N.I.H. Director Francis Collins On Agency Goals

The National Institutes of Health is comprised of 27 institutions and centers and has a budget of more than $30 billion. The newly appointed director, Francis Collins, discusses his goals for the agency in the coming years and explains how basic medical research gets funded.

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IRA FLATOW, host:

You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. What if you had tens of billions of dollars to spend to try and cure diseases? How would you spend it? Cancer? AIDS? Autism? Swine flu? What about some of those so-called orphan diseases that only a handful of people get?

Well, $30, $40 billion, roughly, just happens to be what the National Institutes of Health, one of the largest funders of basic medical research in the world, has to work with. Under the NIH umbrella is the National Cancer Institute, the National Institute of Mental Health, the National Institutes of Allergy and Infectious Diseases, headed by Anthony Fouci.

The NIH has been under a microscope recently by critics and commentators who claim that it shies away from funding research that is innovative and not in the mainstream. Some critics say the peer-review process of deciding who gets funding is arcane. It puts some innovative research at a disadvantage if it doesn't fit into the mold expected by the scientist reviewers.

At the helm of the NIH is a newly appointed leader, a well-respected scientists with a great reputation. He has also been known to be quite an innovator himself. Will he carry over that innovative spirit to his new job now that he's, well, it's hard to say, a bureaucrat? We'll find out what he has to say.

Francis Collins is his name, and he was recently picked by President Obama to be the director of the National Institutes of Health. You may remember Dr. Collins' name from his work on the Human Genome Project. He's served in the past as the head of the National Human Genome Research Institute. He's also author of the book, "The Language of God: A Scientist Presents Evidence for Belief." He joins us from NIH headquarters in Bethesda. Thanks for being with us again, Dr. Collins.

Dr. FRANCIS COLLINS (Director, National Institutes of Health; Former Director, National Human Genome Research Institute; Author, "The Language of God: A Scientist Presents Evidence for Belief"): Great to be with you, Ira, but did you really call me a bureaucrat? Oh, no.

FLATOW: Well, that's - well, you are, aren't you?

(Soundbite of laughter)

Dr. COLLINS: No, no, no, no, no. I am an incredibly fortunate person to have probably the most exciting job in all of science: overseeing this amazing organization called NIH and having a chance to stand at the helm and try to steer this ship in the direction of the most exciting biomedical research.

FLATOW: Well, I didn't mean that as an insult. I meant it as a challenge, actually, because we've seen, in all the years I've been doing this, I've seen scientists go from being, you know, really fun, innovative, creative people to then going to work for the government, and suddenly they speak like they've lived in Washington their whole career.

(Soundbite of laughter)

Dr. COLLINS: Well, of course, the Genome Project was also run by NIH, and so it's not an unfamiliar place to me. I came to NIH in 1993, and except for the past year, where I took a year off to write a book and think about what I might want to do with the next chapter of my life, I've been in the midst of this NIH process, and all the while, I've kept my own research lab going, and I will continue to do that as NIH director as a way of remaining anchored in the reality of what science is all about.

FLATOW: When you were first interviewed after accepting this position, you laid out some of your priorities, some of your themes for your tenure, and one of those themes was health care reform. Can you explain how NIH will interact about health care reform?

Dr. COLLINS: Well, I think you can't be an American at the moment without being concerned about the direction that health care is going and the need to do something about that scary cost curve as it heads ever upward. And NIH can play a role and has been playing a role in terms of providing the kinds of data, the kinds of evidence, to enable wise decision-making about how we can allocate our resources.

One area that's particularly of interest, right now, is called comparative-effectiveness research, where you try to assess, in a circumstance where there's more than one possible intervention, what actually works best and then try to make sure that that information gets out there so that practitioners take advantage of it.

NIH has conducted such studies over the years. Just take one, for instance, the Diabetes Prevention Program, that showed quite clearly that diet and exercise intervention was extremely effective in reducing the incidence of diabetes in people who already had early signs of it and more effective, in fact, than other interventions involving drug therapy.

