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By Rich McManus

Photos by Bill Branson

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The worst job Dr. Elias Zerhouni ever had was before he entered medical school at the University of Algiers. He took a job with a construction laboratory, testing the strength and durability of concrete and steel bars for large construction projects. Project foremen had been complaining that batches of the company's concrete had been failing regularly, crumbling under heavy loads. Zerhouni set out to discover why.

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He read books on how to make concrete. An engineer showed him how to analyze sand, rocks and cement. Zerhouni found that, of all the elements in the recipe for concrete, the most important is the fine dust that acts as a binding agent for the larger stones. Without the right volume and type of dust, the concrete lacks strength.

Dr. Elias Zerhouni Zerhouni presented his findings to the company, which selected a new quarry for its sand dust and soon realized that the young employee's hypothesis had been correct. Concrete no longer broke under stress, and the company could avoid the costly process of demolishing substandard batches. But it took someone willing to dig deep, and deal with the fine particles to solve the problem. These days, 4 months into his post as the 15th director of NIH, Zerhouni is again acquainting himself with the fine particles, this time of a $27 billion agency. By immersing himself in the small parts of the institutes — by late August he had been to nearly half the 27 institutes and centers and impressed many IC directors with his quick grasp of their issues (see sidebar), not to mention the many individuals he has surprised with his warmth — Zerhouni hopes eventually to mold a stronger, more enduring NIH.

"After being a [construction] consultant, I said 'That's a great job, but I think I like research better, in the lab," Zerhouni recalls. "That was before I decided to go to med school. I had wanted to be an engineer because I was good at math and physics...I worked [construction] for 6 months, and it was good money, but I didn't like the engineering aspect. I liked more the research aspect. My experience was to test, to test, to test and ask 'Why is it failing?' That's when someone said, 'You know, you should go into research — you seem to ask the questions rather than implement the solutions.' That's what convinced me to go into medicine, actually."

Business Before Pleasure

As the Labor Day holiday weekend approached, Zerhouni was not preparing to enjoy a few days of windsurfing or boating at his house fronting the Chesapeake Bay. Rather, he was planning for the NIH director's annual Leadership Forum, a traditional exercise he embraced for its opportunity to identify priorities in conjunction with the IC directors, build consensus and "really go into depth" on the major issues confronting NIH. An unabashed lover of the water — he grew up on the Mediterranean Sea and spent hours of every summer day swimming and diving with friends (he can hold his breath for nearly 3 minutes, and is still able to dive to depths of 30 or 40 feet and linger for up to half a minute) — Zerhouni nonetheless put aside pleasure to focus again on leading NIH, an activity he says takes all of his time, postponing even the radiological research projects he hopes one day to pursue here.

Zerhouni poses for one of his new official portraits on the lawn of Bldg. 1.

"I think it's important initially, when you take on a new job, to focus 100 percent on the new job, build teams, have appropriate interactions with the IC directors and all of the management team, set up some operating principles, and become also a spokesman for NIH, across many constituencies," he said. "That requires 100 percent commitment and focus."

The forum, he said, would enable him to define a "roadmap for action" that he had been thinking about for the previous three months, and which would cover the next 3-5 years of NIH's future. Focus groups composed of both intramural and extramural scientists helped set an agenda that was to include such topics as: access to research resources, databanks, bioinformatics, molecular libraries, clinical research networks — "a whole slew of issues that seem to be multidisciplinary, requiring teamwork. How do we encourage that, and more importantly, what new areas of science do we need to focus on that have a lot of promise to them, but may need NIH encouragement? Systems biology is one, biological engineering, mathematics of model systems — those are the issues...My philosophy is that every institution and its people have a certain amount of energy, and you don't want to diffuse it — try to be all things to all people — but try to focus it strategically on the things that will make the most difference."

Zerhouni said the briefings he has been getting at his fact-gathering visits to the ICs have been an inspiration as he learns the ropes at NIH. "It's been terrific, actually. I have to say that the quality of the presentations, the discussions, the people — it's just outstanding," he said. "I'm very pleased to walk around and meet people, and get a sense of the challenges and the opportunities for the institution."

