A Man For All Seasons, Part I

GUEST: Dr. Harold Varmus
VTR: 12/03/2004

I’m Richard Heffner, your host on The Open Mind.

And I must say that some of the most interesting moments I spend in preparation for these conversations with public persons come when I try to puzzle out quite how to begin them … how to introduce my guests to you.

And today my puzzlement is made all the greater by the seeming disparity between my guest’s official status and enormous professional achievements – and THEY are VERY clear and well defined! – and the reason I actually invited him here to The Open Mind.

For Dr. Harold Varmus is President of the world-renowned Memorial Sloan-Kettering Cancer Center here in New York, has shared a Nobel Prize with a colleague for studies of the genetic basis of cancer, has won many other distinguished scientific and medical awards, writes beautifully, researched and taught for two decades at the University of California medical center in San Francisco, and for the greater part of the Clinton-Gore Administration presided brilliantly over the National Institutes of Health in Washington.

And yet none of the above explains precisely why we’re seated here together today.

What DOES, however, is quite how intrigued I am with the film and television criticism of medical science-geared entertainments Dr. Varmus has recently written for the New York Times … one about an NBC program titled “Medical Investigation” and another about a Robert De Niro film concerning human cloning titled, “Godsend”. Indeed, maybe there are even more such critiques I don’t yet know about!

So that I wonder if we Memorial patients must worry that my guest, truly a man for all seasons, is now on the slippery slope to media America. Is that a fear I need to entertain?

VARMUS: Well, I don’t think I’m going to be spending full time writing reviews or, or producing TV shows. But, I have for many years had an interest in how the public comes to know about science and medicine. Some of the things we do as scientists and as doctors are among the most exciting developments of the, of the current era, and television and movies provide some of the most powerful ways for us to reach the public with some notion of what we do and what themes we grapple with and how we behave as individuals trying to understand nature and applying our knowledge to the betterment of patients.

HEFFNER: And your opinion generally about the way the media treat science and medicine?

VARMUS: Well, it’s not easy to sum that up. It’s obviously a mixed impression. I do think that one vehicle for getting our message out, mainly science journalism has improved dramatically over the last 30 years … the period I’m most familiar with because I’ve been doing science for about 30 or 35 years. I do think that there are many people who take science journalism much more seriously than, than was the case when I began my scientific career.

People call themselves science journalists, they have … they go to special programs at MIT and Stanford and other places where they, where they engage seriously in discussions with scientists. There are many books that have been written recently about major themes in, in science, like the genome project or cloning and stem cells. So I think that part of the, of the scenery is, is pretty well taken care of. Not all newspapers are willing to run science journalism because most newspapers operate on sports and murder cases and other things that attract the interest of a reading public. But for papers like The Wall Street Journal and The New York Times and many others, there is serious scientific journalism almost every day.

Now where things have been … I would say have a more checkered history is in the mass visual entertainment ranging from theater to movies and especially television which has the biggest audience. For someone like myself who does spend a fair amount of my time trying to speak to the public from a lectern, know I’m lucky if a thousand people turn up to a lecture that I might give for the public on, on advances in cancer research. But when ER runs a show or when a movie producer puts together a movie, they’re addressing millions of people and sometimes tens of millions of people and that’s a platform that carries a great responsibility.

And one of my roles as a critic of what is done with that kind of opportunity is to take people to task when I think they are abusing it.

HEFFNER: And you do think that at times.

VARMUS: At times I do. Because at times I think they portray scientists in a, in an inappropriate light and miss an opportunity to say “yes, scientists are human like everybody else, but there’s good just as much as there is bad.” (Laughter) And, and there are, you know, there are mixed arguments about things that sometimes … too simplistically viewed as being evil and complicated and dangerous.

HEFFNER: Forty years ago … and that’s a long, long time ago, the triple AAAS …

VARMUS: Seems less long to me than it did (laughter) twenty years ago.

HEFFNER: (Laughter) Well the American Association for the Advancement of Science asked me to be a consultant …

VARMUS: MmmHmm.

HEFFNER: … on this very question and we tried to introduce real life science, scientists to real life people in the media … those who write, and produce. And, for a while it seemed to work and then, of course, the demands of the media, themselves, overcame the good intentions to a very considerable extent. I mean when the bottom line is your bottom line …

VARMUS: Yeah.

HEFFNER: … how successful can those efforts of yours be?

VARMUS: Well, I think in the, in the print media, it’s still pretty successful. But, you have the new New York Times Science Section … while I think it’s become a little diluted recently, there’s too much health stuff and not enough of the hard sciences.

But for the most part, over the last ten or 15 years, the, the Tuesday Science Times has been a pretty effective means to portray serious science. And I, I respect that. And I, I find the Wall Street Journal does that on a regular basis as well. I think what’s been more difficult is to get the, the science that lies behind the things that the public has come to take for granted, but not connected with scientific research. Portrayed in a way that’s interesting.

