THERE WAS -- AND STILL IS -- AN ALL-MALE EATING SOCIETY AT JOHNS HOPKINS UNIVERSITY medical school called the Pithotomy Club, which is famous for the comedy revue it stages every year lampooning the school's faculty.

The show dates back almost to the club's founding at the turn of the century, and in its heyday was hugely popular with the alumni. It was a bonding ritual for male students and faculty, a chance for the once and future elite of American medicine to gather for obscene songs and skits, get drunk, and then -- because the club had only one toilet -- urinate together in the alleyway next door. F. Scott Fitzgerald immortalized the "Pit" in a short story. H.L. Mencken said the only time he had seen something cruder was in a show put on by sailors in London.

Bernadine Healy does not like to talk about the events that led her, 10 years ago this spring, to do battle with the Pithotomy Club. To the woman who now holds the most powerful position in American science, the day the Pithotomy Club made her the subject of its annual show is a distant and traumatic memory, an episode so personally painful that over all of the intervening years she says she has tried to repress it.

But when Healy speaks of the plight of women in science, of her plans to redress the scientific establishment's neglect of women's issues, or when she confronts the establishment with her own new and radical agenda -- as she has over and over again in her first year as head of the National Institutes of Health -- it is difficult not to call the Pithotomy episode to mind.

Healy was then one of the Hopkins medical school's brightest stars, an intense and ambitious young cardiologist who made an inviting target for the Pithotomy wags. She had recently been divorced from another member of the Hopkins faculty, Gregory Bulkley, and in the show's central skit he was portrayed as mad with jealousy, stalking physicians he suspected of sleeping with his ex-wife. Healy, played by a man dressed in a long blond wig, fish-net stockings and coconut-half brassiere, was depicted performing a variety of pornographic acts on other physicians until, at the end, she was discovered in flagrante by her ex-husband. The show closed with the man who played Bulkley singing "Cardiology Girl," a bawdy takeoff of the Playboy centerfold-inspired hit song "Calendar Girl."

"It would be one thing if a men's club got together and wrote degrading pornographic things about each other," Healy says, her voice rising with the memory. "But when they started to bring women into it, to bring women faculty into it, I thought it was offensive.

"I had just gone through a divorce. I was very vulnerable. I was a single mother trying to raise a child. This was the final straw. I let it be known that the club had to stop."

She tried to argue that the show was sexual harassment. But this was 1982.

"I got no support when I brought it up. I was rebuffed repeatedly. I kept hearing, 'Bernadine, knock it off. Boys will be boys.' "

Still, she worried that the skit -- including what the show's creators conceded was a groundless accusation of infidelity -- might damage her reputation. She demanded a list of the participants in the show, and when she was refused, asked again. At staff meetings, she would not let the subject drop. Finally, after she threatened a lawsuit, she got a face-to-face meeting with the club's officers.

"I made every one of them answer how they would have felt if {the skit} was about their sister, their mother or their wife. I went around the table and questioned their integrity, their sensitivity, their character."

Only one friend at Hopkins, Healy remembers -- a woman -- ever came forward to tell her that what she was doing was right. Other faculty thought she had no sense of humor, no sense of perspective; that she was not playing the game. The dean told her he was worried about her career.

"I was one of the leaders of that institution," she says now. "But after that episode I would go in a room and there were different vibrations. It did not make me popular."

She was gone from Hopkins by the following year. IT'S A COLD DAY IN FEBRUARY AND Bernadine Healy, now the chief of NIH, is at a scientific symposium at the University of Connecticut. To her right is a man, her host, the governor of Connecticut, Lowell Weicker. To her left is another man, and to his left another man and another man and on and on down the lecture hall's long dais, 13 consecutive men in all, all but one white, all but two graying, the aristocracy of science.

In the audience there are more men. Rows of them in suits and ties. Biologists and chemists and clinicians here to listen to Healy's vision for the scientific future.

They do not like what they hear. She is new, and she wants to change things. She says she wants to restructure the American scientific enterprise, to make NIH, its $9 billion-a-year budget and the thousands of researchers it funds around the country, more responsive to the public. Borrowing metaphors and concepts from the world of industry, she talks of setting priorities, of bringing order to science, and these men -- accustomed to the friendly anarchy of academia -- shift uneasily in their seats.

