Harold Varmus Reflects On A Life In Science Harold Varmus wrote his college thesis on Charles Dickens. He went on to win the Nobel Prize in medicine. Last month he was tapped by President Obama to serve as a science adviser. He describes his unusual career path in his new memoir The Art and Politics of Science.
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Harold Varmus Reflects On A Life In Science

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Harold Varmus Reflects On A Life In Science

Harold Varmus Reflects On A Life In Science

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IRA FLATOW, host:

You're listening to Science Friday on NPR News. I'm Ira Flatow. President Obama pledged in his inaugural speech to restore science to its rightful place, and he wasted no time rounding up a circle of science advisers to help him accomplish that. Back in December, the president appointed my next guest, Dr. Harold Varmus, to serve as co-chair of the President's Council of Advisors on Science and Technology. Dr. Varmus took the road less traveled to get to the President's Council.

There was the college thesis on Charles Dickens. There were a couple of rejections from Harvard Medical School, dropping out of a Ph.D. English lit program at Harvard for Columbia's med school, a stint at hospital in northern India as a med student, and then some really fantastic achievements after years of research, picking up a Nobel Prize in medicine in 1989, a share of it for his work on cancer genes, then, the top post at the National Institutes of Health under President Clinton. These are just a few of the milestones Dr. Varmus recounts in his new memoir, "The Art and Politics of Science."

And now, as a presidential adviser, he is faced with a bunch of whole new challenges and opportunities in science and the public understanding of science. And joining me now to take a look back at his life in science and a look ahead at science under the new administration is Dr. Harold Varmus, author of "The Art and Politics of Science." He's also president of the Memorial Sloan-Kettering Cancer Center here in New York and co-chair of the Presidential Council of Advisors on Science and Technology. It's great to have you back.

Dr. HAROLD VARMUS (Author, "The Art and Politics of Science"; Co-Chair, President's Council of Advisors on Science and Technology): Ira, thank you very much.

FLATOW: Thank you. What is your job on that council? What is the job of the…

Dr. VARMUS: Well, it's a part-time job. I'm keeping my day job at Sloan-Kettering.

(Soundbite of laughter)

Dr. VARMUS: And I'm still doing some science in a laboratory I enjoy quite a bit. And this is an advisory position obviously, but it's one that we think is going to be very important. The president has had a council of advisers on science or technology since the days of Sputnik, but the influence of that council has been variable over the years. Richard Nixon basically fired it, and other presidents have used it to greater effect.

And while the initial issue was Sputnik and nuclear competitiveness, now, especially because of President Obama's views on science, we expect it to be much more wide-ranging. One of the things that has impressed me about Barack Obama from the first time I met him is that he seems to understand the connections between training and educating and importing scientists to create a workforce, the effect of science on our energy policy and on climate change and industry and the economy, on manufacturing, on information technology and on health - all the things that are central to what he would like to achieve for the country.

That's why, when he says - as he said the other day, putting science back into its rightful place, he means at the center of generating knowledge that's useful to the country. And he's said to many of us in interviews that he sees science as a centerpiece of his new administration.

FLATOW: How do you know you'll get any real time with the president?

Dr. VARMUS: Well, of course, it's a little hard to know that, but one of the things that is really extraordinary is here we are, the administration's only a few days old, and we're having this conversation. Traditionally, this science council is usually put together sometime near the end of the first year, and instead, in this case, Barack Obama met with several scientists to…

FLATOW: He met with you?

Dr. VARMUS: He did, privately, and - I was not alone, there were several people who had private discussions to think with him about how science will play a role in the new administration. But I think the fact that he's paid attention to this up till now augers well for the future. Obviously, (Laughing) he's got a lot of things on his plate, and we don't expect to have a lot of his time, but certainly we expect, I think, reasonably, to have some.

FLATOW: Now, how do you interact with the formal science adviser that the president has?