So those kinds of things, we will be doing even more of in the current circumstance, trying to provide the data to enable our health care system to move forward in a way that achieves better outcomes but also reigns in some of this scary cost curve that otherwise we really can't sustain.

FLATOW: Now, the members of NIH, the different department heads of the different institutions, are all very vocal, and a lot of them out front visible scientists. Do you see yourself, being the chief of them all now, being a little more visible than your predecessor?

Dr. COLLINS: Well, I guess that's going to be somewhat up to other people, but I am excited about the way that biomedical research is going, and I enjoy the opportunity to talk about that. And so on occasions, well, like being on NPR SCIENCE FRIDAY, I'm likely to be quite willing to come forward and talk about the opportunities, to give information to the public about how we're spending their money, hopefully to inspire young people who are thinking about a career in medical research that there are great opportunities here. I think that's all part of my job.

FLATOW: There has been no funding - criticism of the funding process at NIH. There - I can read you various blurbs from different places, from different people who say that the peer-review system there is so rigid and set in its ways that new ideas, and I know you're a gentleman of new ideas, have a hard time cracking what we used to call in the old days the good-old-boy system, the old-boy network, of getting new ideas through to get funding, and they fall by the wayside if they don't pass a rigid test of oh, I think this is going to work, this is not going to work. Are you going to try to loosen that up a bit?

Dr. COLLINS: Well, absolutely, and this has been a chronic area of great interest and concern. I think first of all, you should say, however, that the peer-review system that NIH uses for biomedical research is the gold standard for the rest of the world, because it does require investigators to put forward ideas and defend them in front of their peers before large sums of money get spent.

Lots of other places that give out research dollars don't have such a rigorous system for weeding out things that really aren't worth supporting and trying to identify the things that are most likely to succeed. But it is true, especially in tight budgetary times, that peer review can tend in a conservative direction, of funding the things that are more surefire as opposed to the high-risk ones.

My predecessor, Elias Zerhouni, was very concerned about that and initiated a number of programs, which I think are significant in this regard. Things like the Pioneer Awards, which are given to investigators to explore high-risk ideas without having to exactly defend where they're going to go with them, things like a new program, the Transformative R01s. R01 is the standard NIH grant.

Well, these are only given to people who come forward with ideas that are truly transformational, things like the new innovators, which are intended for investigators who have not previously had their own major grant from NIH but are required to be innovative.

Much of what I've done in my first three-and-a-half weeks of being here has been to review hundreds of summary statements of some of these awards to see what's there, and I must say there's very exciting stuff, and we are doing everything we can to be sure that part gets funded, but this is a constant struggle.

We are in the midst of a review - of a renovation of the peer-review process. By the early part of next year, I think we'll have a sense of how that has succeeded in addressing some of these concerns, but it's going to be an ongoing process. We will never be confident we've got it right.

FLATOW: Give us an idea of how many proposals you get and what percentage of them actually get funded.

Dr. COLLINS: Well, I should say that one particular example of that we should mention is the Recovery Act, which has provided NIH an opportunity to try to fund a great deal of innovative science that otherwise we would not have been able to do during the course of this year and next.

FLATOW: Is that the $10 billion stimulus money?

Dr. COLLINS: That's the $10 billion that came from the stimulus package to NIH, recognizing that biomedical research is actually a very positive way to stimulate the economy. It creates jobs. It creates goods and services. It multiplies the effect more than two-fold in less than a year. But it's also a great way of getting some exciting biomedical research done that's going to have profound consequences for all of our health.

One of the programs that NIH put forward in a big hurry, knowing that this was a unique moment, something called challenge grants. We invited people to come forward with really ambitious, creative ideas, and we thought maybe we'd get a few thousand proposals. Well, actually, we got about 21,000 proposals, and when the dust all settles, even with this marvelous increment coming from the Recovery Act, we're only able to fund about three percent of those.

FLATOW: Three percent, wow.

