g o v e r n m e n t & policy
NIH DIRECTOR SPEAKS OF SUCCESS
During an interview late last month with C&EN Associate Editor William Schulz, Varmus reflected on his tenure and record ofsuccess at NIH and the challenges that lie ahead for the agency.
C&EN: Before being named director of NIH, you outlined for the Administration three problems in basic science: Increasing the budget for NIH, new investments in facilities and equipment, and minimizing targeted research. What's the progress? Varmus: We made 11 recommendahen National Institutes ofHealth ning ways. And while he has never admit- tions, and those were among them. How Director Harold E. Varmus took ted publicly to error, Varmus has modified have we done? Clearly, after an initial pecharge of the agency in 1993, his original proposal for E-biomed, now riod of budget difficulties, we have done some colleagues questioned whether he had called PubMed Central. Instead of a site pretty well. When I arrived here, it was a the experience to manage such a complex where scientists couldfreely post research re-climate in which everyone was talking organization. A physician who was profes- sults in the life sciences, it will be a site that about budget cuts. I took a stance, which sor of microbiology, biochemistry, and bio-includes the National Library of Medi- looked a little peculiar but I think actually physics at the University of California, San cine's PubMed online service, a portal site it was right to say to Congress, "At least Francisco, Varmus shared the 1989 Nobel for established journals to post their pub- assure us that what you will offer us is the Prize in Physiology or Medicine with col- lished articles, and a preprint archive for possibility of living at our current level by laborator J. Michael Bishop for their work non-peer-reviewed articles (C&EN, Sept. providing us with inflationary increases. We will try to adapt to that." Clearly, we on retroviral oncogenes. 6, page 11). Varmus faced a number ofserious manWhile he wouldn't confirm or deny ru- are not at steady state—we're growing. But I think that we probably made a agement issues, including the need to make mors of'his departure, Varmus'comments improvements in NIH's intramural re- about the Administration signaled that sensible move by saying not that we are search program while maintaining quality some unhappiness may exist, particularly entitled to big increases, but give us some in the extramural research program—which in regard to this year's budget request for assurance that we can live in a certain way. And clearly, since the budget outlook has accounts for the bulk of NIH spending. NIH by the Administration. improved so dramatically since Six years later, with wideg 1993-94, we've been given good spread speculation about his | resources—not just in '99 when departure from NIH by year's | we had the bonanza year, but end, few doubt Varmus' mana£ even in the previous three years gerial and political ability. His S we had very substantial increashandling of Congress alone has o es. It made us feel we could do led to unprecedented federal sup£ new things as well as keep the port for NIH—nearly $16 bil| old things rolling along. lion in 1999, almost double the amount when he took charge of ^ Facilities and infrastructure the agency and the envy of other » are a more difficult issue. I realscience agency directors in the | ize that there are a lot of shortfederal government. In fact, NIH comings out there in physical is sometimes referred to as "the infrastructure—no doubt about new NASA" because of budget that. We've made some repairs increases Varmus has obtained on the intramural campus, but and the widespread public supwe still have a lot of buildings to port of NIH those increases pull into shape, and that's true imply. around the country. On the other hand, we also More recently, he has promotknow that the optimism about ed NIH-funded research with huthe support of medical reman stem cells—cells that are search has inspired many instiderived from human embryos tutions to start building proand fetuses. Though this issue is grams with the expectation ethically thorny, Varmus apthat there will be strong suppears to have convinced a maport and that the indirect costs jority in Congress that NIH can that people receive from grants and should lead this groundwill help to pay off—to amorbreaking research effort. tize—the loans required to However, Varmus has not build those buildings. There's charmed everyone with his win-
Though questions linger about his future plans, Harold Varmus has made an indelible mark on federal health agency
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g o v e r n m e n t & policy no doubt that facilities money that goes along with NIH grants will help. Nevertheless, my own view is that there ought to be some more targeted construction projects. We need to do a better and more deliberate job of repairing the infrastructure. Instrumentation is something we have made very significant progress in trying to remedy—both by increasing the shared instrumentation grant program and with other grant programs to support purchases of instrumentation. We have focused NIH's research more than ever on instrumentation and technology development. That is not the traditional mode in which NIH is thought to work. But through our bioengineering program, and through a deliberate recognition that science does advance when technology advances, we have tried to move a little bit away from the traditional hypothesisdriven, cottage industry, peer-reviewed stuff to programs that are clearly designed to create better instrumentation. I see many indications that most NIH institutes are interested in supporting even more of these programs in the future. Targeted research—you know, NIH has produced some targets of its own. And that's okay, we're setting priorities. Congress has been very kind to us in the past few years, but our appropriations bill has been mercifully free of the kind of earmarks that are most detrimental, that trouble me the most. But remember that NIH is successful in part because the institutes are named in a way to make the appropriators and the public feel that the money is going to certain causes: There are the National Institute of Diabetes & Digestive & Kidney Diseases; the National Cancer Institute; the National Heart, Lung & Blood Institute, and so on. People know that money is going to support a wide range of research on a topic that clearly benefits public health.