Dr. VARMUS: Well, John Holder…

FLATOW: John Holder. Yeah.

Dr. VARMUS: Who is the science adviser and will be the head of the Office of Science and Technology, is the full-time guy down there. He's one of the three co-chairs, the third being Eric Lander, who's a well-known genomiscist and head of the Broad Institute in Boston. And right now, the three of us have been meeting to consider our plans for the council, and of course, John is the key person. He's there full time. He runs the Office of Science and Technology policy. He's the person who will be advising the president directly on a regular basis and sitting-in on meetings. I don't expect that Eric and I will be in Washington for meetings more than perhaps once every month or two, depending on what kind of problems we're asked to consider.

FLATOW: Do you think that there is enough money for science in this new budget and…

Dr. VARMUS: Well, look, science - no scientists ever say that there's enough money.

(Soundbite of laughter)

FLATOW: Well...

Dr. VARMUS: But, right now, of course, we're on the horns of the dilemma. The country is in difficult shape economically. On the one hand, part of the answer is to include science in the stimulus package, and there're many good reasons to do that that most people have probably not thought about. You know, when you give a grant to a scientist, you're not simply paying in the abstract for an idea, you're paying for a scientist to do work, which means having people in his or her laboratory who get a salary, and it means buying equipment and materials that are frequently made by an American manufacturers.

We know from studies that have been carried out that there is an immediate local effect of spending on science in the community because of the salaries and the expenses. And then, there's a long-term effect of the return to the country from government spending on science, estimated by most economists to have about a 150-percent return. So, there are many reasons to make this kind of investment, but the investment is going to be short-term, rapid impact investment. And we, as scientists, know that science is a long process, and it is necessary to think about how science budgets will fare over the long haul. And there, the problem is pretty difficult because we know that the economy is in difficult straits, and it's going to be difficult to increase domestic spending on anything.

FLATOW: Yeah. Yeah. 1-800-989-8255, talking with Harold Varmus, Nobel Laureate in medicine and author of "The Art and Politics of Science," new book just out. And let me just say up front what a great effort - great book this is. It's not just - it's a memoir about your life, but along the way, you explain the science that you're involved in and the science of genetics so wonderfully that any lay person can really understand it.

Dr. VARMUS: Well, I appreciate that.

FLATOW: And one of the things that's interesting - and I talked about you taking the road less traveled because you never started out to be a scientist, did you?

Dr. VARMUS: No, I was - my father was a physician, and I was of course, like any Jewish boy growing up in the suburbs of New York, labeled as a future doctor. And I don't know, I accepted that label for some time. I went off to Amherst College and frankly, was rapidly seduced by lots of other things - running the school paper and thinking about becoming a journalist, loving philosophy, dabbling in physics. Amherst was a place where you could do that very easily and think about different careers. And by the time I was college senior, I was headed for a career in literature, and indeed, went off to graduate school and only then sort of woke up to the fact the I was going to leave a lot of other things behind, especially science and medicine.

FLATOW: But you found science to be more fun. Would that be right?

Dr. VARMUS: Well, it was a long time before I found that out, because I went off to medical school. My initial intention was to be psychiatrist, to blend psychiatry with an interest in literature, and it was only when I was obligated to do some kind of national service - it was the Vietnam War years. Those of us who objected to the war tried to find some other way to serve than by going to Vietnam.

I was one of the lucky ones who was able to go to the National Institutes of Health, and at the age of 28 - a very advanced age in today's science training program - was thrown into a lab to do stuff that was extraordinarily abstract for someone who was used to treating patients and reading novels. Suddenly, I was asked to explain how one little molecule regulated genes and bacteria. It seemed like an abstraction, but then I learned this stuff is fun.

FLATOW: Right. And you had to relearn again, once you became head of NIH, how to do things as an administrator.