Changes in OD and Recruitment

With respect to the Office of the Director, Zerhouni said he's mulling some eventual changes. "I'm really thinking through that," he said. "At this point I have not made up my mind yet...Change for the sake of change is not something that I encourage. I want to identify what are the right things to do." He envisions an OD that works more closely with the ICs, communicates more effectively with the outside world, and that adopts a decision-making process that is more cogent and less taxing on staff.

Of several vacancies at the top of some institutes, he said, "One of the most, if not the most important jobs of a director is to recruit the best and brightest as heads of institutes and centers. I consider that probably my highest priority...It is not good to leave institutes without permanent leadership for too long a time...I think we'll be making some announcements pretty soon. I'm very pleased by our ability to attract some outstanding candidates to the NIH. It's taking me some personal effort and many, many phone calls, but I think that's what you need — you need to create a sense of excitement and positive energy so that the best people out there will consider a leadership position at NIH. After all, being an IC director is an outstanding opportunity for someone who would want to make an impact on science."

Town Meeting Series Planned

To improve morale on campus, Zerhouni has proposed a series of "town hall" meetings, the first of which is scheduled for Masur Auditorium at 1 p.m. on Friday, Oct. 4. "For an organization as large as NIH, town meetings need to be regular events," he said, "where the leadership of the institution communicates with the members of NIH and the community at large. It's a chance to share challenges and opportunities, have questions asked. I am very much in favor of an open and interactive style of management. Good communications helps morale, helps everyone continue their outstanding commitment to the NIH. I'm impressed with the culture here of dedication to the NIH mission by everyone...I believe the NIH director should not be a remote figure. After all, transparency in who you are, what you do and where you intend to go is very important not only for morale, but for effectiveness of the organization. So I intend to communicate, communicate, communicate."

Director plans new roadmap.

Addressing NIH relations with its parent Department of Health and Human Services, Zerhouni said that, particularly after a period of growth, it's important to "harmonize interactions between various functions...So far we've had a very open dialogue in areas of public affairs and legislative affairs...Departmental and government-wide activities need to be coordinated, but there are activities that are NIH-specific that need to be preserved at NIH, and they will be preserved. You need the proper balance between centralization and decentralization."

To achieve a so-called "soft landing" after the doubling of the NIH budget during the past 5 years, Zerhouni said he would advocate as strongly as he could to defend the value of continued investment in biomedical research. "The opportunities in science have never been greater. My job is going to be to make that point."

Zerhouni is concerned that "public recognition of the agency is not as high as one would think. And yet, all of the major advances in health care, and in discovery, over the past 30 years have come from NIH." He wants to promote NIH as being in the vanguard in health care and research progress.

An Appetite for Fun

Turning to his hobbies, the director avidly described a lifelong love affair with the water. "I started diving when I was probably 3 years old...I grew up by the water. I spent probably 5 or 6 hours per day in the water when I was a kid. From age 12 to 19, I was a competitive swimmer. From 10 o'clock in the morning I was in the water til 3 in the afternoon — like the kid who was swimming with Flipper (the dolphin star of a 1960s TV show) all the time. I was also spearfishing — that was my hobby. Then when I grew up and had a little more means, I began recreational scuba diving, not wreck-diving or deep-diving. I trained all my kids to scuba dive, too...My daughter, she's the best of the group."

He spent an August vacation simply enjoying the pleasures of a waterfront home. "I love crabs," he said. "My wife hates them, but I love 'em, so I take her share." Playing music on the lute is probably his second favorite pastime, he said, chiefly Spanish and Moorish tunes "from where I grew up." Of his home country, he said he rarely returns to Algeria "because it is very troubled — maybe once every 2 or 3 years I'll have a trip."

