Is The Nih's Doctor In? You'd Better Believe ItJohn Carey
Washington isn't a town for the impatient: It rewards timidity and coalition-building more than boldness. So the place hasn't quite figured out what to make of Dr. Bernadine P. Healy, director of the National Institutes of Health--and vice versa. "I do not believe," she says, "in kneeling at the altar of consensus."
No, she doesn't. In her first 12 months on the job, a period many fledgling chieftains spend redoing offices and surveying the landscape, the 47-year-old cardiologist has plunged boldly--some say recklessly--into one controversy after another. She eased out two top NIH officials, angering bureaucrats below. She revamped the NIH's handling of several highly charged cases of scientific misconduct, setting off a dispute with House Energy & Commerce Committee Chairman John D. Dingell (D-Mich.).
And that's just the half of it. Supporting a new NIH practice of seeking patents on pieces of genes, Healy touched off a bitter battle with Nobel laureate James D. Watson that ended in April with the geneticist resigning as head of the NIH's genome center. She was in favor of doing a survey of teen sex behavior and of research using fetal tissue, and was overruled in both cases. She also has stirred up the NIH's parent--the Health & Human Services Dept. (HHS)--plus the science community, with a grandiose strategic plan for all biomedical research. The breakneck pace, plus Healy's style, has led disgruntled agency officials to call her "She Who Must Be Obeyed." Still, few disagree that the NIH--facing budget strains after two years without a permanent head--desperately needs a strong boss. "Dr. Healy has pluses and minuses," says one top HHS official, "but her pluses far outweigh her minuses."
Healy's task is to halt a creeping decline. A decade or so ago, says Katherine L. Bick, former director of extramural research, the NIH "was almost a magical place." Researchers had the freedom and funds to pursue everything from polio vaccines to the genetic causes of cancer. This island of discovery was largely protected from the vagaries of government and politics.
NIH is still a respected agency, doing $1 billion a year of its own research and supporting more than 50,000 U.S. scientists. But the $9 billion enterprise is showing strains. NIH officials complain of overcrowded labs, a brain drain, and political intrusions into their world.
`SICK PATIENT.' Healy's predecessor, James B. Wyngaarden, was forced out in 1989, partly for not opposing abortion. Probes of misconduct in prominent labs have cast doubt on the integrity of science. And reflecting rapid expansion in biomedical research and a stagnant budget, scientists complain that too many good ideas--and promising young researchers--are withering for lack of funds. "NIH was a sick patient when I came here," says Healy. She adds, only half in jest: "Things were so bad they couldn't find a man to take the job."
Healy certainly had the qualifications. After growing up over her father's perfume factory in Queens, N.Y., she excelled at Vassar, at Harvard medical school, as a researcher and administrator at Johns Hopkins, and as research director at the Cleveland Clinic. Her Washington experience includes a stint at the White House Office of Science & Technology Policy in the mid-1980s. Even during her early career at Hopkins, recalls David A. Blake, now senior associate dean at its medical school, "you knew she was going to be the first woman dean of a major medical school or head of NIH."
Her vision for the NIH is unabashedly expansionist. "The single most gaping failure of NIH today is that it has not become a truly visible public and policy priority," declares Healy. Her plan is to convince Congress and the public that the NIH is so vital to the health and economic competitiveness of the nation that it deserves huge budget increases.
Over the winter, Healy and her staff wrote an 800-page strategic plan listing scores of areas, from genetics to embryology, that need more research. Funding them all would have meant nearly doubling the NIH budget. The tome was to be released at a February meeting of scientists and NIH leaders. But at its HHS review, officials were amazed at Healy's audacity. "Both the President and the Secretary would be embarrassed by the plan's unveiling," wrote Martin H. Gerry, Assistant HHS Secretary for planning and evaluation, in a Jan. 10 memo. "The only 'strategy'. . . seems to be acquisition of additional funds." To Gerry, such budget-busting was political folly. After heated meetings, HHS Secretary Dr. Louis W. Sullivan let Healy release a 14-page framework along with background papers.
GENE WARFARE. With typical confidence, Healy says she won the day. "Gerry had a position that I totally disagreed with," she says. "And when we argued it through, my view was the most compelling." But victory came with another political constraint: "We cannot come out and admit what we really think about concrete budget figures," she concedes.
The plan also provoked scientists. Researchers were miffed that they hadn't been consulted, that pet areas of science were ignored, or that the NIH might focus on boosting economic competitiveness rather than basic research. In meetings since, Healy has won most of them over with assurances that their concerns will be addressed. In fact, the strategic plan is now on the fast track.
Still, the episode fed already strong criticism of Healy's style. "HHS has a lot of problems with Dr. Healy and her fervor for her own initiatives," gripes one top staffer. And the tiff with Watson--a discoverer of the structure of DNA--underscores her reputation for punishing disloyalty. Watson publicly criticized her support for the NIH's policy of filing patents on fragments of genes, a process he thinks will stifle scientific cooperation. Healy subsequently questioned whether Watson, a part-time NIH employee, had a conflict of interest because of his biotech holdings. Watson says this convinced him that she wanted him out. "She can be inflamed very easily," says one NIH staffer. "Watson did that, and he's gone."
Supporters call Healy's reputation for combativeness simply the price for bold action. "She has ruffled some feathers," says Joel M. Schindler, a former NIH official. "But NIH needed some ruffling--and I think she hasn't ruffled enough." Others wonder if the criticism masks resentment of a woman at the top of a once male bastion. "I think she's gotten a bum rap," says one Hill aide. "She doesn't kowtow the way she's supposed to."
Still, Healy isn't ignoring her patrons. She put a new $176 million NIH building, named after House Appropriations Committee Chairman William H. Natcher (D-Ky.), on the fast track. And she recently spent two weeks at tedious congressional hearings on each of the NIH's 20 centers and institutes. So far, there haven't been any repercussions from Healy's August sparring with Dingell. He had hauled her before his oversight subcommittee to question why she had reorganized the NIH's science misconduct office during probes of Nobel laureate David Baltimore and AIDS researcher Robert C. Gallo. Dingell, who worried that Healy might whitewash misconduct, now declines to comment on her performance.
For Healy, the rough road has been an education. "When you make decisions, you get more than criticized," she says. "You become cannon fodder." But that hasn't shaken her resolve to "make this place better." Already, her push for research on women's health and interest in disease prevention is helping NIH respond more quickly to the needs of the nation. Barring more missteps, this unconventional bureaucrat may be what the doctor ordered. "She has a style that some people aren't used to," says Dr. Anthony S. Fauci, head of the NIH's AIDS effort. "But she is, and will be, a very positive force for NIH--and science."
HEALY'S REGIME A TOUGH FIRST YEAR... APRIL, 1991 Bernadine Healy takes over as director of the National Institutes of Health AUGUST, 1991 John Dingell questions Healy's handling of alleged scientific misconduct at NIH and elsewhere JAN.-FEB., 1992 Healy's strategic plan draws protests from the HHS and scientists APRIL James Watson, director of the NIH's Genome Center, resigns after public disputes with Healy ...AN AMBITIOUS AGENDA MANAGEMENT Instill a corporate mentality in the NIH's 20 institutes, divisions, and centers IMAGE Burnish the image of the NIH and biomedical science by beefing up public relations FUNDING Engineer a boost in the agency's nearly $9 billion budget by convincing Congress of the NIH's vital contribution to the nation's health and economy. Examples include research into biotechnology and vaccines