It’s not customary for a philanthropic organization to confess that the bulk of its awards support unadventurous plodding and that creative ideas of potentially great value are routinely turned down.

So, let’s hand it to the National Institutes of Health. It has just issued such a confession in announcing a new and supposedly bold program of research grants designed to elude scientific conservatism and make big leaps in knowledge and health care. But don’t expect a fast track to biomedical nirvana. The new program at the $30-billion-a-year NIH “follow years of discussion as to how to encourage thinking outside the box,” according to a heavily involved NIH official, Alan Krensky, head of an internal think tank at the Bethesda behemoth. Budget plans call for a total of $250-million over five years—if money is forthcoming.

Intended to be “transformative”—i.e., make an important difference in health care and scientific understanding—the new grants are designated T-R01’s, to distinguish them from the plain old R01’s, NIH’s traditional basic grant for investigator-initiated research. Coveted for their prestige, as well as the accompanying money, the old R01’s have long constituted the scientific core of NIH’s multi-billion-dollar extramural program, a mainstay of research in academic medical centers and many university research departments.

With the overall budget in the doldrums for the past five years, and applications for NIH money carefully screened by external peer-review panels and internal councils, the odds for success have declined to one in five of those seeking support. As the success rates have slumped, the biomedical gossip mill has resounded with warnings to play it safe by seeking money for sure-shot research rather than big leaps into unknown territory. Now comes the official confession, ”NIH Announces New Transformative R01 Funding Program,” in which NIH says, yes, it’s true, but now we’re going to do it differently, with a relatively small portion of our cash.

“While R01 grants support the bulk of mainstream NIH investigator-initiated efforts,” NIH states, “the structure and review of R01 proposals can discourage submission of the most bold, creative, and risky research proposals.” T-R01s, with new review criteria, are the remedy, the announcement continues, adding that the purpose is “to support exceptionally innovative, original or unconventional research that will allow investigators to seize unexpected opportunities and cultivate bold ideas regardless of the anticipated risk.”

In the ebullient comments from the biomedical mandarins backing the new grants, outsiders can glimpse the arthritic condition of the world’s great biomedical-research institution.

Keith R. Yamamoto, UC-San Francisco, who co-chaired the NIH committee that drew up plans for the new grants, reiterated support for the long-shot approach, stating, “Conventional wisdom says that R01 applications of this sort are ‘dead on arrival.’ The hope is that the T-R01 program will liberate scientists to unveil extraordinary ideas and approaches and that novel review and support procedures will select the best for funding.”

NIH Director Elias Zerhouni pitched in, too, stating that the new program “will pilot novel approaches to peer review to facilitate identification and support of the most ground-breaking, high-impact research.”

The new program is worth a try, but doesn’t come close to the problems that inspire NIH to proclaim a turnaround in favor of bold ideas, scientific risk, important breakthroughs, high-impact research, and all the other techniques and values that should dominate the workings of an effective philanthropic organization.

The political reality behind the inspirational words is a struggle between two sectors in the biomedical-research world. On the one hand, there’s the traditional biomedical research community, which regards NIH as a bank for investigator-initiated basic in academe, particularly in medical schools. On the other, there’s a broader research and health-care community that wants NIH to focus its vast resources on health rather than science. Director Zerhouni has fought a long battle on behalf of greater emphasis on health-related research, most notably in establishing the NIH Roadmap for Medical Research. Designed to “accelerate the translation of research to improvements in public health,” the Roadmap is regarded by NIH’s old timers as a diversion from the true path. On paper, it’s supposed to take up 5 percent of the NIH budget, someday. But so far, it has received less than 2 percent, along with continuous sniping.

NIH is too big and too encrusted with old-boy alliances and obligations, customs and traditions. Congress should break it up into several granting agencies, including a virtual NIH that would do its reviewing and granting on line. Slow to adopt online review, NIH still mainly relies on face-to-face meetings of review panels, which entails some 18,000 reviewers traveling to Bethesda three times a year for two to three days of discussions. The big goal is to reduce the time required to get a grant out the door—currently about nine months.

Change is promised by both presidential candidates. Maybe NIH will be on the list.