Raynard Kington came to NIH from the Centers for Disease Control and Prevention in Atlanta, where he was director of the Division of Health Examination Statistics and led the landmark and ongoing NHANES study (National Health and Nutrition Examination Survey). Before that, he was a senior natural scientist at the Rand Corporation, co-director of the Drew/Rand Center for Health and Aging, and assistant professor of geriatric medicine at UCLA. A former NIA grantee, Kington’s research has focused on the relationship of socioeconomic status and health status, racial and ethnic differences in health status, factors affecting health-care utilization by the elderly, the economic impact of health-care expenditures on the elderly, and health behaviors of Hispanic and black immigrant populations. Kington was recruited to NIH in October 2000 to succeed Norman Anderson, the first director of the Office of Behavioral and Social Sciences Research, begun in 1995. In February 2002, he was named acting director of NIAAA (in which position, he told the Catalyst, he "got to see from the inside how the institutes work and all the countless decisions that go into being an institute director"). Kington got his M.D. degree from the University of Michigan School of Medicine, Ann Arbor, and his M.B.A. and Ph.D .in health policy and economics at the Wharton School, University of Pennsylvania in Philadelphia. He is board certified in internal medicine and public health and preventive medicine.

For the third time in two and a half years, Raynard Kington has taken on a new NIH role. Appointed in October 2000 by then–acting director Ruth Kirschstein to assume the directorship of the Office of Behavioral and Social Sciences Research (OBSSR) and again in February 2002 to serve as acting director of NIAAA, Kington succeeded Kirschstein as NIH deputy director in February of this year. He spoke with The NIH Catalyst April 21.

Q: Why were you selected to become the NIH deputy director? Was there a conceptual change in the nature of the role that pointed to the appointment of a person with your experience and skills? http://www.nih.gov/about/director/rkbio.htm

KINGTON: The search for a new deputy director evolved from discussions between Dr. Zerhouni and Dr. Kirschstein, who has become senior advisor to the director and continues to play an imprtant role at NIH. An advisory committee was formed; I was invited to apply, along with others. Some applicants were interviewed by the committee, and then a short list was passed on to the director, who had a series of interviews with all the candidates.

As for a change in the role of deputy director, I think this type of job always changes depending on the skills, experience, and interests of whoever is filling it—that, and whoever is the NIH director, because he or she also shapes the role of the deputy director. My guess is that it’s always been a somewhat fluid job. There are certain traditional aspects: The deputy director is like a ‘director’ for the OD—the day-to-day OD operations manager, the overseer of appointments to committees, that sort of thing, in some ways like like the chief operating officer of a corporation.

It’s hard for me to say why I was selected. It probably helped that I had some managerial experience, but there’s no school to teach you how to run an organization of this size. Nothing prepares you to help run NIH—and everything prepares you to help run NIH.

In a way, it’s like being an intern again. I have a reasonable knowledge base to start from, but it’s like going from medical school, where you’re somewhat removed and buffered from decisions, into a place where suddenly you’re making decisions, often by yourself, for a sick patient at 1:00 a.m. just a few weeks after you were a student. Suffice it to say, this is an intense period of learning—but exciting, too.

Q: What attracted you to the job?

KINGTON: The most influential factors were Dr. Zerhouni and the role of this institution in the scientific community and the nation. I was impressed by Dr. Zerhouni’s vision for NIH scientifically and managerially, and I thought I would learn a lot from him.

I’ve always been interested in how science is managed. Most of the glory goes to the scientist—as it should—but the scientist does not work in a vacuum. I recently read a great article in the Chronicle of Higher Education by Stanley Fish, a creative thinker and a dean at the University of Illinois at Chicago. He writes about how faculty at universities often dislike administrators and then went on to make a compelling case for how complex and essential the administrator’s job is. Echoing James I of England, who said "no bishops, no king," Fish wrote, "no administrators, no life of the mind," and I would say, "no administrators and no support, no science."

NIH is full of scientists who made the conscious decision to put the process first; they decided they could best contribute to science by helping to run the agencies that fund and guide science. I’ve always been interested in what goes on behind the closed doors that makes the glory of science possible, which is why during my training I also earned my MBA. I wanted to see how things work, how you get things done.

In terms of the challenge of getting things done and dealing with change, it’s hard to pass up a job like this.

Q: What is your job? And what are your priorities?

KINGTON: I’m here to help Dr. Zerhouni implement his vision for NIH. My position is inherently collaborative; I work with the deputy and associate directors, with the IC directors, with Dr. Zerhouni, and with the various constituencies. In many ways, mine is a "glue" position. There are days I have scheduled back-to-back meetings from 7:00 a.m. to 6:00 p.m., with no time for lunch, no breathing space, which is new for me. And when there is some breathing space, there are usually countless ad hoc meetings throughout the day—hallway meetings—those informal quick exchanges of information that are so typical of scientific managers at most places this size.

Typically, my work combines forward-looking strategic development, responding to flares—or mini-crises of various sorts—and helping to guide those operational activities that keep NIH moving.

We often need to respond quickly and coherently to queries or concerns from the press, Congress, outside constituencies, or other parts of the Department. When that response requires the integration of information from our legislative, policy, and communications offices, as well as the scientists, and entails NIH responding as an institution, that’s the kind of flare I’m likely to be involved in. We have a team-oriented approach. Response teams could involve all the associate and deputy directors—there are about 10 involved in this type of activity—and a subgroup of IC directors. Depending on the specific issue, the primary response could come from within a specific institute, with just OD oversight.http://www.nih.gov/icd/od/ocpl/index.html

Q: What of some of the more intense issues of the day—the changing security alert levels, the need to address SARS (severe acute respiratory syndrome)?