Unlike the men who have come before her in this job, she does not soothe her audience or pause to attend to the hundreds of federally funded egos in the room. Instead, she talks powerfully and quickly; in complete, precise sentences separated by semicolons, not periods; in a cadence that leaves little room for contradiction or interruption.

Later, in a series of separate seminars around the building at which parts of Healy's plan are discussed, the scientists will stand up to cavil and complain. It is not that they do not respect her. Or that they doubt her intelligence or commitment. It seems something less intellectual than emotional. It is that she does not fit in.

This has been very much the story of Bernadine Healy's first 12 months at the helm of NIH. At the peak of a career that had taken her from Johns Hopkins to the White House science policy staff in the mid-1980s to the presidency of the Cleveland Clinic, one of the country's most prestigious private medical research groups, the 47-year-old cardiologist came to Washington with an aggressive agenda to reform biomedical science. But she has not always been well received. She is a figure of controversy, intimidating to some and disparaged by others. Her efforts have often been viewed less as an attempt to help medical science regain its footing than as a blunt challenge to the accepted way of doing business.

This is partially the result of Healy's message, a tough-minded diagnosis of medicine's ills that calls for scientists to be more rigorous in setting priorities. It is more the result of the peculiar culture of medical science, which resists direction -- and even more the result of the extraordinary, and sometimes overwhelming, character of Bernadine Healy herself.

She is, as head of NIH, one of the country's most important people. This may seem like an overstatement, because she is not a household name and does not draw a crowd when she goes shopping. But she is the person responsible for the hundreds of laboratories scattered around NIH's Bethesda campus as well as the thousands of basic and applied medical research facilities funded by NIH in universities and hospitals across the country, a vast enterprise without parallel anywhere in the world.

That enterprise is now in crisis. NIH has enough money only to fund about one quarter of the very best research proposals it receives. Young scientists are becoming disillusioned and seeking careers elsewhere. Good ideas are being ignored. Many established scientists believe that what limited funds do exist are going to the wrong projects, to politically popular research areas like AIDS and the human genome effort -- the multimillion-dollar attempt to map all the genes in the human body -- rather than to smaller but crucial basic science projects. At the same time, American medical research is facing increasing scrutiny from Congress over the mismanagement of its resources and because of a perception that it cannot police itself adequately against scientific fraud.

If these challenges are met over the next few years, it will be because Bernadine Healy met them; and if the crisis worsens, she, more than anyone else, will take the blame.

Healy has not shrunk from this responsibility. Upon taking office, she drafted a sweeping plan for the reorganization of NIH. To address the huge gaps in medicine's understanding of women's health, she proposed one of the largest and most expensive studies of human health in history. She has been straightforward about what she sees as the problems with the way science investigates misconduct and has proposed major changes in the investigative arm of NIH. She has spoken her mind. She has charged through the quiet halls of the institutes, raising more of a ruckus in her first few months than many of her predecessors did in a lifetime.

Along the way, Healy has won praise for her energy and her intelligence. But it has not been an easy year. At NIH, where every other director in the institutes' history has been a man, where 12 of the 13 institute directors are men, and where 175 of the 203 top-level officials and 241 of the 294 senior managers are men, she remains something of an outsider. At meetings with the scientific community, her proposals for reform have drawn skepticism. She has fought with Rep. John Dingell (D-Mich.), the perennial NIH watchdog. Dingell staffers call her a "female John Sununu" because of what they say is her arrogance. She has fought with Nobel Prize-winning biologist James Watson, the longtime head of NIH's Human Genome Office. She has battled with her superiors in the Department of Health and Human Services.

At the University of Connecticut, in her pleated skirt and pearls, she is focused and formidable. She looks a little like Margaret Thatcher -- a younger and prettier version, perhaps, but with the same high-frosted blond hair, the same imperious cheekbones, the same iron gaze. She writes on a small notepad. She walks briskly from one seminar room to another, then sits in the back, alone, as the men complain in front of her.