Dr. COLLINS: The standard at the moment at NIH has fallen down to about 20 percent of grants that come in that we're able to fund, which is to say 80 percent don't get paid. And that is clearly not a healthy circumstance. And most people looking at this situation would say a much healthier success rate is in the neighborhood of 30 percent, but we haven't been there for several years.

FLATOW: There's been a lot of talk recently about the war on cancer and not yielding great results as people had hoped for. Is it a question of just throwing more money at it, as we've heard over the last decade, or do you really need some new directions?

Dr. COLLINS: Well, Ira, I think we have some new directions. This is one of the areas I'm most excited about, and this is going to be a big boost from the Recovery Act.

We know that cancer is a disease of DNA. It comes about because of glitches, of mutations in vulnerable places in the genome that cause a good cell to go bad. And yet up until now, we've pretty much been limited to looking in specific places where we had a hunch that we might have mutations.

Now, with the advances in technology, many of them coming from the Genome Project, we finally are positioned to do this in a comprehensive way and actually get all of the answers to how cancer comes about. That has been achieved in a pilot effort for brain tumor and for ovarian cancer, and one big consequence of having the Recovery Act dollars is now the opportunity to scale that up and go after 20 common tumors and basically tell the entire scientific community, in an open-access way, by tackling those tumors, exactly what is wrong in each one of them - for lung cancer, for prostate cancer, for breast cancer, for colon cancer.

All these types, we will finally have the whole story, and that is going to illuminate hundreds of new drug targets that we didn't know about, as well as all kinds of diagnostic opportunities and opportunities for prevention.

We are about to see a real quantum leap in our understanding of cancer.

FLATOW: Not that I'm going to dispute this, but if this - this sounds like I've heard this before, you know, in other years with other directors and other decades, starting with Richard Nixon.

(Soundbite of laughter)

Dr. COLLINS: Well, yes. We did have the war on cancer going back quite a ways, and I don't mean to put that down because that was incredibly ambitious, well-intentioned. Ted Kennedy had a big role in getting that war on cancer started back there. And any of us who have been involved in medical research have great reverence for Senator Kennedy and greatly miss him, but the war at that point was being declared at a time where we didn't have the right weapons to really know how to win.

What's happened in the last few years, and I can't overemphasize this, we have really moved into territory where we're finally empowered. We've got the weapons to be able to figure out how to win this war.

FLATOW: All right, Dr. Collins, we'll talk more about the war and some other topics. Our number, 1-800-989-8255, talking with Francis Collins, new hear of the NIH. Stay with us. We'll be back with your calls and questions after this break.

(Soundbite of music)

FLATOW: I'm Ira Flatow. This is SCIENCE FRIDAY from NPR News.

(Soundbite of music)

FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking with Dr. Francis Collins, who is the new head of the National Institutes of Health. Our number, 1-800-989-8255, and also we're tweeting @scifri. That's @-S-C-I-F-R-I.

Dr. Collins, there has been some criticism of your appointment to head the NIH because of your religious beliefs, and I wanted to give you an opportunity to address some of this criticism. I know that you have been addressing it. Especially, I know one of the most vociferous critics has - is Sam Harris. He's an author of "The End of Faith" and co-founder of The Reason Project, and he thinks that your religious beliefs stand in the way of understanding -completely understanding, things like, you know, our soul, free will, moral loss, spiritual hunger, genuine altruism, etcetera, as he writes. Do you think some of these things might stand in the way of understanding who we are and what we do without having to bring in a religious element into it?

Dr. COLLINS: Well, I know those concerns have been voiced by Mr. Harris and others, but I'd really like to reassure people that I don't think there is a need here to worry that somehow the new director of the NIH has a religious agenda. I do not.

I do think that we, as human beings, have an opportunity, when we are stepping outside of the details of daily life, to think about the big questions, and I do think it's a mistake for science to imagine that it is the only way to try to answer some of those really large questions, like why am I here anyway? What's life all about? Does God exist?

