The Art and Politics of Science, Part II

GUEST: Dr. Harold Varmus
VTR: 04/14/2009

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

And my guest is once again Nobel Laureate in Medicine Harold Varmus, whose new W. W. Norton memoir, The Art and Politics of Science is a wonderful introduction not only to his own training and achievements as a pure scientist, but to his years as Director of the prestigious National Institutes of Health during most of the Clinton Administration.

For nearly a decade now Dr. Varmus has been President of the world-renowned Memorial Sloan-Kettering Cancer Center here in New York … and has just been appointed to co-chair President Barack Obama’s Council of Advisors on Science and Technology.

So let’s pick up now where we were last time and Dr. Varmus, we were talking about the new Administration, its attitude towards science. Not so much to condemn the old Administration, but to look into the future. What do you see when you look into the future?

VARMUS: Well, I see a President who has inherited a lot of very deep problems. In foreign relations, the economy, immigration policy, energy needs, environmental degradation and concerns about climate change.

And the thing that I find inspiring about Mr. Obama, one of the reasons why I’m very happy to have an advisory role in his Administration is that he perceives the role that science can play in virtually all of these arenas. America has been successful to a very substantial extent because we have encouraged our best minds, attracted talent from abroad, made discoveries, applied those discoveries to our commercial enterprises and our leadership in the world owes a great deal … often an unappreciated great deal to how we’ve succeeded in science and technology.

Now we’ve had failures in this, in this realm as well. And I think the President appreciates that. We don’t have … what’s conventionally called a scientifically literate public because our educational system has been geared … we use metaphor … to mining its diamonds as opposed to encouraging development of the pipeline. And it is important, as the President has acknowledged, to insure that all Americans who go through our high schools learn the precepts of modern science; learn enough about math to understand risk and to be able to evaluate increasingly common public arguments about things that range from disease incidents to stem cells to the effects of, of global warming … on our many activities the contribution that carbon emissions make to, to our environment.

And to appreciate those things one has to have some grounding in science and all too often those who don’t show the potential for stardom in K through 12 education system, get ignored. We need to change that.

HEFFNER: How do you change it in the educational system? What do you want …

VARMUS: The fundamental thing is, of course …

HEFFNER: … the educational system to do?

VARMUS: … of course our public education system is grounded in the states and the Federal role at this point is, is to a very large extent advisory and based on advocacy.

But the, the first step in my mind is always better salaries for teachers. If we don’t increase the prestige of teachers and pay them more, we going to be stuck with an inferior system. The way things stand now fewer than a third of science teachers in high schools actually have a degree in science. And we don’t have science teachers who understand how science works, they’re going to do what, you know, is obviously excusable under the circumstances, they’re going to depend on text books and on the, the dreary of recitation of scientific facts as opposed to teaching the scientific process that has turned so many people away from science over the years and make them feel … making them feel that science is neither approachable nor enjoyable. And you know, we need to change that. We’ll only change it by attracting college graduates in, in science curricula to, to an experience as teachers of high school science.

HEFFNER: If someone were to turn to you … given your years now, not just at the National Institutes, but at Sloan Kettering and to say, “Well, let’s take this one great area …

VARMUS: MmmHmm …

HEFFNER: … that’s related to science … cancer. Where are we in terms … I’m not going to ask the question that so many people ask you … do you have a cure yet …

VARMUS: (Laughter)

HEFFNER: … for cancer …

VARMUS: If I had it, I would tell you, believe me.

HEFFNER: I, I’m sure you would. Your answer is so frequently “there are so many cancers”.

VARMUS: Yes, well and that is, and if I do say so myself, the correct answer. One has to appreciate that we’re not talking about one diseases, we’re talking about lots of different diseases, how many we’re not even sure yet. But …

HEFFNER: And where are we?

VARMUS: Well …

HEFFNER: With the many.

VARMUS: Yeah, with the many we understand basic principles of how cancers arise, regardless of what they, what specific types of cancer they are. In some cases, we’ve made tremendous progress and can control cancers so they no longer are killers. But, unfortunately for the vast majority of patients who have the common forms of adult cancer of the colon, of the lung, the breast and others … we, you know, we still have a long way to go to reduce mortality to an acceptable level … which in my mind is basically zero.

I think we should be able to control all cancers. We’re not going to eliminate the, the occurrence of cancer. We can reduce it in some cases … for example, of lung cancer by finding ways to control tobacco habits. But cancer is part of the human condition, it comes about as a result of mutational processes that are essential to life and to diversification of forms of life. And we’re not going to eliminate cancer entirely.

