By Carla Garnett

Photos by Ernie Branson

On the Front Page...

Unsanitary hospitals in Afghanistan and unexpected optimism in Africa have changed Tommy Thompson. Three times as HHS Secretary he has traveled to Afghanistan and witnessed multiple surgical procedures performed back to back without seeing medical staff wash their hands or instruments in between. With no clean running water, it was explained, there's no use in scrubbing. In a country where women are forbidden to practice medicine and are also not allowed to be examined by male physicians, the rates of death and disease for mothers and children are about as high as can be imagined. "You'd be hard-pressed to go there and not come away a different person," he said during a June 8 visit to NIH, recalling some of the horrible health care conditions he had found on his global journeys. "It's the worst country in the world for maternal deaths. I don't think there was a dry eye."

Continued...

Secretary Tommy Thompson (l) gets CRC tour from CC director Dr. John Gallin.

As deplorable as health care conditions were in war-torn Afghanistan, where HHS is now helping to build a new hospital for women and children, Thompson said life in several HIV/AIDS-ravaged African countries is gradually improving, due in large part to antiretroviral drug deliveries from the United States.

Recalling several families he met there, Thompson described Rosemary, whose husband had died of AIDS in 1994 leaving her HIV-infected with 4 children to support. In 1995, when her brother too succumbed to AIDS, she inherited 3 more children and an elderly mother to tend. By 2001, Rosemary herself was near death, until her condition was stabilized with antiretrovirals. Visiting the small mud hut she shared with 8 other people, Thompson said he was surprised as much by her emotional resiliency as her physical rebound.

"I would expect her to be very withdrawn and very pessimistic," he noted. "But she was actually just the opposite. She was ebullient...It was so moving that I wish every one of you could have heard her tell her story, because you would then realize how important you are to the future of this country and the world. What you are doing here is making a difference to people you will never see."

Secretary Thompson and NIH director Dr. Elias Zerhouni share a light moment.

In a village 4 hours from the Ugandan capital Kampala, Samson, a carpenter, also HIV-positive, whose wife had died of AIDS in 2002, talked to Thompson about gratitude. "We had no hope," Samson said. "We had no optimism before you started delivering the medicine. You are giving hope and courage to a whole continent."

Mutual Admiration Expressed

NIH director Dr. Elias Zerhouni, who introduced Thompson at the all-hands meeting that concluded the Secretary's day here, praised Thompson's leadership style as "humanity in action.

"Leadership is not something you can invent on the job," Zerhouni explained, remembering trips he has taken with the Secretary and describing the insight that led Thompson to give a Wisconsin dairy cow as a gift to a poor African village. "It's something you have or you don't have. I have had the pleasure over the last 2 years to watch leadership in action. My interactions with him have always been very open, very frank, very direct and at the same time, very humane. What we have here is not someone who cares just about budgets and politics, but he cares deeply about health, for us, and how NIH can serve its role."

Thompson is greeted upon arrival by Zerhouni, NIH Police Chief Al Hinton (c) and several members of the NIH Police force.

In turn, Thompson lauded Zerhouni as "an outstanding leader. I've had the privilege to be in public life now for 38 years and during that time I've had the opportunity to meet a lot of successful leaders. I would have to say that Elias Zerhouni is par excellence. He is a good person, a wonderful leader and a great friend."

'Stronger, Better' as One HHS

In the Natcher auditorium, Thompson began by recounting some of his experiences on campus (see sidebar for details).

"Coming here is another of those outstanding days that I've had as secretary of this great department," he said. "To be able to witness what you people are all about, to be able to see the tremendous progress and the great opportunities that you give humanity by the kind of research that's going on on this campus is just absolutely amazing. I got a chance to hear from what I consider giants, individuals who are doing so much to improve the quality of health not only of America, but of the world."

Referring to an issue that has been debated in recent months — consolidation of department functions such as human resources — Thompson sought to reassure employees about efforts to further unify HHS.

IC directors (from l) Dr. Judith Vaitukaitis of NCRR, Dr. Nora Volkow of NIDA, Dr. Stephen Straus of NCCAM, Dr. John Ruffin of NCMHD and NIBIB deputy Dr. Belinda Seto meet with the Secretary in Wilson Hall.

"I know there's been a lot of concern about integrating the department again and having it function as one, but we're so much stronger and better when we do that," he said. "We have some of the best doctors, researchers, scientists and employees in the world in this department, and we're going to be a lot stronger and better when we work together to develop a mission and accomplish our objectives."

