Harold E. Varmus, a co-recipient of the 1989 Nobel Prize in Physiology or Medicine, left the federal government last month after serving as director of the National Institutes of Health and, for the past five years, as the head of its largest division, the National Cancer Institute. Dr. Varmus began work this month as a university professor of medicine and a senior adviser to the dean at the Weill Cornell Medical College, in New York. Just before leaving Washington, Dr. Varmus visited The Chronicle to discuss the budgetary challenges facing the NIH, their likely effect on younger scientists, and the future of medical research in the United States.
PAUL BASKEN: Welcome. We're here today with Dr. Harold Varmus, a Nobel laureate, who is the head the National Cancer Institute and is leaving to take a faculty position at Weill Cornell, in New York. Dr. Varmus authored an article last year that talked about the problems facing the biomedical enterprise in this country, the NIH, and the trainees and researchers who are being — basically the next generation of medical researchers in this country — the problems that are facing them in terms of budgetary constraints. Dr. Varmus, can you tell us what it is exactly you said in this article and what you recommended be done?
HAROLD VARMUS: Sure. A few of us, including a former university president, the former president of the National Academy of Sciences, and an esteemed scientist at Harvard, and I, representing NIH and speaking for biomedical-research community which I've been a member of for over 40 years, have been concerned about how the stringent appropriations of our budget over the last 12 years or so at the NIH has begun to have a deleterious effect on the biomedical-research enterprise.
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But nevertheless, people who are trying to do it have difficulty getting grants, have difficulty getting their papers published in the most esteemed journals, find there's little time for thinking deeply about the science they're trying to do because of their other responsibilities to raise the petrol they need to keep their enterprise going. And this has had a negative effect on taking risks in science. And has made the whole system more conservative than it ought to be.
PAUL BASKEN: Some of the recommendations, the specific recommendations you have in the article, talk about things that Congress needs to do. And we know that that's been a problem, getting Congress to do that all along. So there's that issue. And then some of the things the NIH has already been trying, such as putting emphasis on people rather than projects, styled grants, and such as getting better peer review, such as getting more grant money to younger researchers. What hopes do you have that you're actually going to be able to make headway against Congress, too, on the issues the NIH can do, since they're already doing some of these things? What actually are you saying to the NIH that they need to do differently?
HAROLD VARMUS: Well, a couple of things here. First, there are a lot of moving parts in this system, and it's very difficult to change one or two without affecting the others. So getting a plan for making some of the changes that we recommend is not trivial. The things that Congress needs to do are fairly few in number. And I think it's going to be difficult, as you say, to make those happen. But there are many things that we are in charge of as a scientific community.
Yes, the NIH is thinking and talking about many of these things. But ultimately, many of the things that get done have to be done at the institute level. The National Cancer Institute, for example, has started a new grants program called the Outstanding Investigator Award, which would give our very best people, chosen at about a rate of 50 per year, seven years of major support so that they can work in a much freer environment.
A few other institutes are doing the same thing. And the NIH as a whole is definitely supportive of that kind of initiative. But ultimately it's the individual laboratories, institutions, and institutes that have to enact these changes. One important thing is changing the way graduate training is done. We now know that approximately one entering student in 10 will actually end up in the typical, traditional sort of academic career, a principal investigator working in an esteemed academic institution, running a laboratory full of students and postdocs. That doesn't happen very frequently.
And graduate training needs to be adapted to that situation. We don't want to discourage smart people from entering biomedical science, then allowing the graduate training and possibly postgraduate training — postdoctoral-fellow training — to act as a sieve that ends up producing the very best people who are best equipped to run a laboratory and want to take on the rigors and the competition of a sophisticated laboratory career. But there are many other careers for people who have degrees in science — doing policy, working in government in policy, working as educators at a different level, working in industry.
And we need to modulate graduate training, which could be done at an institutional or even departmental level, to make the changes required to optimize the situation that's now creating a great deal of stress for the thousands of students who are in graduate programs and think that the only way to succeed in life is to become an academic principal investigator.
PAUL BASKEN: You're in a unique situation in which you've both been a director of the NIH and now a director of one of its institutes. And you mentioned the fact that part of the issue with the NIH is sort of getting all the institutes to do different things. And I'm wondering, Is it your sense that that setup is good over all, that you have so many institutes who can go off and do different things on their own? Or is that maybe proving to be a hindrance in some of these reforms that you want to get through?
HAROLD VARMUS: Well, I've seen it from both sides. And there are times when the notion of a confederacy creates difficulty, because you would like to have certain policies established across the board. On the other hand, it is important to harness the individual genius of different institutes, which have different perspectives, different leaders, different subject matter to contend with. And I do think there is an element of health in the diversity of the institutes.
However, I've argued for many years that we have too many institutes, that the NIH is hard to run. And my own predilection for being an institute director is based largely on just being closer to the science that's actually done.
PAUL BASKEN: Thank you, Dr. Varmus.