Is It Time to Restructure the National Institutes of Health or Research Mindsets?

The main thesis of the article by Hekler et al. (p. 965) in this issue of AJPH is important and worthy of discussion. Their ideas on epistemic exclusion according to race (and other characteristics) are strong, have previously been raised, and need to be addressed further.1 However, the essay opens with an argument for restructuring the National Institutes of Health (NIH) but ends with an alternative pathway. It lacks evidence to support some of its claims and does not provide certainty of outcomes if indeed such changes are made. A more balanced perspective is needed, especially given that the return on NIH investments is clear in terms of health and medical advancements over decades.These arguments to restructure the NIH should not be used to judge the efforts ofthe biomedical community to fight racism. For example, the NIH UNITE initiative (as noted by the authors) was established to identify and address structural racism within the NIH and the greater scientific community.2 The initiative aims to "establish an equitable and civil culture within the biomedical research enterprise and reduce barriers to racial equity in the biomedical research workforce."2 These and other current efforts across the research enterprise will have a positive impact on the larger scientific community in moving toward racial equity with the strong engagement of external groups, especially marginalized populations.