But those are not scientific questions. As the director of the NIH, it seems to me it would be utterly inappropriate for me to spend my time exploring those, or spending government resources in the scientific community addressing those kinds of issues.

So I want to reassure everybody that my agenda as the NIH director is a scientific one, not a religious one. It is odd, though, isn't it, that there's such a strong outcry from some quarters, that somehow a scientist cannot have interest in religious matters? What about Isaac Newton? You know, what about Gregor Mendel? There's a long tradition of people who made substantial advances in science who also thought that questions of a larger spiritual sort were important.

FLATOW: But when you talk to psychologists, psychiatrists or researchers and neurologists, one of their main areas of research and what they want to know about is the mind and the elements of the mind like morality and altruism, and you seem to be saying that any discussion of that has to include elements of religion there because that completes the picture.

Dr. COLLINS: I don't know if I say it has to. I do think the study of the mind is one of the great frontiers of scientific research right now. I'm enormously interested to see where neuroscience can take us in understanding these complexities of the human brain and how it works, but I do think there may be limits in terms of what science can tell us about what does good and evil mean anyway, and what are those concepts about?

Evolution has a lot to say about that, and I think we should all be thoughtful about the ways in which evolutionary psychology is illuminating those questions. I find that fascinating. But I think it's probably overreaching for science to say that they have ruled out any other important perspectives about issues like morality and about issues like the spiritual aspect of humanity.

FLATOW: So if scientists came to you with research proposals that would delve into the scientific aspects of these, you would not turn them down, saying these are really out of the purview of science?

Dr. COLLINS: Oh, heavens no. I think those are extremely important research studies, and if well-designed and subjected to peer review in the NIH way that proved them to be highly meritorious, I would love to see more of that work get done.

FLATOW: 1-800-989-8255. Let's go to Portland, Dr. David McCaron(ph) is it?

Dr. DAVID McCARON: That's right, Ira. Actually, I was on the show about a decade ago.

FLATOW: Well, welcome back.

(Soundbite of laughter)

Dr. McCARON: With you, arguing about salt and blood pressure.

FLATOW: Absolutely.

Dr. McCARON: First of all, Dr. Collins, I applaud the position about personal beliefs. It's absolutely critical that we hold those types of our lives to the same standard that we do science. So the question, though, may be even a more challenging one, and that is we're in a position now where the U.S. government is the major funder of medical research, essentially in the world, when it comes down to it.

At the same time, and an example would be the Obama administration, which I think is also to be applauded, trying to determine what is effective therapy. And we're in this conundrum, that the source of major funding is also sitting at the table determining, potentially, what is the most effective therapies for the society, setting public policy.

And to me, that's like a drug company developing a drug and then going to the FDA and appointing that scientist to chair the panel that approves the drug. And it's obviously not the people at the NIH that are setting these policies and reviewing therapies, but it is, a lot of times, principal investigators, of which I used to be one, that are getting large sums of money from NIH, and they're sometimes in a very tough position of not wanting to pass judgment on a policy that's based upon NIH research. I'll stop.

FLATOW: Okay.

Dr. COLLINS: Well, I think you're pointing to an important issue about how does the information that comes out of medical research find its way into those decisions, particularly when it comes about reimbursement for care.

I am proud to be part of the Obama administration. I'm honored to have been chosen by this president at this time to play this role, as far as trying to provide the evidence, the data, that we all need in order to make rational decisions.

Some of that will be data that finds its way into what third parties decide to do, whether they're insurance companies or the government, in terms of what they think is scientifically legitimate and therefore ought to be supported by payment. And that's not new. That's been going on a long time. In fact, people would say there's probably been a problem of insufficient data, not too much.

But recognizing that people are quite concerned about whether that information could get used in a way that deprives people to access to therapies that might have helped them, I think we have to be very careful at NIH when we do these studies, and when we publish them, to explain what we've learned from this and what we haven't.

