Leadership and the NIH

Abstract

The new director of the US National Institutes of Health (NIH), Elias A Zerhouni, faces an enormous challenge in his new job. The agency is massive: it has 27 different institutes and centres, 15 000 employees, and an annual budget that in 2003 is expected to top US$27 billion, double what it was 5 years ago. About 10% of these funds will go to support research by NIH's scientists and about 80% to support 2000 science projects at universities and research institutions in the USA and abroad. NIH's influence is so great that whether he likes it or not many of the decisions Zerhouni will make in his new position are likely to affect the course of biomedical research for years to come.Zerhouni's record indicates he is talented and hardworking. He was born in a small town in western Algeria, the son of a schoolteacher who taught mathematics and physics. Zerhouni went to the Medical School of the University of Algiers, graduating in 1975, and then came to the USA to enter the radiology training programme at Johns Hopkins University School of Medicine in Baltimore, Maryland. He went on to join the Hopkins faculty, in time becoming both a professor of radiology and a professor of biomedical engineering. In 1996 he became the chair of the department of radiology and now also serves as the school's executive vice dean.As a researcher Zerhouni developed computed tomography densitometry techniques to distinguish malignant from benign lung nodules, and magnetic resonance imaging to assess heart function. As an administrator he is credited with developing a comprehensive strategic plan for research at Hopkins, helping reorganise the school's academic leadership, and working with government officials to plan a biotechnology research park and urban revitalisation project near the Hopkins campus. His colleagues clearly hold him in high regard, admiring him for his scientific acumen, good business sense, and sound judgment.He will need all these qualities for the job-ahead. The NIH has been without a permanent director for 2 years. Although the acting director, Ruth Kirschstein, is credited with doing a good job, a temporary appointee cannot act with the authority needed to shape long-term policies. As the new director, Zerhouni will have to move quickly to ensure that the funds the President and Congress have lavished on the agency are well spent. He will also have to recruit new directors for a number of institutes that have also been without permanent appointees. And he will have to decide if he wants to tackle the agency's unwieldy organisation. Currently, each of the 27 institutes and centres receive their own funding and mandates directly from Congress. The arrangement in effect divides NIH into many different fiefdoms over which the director has influence but limited power. As biomedical research becomes more multidisciplinary, such divisions could become a serious problem.But, as director, Zerhouni will also have to guide the agency through the increasingly bitter political battles involving such biomedical advances as genetic engineering, stem-cell research, and cloning. So far it is hard to tell how Zerhouni will handle this challenge. Since his appointment he has kept a low profile, and in a statement prepared for his Senate confirmation hearing he seemed to be trying to stay as much as possible out of such frays. The director's role, he said, would be “to inform the debate by developing and communicating the most objective data”. He also said he would work “within the policy guidelines laid out by the President, and in strict compliances” of laws passed by Congress. “The NIH and its director should not be or made to be factional but must always be factual,” he said.It is unlikely, however, Zerhouni, despite his best intentions, will be able to remain outside these battles. Facts can inform these debates but values decide them. As head of the largest and perhaps most influential biomedical research organisation in the world, Zerhouni will inevitably be forced to take stands based on his understanding of the facts as well as his values, stands that may be unpopular with the President, Congress, the American people, or the scientific community. This may well prove to be the toughest part of his job. The new director of the US National Institutes of Health (NIH), Elias A Zerhouni, faces an enormous challenge in his new job. The agency is massive: it has 27 different institutes and centres, 15 000 employees, and an annual budget that in 2003 is expected to top US$27 billion, double what it was 5 years ago. About 10% of these funds will go to support research by NIH's scientists and about 80% to support 2000 science projects at universities and research institutions in the USA and abroad. NIH's influence is so great that whether he likes it or not many of the decisions Zerhouni will make in his new position are likely to affect the course of biomedical research for years to come. Zerhouni's record indicates he is talented and hardworking. He was born in a small town in western Algeria, the son of a schoolteacher who taught mathematics and physics. Zerhouni went to the Medical School of the University of Algiers, graduating in 1975, and then came to the USA to enter the radiology training programme at Johns Hopkins University School of Medicine in Baltimore, Maryland. He went on to join the Hopkins faculty, in time becoming both a professor of radiology and a professor of biomedical engineering. In 1996 he became the chair of the department of radiology and now also serves as the school's executive vice dean. As a researcher Zerhouni developed computed tomography densitometry techniques to distinguish malignant from benign lung nodules, and magnetic resonance imaging to assess heart function. As an administrator he is credited with developing a comprehensive strategic plan for research at Hopkins, helping reorganise the school's academic leadership, and working with government officials to plan a biotechnology research park and urban revitalisation project near the Hopkins campus. His colleagues clearly hold him in high regard, admiring him for his scientific acumen, good business sense, and sound judgment. He will need all these qualities for the job-ahead. The NIH has been without a permanent director for 2 years. Although the acting director, Ruth Kirschstein, is credited with doing a good job, a temporary appointee cannot act with the authority needed to shape long-term policies. As the new director, Zerhouni will have to move quickly to ensure that the funds the President and Congress have lavished on the agency are well spent. He will also have to recruit new directors for a number of institutes that have also been without permanent appointees. And he will have to decide if he wants to tackle the agency's unwieldy organisation. Currently, each of the 27 institutes and centres receive their own funding and mandates directly from Congress. The arrangement in effect divides NIH into many different fiefdoms over which the director has influence but limited power. As biomedical research becomes more multidisciplinary, such divisions could become a serious problem. But, as director, Zerhouni will also have to guide the agency through the increasingly bitter political battles involving such biomedical advances as genetic engineering, stem-cell research, and cloning. So far it is hard to tell how Zerhouni will handle this challenge. Since his appointment he has kept a low profile, and in a statement prepared for his Senate confirmation hearing he seemed to be trying to stay as much as possible out of such frays. The director's role, he said, would be “to inform the debate by developing and communicating the most objective data”. He also said he would work “within the policy guidelines laid out by the President, and in strict compliances” of laws passed by Congress. “The NIH and its director should not be or made to be factional but must always be factual,” he said. It is unlikely, however, Zerhouni, despite his best intentions, will be able to remain outside these battles. Facts can inform these debates but values decide them. As head of the largest and perhaps most influential biomedical research organisation in the world, Zerhouni will inevitably be forced to take stands based on his understanding of the facts as well as his values, stands that may be unpopular with the President, Congress, the American people, or the scientific community. This may well prove to be the toughest part of his job.