Personal Health Paramount

Thompson also stressed his wish that HHS employees — and NIH'ers in particular — personally serve as examples of healthy living for the entire nation.

"I look around and I see America is not being very healthy," he noted. "We have an opportunity — a responsibility — for ourselves, for this department and for this country to try and transform America."

Acknowledging that 125 million Americans suffer from one or more chronic illnesses and that the cost of health care in America is $1.5 trillion per year and on the rise, Thompson said new strategies to promote prevention are key.

NLM director Dr. Donald Lindberg (l) and NEI director Dr. Paul Sieving

"For the past 30 years," he pointed out, "we have spent all of our money on curative medicine and not on prevention. We all know that if we're really going to transform America, we have to get involved in prevention. That means each and every one of us — it means that you as an individual have to do your part and look the part. It's for your own personal good, but also to demonstrate to America."

The Secretary took aim at smoking, diabetes and obesity. He warned that smokers forfeit about 15 years of their life to illnesses related to the habit. "We have to make sure that we make this a smoke-free campus at NIH, because you're the experts," he said.

Noting that more than 17 million people in the U.S. have type 2 diabetes and about 41 million U.S. adults ages 40 to 74 have pre-diabetes, Thompson cited NIDDK's Diabetes Prevention Program, which found that overweight people with pre-diabetes can lower their risk of developing type 2 diabetes by nearly 60 percent if they lose 5 to 7 percent of their body weight by cutting fat and calories in their diet and increasing their physical activity to 30 minutes a day, 5 days a week.

CRC Project Manager Yong-Duk Chyun (c) gives an overview of CRC infrastructural components.

"We have to get the message out about diet and nutrition," he said, applauding efforts by NIDDK and its director Dr. Allen Spiegel. "We have to show America that we can be better. You lose a few pounds, you feel better. You are NIH. You're the best. You're too darn important to smoke, you're too important not to eat right, and too important not to exercise. If we do that as a department, we can have an impact on the whole federal government."

HHS Touches Everyone

Finally, Thompson addressed efforts to combat bioterrorism. Earlier he had visited the construction site for NIH's newest lab structure, Bldg. 33, which will house research on substances that could be employed for bioterrorism.

"We never expected to be involved in 19th century diseases being used as weapons," Thompson said. "[But] we have to be prepared for that. We have the opportunity through NIH to lead the world and make it safer. At the Department of Health and Human Services, we touch every man, woman and child on a daily basis. The country depends upon us."

The Secretary concluded by again applauding NIH. "To be able to work here and be involved in something that is transforming America, transforming health care, has got to be exciting for you," he said. "I just want to personally and publicly thank you for your tremendous hard work, your devotion to what you're doing and the tremendous ability and passion that you bring to this job. We have the best department in the federal government and I have the best employees in federal government."

