The National Institutes of Health, Donald S. Fredrickson once said, are the place "where big science and big government meet." As director of NIH from 1975 to 1981, Dr. Fredrickson mediated between the life sciences and the highest levels of the federal government during a time of political and fiscal uncertainty.
During his tenure Fredrickson pursued three main goals in his negotiations with scientists, politicians, administrators, and the public. First, he sought to delineate more clearly the relationship between basic scientific research and clinical practice, and thus between NIH, the nation's leading biomedical research institution, and the government agencies and private institutions that deliver health care to patients. Under pressure from critics to show that basic research could yield new therapies, the NIH director strove to accelerate the transfer of scientific discoveries and technologies to hospitals and doctors' offices. Fredrickson set up the Office of Medical Applications of Research in January of 1978 to spearhead this effort.
In a more far-reaching and ambitious attempt to make biomedical research more immediately relevant to health care, Secretary of Health, Education, and Welfare Joseph A. Califano, Jr., called for a coordinated approach to health research across federal agencies, based on a five-year plan to be developed by a committee under the chairmanship of the NIH director. The effort culminated in a National Conference on Health Research Principles, held at NIH in October 1978. Chaired by Fredrickson, the conference brought together over 700 representatives from federal agencies, professional societies, and the public who discussed broad scientific and organizational objectives that should guide federal support for biomedical research. The only principle to be endorsed by all participants was that the federal government must be the main source of funding for biomedical and health research.
Despite the failure to work out a more detailed biomedical research policy, efforts to coordinate biomedical research throughout the federal government proceeded, not only in the new and rapidly-expanding field of recombinant DNA research, but in other areas as well. The National Toxicology Program was founded in November 1978 at NIH to facilitate the sharing and publication of the results of toxicological testing programs conducted by the National Cancer Institute, the Food and Drug Administration, and other federal agencies. In 1979, Congress established an Interagency Radiation Research Committee, headed by the NIH director, to formulate a federal strategy for research into the biological and epidemiological effects of ionizing radiation.
Fredrickson's second major initiative was to stabilize funding for NIH extramural research grants, the primary source of financial support for biomedical researchers at academic institutions, at a time of budget pressures and rising doubts about the relevance of basic research to health care. After nearly three decades of expansion, during the latter half of the 1970s NIH faced the prospect of funding shortfalls as a result of rapid inflation in the cost of research. Moreover, some members of Congress proposed to curtail the authority of NIH to distribute extramural research grants, its main means of fostering biomedical research. Fredrickson was skillful enough in his budgetary negotiations with Congress to keep the basic research mission of NIH intact, and even to increase funding in real dollars (after adjustment for inflation) during his tenure. He had the support of Secretary Califano, who requested that NIH fund a minimum of 5,000 research grants, a request that was eventually honored by Congress.
New research facilities were added at NIH under Fredrickson's leadership. He oversaw planning and construction of the $100-million Ambulatory Care Research Facility, an out-patient facility for clinical trials and the counterpart to the in-patient Clinical Center opened in 1952. In 1978, construction began on the Lister Hill National Center for Biomedical Communications, a new facility for studying the uses of medical informatics and for disseminating health information through electronic media.
Finally, Fredrickson devoted himself to addressing the particular professional interests of the biomedical and health scientists he led as NIH director. Above all, he worked to resolve concerns over the potential health and environmental risks of genetic engineering, concerns that came to a head during the controversy over recombinant DNA. Moreover, in 1977 Fredrickson initiated a series of NIH Consensus Development Conferences to provide a forum in which NIH administrators and scientists could reconcile scientific and professional differences. The first conference, for instance, was prompted by the debate over the risks and benefits of mammography in younger women as a cancer-finding technique, a debate that erupted in the fall of 1977 as a result of a large-scale screening program undertaken by the National Cancer Institute. Another issue addressed at Consensus Development Conferences were the divergent methods and resource requirements of scientific and clinical researchers.
Donald Fredrickson was not only an accomplished scientist, but an effective leader of the world's largest biomedical research facility during a difficult era in its history. This assignment, as he stated and made clear through his example, was "not a job; it's a cause." Even in the face of political controversies over the cost, direction, and risks of biomedical research, Fredrickson proved a staunch, self-confident defender of the freedom of scientific inquiry and of the interests of scientists, to the extent that, at times, he incurred criticism from high-ranking government officials. Among them was the new Secretary of Health and Human Services, Patricia Harris. However, rumors that Fredrickson would be ousted from his position as a result of such criticism turned out to be unfounded. He resigned at a meeting of NIH staff in the Clinical Center on July 1, 1981, long enough after the inauguration of the Ronald Reagan administration to demonstrate the independence of his office, he pointed out later in his life.