Plan to restructure NIH would stall science, not streamline it

As budget negotiations heat up in Washington, the fate of the National Institutes of Health hangs in the balance. While most attention has understandably focused on proposals to slash its funding by as much as 40 percent, another, equally troubling idea is quietly gaining traction: a complete reorganization of the NIH’s structure.

One recent proposal by members in Congress would consolidate the NIH’s 27 specialized institutes into just eight, claiming it would reduce redundancy and improve efficiency. 

But this plan would not streamline science — it would stall it. Merging smaller institutes into larger ones would increase bureaucracy, not reduce it. 

And let’s be honest: When has more government bureaucracy ever led to more innovation?

Reorganizing the NIH may sound like modernization in theory. In practice, it would unleash years of administrative upheaval — rewriting missions, reassigning staff, restructuring advisory councils and disrupting funding priorities.

The resulting delays would slow our country’s scientific engine and give major global competitors like China a chance to pull ahead in the race for leadership in biotechnology and medicine, putting both our innovation and national security at risk.

America’s world-leading biomedical research ecosystem depends on the NIH — industries that support more than 10 million U.S. jobs and generate more than $3 trillion in economic activity, about 11.5 percent of our GDP. 

Discoveries made in university labs with NIH funding are developed into life-saving treatments by private pharmaceutical and biotech companies. In fact, 99.4 percent of FDA-approved drugs are based on NIH-supported research. 

Everyone who has ever taken medication, from ibuprofen for a headache to immunotherapy for cancer, has benefited from this powerful public-private partnership, with the NIH at its heart.

The NIH is the most successful biomedical research institution in human history, envied by countries that have spent decades trying to replicate its model. Why? Because it works. 

The current system of specialized institutes at the NIH has led to transformative breakthroughs in cancer therapies, heart disease treatments, infertility, brain-machine interfaces and countless others. These achievements did not happen in spite of the NIH’s structure, they happened because of it.

One of NIH’s greatest strengths is that each institute focuses on a specific public health challenge, from cancer and aging to mental health and infectious disease. 

These are not bureaucratic silos; they are engines of innovation, each tailored to the unique biology of the conditions they study. Specialized research is essential because what works for treating cancer will not work for understanding the causes of autism. It’s apples and oranges.

Here is one example of how the proposed reorganization could harm science: Institutes that currently focus separately on neurological disorders, oral health and vision would be combined into a single “Institute for Neuroscience and Brain Research.” No clear explanation has been given, but the reasoning seems to be purely anatomical—if it is in the head, it can be studied together. 

This would lump together research on Parkinson’s disease, tooth development and blindness, despite their vastly different biology and treatment needs. The result won’t be the best apples and oranges ever grown — it’ll be fruit sludge.

Why consider such a sweeping overhaul? While consolidation is often promoted as a path to efficiency and modernization, the broader implications raise serious concerns. 

Reducing the number of institutes would concentrate decision-making power, increasing the risk of political influence over scientific priorities. Currently, each institute director has significant autonomy in how congressionally appropriated funds are spent — a structure designed to protect research agendas from shifting political winds. 

Diluting this decentralization would make science more vulnerable to ideological pressure from either side of the aisle. At a time when public trust in the NIH is already strained, the proposed reform would only deepen the problem.

Equally concerning, merging institutes may diminish the role of patient advocacy groups that have long supported specialized research efforts. 

These groups do more than lobby policymakers, they help ensure that NIH priorities remain aligned with the needs of patients. Forcing them to compete for attention within broader, less focused institutes could weaken their impact and silence the voices of the patients they represent.

There is no question that the NIH must evolve to meet today’s scientific and societal challenges. Many scientists agree that some reform is long overdue. With a new director now leading the NIH, there is a real opportunity to strengthen its foundation, help it respond more effectively to today’s health challenges and restore public trust. 

But the proposed reorganization is no such reform. It is a blunt instrument — one that would weaken the very foundation of America’s scientific leadership in biomedical research, with consequences that could last for generations.

Cory Miller is a professor at the University of California-San Diego who has been continuously funded by the NIH for more than 20 years, served on numerous NIH grant review sessions and been involved in several NIH committees.