Due to an editing error, a story in yesterday's Health section identified the Institute of Medicine as a part of National Institutes of Health. It is an independent agency. (Published 7/18/90)

For nearly a year, the National Institutes of Health, the nation's premier biomedical research laboratory, has been without a director. It's the first time in its 100-year history that the position has been vacant for so long.

Some policymakers say they are concerned that the job, traditionally one of the most prestigious and influential scientific posts in the country, will not be filled soon. A variety of factors including salary, President Bush's opposition to abortion and fetal tissue research, the embarrassing public withdrawals of a host of candidates and the administration's slowness at filling key positions is hobbling NIH, they contend.

"The NIH represents a major force in biomedical research," said Samuel O. Thier, president of the Institute of Medicine, one of the 13 member institutes of the NIH. "Its general sense of direction and strong leadership is being eroded."

Sen. Edward M. Kennedy (D-Mass.), who is among the most influential health policymakers in Congress, takes a stronger view. "The inept attempts to find a new director have become a major embarrassment," he said. "The NIH and the nation's medical research are suffering. It is long past time for the administration to end the disarray . . . and name a director worthy of NIH at its best."

The leadership vacuum, according to Kennedy and Thier, is preventing NIH from taking new initiatives in scientific fields and has deprived the scientific community of a key lobbyist on Capitol Hill and in the White House. Others say they think the absence of a permanent director is symptomatic of a lack of concern about biomedicine and fear that the U.S. could be eclipsed by other nations in that field, at least. Acting director William Raub, a 24-year NIH veteran, is doing a good job, many within and outside NIH say, but he lacks the clout of a permanent director.

Administration officials say they are moving as fast as they can to fill the job. "A search committee headed by Dr. Sullivan has been in operation, and we expect that committee to propose a candidate very soon," said White House spokeswoman Alixe Glen, referring to a group headed by Health and Human Services Secretary Louis B. Sullivan. An administration source said that the White House has a candidate in mind and that he could be named by the fall.

Attracting outstanding candidates, some say, has been complicated by layers of bureaucracy that have been superimposed between the directorship and the President and by the position's lack of any real power.

The approximately $8 billion annual budget and the staffing of the 13 institutes with 15,000 employees that make up the NIH are controlled by individual directors, each of whom presides over what amounts to a scientific fiefdom. Each institute director reports to the NIH director, although many have other sources of power and influence in Congress or in the White House. In many ways, the NIH director's position is similar to the Surgeon General's. And as C. Everett Koop demonstrated during his tenure, a forceful, persuasive and charismatic leader can use a largely ceremonial job as a bully pulpit for health issues.

Another problem has been the salary. The NIH director, who has traditionally been a medical doctor, earns between $83,600 and $100,000. But just across the street from NIH's 300-acre Bethesda campus, Jay P. Sanford, president and dean of the Uniformed Services University of the Health Sciences, essentially a medical school for the military, earns more; his contract ties his salary to the average pay of medical school deans at East Coast universities. According to an Association of American Medical Colleges study, deans' salaries average around $175,000 annually.

There is also the significant impediment of what is known as the political "litmus test," so called after William H. Danforth, chancellor of Washington University and a leading candidate, was asked about his positions on fetal tissue research and abortion last fall.

Danforth, whose brother John is a Republican senator from Missouri, was outraged and immediately withdrew from consideration. When the questioning became public, it created an uproar on Capitol Hill and among scientists who complained that the "litmus test" was inappropriate for a scientific management job.

Among those who have also refused the job are Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, who twice personally told Bush no; Danforth, who has twice issued statements that he would not accept the job; Yale University School of Medicine Dean Leon Rosenberg; Dominick Purpura, dean of the Albert Einstein College of Medicine in New York City; Sheldon Wolfe, chairman of medicine at the Tufts University Health Sciences Center in Boston, who spent 17 years at NIH as a researcher, and Thier of the Institute of Medicine.

Administration officials say they have stopped using the litmus test, and several candidates who were interviewed recently say they were not asked about their views on those subjects.

Last December, Sullivan convened a 17-member committee that includes the presidents of Memorial Sloan-Kettering Cancer Center and the Massachusetts Institute of Technology to find ways to make the job more attractive. Among the recommendations given to Sullivan in April were making the director's salary commensurate with that of the Uniformed Services dean, giving the NIH director a six-year term and restoring certain responsibilities, such as making appointments to senior NIH positions; final approval for these jobs resides with Sullivan and assistant secretary of health James O. Mason.

Other recommendations included giving the NIH director a $20 million discretionary fund to support new research initiatives and the power to make appointments to the senior executive and senior scientific services, the categories of jobs considered the most desirable in government.

Sullivan declined to be interviewed; a spokesman said he is considering the recommendations. But committee members say they believe Sullivan's staff is resisting most of them.

Historically, it had been the NIH director's job to speak for the life sciences in policy sessions at the highest levels of government. It was up to the director to spot and support important new ideas in biomedical research -- such as the human genome project, the $3 billion effort designed to find all 100,000 human genes.

And it was the director who mediated such scientific disagreements as the genetic-engineering debates of the 1970s, during which some scientists and citizens' groups called for a halt to gene research until theoretical dangers, such as the inadvertent creation of an Andromeda strain, could be ruled out. Donald S. Frederickson, who was then NIH director, set up a system to ensure that the research was conducted safely, mollifying those who called for a total ban. The result is a biotechnology industry that has developed once unimaginable therapies, such as hormones that stimulate blood production.

During the 1950s and '60s, the NIH director regularly met with the president or his science advisor and played an important role in setting research policies, according to James B. Wyngaarden, director of NIH from 1982 until he left the job last July at the request of the White House.

Since the 1960s, as the NIH and HHS grew, so did the bureaucratic layers between the NIH director and the top ranks of government. Now the NIH director reports to the assistant secretary of health, one of the deputies of the HHS Secretary.

Wyngaarden, who is now foreign secretary of the National Academy of Sciences, said he believes the NIH director would be more effective if the position were redesigned to resemble the director of the National Science Foundation, the federal agency that funds most research in the physical sciences. The NSF director reports to the White House and sits on most key policy boards. The NIH director does not and is represented by the HHS Secretary at these meetings.

"The {HHS} Secretary does what he can, but he is not a scientist," Wyngaarden said. "It would not take very much . . . to give the NIH director a voice. Life sciences are emerging as the science of the century, raising the standard of living for mankind. But they are not effectively represented at the highest levels of government."