"Maybe it's because I am a woman, but I have never felt like one of the boys," Healy says. "I have never really been in the inner circle. It doesn't matter that I was a professor. It doesn't matter that I was president of the Cleveland Clinic. I have always been on the edge." She says this without rancor, as almost a point of pride: "It doesn't matter to me that the club is angry with me, because I've never been a member."

BERNADINE HEALY IS BY PROFESSION A cardiologist, medicine's cowboy specialty. Cardiologists are to internal medicine what jet pilots are to the infantry. She is a feminist, a woman who has been outspoken and active on behalf of her sex from the very beginning of her career. And she is a New Yorker, with all the attendant moxie and brashness, who grew up with her three sisters above her parents' mom and pop perfume business in a working-class neighborhood in Queens.

Her parents were the children of poor Irish immigrants, her father, Michael Healy, an "independent character, a great American individualist," as she describes him, a man who quit school at 13 to take the ferry every day from Hoboken, N.J., to his first job as a messenger boy on Wall Street. He met her mother in a New York restaurant, where she waited on his table, and they moved to Long Island City, three blocks from the Queensboro Bridge, where he set up his own business in perfume oils in the family basement.

"My father had a strong sense of the world being a tough place," she says. "He lived through the Depression. He said you have to learn to take care of yourself. He was somewhat humorless when it came to frivolous things. My parents never went out to dinner. Everything was oriented toward improving yourself, toward education, the business, the family. It was very self-contained.

"When I was a little girl, I used to think I wanted to be a nun, and my father would say you can't be a nun -- you'd always be taking orders from a priest. My father was a very old-fashioned conservative Irish Catholic, but he was also an unbelievable feminist. He had a strong sense that no doors should be closed to women, especially his daughters."

All four of the Healy girls would go on to bigger things. The eldest attended MIT on scholarship and then Columbia University for graduate school. The two youngest would follow Bernadine to Vassar College, also on scholarship, and one would go on to be a doctor and the other a lawyer. It was Bernadine, however, who was always the most academic, the most driven, the daughter most under the spell of Michael Healy.

"My father was fiercely devoted to the things that he thought were right. Our dinner table conversation was always about how he would solve the problems of the world from his perch in Long Island City . . . I am most like him. My mother always says that. I'm his girl."

From Vassar, where friends say she was rarely spotted outside of the library, Healy went to Harvard Medical School and then for medical training and a full professorship at Johns Hopkins in Baltimore.

Her resume glitters. She has been head of the American Federation for Clinical Research and the American Heart Association. She was a star in the Hopkins cardiology department, where she built a reputation as one of the school's most productive and creative researchers. In 1984, she went to the White House for a two-year stint in the Office of Science and Technology Policy and then was hired away by the Cleveland Clinic to head its research institute, which doubled in size during her five-year tenure.

She has two daughters, one from her first marriage to Bulkley and one from her second to Floyd Loop, a world-famous heart surgeon at the Cleveland Clinic. She and Loop met and married while she was at the White House, and then she joined him soon after she landed the Cleveland Clinic post.

Theirs is a modern, high-powered marriage. Her husband and daughters remain in Cleveland and she flies home to be with them every weekend. They take fax machines with them on their vacations.

Her friends are unremitting in their praise of her. "There are lots of smart people in medicine," says Stephen Achuff, who was a colleague of Healy's at Hopkins. "But what sets her apart is that she is so well organized. She solves a problem and then moves on. She's like Jack Nicklaus. She has this incredible ability to concentrate on something."

"She has these brilliant notions and ways of synthesizing information, which is why people in a room with her are spellbound. She knows how to sort out the baloney," says Myron Weisfeldt, chief of medicine at Columbia University Medical School. "One of the things I've always said about her is that she is never all wrong. It isn't that she never makes mistakes. It is that there is always an element of correctness in what she does." "The one thing she has is true grit," says her husband. "You don't see that a lot in Washington. Lots of people are going along to get along. But she is not that way at all. She will study the facts and make a decision. She is very decisive."

She is also a formidable opponent, as Dingell found out when he called her before his oversight subcommittee last summer. Dingell summoned her to testify about her handling of a specific case of scientific fraud while she was head of the Cleveland Clinic. It was a critical meeting -- the first between Healy and NIH's most forbidding overseer, and the first on the subject of scientific misconduct, an issue with which Dingell has become almost obsessively involved over the past five years.

