An Apolitical Past

To talk about my path to the NIH directorship, I must begin at the beginning of my life in science. As told in an earlier chapter, I received my first significant training as a scientist at the NIH, in one small part of a government that was also waging war in Vietnam. So I was acutely aware of the potentially paradoxical relationship between NIH scientists and the government that pays for their salaries and test tubes. When I sometimes worried that we might be spending government money extravagantly for new laboratory equipment during my first months doing science at the NIH in the late 1960s, a time when the nation’s investment in the Vietnam War was escalating, my mentor, Ira Pastan, would place our modest laboratory requests in perspective by reminding me how much a new Air Force bomber cost. The unspoken assumption was not just that our laboratory needs were relatively trivial; we also believed that our work was a beneficial search for knowledge, whereas the most prominent activity of the U.S. government was brutal, based on a false reading of Asian history, and destructive to world harmony.

Indeed, none of our requests was ever denied, and I stopped worrying about them. In a very short time, I began to develop a sense of entitlement to government support of research. I set off from the NIH in 1970 for a career as a scientist in the academic sector, unlike most young faculty aspirants I know today, without serious concerns about financial support. I had been awarded what I considered to be a generous fellowship to continue my training in San Francisco,^* and I was optimistic about the promise of medical science as a career. My anxieties had less to do with institutions, government, or society than with my own abilities and career choice: Would I be happy as a full-time scientist if I abandoned the medicine I had been taught to practice? Could I perform as effectively as other young scientists, especially those who had received Ph.D. degrees and sometimes had been working in laboratories since high school, not just during a two-year stint at the NIH?

With time and my growing success as a scientist, even these personal anxieties abated. As a faculty member at UCSF in the 1970s and 1980s, I never had much trouble finding research support from the American Cancer Society or the NIH, and I led a life that was generally full of responsibilities and pleasures at work and at home. So I didn’t sense the need or have the time for efforts to ensure that the government and the public remained committed to the support of science. During those years at UCSF, I conducted and directed research on retroviruses and oncogenes; taught infectious diseases to medical students and experimental virology to graduate students; guided the research strategies and career development of postdoctoral fellows; and wrote papers, delivered talks, attended many scientific meetings, and obtained grants to support further work, more or less as most of my colleagues did. Happily, these were things that I (and they) wanted to do; even better, we were paid by funding agencies and the state of California to do them. For the most part, the public and its representatives in Washington and Sacramento seemed to admire and support what we were trying to do. Science was a public good, not a political issue. Combative politics were about Watergate, the Vietnam War, civil rights, China, and the Soviet bloc. Science and politics didn’t need to mix, and most of us thought it might be better if they didn’t.

An Instructive Interlude: The Recombinant DNA Debate

A notable hiatus in this idyllic state occurred in the mid-1970s. Federal and even local governments threatened to foreclose on the possibilities of using a powerful new technology—called gene splicing or recombinant DNA research—to study many complex biological problems, including my own research subjects: animal viruses and cancer genes. Since the new methods could be used to transfer into bacteria genes from any source—including human genes or genes from cancer viruses—some people imagined some frightening things, like newly engineered, cancer-causing bacteria running amok in human populations. I (and not a few others) thought the imagined dangers were remote and had been exaggerated in the press and in the political debate. But it seemed foolish to deny the existence of some risks—risks that could be rationally evaluated, intelligently explained, and minimized by reasonable guidelines and modification of the experimental methods.

In the summer of 1973, the risks were outlined in an influential letter written by several senior scientists attending one of those Gordon Conferences held at New Hampshire boarding schools.² The signatories and others—led by Maxine Singer, a prominent biochemist at the NIH, and Paul Berg, a Stanford professor and future Nobel laureate for work on recombinant DNA methods—then organized a now famous meeting in Asilomar, California, in the summer of 1975.³ At the Asilomar Conference, the safety issues raised by recombinant DNA technology were openly addressed by a diverse audience, including journalists, government officials, and interested members of the public. For most of the scientists, the goal was to come up with a sensible set of guidelines that would allow the research to proceed without excessive government-imposed restrictions or legal sanctions of the sort that were already under consideration in places like Cambridge, Massachusetts, the home of MIT and Harvard University.