KINGTON: Regarding security, yes, absolutely, I’m involved in the planning that’s largely led by Chick Leasure [deputy director for management] and the people from the security office. Regarding SARS, I’m kept informed of developments but have not been directly involved in activities. Dr. Zerhouni is, and Dr. Fauci [Anthony Fauci, NIAID director] has clearly played a leading role. This is a very content-specific issue that does not cut across NIH. Should it achieve a dimension that requires legislation or a broad communications strategy or have policy implications requiring coordination of multiple institutions and domains, then I might be more involved, along with the appropriate lead associate or deputy director.

Q: And the priorities?

KINGTON: Dr. Zerhouni has clearly identified priorities in a number of areas where NIH is changing, and I’m hoping I can have a positive impact.

For example, we’re rethinking broadly how governance decisions are made here. Now we have lots of committees and informal structures, and we—the OD and the IC directors—are asking ourselves how we can do things better.

The roadmap process is also very much a priority [see "Roadblocks, Road Maps, and ‘The Perfect Storm,’" The NIH Catalyst, January-February 2003) —and the managerial challenge of A-76.

Q: Do you anticipate any changes in the way intramural science is managed—regarding selecting research projects or striving for particular goals? Do you anticipate less autonomy for the scientists here?

KINGTON: The intramural program is a unique national biomedical research resource, and it has a continuous, orderly process of review. There are specific ongoing efforts related to planning for specific parts of the intramural program—for instance, the recent daylong meeting on clinical research here [see "The Agony and the Ecstasy: Clinical Research at NIH,"] and how it’s connected to the clinical research roadmap. Another area of the roadmap is multidisciplinary research, which is related to the intramural program but goes beyond it.

The important question is: Given the scientific opportunities we are now facing, are our scientific activities organized in a way that makes sense? Does the way we think about how research is done need to change, to become more diverse, to respond to interdisciplinary research opportunities? What are the right team structures for responding to the scientific challenges ahead of us? Those issues cut across both intramural and extramural activities.

Q: Is there a possibility that the NIH organizational IC structure might change?

KINGTON: I don’t see large structural change here in the near future. And I would be surprised if the report being prepared by NAS [National Academy of Sciences] recommended the wholesale restructuring of the ICs.

I understand the concerns that generated the request by Congress for an NAS report, but this is not just about external views or pressures on NIH—the basic issue should also generate an internal NIH discussion. Any good organization knows that in order to stay good, you have to ask yourself constantly, are we doing things the right way for where we are now and for where we want to go? If you don’t do that, you’re dead in the water. That’s the normal process at any good institution.

Whenever a new director comes in, there’s always a rethinking. NIH is a huge, future-oriented institution, and change is inevitable—and still unsettling. But circumstances are constantly changing, especially in a scientific institution. I don’t know of any scientific institutions that are static because what we know and what we know we don’t know are constantly changing. Science is all about challenging the status quo.

Q: How does the economy play into these deliberations?

KINGTON: Our economy is in a very different place from where it was in recent years. We have a recession. Budgets are restricted—not just ours, but [those of] foundations and state and local governments as well.

Doing the work of government is more complicated and harder during a time of more limited resources. That’s a big external driver—but in any case, irrespective of the state of the economy, we need to make sure we’re the most efficient, productive agency we can be in terms of meeting our mission to advance science to promote the health of the American people.

My training is also in health economics, and a core tenet of economics is that there will always be unlimited wants and limited resources. That’s just the nature of the human condition. Humans always have the ability to imagine a better existence. We could be in a booming economy, and we’d still have to make tradeoffs. We have to prioritize, to decide how we’ll spend the resources we have to achieve our mission. It’s harder when the resources to make those decisions are growing at a slower rate, but those decisions are always hard, in good and bad economic times—and you have to admit that thanks to the doubling [of the NIH budget over the last five years], we have a lot of resources. The worst thing would be to make those decisions by default.

Q: Do you have your own preferences regarding where research resources should be placed? In discussions, are you an advocate or more of a moderator?

KINGTON: As OBSSR director, I was an advocate for behaviorial and social sciences research, working to advance the incorporation of those disciplines into the ICs here—a "hearts and minds" kind of job. The research I’ve done, the disciplines I’ve been interested in, clearly influence how I think about science. But I cannot be that kind of advocate in this position. I have to be responsive to all 27 institutes and the thousands of diseases and disciplines they represent. But make no mistake about it, the scientific mission I see for NIH is broad.

Deciding where to place resources should be driven by an assessment of where the science is and where the needs are in terms of public health. We integrate our assessment of the scientific opportunities and the needs into our decisions–but always in the background is our knowledge of how science works, that humbling experience of seeing how advances in one area or in basic science not obviously tied to any specific disease end up providing an answer to an entirely different or unanticipated health problem. So we recognize our limited ability to predict the future. But we also know we have brains and c

an use them to make thoughtful decisions–knowing that there’s got to be wiggle room, that this is an inexact process.

Q: Do you have any particular message for the NIH community?

KINGTON: I have great respect for the entire workforce here, and I want to get to know what specific challenges different employees face. I’m exploring doing a once-a-week brown-bag lunch to which five or six people from different parts of NIH would be invited each time. I think that might be a good way for me to become more informed and for individuals across NIH to discuss issues with me.

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