A Prescription for Progress

Monica Bertagnolli MD ’85, director of the National Institutes of Health (NIH), attributes her decision to pursue a career in medicine in part to the influence of her uncle Pierre Carricaburu MD ’77, who practiced family medicine in Bertagnolli’s native Wyoming for nearly four decades.

“He was a frontier doctor in Wyoming,” Bertagnolli says. “One of the wonderful things I got to do in medical school was work with him up in Buffalo, Wyoming, as a student in his primary care practice.”

While Carricaburu helped lead Bertagnolli into the medical field, it was an experience during her third year that would define her professional path within it.

“I walked into an operating room for the first time and just had an immediate epiphany: I have to be a surgeon,” she says. “The minute I saw the environment of an operating room, what happened there, the incredible skill of the surgeons, and what they were able to do for their patients, that was it.” 

Bertagnolli would ultimately go on to spend more than 35 years as a surgeon, with roles at Brigham and Women’s Hospital in Boston and as a professor of surgery at Harvard Medical School, as well as serving as 16th director of the National Cancer Institute. In November 2023, she was named director of the NIH, the first surgeon and second woman to hold the position.

Selected as the speaker for Spencer Fox Eccles School of Medicine 2024 commencement ceremony, Bertagnolli spoke to us about her aspirations for her new role, the inclusive opportunities for tech in medicine, and why she’s optimistic about the future of American health care.

What are the big opportunities you see in this new role at NIH?

The NIH is the largest funder of biomedical research in the world. We ask researchers from all over the world for their very best ideas to improve health, and we fund the most promising of the contributions we get from the biomedical research community. NIH research encompasses the laboratory, the clinic, and the community. All three of those critical environments are necessary in order to understand and improve health, so a great deal of our funding and emphasis is focused on fundamental scientific research. However, one of the things that’s very true of our mission is that our work is not finished when one of our funded researchers makes a scientific discovery. Our work is only finished when people are living long and healthy lives. Because of this, research to find more effective ways to deliver evidence-based care to all people is also a priority.

You have stressed the importance of reaching underserved populations in this role. What does that look like in practice?

We're not getting a very good report card in the United States right now. We see that our mortality rate overall is not declining even though science is delivering new treatments. Life expectancy has declined and there are data to show that the decrease in the quality of health is disproportionately affecting certain communities. Working age adults from age 18 to 65 seem to have rising challenges in health, including substance use disorders, alcohol use, increasing obesity, and suicide rates. It's critical for NIH to pay attention to this and take every action we possibly can to reverse this trend. As someone who grew up in a rural community, I care deeply about making sure that people living in those communities get the very best that biomedical research and medicine has to offer.

You've spoken about the need to build a learning health system that uses both patient data and even artificial intelligence to help aid diagnosis. How can we best achieve a balance between technology and humanity in our health care systems and approaches?

Technology in the service of humanity is what we need. Information technology has exploded. If you go back and look at our newsfeeds from five years ago, you realize just how dramatically technology has changed and altered our thinking about the way we relate to each other and the way we reach out and gain information. Much of that has to do with effectively communicating how health information affect private citizens, but it also influences the way our clinicians deliver health and the way we understand how every doctor sitting at a bedside with a patient can truly understand what the very best approach for that patient should be. 

Our information systems are essential to our ability to gather data and use it to improve health—both for research and the delivery of care—and our ability to precisely target the best intervention for each person depends on information technology. There is no reason why the information that we need to improve health must come only from people treated in the major academic centers in Boston or in San Francisco. We need to share knowledge generated by the experience of people from all locations and all walks of life, so I want to see the ability to generate and share knowledge through information technology at the fingertips of the doctors and patients in communities like Rock Springs, Wyoming, where I grew up. We’re not there yet, but we are making a commitment to develop ways to use technology to achieve better health by engaging everyone.

What does it mean for you to come back and speak at commencement?

I am so grateful to my alma mater. I got the best of the best medical education at the University of Utah: it grounded me so well in the fundamental science and inspired a passion for caring for people.

I'm honored to be giving the commencement address. I do get a lot of invitations to speak, and I can tell you there is not a single one that I was more thrilled to get than the opportunity to come back to my alma mater. It's very special.

What makes you optimistic about the future—not only for NIH but for American health care in general?

There has never been a more exciting time in all of health care. This nation has invested tremendous resources in biomedical research over the last several decades, and the rate of amazing science that we see coming out of our laboratories is accelerating every single month. Every week, I receive a report from our office that shows me the “greatest hits” from the science literature. It's astounding what we see coming in. On top of all of this accelerating response from the basic science community, we now see a new mandate and willingness to make those results produce meaningful benefits for people. 

I've been a cancer doctor for at least three-and-a-half decades, and when I look back at what we were able to do for cancer patients in 1992 when I finished my training compared to today, the contrast is incredible. People are alive, people are cured. That was just a dream when I was first starting my career. 

That's what keeps me very optimistic. We are winning battles every single day. We just need to do even more.