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An expert panel told the US National Institutes of Health (NIH) this week that it should give the public a bigger voice in deciding how to spend its $14 billion annual budget. The panel's suggestions include setting up public liaison offices in all 21 of its institutes, as well as in the office of the NIH director.

The panel also calls for more diverse public representation on the director's advisory committee, and a stronger role for the committee in setting research priorities. And it recommends the creation of a Director's Council of Public Representatives to bring public opinion to the director.

In its report published on Wednesday (8 July), a committee of the Institute of Medicine (IOM) calls on the NIH to introduce broad changes to the way it communicates with the public about research decisions. The agency “must revamp its approach to public input and outreach — at every level — without delay,” writes the committee chairman, Leon Rosenberg, in the report. Rosenberg is a professor in the department of molecular biology at Princeton University.

“By creating formal links to the general public, NIH can ensure that all have a voice in what gets funded, and that more people understand how such decisions get made,” he says. Such changes “would underscore that openness is as important to the process as expertise and objectivity”.

The 120-page report, Scientific Opportunities and Public Needs: Improving Priority Setting and Public Input at the National Institutes of Health, was prepared by a 19-member committee that heard from researchers, NIH staff, disease advocacy groups and members of the public over five months.

It was mandated by Congress last year in a move reflecting the view of some members of Congress that the study would provide a needed line of defence for NIH against Congress's tendency to legislate on the details of research spending. They reasoned that the report could recommend changes in the way that NIH sets its priorities that would ultimately give less cause to Congress to meddle.

Disease advocacy groups have convinced other members of Congress that their causes need funding that is congressionally mandated because NIH's decision-making process is too closed.

The IOM report agrees that the NIH should consult a broader range of opinion: “NIH, especially the Office of the Director, does not have adequate channels through which the public can provide broad input into the NIH priority-setting process, or through which NIH can respond clearly to the public on issues of mutual concern.”

The report “generally” endorses the criteria by which NIH allocates research dollars as “reasonable and appropriate”. But it recommends that the agency should develop data comparing the costs of specific diseases against the resources devoted to them.

NIH officials have told Congress that such data is highly complex and can be misleading, partly because basic research in one field can yield unexpected applications in others. But the panel says that NIH should come up with reliable figures anyway.

“We believe it can't be brushed aside,” says Rosenberg. “If [the numbers] are done systematically and seriously, confidence will grow that this is a legitimate attempt.”

The report recommends — as did an IOM study in 1984 — that the NIH director should have greater authority to control spending priorities throughout the agency, in part by requiring each institute to submit stragetic plans annually.