As Nature went to press, US president Barack Obama had still not nominated a director for the National Institutes of Health (NIH), the $30.3-billion agency that is the world's largest funder of biomedical research. Regardless of when a director is named, the delay is already too long: Obama took office 136 days ago. In the interim, the NIH has been forced to navigate multiple sensitive issues under temporary leadership, including decisions about how to spend a massive $10 billion in economic stimulus money; the drafting of guidelines for expanded federal funding of human embryonic stem-cell research (see above); and the launch of a proposal to tighten conflict-of-interest reporting requirements for its extramural investigators.rnMoreover, the problem goes well beyond the NIH. The installation of senior agency leaders, most of whom have to be nominated by the president and confirmed by a majority vote of the US Senate, seems to go ever more slowly with each passing administration.rnGranted, the Obama White House has been trying. As of Monday the Senate had confirmed 145 people for a total of 373 jobs that need filling, which is not too different from the pace set by the incoming Bush administration in 2001. But that still leaves only 4 of 21 Senate-confirmable posts filled at the Department of Health and Human Services (HHS). Among those HHS posts still waiting for a permanent occupant - in addition to the NIH directorship - are the assistant secretary for health, the top public health adviser to the new HHS secretary, Kathleen Sebelius; the assistant secretary for planning and evaluation, her top policy adviser; and the assistant secretary for preparedness and response, her top adviser on bioterrorism and other public-health emergencies.
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