The Condition Cancer Research Is In
By Sabrina Tavernise (The New York Times) – In a letter to colleagues announcing his departure as the director of the National Cancer Institute, Dr. Harold Varmus, 75, quoted Mae West. “I’ve been rich and I’ve been poor,” he wrote, “and rich is better.”
The line was characteristic of Dr. Varmus: playful and frank, not what one might expect from a Nobel laureate. But it also distilled a central question facing biomedical research today. Is the decline in funding that has shaken universities and research labs here to stay? If so, what does that mean for scientific research?
Dr. Varmus, whose last day at the cancer institute is Tuesday, recently reflected on financial constraints in science, the fight against cancer and his own efforts to remain healthy. Our interview has been condensed and edited for space.
Q. How has our investment in biomedical research changed?
A. Traditionally, the National Institutes of Health has done very well financially. We increased the N.I.H. budget very rapidly, especially from 1998 to 2003, and the numbers of people training to do biomedical research also grew quickly. But now we are facing a problem. Since Iarrived here as head of the National Cancer Institute in 2010, the budget has shrunk. The N.C.I. now has less money in actual dollars, not just inflation-adjusted dollars, than it did then. We are about 3 percent — about $180 million — down from where we were. Adjusting for inflation, we are about 25 percent below where we were in 2003.
The N.I.H. is fundamental to a huge part of our national economy and our national goals. Our work determines how healthy we are going to be in the next century and what kind of health care is going to be delivered. The N.I.H. supplies a tremendous amount of funding to universities, one of this country’s greatest assets. Not to support the N.I.H. in a way that at least keeps up with, or is at least modestly ahead of, inflation just seems like a tactical error.
What are the consequences?
The obvious things are fewer grants and fewer jobs, each grant less well funded than it should be.
But it has also caused something to appear which has not been a characteristic of N.I.H.-funded research activities traditionally. A sense of hypercompetition has arisen as large numbers of new scientists are trained for positions and grants that no longer exist.
You’ve got to get this paper into that journal. You’ve got to compete with 1,000 people to get a job in a distinguished academic institution. You want to have an environment where there is some sense of leisure, so you can think freely and feel that you can take chances.
Wasn’t it always that way?
When I was a newly minted medic and came to the N.I.H. to do my government service, I was interested in finding new things to think about and making a contribution to our understanding of how cells respond to stimuli — how they become cancer cells. You weren’t guaranteed success. But you were likely to succeed if you had good ideas and did some nice experiments and engaged with your colleagues. My work didn’t have to be in one of the three best journals for me to feel like I could get a job.
One of things I’ve tried do as N.C.I. director is to protect our best investigators by giving long-term grants. We favor basic research. We want to encourage people to think about difficult, unanswered questions in science. For example, why do certain organs and certain animals not get cancer? Those are hard topics to choose, especially in this competitive atmosphere, because you could work on a problem like that and not get any answers.
Right now people feel like they can’t afford to fail.
Where are we in the fight against cancer?
One of the major advances we’ve had as a result of cancer research is deep recognition of the complexity of cancer. It’s not one disease, it’s lots of different diseases. Every single cancer is different when you look at it on a genetic level.
When the president recently announced his precision medicine initiative, a lot of it was based on the information we are getting from genetic and molecular analysis of cancer. Precision medicine depends on being much more precise about diagnosis. That allows you to target therapies more correctly and make better inferences about likely outcomes.
This is the most transforming thing that’s happened. We are beginning to understand now how different sets of mutations increase or decrease the likelihood that somebody’s going to respond to a therapy.
There have been some sensational successes in immunotherapies. Some use antibodies that block the immune system’s self-regulation. I think there’s tremendous promise here.
Cancer goes through an evolutionary process that is complex and not fully understood. There’s a tremendous amount of basic disease research to be done.
Is that basic research getting done?
People feel their likelihood of getting funded is greater if they work on things that may have a clinical application. I’m worried about that, because I look at the big things that have changed the face of health care, and it’s usually the result of some pioneering discovery not made in conjunction with the notion of how to treat somebody.
You’ve got to do clinical testing, but if we become slackers on funding the absolutely most fundamental things, we will not hit upon the real answers. To understand how a normal cell becomes a cancer cell — we can’t lose sight of that.
What’s your advice on staying healthy?
I don’t want to go to my doctor, ever. I know flesh is heir to disease.
I’ve been taking aspirin every day. It can be protective against cancers, heart disease and some strokes.
I believe in keeping cholesterol levels down and keeping a healthy lifestyle. I try to be on my bike or doing something every day. Not just for health — I choose the sports I like. It’s a social event as well.
I’m a bit of a fanatic about exercise, but not because I think every day that I get on my bike or go for a run that I’m somehow extending my life. I just feel better when I do it.