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Vol. LIX, No. 5
March 9, 2007
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'We Are Turning the Corner'
Reauthorization Signals Renewed Confidence in NIH, Zerhouni Says

On the front page...

When President Bush signed into law the National Institutes of Health Reform Act of 2006 on Jan. 15 — the agency's third omnibus reauthorization in history and first since 1993 — it signaled renewed confidence in the NIH mission, its employees and its leadership, said NIH director Dr. Elias Zerhouni.

While he anticipates no short-term change in the way NIH operates day to day — after all, the Roadmap for Medical Research has been a prototype embodying the principles of reauthorization since 2003 — Zerhouni sees nothing but benefits emerging from a reauthorization process that has been evolving ever since the doubling of the NIH budget from 1998 to 2003 mandated a fresh look at how a bigger agency functions.

Continued...

To Zerhouni, reauthorization "institutionalizes the concept that there are areas of science where all of us have to come together on a regular basis and exchange concepts and ideas about fields of science that are either emerging, or need to be incubated, that need to be promoted, reinforced. Essentially, it's a Common Fund for common shared purposes across all the institutes.

Dr. Elias Zerhouni

Zerhouni Examines Horizon Beyond Reauthorization

In May, NIH director Dr. Elias Zerhouni will mark his fifth anniversary here. Looking back over a tenure that has included “some rough times, some of which were not our doing — who could have predicted 9/11, or Katrina, or two wars or mandated consolidations?...Even in my most pessimistic projections, I never thought [the budget would] be flat for any length of time” — he nonetheless is heartened by “a real resilience here.

"These things hit this agency like a tsunami,” he said. “You can imagine how destructive this could have been…it’s been one of the most stressful periods in our history. But I admire the way the agency has handled it. I can’t say enough good things about NIH’ers. They are the best of the best.

“We truly crossed the desert in 2006,” he continued. “But we are out of it. I think we have turned the corner in many ways.”

Among his chief objectives as he begins his sixth year as NIH director are supporting new investigators (“That is my number-one priority,” he said), strengthening peer review, renewing leadership in an aging workforce and improving the quality of worklife.

“We need to have a conversation about peer review,” he said. “I am such an advocate of peer review that I always worry that if we don’t have the best of the best peer review possible, we won’t fund the best of the best science…As we have grown, and as we have gotten more applications and more complex science, we absolutely need to have [a peer review discussion] now…Are we doing it right? Are the applications too long, is the cycle too long?...We have to engage the community and make sure that, in these times of stress, our peer review doesn’t suffer.”

Zerhouni is also concerned about leadership development. “There are many retirements coming in the next 5-10 years,” especially within the ranks of top management. “How do we evolve and maintain excellence through the next generation?” he asked.

He also advocates improvements in worklife, including better representation of women in science and a more diverse workforce. “How do we do telecommuting better and how do we have more flexible schedules?” he wondered. “How do we make sure HR [human resources] serves us? I hear so much about these issues from so many of my friends on campus that I’m concerned…Even though budgets are tight, we need to find a way to do better.”

Zerhouni took note of a recent HHS survey of worklife satisfaction, which has improved overall since 2004. But there were a few categories where negative ratings were around 20 percent at NIH. The negative numbers get his attention because “when you have a positive opinion about something, you tell two people; when you have a negative opinion about something, you tell 20 people. That taints the whole thing. I’d really like to have everybody work together on addressing [the negative ratings] and bring them below 20 percent.”

He remains convinced that the nation’s investment in health care research offers the best possible return and that “the challenge of the century is the life sciences…The solutions to many of our societal problems will come from our mastery of the life sciences.”

Reflecting on the highs and lows of his tenure, Zerhouni says “all these changes should not be seen cynically. Sometimes cynicism drives people, but that’s not what I see at NIH. I see people who truly are driven by their positive mission. If you ask them, they all feel that what they do is very important, very positive. There’s always cynicism in life, but the less there is, the better. We are transforming the world here — in a good way.

"There will be some cultural shift in the way we will work in the future," he continued. "There will be quite a premium placed on working across programs to maximize the impact of NIH science on areas that cut across institutes. NIH employees should look for opportunities to participate."

Zerhouni said Congress had to be sure NIH was on the right track before reauthorization could take place. "Before, we had lots of questions about our management" including: Could the agency manage a much larger portfolio? Is the return on investment worth it? What about conflict of interest? And research priorities? "Now we have a unanimous vote from both chambers of Congress, one that endorses both an increase in our budget and essentially is a statement of extraordinary confidence and support.

"We have gone from a period of very stormy weather," he continued, "to turning the corner. I am optimistic about the turn of events for us."

The new law caps at 27 the number of institutes and centers, provides the NIH director expanded authority to manage the agency, encourages ICs to collaborate on trans-NIH research and reforms the agency's reporting system so that Congress can evaluate the NIH research portfolio, according to a summary provided by the Office of Legislative and Policy Analysis (see Reauthorization at a Glance).