But while Dingell routinely turns the most senior of government officials into quivering and compliant witnesses, he had no such power over Healy. She came out blazing, by turns combative, sarcastic and brusque.

"I cannot handle this witness," one of Dingell's colleagues on the committee, Rep. Norman Lent (R-N.Y.), said at one point. At another, after Dingell sarcastically told Healy that "I am just a poor foolish lawyer from Detroit and I get a little befuddled in some of these questions," she shot back: "And I'm just a poor girl from New York."

Her most memorable moment, however, was a wisecrack, impeccably delivered, that punctured Dingell's heavy-handed interrogation. At issue was why Healy signed off on a grant application alleged to have been fraudulent before the accused researcher did. Dingell thought it odd. Healy couldn't see how it made any difference. It was an arcane point. But much to Healy's obvious exasperation, Dingell dragged it out.

Healy: "The actual sequences of the signatures, I think, is being blown out of proportion. If he had signed first and then I had signed, you could argue how could he have signed before I gave my institutional assurances that we were going to give him the space. Somebody had to sign first."

Dingell: "That is an indisputable point. The question, though, is why was it you that had to sign first?"

Healy: "I didn't have to sign first. This is the way it was brought to me."

Dingell: "He signed second and you signed first."

Healy (with a comic's timing): "Who's on third?"

The room erupted into gales of laughter.

BERNADINE HEALY WORKS ON THE fringe of the NIH campus in a red brick building that looks like a college dormitory.

Visitors enter through a plain brown door to the left of the front entrance, on the first floor, just past an unmanned guard's desk, and sit on a chair jammed between two secretaries' desks. Healy's office is adjoining, a long spare room, an unprepossessing arrangement for the head of a multibillion-dollar-a-year enterprise.

This is not a traditional Washington agency, with clean, vertical lines of authority and a corner office for the chief. The men who built NIH purposefully located all the constituent institutes -- the Cancer Institute, the Heart, Lung and Blood Institute, the Infectious Disease Institute among others -- in separate buildings scattered across 300 rolling acres. They wanted to send a not-so-subtle message about the role the director would play: He was not to lead so much as cheerlead, to be a statesman for science, a bookkeeper, someone to lobby Congress for more money but otherwise stay on the periphery. It was a reflection of what the scientific community believed and continues to believe is critical for the most creative and productive research: that science be as unstructured and scientists be as unfettered as possible, that the best minds be left free to follow the idiosyncratic and unpredictable course of scientific discovery.

It is this idea, this catechism, that Healy has chosen to confront. In speeches to scientists around the country over the past few months, she has been saying that it is no longer acceptable for an agency as large as NIH to be without some kind of coherent, central strategy that governs how it distributes its research money. In the 1950s, she says, when NIH was a sleepy research group, the ad hoc way in which the agency and its member institutes organize themselves might have been acceptable. But biomedical science is now a huge enterprise, she argues. The field of biology is exploding. There are suddenly more ideas to pursue than there are resources to pursue them. Congress, once friendly, has grown wary of the scientific community. Huge areas of medical research, such as women's health, cry out for more attention. Borrowing a line from the popular Oldsmobile commercial, she says, "This is no longer your father's NIH."

In her first six months in office, Healy gathered all the top NIH officials together and prepared a strategic plan for the future of the agency, a meticulously detailed document that in its draft form ran to hundreds of pages. One by one, research areas of special interest such as vaccines or biotechnology were identified, and specific research initiatives to expand critical areas of knowledge in each field were drawn up, complete with individualized budgets.

It was an enormous undertaking, unprecedented in NIH history. But the response from scientists has been less than overwhelming. Asked to review the draft document, the big biomedical research groups wrote back long rebuttals. It was attacked when Healy presented the plan at a major scientific conference in San Antonio in January and again when she presented it at the University of Connecticut in February.

"The negative feeling that prevails is a feeling that this is corporate mentality of management from the top down," said William Brinkley, dean of the graduate school at Baylor College of Medicine in Houston. "Science in this country is great because of just the opposite philosophy, of ideas coming from the bottom up. The notion is that scientists identify what is important, and that is often quite unexpected and serendipitous. Now it seems that we are being asked to focus our research on what someone at the top thinks is important."

