Friday, November 16, 2012

NIH Director Calls Off NIDA-NIAAA Merger

Nation’s addiction research institutes to remain separate but unequal.

Two years ago, the National Institutes of Health’s Scientific Management Review Board (SMRB) issued a report recommending that NIH move to establish a new institute focused on substance use, abuse, and addiction-related research to optimize NIH research in these areas. The idea was to combine the two existing addiction research agencies: the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Skeptics like myself wondered if it would ever happen.And now we have our answer—no, it’s not going to happen. (NIH'S Collins)-->

Score one for the alcohol researchers, who mostly opposed the merger from the start, viewing it as more of a hostile takeover. NIAAA has always been the weaker sister in the addiction research family. With only half of NIDA’s billion-dollar budget, NIAAA deals strictly with alcohol research, even if the NIAAA has at times seemed unsure of what constitutes its main area of study—alcohol the addictive drug, or alcohol the healthy beverage. The merger would have represented a recognition that alcohol is just another drug, albeit a legal one.

It was an obvious thing to do. Former NIH director Harold Varmus had complained that the sprawl was hobbling NIH’s ability to “respond to new science.”

However, in a Science (sub req) interview that year,  Francis Collins, the current director of the NIH, said: “I guess most people would have said, ‘Well yeah, of course.’ But when you look at the details…. and you consider that alcohol is after all a legal substance and 90% of us at some point in our lives are comfortable with taking it in while the drug abuse institute is largely focused on drugs that are not legal. So there's a personality of the institute issue here that people thought might be important to preserve, others thought would be good not to preserve.”

It did not take long for the fraternity of alcohol researchers to view the potential move with alarm. Acting NIAAA director Dr. Kenneth Warren offered up what has come to be seen as the basic counter-argument: “The best way forward is a structure that increases collaboration all across NIH… nothing is gained by structural merger.” Warren said he favored “a separate, but equal” pair of agencies. “Alcoholism is a much broader issue than simply addiction.” 

Here is where it starts to get tricky. The assertion that alcoholism is not simply an addiction distills the disagreement down to its essence, which can be found not so much within the arena of science as within the arenas of morality, ethics, and the law.

On Friday, the traditional time for troubling news announcements in the media world, the NIH released its statement  from Director Collins: “After rigorous review and extensive consultation with stakeholders, I have concluded that it is more appropriate for NIH to pursue functional integration, rather than major structural reorganization, to advance substance use, abuse, and addiction-related research.”

Collins added: “The time, energy, and resources required for a major structural reorganization are not warranted, especially given that functional integration promises to achieve equivalent scientific and public health objectives.”

 But the smooth and cost-effective advance of addiction science may have met a stumbling block in the director’s refusal to do the obvious, and streamline the crucial research on drugs and addiction performed by the nation’s premier medical research agency, the NIH. As one observer commented,  there are rumors that “the alcohol beverage industry is lobbying Kentucky politicians, including U.S. Rep. Hal Rogers, chairman of the House Appropriations Committee, to keep the institutes separate because it doesn’t want alcohol to be associated with cocaine.”


rachelrachel said...

"Separate but equal": I can't believe Dr. Warren would use that phrase if he knew its history.

Coincidentally, the unanimous decision was written by Chief Justice Earl Warren.

howard said...

From what I saw, the concern among scientists (can't speak for the beverage industry) was not about preserving some special Institute "personality," but about the axing of specific arms of the research portfolio. I think my alcohol colleagues would echo the importance of the addicted state common to all drugs. But it seemed increasingly clear that the merged institute would have focused on addiction to the exclusion of other health issues--liver disease, FAS, HIV needle transmission, etc.--and that other institutes (NIDDK, NICHD, NIAID) would not have resources to make up for the displaced funding needs. I believe a structural merger that took more of the interdisciplinary issues of drug use/abuse into account could indeed have been effective; the actual proposal seemed more a political play for perceived efficiency. Maybe we try again in a few years?

Dirk Hanson said...

Hi Howard:

What you say makes a lot of sense. And maybe they will try again in the future. My concern is that the respective portfolios of both existing agencies are so weighted down with other concerns that addiction itself sometimes seems to be taking a back seat to myriad related problems having to do with drug and alcohol USE, rather than addiction. It all needs to be studied, but perhaps in different institutes. I would like to see a single institute whose primary research focus is addiction, not use, not abuse, not recreation--just addiction. The other issues are primarily psychosocial. Addiction is primarily a biological disorder. Maybe it's time to separate the two.

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