The Roadmap exercise of the past 3 years has convinced Zerhouni that "there is a need to provide formal venues where people interact and get to know who is doing what across various programs."

He was especially impressed with the results of a "mini-intramural roadmap" exercise conducted last summer with about 100 intramural scientists; it examined where NIH could be a leader in high-risk, high-impact research. "The overall majority was saying [that] what was valuable was to just get together. The fact that you're in the same room, listening to these colleagues of yours and arguing back and forth — I've seen a lot of natural leadership emerge from that."

Zerhouni wants reauthorization — which is being implemented by an ad hoc working group chaired by NIH deputy director Dr. Raynard Kington — to result in "a greater link between intramural and extramural communities. I believe that we need to remove barriers between those two worlds. The Common Fund is not limited to extramural affairs, it’s also intramural. That synergy needs to happen more."

In his view, reauthorization "is moving NIH into a more effective way of balancing what works in science — freedom of exploration, autonomy, decentralization — versus providing an opportunity for people to collaborate and cooperate more freely, without barriers, without silos."

He employs a favorite metaphor to describe the effect of reauthorization: "NIH is an outstanding organization with 27 very strong fingers but very little palm. Reauthorization creates what people have been wishing for — a little more sense of a hand that is coordinated and integrated and more effective."

Zerhouni said reauthorization could have taken two forms — structural, which would have involved consolidating institutes (and which he dismissed as "rearranging the chairs on the deck") or functional integration, a harder choice that involves "putting resources together and coming together for an explicit intellectual debate and analysis…and functionally integrate, at the budget level, a portion of the NIH budget to be worked on by everybody."

The Common Fund, he explained, "is our intellectual venture space. Whatever we do there — it may be an incubator, it may be an accelerator of things we want to do, things that in the past you would have had to go around and pass the hat across all the institutes to do — now you have a place where we can all agree, 'This is important.’”

Reauthorization at a Glance

More than 100 employees at NIH are involved in implementation of the NIH Reform Act of 2006, which has a number of key provisions:
  • There is a new Division of Program Coordination, Planning and Strategic Initiatives, which keeps an eye on emerging scientific opportunities and challenges. “Reauthorization basically institutionalizes the concept of OPASI (Office of Portfolio Analysis and Strategic Initiatives) in law,” Zerhouni said. Included within DPCPSI will be former OD stand-alone components the Office of AIDS Research, Office of Research on Women’s Health, Office of Behavioral and Social Sciences Research, Office of Disease Prevention and Office of Rare Diseases, which will continue their missions as authorized.

  • The Common Fund supports trans-NIH research. “We will grow the fund in relation to our budgets,” Zerhouni commented. “It will be years before the fund reaches [a target goal of] 5 percent of the NIH budget.” He also cautioned, “The Common Fund is not taking money away from anybody. It is providing funds for everybody.”

  • A new Council of Councils will advise on proposals that would be supported by the Common Fund.

  • A new Scientific Management Review Board will conduct organizational review of NIH at least every 7 years.

  • The law requires establishment of an electronic system to uniformly code grants and activities. “This is going to be a challenge,” Zerhouni noted, “but an organization of this size and complexity needs a 21st century portfolio management system. We need better, faster, nimbler, more effective knowledge management systems.”
For a summary of the new law, visit http://olpa.od.nih.gov/legislation/109/publiclaws/reformact06.asp.

He cites the Human Genome Project as a prime example of a venture that, were it proposed today, would be supported by Common Fund resources.

Zerhouni said he could easily have implemented the reauthorization law "from the top down" as simple mandates, but opted instead to form an ad hoc working group with wide representation so he could gain “bottom-up” consultation. “I wanted to engage more people,” he said. “Transparency, openness and candor are very important. This allows the agency to be better over time.”

He credits support from four key constituencies: the institutes and centers and their leadership, Congress, NIH employees and stakeholder groups.

"I was very pleased to see that everybody rowed in the same direction," Zerhouni said. "We demonstrated that all of the concerns about NIH were just not founded. We were able to make the case that NIH is in fact the crown jewel of the federal government."

He said President Bush would not have visited the agency five times if he did not respect the institution.

"There is no doubt that there is respect for this agency on all sides," Zerhouni said. "We have positioned the agency above politics.and established NIH as the most credible source of scientific information for the health of the American people. All of that is paying dividends right now.Half of all the increases in the FY 2008 science budget are coming to NIH.That's a vote of confidence. Everybody on campus should take credit for that."

Zerhouni also credits Rep. Joe Barton (R-TX), former chair of the House committee on energy and commerce: "He was very questioning and skeptical, and the more we interacted with him, the more he became a supporter and a champion. He's an engineer by training, so he understands large organizations.

"We also received strong bipartisan support — Chairman Dingell (D-MI), Chairman Kennedy (D-MA), Chairman Enzi (R-WY) — they all pulled together to do what's good for the country. And we had more than 100 stakeholder groups who supported the legislation," he said.

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