For me, as somebody who's particularly interested in personalized medicine, the fact that we are all different from each other at the DNA level, and that may have consequences for our response to therapies, one of the things I think we need to be closely paying attention to is not to lose track of that in the process of trying to make comparisons between treatments and decide what works best. Because what works best for me might actually not work best for you because we're not quite biologically the same.

I think there are ways to identify those things when they happen, but we ought to be careful not to neglect them.

FLATOW: Thank you, David. 1-800-989-8255. Let's go to another call, Stephanie(ph) in Kansas City. Hi, Stephanie.

STEPHANIE (Caller): Hi there. How are you, Ira?

FLATOW: Fine, how are you?

STEPHANIE: Fine thanks. I wanted to extend a big thank you to Dr. Collins for his research on cystic fibrosis. I have a nine-year-old little boy named Henry that has CF, and Dr. Collins' lab - am I right in saying your lab was responsible for identifying and isolating the gene that causes CF in 1989?

Dr. COLLINS: That's correct, just about exactly 20 years ago, and how's Henry doing?

STEPHANIE: Right. Well, he's doing really well, and he is the third of five kids that I have, and we've got - we're very involved with the Cystic Fibrosis Foundation, and we have a sibling advocacy group coming to Capitol Hill next month. My 12-year-old, Henry's older brother, is going to come with me, and we're going to try to meet the politicians and see what we can do.

My kids obviously - Henry's brothers and sisters - are very keyed in to what Henry has to do every day to stay healthy. And so we thank you for that research, and I wanted to find out, with regard to diseases like cystic fibrosis, some of the orphan diseases, what your plans are, what you see kind of as the future and some of the things that maybe we could even ask for when we come to Capitol Hill.

FLATOW: All right, thanks for calling, Stephanie.

Dr. COLLINS: So thanks for the question, Stephanie, because this is one of the areas, I think, of great excitement and one of the areas I'm personally most anxious to see pushed forward.

While diseases like cystic fibrosis are considered rare, there are more than 6,000 of them, and collectively, they effect 20 million people in the United States. So these are really important for us to pay attention to. And here again, we've arrived at a juncture in the last three or four years of being much more empowered to be able to take the fundamental information that's being learned about those diseases and move that into the development of new treatments.

The CF Foundation has, in many ways, led the way in showing how that can happen with the investments they've made, working with biotech companies and academic researchers, to come up with new drug-treatment approaches to this disease, which are showing great promise.

I'm the keynote speaker, in about a month, at the CF annual meeting in Minnesota. And just looking at the data that's going to be presented there, it really is exciting to see, after two years of a pretty tough slog, that really very exciting, new, therapeutic opportunities are emerging. And we can do that, I think now, increasingly with partnerships between academic investigators who are now better empowered to get involved in therapeutic development than ever and working with the private sector, tackle a long list of rare diseases and neglected diseases of the developing world, and increasingly moving those into the common diseases as well.

There's a new program at NIH called Therapeutics for Rare and Neglected Diseases - T-R-N-D, trend - which is focused on this which I think is going to be one of the most exciting things that we should be watching in the next couple of years.

FLATOW: One of the most, I guess, talked about diseases is autism. Are you going to be spending more money on looking for the causes of autism? And also trying to tell the truth about what we know about autism versus what we keep hearing in the blogospheres all over the place?

Dr. COLLINS: Well, obviously, there's great concern about this disease, and now a disease that afflicts about one in 150 kids - and clearly an indication that that is increasing. And the causes remain very frustrating to try to determine, and people have some strong opinions about this. Is this related to environment? Is it genetics?

One of the areas of strongest investment with these dollars that have arrived at NIH from the Recovery Act is autism. And we are going to learn a prodigious amount in the next couple of years about this, both by looking at potential environmental influences, looking at early interventions to try to see what works, and by looking at potential genetic causes. Because we are now at a point where instead of looking here and there in the genome, we can sequence the entire genomes of a large number of individuals with autism and try to see - is there something there that might explain this very puzzling disease.

FLATOW: What about the future of embryonic stem cell research at NIH?