Dr. VARMUS: Well, I wasn't relearning, that was…

(Soundbite of laughter)

Dr. VARMUS: That was being thrown from an environment where I was running a laboratory with 25 people and a budget of less than $1 million dollars into a place where I had a lot of political interactions to manage an organization with 20,000 employees and several - many thousand grantees and a budget that was already then over 10 billion.

FLATOW: Right. Well, let's talk a little bit about science and politics and what you encountered. A lot of people have talked about the political influence of science in the Bush administration - global warming, other things - but you talk about in your book as - you talk about a section about the Human Embryo Research Panel report in 1994, in which President Clinton's chief of staff, Leon Panetta, called you, asking you to repudiate the conclusions of your own committee.

Dr. VARMUS: Well, that's not a totally fair way to describe what Leon's call meant. He was asking that we exempt some of the recommendations from what we accepted.

FLATOW: I'm quoting your own words.

Dr. VARMUS: (Laughing) Yeah, no, no. But it was…

FLATOW: The word repudiate is in the book.

Dr. VARMUS: Well, we were asked to repudiate one of the conclusions - or a couple of the conclusions.

FLATOW: Oh, OK. OK.

Dr. VARMUS: And indeed, although I refused to do that…

FLATOW: You thought you were going to be fired.

Dr. VARMUS: Well, there was an implicit threat, but what happened was that the president then issued an executive statement that said that his administration would not specifically spend money on research that would create embryos for research use. And indeed, that is a reasonable position. And you know, the stem cell wars that we're fighting now are not about that particular issue.

But the issue is an important one, because if we ever had stem cell therapies that were shown to work but we needed stems cell that have a certain genetic property that prevented them from being rejected when they're used for therapy, it might, in some cases, be necessary to consider making embryos of a certain type to generate cells that would not be rejected. And I think it was the exceptionalism that bothered me. My feeling was that we could have regulations that made - that created a need to have a clear rationale for taking the step that many people would at least want to think about. So...

FLATOW: President sort of made an end around the panel, right?

Dr. VARMUS: What he did was to - I wouldn't call it end around. He responded to one aspect that he didn't want federal funds to be used for. That was not done in legislation; it could always have been changed.

FLATOW: Right.

Dr. VARMUS: And it was not a prohibition of stem cell research. The fact is that no stem cell research was - well, let me step back here one second. When that report was issued in the end of '94, there was no human embryonic stem cell research. It was only embryo research to be contemplated, but that research could well have included the derivation of stem cells. And when that was achieved a few years later, it was achieved through the use of funds from industry and private funds that were controlled by the University of Wisconsin.

FLATOW: Is it a far gone conclusion then that the president is going to lift the restrictions on the embryonic stem cell research?

Dr. VARMUS: Well, I don't have any insight into foregone conclusions, but during the campaign, Senator Obama did indicate that he expected to lift those restrictions, which as you know, are not restrictions on all stem cell research. They were restrictions that prohibited the use of cell lines derived after 9 p.m. on August 9th, 2001.

FLATOW: Right, that special speech he made. Yeah.

Dr. VARMUS: Right. Exactly. That was a congressional - a presidential directive that has, of course, influenced the way in which stem cell research has been funded. And since there have been nearly a thousand new lines generated since then, and many of them are better than the lines that were in existence when he gave that speech, those of us who support stem cell research feel very strongly that it should be reversed.

On the other hand, there are still many aspects of stem cell research that cannot be funded or will not be amenable to funding with federal monies until further congressional restrictions are removed, including a famous amendment, called the Dickey-Wicker Amendment, which prohibits the use of funds for research that would damage or destroy an embryo. And that means - that includes the derivation of human embryonic stem cells.

FLATOW: 1-800-989-8255. We're talking with Dr. Harold Varmus this hour on Talk of the Nation, Science Friday from NPR News. I'm Ira Flatow, talking with Dr. Varmus, who is author of "The Art and Politics of Science," just out. Interesting front and back covers - this can only be a Harold Varmus book. It has interesting - Lavoisier picture on the front, right?

