Powerhouse: What role will science have in the next administration? Credit: Istockphoto

Voting in the US presidential election has concluded, but the haze of uncertainty blanketing Washington, DC, thickened by the state of the economy, is far from dissipated.

The forty-fourth US president (election results were not in as Nature Medicine went to press) faces countless decisions, many of which will affect biomedical research and healthcare. His choice of officials, such as the presidential science advisor, the secretary of Health and Human Services and the director of the National Institutes of Health (NIH), will serve as an indication of the policies that researchers can expect for the next four years. The president and his appointees will divvy up research dollars, confront ethical issues such as federal funding for stem cell research and—many hope—reestablish the role of science in the White House where, some people say, it has taken a back seat during George W. Bush's tenure.

“It's important that science get on the presidential agenda promptly,” says Peter Agre, director of the Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “The science enterprise is in bad need of some cheering up and redirection.”

Among the hundreds of positions whose holders are president-appointed and Senate-approved, there are dozens related to science. The jobs up for grabs could potentially include positions in the Office of Science and Technology Policy (OSTP), Health and Human Services and the Environmental Protection Agency. Upon assuming office, a new president can ask appointees to stay on—as is often the case for the director of the National Science Foundation—or install his own new officials, which is more common. This process can take months, or even years, before all positions are filled.

One item likely to be high on the next president's list is the task of choosing an OSTP director, also known as the president's science advisor. Many hope that OSTP—which was forced out from its White House digs during the Bush administration—will regain office space at 1600 Pennsylvania Avenue and have a closer link to the president. Some even dare to hope that the science advisor could become a cabinet-rank position. “It takes that pall of undervaluing science off the table,” says Mary Woolley, president of the nonprofit Research!America in Alexandria, Virginia.

The top job at the NIH is also a pivotal empty seat. NIH Director Elias Zerhouni departed at the end of October, and Raynard Kington has stepped up within the agency to serve as acting director. Although the NIH can function well for a time under an acting director, there may be a delay in new initiatives. “It's like a ship run by a committee as opposed to a ship run by a captain,” Agre says.

The NIH, after enjoying a doubling of funds between 1998 and 2003, has since suffered under a nearly flatline budget. Scientists' morale has weakened in the wake of the funding crunch. “We have suffered some serious consequences as scientists and as a nation,” says Richard Marchase, president of the Federation of American Societies for Experimental Biology in Bethesda, Maryland. “We desperately need someone who sits in that office and can be an effective advocate for science funding.”

Another place presidential appointees can make a difference is the president's bioethics council. Members who served on the President's Council on Bioethics under Bush will probably retire in September 2009, when the council's funding is set to run out. The new president could extend its charter, or, as presidents usually do, convene his own panel.

These experts are not subject to Senate approval; that means a council can be stacked with members who adhere to the president's policies. However, the recommendations of partisan councils are unlikely to last when the political atmosphere changes, says Ronald Green, faculty director of the Ethics Institute at Dartmouth College in Hanover, New Hampshire: “the more political a panel, the more political [the fate of its recommendations].” For example, many predict that the new president will abolish Bush's ban, supported by his bioethics council, on federal funding for research on all but a few embryonic stem cell lines.

All of these changes will happen as the global economy faces a potentially huge crisis. But the solution to the faltering US economy should include a boost in research dollars, many say. “Science and technology are critical drivers of economic progress,” Marchase says. “It is really critical that these appointees appreciate that opportunities are out there, and that our country will be best served by figuring out a way that we can increase research funding.”