C&EN: Do you speak often with the President or Vice President? What do they talk to you about? Varmus: I see one or the other maybe every six months to a year. It's not frequent. When I do, the conversation is usually trivial—that is, some kind of social occasion. When it is more substantive, it is because there is concern about some particular health or science issue. A good example was the meeting I had with the President a few years ago about our AIDS research. The President has always been concerned about the major diseases. He is not a scientist, doesn't pretend to be, but he is very, very smart and wants to know if we are making progress in cer-
tain areas. He called a few of us down to talk about AIDS and especially about AIDS vaccines. A consequence of that conversation was his including a recommendation for a vaccine center. So getting some of that to happen as a result of his specific interest in one problem is really quite powerful.
the blood and you had fewer and fewer people infected with high titres of virus— that transmission rates would decline. They are not as high as they were a few years ago, but there has been no further decrease in infection rates. And there has also been a shift in the distribution of the population that is being infected—this is not news today, but over the course of the past several years it has shifted to a higher proportion of women, a higher proportion of minorities. One of the few bright spots in today's news was that drug addicts in New York City are seeing a decline in the rate of HIV infection, and that is probably a reflection of a pretty vigorous needleexchange program. It is one of those marks that bothers me because at one time we strongly encouraged the Administration to endorse a needle exchange program. That didn't happen. C&EN: When will the vaccine center be up and running? Varmus: We had a dedication of the building—named for Dale and Betty Bumpers, a former senator (D-Ark.) and his wife—a couple of months ago. The building is going to be open next year. The whole development is a little bit unusual for us in that we have a new research center within the National Cancer Institute and the National Institute of Allergy & Infectious Diseases. It has an unusual reporting structure with oversight not just by the two institutes but by me and by David Baltimore's AIDS vaccine advisory committee. So it is a very interesting organization, and it represents the kind of thing that the intramural program can do effectively—get something set up that's very difficult to do on the outside.
