By Stuart Buck and Eric Gilliam
It’s March 2023. The former National Institutes of Health (NIH) Director was Francis Collins, who announced his retirement on October 5, 2021, over 16 months ago. Yet we are still awaiting the day that President Biden will formally nominate a replacement to lead the biggest biomedical funder in the world, with a 2023 budget of $47.5 billion.
What should we expect from a nominee? NIH Directors historically have been drawn from a select set of individuals who have a fairly similar background. For example, the last several Directors have been:
- Lawrence Tabak (acting). PhD and D.D.S.; previously served for some 12 years as Principal Deputy Director of NIH, and before that, was the director of the National Institute of Dental and Craniofacial Research.
- Francis Collins. PhD in physical chemistry, and MD; previously directed the National Human Genome Research Institute and led the Human Genome Project.
- Raynard Kington (acting Director from 2008-09). PhD in health policy and economics, and MD; previously was principal deputy director of NIH from 2003 to 2008.
- Elias Zerhouni. MD; previously was Dean of Research at the Johns Hopkins School of Medicine.
- Harold Varmus. MD with training at Columbia Presbyterian Medical Center; previously had won the Nobel Prize and had spent over 20 years as a prominent professor at UCSF.
In other words, NIH Directors and acting Directors typically have either a PhD in a biomedical subject, or an MD, or both, and have spent decades in prominent academic positions or at NIH itself.
If we want to go with that model, there are many potential nominees who might make great NIH Directors. Some examples:
- Shirley Tilghman. Currently a professor of molecular biology at Princeton, and formerly the president of Princeton from 2001 to 2013. She has long shown a commitment to institutional reform at NIH and in the broader biomedical workforce. For example, she was a co-author of the famous 2014 article “Rescuing US biomedical research from its systemic flaws,” and chaired a 1998 National Academies report and a 2012 NIH working group, both on how to improve prospects for young scientists.
- Keith Yamamoto. The first Vice Chancellor for Science Policy and Strategy at UCSF, with which he has been affiliated since 1976, and currently president of AAAS (American Association for the Advancement of Science). He co-chairs the National Academies’ Roundtable on Aligning Incentives for Open Science.
- Ezekiel Emanuel. Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Co-authored a piece last year arguing for NIH reform on the ground that it has become “sclerotic and overly cautious.” (He would be controversial, however, due to a 2014 piece on why he hopes to “die at 75.”)
- Jon Lorsch. Has been the Director of NIGMS for 10 or so years, and has expended considerable effort to implement one of NIH’s more innovative programs aiming to fund creative researchers.
But perhaps our traditional criteria for NIH Directors are too narrow. After all, there’s no guarantee that someone who is an excellent scientist/doctor with a long track record of NIH/academic experience will do a good job at thinking of new directions for scientific funding or spotting new talent. That is like assuming that a top professional athlete will also make a great coach. Some athletes would never make good coaches, and some great coaches weren’t top athletes themselves.
Moreover, the best grantmakers don’t always have experience in the field at all! Consider Warren Weaver, arguably one of the best biomedical grantmakers in history—and who had neither an MD nor a background in biomedicine.
In 1933, the Rockefeller Foundation entrusted Weaver with allocating grants for its Natural Sciences Division. Weaver had an undergrad degree in civil engineering and a Ph.D. in mathematics, but had primarily done research in physics where he was, by his own admission, not a first-rate physics researcher.
But he was extremely curious and wide-ranging in his interests, and kept up with adjacent fields of research as well as the modern history of his own field. And he had the valuable experience of having seen a paradigm-changing era of research and tool creation in physics, and having watched those new tools and ideas change the field of chemistry, in turn.
These traits gave him a unique perspective in carrying out his role. Indeed, when he took over Rockefeller’s science program, he showed little interest in funding large physics projects. Instead, he began transitioning the Division’s budget to be 80% focused on what was then an almost entirely undeveloped area of biology, one Weaver would later refer to as “molecular biology” (a term that he invented in 1938!).
Weaver’s thesis was that with a committed budget, and years of effort from top minds, developments in physics and chemistry could help answer important questions about what was happening on the molecular scale in biology, e.g., questions about how genes and cells worked. In other words, Weaver’s prescience arose because he knew what nascent, but potentially world-changing, research looked like in two other fields.
For many initial years, Rockefeller’s work made no headlines but after the discovery of the structure of DNA in 1953, 18 Nobel Prizes were given out in molecular biology by 1965—this new field that Weaver had identified some 30 years before. Weaver had funded fully 15 of them, and had done so an average of 19 years before they won the Nobel.
That is simply an astonishing record of creating a new field and identifying the top talent decades in advance.
If we were open to non-traditional NIH nominees who more resemble Weaver, we might think of people like:
- Daniel Goroff. Currently a Vice President and Program Director for economics at the Sloan Foundation, but has been a Division Director for Social and Economic Sciences at the National Science Foundation, and has twice worked at the White House Office of Science and Technology Policy (OSTP). Like Weaver, he has a background in mathematics, and his first academic position was Assistant Professor of Mathematics at Harvard. He has a strong record of spotting talent and nurturing new ideas.
- Arati Prabhakar. Currently director of the White House OSTP, and formerly the head of DARPA from 2012 to 2017. Previously, she was the first woman to lead the National Institute of Standards and Technology. She has a PhD in applied physics from CalTech. Under her leadership, DARPA awarded $25 million to Moderna to develop mRNA vaccines, far ahead of NIH on this issue.
- Geoffrey Ling. Currently a biotech CEO, but previously was the first director of DARPA’s Biological Technologies Office. Along with Good Science Project board member Michael Stebbins, Ling wrote a memo in 2020 that proposed a new DARPA-like agency for health: ARPA-H, which was launched last year.
- Tyler Cowen. Cowen is an eclectic economist at George Mason University whose most recent book is on identifying talent. At the outset of Covid in 2020, he helped launch and run Fast Grants, a major initiative to hand out hundreds of grants to biomedical scientists within a couple of weeks. Cowen has also handed out tens of millions of dollars for his Emergent Ventures project, and has credibly been called the “best curator of talent in the world.”
- Paul Graham. Now we’re really getting outside the box. Paul Graham has a PhD in computer science from Harvard, but is best known for starting the venture firm Y Combinator, which helped launch Stripe, Instacart, DoorDash, Coinbase, Dropbox, Airbnb, Reddit, and many more. Not only is he excellent at spotting talent, he has a keen eye for how organizations can work well (or not).
To be sure, none of these non-traditional nominees would be chosen or confirmed today. But we should ask why that is the case. After all, why would we create a set of standards that would rule out Warren Weaver, perhaps the best biomedical grantmaker in history? In a time of needed reform, why would we select for someone who is likely to be a champion of the status quo?
We shouldn’t limit the pool of potential NIH Directors to people who are most credentialed in the traditional academic life sciences. To draw on a private sector example, that would be like hiring a new CEO of a beverage company only from the existing pool of beverage company executives. Instead, when a company enters a CEO search, they might look to hire from within their own industry, but they also search far and wide for executives from other industries who have overseen change that their own firm would like to emulate.
That said, if we stick with an NIH Director who is a PhD/MD with decades of NIH/academic experience, we should look for the people with those credentials who are top-notch at identifying talent, polymathic in their interests, eager to experiment with new ideas from different fields, and willing to expend political capital on serious reforms.