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'No Wrong Time To Do Right Thing'
Zerhouni, Staff Present 'Roadmap' to Bethesda Campus Audience

By Rich McManus

Photos by Ernie Branson

On the Front Page...

Launching a communications campaign to keep his Roadmap for Medical Research initiative well-explained and well-justified, NIH director Dr. Elias Zerhouni addressed the home team — campus employees — as part of a nearly 2-hour presentation in Lipsett Amphitheater on Feb. 20. A week later, Zerhouni and the panel he has named to lead portions of the three-element map gave a similar presentation to an extramural audience at the Marriott in Pooks Hill. These events — along with a dedicated web site, a Roadmap intranet and a listserv — combine to keep stakeholders and the public updated on Roadmap status and progress, said NIH deputy director Dr. Raynard Kington, who introduced the employee session.


NIH director Dr. Elias Zerhouni offers details on implementing the Roadmap.

The old Roger Miller hit "King of the Road," was playing in the background as Zerhouni and various institute and center, as well as OD, staff gathered for the in-house presentation. As laid back and comfortable as Miller's tune is, it didn't hint at the forcefulness with which Zerhouni presented the Roadmap. Twice he underscored a dramatic statistic: the total NIH budget translates to $90 per year for each American while each citizen's health care costs average $5,500 per year, and are rising at a rate of 10 percent each year.

"There's no way you can win this race against time...without new approaches," he declared. "The health care system is in great disarray." He later confided that the disparity in investment versus cost keeps him up at night: "I go to bed thinking we spend $90 for every American every year, and that health care costs are five, six times higher than the NIH budget. So I view [the Roadmap] as a national priority, not just as a nice thing to do."

Zerhouni explained the rationale and timing for the Roadmap, crediting both employees and outside advisors with establishing a collegial, cooperative atmosphere during its development. "It has been very touching for me to see so many scientists from inside and outside of NIH coming together" for what he called an unprecedented exercise. He acknowledged much "trepidation and anxiety" on the part of institutes and centers for launching such a wide-ranging initiative in the agency's post-budget-doubling era, but said his plan's reception in Congress, the Bush administration and around the country has been encouraging since it debuted last fall.

He listed five reasons for the Roadmap: We're in a time of "revolutionary and rapid changes in science," Zerhouni said. "There are more data and more challenges in my own particular field of radiology than ever before in the past 10 years"; the increasing breadth of NIH's mission and growth; the complexity of NIH as an institution comprised of many units; the compartmentalized structure of the NIH bureaucracy, with its division by organ, lifestage, disease and scientific discipline; and the rapid convergence of science.

Zerhouni said he feels particularly keenly the need for a cogent answer to those who ask what NIH did with a doubled budget.

He listed a series of Roadmap imperatives: accelerated pace of discovery; more rapid translation of research from bench to bedside, and back; novel approaches; and new strategies, of which the Roadmap is the premier example.

There are many gaps in our understanding of basic biology, Zerhouni laments; "You can't translate a language that you don't understand."

Dr. Dushanka Kleinman, the new NIH assistant director for roadmap coordination, moderated the panel discussion.

Explaining how the Roadmap was developed, Zerhouni again thanked a wide cadre of NIH'ers, and said planners consulted extensively. The IC directors have held two retreats so far, he reported, at which Roadmap workgroup output has been reviewed.

He called the Roadmap a "framework of priorities," a "vision for a more productive, efficient system, not just a collection of slogans," and "a set of initiatives central to extending benefits to patients."

Zerhouni briefly described the Roadmap's three main elements. For "New Pathways to Discovery," he emphasized the need to unravel the staggering complexity of biological systems. He put a slide of cell cycle activity, donated by NIDDK director Dr. Allen Spiegel, next to a diagram for rocket design, illustrating how complicated even the functions of a single cell can be. He said scale, not just intricacy, is also a problem — the molecular library he envisions will have to characterize at least a half million molecules to be truly useful.

He used the story of Gleevec's discovery as a cancer drug to illustrate how insufficient it is to rely on happenstance to move science forward. Originally studied in some other context, Gleevec was only utilized against cancer after someone realized it had potential anti-cancer properties. "Are we going to rely on haphazard events to lead us to new therapies?" Zerhouni asked.

Turning to "Multidisciplinary Research Teams of the Future," Zerhouni said the way scientists are organized today is not optimal for tackling the complexity and scale of biological problems. He encouraged pilot programs, and "take-a-chance" initiatives. "I believe in self-assembly of scientific teams," he said, "and I can't dictate what that is." He said it is important to resist rigidity and ingrained cultural templates.

