CONVERSATION WITH A POLICY MAKER: NIH’s Zerhouni: ‘[Research] is probably the best investment any government can make’

Elias A. Zerhouni stepped down on Oct. 31, 2008 from his role as the 15th director of the National Institutes of Health (NIH), the nation’s medical research agency, which comprises 27 institutes and centers with more than 18,000 employees and a budget of $29.5 billion. During his more than six-year tenure, he oversaw a number of milestones, including the institute’s reauthorization by Congress in 2006, which expanded the director’s authority, and the launching of the Office of Portfolio Analysis and Strategic Initiatives, which transformed the way NIH identifies public health challenges, makes decisions, and sets priorities.
    
More than 83 percent of the NIH’s funding is awarded through almost 50,000 competitive grants and awards to more than 325,000 scientists and research support staff at more than 3,000 universities, medical schools, and other research institutions in every state and around the world. About 10 percent of the NIH’s budget supports projects conducted by nearly 6,000 scientists in its own laboratories, most of which are on the NIH campus in Bethesda, Maryland.
    
A world-renowned leader in the field of radiology and medicine, Zerhouni is credited with developing imaging methods used for diagnosing cancer and cardiovascular disease. One of the world’s premier experts in magnetic resonance imaging (MRI), he pioneered magnetic tagging, a non-invasive method of using MRI to track the motions of a heart in three dimensions, and is also renowned for refining an imaging technique called computed tomographic (CT) densitometry that helps discriminate between non-cancerous and cancerous nodules in the lung.
    NYU Research recently talked to him about the state of the NIH and the future of research in the United States.

The sputtering economy is forcing elected officials to scale back spending on many federal programs. How do you see the tight fiscal situation affecting the NIH budget?

It’s not a new phenomenon, it’s just worse than what it was within the past four to five years. NIH has been able to get 1.5-3% increases, on average around 2%. But if you look at inflation within the biomedical field, which is around 3-3.5%, then you realize that this sort of budgetary pressure creates a downward purchasing power for the industry.
    But I’m not pessimistic because over the past three to four years I have worked extensively in trying to make sure that policy makers understand the importance of innovation. Remember 50 percent of our Gross Domestic Product is related to advancements in research and development that were made over the past 50 years. I believe there are a lot of good policy makers and legislators who truly understand that, so I’m not as pessimistic as some people are.

How do you think the research community can more effectively make the case that funding the NIH is such an urgent and crucial investment?

The NIH budget is not a subsidy; it is an investment that has paid off. If you look at the amount of cardiovascular research we did, and you calculate the amount of dollars [that cost] for each of us individually, it is about $4 per year over the past 30 years. Then look at the results. We have decreased mortality for heart disease by 70 percent. If we had not done this research, right now you would have 1.3 million people dying of heart disease. The return on that, estimated by economists, is anywhere between $1.5-2.5 trillion a year.
    When you look at it, [the NIH budget] is a large number, but when you really look at it, for cancer, it’s $9 per person per year. And look at what you get in exchange—the survival rates for cancer have doubled and tripled.
    This is probably the best investment any government can make—innovation. One Starbucks cup of coffee and you’ve paid for your cardiovascular research this year. Is it not worth it?

When you make a point like that, which seems like such a no-brainer, how do some people refute it?

They say, ‘Look, you’ve been at this thing for 30 years, and you haven’t cured cancer.’ And I say, well, cancer is not a single disease. There are 220 of them and each one of them has several subtypes that have to be treated differently and you have to find a treatment for each one. Look at the results. Patients used to be hospitalized for cancer. Now we can do it through outpatient care. It is amazing to me how people do not give you credit for things that they enjoy every day.
    Sustaining the investment is going to be a big fight, no question, because of the budgetary issues, but it is a worthwhile fight. And universities must play their part too.

Is there any way to rephrase the mission to remind officials how important this work is?

I think we in the scientific community have to get out of our ivory towers and be more communicative, because I think people are no longer just accepting whatever scientists say. There is a significant amount of fear about technology. People are worried about global warming and sometimes blame technology for it, blame science for it.
    This is a very profound societal problem, and it is not a reflection of one administration or another. We can’t think that it [was] just President Bush, and it will just disappear and go back to the old days.


What can the federal government do to better promote careers in the sciences?

If you ask me what is the number one problem that you’re most worried about, it’s the fate of young, early stage career investigators. We have come to a system of training that is very rigid.
    I think that universities and our scientific community are in part responsible for this.  In the past, when people were bright and you could see that they had potential, you gave them the resources early. Today, you have to pay your dues. Which means if you’re 18, you go to college, and that’s four years, so you’re 22. And then you do six to seven years for a Ph.D., that’s 29. And then they force you to do three to six years for a post-doc, that’s 35. Then you need to find a tenure track position. If you were a bright kid, how does that sound to you?
    We’re imposing on our best scientists, essentially, a 16-year waiting line. Who, who is ambitious and creative, wants to do that?
    I would love to have a program that funds people as soon as we can in their mid- to late- twenties, rather than late-thirties. But it goes beyond NIH. It’s also a university problem. And that has to be said. We have to make our training pathways a lot more flexible.

But these training pathways are rooted in such tradition. How can you turn that around?

That is where I disagree. This is a new phenomenon, where we have become hyper-traditional. The issue is that the 24-year-old kid, who is trying to decide between finance, or marketing, or corporate life, and science, is going to say, ‘Okay, this route, 10 years of indentured servitude and over there, I may have a chance to break through in five years and shine. That computation has to change. It is corrosive to our tradition. If you have a bright kid who is really brilliant, give him his Ph.D. in three years. Give him five years of funding to go do what he can in a lab. This one-size fits all approach is what I’m concerned about.
    Our job is to make it possible. To stop bureaucratizing the training of folks and killing them in tradition, and having a lot of senior people scream about their faith in young investigators when they themselves are not giving them a chance.

Elias A. Zerhouni, former director of the National Institutes of Health