The National Institutes of Health (NIH) needs to take a stronger leadership role in managing a 7-year-old program designed to translate basic research into clinical therapies, according to a report released today by the U.S. National Academies' Institute of Medicine (IOM).
The program, called Clinical and Translational Science Awards (CTSA), funds 61 centers at academic institutions around the United States. The IOM report says that those centers lack well-defined, measurable metrics to gauge their success and chances for renewal. As a result, some CTSAs try to do too much—and end up with mediocre results—when they should instead specialize in areas where they're strong and collaborate with other CTSAs to make up for their deficiencies.
"We saw when we studied the CTSAs that some of them are exceptional at certain things and that all are really trying to meet lots and lots of areas of expertise, and it became really impossible for them to do one thing well," says Sharon Terry, the report's vice chair and president and CEO of the Washington, D.C., health advocacy nonprofit Genetic Alliance. "We're basically recommending that, no, we don't ask all 61 to be good at everything. Instead, allow specialization … and share expertise."
Christopher Austin, director for the National Center for Advancing Translational Sciences (NCATS), which administrates CTSA, said today that NIH may not be able to continue supporting 61 centers amid mounting budget pressures. "The program is going to have to be right-sized to fit the budget that we now have," he said.
The report calls for the creation of an NCATS-CTSA Steering Committee to set measurable metrics for success, manage a proposed "Innovations Fund" to spur collaboration both within and outside NIH, and direct collaboration between CTSAs. "The leadership will be coming from NCATS with the CTSAs, rather than the CTSAs themselves trying to provide that kind of leadership," Terry says.
In addition, IOM recommends that NCATS dissolve what it calls an overly convoluted hierarchy of committees within the CTSA consortium and streamline its committee structure; refocus its KL2 and TL1 training grants on teamwork, leadership, and cross-disciplinary skills; ensure that community engagement remains an integral part of CTSA projects; and double-down on the program's commitment to child health.
Austin said in a statement that he supports the recommendations and, with the help of a working group, will begin implementing them immediately.
CTSA scientists that ScienceInsider spoke with were generally happy with the report. Joan Lakoski, assistant vice chancellor for science education outreach, health sciences, at the University of Pittsburgh in Pennsylvania, and a professor of chemical biology in the university's Clinical and Translational Science Institute, says that, "long-term, it's going to be in everyone's best interest to have a closer integration [with NCATS leadership]."
CTSAs receive funding for 5 years, after which the programs go up for renewal. CTSAs' budgets are based on previous NIH support, as well as the scale and scope of the requested project. So far, center budgets have ranged from $4 million to $23 million annually. The program debuted with 12 centers in 2006 and has grown steadily. Its 2012 budget stood at $461 million, but that total shrunk to approximately $435 million this year due to cuts caused by the government-wide sequester.
Last year, CTSA migrated to NCATS from its previous home at the now-defunct National Center for Research Resources. Daniel Ford, who heads the Johns Hopkins Institute for Clinical and Translational Research in Baltimore, Maryland, says he'll welcome a bigger role for NCATS. "I do think most of us understand that there's a need for stronger leadership and identification of goals and where we want to go," he says.