It is not clear how much of this fear is real and how much is imagined. Healy argues that the idea that American biomedical research is currently unfettered is something of a myth. Some of NIH's constituent institutes, she says, do this kind of "top down" research planning already. But they do it behind closed doors. Her plan is also,on a larger scale, similar to what Congresscontinued on page 23 did 20 years ago when it gave NIH a big chunk of money with special instructions to look for a cure for cancer. The war was not won, but it produced some of the most stunning advances in biology in the past century, which may some day lead to a cure.

Healy says her plan will not confine the creativity of researchers but simply give the biomedical establishment a loose but necessary structure. A science policy without central direction can sometimes miss hugely important subjects, she says, like the health of women and minorities. She also sees a strategic plan as the best way to get money out of Congress. Why would anyone vote science an extra two or three billion dollars if scientists can't demonstrate convincingly how they would put that money to good use?

"I don't think we will inspire substantial investment unless we have a compelling vision, a compelling statement," she says. "We have so often portrayed ourselves as an agency that only worries about the number of grants. I don't think that is an idea that inspires people."

But the antagonism of the scientific community can't be defused with logic alone; it's partly about something more subtle. It seems as much a difference of language and style as it is of substance, the culture shock caused by introducing an active and powerful leader to a world that never really wanted one. At the conclusion of the San Antonio meeting, for example, the assembled scientists presented Healy with a manifesto. It wasn't so much that the idea of planning was dead wrong, they said, but that she was moving too quickly, moving without consulting the scientists themselves.

At the Connecticut meeting, the men in the audience flinch when she uses the phrase "strategic plan" over and over again. It is the language of MBAs. They are MDs and PhDs. For people accustomed to the gentle rhythms of laboratory work, there is an unseemly insistence about Healy's manner. "She thinks like a cardiologist," is how one prominent scientist puts it, not meaning the phrase as a compliment.

Within NIH, the unease with Healy seems just as marked.

"There is a lot of waiting in our system, so we learn not to shoot from the hip," says one NIH official. "We have to wait on Congress. We have to wait on our researchers. We have to wait for ideas to come in. We have to wait for paperwork to be done . . . We're never quick to say something is good or bad."

Healy, by contrast, likes argument and open discussion. "I don't mind when people disagree with me," she says. "I love it when people disagree with me." But she says that sometimes when she is seeking frank opinion, she doesn't get it. This puzzles her, and she worries that her colleagues disagree with her behind her back.

At NIH, it also matters that she is a woman in what is still very much a man's world, a fraternity with its own private code. The hallway leading to Healy's office is lined with the solemn-faced portraits of her predecessors, every one a white man. Healy herself is something of an accident: The Bush administration's first six choices, all male, turned down the $143,800-a-year job. "Many men I've seen have a group around them. They have a large body of people with whom they interact, and they make a decision by the group method," says Florence Haseltine, director of the Center for Population Research at NIH. "But I've never known a woman who has gotten to the top who makes a decision that way. We've always been isolated. There aren't enough of us. We make decisions independently. It's not that we don't consult. It's that we don't have a lot of people we can talk to.

"I suspect that a lot of the old-time men are nervous {about Healy} because they don't know how to access her," Haseltine adds. "Many of them never knew her before she came here, and men feel uncomfortable if they don't know how to have a handle on a person in power. Everyone knew {Healy's predecessor James B.} Wyngaarden because he was in the gel, in the matrix. But she doesn't owe her success to anyone. She made it on her own."

BERNADINE HEALY'S MOST AUDACIOUS act as director of NIH has been the Women's Health Initiative. The idea came from Congress, from the Congressional Caucus for Women's Issues, which had been pressuring NIH for some time to pay more attention to women's health. When Healy came aboard, she listened.

"I was faced with a choice," she says. "Do I become an apologist for NIH, or do I look at it and say, 'Let's fix it.' We had all been apologizing for years, and now was the time to fix it."

