For immediate release:
Thursday, March 9, 2006
12:01 a.m. EDT


Christopher Fleming

Zerhouni Says Today’s Curative Model Of
Medical Practice Is Unsustainable

 NIH Director Says New Understandings Of Biological Systems
Are Needed, Discusses Strategies For Innovation

Bethesda, MD -- The practice of medicine needs to be fundamentally altered, and only scientific innovation can make this happen.

That’s the vision of National Institutes of Health (NIH) director Elias Zerhouni, M.D., articulated in an interview published today on the Health Affairs Web site. Through the NIH Roadmap, Zerhouni has sought to position his agency as a force for innovation. “The job of the NIH director,” he says, is to “be a provocateur, not the manager of the status quo.” You can read the interview at

Zerhouni’s conversation with Health Affairs deputy editor Barbara J. Culliton is the first of several interviews with leading biomedical innovators that the journal will publish in the coming months. The series is funded by the nonprofit Institute for Health Technology Studies (InHealth), Washington, D.C.

According to Zerhouni, increases in the intensity of care, and consequent increases in costs, have rendered the current method of medical practice unsustainable. “If you looked at the medical team caring for one patient in 1960, you probably had the doctor and nurse and part-time work from a laboratory person -- two and a half people,” says Zerhouni. Nowadays, “you’re talking about seventeen, eighteen, nineteen people per patient per encounter.”

The situation calls for “major changes, not changes at the margin,” the former Johns Hopkins professor declares. “Electronic medical records” -- the current darling of many commentators -- would be nice, “but they are at the margins.” The same is true for national health insurance:  “Because you have no billing and no administration, you will gain another 5 percent. That’s not enough to make a dent.”

The solution advanced by Zerhouni is to intervene earlier in the disease process. He says that medicine should take aim at the “preclinical phase” -- when “something is happening biologically that you’re not aware of” -- rather than at later, symptomatic phases of disease, when intervention is likely to require costly treatments. Zerhouni refers to this as moving from a “curative” model to a “preemptive” model, and he takes care to differentiate prevention from preemption: “Prevention is stopping something you know is there.… Preemption is removing the initial molecular event -- precluding the possibility of that thing even happening.”

Transforming medicine in this way requires an equally profound transformation in the biomedical scientific enterprise, Zerhouni says. “We need to get away from the reductionist approach” in which “one gene or one event causes disease,” and move toward an “integrated understanding of systems biology,” of entire “groups of molecules interacting with each other.” Zerhouni suggests that new technologies such as genomics, proteomics, and nanotechnology have laid the groundwork for the revolutionary progress needed.

Through the NIH Roadmap, Zerhouni has attempted to put the NIH squarely in the revolutionary vanguard and to overcome the conservative impulses and turf preservation instincts that can impede scientific innovation. One example: the Pioneer Award, designed to fund “truly innovative work, not anything that is already going on.”

“You’d think that would be welcomed,” observes Zerhouni, who has led the NIH since May 2002. “But everybody said, ‘Oh no, we’re already pioneering. We don’t need a pioneering award program.’” It turned out, though, that “one of the first Pioneer Awardees was a nanotechnologist, who in one year developed a barcode for identifying biological traits.” Six of the nine scientists who received Pioneer Awards in the first year had never done any NIH-funded work and “were all in new fields for us, including the hard sciences and bioinformatics.”

Zerhouni says that the Pioneer Award experience has made the institutes more receptive to funding innovative ideas through normal channels as well. He thus sees the story as a happy one in many ways, but he also sees a cautionary tale about the power of inertia. “For twenty years, [the NIH] talked about funding an innovative research award, but nothing got done,” Zerhouni says. “I understand now why it took twenty years.”


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at


©2006 Project HOPE–The People-to-People Health Foundation, Inc.