Before the interview began, Zerhouni posed for NIH photographers on the lawn of Bldg. 1; these would be the official photos of the NIH director. The director's aides had been worried about the photographers' plans to have Zerhouni stand atop a picnic table, in order to get the best angle of him with Bldg. 1 in the background. What if he fell and got hurt? Would he look ridiculous? Discounting their concerns, Zerhouni simply said, "Let's do it," mounted the table without pause, and posed — chin up, chin down, somber and grave, jovial and amused, arms crossed, arms at his side — whatever the photographers asked of him. Game to do whatever he needed to in order to get the job done, even if it kicked up a little dust.

'How's the New Director Doing?' At the end of a half-hour interview with the Record, NIH director Dr. Elias Zerhouni proposed something unorthodox: "Maybe the thing you should do is talk to other people about what they have seen of me over the past three months...I think it's more interesting than me speaking...After all, how much can you get out of a 30-minute interview? Maybe you want to ask the IC directors and some people around here, 'How's the new director doing?'" "It is impressive to see how quickly Dr. Zerhouni has become knowledgeable regarding the quality and loyalty of the NIH senior staff," observed Dr. Yvonne Maddox, deputy director of NICHD and recently NIH deputy director as well. "In doing so, he has re-instilled a tremendous amount of confidence among staff. He seeks their counsel, gives them significant responsibility and lets them get their jobs done." Said Dr. Michael Gottesman, NIH deputy director for intramural research, "Dr. Zerhouni has been a very quick study, absorbing huge amounts of NIH lore and policy and adeptly adding his own, unique perspective. He has impressed everyone by his grasp of both basic science and clinical research, and his goal is to maximize the return on the public's investment in the NIH. He understands the important contributions made by the NIH intramural program and has encouraged intramural scientists to take full advantage of the opportunities afforded by the resources in the intramural program. He favors facts over opinions, and all of his decisions so far have been data-driven. All in all, an outstanding beginning." "In my opinion, Dr. Zerhouni is doing an excellent job as the new NIH director," said NIDCD director Dr. James Battey, whom Zerhouni has tapped to lead a new NIH task force on embryonic stem cell research and related issues. "He has taken the time to listen closely to his colleagues at NIH about research opportunities, and has actively sought input from the research community. Based on this broadly-based input, I am confident he will chart a course for NIH that will capitalize on the many opportunities and compelling needs of the biomedical research community." "Dr. Zerhouni has rapidly proven himself to be a knowledgeable and highly capable leader," noted Dr. Francis Collins, director of NHGRI. "His command of basic and clinical biomedical research is impressive, and he has a real vision for the future of NIH. Furthermore, he has already demonstrated remarkable skills in organizational leadership. We are fortunate indeed to have such an inspiring and dynamic new director." Adds NIAID director Dr. Anthony Fauci, "I have been very favorably impressed with Dr. Zerhouni, both as a person and as a talented scientist/administrator. He has quickly grasped the complexities of the job, has shown leadership, insight, energy and conviction, and importantly, he is a very enjoyable person to work with." Concluded Charles Leasure, Jr., NIH deputy director for management and chief financial officer, "He appears to be the perfect person for the times — an outstanding scientist and physician who recognizes the need to apply the latest management theories and techniques to make the best use of the resources given to us by the taxpayers as NIH tries to prioritize future research efforts."

'Communicate, Communicate, Communicate' Zerhouni emphasizes his reliance on clear communication. Whether or not Dr. Elias Zerhouni knew he was mimicking Joseph Pulitzer's journalistic admonition, "Accuracy, accuracy, accuracy," or perhaps real estate's maxim, "Location, location, location," he nonetheless offered his own advocacy — in memorable triplicate — for communications. "The best scientists are great communicators," he said. "I have not known a great scientist who was not a great communicator...When you have to compete for your grants and your programs, you have to be a very good communicator because you need to convince people. I really believe that the best science is served by the best communication. To not communicate as a scientist means that maybe you don't know or understand your science well enough to communicate it well. What you understand well can be communicated well. It's a matter of not just discipline but obligation to the public for scientists to communicate both the excitement of science, the prospects of science and the accomplishments of science. This belief in communication is something I've had all along."