Matter." Institute of Medicine. 2004. NIH Extramural Center Programs: Criteria for Initiation and Evaluation. Washington, DC: The National Academies Press. doi: 10.17226/10919.
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BOXES

ES-1

 

Suggested Criteria for Initiation of Center Programs,

 

8

ES-2

 

Potential Indicators for Evaluating NIH Center Programs,

 

12

1-1

 

NIH Research Center Grants,

 

17

4-1

 

Suggested Criteria for Initiation of Center Programs,

 

102

5-1

 

Some Previous NIH Evaluations of Specific Center Programs,

 

109

5-2

 

Potential Indicators for Evaluating NIH Center Programs,

 

119

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Grants for research centers located in universities, medical centers, and other nonprofit research institutions account for about 9 percent of the National Institutes of Health budget. Centers are popular because they can bring visibility, focus, and increased resources to bear on specific diseases. However, congressional debate in 2001 over proposed legislation directing NIH to set up centers for muscular dystrophy research highlighted several areas of uncertainty about how to decide when centers are an appropriate research mechanism in specific cases. The debate also highlighted a growing trend among patient advocacy groups to regard centers as a key element of every disease research program, regardless of how much is known about the disease in question, the availability of experienced researchers, and other factors. This book examines the criteria and procedures used in deciding whether to establish new specialized research centers. It discusses the future role of centers in light of the growing trend of large-scale research in biomedicine, and it offers recommendations for improving the classification and tracking of center programs, clarifying and improving the decision process and criteria for initiating center programs, resolving the occasional disagreements over the appropriateness of centers, and evaluating the performance of center programs more regularly and systematically.

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