Nominees for NIH Director, Surgeon General Announced

WASHINGTON—In selecting the new director of the National Institutes of Health (NIH) and the new surgeon general, President Bush steered a middle course through political thickets and chose two men whose views on stem cell research, human cloning, and other moral and ethical issues confronting biomedical research dovetail with his own.

Both nominees appear likely to win Senate confirmation easily, in spite of some dissatisfaction voiced about NIH director-designate Elias Zerhouni, MD, of Johns Hopkins University, by some antiabortion groups and the unfamiliarity of Washington officialdom with surgeon general nominee Richard Carmona, MD, an Arizona surgeon and emergency medical administrator.

Vacant for 2 Years

Dr. Zerhouni will fill the NIH directorship that remained vacant for more than 2 years after Harold Varmus, MD, left to head Memorial Sloan-Kettering Cancer Center. Dr. Carmona succeeds David Satcher, MD, who announced last summer that he would leave office when his term ended in February.

Filling the NIH job proved a difficult task for the Bush Administration because of tension regarding the issue of human embryonic stem cell research. The President has approved a limited amount of such work, but many political conservatives and religious groups oppose any use of embryonic tissue for scientific research or therapy.

White House press secretary Ari Fleischer acknowledged the issue in discussing the two nominees. "They serve the President, they serve his policies, and I don’t think you would expect the President to appoint people who hold wildly different views than he does," he said.

In introducing Dr. Zerhouni at a White House ceremony, the President said that the radiologist shared his view that human life should not be destroyed or exploited to benefit others. "And he shares my view that the promise of ethically conducted medical research is limitless," Mr. Bush said.

For NIH, this is a time of financial uncertainty and what many regard as a leadership vacuum. The highly regarded agency went more than 27 months without a director, a vacancy that somewhat dimmed its influence in the decision-making processes within the Department of Health and Human Services (HHS), on Capitol Hill, and in parts of the executive branch.

Moreover, at the time of Dr. Zer-houni’s nomination, six directorships were vacant at NIH institutes. With his confirmation, NIH insiders expect the Administration to fill these vacancies with some dispatch.

Budget Issues

Starting with the fiscal year 1999 budget, Congress has increased NIH’s funding at a pace intended to double its budget by fiscal year (FY) 2003, which begins on October 1. In his budget proposal this year, President Bush included enough money to complete the effort, and Congress seems inclined to do so.

What remains unknown is how much money Congress will approve for NIH in FY 2004, particularly in light of the first deficit federal budget in several years. Dr. Zerhouni could find himself leading the organization through a period of stagnant budgets or meager increases.

Both HHS Secretary Tommy G. Thompson and colleagues at Johns Hopkins describe Dr. Zerhouni as a consensus builder, a skill he will need at NIH. He has accepted a job that gives him limited authority over the largely autonomous NIH institutes. Former NIH director Donald Fredrickson, MD, once described the only real power of the post as "the power of persuasion."

As surgeon general, Dr. Carmona will lead the Public Health Service commissioned corps, a group of 5,600 health care professionals spread throughout a number of HHS agencies and other federal departments. His, too, is a leadership role that traditionally has relied on the power of persuasion in describing health problems to the American people, including the famous series of reports on the ill effects of cigarettes and other tobacco products.

Three Tasks

At the White House, Mr. Bush specifically charged Dr. Carmona with three tasks: Ensuring that America is prepared to respond to major public health emergencies such as bioterrorism; leading a new initiative that focuses on prevention, fitness, and healthy living as keys to reducing disease and improving medical care; and speaking out to the nation about the health dangers of alcohol and drug abuse.

Although both men bring a list of accomplishments to their new positions, their backgrounds are quite unlike each other and, in most ways, quite unlike previous NIH directors and surgeons general.

Born in Algeria

Dr. Zerhouni, 50, was born and educated in Algeria and received his medical degree and radiology training there. He joined Johns Hopkins in 1975. Since then, he has earned a reputation as an able researcher and administrator.

He rose to professor of radiology and biomedical engineering and chairman of the radiology department; served as vice dean of research; and was executive vice dean of the medical school when named to head NIH. Dr. Zerhouni holds a patent on a device to enhance magnetic resonance images and has helped form a company to market it.

"He has a clear understanding of the relationship between science, academia, and industry that will serve NIH well," Secretary Thompson said.

Dr. Carmona, 52, will bring to Washington a colorful past. The Harlem-born Hispanic-American dropped out of high school, became a Green Beret, fought in Vietnam where he was wounded, and earned his high school equivalency degree (GED). Later, he attended college, became a nurse, and then went on to medical school and to specialize in trauma surgery.

In 1985, he created the first trauma-care system in southern Arizona, and a year later, he joined the Pima County Sheriff’s Department as a part-time member of its SWAT team. Six years later, he was wounded in a shoot out with a murder suspect who died of his wounds in spite of Dr. Carmona’s efforts to save him.

"Dr. Carmona has redefined the term hands-on medicine," President Bush said.