The participants at Asilomar found consensus on proposed rules for the governance of recombinant DNA research; the NIH has used the recommended approach successfully, with occasional modifications, for over three decades.⁴ The importance of this achievement cannot be overemphasized. The world of biomedical science would be very different today if recombinant DNA methods had been prohibited, or severely limited, on the basis of the early scenarios. These methods are now the underpinnings of virtually all molecular research in biomedicine, and they are the essential tools employed by the biotechology industry for production of many components of modern medical practice, such as the hepatitis B virus vaccine, human insulin, monoclonal antibodies for treating cancer, and growth factors for promoting growth of blood cells. They have also been indispensable for the Human Genome Project and its sequels, and for many major discoveries in biology over the past thirty years.

The Asilomar meeting and its consequences taught scientists at least two significant lessons: our relationship with government and the public is sensitive to changes in the methods used for scientific work; and an active and open engagement with an anxious public can produce successful outcomes. The productive conclusion of the controversy over recombinant DNA continues to inspire current efforts to gain societal approbation of human embryonic stem cell research. But the stem cell debate has been complicated by the injection of religious convictions, not just concerns about safety, into the arguments opposing the new science, as further discussed in chapter 13.

Although I followed the gene-splicing debates closely in the science press and through colleagues who participated actively, I was not sufficiently established as a scientist in 1975 to have been invited to the Asilomar meeting; so my own interests and abilities in such negotiations were not tested. A decade later, however, I had my first direct experience with a political debate about science.

Naming the AIDS Virus

One day near the start of 1985, while working in my laboratory at UCSF, I received an unexpected phone call from Dani Bolegnesi, a virologist at Duke University. As an ally of one of the warring parties, he asked me to help resolve a contentious and increasingly public fight over the naming of the AIDS virus, the retrovirus that had been isolated from AIDS patients, grown in cultured cells, and partly characterized during the preceding two years. While narrower in scope and scientific impact than the recombinant DNA debate, this fight was closely followed in the scientific press, in part because of the elements of personal ambition involved, in part because resolution would ultimately determine how the entire world spoke about the cause of the greatest epidemic of our time. Although governments were not directly involved in the debate over the name of the virus, there were national issues at stake—reputation and revenue—and the affair had taken on some attributes of international strife.

One of the two principal combatants, Robert Gallo, was an American scientist at the NIH; the other, Luc Montagnier, was a Frenchman at the Pasteur Institute. They both had passionate supporters on their respective sides of the Atlantic, including attentive members of governments and those who worried about where the proceeds from commercialization of test kits (and any future therapies or vaccines) would end up. Because scientific tradition dictates that those acknowledged as discoverers can name their discoveries, the two were fighting about much more than nomenclature: hotly disputed claims for priority of discovery of the AIDS virus were at stake. Acceptance of a name for the virus by the scientific community could affect the outcome of debates over patents and distribution of royalties, and the decision could influence the award of important prizes, with implications for national stature. In addition, the names under consideration for the AIDS virus reflected different views about the nature of the virus, the manner in which it should be classified, and its significance as an agent of disease. These issues, as well as the lure of gossip and fights over priority, attracted the attention of scientists, physicians, AIDS activists, government officials, and the general public.

The situation boiled down to four basic options. Montagnier argued for lymphadenopathy virus, LAV, the name that he had given to the particles he had first observed in electron microscopic pictures of cells from the swollen lymph glands of patients who were in the course of developing AIDS. That name was unpopular in some quarters because it did not conform to the usual format and utility of retroviral names,^* and, in other quarters, because it did not conform to what Gallo wanted. Gallo wanted to name the virus HTLV-III, the third “human T cell leukemia virus,” putting the virus in a category for which he had appropriately received credit as chief of the NIH laboratory that discovered the first member of that group of viruses, HTLV-I. (Because the AIDS virus did not appear to cause leukemia, he proposed adding “lymphotropic,” a term meaning that the virus preferentially infected lymphoid cells, as a more appropriate “L” word.) But this presented a serious problem for many virologists, regardless of their views of the disputed claims to priority: the AIDS virus seemed to be different from the HTLVs with respect to genetic content, shape of the virus particle, disease spectrum, and even multiplication strategy—too different to be classified with the HTLVs. The third camp was composed of compromisers, those willing to accept the cumbersome designation HTLV-III/LAV to try to satisfy the protagonists, both of whom claimed that they might accept the compromise. The fourth viewpoint held that a new name—more useful and more appropriate—should be sought. This fourth option had the added benefit of complying with neither of the two opponents and thus avoiding the suggestion that the priority dispute was going to be resolved by settling on a name.