Dr. VARMUS: Well, remember, that's a painting actually.

FLATOW: It's a painting, exactly, very famous painting.

Dr. VARMUS: It hangs right here on our city, just a few blocks away from where we're talking.

FLATOW: And then it has you and your ten-speeder - your (Laughing) bicycle on the back - back flap, which is probably your trademark in Washington.

Dr. VARMUS: Well, it's good to have something that…

(Soundbite of laughter)

Dr. VARMUS: A non-controversial, nonpartisan trademark.

FLATOW: As long as I've known you, you've been riding that bike, and it's got to be…

Dr. VARMUS: Well, that one or many others.

(Soundbite of laughters)

FLATOW: Decades now - or many others. How will you - being a regular adviser - you say it's a part-time job - is it a kind of job where you have an idea and I should talk to the president or council about it or they come to you?

Dr. VARMUS: No, I don't think so. Well, you know, it remains to be seen, Ira.

FLATOW: But if you feel strongly about something, can you go and try to…

Dr. VARMUS: I think - you know, I'm not part of the administration in that sense.

FLATOW: Yeah.

Dr. VARMUS: And I think the way I would proceed there would be to talk with John Holdren, who is the science adviser…

FLATOW: Right.

Dr. VARMUS: Consider the question of whether some topic that strikes me or my other co-chairs or any member of the council as important or anybody we hear from - of course, even before the council is formed and meeting, we're hearing from a lot of our colleagues about ideas that they think should be studied or promoted with - in the context of this new activity. And you know, I think, we will be a conduit for the scientific community, and I think that's an important role.

FLATOW: 1-800-989-8255. Let's go to the phones, to Johnny in San Francisco. Hi.

(Soundbite of radio feedback)

FLATOW: Turn your phone down, please - turn your radio down, please. Johnny, are you there? Oh, he's put the - he's put the phone down next to the radio. That's a cardinal error of talk radio. He wanted to know whether the president - in your conversation with him - how any president is able to digest scientific information and make a decision on it? Does he know enough science, I guess, or what does any president have to know?

Dr. VARMUS: Right.

FLATOW: There have been books out now - the science the president should know, right?

Dr. VARMUS: That's right, that's right. And there are some very good ones actually, one by a colleague at University of California, Berkeley. I think the expectation is not high that he would have a sophisticated knowledge of specialized science. I don't have a sophisticated knowledge of (Laughing) many aspects of modern science. I think the job of the science advisers, whether these are advisers like Steve Chu, who's a cabinet secretary, or the new head of the NIH, whoever that might be, or John Holdren or any of us on the PCAST, is to try to explain in understandable language. He clearly has a level of sophistication that is unusual, and his interest in science is palpable.

FLATOW: Yeah.

Dr. VARMUS: So, I think, you know, many of us in the scientific community have a right to feel encouraged that he's going to ask for an explanation. He's - one of the things that I find extremely encouraging about his approach to life is, A, he's curious - very important trait. B, he's perfectly happy to say, I don't know what that means. Explain that to me further.

And I think he'll get it and that - you know, our job is not to make policy. That's not what the science advisory team is there for. It's to say what science tells us about a problem that he's interested in trying to solve. And then he and other people who do domestic and foreign policy have to decide how they're going to incorporate the best, unadulterated information we can give them into the policy they're making.

FLATOW: And you think - do we have to unwind the last eight years, do you think?

Dr. VARMUS: Well, you know, I don't think it's - many of us were outspoken about what we saw as the defects in the relationship between government and science over the last eight years. And I have to say, Ira, that not everything about that relationship was bad. There were some things that were done in the Bush administration that some of us applauded. But right now, we're focused on trying to get the pieces to work properly in this administration, which means getting information from the best people in a completely unaltered way.

FLATOW: OK.

Dr. VARMUS: I think we can do that.

