PHOTO: NATIONAL INSTITUTES OF HEALTH524 29 OCTOBER 2021 • VOL 374 ISSUE 6567 science.org SCIENCENEWS | IN DEPTH
A
s the search for the next director
of the U.S. National Institutes of
Health (NIH) gears up, observers
are wondering: Is it time for the
White House to abandon tradition
and choose a biomedical scientist
who does not hold a medical degree?
It’s been a topic of discussion since NIH
Director Francis Collins announced on
5 October he will step down by the end of
the year—and urged that a woman succeed
him. The question may be especially rele-
vant this time because insisting on a physi-
cian at the helm of NIH could complicate
efforts to recruit a woman or a person of
color (POC). Among potential candidates
whose names quickly popped up was Uni-
versity of California, Berkeley, biochemist
Jennifer Doudna, who won a Nobel Prize in
2020 for co-discovering the CRISPR gene-
editing tool but does not hold an M.D.
There is no legal requirement that
the NIH director be a physician, but all
16 directors in the agency’s 134-year his-
tory have had a medical degree. Collins
himself, an M.D. and geneticist with a
chemistry Ph.D., has an active medical li-
cense. He has occasionally seen patients at
the NIH Clinical Center, which treats thou-
sands of people each year, although not as
part of patients’ official care teams, an NIH
spokesperson says.
Jeremy Berg, former director of the
National Institute of General Medical
Sciences (and former editor-in-chief of
Science), argued on Twitter that “medical
training matters” because the NIH director
oversees clinical programs and the Clini-
cal Center. In addition, not having the M.D.
title after the NIH director’s name “could
be a political liability as issues arise,” he
wrote. Others disagreed: An M.D. require-
ment “holds back on the NIHs[sic] evolv-
ing mission,” which includes areas such as
public health and bioengineering, tweeted
Georgia Institute of Technology biomedical
engineer Krishnendu Roy. “The right, po-
litically savvy person can be an asset.”One former NIH director sees it both
ways. Cancer biologist Harold Varmus, an
M.D. who stopped practicing medicine in
the early 1970s and let his license lapse in
the late ’80s, a few years before he became
NIH director in 1993, says an M.D. is not
needed to oversee grantmaking or set up
research programs. “The vast majority of
the work can be done perfectly well by
someone with a Ph.D.”
But Varmus says knowing “the vocabu-
lary of medicine” can be “useful.” Members
of Congress might expect an NIH director
to have an M.D., he adds. It could make it
“easier” to persuade lawmakers that NIH
needs more funding “not just to pursue a
basic understanding of science, but to im-
prove health,” Varmus says. The degree canalso be relevant when members of Con-
gress ask NIH for medical advice for them-
selves or a family member, Kathy Hudson,
a former NIH deputy director, told STAT.
Yet others suggest times have changed.
“The tradition seems dated,” says longtime
NIH observer Tony Mazzaschi, chief advo-
cacy officer of the Association of Schools
and Programs of Public Health. With NIH’s
budget now pushing past $41 billion, he
thinks management and communication
skills “are more essential than ever. Per-
haps those skills need to be considered on
par with scientific expertise.”
Mary Woolley, president of the group
Research!America, which advocates for
biomedical research funding, agrees that
an NIH director’s administrative skills
should carry a lot of weight. She notes that
hospital CEOs were once expected to have
medical degree, but that is no longer the
case. “I just think it’s time to think more
broadly,” Woolley says.
Woolley and Varmus both served on a
committee of biomedical research leaders
that recently pondered the M.D. question.
The panel, which included past NIH Direc-
tor Elias Zerhouni and two other former NIH
officials, noted in a report last year: “It is es-
sential that the Director has wide knowledge
about medicine. However, we do not view
the MD degree as an essential attribute.”
An M.D. requirement could shrink
the pool of high-profile POC and women
researchers—ruling out not just Doudna,
but also others, including biochemist Erin
O’Shea, president of the Howard Hughes
Medical Institute, one of the largest pri-
vate funders of biomedical research in
the United States, and neurobiologist Cori
Bargmann, head of science at the Chan
Zuckerberg Initiative, another large fund-
ing philanthropy. (NIH has had just one
woman as a director, Bernadine Healy.)
The White House has said it expects to
nominate an NIH director before Collins
steps down. The post requires approval by
the Senate health committee, which could
take time because of other pressing business,
including the expected nomination of a Food
and Drug Administration chief. Confirma-
tion also requires approval by the full Senate.
But the NIH candidate could begin to learn
the ropes as soon as they are named, Varmus
says. “If we had a nominee by the end of the
year, that would be a triumph.” jNIH Director Francis Collins (center) with former directors and fellow M.D.s Elias Zerhouni (left) and Harold Varmus.
By Jocelyn Kaiser
BIOMEDICAL RESEARCH
Should the next NIH director have an M.D.?
Some observers say White House should drop that tradition to broaden the candidate pool