A few years earlier, Peter Vogt had proposed my appointment to the International Committee on the Taxonomy of Viruses (ICTV). Having become head of the Retrovirus Study Group of the ICTV, I was given the charge by the ICTV’s chairman to try to resolve the debate over the name of the AIDS retrovirus. To approach the problem in a balanced fashion, I convened an international panel of informed scientists, including Gallo, Montagnier, a couple of their well-known supporters, and a substantial list of senior, nonallied virologists interested in retroviruses, infectious diseases, and problems of virus classification. In addition, I solicited written opinions from many other virologists, clinicians, and various people engaged with the AIDS epidemic.

Members of the panel read the arguments for and against the names already being used (HTLV-III, LAV, and the combination compromise), generated a long list of other possibilities, most of which varied with respect to the one or two words between human (H) and virus (V), and then brokered an agreement for the consensus choice that was announced in May of 1986 and is now recognized everywhere: human immunodeficiency virus (HIV).^{5 *} However difficult this process was—with leaks to the press by Montagnier, belligerent letters to me from Gallo that were copied to most of our nation’s leaders, surly and aggressive behavior by the two rivals, and refusals to sign the final statement by Gallo and his close colleague Max Essex, a virologist at Harvard’s School of Public Health—it was interesting intellectually and socially. It also succeeded and it mattered. And the outcome has worked well for many purposes—scientific, political, economic, and medical.

Political Engagement

During the years when I was negotiating the name of the AIDS virus, my status in the scientific community was changing. In 1984, I had been elected to the National Academy of Sciences (NAS).^** This mark of respect from my colleagues was confirmed and accentuated by the several prizes that Mike Bishop and I received during the 1980s for the discovery of proto-oncogenes. So, without my having to do much more than admit to an interest in fostering the good will of society toward science, when the next problems appeared—constrained budgets for federal science agencies, alleged misuse of government funds at universities, and accusations of misconduct in science—the NIH, the NAS, and science advocacy groups were likely to call upon me for opinions, talks, and committee work.

I first testified before Congress in about 1986 when I joined some better-known colleagues, including the Nobel laureates Jim Watson, Dan Nathans, and David Baltimore, to tell a special session of the House Appropriations Subcommittee, which finances the NIH, why it should greatly expand funding for research to combat AIDS and HIV.^* Afterwards, Chairman Bill Natcher and other congressmen were eager to be photographed with Jim Watson, showing me that a scientist could be treated like a movie star. Furthermore, allocations for NIH-supported AIDS research were actually accelerated—something happened!—despite the Reagan administration’s well-documented apathy toward the rapidly expanding and medically frustrating epidemic.

Especially after Mike Bishop and I received our Nobel Prize in 1989, my opportunities to work on behalf of the scientific community in the political arena increased sharply. But I wasn’t dragged unwillingly into these activities. I enjoyed them, even before I entered the fray more fully in 1993 as NIH director. For one thing, they raised interesting and perplexing questions: How should the federal government allocate its science budget among competing disciplines and agencies—or the NIH budget among diseases or among the more than twenty separate institutes? What fraction of a research grant should be used to support the services provided by the investigator’s institution—its administration and facilities—rather than the direct costs of the equipment, supplies, and personnel used in research? What constitutes misconduct in scientific research and how should allegations of misconduct be pursued? How can scientists better inform the public and its representatives in government about the benefits and risks of sophisticated and potentially controversial or dangerous research?