Take ER as a good example. You know medicine is actually built on science. People tend to forget that. And yet even though ER is continually portraying things that have required fairly astute scientific observations and has, on some occasions, presented … I remember distinctly a show about transplantation, for example, where the ethical and, and physiological aspects of transplantation were laid out very clearly for viewers … the importance of donation was subtly placed in the context of a good story line … there’s always a good story when a transplant is, is in play.

All those things were laid out in quite a healthy way, but ER … for many years … systematically … denigrated the character and activities of scientists. They showed scientists attempting to aggrandize grant money in, in nefarious ways; they showed scientists and doctors who had grants talking about grant money as though it were only a way to enrich the pockets of the hospital or the university.

It made science seem like pure careerism without any higher goals … when a student who was seeking a Ph.D. as well as an M.D., was shown on the show, they were always viewed as unable to make any human connection with patients and dropping chemicals or radio isotopes on the floor of the clinic. So there was a kind of undercurrent of anti-science at the same time that the show was, was illustrating, every time, some remarkable achievement that couldn’t’ have occurred without scientists behind it.

HEFFNER: Less so now?

VARMUS: Well, I think ER has become a much less effective show over the last … I actually stopped watching it regularly; I used to be addicted to it. But, it became more of a soap opera and less of a place to show off what medical science can do and illustrate interesting case histories.

HEFFNER: Well, let me ask you a question … in terms of a little delving into our national psyche …

VARMUS: MmmmMmm.

HEFFNER: How do you explain the positioning of the scientists, not as the “mad” scientists, as … that used to be …

VARMUS: Right.

HEFFNER: … the fear …

VARMUS: … I think it’s less of a “mad” scientist than sometimes a scientist …

HEFFNER: A greedy scientist.

VARMUS: Greedy. Or …

HEFFNER: But why? Why? Anti-intellectualism, generally?

VARMUS: I don’t think it’s so much that. I think part of it is to attempt to make the show more interesting. And I, you know …

HEFFNER: You have to have villains.

VARMUS: Right. And one of the … one of the attributes of television and movies that are very much in play when you try to do a movie or a TV show that has a science or a medicine component, is it does have to be part of a storyline … it’s got to be interesting to a large audience and it takes a certain amount of imagination and cleverness to develop a storyline that actually shows science in, in a good light. It’s very easy, in most cases, to make science out to be the villain. And it makes me unhappy when that happens.

You know, try to portray a scientist at work, which of course, for many of us is the, the ideal … to show what the life of science is about, is not, not an easy trick. A friend of mine, Leon Lederman, Nobel Prize winner in Physics, had for many years tried to shop around in TV studios a show … I think it was called “The Dean” … and the effort was to show the dynamics of a, of a prestigious research oriented university that had scientists, many scientists on the payroll and, in the context of a dramatic situation, that might involve a case of scientific misconduct or abuse of grant money or something else that displayed one of the real life dramas of science, also show the good work that scientists are doing and trying to, as you … as the story unravels, the context would be one in which you, you could begin to appreciate what the good work was.

HEFFNER: I take it it didn’t fly.

VARMUS: It didn’t get … it didn’t, it didn’t make it. Yeah. That’s too bad. The show that we mentioned earlier, this show called “Medical Investigations” was, I believe, initially conceived as an effort to show the good work of the NIH. But there were some immediate flaws. One was that the writers really didn’t know what the NIH did and verisimilitude is an issue. You really don’t want to portray the actions of one agency in the name of another.

And what the so-called medical investigators were really portrayed as doing was the work of the Centers for Disease Control, the CDC. And then to try to make the characters interesting, the writers seemed to make the characters rude and abusive and, you know, and while I don’t deny that there are scientists and doctors who may, on occasion, be rude and abusive, to have a kind of uniformity of abuse and rudeness was … really didn’t make sense or, in fact, as, as entertainment it didn’t work because these people were so predictably abusive to anybody who got in their way.

HEFFNER: You really think you can mix fire and water here?

VARMUS: I do.

HEFFNER: You can entertain. You can educate and entertain ..

VARMUS: Sure. Because it does happen. I mean it certainly happens in the theater, there have been a few plays recently that at least show science as something that is on the minds of serous people. A play “Copenhagen” which not everybody liked. My wife was not a fan of it, but I thought it was very effective piece of drama … does, does that. And the play about Richard Feynman … “QED” …

HEFFNER: Right.

VARMUS: … with Alan Alda … was, while it didn’t show physics at work, because quite frankly you’re not going to have a theater audience sitting there watching a scientist or a mathematical physicist writing equations on a blackboard for two hours … but, but it did give a sense of a life of the mind of a distinguished physicist and I thought it was extremely effective. I’m sorry it didn’t play longer.