C&EN: So the main goal is to develop an AIDS vaccine? Varmus: Well, it's a vaccine center, and certainly the first target will be AIDS. But that building will, I hope, last beyond the C&EN: You and your agency have C&EN: The front page of today's discovery of an effective AIDS vaccine. been very fortunate In terms of winning Washington Post included a disturb- There are other major vaccines to be budget increases. Other science agen- ing story that the incidence of new made, the most obvious of which are vaccies have not had that experience. AIDS infections, at least among some cines for malaria and tuberculosis. Varmus: It's probably because of the subsets of the U.S. population, seems kind of work we do. In the budget for to be on the increase again. C&EN: Are you concerned at all that the National Aeronautics & Space Ad- Varmus: The incidence of new AIDS in- your emphasis on increasing the NIH ministration, everything is a big project fections has been maintained at about budget has led to an imbalance in the and very expensive, and its budget will 40,000 per year for the past few years. total federal R&D portfolio? be evaluated case-by-case in a way that That hasn't changed much in the past Varmus: I am not concerned that NIH ours won't be. We have something like couple of years. It is a problem that we has done well. I am concerned that other 30,000 research project grants. It is just haven't been able to get it down. A lot of agencies have not done as well. I am unnot possible to review our appropriation us thought that as we got control of virus happy that the National Science Foundarequest at that level of detail. infections—got control of viral levels in tion, in particular, and some of the other 36
SEPTEMBER 20,1999 C&EN
and, given all the mechanisms for prolif thousands of journals in the life sciences. eration, we could easily be 75 institutes There are a few that have front-of-the-book and centers in the next 40 years. That stuff—the value-added stuff. Some people would not be good. It is already very diffi from Science and Nature have been very cult to manage NIH. One reason is be worried. But if they removed all of their cause the budget process is awkward. content, all of their scientific reports, peo There is a tremendously strong correla ple would still buy the magazine. tion between the age of an institute and the size of its budget. That already tells C&EN: Would you say that some of you that something is wrong. the criticism you have received is just What I proposed is a reorganization of the human reaction to change? NIH in which we would have basically six Varmus: Well, one of the elements that C&EN: You gave a talk recently on the large institutes—the National Cancer In I am quite concerned about is that mem structure of NIH, meaning the way thestitute, the National Brain Institute, and a bers of the rank andfilehave been quite National Institute of General Medical Sci supportive of my proposal. But there is agency is organized and managed. You proposed collapsing the structure andences—but it's not the current General no way for the rank andfileto make its Medical Sciences, it's basically all of inter feelings known. Traditionally, people combining some of the institutes. Could nal medicine rolled into one and the sup who are in the trenches speak through you elaborate on what you have in mind? Varmus: This was a bit of a game in a porting basic science. Then there would the leaders of their professional societ sense, but it's a serious game. I was be an institute for the study of environ ies. And many of the societies have been asked to speak at a symposium on the mental infectious diseases, an institute particularly nervous. And I can under next 40 years in genetics and the next that basically studies human develop stand their anxiety. 40 years in science policy. That's always ment, and an NIH Central in which the Some societies—some, not all—don't hard to do, but I had been struck by an director of NIH and a lot of programs that make much or anythingfromtheir jour article that appeared in the New York are currently in various centers and insti nals. But for those journal publishers that Times about one vote in the Constitu tutes are gathered together under his or do, this is a change in the dynamics. It's tional Congress on the ultimate organi her charge. It would include a clinical going to require that costs be shifted zation of the U.S. The claim was that, if center, the NIH review process, and spe from subscribers to authors. Which is one delegate from Massachusetts had cial funds for technology development fine with us. NIH is paying a lot for pub voted differently, we might now be 10 that affect everybody. lishing, whether we pay through subscrip independent nation states instead of 50 tions or through authors' fees and page federalized states. C&EN: Why have people reacted so chargesfromreprint costs. So we think it's I began thinking about NIH and its negatively to your E-biomed/PubMed going to balance out and probably end up evolution. The striking thing to me is how Central proposal, especially some of being cheaper and much more effective. But I feel that many leaders of the societ the proliferation of institutes and centers the major journal publishers? has continued over the years. NIH has Varmus: The leading journals—they will ies responded a little more heatedly than evolved in the past 50 years from what have very little to worry about. People are I would have expected, in part because was just NIH and the National Cancer In not going to stop subscribing to the major they were envisioning change occurring stitute to 24 or 25 institutes and centers journals. And they shouldn't. There are immediately. Of course, things are going science agencies have not fared quite as well, because I have tried to make the case that we need all of the sciences. When I go out on the stump about our budget, one of the themes I emphasize is harnessing the allied disciplines. By al lied disciplines, I mean math, physics, chemistry, computer science, engineer ing, and others. NIH can harness the al lied disciplines, but we cannot be the sole supporters of those disciplines.
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