FLATOW: We have to take a break. We'll come back and lots more about the future with Harold Varmus, author of "The Art and Politics of Science." 1-800-989-8255 is our number. Also, you can tweet us - yes, that's it - tweeting. Our Twitter is @scifri, and also, in Second Life, you can go over to Science Friday Island and leave us a question there. Stay with us, we'll be right back after this break.

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FLATOW: I'm Ira Flatow. This is Science Friday from NPR News.

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FLATOW: You're listening to Science Friday from NPR News. I'm Ira Flatow with Harold Varmus, author of "The Art and Politics of Science," just out. Dr. Varmus' long and spectacular career - he's a Nobel prizewinner; he's head of the NIH. He's now become an informal science adviser to the president. What - let's talk a little bit about restructuring some things that might work better. There's been talking, for example, about restructuring, resizing the Food and Drug Administration. Would that be a good idea? Would that work better?

Dr. VARMUS: Well, I think it's definitely worth studying very carefully. The Food and Drug Administration, of course, is a regulatory agency that has a very strong science base. It has a tremendous domain, not just drugs, but other kinds of unusual therapeutics, whether it's devices or new biologicals. They have jurisdiction over stem cells. You may have read that they just approved the first trial for human embryonic stem cell research.

FLATOW: Right.

Dr. VARMUS: At the same time, they're charged with part of the food industry, with the USDA - the Department of Agriculture - being responsible for the other part. The budget has not increased, not kept pace with its responsibilities. There have been efforts to increase its financial resources by asking drug companies to provide money for the agency. And one could argue this is not the best way to carry out these enormous responsibilities that are obviously very prone to conflicts of interest. So, there is an idea on the table that we create a separate agency for oversight of food and leave the FDA, which would then, I suppose, be the DA or the…

(Soundbite of laughter)

Dr. VARMUS: An agency that had jurisdiction over health treatments, whether it's prevention or treatment.

FLATOW: Right.

Dr. VARMUS: I think that's something that could be a task assigned to the President's Council of Advisors on Science and Technology. It could be a special task force. I think it would be a very interesting thing to do and perhaps very worthwhile. Now, it's hard to get these kinds of things through Congress, and that would have to happen.

FLATOW: Right. 1-800-989-8255. The president has emphasized his - I mean, a complete turnaround from the past administration about global warming - and that he understands the problem, and he's willing to do something about it. Is America going to have to take a leadership role in this?

Dr. VARMUS: Absolutely. And I don't want to predict what specific steps are going to be taken, but I think that President Obama understands that America has to be a leader. And that means, of course, being a joiner as well, that is, joining with other nations in trying to address this enormous problem. And some of the first steps that seem to me to be extremely positive is naming to his administration people like John Holdren, who are remarkable scholars in this area, Jane Lubchenco, who's going to be running the Oceans and Atmospheric Administration. Bringing people like this in indicates…

FLATOW: They're very proactive people.

Dr. VARMUS: Very.

FLATOW: And I know Jane pretty well. She's been on the show a few times. And I liken putting her in charge of the oceans to putting Ralph Vader in charge of cars. You know, she's very involved.

Dr. VARMUS: As you know, the oceans are deeply threatened in many ways and getting the right science done and learning from that science - it's not just a matter of waters rising, it's also destruction of coral reefs and loss of fish populations in many parts of the world. These are crucial issues that need to be very aggressively addressed.

FLATOW: 1-800-989-8255. Let's get a phone call or two - Andrew in Cleveland. Hi, Andrew.

ANDREW (Caller): Thank you for taking my call. This is my first time actually being able to get on your show. This is great. My question is - is there anything, moving forward, that would maybe form a coalition with other - say, like, you know, your European nations or other scientists from other countries that have not had their hands tied by, you know, eight years of the world is flat. I wasn't - you know, I was kind of curious if there's a…

FLATOW: Do you have a specific…

ANDREW: Sharing of notes on the horizon.

FLATOW: Do you have a specific issue in mind in particular, Andrew?