HEFFNER: But, but my question is …

VARMUS: Yeah.

HEFFNER: … whether you can reach … what you obviously want and that is the largest possible audience …

VARMUS: Yeah.

HEFFNER: … in this way.

VARMUS: Ahmm … a show that didn’t get as much attention as I thought it would, and I’m not sure why it didn’t … was a show called “Century City”, I believe … I mentioned it in one of my reviews in the Times because it portrayed the debate about cloning in an extraordinarily interesting way. As a TV series it was set in a Los Angeles law firm and one of the lawyers was asked to take on the case of a man who’s son was, was dying of liver disease and he was trying to make a clonal line of normal liver cells that would be transplanted into, into his son. And this … the experimental work was being done abroad because it was excluded from funding in the US …
HEFFNER: That’s making a point.

VARMUS: Making a point. And when the father tried to bring in the embryonic cells that were going to be used to generate these, these living, healthy liver cells for his son, he was arrested and that’s where the court case began. And, you know, all the … you know, the scientific arguments, the legal arguments, the medical case …it blended together in a really extraordinary way. It was a gripping drama … inherent in the text was a lot of important science, very clearly explained … I thought that was remarkable. But the show … maybe, maybe it was pitched a little bit too high … I’m not sure. It just didn’t take off.

HEFFNER: But you see, that’s the point. Maybe it was pitched a little bit too high.

VARMUS: Maybe.

HEFFNER: As I, as I have read so much of what you’ve written, I made particularly a note here … something you said in one of your speeches … well, let’s see, I wrote it down on my folder. You said it … it was at CalTech …

VARMUS: MmmHmm.

HEFFNER: And you were talking about examination of topics of the highest order and the greatest difficulty. And you were really talking about raising our sights, and I wondered whether that isn’t somewhat contradicted by what you need to do when you do try to reach mass audiences. And whether it isn’t your own enthusiasm, and I see you are an enthusiastic person …

VARMUS: MmmHmm.

HEFFNER: … that takes you along those lines. For instance, I know that in the recent election you weren’t exactly reticent about your support for the Democratic candidate.

VARMUS: That is true, although my main point in what ever actions I took during the campaign were really addressed to the proper relationship between the scientific community and government. And, you know, I was a supporter of Mr. Kerry’s, but most of what I had to say was really about the current relationship between government and science.

HEFFNER: Antagonistic?

VARMUS: I don’t think it’s so much antagonism. I think it’s neglect and, and a tendency to shield the government from an opinion it didn’t want to hear. That was an important component. Another important component is the, the government’s failure to recognize that, that in a, in a nation with a depleted treasury, it’s very difficult to support the innovations that government is uniquely equipped to support.

The best return the government gets for any of the money it spends is in science. That’s been well documented. And when our treasury goes broke, which is happening as a result of tax policy, the government can’t support scientific programs.

The other thing that bothered me was perhaps a subtlety, but it’s an important message to take away from any effort to understand how scientists work, and that is that any organization and any individual operates most effectively when they use the, the simple principles of scientific thinking. That is … you gather up evidence, you make an hypothesis, you test the hypothesis by looking at the evidence and you move forward in an evidence-based way. And that’s exactly what didn’t happen when the government began to take on the problem of Iraq.

They asked a lot of questions, they ignored the answers and they moved ahead toward, toward a war that, to my mind, was never justified based on evidence.

HEFFNER: There’s no RX for that kind of thinking, is there?

VARMUS: Well, we call it democracy. An election of somebody else. (Laughter)

HEFFNER: Ahhh, but it didn’t happen that way.

VARMUS: It didn’t happen that way. And we’ll, you know, we’ll live to fight another day.

HEFFNER: But your point was made. It was made again and again and again about the irrational basis for …

VARMUS: But, but I think, you know, I think there was an interesting … we’re now off on another topic, but I think it’s actually a useful one. The election is decided on many grounds, there are many reasons people voted the way they did. We only had one plebiscite on science policy in this last election, and that was held in California, where a proposition to support public funding of stem cell research was conducted under the aegis of Proposition 71. And there, despite the fact that many people I know, who were actually supporters of Mr. Kerry and voted against it, on, on grounds that we could talk about, if you like, that despite that, the Proposition prevailed 58 to 41 and, and that was actually a bigger margin of victory than, than Kerry had in that state. So, it’s clear that, that the public does understand many aspects of the arguments about science and the imposition of religious ideology on decisions about science is not something that most people support.

HEFFNER: Is there a different way of going about things at the National Institutes now than during the years when you were there?

VARMUS: I have great admiration for Elias Zerhouni, who’s the Director of the NIH and I think he’s done many good things. The two difficulties that I see at the NIH at the moment … first of all, despite the fact that the NIH has had a massive increase in its budget over the, the years from 98 to 2003, this year’s budget for the NIH is sub-inflationary; it’s only about 2% and then there’s some taps taken on that budget, it will be under 2%. And the fact is that even after a major increase overall, an inability to continue to have moderate increases is quite debilitating.

