What does it take to become a “scientist on the inside”, influencing decisions around innovation and entrepreneurship in a trillion dollar U.S. government policy organization? This was the focus of Lee Hartwell’s interview of Greg Downing, Executive Director of Innovation in the Office of the Secretary at the U.S. Department of Health and Human Services (HHS) during a session of ASU’s “Interdisciplinary Approaches for Innovating in Healthcare Technologies” course, which is affiliated with Project HoneyBee.
The algorithm of success
Greg describes his path through medicine, healthcare, and policy as “asynchronous”, but he noted several key factors that have consistently made a major difference in propelling him toward success. What are they? Great mentors, lucky timing, actively harnessing opportunities when they are presented, and a willingness to take risks and make big changes. His humility and humor make it easy to gloss over decades of his focused, tireless commitment to hard work. He has served in numerous science policy and program management roles while simultaneously maintaining an active medical practice in newborn pediatrics. He also holds a PhD in Pharmacology. When asked for his impressions of Greg, Center for Sustainable Health Director Michael Birt said: “I’ve learned what leaders in the White House and NIH have known for many years. Greg Downing is that rare someone who understands the science and gets things done.”
Wonderful science teachers encouraged and fostered Greg’s early love for chemistry and biology, and he originally saw pharmacy school as a pathway toward medicine. “I wasn’t the world’s best student,” he reflected, “but I worked really hard.” From there he went to medical school, where he focused on primary care. At 23, he went to the Cleveland Clinic to learn interventional cardiology. Despite the clear path towards a successful cardiology career in front of him, one day he simply realized how far he had strayed from his initial passions in primary care.
What he was doing every day was essentially end-of-life-care, and he was feeling less and less inspired. A friend told him, “You’re great at procedures. You understand all the principles of physiology. There’s a thing called Neonatal Intensive Care Unit down at this hospital. You should go there.” So he did, without hesitation.
“I’ve always worked on the fringes of ideas, across different departments, and sort of bucked the trends,” he said. “That’s where I have found the best opportunities of discovery really occur.”
During his fellowship he focused on the molecular methods of understanding key problems: “signal transduction mechanisms were all the rage,” he remembered. He also spent half a year at Burroughs Wellcome, where his Saturday afternoons were devoted to reviewing scientific papers with George Hitchings and Gertrude Elion, before they won the Nobel Prize for their antiviral work. Greg’s main interest at the time was in understanding the scientific method more broadly—how things work, which drove him to pursue his PhD.
The right place at the right time
Greg then did a PRAT fellowship at NIH in 1993, where he realized how much he loved to write. At that time, NIH Director Harold Varmus happened to have a lab in same building as Greg’s. “One day I was sitting eating pizza and reading when Harold came by and suggested I check out an open position in the science policy office,” Greg reflected. “That’s where my transition into the policy realm really started. That put me in a community with leadership from industry and broader healthcare settings.”
His initial work in science policy focused on clinical biomarkers and surrogate endpoints, particularly how to get the pharmaceutical industry focused on things other than clinical endpoints. Greg had the opportunity to spend time (as “the guy in the back of the room taking notes”) with the heads of Johns Hopkins and the CEOs of pharma companies. He learned a lot about how different sectors think, act, and communicate.
Getting in early
His next journey was more proactive than reactive. He aggressively pursued an opportunity at NCI developing an advanced technology portfolio. “When you see something emerging that’s really cutting-edge, you want to get in as early as possible,” Greg reflected. That way, he explained, you understand the nuances of every part of the foundation.
Fast-forward to 2005, when the HHS secretary wanted to know something about the applications of molecular medicine, including gene sequencing. The delegation chain landed on Greg, who was asked to compile a report on the scientific opportunities in what would come to be known as personalized medicine. Greg had built a reputation for being able to synthesize large amounts of information and making it digestible for non-scientists, and happened to also have a habit of putting notebooks together on referenced information anyway. The task was an easy one; he put together the report, handed it off, and thought that was the end of it.
But it was just the beginning.
This notebook made its way to the White House, and Greg’s name became more well-known, as did his ability to manage projects and translate complex information. His scientific career and clinical practice experience gave him valuable credibility in the policy world. “Suddenly, everyone wanted to talk to me.”
This is also when Greg and Lee Hartwell first met, when Lee came to NCI to discuss the need for better technology for biomarkers to enable earlier detection of cancer. “The result was an initiative that Greg led, through the whole complicated process of design and marketing,” Lee reflected, “and through the process by which the scientists who have input at NCI approve new initiatives. And this is not easy, because they’re naturally very concerned about using money for anything other than their own individual research projects.”
Understanding how things work
Greg grew up near Detroit, and the auto industry and machines played significant roles in his youth. “I like to know how things work, and I often view the government as a big machine,” he noted. Putting the pieces together and understanding the mechanics has been essential to being able to see organizations as machines and cogs in the national economy and to understand all their nuts and bolts. “One of the big tools I’ve had for advising policymakers is simply to help them understand how that machine of government work, for example how the FDA relates to the CDC.”
Now, as Executive Director of Innovation at HHS and with the experience of working through six political administrations under his belt, Greg sees this analogy as more relevant than ever. “When you’re trying to be innovative and push the frontiers of science, to engage political leadership you need to help them understand the impact of the science—how all the parts of the machine affect each other—and how they could execute.”
When asked for final advice to students from a variety of disciplines but all interested in healthcare, Greg said that there has never been a better time to be an innovator in healthcare. “Being able to do clinical work and apply that knowledge into broader policy setting is a tremendous asset. Play out your interests. Keep asking questions. Be open to new pathways. And don’t let people saying ‘No’ interrupt your journey.”
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