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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2010; 37(5): 621.
PMCID: PMC2953210

Review of The National Institutes of Health

1991–2008
Reviewed by Myron L. Weisfeldt, MD

John A. Kastor, MD. 296 pages. New York: Oxford University Press, Inc.; 2010. US $49.95. ISBN: 978-0-19-973799-4. Available from: Oxford University Press USA, 198 Madison Ave., New York, NY 10016. www.oup.com/us/catalog/general/subject/Medicine/HistoryofMedicine/?view=usa&ci=9780199737994 .

Fields of Medicine: Recent medical history, government policy, biomedical government research.

Format: Hardcover book. Trim size: 6-1/8 × 9-1/4 inches.

Recommended Readership: Experienced investigators in biomedical research, advocates of general and disease-specific biomedical research, and persons concerned about public policy related to U.S. biomedical research.

Purpose: The book presents historical information concerning the last 20 years of the 55-year history of the National Institutes of Health, cataloging crucial events and factors leading to the current NIH structure. The monograph also provides unique depictions of the vital people in leadership positions at the NIH, as well as in Congress, who have had a significant influence on funding and other policies and procedures, including research emphasis, within the National Institutes of Health.

Content: The monograph begins with a broad statement of the history of biomedical research and the founding of the NIH, and then goes into a lengthy discussion of the nature of the intramural research program and staffing of the NIH in general and in specific Institutes. It then similarly characterizes the extramural research programs of the Institute and, to some extent, their evolution during the 20 years in question. This is followed by a very lengthy depiction of administrative structures of the Institutes within the NIH. There is an Institute-by-Institute review of the founding of the Institutes, the conceptual underpinnings, and the leadership history up to the present time. Along with subsequent discussions of the research centers, these Institute and Center descriptions constitute nearly half of the entire monograph.

The book then goes on to very strong sections dealing with the historic evolution of finances and funding of the National Institutes of Health, with particular emphasis on those factors that governed the doubling of NIH funding over a 5-year period ending in 2003, and on the subsequent challenges and difficulties that have arisen because those funding approaches did not allow for a gradual return to usual funding levels. Kastor describes the abrupt decrease (that is, a small decrease relative to inflation) in funding that took place over the next 5 years.

Strengths: As Kastor's great strength, he depicts exquisitely and with remarkable candor and insight the modern directors of the NIH during this 20-year period: individuals who truthfully have had such a major impact on biomedical research and on the successes and directions of the NIH. As in Kastor's other publications, he addresses himself to controversial areas that are topical and crucial to understanding the evolution of thinking and policy within the National Institutes of Health. Particularly strong is his depiction of the sequence of events with regard to the establishment of rules dealing with conflict of interest on the part of intramural NIH investigators and staff. This book reflects the type of detailed interviewing that is so important when one is trying to deal with recent history, particularly in controversial areas where individual prejudices may be strongly divergent. Much of the book is built on interviews conducted by Dr. Kastor with “important people” in key positions within the NIH, as well as with members of Congress and the general biomedical research community. He interviews major leaders, trendsetters, and agents of change in biomedical research. Kastor makes every effort to create a balanced view of controversial issues and to present the key elements of decision-making, along with his personal interpretations and conclusions. Those sections of this monograph are extremely strong.

Weaknesses: The presentation of Institute-by-Institute and Center-by-Center history during the 20-year period may be more detailed than most readers will appreciate. This catalogue does, though, provide a very reasonable roadmap to someone who is concerned about where his or her type of research might fit within the spectrum of the NIH Institutes and Centers. Some readers may wish to get the flavor for the Institutes and Centers by reading in detail several of the descriptions of the larger units, and then by viewing, more rapidly, the many other enterprises within the overall NIH.

Overall Grade: vvvvv

Footnotes

Grading Key vvvvv = outstanding; vvvv = excellent; vvv = good; vv = fair; v = poor


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