It is an issue about which she has always been outspoken. She comes from a profession, cardiology, that decided to explore heart disease risk factors by studying 15,000 men -- and zero women; that looked at aspirin as a preventative therapy for coronary disease in 22,000 men -- and zero women; and that tried to answer the question of whether estrogen was protective against heart disease in women by conducting a study of the role of estrogen in preventing heart disease in men.

She successfully pushed for an initiative on women and heart disease while active in the American Heart Association in the 1980s, fighting the indifference of her colleagues, she said, and the perception in the field that "women's complaints about chest pain were emotional or inconsequential."

At NIH she saw an opportunity to push the same goal on a much larger scale, and within months of taking office proposed one of the largest and most expensive clinical studies in history, a $500 million, 10-year trial involving 140,000 American women. The idea of the trial is ambitious: to measure, in a single study, the effectiveness of hormone replacement, dietary modification and vitamin supplements to combat heart disease, breast and colon cancer, and bone loss in post-menopausal women, simultaneously overcoming the huge knowledge deficits that surround both the health of women and the health of the elderly.

The idea is not without its share of critics. In a letter to Healy last summer, a group of epidemiologists complained that the design of the trial seemed rushed, that the premises on which it was based were suspect. Part of the study, for example, involves a comparison of women on a modified low-fat diet with those on a normal diet. But how do you keep a large group of women on a low-fat diet for 10 years? And won't the control group naturally decrease its fat intake over time, as has been the general dietary pattern of the past decade? In other words, after a decade how can anyone be sure there will be any difference in the diets of the two groups?

Another question is age. What if there is a major connection between diet and illness, but it only makes a difference in younger women? Aren't there risks in limiting the trial to post-menopausal women? Finally, does it make sense to gamble on one big study?

"It is a massively expensive study, and it seems rather risky to put so many eggs in one basket," says Lynn Rosenberg, professor of epidemiology at Boston University. "It might be a surer bet to do a larger number of smaller studies so that it wouldn't matter much if one turned out to be a dead end. Whereas if one of the larger studies turned out to be infeasible, it would all have been a huge loss."

Some of these criticisms have been heeded by NIH, and the study design continues to go through refinement. But it is clear that on the big issues of how large the trial should be and how quickly it should proceed, Healy's mind is made up. The boldness that seems to scare off some epidemiologists is precisely what she finds compelling about the idea.

A large trial allows you to include a very diverse population, she says. It allows you to draw conclusions about the lives and experiences of ordinary people. It gets away from the limitations of white male populations usually picked for study by medicine.

She is passionate on the subject. She calls it "one of the most exciting clinical trials ever done." It represents everything she has worked for, everything she's been trying to accomplish by asserting herself among men.

"Women's issues have been ignored because women have not been a force in our society," she says. "Women have not been listened to; even women of professional standing have not been taken seriously."

She remembers when she fought at the American Heart Association for a new focus on women's health, a campaign to educate patients and doctors about the threat of heart disease.

"Initially my efforts were not well received; it wasn't viewed as important." But, she says, she kept pushing anyway, year in, year out, until she got her way. "It just goes to show that you should never get discouraged if you think you are right." She pauses and reconsiders. "You should never get discouraged if you are right."

EVERY FRIDAY AFTERNOON, BERNADINE Healy flies to Cleveland to be with her husband and two daughters. She gets home in time for dinner on Friday and leaves Monday morning after she has kissed her children goodbye.

In a year at NIH, she has never missed a weekend home. She has turned down five honorary degrees because they were to be given out on weekends. She has passed up the White House correspondents' dinner and the vice president's Christmas party. She has skipped or rescheduled important meetings.

During the week, she talks with her husband or daughters at least three times a day, more if there is a difficult homework assignment or a dentist's appointment to be arranged.

"Everyone sort of looks at Bernadine," says her husband, "and says, 'How do you manage?' " "But the family has been very supportive. We haven't had any problems. The children have been fine. If anything, they are closer to their busy father than they have ever been. And on weekends we spend a lot of time together . . . Call me up in five years and ask me how it is, though, and I might say something else."

In Washington, things have been a little harder. There is Dingell's office, first of all, which has never quite forgiven Healy for her performance at last summer's hearing. Dingell staffers write or call, demanding information, sometimes daily. The men on Dingell's staff gossip about her with reporters, seeming to delight in the slightest innuendo. It is a constant annoyance for Healy, leading some to conclude she made a tactical error in confronting him so boldly last summer.