ANDREW: Well, specifically, I would be interested definitely in any international sharing of notes in stem cell research or specifically, you know, a lot of neurological disorder research or definitely medicine or genetic research.

FLATOW: OK. We'll get an answer.

Dr. VARMUS: Well, let me just say briefly that science is constitutively an international activity. Scientists from all over the world meet fairly regularly to share their findings, and the findings are published in journals that, one way or another, are made accessible to people. Sometimes you've got to pay subscription fees, but as Ira knows very well, I've been a proponent of trying to make the scientific literature even freer and much more accessible.

FLATOW: Public library of science.

Dr. VARMUS: And we'll come back to that.

FLATOW: Yeah.

Dr. VARMUS: And libraries created by…

FLATOW: And libraries, yeah.

Dr. VARMUS: By NIH and by organizations in the U.K. But I do think that the question you're asking has a deeper resonance, and that is that we should be thinking about ways to use science, scientific training, health research, health delivery as a component of our foreign policy. We should have more scientists in our embassies. We should be using our embassies abroad to bring scientists to other countries, especially developing countries.

Science is a unifying force in the world. On the whole, it does good. Most of the work that we do is not classified. There are opportunities to build on a community that already exists as a result of international meetings to try to solidify relations between countries, even those that are having political disputes.

FLATOW: And transparency - President Obama has talked a lot about transparency. I guess - and you've devoted a large part of your career to the openness in the scientific community?

Dr. VARMUS: Yes.

FLATOW: Talk a bit about that a little bit.

Dr. VARMUS: I think the thing that I'm most interested in is taking advantage of the Internet to make science available - first, to all scientists around the world who can use that information and frequently are prohibited from seeing it because it's hidden behind subscription barriers. And now, there are ways to reduce the costs of publication and to pay the price that always remains in publication upfront with author's fees, at which point, the articles can become completely free to anyone in the world who's got an Internet connection.

Secondly, it's possible to create libraries through the public domain, like the NIH, in a way that allows individuals to search the literature. And that means, not just scientists, but people like you, Ira, who are trying to prepare for a radio show, and a science reporter, a science teacher, a high school student who is stimulated by something he's read in a high school course - there are lot of people - health care advocates and many others - who really want access to the knowledge, much of which they've paid through - for through tax dollars that support the nation's science and science agencies.

FLATOW: And a lot of it's very expensive, some of those publications.

Dr. VARMUS: But the cost of publication is roughly 1 or 2 percent…

FLATOW: Yeah.

Dr. VARMUS: Of the total cost of doing research.

FLATOW: Right.

Dr. VARMUS: And it should be considered part of the act of doing research. And now, as a result of government action - congressional action about a year and a half ago, all work that's supported with money from the NIH has to be deposited in a freely accessible form within a year after publication in the NIH's public library, called PubMed Central.

FLATOW: Let me quote something that you said in an article you wrote in Science magazine - you co-authored. (Reading) We look to our new president and vice president for leadership in fulfilling the promise of science for our nation. We hope that they will not fall prey to the view that the problems of our society might be solved by a shift in emphasis from basic science to applied research. Instead, the U.S. federal government should act decisively to revitalize the support of fundamentals, as well as applied research.

Dr. VARMUS: 1994.

FLATOW: Sixteen years ago.

Dr. VARMUS: Right.

FLATOW: You wrote that in January - the January 22nd issue of Science in 1993. Sounds like you could have written it today.

Dr. VARMUS: I could, although, I would also point out that we need to be cognizant as scientists of the potential applications of what we do. And science, especially in an economy that's hit as hard as ours has been, needs to be done with a recognition that while - I'm, you know, an enormous proponent of basic science and the joy of discovery and giving free range to our imagination. The public and people who make decisions about science funding need to understand that what gets done in the arena of basic science does make it, through a series of steps, to the kinds of applications that the country needs, that our economy is built on science in a very, very substantial way.

