As St. Jude President & CEO, Dr. James R. Downing built a Legacy of Hope

If you ask Dr. James R. Downing what he remembers from his first job on a Ford Motor Company assembly line 52 years ago, he’ll tell you his ears sometimes still ring from the noise. But it was the work ethic that stayed with him — the idea that with raw materials and the right ideas you can build something from scratch. 

“That made me realize that if I'm going to be working the rest of my life, I'd better find something I enjoy,” said Downing, who has served for 12 years as St. Jude president and CEO. Downing brought that philosophy and early lesson to his lifelong pursuit of medicine that transforms lives, fueling a 40-year career at St. Jude Children’s Research Hospital®. 

From a medical residency in St. Louis, Missouri, to a fellowship in Gainesville, Florida, he landed his first faculty role in Birmingham, Alabama, before St. Jude called with a job offer.

At first glance, he thought the campus was unremarkable and wouldn’t provide the level of opportunity he would have at larger academic medical centers.  

But at St. Jude, Downing found a mission. United by a common purpose, St. Jude was a place of rigorous scientific questioning and uncompromising care for children with diseases like sickle cell and pediatric cancer. He saw that purpose reflected in every person and in every corner. And by the end of his visit, he knew St. Jude was where he would make the most impact. He found role models who believed that science can “never be too rigorous.” 

Over the next several decades, his role at St. Jude evolved from an associate member at the first molecular diagnostic laboratory at St. Jude to chair of the Department of Pathology. In 2004, he accepted the role of Scientific Director and then president and CEO in 2014. 

In each position, he would think about how St. Jude could have a greater impact in addressing catastrophic childhood diseases. His diagnostic laboratory laid the foundation for how tumors are understood, classified and treated. That desire to understand why and how cancer arises in children led to the Pediatric Cancer Genome Project, the world’s first major investment in pediatric cancer genome sequencing. This collaborative project with Washington University in St. Louis uncovered genomic insights that have enabled more accurate diagnoses, risk stratification and the development of targeted therapies that are more effective and less toxic. At a time when genomic sequencing was primarily focused on adult diseases, this project offered hope to families dealing with childhood cancer. 

“It succeeded because we were willing to chase big ideas and make the most of a unique moment in history,” he said. 

It wouldn’t be the last time Downing chased a big idea. As CEO, Downing also championed work on catastrophic pediatric neurological diseases. The Pediatric Translational Neuroscience Initiative was launched in 2018 and is accelerating the discovery of therapies for devastating single‑gene disorders that currently have no effective treatments. 

St. Jude forged major scientific partnerships and built world‑class programs in structural biology, imaging science and cellular biology to pursue targets once considered impossible to treat with conventional medicine.  

“Our core business is to generate knowledge,” Downing said, emphasizing that St. Jude then shares that knowledge with the world. “We generate knowledge to allow us to cure the incurable. We generate knowledge to allow us to treat the untreatable.” 

Across every effort, Downing’s vision has expanded what is possible. But perhaps no initiative underscores his legacy more than the efforts of St. Jude to improve survival rates for children with catastrophic diseases around the world.  

An estimated 400,000 children around the world develop cancer each year, and half aren’t diagnosed. In some low- and middle-income countries, four in five children will die from their disease. Meanwhile, in high-income countries, four in five children will survive. Recognizing the disparity in outcomes between countries, Downing forged a new path with St. Jude Global to change this reality. 

The St. Jude Global Alliance, a collaborative body with more than 400 institutions from nearly 90 countries, develops workforce training, builds capacity and shares research expertise.  

Downing is a key leader in the Global Platform for Access to Childhood Cancer Medicines, a $200 million effort to dramatically increase access to quality cancer medicines for an estimated 120,000 children around the world in conjunction with the World Health Organization, UNICEF and the Pan American Health Organization Strategic Fund.

This ambitious work is spurred by simple questions asked by Downing: “If not St. Jude, who? Who's going to tackle these problems? Who's going to make that future look different than it does today?”  

“The greatest legacy of the Downing era was the way St. Jude pioneered bold new horizons for its life-saving mission,” said Marlo Thomas, National Outreach Director, St. Jude Children’s Research Hospital.

“Through our landmark St. Jude Global program, my father’s founding vision now extends its warm embrace to children worldwide who never before had a chance to benefit from the hospital’s groundbreaking science — helping the undiagnosed and untreated, providing drugs and funding to low-income countries. Dr. Downing’s stewardship of this remarkable achievement firmly establishes St. Jude as the most important Pediatric Research Center in the world and positions us as the leaders in the fight against childhood cancer into the future.” 

As he concludes his tenure as CEO this year, he will continue to address global health disparities for children with cancer and other catastrophic diseases as a faculty member in Global Pediatric Medicine.

Downing’s bold vision and commitment to research and care have advanced the dream of founder Danny Thomas that no child should die in the dawn of life. His leadership helped expand the impact St. Jude is having on children everywhere, laying a foundation on which future leaders can build.