New era at the NIH

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Elias Zerhouni announced last week that he will resign as Director of the US National Institutes of Health (NIH) at the end of October. After 6·5 years as head of the world's largest biomedical agency, what will his legacy be?Zerhouni created mechanisms for the NIH's 27 institutes and centres to do more cross-cutting work on common interests such as obesity and neuroscience. He encouraged more out-of-the box research with the NIH pioneer and new innovator awards. He stood up to the President on stem-cell research and has convinced Congress to increase funds for the NIH. Perhaps one of his greatest achievements is the launch of the Clinical and Translational Science Awards in 2006, which have strengthened clinical and translational science in the USA by funding a national consortium of 38 academic health centres in 23 states.Zerhouni has been an effective advocate for science. But many at the NIH feel that he has not been the same for scientists. Top researchers have left the agency as a result, morale is low on campus, and it has been hard for the NIH to attract foreign talent.These problems could get worse. The budget for biomedical research in the USA is likely to remain flat. Even though the Democrats pledge to double the NIH budget if they win the election, the current economic downturn might make this promise hard to keep. This prospect raises several issues for the next Director. How will the NIH train and encourage the next generation of scientists if grants become harder for young investigators to get? How will it attract top scientists from abroad if it cannot pay competitive salaries? How will the agency support more clinical research, which is far more costly to do than basic science? NIH-funded trials have already been stopped or have not started because of a stagnant budget.The NIH cannot rely on the next administration for more money. It will need to be smarter about what it funds in the future and more efficient. The chief challenge for the new Director will be to work out how to do more expensive clinical and innovative research as governmental purse strings tighten. Elias Zerhouni announced last week that he will resign as Director of the US National Institutes of Health (NIH) at the end of October. After 6·5 years as head of the world's largest biomedical agency, what will his legacy be? Zerhouni created mechanisms for the NIH's 27 institutes and centres to do more cross-cutting work on common interests such as obesity and neuroscience. He encouraged more out-of-the box research with the NIH pioneer and new innovator awards. He stood up to the President on stem-cell research and has convinced Congress to increase funds for the NIH. Perhaps one of his greatest achievements is the launch of the Clinical and Translational Science Awards in 2006, which have strengthened clinical and translational science in the USA by funding a national consortium of 38 academic health centres in 23 states. Zerhouni has been an effective advocate for science. But many at the NIH feel that he has not been the same for scientists. Top researchers have left the agency as a result, morale is low on campus, and it has been hard for the NIH to attract foreign talent. These problems could get worse. The budget for biomedical research in the USA is likely to remain flat. Even though the Democrats pledge to double the NIH budget if they win the election, the current economic downturn might make this promise hard to keep. This prospect raises several issues for the next Director. How will the NIH train and encourage the next generation of scientists if grants become harder for young investigators to get? How will it attract top scientists from abroad if it cannot pay competitive salaries? How will the agency support more clinical research, which is far more costly to do than basic science? NIH-funded trials have already been stopped or have not started because of a stagnant budget. The NIH cannot rely on the next administration for more money. It will need to be smarter about what it funds in the future and more efficient. The chief challenge for the new Director will be to work out how to do more expensive clinical and innovative research as governmental purse strings tighten.