FLATOW: Well, and you know, so little - this - in 16 years since you wrote this - as a journalist, so little of science is actually getting out to the public now. You know, there are fewer science reporters, there are fewer public newspaper, you know, sections devoted to science.

Dr. VARMUS: That's true. But this show is one of the manifestations. The Science Times does quite a good job. I don't think it's all bad news, but I agree with you, the number of science reporters has gone down. But of course, that's a result of what's happening to the newspaper industry more generally. It's not specifically targeted to science.

FLATOW: Mm hmm. Where would you like us to be four, five, six years from now?

Dr. VARMUS: By we, what do you mean?

FLATOW: I mean, the country, scientifically speaking. What would you like to see - if we're having this discussion, now it's the end of one term of President Obama's and we will have seen what accomplished in the last four years? What would be a good sign for you?

Dr. VARMUS: One good sign always comes back to budgets, and I think that's very much on the minds of all scientists at the moment, that healthy, predictable, steady increases in science budgets to allow people to go into science with the reassurance that if they do a good job, they compete effectively, they will have stable careers in science and be able to do the work for which they spent 10 to 15 years training. Second, ensuring that our training institutions are healthy and that we are training people to be, not just scientists, but to understand evidence-based learning and rational thinking. Of course, the third aspect, which is sort of self-evident, is that I would like to see science discover important things and help turn important discoveries into useful instruments of societal improvement, and that's - you know, it's hard to make some specific predictions.

FLATOW: Right. Well, let me just (Laughing).

Dr. VARMUS: In my field, I'd like to see more drugs for cancer treatment and better ways to prevent cancer.

FLATOW: How many times do you get asked when are we going to find a treat - a cure for cancer?

Dr. VARMUS: Well, I get asked pretty often but, you know, I think it's a question that's worth pursuing.

FLATOW: What don't we know yet?

Dr. VARMUS: Yeah, well at this moment...

FLATOW: What don't we know about cancer that we need to know?

Dr. VARMUS: Well, one surprisingly simple thing we don't know yet, but we are rapidly learning, is the full repertoire of genetic damage that's occurred in a cancer cell. We know the principles. We know some of the damage. We've learned how understanding that damage can lead to better therapeutics and - but we've also only in the last few years had the tools for analyzing a cell's genome - the complete collection of genes that would allow us to develop a sophisticated and complete picture of what's wrong with a cancer cell. I think that's - and you know, in saying that, I have to emphasize that what's wrong with the question when we're going to cure cancer is that cancer is not one disease. It's many different diseases arising in many different tissues.

FLATOW: Right.

Dr. VARMUS: And that's one of the things we learn from the genetic analysis.

FLATOW: Well as president of Memorial Sloan-Kettering, I give you the blank-check question that I give scientists sometimes, which is - if you had a blank check, how would you spend it on cancer research? What would you be wanting to focus in on?

Dr. VARMUS: Well, look, there's no one thing that you focus in on because cancer is a complicated problem. There are many different cancers. I think many of the things that are being done can be done more rapidly, that only means expanding the budget for certain things of that kind.

FLATOW: I've given you a blank check.

Dr. VARMUS: Yeah, you know, the blank check is…

FLATOW: Is it not the right question?

Dr. VARMUS: It's not the right question because, for better or for worse, there are things that money can't buy. One of them is genius, and having brilliant people working on problems and having ideas, having the leisure - an escape from grant writing to actually do the work that they're supposed to do - these are the things that create opportunity for the leaps of genius that get us where we want to be.

There are some other things that are obviously important that are simply going to be expensive and require training of clinical investigators, and the most obvious is just doing more clinical trials. We have a lot of new drugs coming through the pipeline. Testing those drugs appropriately, having incentives for doctors to conduct clinical trials and patients to enter them - very important. We've made a lot of progress in pediatric cancer for a very - to a very large extent because virtually all pediatric patients were at academic health centers. They were encouraged to enter clinical trials, and we made a lot of progress.