In 1991, I spoke at an unusual public symposium staged at Stanford University on the ethical and societal implications of molecular approaches to human genetics. It was a revelation to find a large audience composed mostly of nonscientists become fully engaged in sophisticated talks about the social risks of genetic testing, molecular medicine, and other new technologies. The next year, I organized a similar weekend-long event at the Palace of the Legion of Honor in San Francisco, featuring a symposium, called “Winding Your Way through DNA,” on the consequences of the recombinant DNA revolution.⁶ To help the audience prepare for the scientific talks, the neighboring San Francisco Exploratorium developed exhibits that displayed the methods, principles, and products of modern biology, and high school students and their teachers were guided through the exhibits by UCSF trainees. Speakers at the symposium included Herb Boyer and Stan Cohen, reliving the moments of conception of the first recombinant DNA experiments; Jim Watson, describing the discovery and implications of the DNA double helix; and several other leading scientists, discussing medical, agricultural, economic, and ethical issues that emerged from the new technology. With over twelve hundred attendees and five thousand watching by satellite at twenty-seven sites, the symposium was accompanied by student workshops, videotaped interviews with speakers, and sales of coffee cups and T-shirts.

At about the same time that I was becoming more engaged in a wider world, I was also becoming a UCSF heretic. I began to wonder whether a scientific paradise was the right place to spend the rest of my career. Perhaps UCSF had become too comfortable, the pleasant routines too predictable, and my somewhat undemanding role there lacking in challenge. Although I had prestige and plenty of laboratory space, I had very little role in governance, in part because for many years I had avoided committee assignments and faculty responsibilities other than teaching, recruiting, or research.

For some of these reasons, late in 1991 I became a willing candidate to succeed David Baltimore as the director of MIT’s Whitehead Institute, the place where I had worked during a second sabbatical in 1988–89. My biggest surprise was not learning that someone else was chosen.^* Rather, the revelation was discovering my genuine disappointment that I would not be moving to a new and different kind of position. Apparently, I wanted a change and sought administrative responsibility and leadership.

Becoming NIH Director

Then, in the spring of 1993, another opportunity suddenly arose, one that seemed, at least superficially, to be even more of a departure from my established habits as a lab-oriented academic. Bernadine Healy, the Johns Hopkins cardiologist who had been appointed by George Bush Senior in 1991 as the first female director of the NIH, was being asked to leave the NIH by the recently arrived Clinton administration, despite having at first been allowed to stay on. (This change of heart is generally ascribed to her feisty relationships with some powerful members of Congress, especially the important Democrat John Dingell, who claimed to show his fondness for the NIH by watching it closely for improprieties and by investigating it vigorously and frequently.)

Bernadine Healy was unpopular with most of my colleagues, who bemoaned her lack of laboratory experience, her corporate approach to “strategic planning” for the NIH, her allegiance to the Bush-Quayle administration, and her own political ambitions. (She later made an unsuccessful run in Ohio for the Republican nomination for the U.S. Senate.) But I had had a few exposures to her and her job—once in Building One (which houses the NIH Director’s Office on the NIH campus in Bethesda), as part of an advisory group on reimbursement for “indirect costs” of research, and once in a nearby hotel, as part of a large gathering of scientists asked to tell her how we would spend a $1 billion increment in the NIH budget (an unlikely event at that time). On both occasions, I was impressed by her command of information, her self-confidence, and her clear and forceful oratory, even when I was not in tune with her methods or her conclusions. Moreover, I was taken with the importance and complexity of the topics she had taken on, and could imagine why someone would interrupt an academic career to lead the NIH through bureaucratic, political, and financial thickets.

In view of my utter lack of administrative experience, I was surprised when I got a call from Bruce Alberts, my former UCSF colleague and the new president of the NAS, who was chairing an NIH director search committee, composed largely of leaders from academia and other “outside” constituencies and assembled by Donna Shalala, the secretary of Health and Human Services (HHS).^* Bruce asked whether I would consider becoming a candidate and subjecting myself to a phone interview with his committee. I said yes.

The interview by conference call with the Alberts committee was not especially interesting or challenging. I had been supplied beforehand with a list of relatively predictable questions about NIH policies and funding. By that time—spring of 1993—I had made several visits to the NIH, the NAS, and Congress to discuss such questions, so I gave what were by then well-practiced answers to the search committee, and did not hear any negative reactions from its members. Soon thereafter, as evidence that I was on the “short list,” I received an invitation from my prospective boss, Donna Shalala, to meet with her and others in the Clinton administration in Washington in June.

