Physicians, Heal Thyselves!

By Dick Thompson/Washington

Inside the laboratories of the National Institutes of Health, 3,200 of America's best researchers are tackling medical mysteries that range from conception to aging. But one of the most perplexing problems confronting the NIH is its own health. Considered by many to be the world's most productive biomedical-research facility, the NIH is nonetheless suffering from a multitude of ailments. Noncompetitive salaries have made it difficult to retain top researchers or hire replacements. Political meddling has stopped some areas of investigation and assumed control of others. A recent monitoring of ethical infractions, concerns about allegations of fraud, and new conflict- of-interest regulations have combined to drag down morale. The Bush Administration let the situation worsen by leaving the NIH without a director for nearly two years. At least three men turned the job down, some protesting the Administration's abortion "litmus test."

"Things are so bad, some have said, they couldn't even get a man to be NIH director," jokes Bernadine Healy, a cardiovascular researcher. This week Healy, 46, makes her debut before Congress as the new NIH director, the first woman to hold that job. To many it appears that George Bush may finally have summoned just the right doctor. In addition to work in medical and research areas, Healy has had a lengthy career in science policy. She has served on several federal science-advisory committees and, most recently, as chief of the Cleveland Clinic Foundation's Research Institute. Most important, she knows intimately the problems confronting the NIH. "This is not only a job worth doing but also one that can be done," she says.

Healy is now entrusted with the world's most unusual biomedical-research center. No other institution houses as many biomedical researchers on a single campus. "It's the linchpin of biomedical research," says Yale medical school dean Leon Rosenberg. Last year alone, NIH scientists or their associates on university campuses began the first federally sanctioned gene therapy on a human, located the cystic fibrosis gene, developed a drug to reduce paralysis from spinal-cord injuries and demonstrated that the drug AZT prolongs life in AIDS patients.

But the excitement of medical discoveries has masked the NIH's growing problems, especially funding. The 13 institutes that make up the NIH consume $8.3 billion in federal financing. While the NIH budget has grown steadily throughout the 1980s, politicians have earmarked larger portions for specific projects (such as AIDS research and the Human Genome Project) and left fewer dollars for fundamentals. Moreover, the wages paid federal scientists, which have never been comparable to those paid their counterparts outside government, have fallen dramatically behind -- and the lure of fatter paychecks is becoming almost irresistible. The average salary for scientists with 10 years' experience is about $60,000. Researchers with that experience can double their paychecks at most universities, and in industry their wages can triple. The salary discrepancy has made it difficult to find replacements, particularly since today's medical-school graduates are burdened by enormous loans. Says J. Edward Rall, director of the NIH's Office of Intramural Research: "If somebody owes $80,000, it is difficult to contemplate a research career with the government. You just can't afford it." A proposed job category that would allow 200 top scientists to be paid as much as $138,900 is being re-evaluated by the White House.

Poor pay has long been an accepted fact of life for government scientists. But the rise of political meddling has so soured the atmosphere around the campus that the salary differential has become more important. The most obvious limitations on scientific inquiry have come from conservatives, who have won official or de facto bans in such abortion-sensitive areas as contraceptive research and the use of fetal tissue as a treatment in Parkinson's and Alzheimer's diseases. When 20-year NIH veteran Lynn Loriaux was prevented from studying the French abortifacient RU-486, he left last August and became director of endocrinology at Oregon Health Sciences University. "It was just too hard to find the freedom to work in this area," he says. Since the ban on speaking fees for federal employees went into effect last year, NIH researchers have been prohibited from accepting lecture fees and other traditional forms of supplemental income offered to their academic brethren. And the institutes' new science police, prowling for the scent of fraud, visibly signal a more stringent environment on the campus. "All these things take their toll," says immunologist Joseph Bolen, a 10-year NIH veteran who has just resigned to take a position with a pharmaceutical firm.

In tackling these problems, Healy is aware she will need to build a strong consensus for action. "No one woman, or man, will be able to do it right without a lot of support," she says. During the past two years, the individual institute directors have moved into the power vacuum at the top, and it will be difficult for her to wrest back authority. The NIH is a national treasure. Healy's difficult task is to make sure this treasure is not squandered, even if it means using every remedy in her black bag.