Dr. COLLINS: Well, obviously, great opportunities have arrived scientifically and also in terms of policy with the Obama signature of the executive order back in March that opens up the possibility of federally funded investigators being able to work with a larger number of human embryonic stem cell lines than before. In addition, from my view, one of the most exciting scientific developments in the last decade has been the realization that you could take a skin cell and talk it back into becoming a so-called pluripotent, these induced pluripotent stem cells that each of us potentially could have created for us if we needed them to replace things that aren't working in applications like diabetes or Parkinson's disease or spinal cord injury. All of those are areas of great promise, but at the present time uncertainty as far as how realistic that promise is. I want to see that pushed extremely vigorously in the coming years. And I think, scientifically, we have the chance and a lot of investigators interested in plunging in and pushing this forward.

FLATOW: Talking with NIH director Dr. Francis Collins on SCIENCE FRIDAY from NPR News. I'm Ira Flatow. Lots of people, lots - asking lots of questions. So, let's see if we can get to a few more of them. Let's go to Jamestown, New York. John(ph), hi. Welcome to SCIENCE FRIDAY.

JOHN (Caller): Hey. Good afternoon. Honored to speak with you, gentlemen, today. I just can't believe it. My question is this. As far as nutrition goes, I joined a group four years ago called Life Extension Foundation - a big group of scientists, a big group of doctors that believe in mainstream medicine along with alternative medicine. I've often said to my friends in discussion that we can't possibly take control of the medical disaster that we have going on in this country as far as costs scopes unless we use integrated medicine. For instance, I take for my arteriosclerosis - I'm a self-employed carpenter. I have no insurance. I think President Obama's speech the other day was actually fantastic, just wonderful. Loved it.

FLATOW: All right. Let me get an answer because we're running out of time. Nutrition…

JOHN: Here's the deal: I take a Pomegranate CocoaGold and a fat enzyme instead of expensive statin drugs, atenolol, which is clinically, human-study proven to clean my vascular system and heal my endothelium. How come we're not going quickly in that direction? Thank you.

FLATOW: You're welcome.

Dr. COLLINS: So, I think lots of people are interested in these alternative medicine approaches and how they can be integrated with what you'd call sort of more the mainstream medicine approaches. The NIH has a whole center devoted to this, the National Center for Complimentary and Alternative Medicine, which has, as its goal, to apply in a rigorous way tests of these alternative therapies to see what works.

I think that's the real question is what's the data? Do these particular interventions, be they traditional drugs or be they more alternative approaches, show benefit when you apply them rigorously - not just what you hope the answer to be, but let's find out what the answer really is. And in that regard, we're going to continue to push that effort as vigorously as we can and try to give the public the information they need to make decisions about what kinds of interventions they want to choose for themselves.

FLATOW: A quick question before the break from Laura Goynoyd(ph) in Second Life. Is DNA sequencing going to become a standard part of tumor treatment -I'll just add, other kinds of treatments? How important will it be to get your DNA sequence to know what's going to work for you?

Dr. COLLINS: Oh, I think it's going to be the mainstream of medicine in another five or six years when the cost of sequencing your genome drops to $1,000 or less, it's going to be very compelling to do that. If you're interested, get that information in your medical record in a carefully controlled way so that it's private. And then, when your care provider needs to know something quickly about whether you're about to get a drug that's going to make you better or cause a side effect, that information will be there.

And for cancer, I think as soon as we can afford it every tumor ought to have its complete DNA analyzed because that's going to tell you what's the right choice of drugs for that tumor that will be smart bombs instead of the carpet bombing approach which doesn't always work as well as we want it to.

FLATOW: And then, a digitized computer database will save us money.

Dr. COLLINS: Oh, absolutely. Because if you want to know your genome sequence for a whole host of reasons for the next 20 years, it's better to just do it once, get it digitized, and have it there instantly when you need it. It's not going to change if you're talking about your inherited DNA sequence.

FLATOW: Okay. Can you picture a day when you'll carry a little thumb drive around with you…

(Soundbite of laughter)

FLATOW: …with your sequence in it?

