The director of the National Institutes of Health would have unprecedented authority to decide federal spending priorities for biomedical research and would gain new powers to kill or consolidate the agency's 27 institutes and centers under draft legislation released by a House committee yesterday.

The proposed changes, drafted by the Energy and Commerce Committee in consultation with NIH Director Elias A. Zerhouni and others, are part of an effort in Congress to reauthorize the $28 billion agency for the first time since 1993.

If the effort succeeds along the lines discussed at a hearing yesterday -- by no means certain, considering previous failed attempts to accomplish the politically touchy process -- it could result in a major shake-up of long-standing hierarchies in the NIH.

Traditional powerhouses such as the National Cancer Institute could get less research funding, a possibility that prompted the American Cancer Society to call for "an appropriate level of accountability" if the legislation is passed. Smaller institutes and centers could be newly empowered.

Patient advocacy groups that focus on particular diseases could lose the access that in the past has allowed them to influence the allocation of money to their causes.

Over time, the changes could also affect medical schools and research universities, which rely on steady infusions of NIH grants and, to varying extents, have tailored their programs to NIH priorities.

"I see great wisdom in what the committee is proposing," Zerhouni told the committee. But Zerhouni stopped short of a blanket endorsement, noting that many details had to be filled in.

Committee Chairman Joe Barton (R-Tex.) has said NIH reauthorization is a major goal this year. His draft legislation would not immediately reduce the number of institutes and centers at NIH -- an option that others favor but would almost certainly prompt intense political infighting. Instead it proposes to consolidate them into two major divisions -- one containing the institutes that focus on specific diseases or organs and the other containing those that focus more on basic research.

Each of the two divisions -- along with the office of the director and a new division that would coordinate research that cuts across traditional institute lines -- would constitute a budgetary line item. That would reduce to four the nearly 30 NIH budgets now appropriated by Congress.

It would then be up to the NIH director -- with input from others -- to decide how the money should be distributed.

The proposal received mixed reviews from scientists, patient advocacy groups and medical school administrators. Some said they appreciated the efficiencies that NIH might gain from the reorganization. Others expressed concern that centralizing power in the office of the director might make the agency, and the nation's medical research agenda, too beholden to a single political appointee -- a fear never far from researchers' minds given the controversy over federal funding of embryonic stem cell research.

The changes "could result in ideology or political opinion trumping good science," said Rep. Tom Allen (D-Maine).

Under the plan, each institute and center would set aside money, perhaps 5 percent of their budgets, for projects that cross institutional lines -- what Zerhouni called a "common fund for the common good." It would also empower Zerhouni, with the approval of the Health and Human Services secretary, to establish or terminate institutes and centers, though the total would be capped at 27.

The proposal would, for the first time, allow the director to award research grants independent of the agency's institutes and centers.

Still uncertain is how the Senate would approach reauthorization and whether the process would become bogged down as lawmakers start to pepper the legislation with controversial research restrictions or politically motivated demands.

NIH Director Elias A. Zerhouni did not endorse the draft legislation, saying there are still details to be worked out.