NIH Director Elias Zerhouni calls for new medical research models to address 21st century illness patterns

The vanguard of modern medicine must move toward pre-empting disease at a molecular level, and to do that, it will need a new mindset for research that breaks down the traditional barriers between disciplines, National Institutes of Health Director Elias A. Zerhouni told science writers who gathered recently at AAAS.

Speaking to journalists and public affairs officials at an event sponsored by the D.C. Science Writers Association, Zerhouni described how the NIH Roadmap he developed after taking the leadership role a little over two years ago is working to identify gaps—and opportunities—in biomedical research.

"The process won't occur in one swoop," said Zerhouni, a radiologist. "It will take time to move from curative to preemptive medicine."

NIH developed the medical research roadmap shortly after Zerhouni took office in May 2002. The research priorities contained in the plan were derived from meetings involving more than 300 national medical leaders in academia, industry, government and the public.

"As science grows more complex, it is also converging on a set of unifying principles that link apparently disparate diseases through common biological pathways and therapeutic approaches," he wrote in AAAS's Science magazine last October. "Today, NIH research needs to reflect this new reality."

"Technologies for research are changing very quickly," Zerhouni told the writers gathered on May 19. "Chronic conditions are on the rise." Because of changes in the environment and in nutrition patterns, medical staffs today are dealing with less lethal problems and more long-term illnesses. "In 1910, people consumed—on average—close to 28 pounds of sugar a year," he explained. "Today, we consume more than 300 pounds of sugar in a year."

Because biology is so complex, the NIH is encouraging interdisciplinary collaboration and research. "The medical community needs to stimulate intellectual capital by allowing interaction that wouldn't occur otherwise," Zerhouni said.

For instance, he said, obesity must be studied from different perspectives and disciplines. It is an issue of behavior, neurobiology and metabolism, and it presents clinical issues. All of these roots must be explored in order to solve the public health problems posed by obesity.

"We need to begin by dealing with disease using models of preemption that exist," Zerhouni said. But every disease has a pre-clinical phase—a point at which the disease is developing without showing obvious symptoms. "We need to intervene before the disease sets in," he said. "We need to increase our knowledge of molecular events before the disease emerges."

How would cutting-edge pre-emptive medicine look in a clinical setting? asked one member of the audience. Medical workers will "need a fabric of information systems that connect, to run the diagnostics and reports to identify trends and patterns," Zerhouni replied. And, he predicted, conducting clinical research trials will require "fundamental change in the way we pay for health care."

Zerhouni's meeting with science writers at AAAS came as the National Institutes of Health are under scrutiny by the U.S. Congress for allowing government scientists to develop close financial ties with industry. He has promised to work with Congress to re-write the conflict of interest rules that govern 6,000 scientists who work for the NIH. In his speech to science writers, he detailed his proposals. All NIH employees should be banned from holding stock options, he said. NIH employees should not serve on the board of directors of private companies. And there should be a layer of policymakers at NIH who make and approve grants but who have no interactions with corporations.

But he argued for a middle road that would stop short of an outright ban on doctors and scientists engaging with private industry. Instead, such interaction should be allowed—but more closely regulated—so that NIH can recruit and retain top scientists and so that they can bring information and data from the private sector back to NIH.

Zerhouni praised the science writers for their role in helping to build trust between scientists and a sometimes wary public. "Science writers are essential to further science," he said. "It is crucial for people to be informed in order for progress in science."

—Monica Amarelo

7 June 2004