National Institutes of Health Health Article

NATIONAL INSTITUTES OF HEALTH

The National Institutes of Health (NIH) is the principal federal agency that supports and conducts biomedical research on the prevention and treatment of disease. It is the center of biomedical research in the United States and the foremost medical research enterprise in the world, with a budget in 2001 of $20.3 billion. An agency of the U.S. Public Health Service, it is a part of the U.S. Department of Health and Human Services. There are twenty-seven institutes and centers that comprise the National Institutes of Health, and the research supported by these institutes ranges from basic molecular and genomic biology to translational and applied studies involving individuals and large populations. Training for careers in biomedical research is also an important part of the NIH mission, as is the dissemination of information from this research to the public, to health providers, and to scientists.

HISTORY OF NIH

The history of NIH reflects an interweaving of the disciplines of public health, medicine, and basic biology, with a changing emphasis among these areas as health science progressed. The NIH had its origins in the Laboratory of Hygiene, which was created in 1887 to research cholera and other infectious diseases. The laboratory was an out-growth of the Marine Hospital Service created in 1798 and, in turn, became the Public Health Service in 1912. Early activities focused on infectious and communicable diseases brought to the United States on incoming ships, and on the prevention of epidemics of yellow fever and cholera. In 1914, Dr. Joseph Goldberger described his findings that pellagra was a nutritional deficiency disease, rather than an infectious disease, and could be prevented by appropriate diet. This discovery marked a shift from infectious disease investigation. Research on the importance of nutrition in disease causation was fostered by this discovery, and the essential nature of vitamins in health followed.

The modern era of NIH began in 1930 with the redesignation of the Hygienic Laboratory as the National Institute of Health. In 1935, 45 acres of land in Bethesda, Maryland, were donated for the use of the National Institute of Health. Additional gifts of land were made and the buildings and grounds on the current site and were dedicated in 1940.

The National Cancer Institute Act was passed in 1938, and the first awards for research fellowships were made the following year. Laboratories at NIH were important in improving prevention and medical care during World War II. The contributions of science to the war effort provided a compelling rationale for the remarkable investment in biomedical research that followed during the second half of the twentieth century.

The Public Health Service Act of 1944 provided the legislative authority for post–World War II research programs and made the National Cancer Institute a part of NIH. In 1948, the National Heart Institute was authorized, and the name of NIH officially became the National Institutes of Health. The research emphasis shifted to investigation of basic biology and biochemistry and the disorders of biology that lead to disease. Prevention and treatment of diseases have been based largely on understanding the fundamental alterations in biology following World War II. Support for research conducted at colleges and universities also increased with an expanding budget. Other institutes and centers have been authorized and totaled twenty-seven in 2001. A clinical center on the Bethesda campus was dedicated in 1953 as the principal on-campus or intramural resource for clinical research. This facility combines patient facilities (inpatient and outpatient) with laboratories to foster integration of research from patient to laboratory.

During the second half of the twentieth century, the breadth and complexity of biomedical research activities conducted at NIH and supported at non-NIH sites increased. From 1950 onward, research emphasis shifted to chronic diseases, which had assumed epidemic proportions in the United States and other industrialized countries. Basic levels of molecular biology and genomics were increasingly probed. This led to an important benchmark at the turn of the millennium—the publication of the human genome map. Information on the inherited susceptibility and the interplay between genetic and environmental factors will eventually provide insights that will be translated into practical research.

Studies of large populations, like the Framingham Heart Study, have also been initiated by NIH to delineate risks for disease. Similarly, large interventional trials have tested effective means of preventing and managing these risks. These investigations were an outgrowth of an improved understanding of disease causation and the need to extend these findings to patients and populations. The growth of knowledge has been exponential, and the investment in biomedical research has produced a remarkable return to the public in improved health and increased longevity. Political support for the NIH budget has been consistent and bipartisan, reflecting broad public-interest support and confidence in the benefits of health research.