Secondly, the management of the NIH has been problematic over the last couple of years. Management not by the Director of the NIH, but by the Department. And the Department is loving NIH to death, it’s, it’s overseeing too many things, it’s, it’s taken management functions and brought them downtown to the Department. It makes things inherently more political. There’s a tremendous, tremendously detailed and overly intrusive effort to manage travel schedules and decisions of who speaks to whom. This is not the way … you know, NIH is an unusual agency.

It’s more like an academic institution stuck into a political government. Preserving the NIH as a refuge from politics and a place where science is done by government scientists and money is given out by government scientists to people all over the world, takes a very delicate kind of management. Donna Shalala was extraordinary in doing that. She would rein us in if she thought we were really going wrong. But for the most part, she gave us a free lead.

HEFFNER: But you were rather extraordinary I gather, in the way you administered the NIH.

VARMUS: Well, I … I’m … I try to bring in very strong people to run the NIH Institutes and then give them as much of a free lead as possible.

HEFFNER: And you made friends for the …

VARMUS: Well, in Congress …of course, it was an easier time. The budget was … sorry, the, the NIH economy, if you will, that is the … it was clear we were heading for a period of, of growth. The country was seeing a massive debt reduction and, and a much improved balance in the budget. We weren’t at war, we hadn’t been attacked on 9/11; the country was a happier place to be then. Much less divisive and I think we just had an easier environment in which to be effective.

HEFFNER: I wouldn’t ask you, what are you gong to do when you grow up …

VARMUS: (Laughter)

HEFFNER: … but I, I wonder what you’re thinking about the, the future. Because the shifts you’ve made have been so interesting.

VARMUS: Well, I’m still early in my time at Memorial Sloan-Kettering. We’ve changed a lot of the, a lot of the aspects of the place … we’re building a major new research building. We’ve just become an official graduate school. We’re expanding our clinical facilities. I think we’re also entering, perhaps most importantly … we’re entering an unusual time in the history of, of cancer therapy … because for those of us who’ve been laboring to understand the genetic bases of cancer for the last twenty or thirty years, we now see the fruits of those labors beginning to ripen.

Just in the last few years we have drugs that, that specifically counter the effects of proteins made by the mutant genes that drive the development of a cancer cell. Those drugs are just the harbingers of a revolution in cancer therapy that is very profound. This means that already at our place, and many other places, when individuals are diagnosed with cancer, it is appropriate to take a DNA sample as well and look at the mutations that, that are responsible for that cancer and to begin to make plans for that patient that are appropriate to the kinds of mutations that we can now precisely diagnose.

Now there’s, you know, the kind of thing that can be incorporated into a TV show or a movie about, about … it may not even be a show or a movie that’s really about cancer, but an individual gets cancer and rather than hanging crepe, we have the patient go to, to a DNA pathology room and the biopsy is taken and the DNA sample is worked up, and we show what that DNA analysis looks like and, and we say, “Aha, this patient has a mutation in the EGF receptor gene and that means that we can now treat this patient with this powerful new inhibitor of the enzyme that is promoting the growth of the tumor.”

And you can do that in, in the context of a show in a way that illuminates the science, show the application of science to human health, shows the helpful and interesting and even quirky nature of the, of the physicians and scientists who are involved. And then the character who can go on to execute the rest of the plot and, all in the course of showing what the …

HEFFNER: And if I wanted to be cute, I’d say …you’d better register that idea. Except that I know that you want and in this new computerized publication that you’re into, you’re really pushing this idea of making as many ideas available free …

VARMUS: Right.

HEFFNER: … to as many people as possible

VARMUS: Yeah. So you’re now going to talk to me about our adventure in open access publishing …

HEFFNER: Yeah.

VARMUS: … which has, ahem, been a very major event in my life over the last few years because many of us in the scientific community believe that, that science has not yet taken full advantage of the opportunities that the Internet provides to change the way we do our publication.

HEFFNER: And guess what the sign is that I’m getting … “say, Good-bye”.

VARMUS: Good bye.

HEFFNER: Will you promise to come back and talk about that?

VARMUS: And anybody who wants to learn can just go to www.plos.org and they can see the full debate and the, the kinds of journals that can be made available immediately … no fees … with the touch of a mouse … to the public in general.

HEFFNER: Don’t mention a mouse. Dr. Varmus thank you so much for joining me today.

VARMUS: Pleasure. Thanks.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time, and if you would like a transcript of today’s program, please send $4.00 in check or money order to The Open Mind, P. O. Box 7977, FDR Station, New York, New York 10150.

Meanwhile, as an old friend used to say, “Good night and good luck.”

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.

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