With regard to the third element, "Re-engineering the Clinical Research Enterprise," Zerhouni said, "I personally believe that clinical research is a new core discipline, not an old one, and needs to be treated as such...There is power in having better ways of culling out clinical reality."

NCCAM director Dr. Stephen Straus listens to fellow panelist Dr. Amy Patterson, director of NIH's Office of Biotechnology Activities.

Zerhouni said the Roadmap is a trans-NIH enterprise involving pooled resources, and open competition for all. Its funding history is on an uphill climb, from 0.34 percent of the 2004 budget (or $128 million) to 0.63 of the FY 2005 budget (or $237 million), climaxing at 0.9 percent of the budget in the effort's sixth year.

Answering concerns about timing, Zerhouni said, "There is no wrong time to do the right thing." One recognizes the greatness in an institution not by what it does when things are easy, he said, but by how it behaves in the face of challenges. He concluded with thanks to all the IC directors "who have supported this effort magnificently," and particularly credited NIDCR's Dr. Dushanka Kleinman, newly appointed to the role of NIH assistant director for roadmap coordination, as being "a breath of fresh air."

Kleinman then moderated an extended session during which the Roadmap's three elements were briefly described by members of some of the 9 working groups charged with implementing the initiative. As the session ended, she asked those with further interest to contact either their designated IC Roadmap liaison or to send email to the Roadmap web site at

To view the entire Roadmap session for employees, visit

Panels Offer First Semester Roadmap Report Cards

Even though the Roadmap for Medical Research only slightly involves the NIH intramural science programs (chiefly as a means of training clinical researchers), the initiative nonetheless claims the time of many campus employees, mainly those involved in administration and extramural programs. From a plethora of new centers to be established nationwide to the exercise of such arcane funding mechanisms as T-90s and P-20s, the Roadmap already has laid some substantial asphalt, and the pavers are just getting started.

"I'm just a member of the road crew," quipped NIMH director Dr. Thomas Insel as he and NIGMS director Dr. Jeremy Berg presented report cards on New Pathways working groups they cochair devoted to molecular libraries and imaging (Insel) and bioinformatics (Berg).

IC directors (from l) Dr. Lawrence Tabak, Dr. Jeremy Berg and Dr. Thomas Insel participate in panel.

Insel decried the lack of small molecules and probes for research on cellular function. "There is no public database of chemical information, no GenBank for chemicals," he said. His group, composed of 44 members from 20 institutes and centers, envisions a "PubChem" database to be hosted by NLM's National Center for Biotechnology Information. It would hold information on some 500,000 small molecules. His group also plans a consortium of 8-10 screening centers, including one intramural site called the NIH Chemical Genomics Center, to be housed temporarily in Bldg. 50 then move to a dedicated facility at Twinbrook. "The goal is an NIH tool kit, not a drug factory," Insel said, addressing misconceptions that NIH is to be involved in drug discovery.

Berg's group is funding four National Centers for Biomedical Computing in FY 2004, with another four expected in the future. They are to focus more on software development than "big-iron" hardware, he said, and are committed to use of open-source code. The latter requirement has prompted concerns about intellectual property rights, a worry that Insel also addressed with respect to the development of useful biologics (vs. therapeutics) in his group's molecular library. "It's a thorny issue and it's not yet entirely resolved," Insel said.

Berg added that two Centers of Innovation in Membrane Protein Production are to be funded in 2004.

The Roadmap working groups are all chaired by IC directors, and NIDCR director Dr. Lawrence Tabak, along with former CSR director Dr. Ellie Ehrenfeld, discussed Multidisciplinary Research Teams of the Future, which is going to require abandoning the old "rugged individualist — you only eat what you kill" approach, said Tabak, in favor of diverse teams who somehow learn to share credit in a new way.

Ehrenfeld described NIH's version of the MacArthur Foundation's "genius" awards — the Director's Pioneer Award, which basically funds people with outstanding prospects rather than a specific research plan. NIH expects to award 5-10 of these yearly, said Ehrenfeld. "They will be very prestigious."

The third panel that reported to employees, on Re-engineering the Clinical Research Enterprise, included NIAMS director Dr. Stephen Katz, NCCAM director Dr. Stephen Straus, and Dr. Amy Patterson, who directs NIH's Office of Biotechnology Activities. Katz conceded that "almost the number one priority for us is what we call 'harmonization'— there is too much variability in rules and regulations [governing research with human subjects] both between and within agencies." Patterson put it another way: "There are too many traffic signals along the road from the bench to the bedside."

The full report cards for the Roadmap working groups, updated regularly, are available at

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