National Institutes of Health (NIH)

DEFINITION: One of eleven agencies constituting the US Department of Health and Human Services

History and Mission

The National Institutes of Health (NIH) is a US federal agency that occupies a multibuilding campus in Bethesda, Maryland. It consists of a variety of offices, institutes focused on specific medical problems, research laboratories and centers, a center for scientific review, and a national medical library. Its main goal is to discover knowledge that will improve the state of public health for all persons, especially those in the US. This goal extends to all medical conditions afflicting men, women, and children of all ethnic backgrounds. It also extends to seeking knowledge in areas of basic biological research, clinical research, and research on policy and practice in healthcare.

The National Institute of Health was formally established by the Ransdell Act of 1930, which bestowed the name on what was formerly called the Hygienic Laboratory (HL) of the Marine Hospital Service (MHS) in New York. The Ransdell Act also allowed for the establishment of fellowships for basic medical and biological research. The very beginnings of the NIH extend back to 1887, however, when basic laboratory work into medical problems was pursued by the MHS, the founding body of the US Public Health Service (PHS). The MHS was formed in 1798 to provide hospital care for seamen, but by the 1880s, it had shifted its focus to screening ship passengers for infectious diseases capable of starting epidemics.

New European research in the 1880s suggesting that microorganisms caused such diseases spurred American interest in medical research and helped form the original HL. Work by the HL continued, with the laboratory eventually moving from the MHS to its own Washington, DC, campus. The study of microorganisms continued, extending from study of individual persons to studying the effects of bacteria on water and air pollution. Progress for such work was rewarded in 1901 with governmental money for the construction of a building (completed in 1904) to house the HL and further foster work focused on advancing public health. Because the value of such work was not well established, however, no permanent funding was provided, leaving the organization subject to ongoing evaluation and supplemental funding.

In 1902, the MHS was reorganized and renamed the Public Health and Marine Hospital Service (PH-MHS); in 1912, it adopted the shortened name of the Public Health Service (PHS). During the intervening time, the HL continued its work and expanded to work in chemistry, pharmacology, zoology, immunology, and the regulation and production of vaccines and antitoxins. Additionally, new scientific staff were added to the staff of medical doctors already on board. Changes in the mission of the organization in 1912 also opened the door for the pursuit of research on noncontagious diseases and water pollution. This work continued during World War I in the form of examining sanitation, anthrax outbreaks, smallpox, tetanus, influenza, and other combat-related conditions. The success of the PHS’s work in these areas caught the attention of legislators and resulted in the Ransdell Act of 1930, which established both the National Institute of Health and the practice of setting aside public monies for funding medical research. In 1937, the National Cancer Institute (NCI) was created. In 1944, the PHS formally designated the NCI as a component of the NIH, setting the pattern of a problem-focused structure within the NIH that continues to the present.

World War II led the NIH to focus almost exclusively on war-related problems. This involved examinations of fitness for military service and issues such as dental problems and syphilis. The effects of hazardous substances and conditions on workers in war industries; risks armed service professionals faced from lack of oxygen, cold temperatures, and blood clots while flying; burns, shock, bacterial infections, and fever; and the development of vaccines and therapies for tropical diseases such as malaria also composed much of its work during this time.

Successes established during the wars by such medical research led the PHS to take the 1944 Public Health Service Act to Congress. This act led to grant-funding mechanisms being extended from the NCI alone to the entire National Institute of Health. Additionally, an increasing public interest in health organizations caused Congress to create additional institutes for research on mental health, dental diseases, and heart disease between 1946 and 1949. In 1948, the National Heart Act allowed for the formal pluralization of the National Institutes of Health, rather than a singular institute with the NCI as a subinstitute. The Public Health Service Act of 1944 also provided funding for the Warren Grant Magnuson Clinical Center, which opened in 1953 to focus exclusively on clinical research on health.

From this point forward, each of the individual institutes now composing the NIH came into being. By 1960, there were ten institutes, and by the mid-2020s, there were twenty-seven institutes and centers. As different health interests develop and advances in medical knowledge are needed, the NIH has responded by allocating its resources to pursue goals in those areas. This has been done both by developing institutes and also by creating specialized offices to pursue contemporary medical problems.

Illness and medicine know no boundaries, however, so the NIH has also maintained an interest in global public health issues. Such interest was formally shown in 1947, when grants were first awarded to investigators abroad. Similarly, in 1968, the John E. Fogarty International Center (FIC) was created to coordinate international research efforts, involving liaisons with the World Health Organization and a variety of international research organizations. The FIC also supports language translation, documentation, and reviews of new health findings. It facilitates biomedical communications through its maintenance of the National Library of Medicine (NLM), MEDLINE, CATLINE, AIDSLINE, and numerous other databases for researchers, physicians, and the public at large. Similarly, focused consensus development conferences, where investigators and clinicians from around the world can meet to evaluate new and existing therapies, are another way in which international interests are pursued.

In keeping with its practical focus, the NIH has strived to seek out knowledge that yields new drugs, devices, and procedures that are useful not just for the government but for the public at large as well. In 1986, the Technology Transfer Act allowed for a partnership between NIH-funded research and the private sector. Encouraging researchers to examine possible commercial and practical applications of basic medical research to wide-reaching clinical or research use benefits overall scientific and health progress. Partnering with business allows private industries to take over the process of marketing and developing products in a manner more affordable to them than to the government, allowing the government to focus on development while benefiting through the use of the eventual marketed products.

