NIH Director Elias A. Zerhouni, MD, Reflects on Agency's Challenges, Priorities

LAST MONTH, AFTER NEARLY 5 months of delay, Congress finalized the 2003 federal budget, which included a sizable increase for the National Institutes of Health (NIH), bringing the agency’s budget to $27 billion. This increase capped 5 years of growth that effectively doubled the budget for NIH, which is the principal funding source for biomedical research in the United States. The agency’s research portfolio is enormously diverse, ranging from supporting AIDS research, to research on regenerative medicine, to studies aimed at addressing terrorist threats to human health. Presiding over the more than two dozen institutes and centers that make up the NIH and the challenges of charting a course for the agency’s future is Elias A. Zerhouni, MD, who became the NIH’s 15th director about 10 months ago. Prior to that appointment, Dr Zerhouni served as executive vice dean and professor and chair of the Department of Radiology and Radiological Science at Johns Hopkins University School of Medicine in Baltimore. I had the pleasure of working with Dr Zerhouni during his tenure at Hopkins and was not at all surprised to learn of his appointment to lead the NIH. He possesses wisdom, industriousness, creativity, generosity, and a wonderful sense of humor. During a recent conversation, Dr Zerhouni spoke about his position and the challenges the NIH faces. The following are excerpts from that conversation. Dr DeAngelis: What has been the biggest surprise of your new position? Dr Zerhouni: One surprise has been the difference between academia, where I had many jobs but one “boss,” and the NIH directorship, where I essentially have one job but must respond to many forces. There are 27 institutes within the NIH, and many points of interest, including health professionals, patient