Never let it be said that Canadian Institutes of Health Research (CIHR) President Dr. Alan Bernstein lacks nerve.
Few, if any, heads of scientific granting councils around the world would subject their agency's structure, functions and processes to the scrutiny of international peer review, as Bernstein did by asking a 27-member high-powered panel chaired by Oxford University Regius Professor of Medicine Dr. John Bell to peek under CIHR rocks.
Bernstein admits that midway through the process he gazed around the room, saw the intellectual firepower training its guns on his 5-year-old agency and asked himself: “What have I done here?”
Given the verdict, he's probably still shaking his head, as the International Review Panel (IRP) pulled few punches in its final report.
Overall, the science is fine, although it's premature to legitimately judge the success of the great experiment, i.e., dissolving the old Medical Research Council and recreating from its ashes a new agency featuring multidisciplinary “virtual” health research institutes that vastly expand the ambit of Canadian research beyond basic biomedical science to include 3 other pillars: clinical, population health, and health services and systems research.
But many CIHR operations are overly complex, if not downright incoherent and chaotic, the IRP states in its final report. Peer review panels are fatigued, while there are so many strategic initiatives it's arguable whether any are actually strategic priorities.
Even the CIHR's governing council was taken to task, in need of having its wings clipped and more “clarity” with regard to its responsibilities.
“New structures need now to be imbedded, transparency in decision-making and process is crucial and sound governance becomes increasingly important. We believe that this represents a natural progression in the growth of this new entity but nevertheless a crucial one for the long-term viability of the organization.”
When the CIHR was formally created in 2001, proponents argued expansion of its mandate to 4 pillars was justification for a major funding increase. Its core budget has since risen from about $250 million a year to a current level of $717 million. It also administers another $111 million in flow-through monies under the Canada Research Chairs and Networks of Centres of Excellence programs, leaving the CIHR in charge of a whopping $828 million.
The agency's structure was a careful compromise. Unlike the US, where the National Institutes of Health individually administer enormous pots of money for both intramural and extramural research, the bulk of Canadian operating grants would continue to be centrally administered, while the CIHR's 13 virtual institutes would oversee more modest pots for strategic initiatives. The compromise gave the governing council the means to ensure that the basic, biomedical community wouldn't simply gobble up budget increases and that the agency would indeed significantly expand research in the other pillars, as well as invest more in multidisciplinary research and promote interdisciplinary collaboration in areas of national health need.
In many respects, the IRP recommendations can be viewed as a call for limitations on that expansion. Among recommended measures are ones that would give the CIHR's 13 institutes, and their scientific directors, authority over all grants that are issued under their respective themes (such as neurosciences or cancer). Even competitions for basic, investigator-initiated operating grants would fall under Institute administration.
The pie would be divided by a “research committee” comprised primarily of Institute scientific directors, thus providing more of what the IRP called “academic leadership.” The IRP argued the committee should be handed oversight of all CIHR funding, including determining a suitable balance between investigator-initiated and strategic initiatives for each discipline. The risk in such an approach, of course, is that larger, more biomedical disciplines, like neurosciences, might gobble up a larger chunk of available monies, at the expense of smaller disciplines in the other 3 pillars. There'd also be less incentive to pursue multidisciplinary and interdisciplinary research, and fewer mechanisms and programs to promote such research.
Bernstein declined to discuss the recommendations in any detail, saying that although the governing council discussed them at a late August retreat, no decisions have been taken. Moreover, the CIHR wants to undertake extensive consultation with the research community before making changes.
Broadly speaking, though, Bernstein said it may be timely for CIHR to devolve some of its decision-making authority. “How I read that is [the IRP] wanted to have more transparency and clarity as to how overall decisions are made and suggested one way to do that would be to devolve down to what they called this research committee.”
But governing council felt they needed “more time, and more input from scientific interests and the broader community” before agreeing to limit its powers, Bernstein added. “But clearly, if they're going to devolve more, we need to look at the structures underneath.”
The IRP also took the CIHR to task for its plethora of strategic programs and the impact those have on peer review. “We were told that researchers are now suffering from significant review fatigue. Ensuring that panels are supplied with high quality and senior scientists is apparently proving difficult and the changing of panels due to potential conflicts of interest makes these problems even more difficult. The small size and short duration of some grants, the establishment of a large number of new grants committees and the presence of committees that see few proposals suggests that the peer review system is not being optimally managed. There appears to be no open and transparent process for the establishment of new panels. Nor does there appear to be clear criteria or process for their evaluation and, in the event that a particular panel is no longer needed, how this decision is to be reached. There have many been new panels established and none eliminated in the past 6 years.”
Yet, it's difficult to imagine an argument that would generate less political sympathy than complaints from the scientific community about the trials and administrative tribulations of having to administer ever larger pots of taxpayer dollars, for both basic and strategic research.
Bernstein carefully sought middle ground.
The scientific community, he said, greatly appreciates that the federal government has in recent years trusted the CIHR (and therein, the academic community) to administer new pots of money, like ones for HIV/AIDS, the flu pandemic and cancer. “It expresses a confidence on government's part that the CIHR is capable and will respond to the country's strategic needs.”
Still, a tighter leash on strategic programming may be warranted, Bernstein said, adding the future may see fewer strategic grants awarded, at a higher level. To that end, CIHR has already done some trimming. “If you look at the last of our RFAs [request for applications] that came out in June, there's fewer of them, considerably fewer, about 20% fewer.”
As for the strain on peer reviewers that's caused by the explosive growth in public spending on health research, Bernstein was quick to dispel any notion that the solution is to cut funding, arguing that far more productive solutions can be found by either promoting more interagency peer review and by convincing “more senior people in the scientific community in Canada that they should be part of the review process. They can't be above it.”
In response to the IRP's assertions that governing council needs to clarify its roles and responsibilities by becoming more of an advisory committee, rather than “a committee with executive functions or as a main Board of the CIHR,” Bernstein said council isn't adverse to a less hands-on approach. “It has no difficulty accepting the notion that council should be more involved in policy and strategic direction. But they did not want to become aloof, in the sense of meeting in a perfunctory way and just looking at the books and making sure they were balanced every year.”