But we can detect it earlier, we can treat it better. We can control its manifestations when cancers have, have appeared. We can show we do that with some selected cancers now, but we aren’t uniformly successful.

HEFFNER: Do that frank, honest approach diminish the interest in people in supporting basic science that leads …

VARMUS: I don’t think so. I think what it tells people is that when we have basic knowledge about cancer we can devise new ways to detect it and treat it and even prevent it.

And we have made progress, dramatic progress on some cancers. And that includes some of the common cancers I mentioned where death rates are still unacceptable, but, but there’s no doubt that we’ve made tremendous progress in both preventing and treating breast cancer. Even though, as I say, death rates are still significant. And it’s a common disease and we need to make a lot more progress, but, but the fact is progress has been made and our understanding of the disease is dramatically greater than it was.

And then, not to be forgotten … the experience of being a cancer patient is dramatically changed by, by many of the things that we’ve learned how to do to control pain and nausea and bone marrow suppression and many of the complications of treatment and for that reason, you know, you don’t say the “c” word anymore.

We, we talk about … we talk about cancer as another chronic disease. Many of our patients even though they, they have a disease that may ultimately be mortal, nevertheless these are diseases that people can live with and work with for many, many years because of our enhanced ability to control the disease for long periods of time.

HEFFNER: It’s fascinating … the “c” word. It wasn’t so many years ago that I learned that I had cancer and I’m terribly much aware of the unease that people had in talking about it, feeling that I would shy away from it. That’s changed and …

VARMUS: Dramatically.

HEFFNER: … in the half a dozen years ….

VARMUS: … and it’s changed in part because we, we, you know, recognize that this is … you know … cancer is still a terrible disease for many people. I’m not trying to minimize that. But, but the approach is a much more open one for many reasons.

I think in general our society deals with problems like cancer or sexual orientation or race in a, in a somewhat more open way than we used. But part of the explanation for our changed approach to cancer is that, that we do have better ways to control it, we do have people who have built advocacy groups and, and patient survivorship and support groups that are immensely helpful in, in allowing people to confront this disease.

It’s a disease like others. Heart disease and diabetes and stroke and many neurological diseases are also devastating diseases just as much or more so than, than cancer. And we don’t shy away from talking about those.

So, I think it’s a very healthy thing that society has come to accept cancer as, as another form of understandable illness. I think one of the things that made cancer difficult to, to grapple with initially is that it’s so mysterious. And now we actually can say in pretty concrete terms what goes wrong with a cell to make it a cancer cell. And if that helps in beginning to understand why your own cells turn on you.

HEFFNER: That’s an interesting phrase “your own cells turn on you.”

VARMUS: Well, you know, this is not an infection. I mean infection contributes to the development of some cancers. But the, the striking thing for those of us who have been studying it is that a normal cell undergoes mutational changes and, and as a result it acquires new properties, excessive growth, a failure to die on schedule. And that means too many cells and you have an accumulation of your own cells that, that presages your mortality. And that’s a difficult thing to accept.

HEFFNER: You know, that, that brings me back to something I meant to ask you about in our, our first program … talking about your new memoir The Art and Politics of Science somewhere in here and I have to thumb through my notes to find the page you talk about the, about Lisenko, you talk about the Soviet Union and …

VARMUS: MmmHmm, MmmHmm.

HEFFNER: … and the limits on the ability …

VARMUS: Right.

HEFFNER: … of scientists. The inheritance of acquired characteristics and perhaps I should wait till we’re off the air and ask you this …

VARMUS: (Laughter)

HEFFNER: … but I remember when I was at Columbia College studying with Theodosius Dobzhansky, the great geneticist, and he said, “someday we’ll learn to have a little more respect for Lisenko and the notion of the inheritance of acquired characteristics”. Have we come to that point yet?

VARMUS: Ah, not exactly. I mean we do understand that, that there is an environmental component to disease that’s very important. But that’s not the same thing as genetic change.

Genetic change … some of it … the only part that inherited are, are, are aspects that involve chemical modification of DNA and that is there is a parental imprinting of our genomes that is not encoded in the simple sequence of our bases. But the, the significant principles of Mendelian Rules are still in place and they’ve become more complicated because we know that genes can undergo changes that Mendel would not have predicted. But nevertheless …

HEFFNER: You don’t think they’re going to come …

VARMUS: … the, the notion of acquired characteristics … well, you know, it’s more than, than just saying that the, the soma can contribute to the germ line, which is a very problematic idea. It probably doesn’t have any bearing on the situation.

But this notion that an environmental experience or something that occurs during your lifetime that’s not a change in your, in your genome can be transmitted… it doesn’t have any deep validity at this point.

