The organization and structure of the national institutes of health

In the assessment of domestic federal programs and the agencies responsible for them, few have been as frequently and highly praised as the National Institutes of Health (NIH). Contributing to that success in part is an unusual organization and structure. Based on a series of semiautonomous, disease-oriented program divisions supplemented by several support units with a co-ordinative function performed by the Director, NIH, a remarkable and essential combination of administrative stability and flexibility, as well as scientific and political acceptability, has emerged. The changing environment in which NIH now functions, however, suggests the need for a greater degree of intra-NIH and extra-NIH program integration and co-ordination. Concomitantly, there must be more consistent federal policies, a clearer definition and understanding of "technology transfer" and additional resources for the directors of NIH and the individual Institutes.