Meet the people shaping the future of science: Hold the dream...
Photo: Robert Severi
Elias Zerhouni was 24, with a medical degree from his home in Algeria, but he just knew he had to move to the US. Since then he's come a very, very long way. Zerhouni is now in his second year as head of the world's most powerful research organisation, the National Institutes of Health, whose $27 billion budget is one-sixth the GDP of his native country. Sylvia Pag�n Westphal asks him how that journey informs his role
What made you feel you had to be in the US?
When I went to Algiers University I signed up for a mathematics degree. But after few courses I wasn't satisfied with pure mathematics, I wanted more reality, so I switched to medicine. I had an uncle who was a radiologist, and he showed me an image of the world's first CAT scan. It was of someone's brain and you could see a big tumour. He said to me: "You see, this is medicine combined with physics, computers and maths, and I really think that it would be good for you." I thought it was great. I mean, looking inside the human body and understanding it without destroying it. My uncle said the only country that would treat me well and was truly visionary was America. He said I needed to find a way to go there.
So your family got together to help you?
Yes. I had exactly $369 and I spoke broken English. When I came here with my wife we didn't think we would be able to stay long. I was a qualified doctor so I worked in the emergency room on night shift, which nobody wanted. But you know what? It was the best thing I did. It gave me a training that I couldn't have hoped to get anywhere else, and that's how I got to know a couple of faculty members at Johns Hopkins. By that time what I had seen in the US was so good and the people were so good that I really fell in love with the system here.
How did - and does - growing up in Algeria colour who you are?
My father was from the first generation of Algerians who were really able to go to school: during colonisation there was 90 per cent illiteracy. If you grow up in a country where you feel oppressed and second class, you get a real feeling of injustice. So I have that profound sense that there are things in life that you need to fight against, and injustice is one of them. I have a very strong sensitivity for the underdog. And growing up in a family with a teacher as a father made me worship education. Add to that, I was the fifth brother in a family of seven boys and you develop survival skills and a sense of partnership.
Do they know who you are in Algeria? Are they proud of you?
Yeah, I think so. They think I'm the kid who's done good.
Some people have said that being a Muslim American played a big role in President Bush's decision to appoint you. Did it?
I absolutely don't think so. They had a very good idea of the profile they wanted: an established scientist with credibility who had management experience. It had nothing to do with who I was or where I came from. I don't want to be seen as representing an ethnicity. Yes, I am an Arab-American Muslim, and I am serving my country and doing it with all my heart. But my work is representing the NIH and the science at NIH, which is a world-class institution. I strongly believe that one of the strongest core values of our country is that it is not who you are that determines where you go; it is what you've done and what you have accomplished.
Yes, but you have done things that suggest you feel that being an Arab-American is an important part of your public identity. For example, you featured as a success story in a government-sponsored documentary designed to be shown in Arab countries where US views are not necessarily welcome.
I was asked by the State Department to do it, and I really think that it would not be in our best interests as a country to have a gulf of misunderstanding between us and one of the most prominent religions in the world and the Muslim countries. So I am for closeness and I think that America is too precious a value system to break down in its relationships with other countries. I don't like it when there is an almost automatic association of evil and Muslims, and evil and Arabs. That I think is wrong.
Do you enjoy having to deal with Capitol Hill and all those politicians?
It is absolutely necessary for science to have people like myself willing and able to manage all those aspects of science. It is a complex world, but at the end of the day, this is a noble mission. The political interactions are a necessity.
What is the most important medical question you would like the NIH to answer?
To me the most important question is how to put together the teams of scientists combining physical sciences, biological sciences, information sciences - to quickly, quickly find the immediate causes of disease. The paradigm of the 20th century was that doctors didn't really come in until you had developed a full-blown disabling disease. I think the challenge of the 21st century is going to be finding out how to intervene prior to the crash. You don't get a heart attack overnight: you get it because years prior to it arteriosclerosis had set in. You don't get diabetes overnight: you get it because for many years there was a sub-clinical phase that you didn't perceive.
That all sounds very preventive?
Yes, but it's a bit more than that. Over the past 10 years we have made really significant progress in understanding how a disease develops. Take cancer. Now we understand that there is a series of genetic mutations that lead to disorders in the way cells regulate themselves. The research we do will have a huge effect on prevention, because if we know the first events before the disease starts, we can probably come up with what I call molecular prevention, based on a better understanding of the complexity of biology. This is where science is going.
Most of those diseases you are talking about are "rich" western diseases. What about preventing "poor" diseases that afflict the majority of people?