HEFFNER: Alright, I’ll wait for another 50 years and ask …

VARMUS: Well we’ll get we can ask again, yes, that’s a good idea.

HEFFNER: … a distinguished scientist. Going back to the Science Council … I remember when Bill Golden was here …

VARMUS: MmmHmm.

HEFFNER: … first so excited about the notion of needing to have a scientific advisor to the President. What will be the relationship of this Council to the Advisor to the President?

VARMUS: Sure. So, Bill Golden who died recently was a great patriarch of science and was the, the man who got the Science Advisor position established in the White House almost 60 years ago … was very instrumental in, in developing the nation that, that the President should be getting advice from the scientific community.

And that notion was expanded in 1957, just after Sputnik when Eisenhower asked for the creation of a council of Advisors, had a slightly different name than it does now, but basically it’s a bunch of outsiders who come to Washington on a regular basis, work with the Science Advisor and meet with the President and give him advice on a variety of topics.

When that group, which we’ve now called PCAST for simplicity, was first convened, it was, it was a group of about 20 elderly White male physicists. And that was in a sense a manifestation of the Cold War, of anxiety about nuclear threats, in response to the, the achievements Soviets made of putting a small vessel into orbit … Sputnik. And perhaps appropriate and characteristic of its time, but no longer appropriate for what we intend to do in this era.

So, what will happen in, in this Administration is that we’ll have a Council, yet to be fully announced, that will have representative of many different scientific disciplines, not just physics, but other … many other scientific areas ranging from biology to chemistry to information science and, and economics and other aspects of, of social sciences.

With a great geographical and ethnic diversity to provide advice across a very wide spectrum of activities and interests that the President ought to have that can be informed by what we know about science and technology.

The, the relationship that you ask about is simple. The President’s Science Advisor, John Holdren, who’s trained as a nuclear physicist, who’s very knowledgeable about everything from arms to energy to environmental sciences is working full time in Washington running the Office of Science and Technology Policy as well as advising the President. He is one of three co-chairs of our Council. The third is Eric Lander who is a distinguished mathematician and genomics researcher at the Broad Institute in Boston.

And the three of us will provide oversight to a group of probably, roughly 20 people or so who will meet on some … as yet … undetermined regular basis to decide what should be studied in greater depth and what kind of advise to give the President.

HEFFNER: I gather the most important thing is that whatever the advise is, it will fall upon an open mind.

VARMUS: Ah, indeed. That perhaps might be an invitation to bring the open mind on, on to your show.

HEFFNER: (Laughter)

VARMUS: But, but … yes, we like to think it’s an open mind. We know from our own personal experience with President Obama that he, indeed, is a man of tremendous curiosity and rare intelligence and scholarly attitude.

HEFFNER: You know we’ve been talking about science and I’ve been thinking about the word “reason” and it seems to me that what we have in the White House now is a man who respects reason above all else.

VARMUS: Reason and not, not just reason, but reason that is looking for evidence and wants to draw conclusions from facts. So that’s what, what science is all about. I mean it’s not as though science is some laboratory exercise.

Science is knowledge and knowledge is acquired by asking questions and looking for information that tells you what the answer might be.

HEFFNER: You’ve been quoted as saying that you think that the area of foreign policy …

VARMUS: MmmHmm.

HEFFNER: … is subject to help, openness, a scientific approach … aid on our part … to health and other science adventures abroad.

VARMUS: Indeed, I, I think science and health are two areas that have been moderately neglected in the history of the US as a, as a vehicle for improving relations between countries.

It doesn’t imply any endorsement of another government’s policies for us to have relations with … that, that involve American scientists working with scientists in another country … even a country that has partially hostile relations.

We’re not going to go in some country with which we’re at war, but, but there are countries with which we have profound differences over commerce or military activities or other things where we can build bridges that are effective in establishing rapport between our countries … useful in development new knowledge and serve as a vehicle for improving our reputation in the area and in the, in the country that with which you may have disagreements.

HEFFNER: Now is this Harold Varmus scientist? Or Harold Varmus political scientist?

VARMUS: Well …

HEFFNER: … who’s talking this way.

VARMUS: … it, it … both in a sense. It’s not the Administration speaking. Obviously these are views that I will … have expressed in the past and will continue to express in, in whatever role I have in, in, in … as an advisory. But these do not imply any commitment (laughter) by the US government to anything. But, but I think we have learned some lessons over the last 20 or 30 years about the utility of science and health as, as means for, for promoting cooperative action between countries.

I’ve been hearing from many countries in which we have made approaches about the, the benefits of helping to build science in those countries.

