When You Stand on the Shoulders of a Giant, What Do You See?

This blog contains my remarks from the 2022 Lindberg-King Lecture and Scientific Symposium: Science, Society, and the Legacy of Donald A.B. Lindberg, M.D., which took place on September 1, 2022. Watch a recording of the event here.

I had the great fortune of becoming the director of the National Library of Medicine immediately following the 30-plus-year tenure of Donald A.B. Lindberg, MD. I am sure that each of you here today treasures your own recollection of Don, maybe from a conversation or a laugh you may have had with this great leader, teacher, visionary, and colleague (and husband to Mary, father, grandfather, and friend). I am both proud and humbled to stand on the shoulders of this giant as I lead this incredible organization.

I know more viscerally than most about Don’s legacy as NLM director. I sit in the office he occupied, I walk the halls he walked, I work with the people he hired, and I see and experience the fruits of his judgement, investments, and vision.

I now sit where Don once sat, representing NLM at the leadership table of NIH with the other Institute and Center directors. With Don paving the way, I have a platform to extend NLM’s thought leadership and technical knowledge to guide NIH’s continued efforts to advance data-driven discovery. The good will and collaborative spirit engendered by Don across NIH opened doors for me and helped me continue his legacy to deliver on the promise of science accelerated by broad access to literature and data.

Don and I share a deep commitment to ensuring that the public benefits from NLM’s efforts to assemble, organize, preserve, and disseminate biomedical knowledge for society. It was his early vision that made MedlinePlus a trusted resource for consumer health information and ensured that the PubMed citation database and the PubMed Central full-text literature repository were open and accessible to everyone, everywhere, with an Internet connection, at any time and place.  

Don’s commitment to the public was also evident in his efforts to educate the next generation of biomedical informatics scholars. Frankly, I believe that of all of the aspects of his job, engagement with trainees was his favorite!

When you stand on the shoulders of a giant, you have a great advantage. The foundation Don built and the relationships he established provided me, the 4th appointed director of NLM, with a playbook right out of the gate. It is not enough to solely rely on his vision to guide our future as Don also inspired innovation; in one of our last conversations, he said to me, “This is your game—make sure you play it well!” In order to do that, I cannot simply stand on the shoulders of a giant; I must also keep my head up and my eyes forward to the future to envision new pathways and find new opportunities to bring forward the riches of NLM to the future benefit of science and society.

I close by inviting all of you to stand on the shoulders of this giant and meld your sights with his, for it is not by holding tight to that which he could see, but by using his vision as a stepping-off point for our own that will serve his legacy.

Promoting Accountability to the Public

One of the most important commitments of NIH leadership is to uphold the public’s trust. Funding for NIH comes through tax dollars appropriated by Congress, and it is expected that NIH will spend these funds in a way that best serves the needs of the public. Within NLM, this means that we allocate our more than $460 million in annual appropriations in a manner that helps us achieve our mission and the vision of our stakeholders. I’ll bet you are wondering how we actually do this!

I am sure that if you asked any one of my 26 peer directors at other NIH Institutes and Centers, you’d get 26 different perspectives. Here’s what guides me and here’s how I live out this commitment.

Demonstrate Responsible Stewardship
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Each and every day, I work to ensure that decisions about investments and support provided by NLM funds are based on data, analysis, and expert review. We devised a portfolio analysis approach to account for the 100+ public-facing products and services that exist across NLM — ranging from PubMed to GenBank to our research programs. This approach has enhanced NLM’s planning and decision-making processes. We document the basis for our decisions using performance data, funding projections, and feedback to assess responsiveness to our stakeholders’ needs. I meet weekly with our budget officer to review trends and directions in expenses and funds. I work closely with NIH leadership to align new initiatives with NIH priorities and to provide accountability in use of funds for our efforts.

Engaging Stakeholders

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The work of NLM is guided by public law and our NLM Strategic Plan 2017-2027. We engaged with more than 100 individuals representing scientists, clinicians, public health specialists, patients, and patient advocates in the development of our strategic plan. Our congressional authorization charges NLM to acquire, organize, preserve, publish, and make available information related to biology and the health sciences, including medicine, nursing, public health, psychology, and other related sciences, to support research and public health.

We are committed to serving scientists and society. NLM uses a variety of mechanisms to engage with our stakeholders through workshops and materials such as those available through NLM’s ClinicalTrials.gov, requests for information, and public meetings with our NLM Board of Regents. We report to Congress by detailing how we have spent the previous year’s funds and provide a vision of the bright future anticipated in the upcoming year through the annual process to develop our Congressional Budget Justification as part of the development of the President’s Budget request.  

Soliciting Guidance

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I have written several times about the leadership model I use to guide our actions at NLM. My leadership team includes the Deputy Director, Executive Officer, and Scientific Director, and the directors of our four key divisions (the National Center for Biotechnology Information, Library Operations, Extramural Programs, and the Lister Hill National Center for Biomedical Communications) and four operating offices (Office of Computer and Communications Systems, Office of Communications and Public Liaison, Office of Strategic Initiatives, and Office of Administration).

We meet biweekly as a team and in smaller groups as needed. We review budget planning principles, discuss major initiatives (such as the renovation of our buildings), and management of expenditures. I rely on this group’s experience to bring forward new initiatives and to inform the direction of NLM through the lens of their divisions, offices, and responsibilities. I’ve learned that it is critical to be clear with our leadership team whether my intent is to seek consultation or delegate decisions to the larger group.

NLM prides itself on being a trusted source of health information for the nation and the world. One component of trust is promoting accountability for the funds entrusted to NLM in support of our mission. Let me know how we can continue to merit your trust!


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