Organizational Structure and Method

The NIH is organized to accomplish its goals by using its offices, institutes, and research centers. Research is conducted on the NIH campus in its own funded laboratories, as well as in the labs of scientists supported by NIH funding, who are stationed in institutes of higher education, teaching hospitals, and research institutions in the US and other countries. In addition to supporting ongoing research, the NIH also supports research infrastructure by maintaining a library and a variety of printed and electronic resources to facilitate communication among its researchers, the larger scientific community, policymakers, and the public. Scientific research also is supported through development of one of the most valuable resources known to medicine: new researchers. The NIH sponsors a variety of training programs focusing on medical training and research to keep a large body of high-quality scholars and investigators in development. Such programs extend from career development for postdoctoral researchers and predoctoral training, to high school level learning in the sponsoring of internships and other learning experiences for teenagers interested in medical science careers.

Funding for research and training programs outside the NIH campus and research centers is facilitated through grant proposal programs that distribute federal tax monies devoted to such endeavors. Applicants to such programs are able to submit independent proposals for work related to the goals of the NIH that they believe is demanded by the state of science and knowledge. They are also able to submit proposals in response to program announcements and calls for proposals on specific topics as outlined by the institutes and offices of the NIH. Many grant mechanisms exist for such proposals, including grants supporting the work of individual trainees, training programs for cohorts of researchers at different stages of career development, the ongoing work of career scientists, small grants for new or experimental work, focused projects, and even centers of research excellence where many researchers focus on the same topic of study. In addition, grant support is offered to sponsor conferences and academic meetings on special topics in health research and training.

To receive this funding, those wishing to be considered must submit proposals for confidential peer review through the Center for Scientific Review (CSR), which is part of the NIH structure. Proposals are reviewed by panels of experts who evaluate the research plans, goals, staff, environment, and overall innovation and merit of the work proposed. In addition, ethical considerations about the proposed research are reviewed and considered for both animal welfare and the welfare of human research participants. Emphasis on issues of medical ethics had been a long-standing issue for research. It was, however, highlighted in the 1960s, when grantees receiving NIH grant monies were required to state the ethical principles guiding their research on humans, and in 1979, when written guidelines for research on human subjects were established. Once through peer review, proposals are reviewed again by a national advisory council to determine the priority of the work in addressing the goals of the NIH and its institutes and offices. After the proposals are approved by this council for advancement, the individual institutes (sometimes cooperating with specific NIH offices) work to fund them with the monies allotted. Unfortunately, not all proposals can be funded. It should be noted that even after funding, the work of the NIH continues to ensure that proper research ethics are followed through the life of the research.

Research funded by the NIH is facilitated by the various institutions and research offices that fall under its organizational umbrella, each focusing on a discrete area of health interest. Some of the institutions involved include the NCI; the National Eye Institute; the National Heart, Lung, and Blood Institute; and the National Human Genome Research Institute. Also included are the National Institutes on Aging, Alcohol Abuse and Alcoholism, Allergy and Infectious Diseases, Arthritis and Musculoskeletal and Skin Diseases, Child Health and Human Development, Deafness and Other Communication Disorders, Dental and Craniofacial Research, Diabetes and Digestive and Kidney Diseases, Drug Abuse, Environmental Health Sciences, Mental Health, Minority Health and Health Disparities, and Neurological Disorders and Stroke.

In addition to these institutes, the NIH has numerous offices focusing on specific issues or populations that need to be addressed in health research. These offices focus on contemporary issues of importance for research and include the Offices of Technology Transfer, AIDS Research, Research on Women’s Health, Behavioral and Social Sciences Research, Dietary Supplements, Rare Diseases, Science Policy, Biotechnology Activities, Science Education, and Information Technology. There are also offices that focus on the management of research, specific organizational issues at the NIH, or the communication of information from the NIH to members of the public. These include the Offices of Intramural Research, Extramural Research, Program Evaluation and Performance, Human Resources, Financial Management, Acquisition and Logistics Management, Management Assessment, and Communications and Public Liaison, as well as the NIH Legal Advisor and the Freedom of Information Act Office.

Perspective and Prospects

The NIH has been responsible for supporting some very influential research for more than one hundred years, garnering more than eighty Nobel Prizes for NIH-supported work. More vaccines against infectious diseases are available than ever before. The successful mapping of the human genome has set the stage for enhanced genetic testing and the development of gene therapies. Substantial decreases in mortality rates have been achieved for heart disease and strokes. Survival rates for individuals afflicted by cancer have increased, as have survival rates for infants with respiratory distress syndrome. Recovery from spinal cord injuries has been enhanced to lessen the probability of long-term disability. Advances in the pharmacological and behavioral treatment of mental health problems such as depression, anxiety, bipolar disorders, and schizophrenia have been achieved. Preventive approaches in dentistry have been highly successful in stopping and slowing dental problems.

Given such successes, billions of dollars of federal tax monies continue to be devoted to the NIH budget to foster continued scientific advances. New work focused on improving prevention, screening, assessment, diagnosis, and treatment for conditions such as AIDS, alcoholism and drug dependence, Alzheimer’s disease, arthritis, blindness, communication disorders, diabetes, heart disease, kidney disease, lung cancer, lupus, mental illnesses, Parkinson’s disease, stroke, and other persisting conditions continues on a daily basis. While great successes have been achieved to date, new research is needed that will focus on specialized approaches that may enhance health for women, minorities, youth, and older adults. The combination of these needs, past successes, and governmental commitment to improving the state of public health ensures that the NIH will continue onward with its mission for the foreseeable future.

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