While He Was Here Tours, Briefings Fill Secretary's Day at NIH Prior to the afternoon's all-hands meeting, HHS Secretary Tommy Thompson spent the day at NIH, touring various construction sites and meeting with small groups of NIH'ers, including the institute and center directors and representatives from the extramural and intramural sectors. Summarized below are a few highlights from his day-long visit. After being greeted by NIH director Dr. Elias Zerhouni and talking with IC directors in Bldg. 1, Thompson received a condensed overview of extramural research activities from Dr. Norka Ruiz Bravo, NIH deputy director for extramural research. Surrounded by renderings, NIAID's Dr. Thomas Kindt (second from r) and Dr. John LaMontagne (r) point out features of Bldg. 33 to Thompson (l) and Zerhouni. Commenting that the breadth of NIH's scientific portfolio permitted a showing of only a brief birds-eye view, she then introduced her colleagues, Dr. Israel Lederhendler of the Office of Extramural Research and the National Institute of Mental Health, Dr. Lynn Luethke of the National Institute on Deafness and Other Communication Disorders, and JoAnne Goodnight of the Office of Extramural Research. Their stories of eRA (electronic research administration), the information technology system that supports NIH's scientific enterprise, and of basic scientific discoveries maturing — and in some cases already applied to health and disease — provided a natural segue for a briefing by Dr. Jack Spiegel, senior advisor for technology transfer operations in NIH's Office of Technology Transfer. He discussed a number of issues, including a recent public meeting NIH held to collect comments for and against using federal march-in authority in connection with Abbott Laboratories' HIV protease inhibitor drug ritonavir (trade name Norvir). In addition, Spiegel told the Secretary that OTT recently hosted an international gathering of intellectual property holders and others interested in minimizing intellectual property impediments to the development of SARS-related products. Also addressed were efforts by OTT to help resolve such complex issues among various governmental and private entities who are advancing development of an avian flu vaccine. Dr. Norka Ruiz Bravo (second from l), NIH deputy director for extramural research, and colleagues discuss electronic research administration. "The Secretary was briefed also on an array of recent international technology transfer activities to reduce health burdens in developing countries for diseases such as HIV/AIDS, tuberculosis, rotavirus, malaria, dengue fever, meningitis, cancer and diabetes," Spiegel concluded. After lunch with Zerhouni and OD senior staff, Thompson toured the nearly complete Clinical Research Center and checked out design plans, a model and construction site for Bldg. 33. Later, in Bldg. 1, the Secretary heard from four intramuralists, including Dr. Pamela Robey, acting NIDCR scientific director and chief of the Craniofacial and Skeletal Diseases Branch. "What I told him is that my branch has been working on post-natal (adult) stem cells that form hard tissues for many years, starting with bone marrow stromal stem cells that have the ability to form bone, cartilage, the stroma that supports blood formation, fat and perhaps other types of cells," she said. "Using the techniques that we had developed, Dr. Songtao Shi, a tenure-track investigator in my branch, isolated stem cells from adult third molars and from baby teeth. These cells have the ability to form dentin, one of the mineralized layers of teeth. If we are able to identify an enamel-like biomaterial, we feel that we will be able to reconstruct a viable tooth, and be able to build up the bone around an implanted tooth by using post-natal stem cell therapies." NIH deputy director for intramural research Dr. Michael Gottesman (third from r) and several investigators from intramural NIH brief the Secretary on a number of projects in progress. Dr. Susan Buchanan of NIDDK's Laboratory of Molecular Biology discussed her work with integral membrane proteins and potential vaccine development. "I explained to Secretary Thompson how we are determining the crystal structures of proteins from bacterial pathogens such as Yersinia (plague) and Neisseria (bacterial meningitis) to aid both vaccine and drug design," she said. "Specifically, we use X-ray crystallography to study the structures of membrane proteins in the outer membranes of Gram-negative bacteria. These proteins are exposed at the bacterial cell surface, and thus make good drug targets because drugs do not need to penetrate the cell. Many of these proteins are essential for cell viability and also elicit good immune responses from host tissues, so they may also be good candidates for vaccines." Dr. Andrew Singleton of NIA's Laboratory of Neurogenetics talked about interinstitute research his group has been performing on the genetics of Parkinson's disease. "In particular I spoke about a large collaborative project between NIA, NINDS, NHGRI and the Mayo Clinic that led to the identification of an alpha-synuclein triplication mutation that causes Parkinson's disease," he explained. "The identification of this mutation has had a profound effect on our understanding of the molecular mechanisms that lead to Parkinson's. I also talked about the fact that much of the groundwork for current Parkinson's disease research was laid by an NINDS-sponsored meeting in 1995 to discuss how to tackle PD research. This led to the cloning of alpha-synuclein as a gene for PD by an NHGRI lab in 1997." Amid work on the CRC's interior, Zerhouni (l), Thompson (c) and Gallin stroll the halls of the new facility. The intramural session lasted about 40 minutes, according to NHLBI senior clinical investigator Dr. Richard Childs of the Hematology Branch. "I mostly discussed in vitro and in vivo data on how allogeneic stem cell transplantation can be used as an effective form of NK-cell and T-cell based cancer immunotherapy to treat a wide range of malignancies," he said. "[Secretary Thompson] seemed very interested in our mouse and human data showing how metastatic kidney cancer could be successfully treated through this effect. We discussed how NIH was one of the few places in the world that these types of pilot trials in humans could be conducted. We also discussed some sentinel findings from a trial conducted in the NHLBI intramural program showing that some treatment-refractory solid tumors could be eradicated through this type of donor immune effect." Culminating his day at NIH with an address in Natcher, Thompson reiterated his appreciation for the work — and especially the workers — here. "The future of NIH is in good hands," he concluded, "and the leadership is just outstanding." NIH'er Ed Burns (l) addresses Thompson and Zerhouni.