Francis Collins has been a staunch advocate of genomic medicine. Credit: P. FRANZ/AP

As Francis Collins prepares to take the helm of the US National Institutes of Health (NIH), opinions are divided about how the geneticist will steer the agency through its extraordinary funding boom.

Following President Barack Obama's long-anticipated nomination of Collins on 8 July, Harold Varmus, NIH director from 1993 to 1999, and now president and chief executive of the Memorial Sloan-Kettering Cancer Center in New York, described him as "a terrific scientist, inspirational leader, superb manager, and adept politician. I have great confidence in his ability to lead the NIH in complicated times."

But some believe that Collins has focused too much on genomics to the detriment of other approaches to improving health. Collins directed the NIH's National Human Genome Research Institute (NHGRI) for 15 years until 2008, led the public effort to sequence the human genome and was a co-discoverer of the gene responsible for cystic fibrosis (see Nature 460, 164–169; 2009). "The genetic approach is extremely important, but it is a tool, it is not the be all and end all," says Fran Visco, president of the Washington-based National Breast Cancer Coalition, which has called on the NIH to back more research on the environmental causes of breast cancer.

There are also concerns about whether Collins's very public expressions of his evangelical Christian faith will affect his job. He laid out his beliefs in a 2006 book, The Language of God: A Scientist Presents Evidence for Belief, and last year founded the BioLogos Foundation, which aims to help Christians integrate their faith with contemporary science.

Steven Pinker, a psychologist at Harvard University, says he has "serious misgivings" about the nomination. "Collins is an advocate of profoundly anti-science beliefs, and it is reasonable for the scientific community to ask him how these beliefs will affect his administration of the NIH and his efforts on behalf of the scientific enterprise."

Several scientists close to Collins say that his faith will not affect his NIH duties. "In all the years that I worked with Francis — and there were a lot of years — I never once saw evidence where his religious faith was in conflict with his scientific judgement," says developmental biologist Shirley Tilghman, president of Princeton University in New Jersey, who sat on Collins's advisory council when he directed the NHGRI.

"We would count him as an ally," adds Joshua Rosenau, a policy analyst at the National Center for Science Education, a non-profit organization in Oakland, California, that defends the teaching of evolution in schools. "It is helpful to have scientists like Francis Collins speaking out about how they personally reconcile science and religion."

The BioLogos Foundation has confirmed that Collins would step down from his role there before taking up the reins at the NIH. It's the right move, says Varmus. "Discussion about the foundation and his involvement with it could readily become a distraction from the business of running the NIH," he told Nature.

Collins takes over an NIH awash with cash, yet bracing for leaner times after a one-time bolus of US$10.4 billion in economic stimulus spending runs out in September 2010. Spending the money both rationally and quickly is already proving a daunting challenge for the NIH — the world's largest funder of biomedical research — whose peer-review system is close to being overwhelmed by a flood of applications (see Nature 459, 763; 2009). "Everybody and their brother is going to have an idea of how to do this," says Tilghman. "He's going to have to sift through all those ideas and plans and ultimately do what is best for the United States. And he is going to have to do it relatively quickly."

Since Obama's 2010 budget requested only a 1.4% increase for the $30.3-billion agency, the NIH could also face the kind of boom and bust it confronted in 2003, when its rapidly expanded ranks of scientists were left competing for slices of a suddenly very finite pie. "He's going to have to fight for budget," says Paul Nurse, the Nobel-prizewinning biologist who is president of the Rockefeller University in New York.

The NIH is a behemoth that now has 27 institutes and centres and about 18,000 employees — much larger than the more focused NHGRI. "A big challenge for him is going to be to shift into a new role from his old role," says Elias Zerhouni, who left the NIH director's job last October. "You can't just dictate what you think is right. You have to listen a lot more."

White House rules prevent Collins from speaking to journalists before his nomination is considered by the Senate Committee on Health, Education, Labor, and Pensions, chaired by Senator Edward Kennedy (Democrat, Massachusetts). Kennedy has called the choice of Collins "inspired", and said he would work to see that the nomination is approved "without delay".