Right. I think we're more and more conscious of the need to have a global view of disease because we also realise that diseases of the developing world dampen the economic potential of these countries, which then creates instability. We also realise that we're not immune from the challenges that affect the rest of the world. SARS, AIDS and West Nile virus are good examples. Obesity is affecting us and everybody else. So we need to have more of a global vision, no question about it.
Having a vision is great, but we know how to stop some of the diseases wreaking havoc in poor countries - by getting more mosquito nets to people, or making antivirals available. Doesn't the NIH have a role here?
Our job is to make sure we understand the language of life and the interaction of all biological systems within the environment. The more we advance, the easier it will be to implement changes. But the NIH itself is not a service agency. We need to make sure people understand that it is not charged with curing all diseases. The institutes are not hospitals. But we can play a leadership role.
For example?
I have supported a partnership between the NIH and the [Bill and Melinda] Gates Foundation to invest in areas of research that we thought might be underfunded. The Gates Foundation will contribute $200 million, and we will issue what we will call grand challenges in global health. Those will relate, by the way, to research for mosquito netting, which is of very pragmatic importance.
What do you make of people like Gates using their fame and fortune to bring attention to "forgotten" areas of research?
These are good things. Federal agencies use taxpayers' dollars, and taxpayers want their diseases addressed. Foundations don't have the same restrictions so they can complement and stimulate new portfolios of activities. If there is one area where 90 per cent of the burden of disease in the world is in the developing world but only 10 per cent of our research is done on those diseases, then it's great to have philanthropists who identify needs that none of us can address. That's a synergy that I think should be encouraged.
Another hot potato is stem cells. After helping build a huge stem cell institute at Johns Hopkins, you now take Bush's more conservative views, which limit funding to certain cell lines and prohibit creating new ones. Why?
Look, I'm a scientist, and I do believe that stem cell research has huge potential. I keep my personal opinions out of leadership. I didn't participate in the president's decision because I wasn't appointed then, but I really considered it an advance. For the first time, the government was going to fund embryonic stem cells and I saw this as a plus.
But there are many scientists, some at the NIH, who didn't consider it an advance - and think Bush's decision was a big blow to US stem cell research.
I think we have to be factual and, frankly, at this point no one knows what direction to take to truly effect cures. It is a tough road. When you try to do what I am doing, which is show leadership and make the science advance rather than lock it into a sterile debate, you please no one. One side says: "This director is in favour of stem cell research," and the other says: "He's not in favour of stem cells enough." I took the job and I knew that would be the price to pay, but deep down I know we are doing the right thing.
What is it like to run such a huge, multibillion-dollar organisation that has been attacked as having grown too fast and become fragmented?
If you look at the NIH, it has 18,000 people. It is manageable, just like General Motors has 300,000 people or more. If you adopt the right management principles you should be able to run the NIH. So I don't believe these extraordinary statements that it's unmanageable. It's true that when you have organisations that grow in size they also grow in complexity, and typically they grow in complexity a lot faster that they grow in size, so it's important for us to continuously review the way decisions are made.
Are you saying the NIH could be run like a Fortune 500 company?
No, it is completely different from a big company. There is nothing like it. People will say, "Oh yes, he's using corporate models," but that's totally idiotic. I have said there are institutions much larger than the NIH that have been able to succeed, but that's where the analogy stops. The NIH is in a unique position in that it combines academic thinking, science research and discovery, which really calls for freeing up human exploration. Our mission is to understand biology to the most fundamental level - and to deliver treatments and cures to people. Now if fragmentation and the complexity of the organisation prevent that, I have a problem with it. So the core issue is whether the organisation as it has evolved is standing in the way of science or promoting it.
Is this why soon after you took up your post you orchestrated a series of meetings to figure out a research "road map"?
Yes, with the road map we have created new ways of funding pioneering research by focusing on building the scientific teams of the future and re-engineering clinical research.
What does that mean?
I hope 20 or 30 years from now people will look back and say: "That director really started the movement for the design of the scientific team of the 21st century." By which I mean I want to bring together young scientists from many different fields and integrate them better than they are today. I want to remove the roadblocks for them to be creative early in their careers.
What about clinical research? How will the road map change that?
Medical research is in dire need of transformation. For years, people have been saying it's breaking down, it's not working. We don't even have a common informatics. Can you imagine running the internet with seven different browsers and having 10 Microsoft companies out there, each one selling a different product? That's what it's like.
Do you ever think of going back to Algeria?
No, no, I have three kids who were born here, terrific Americans. My kids are probably 90 per cent American and probably 10 per cent Algerian. I've spent more than half of my life here so now I feel as American as I feel Algerian.
This interview was first published in New Scientist print edition, (www.newscientist.com/opinion/opinterview.jsp;jsessionid=LIPKGLIBEJCB?id=ns24291)
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