Aside from one discouraging chat with a functionary from the White House’s Office of Science and Technology, who thought that I would be better placed as deputy director of the NIH in view of my limited administrative experience, my day in Washington increased my appetite for the job. Some journalists had portrayed Donna Shalala as aggressive, self-promoting, and egotistical, so it was a relief to find that she was warm, funny, and very smart. She quickly made me feel that the job was mine if I wanted it, and she allowed me to do what might have seemed impolitic to others—to meet with several of the directors of individual NIH institutes, who would later have to view me as their immediate boss. This proved to be a wise strategy, since it allowed me to see how very competent they were and also showed them (as several told me later) that I would care what they thought. By the end of the day, I called Connie in San Francisco and told her that I thought we might be moving to Washington soon.

After I returned home, press reports in science journals and even the New York Times reminded me that the president had not made his nomination and that there were other candidates, including some prominent women. Since Bernadine Healy’s appointment as the first female director had attracted a lot of attention and her term had been very short (less than three years), the appeal of naming another woman was apparent. It was especially gratifying to learn in July that a long list of women scientists had sent letters of support for my nomination. As interest in the director’s position mounted that summer, both locally and nationally, I began to appreciate the meaning of “Potomac fever,” the infectious atmosphere of being under discussion and possibly slated for influence and authority in Washington. When the word finally arrived that I would be nominated by President Clinton, even though we had never met, I quickly accepted and began to reorganize my life and the lives of my family and laboratory members.

In a two-day trip, Connie and I found a private school (importantly, one without a dress code) for Christopher and placed a bid on a modest but attractive house in Woodley Park, in the District of Columbia, convenient to both the Metro’s Red Line and Rock Creek Park. This offered public transportation as well as a bike route to the NIH, twelve miles to the north, in Bethesda. (Living on the NIH campus in the house earmarked for the NIH director never appealed to us: the décor was disturbing, the location was too visible to the NIH’s more than fifteen thousand employees, and the setting was too pastoral for inveterate urbanites.) By Labor Day, we were temporarily installed in institutional housing on the NIH campus, while waiting to take possession of our house in Woodley Park, and attending an Orioles baseball game at Camden Yards, in Baltimore, while waiting for Senate confirmation.

Confirmation proved to be a frustrating experience. Even without any visible opposition and despite unexpected accolades from Republicans of a conservative bent, like Orrin Hatch, Strom Thurmond, and Judd Gregg, the process took entirely too long. Ted Kennedy, then the Chairman of the Senate Committee on Labor and Human Resources, conducted a confirmation hearing in early October, more than a month after I arrived in D.C. I delivered a brief statement of my goals for the NIH, basked in the approbation of my California legislators, Senator Barbara Boxer and Representative Nancy Pelosi, who sat briefly by my side, and then listened happily to flattering statements from the chairman and virtually every other member of the committee. The only cautionary comment came from Senator Daniel Coats, a Republican from Indiana, who quoted from The Prune Book, a handbook that describes major federal positions,⁷ and wondered whether I had the “steel backbone” claimed to be required to run the NIH.

A few days later I experienced another spike of Potomac Fever when Ted Kennedy called me at home to say that the committee had approved my appointment unanimously. Still, their recommendation could not be acted on by the full Senate, as required before I could go to work, because some unnamed senator had used one of the less well-known and distressing privileges of the Senate, by placing an anonymous hold on my nomination for unknown reasons.

Days passed—many days. Press reports of my still unconfirmed appointment focused on my unusual but not entirely reassuring credentials for the job. On the one hand, I would be the first Nobel laureate to serve as NIH director, and the first director to run an active laboratory—which implied that I would be close to the real work of NIH-supported scientists and popular with the rank and file. On the other hand, would I have the time and the experience to do the real executive work of the NIH director? I was not shy about telling reporters that I had never run anything larger than my own lab group with about 25 members; the NIH had nearly 20,000 employees, and over 30,000 grant recipients. I had never managed a budget much larger than my own research budget of about a million dollars (and I wasn’t always deft at managing that). The NIH budget was then just under eleven billion dollars, a difference of over four orders of magnitude.

The delay in my confirmation was frustrating, but it did provide my family time to get our lives in order. Our older son, Jacob, was by then a student at the University of Iowa; Christopher, who had agreed to move with us as a high school junior (no small sacrifice) was enrolled at Georgetown Day School. Connie had been working as a freelance writer after several years as editor of the book section of the San Jose Mercury News and a year as a Nieman Fellow at Harvard; now she was filling in at the Washington Post Book World for an editor who was on a sabbatical. We moved into that house we liked near the Metro and the bike paths in Rock Creek Park. And I began a commuting practice that gave me a kind of identity in Washington—the NIH director who rode his bike twelve miles to work.

