Nature last spoke in-depth with Harold Varmus in July, 2011, one year after he became director of the $5 billion National Cancer Institute (NCI), the largest of the 27 institutes and centres at the National Institutes of Health. (NIH).
Today, in a rare press conference, Varmus, who directed the entire NIH from 1993 to 1999, spoke to a crowd of 75 at the National Press Club in downtown Washington, DC. His advertised theme was the obstacles — biological, economic, institutional, cultural — to making bigger strides against cancer.
Varmus, who in 1989 shared a Nobel Prize for his studies on the genetic basis of cancer, applauded what he called the “extraordinary” recent advances in our understanding of cancer biology, and in the scientific and computational toolkits we can now deploy against it. Still, he noted, cancer mortality rates have been stubbornly slow to decline and some of the most enticing targets for therapies have not yet yielded breakthroughs. He pointed, by way of example, to KRAS, a gene known for nearly thirty years to be mutated in roughly one-third of all cancers — knowledge that so far has not led to an effective, targeted therapy.
“I remain an optimist,” he said, but “we have to temper expectations.”
Varmus also reported on the bleak success rate for scientists seeking funding from the NCI: it is at a historic low of 14%. The picture is not much rosier for the whole of NIH: the average success across all institutes and centers is only 17%.
Varmus took a wide range of questions after his prepared remarks. Here, edited for brevity, are his responses to a few of them.
What do you hear from either US presidential candidate [US president Barack Obama or former Massachusetts governor Mitt Romney] that would incline you to think that he would be better for medical research than the other guy?
I don’t think it’s the fault of the candidates that there has not been a whole lot said about medical research in the campaign. Part of the issue is having you in the journalistic community ask the questions in a forceful way. I’d like to hear questions asked at the debates, for example.
I would be surprised if anybody running for president — my candidate or somebody else’s — didn’t say they supported medical research. Of course the question is what you do about certain, specific issues [like] stem cells? Do you favor investing disease by disease, or do you want to make your investment in basic science? Do you see NIH only as an economic generator or also as a discoverer? There are some very, very good questions that could be asked that would ferret out quite quickly the views of the candidates.
You talked about the funding issues and the low percentage of grants that are funded through NCI now. How are you preparing for sequestration [an enacted, across-the-board budget cut that would affect virtually all areas of non-mandatory US government spending in 2013]?
The question is, in this financial situation, what do you think of sequestration? I don’t like it, and I assume it won’t happen. The administration and we are looking to Congress to try to solve this problem, because it would be very damaging to biomedical research. The NCI has a tremendous commitment base. I have already promised a lot of [the existing $5 billion budget] to current grantees. So I have a lot of cheques to write before I can begin to write cheques to new investigators. If our budget were reduced 8%, and we got $4.6 billion this year, and we didn’t do anything else, do the math. We would award a very significant fraction fewer [new] grants — perhaps a reduction of as much as 40%.
You mentioned at one point that there has probably been decreased accuracy in published research, given the hurry to publish. Have you taken any steps to instill more quality controls?
The question is: who bears the responsibility for setting appropriate standards at the level of the execution of the work, the publication of the work? Is it institutions, whose reputations might suffer from lack of reproducibility? Is it individual investigators? Is it NIH? Is it journals? I think everyone [at a recent NCI workshop on the issue] acknowledged that there are responsibilities at all levels. How they are executed is a delicate matter. Because what you don’t want to do is set up the situation in which the requirement to be replicable is so severe that you begin to squash innovation and original results.
I mean, science, important science, is self-correcting. And I don’t want to rely on self-correction all the time. I want standards. I want mentoring. One issue that I feel very strongly about is an over-dependence on evaluating scientists on publication in certain journals that happen to be represented in this room. There is a kind of disease out there of people evaluating their fellow scientists based on whether or not their papers have appeared in Cell, Nature or Science. And that is an unhealthy situation. People should be reading papers, not just judging their worth based on where they are published.
Last week, Ronald DePinho who is president of the MD Anderson Cancer Center in Texas launched something he called the ‘Moon Shots’ initiative. It amounts to a $3 billion investment that seeks to make significant leaps in the battle against eight cancers. Would you consider something similar and if not why not?
We encourage our cancer centre directors to be ambitious. And they can choose how they want to be ambitious, the tone that they take. I am not going to comment on his particular take on this.