Monica Bertagnolli, new leader of the NIH, wants to expand participation in medical research

When Dr. Monica M. Bertagnolli moved into the director’s suite of the National Institutes of Health, she brought with her a single work of art, a lithograph created by the granddaughter of a cancer patient she once treated. It depicts an abstract geometric female figure and the organs she lost to cancer. Its title: “We are not what you have taken: an answer to cancer.”

The image speaks to Dr. Bertagnolli, an oncology surgeon who previously led the National Cancer Institute and is herself a breast cancer survivor.

After being nominated by President Biden in the spring and winning Senate confirmation last month, she became the 17th director of the NIH, which has a budget of more than $47 billion and occupies a sprawling campus in Bethesda, Maryland. . She is only the second woman to lead the biomedical research agency on a permanent basis.

Several weeks into her tenure, The New York Times visited Dr. Bertagnolli in her office in Building 1, a stately brick structure where President Franklin D. Roosevelt dedicated the Bethesda campus in 1938. This interview has been edited and condensed.

You’ve been here for a few weeks. What are your observations?

The research labs funded from here are incredible for fundamental science. We need to continue all that work. But what we’ve had challenges with is really being able to deepen our research in the clinics in each community where people are treated and cared for.

I think we’ve done very well at our major academic medical centers. But if we are really going to do clinical research in a way that achieves the results we need, we need everyone to have the opportunity to participate.

It sounds like you want more participation of rural people in clinical trials and want to incorporate the data we have into the treatment they receive.


I can’t help but ask if this is because you grew up on a ranch in rural Wyoming.

Sure. Because I understood that healthcare delivery was different for the people I grew up with. From my ranch to a paved road it was 18 miles. And from the ranch house when I was a kid to the next landline for a phone was about 50 miles.

But did you have a phone?

No, we didn’t. Not at the ranch in the summer. When school started, my mother moved with the children to the city. We also had a house in the city. And on weekends we went back and forth to the ranch. We had a telephone in the city.

Activists are pressuring the NIH to use so-called entry fees to claim patents on drugs developed with tax money, as a way to lower prices. Are you open to that?

Absolutely. It is part of my authorities as director of the NIH. But I have to be really sure that if entry rights are ever used, the result will be the desired result, which is that people will get better access, because that is really the goal. We want all people to have access to the benefits of biomedical research. (After this interview, the Biden administration issued a framework proposal to guide the agency’s use of entry rights).

The NIH has come under scrutiny for its funding gain of function research — including in Wuhan, China — that some experts consider dangerous and could lead to the next pandemic. Are you reviewing that type of research and do you plan to make any changes?

The gain-of-function research you’re specifically referring to is modifications of potential pandemic pathogens, right? What if we could develop a vaccine long before we would have to see a new virus that will be another Covid-19 virus? That would be a great benefit. But if we are going to do that kind of research, we must ensure that the risks are completely minimized and always keep in mind that the benefits justify the risks.

The White House is weighing recommendations of the National Scientific Advisory Council for Biosafety to improve oversight. Where is that?

To be fair, I still don’t know. But it is a high priority for all of us and I will be a very active participant because supervision is essential for that type of research.

The Pew Research Center recently post a poll showing that Americans’ trust in science has continued to decline, and more so among Republicans than Democrats. Does that worry you?

A lot of it is like that. Everything we try to do in science is about providing better care for people. It is absolutely impossible to provide better care to treat people without trust.

But I’m thinking about trust, in general, in institutions like the NIH. We are seeing Republicans on Capitol Hill be critical of the NIH What can be done to close that partisan gap and restore Americans’ faith in the institution?

Be very transparent, very honest in what we know and what we don’t know. Think about what we just went through as a nation: the trauma we’ve all been through. It’s ridiculous to think that we won’t get over a trauma like that without real consequences. But I also think we can use it as an opportunity to really build trust in science, because I think science has helped us get out of the dark days of this pandemic.

You have been a patient and you have talked about it. How do you feel? Can you talk about your condition?

I am a cancer survivor. I think we all have to be humble when faced with a cancer diagnosis. So my chances of living the rest of my life cancer-free are very, very high. That’s the good news. And what I tell everyone when they ask me about this is that all the evidence that guided my attention came from NIH-funded research.

I would be remiss if I didn’t ask her about being the second woman among 17 directors. I walked down this hallway and saw many portraits of men. How does that affect the way you think about the role you play?

I am very happy to see that women have opportunities to show what they can do. If you look down that hallway, for all those years, there were really talented and capable women, too. They just didn’t have the chance.