The turning point in the renewal process came in the summer of 1975, as Dr. Donald Fredrickson took over as NIH director and Dr. Gordon retired from the PHS and announced plans to take an academic appointment. Determined to reassert and redefine the NIH’s mission in the face of rising public demands on biomedicine and increasing fragmentation within disease categories, Fredrickson brought a new activism and vision to the political process, a willingness to overcome deficiencies and to engage state-of-the-art problems with the expectation of optimal results.116 In short order Fredrickson secured a $90 million construction appropriation for the Ambulatory Care Research Facility (ACRF), proposed a new agency focus on clinical trials, and called a three-day retreat at Easton, Md., to review clinical operations, address deficiencies, and assess emergent clinical research needs. Out of this January 1976 conference came decisions to create an intensive care unit and to centralize quality assurance under a strengthened Medical Board.117 In July, hospital leadership passed to Dr. Mortimer B. Lipsett, an endocrinologist with previous service as branch chief in NCI and NICHD. Lipsett simplified research review and made it a Clinical Center responsibility by setting up institute panels monitored by the CC’s Office of Planning and Policy Development. Lipsett also renewed Gordon’s effort to obtain a separate congressional appropriation for the hospital. He formalized a mission statement for the Clinical Center that placed patient care ahead of research requirements and detailed for the first time ancillary responsibilities in the areas of bioethics, information dissemination, and in-house diagnostics and patient care research.118

From May 1977, when excavation began for the ACRF, until January 1982, when the first patients were moved in, construction was a constant feature of hospital life. Numerous areas of the old building underwent renovation, and program modernization became endemic for a wide variety of activities. Lipsett registered efficiency gains by raising bed occupancy from 65% to 75% and by opening new services, particularly Critical Care Medicine. However the serving Clinical Associates still considered the Clinical Center “not a full service hospital.”119 Adverse political influences continued, particularly the recurrent demand to bill research patients and the reimposition of personnel ceilings in 1979, which threatened 250 positions out of 1,573.120 Inflation prevented planned expansion of clinical trials in 1980 and 1981, but research conducted by the operating departments showed new promise. Investigators from the Blood Bank and NIAID identified “non-A, non-B hepatitis” as the source of 80% of transfusion-related cases.121 This allowed comprehensive screening of blood and blood products, thus dramatically increasing safety of transfusion. Another significant innovation was positron emission tomography (PET), which the Nuclear Medicine Department began using to do brain scans in 1979 and to support early research into Alzheimer's disease.

With the resumption of institutional growth and budgetary expansion in the Fredrickson era, prospects again seemed hopeful for new advances in clinical research. In 1982 three intramural researchers shared Lasker Foundation Awards for molecular-level discoveries with important therapeutic effects: Dr. Robert C. Gallo (NCI) for work leading to isolation of the human retrovirus; Dr. Elizabeth F. Neufeld (NIADDK) for identifying the enzyme defect causing mucopolysaccharide storage disorders; and Dr. Roscoe O. Brady (NINCDS) for demonstrating the metabolic causes of lipid storage diseases.122

In 1983 a comprehensive AIDS research program was announced, featuring 25 intramural investigators and focused on Critical Care Medicine patients. The following year Dr. Steven A. Rosenberg began Phase I trials in immunotherapy, and Dr. W. French Anderson initiated gene therapy experiments, which would lead, by decade’s end, to a proliferation of genetic research and prospective cures for many metastatic cancers.123 Also in 1984, Gallo’s confirmation that the retrovirus HIV causes AIDS placed Clinical Center laboratories and researchers at the vital center of the emerging field of molecular medicine.

The challenge of reorienting hospital activities fell to Dr. John L. Decker, NIADDK clinical director, who was appointed Clinical Center director in August 1983. Faced with dramatic growth in outpatient services and Reagan administration actions to freeze staff positions and require payments from patients, Dr. Decker and his staff decided in January 1985 to contract out Anesthesiology and Surgical Services in order to increase outpatient staffing. Representatives Natcher and Dingell of the Appropriations Health Subcommittee prevented the patient-payments provision from becoming law in 1985, and in the following year Congress began to increase steeply NIH’s budget for AIDS research.

Further readjustments were finalized at a second administrative retreat at Easton in January 1988. The hospital would continue to support “modest growth” in emergent areas such as bone marrow transplantation, and clinical expenses would be more closely regulated by putting institute funding of central services on a more flexible, patient/day basis. When Dr. Decker retired in June 1990, his successor, Dr. Saul Rosen, focused hospital management on quality assurance and the restoration of clinician confidence in patient care activities.124