This spring there was a much-reported flap with James Watson, the Nobel laureate biologist who ran NIH's effort to decode the human genome. He does not like Healy. Years ago, when Healy was at the White House, he blasted her in a speech, saying that the person setting science policy was "either unimportant or a woman." When she came aboard, he publicly criticized her decision to consider patenting human genes isolated by NIH, saying it would stifle research. Later, when officials of the Department of Health and Human Services raised conflict of interest concerns about his stock ownership and directorships in biotechnology firms that were interested in those same patents, he noisily quit, saying that Healy didn't like him and wanted him out.

Then there are Healy's relations with her superiors at HHS. They did not like her original strategic plan. "The only 'strategy' . . . seems to be the acquisition of additional funds," wrote one top official in an internal memo, after estimating that Healy's proposed initiatives would double the NIH budget. Department insiders whisper maliciously that she is campaigning for the job of HHS secretary.

Her press notices have not always been good. In one New York Times profile, she was called impulsive, which rankled.

"I'm many things, but I am not impulsive," she says. "I make up my mind and I'm fierce about pursuing it, and I'm relentless and tenacious. But I'm very rational. I'm very nonemotional in the way I do my business and the way I conduct myself. "I bend over backwards to make sure I'm not allowing my emotions to influence my decisions."

Still, the theme has been picked up in one account of Healy after another. Science magazine, reporting on the Watson affair, said that she "lost her cool." The influential Science and Government Report called her the "short-tempered diva of biomedical research." And on and on.

"A woman is bitchy, and a man knows what he wants. A woman is aggressive and harsh, and a man is directed and goal-oriented," says Pam Douglas, a cardiologist at Harvard Medical School. "These things are kind of cliches now, but they are still very true. If we expect women to be emotional and warm and fuzzy, then a woman who knows what she wants and gets it is going to be a real shock."

At the University of Connecticut, there is frustration of a different kind. Healy would like to draw up a list of research topics that deserve to be priorities. She has assembled a sample list to work from. But the scientists in attendance each have their own special interests and quiver at the thought of excluding anything. A man from the Pfizer pharmaceutical company says he is upset because fermentation technology was excluded. "There is no mention of chemistry," says another. "You have structural biology but not developmental biology." A man from Pittsburgh asks why the document is "unnecessarily defensive about computing." A man from the University of Connecticut worries about the absence of software systems, a man from Brown about biomaterials, another from Brandeis about conventional electron microscopy, and yet another about "parasitic diseases" and the "excess of stress on applied immunology."

They do not like the idea of listing priorities.

"This is not what the scientific community wants to see," says one distinguished-looking gray-haired man. "What we need is the same kind of science-driven process we have always seen. We ought to get back to the basic question of 'Is it good or bad science?' "

There is applause.

At midday, Healy leaves to go back to Washington. On the airplane she reexplains her position carefully. She is philosophical about the reception she has received. It is not the first time she has walked into a room and felt the vibrations changing.

"You can't be NIH director if you want to be loved," Healy says. "You find your love somewhere else. From your husband, your kids, your dog."

She laughs and brightens. Later, she tells a story about taking her troubles home to her daughters. Someone had written an article making fun of the way she talks, about her fondness for quoting Saint Augustine, and it bothered her. In many ways she is quite honest about still being the bookish Catholic schoolgirl. She peppers her speeches with references to everyone from Confucius to Cotton Mather, and she says one of the first things she did after getting the NIH job was read the Constitution. But on the particular day she read the critical news article, after dodging all the other arrows at NIH, it struck her the wrong way.

"I read it to my 12-year-old, saying this is what I have to put up with. But she said, 'Mommy, that's not bad. He's saying you're not a wannabe.' " Girls of her daughter's age, Healy explains, do not want to be wannabes -- people whose ambition is to be like someone else.

Healy's features soften. Then her voice rises an octave as she imitates her little girl.

"What he's saying is that you're not a wannabe. You're an original." Malcolm Gladwell covers science and medicine for The Post's National staff.