After my picture on a bike in front of NIH’s Building One appeared in the New York Times, an advance man for Clinton commented to Connie, “Who thought up the bike thing? Great image,” and claimed that the young congressman Joe Kennedy kept a bike in his office but never used it. I did, nearly every day, in hot weather and cold, taking a morning shower in the third subbasement of Building One, the janitorial locker room, and trying to remember to have an ample supply of clean socks, shirts, and underwear at the office. This practice helped me handle the stresses of the job and also brought me an unexpected accolade—Montgomery County Commuter of the Year—the following year.^*

Since I had still not been confirmed by the Senate, I was not really at work, just roaming the NIH campus as a “special volunteer.” The time was useful for meeting many of the so-called intramural scientists and the administrators on the campus; visiting some of NIH’s outlying sites throughout the Washington area, in Rockville, Poolesville, and off-campus Bethesda; learning some of the intricacies of the budget process and administrative procedures; and preparing to move about half a dozen members of my UCSF laboratory to Building 49 on the NIH campus, while finding suitable settings for the other twenty or so to continue to work in California.

Someone in the NIH Office of Public Affairs suggested that I might benefit from a few sessions with a public speaking consultant, since I would soon be expected to make more public appearances than I ever had before. Despite my initial skepticism, this proved to be wise advice. In a series of three weekly sessions in her studio on Old Georgetown Road in Bethesda, Ms. Virginia von Fremdt gave me confidence as a speaker. She did this in two ways: by making short videos that allowed me to watch myself speaking from a podium and by encouraging me to depend on my natural style, rather than adopt a cautious bureaucratic voice. She praised my tendency to bound up the steps to the stage, told me not to slow the generally rapid pace of my oral delivery (lest I lose energy and enthusiasm), and convinced me that I could generally be more effective by talking naturally (even if a bit clumsily) from a few notes than by reading a verbatim text without error. This training also led me to recognize that I would be unlikely to find a speech writer who could capture my style effectively. In fact, I have never been able to use a talk composed for me by someone else—a situation that has restrained me from accepting too many invitations to speak.

Thanks to the sound advice I received from Ms. von Fremdt, I recognized that elements of style helped to attract favorable attention and get my message across. It also made me conscious of how other aspects of my behavior could help define me as an institutional leader—someone who was reasonably accessible, without pretensions, and slightly eccentric. I tried to dress for the occasion, not for my position: in a suit and tie to make my case at congressional hearings, but in khakis and an open collar to meet with colleagues on the NIH campus. Although I would have access to a car and driver once fully installed as director, I resolved to walk whenever possible, and without an accompanying retinue. Rather than drive my car to work (federal rules prohibited use of a driver to go between work and home), I would ride my bike or take the Metro. When I needed lunch, I would buy it (and be seen doing so) in one of the NIH cafeterias.

Still, these many efforts to prepare for the job, rather than do it, were becoming tedious. Finally, sometime in November, someone learned that Senator Charles Grassley of Iowa was responsible for placing the hold on my nomination. This news surprised me because I had already responded to a letter from him about my views on misconduct in science, an issue that he had taken up as part of his efforts to protect governmental whistle-blowers against reprisal. Having neither met him nor heard further from him, I assumed my response had been satisfactory. But, unknown to me and my colleagues, he expected an independent response from Secretary Shalala to a letter nearly identical to the one I had answered some weeks earlier. (We had presumed that my response would suffice, since letters to a secretary are often answered by the relevant agency head.) Once we understood the problem, repairs were swiftly made, the blackball was removed, and my confirmation took place, very early on a November morning just before the 1993 Thanksgiving recess, as part of a vote on a lengthy list of nominees, not unlike a mass wedding conducted by the Reverend Moon. For anyone watching on C-SPAN (I was not), it would not have been much of a show. I was sworn in the same day, surrounded by a small gathering of family members and colleagues, with Donna Shalala officiating. It was more like a common-law marriage than a coronation. In the process, I had learned something about the oddities of our government.