NIH Chief encourages radiologists to embrace molecular future

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CHICAGO, Nov. 27—Elias A. Zerhouni, MD, director of the National Institutes of Health (NIH) encouraged his fellow radiologists to embrace and seek to understand the biological complexities of molecular medicine in order to lead the healthcare industry into the future in his Eugene P. Pendergrass New Horizons lecture, “Major Trends in the Imaging Series” yesterday at the 93rd annual meeting of the Radiological Society of North America (RSNA). Zerhouni spoke to a near full-house crowd in the 4,200-seat Arie Crown Theater at McCormick Place.

Zerhouni was named by President Bush as director of NIH in 2002. In that position, he oversees 27 of the agency’s institutes and centers with more than 18,000 employees and an annual budget of $29.2 billion. Under his leadership, about 10 percent of the NIH’s budget supports projects conducted by nearly 6,000 scientists in its laboratories, most of which are located on the NIH campus in Bethesda, Md. As a MRI specialist, Zerhouni attended RSNA for 25 years.

He began by addressing the direction of imaging sciences in the next few decades. In tracing the history of the NIH, he commented that changes always occurred “because of two factors—one a public health need and two, a breakthrough in science.” For example, in 1887, the laboratory of Hygiene; in 1937, the National Cancer Institute was established and approved by the U.S. Congress; and in 2000, the National Institute of Biomedical Imaging and BioEngineering (NBIB) was launched. 

Zerhouni highlighted the final alteration to NIH as a necessary response to both public health needs, and particularly, innovations in science. He cited his colleague, Roderic I. Pettigrew, MD, PhD, director of NIBIB, who said, “We are the NIH engine for integration of the physical and biological sciences.”
He listed current challenges to public health, such as a shift from acute to chronic conditions (80 percent of cases are now chronic); an aging population; health disparities (both within countries and between countries); and non-communicable diseases (such as obesity). After noting these challenges, he suggested that the industry needs to evolve to match these impediments, stating “if we practice medicine in 20 years as we do today, we will have failed. The question remains what are the contours of these changes.”

According to Zerhouni, three trends are going to be tremendously important for the transition: new pathways to discovery; research teams of the future (he said that “science cannot be conducted without breaking barriers between the disciplines”); and re-engineering the clinic research enterprise.

In the 21st century, unlike the 20th century, “we need to intervene before symptoms appear, which is really the dream” of our industry, Zerhouni said. He said that in order to implement such practices, the medical community needs to adopt “P4 medicine,” which means more predictive, more personalized (can no longer apply one-size-fits all solutions to the entire population), more preemptive, and more participatory. These trends will have to be served by the advances in science, according to Zerhouni.

He exemplified the impact of the Human Genome Project and HapMap, which concluded in the late 1990s, that helps us understand genome-wide application studies. As a result of the project, there has been an explosion of genome-related discoveries in the medical sciences in 2007 compared with a much smaller impact in the previous eight years.

Zerhouni also said that “today, a fundamental scientific barrier is our limited ability to understand the complexity of molecular science. Though we have made huge leaps in understanding how these circuits work, we need to shift from a hardware understanding to a software understanding of biological medicine.”

He suggested that the future of understanding biological data needs to be quantitative, non-destructive, multi-dimensional, have a high temporal resolution, spatially resolved, high data density and have common standards. Zerhouni said imaging will be tremendously relevant to this future of the molecular field because imaging already fits each of these requirements to understanding biological data.

Imaging needs to exist as an objective biomarker for this biological progression, Zerhouni said. He also noted that the community needs imaging in vivo to identify specific molecules—what is activated, and it needs to be tracked through in vivo imaging. “Physiology and biology will never be the same again after the introduction of in vivo imaging,” he noted.

In the past, radiologists determined that they had to break barriers to provide scientific change in healthcare, according to Zerhouni. He said that perhaps this is the time in history to redefine the imaging sciences because “imaging is no longer going to be defined by the tools we have, but instead, by its larger impact on the medical industry.”