I’ll give you one example. About almost 20 years ago two major government agencies … part of NIH and USAID built a malaria training and, and research center in Bamako, Mali. Ah, Mali is a country with which we have quite good relations, but it’s an extremely poor country and its one that … in which science did not thrive.

But as a result of this center which we’ve built there is a, a tremendous interest in science in the Malian government. They pay great attention to the center. The center is a great vehicle for training scientists throughout Africa in malaria research. It’s resulted in the training of many young Malian scientists who come to the US and then go back. And it’s a, it’s a very constant and productive bridge between our two countries.

HEFFNER: What about the movement the other way … we’ve … I’ve heard a great deal about the fact that in recent years scientists who would come here from other countries to be trained, perhaps to stay, perhaps not … but to increase the scope of our knowledge of the world …

VARMUS: Well, I …

HEFFNER: … haven’t been coming … will they now? Do you think the movement will …

VARMUS: No, scientists have been coming from other countries to the US. There have been some, some difficulties with immigration policy …

HEFFNER: Okay.

VARMUS: … that created some, some minor problems and I shouldn’t call them “minor”, they, they, they have not resulted in dramatic … and dramatic declines in the, the number of people who come here for training. Ah, but and those are policies that need to be worked on. But, I thought we were going with this was to point out that, that there is, there is a potential problem bringing scientists of talent to the US and then not having them go back to their home countries where they can play a very important role in the development of those countries.

HEFFNER: You mean the “brain drain”?

VARMUS: Yeah, the brain drain. And I, you know, I think the brain drain is, is a two edged sword.

On the one hand the US has a vested interest in trying to bring great minds from anywhere to settle in this country. This is a country built on immigration and I think it remains a very … very potent part of our effort at, at progressing in a, in a way that’s advantageous to the nation.

Only 12% of our country are immigrants, but 25% of our scientists, 25% of the members of the National Academy of Science, 25% of our Nobel Prize winners, the last fifteen years have come from, from other parts of the world. That’s an interesting set of statistics.

On the other hand, I think it’s also important for us to recognize that we bring to this country for training a great many more scientists than we can possibly employ.

And we ought to be helping to make the home country, the country of origin, a place to which scientists we train can return. And certainly that’s true in the example I gave you of the Center in Mali. People who come here from Mali to be trained in malaria research, can go back there and work very productively. And many have.

HEFFNER: Dr. Varmus, we have two or three minutes remaining. A question you may think passing strange … what are you going to do when you grow up?

VARMUS: (Laughter)

HEFFNER: What’s the future?

VARMUS: Well, look I have a very good job that I’m enjoying doing right now, running the Memorial Sloan Kettering Cancer Center at a time of, of economic difficulty. And we’re, we’re surviving quite nicely … thank you.

But, but it does create problems, we want to do the best we can to exploit the opportunities that have resulted from changes in our understanding of cancer as a disease. We want to play a role in adapting to whatever changes occur in health care in the Obama Administration. So there are many exciting things for us to work on at Memorial Sloan Kettering. I have a lot …

HEFFNER: But I was talking about its President … you.

VARMUS: Well, sure, but, but as President I’m taking a very active role in what we do at the Center. I also, as you know, have some outside interests of significance in trying to revolutionize the way we publish scientific literature through open access business methods and by creating a digital public library which exists at NIH in England. So, I will continue to work there.

I’m doing a lot of things abroad. I look forward to my activities on the President’s Council of Advisors on Science and Technology. I’m continuing to finish up some work for the Institute of Medicine on global health. I hope to play an active role in that, in that area. And maybe I’ll write another book sometime.

HEFFNER: I certainly hope so, particularly given the excellence of this one. Brief question … the lot of open science. The lot of what you were campaigning, crusading for. Satisfied with what’s happened?

VARMUS: Well, we’ve made a lot of progress because virtually every major funding agency in Europe and the US has endorsed the policy that, that work supported by those agencies needs to be in the public domain within six months to a year. Varying by agency. We’ve also made a lot of progress through open access publishing. Some colleagues and I founded the public library of science … PLOS … P L O S dot org where all the journals we publish make their content immediately available to anyone in the world. We pay our publication costs by asking the, the authors to use part of their grant money to pay publication costs, which averages about 1% of the cost of doing the research. This is working as a business model, it’s becoming increasingly popular among scientists and that, too, has been, in my view, a partial victory.

We’re, we’re not there yet, my goal is to see the scientific literature completely transformed and, hopefully, that will come to pass.

HEFFNER: Good. Positive note to end on. Thank you again for joining me today, Dr. Varmus.

VARMUS: My pleasure, thank you.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. For a transcripts 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.