Mr. COLLINS: Oh, probably something much smaller than that. But, yeah, I'm sure this kind of information is going to be very much something we all value. It's who - at a certain level of digitized information, it's who we are.

FLATOW: All right. We're going to take a break, and I'm going to hold over. Dr. Collins, if you'll stay with us a little bit longer…

Dr. COLLINS: Sure.

FLATOW: …and take some more of your questions. Our number: 1-800-989-8255 is our number. Talking with Dr. Francis Collins, new head of NIH. Also, we're twittering, @scifri. And as you can see, folks are gathering at Second Life, asking their questions, so we'll be right back after this break. Stay with us.

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FLATOW: You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. We're talking with Dr. Francis Collins, new director of the National Institutes of Health. Our number, 1-800-989-8255. Let's go to Carl(ph) in Chicago. Hi, Carl.

CARL (Caller): Hi. This is Dr. Carl Boccelano(ph).

FLATOW: Go ahead.

CARL: I want to let you know that I was a medical student at the University of Michigan for 1991 and 1995 and had the wonderful opportunity to have Dr. Collins give us lectures - introductory lectures as a first year medical student. And I was just - I heard the news that he was the - became the director of NIH and was very, very about that. He was able to do high-level research and yet give very introductory lectures to students in a way that kept us interested and often drew in a lot of humor between him and his co-investigators, which we always enjoyed. I was also present for one of his talks, how he, sort of, reconciled his religious beliefs and his research in medicine. And being a Catholic, I was very impressed with his thought process. And we're sad to see him go to Boston after the University of Michigan, but knew he was moving out to bigger and better things. And, once again, as an OBGYN, I talk to patients every day about cystic fibrosis strain and just want to thank him of all of his work.

FLATOW: Thank you, Carl.

Dr. COLLINS: Thanks, Carl. That's wonderful.

FLATOW: Let me see if I can get one quick call in here before we have to go because we're running out of time. 1-800-989-8255. Let's go to Iggy(ph) in Kansas City. Hi, Iggy. Quickly.

IGGY (Caller): Oh, hey, Dr. Collins. I have a quick question. You know, you're an evangelical Christian, my understanding, so you probably adhere to the statement: faith is belief in things not seen. So my question to you is how can you have this approach to basically fighting these dreadful diseases that had been bestowed on us by your God? Either he created these dreadful diseases and they were good or these diseases developed after the fall of man. So I'm just kind of curious to know how you can reconcile this mythological approach in rational investigation, if you wouldn't mind.

FLATOW: Thank you, Iggy.

Dr. COLLINS: Well, that's a question that's difficult to answer in a soundbite. That's one of the questions I think believers and non-believers have struggled with down through the centuries. What is the source of evil? What is the cause of human suffering? I did write about that in this book called "The Language of God" that was referred to in the introduction and I'd certainly refer the caller to that. But, basically, I think one argument that's been put forward is that the way in which the earth came into being and the way we came in to be creates certain possibilities of things going wrong. And if you want to have life, you also need to have life change and sometimes that means it changes in ways that causes illness. And, of course, a lot of the illness that we see around us are things we do to ourselves. If we are in bad shape because of bad choices we have made, I don't know that we should blame external forces for that. At the same time, when you see a child with cancer, you have to wonder, now, wait a minute. What's going on here?

I think there are answers to those questions. They're not easy answers. They are answers that I don't think anybody should feel complacent about, but I think they can be explored from a spiritual perspective in a way that actually increases your interest in the possibility of God rather than discounting it.

FLATOW: Dr. Collins, I want to thank you for taking time to be with us today. We've ran out of time.

Dr. COLLINS: It's a pleasure to be with you anytime, Ira.

FLATOW: Always pleasure to have you back. Francis Collins, director of the National Institutes of Health, talking about becoming the new head of NIH, and also talking about his book, "The Language of God: A Scientist Presents Evidence for Belief."

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