FLATOW: All right. Let me just remind everybody that this is Science Friday from NPR News. I'm Ira Flatow talking with Doctor Harold Varmus, author of "The Art and Politics of Science." There's so much more we could have talked about, but you did raise an interesting point about - you can throw just so much money at a problem, and it boils down to genius - the 1 percent inspiration, 99 percent perspiration argument. How much of science is actually just sitting and thinking of the right thing to know or the right test to conduct?

Dr. VARMUS: That's a very significant part.

FLATOW: That's it.

Dr. VARMUS: And there is still a lot of perspiration. We - I think most people in the scientific community agree now that even in academia, a lot of fairly straightforward, predictable work that may have unpredictable conclusions need to be done. Sequencing, determining the complete nucleotide sequence of the entire set of chromosomes in a variety of different cancers, is going to yield very interesting information. We've only achieved that with a few cancers so far. And that, right now, is perspiration, not inspiration, but the analysis does require a very high degree of inspiration. But I think - I mean, we have problems that we all can define - for example, there are a few genes that we know about that are mutated on a very high percentage of cancers, and yet we have no way to interrupt the activity of those genes.

FLATOW: Because?

Dr. VARMUS: Hmm?

FLATOW: Because?

Dr. VARMUS: We just don't know how to do it.

FLATOW: We don't know how to do it.

Dr. VARMUS: And...

FLATOW: We know the mechanism that's involved? We know how it…

Dr. VARMUS: We know the mechanism. We know how these - how the proteins work. We know what proteins do, but we don't have a way to interfere with the signal that's emitted from that bad protein.

FLATOW: And you know what the signal is?

Dr. VARMUS: Yeah. But, you know, this is a real challenge. And if somebody could figure that out, that would probably affect our approach to treatment of about a third of human cancers.

FLATOW: You just - how to block the signal?

Dr. VARMUS: Right.

FLATOW: Is that a molecule for - you know, is that some sort of molecule?

Dr. VARMUS: Yeah, it's all happens as a result of one change in one of the 170-some building blocks of a protein, called the Ras protein. And we know exactly what the effect of that change is. We know the kind of signal. We know what other proteins are affected by that single change. We know that kind of change is found in about a third of all human cancers. And yet, we don't know how to interrupt that. I believe we'll get the answer to that in the next five, 10, 15 years. But we've known a lot about this for 10 to 15, even 20 years, and still, it's an unsolved problem.

FLATOW: So, it's an engineering problem?

Dr. VARMUS: I don't think it is an engineering problem.

FLATOW: No?

Dr. VARMUS: Engineering problems are problems that we, I think, understand the building blocks for…

FLATOW: Right.

Dr. VARMUS: Like getting to the moon, and then, you know, just matter of assembling the parts. Here, I think somebody has to have a totally different idea about how cells work and how - I mean, one of the things that's happening as a result of our ability to assess virtually every component of a cell at once is - I mean, we could say it's appreciating the cell as a machine - throwing a wrench into one part might affect the functioning of another part.

FLATOW: Alright, Doctor Varmus, thank - we've run out of time. I want to thank you very much for taking time - coming by again.

Dr. VARMUS: Ira, always a pleasure.

FLATOW: We'll have to have you back - maybe come back as a regular guest and to talk to us on a regular basis.

Dr. VARMUS: Be happy to do that. Thank you.

FLATOW: Harold Varmus - "The Art and Politics of Science," a great book. Put it on that list for books for yourself. We've run out of time.

(Soundbite of credits)

FLATOW: Surf over our Web site at sciencefriday.com. We're podcasting and blogging and Twittering. And our video Pick of the Week is up there. We have a collection from Lamont-Doherty of the greatest mud samples in the world - the largest collection. It shows some very interesting samples there. Have a great weekend. We'll see you next week. I'm Ira Flatow in New York.

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