Not only will Summers will have to win over Fineberg loyalists, he will have to work through differences in outlook between economists and public health professors, whose work is often intertwined but whose priorities sometimes diverge.

For example, when Summers was chief economist at the World Bank, he signed off on a controversial memo--authored by a staffer--that discussed the economic utility of dumping toxic waste in poor countries. Although Summers apologized for the memo and has said it was written ironically, it has continued to dog him. Such pure economic calculations may provide cost-effective solutions, but they are distasteful to those whose primary concern is not utility but health. Bloom says that such pure economics should not dominate decisions that could affect public health.

"From my perspective, cost effectiveness analyses are effective and often essential in thinking through priorities. But there are other values, and cost effectiveness along should not determine policy," Bloom says.

Nevertheless, people who have known Summers, especially at his time in the Treasury Department, stress that while he uses economic principles to help set priorities, they do not trump other social values.

"His social values are in the right place and they temper his views as an economist," says John Podesta, who served as chief of staff under President Bill Clinton, and who worked with Summers when he was at the Treasury.

Podesta says that Summers does not subscribe to the "mercenary view" that what's good for the economy must be the right thing to do, but takes the greater good into consideration when making decisions.

Big Science, Big Money

Although Stone's comment about science could be taken as an implicit criticism of President Rudenstine, even Rudenstine has said he wished he knew more about science.