printable versionHarold Varmus offers advice to next director of NIH
Harold Varmus
Harold Varmus, MD, co-chair of President Obama's Council of Advisors on Science and Technology, recently published a memoir, The Art and Politics of Science. After winning the 1989 Nobel Prize in Physiology or Medicine, Varmus served as director of the National Institutes of Health in the Clinton administration. He recently spoke with Paul Costello, executive director of the medical school's communications office, for a podcast in the "1:2:1" interview series, available at http://med.stanford.edu/121/. What follows was adapted from that conversation.
1. How would you advise the next NIH director to go about setting priorities?
Varmus: This was probably the most perplexing part of the job, and I think one has to do a number of things to make this work. One is to be able to articulate to a large number of disease advocacy groups the way in which one tries to achieve balance. It is simply neither feasible nor desirable to try to draw some kind of straight line between burden of disease and research funding. Secondly, it's very important to recognize that the NIH cannot focus all of its energies—and should not focus all of its energies—on research that can be easily tagged as disease-specific. Indeed, the importance of fundamental research, of technology development and of the study of disease that presents unusual opportunities is important, because it frequently produces results that inform approaches to other disorders.
2. How can the agency guard against the boom-and-bust funding cycles that it's seen over the past decade?
Varmus: Well, it hasn't done that very well. At the moment, of course, we're struggling with a very difficult situation; namely that we all know, from what economists have taught us, that every part of our society should be spending more money. The NIH has been lucky, in one sense, in receiving a very large allocation of funds under the American Recovery and Reimbursement Act—$10.4 billion above its usual budget—to be spent over the next two years. But getting a large bolus of money is basically getting a steep increase without any promise of having that level of funding sustained. Science is not something you can buy and do in a one- or two-year period. It requires a longer-term investment.
Our challenge is to figure out how to spend this money in a way that benefits the public, benefits science, provides an economic stimulus and builds resources that will make science better in the future, even if there isn't the kind of increase in the budget that would allow these levels of spending to be sustainable.
This is not easy. I think one of the things we can do is try to explain to people in the administration, and to Congress, what the impact of sudden spurts of funding might be, and try to work with those folks to ensure that we spend the money in the most reasonable possible way without incurring the sharp decline in grant-applicant success rates that is currently being predicted for 2011.
3. You wrote in your book about the size of the NIH. Is it too large?
Varmus: It's not the size that disturbed me. It's the way in which it's organized. So the size of the NIH—that is, the people required to run it, the amount of dollars that's appropriated to it—that's all fine. What concerns me is that it has been built up as a very variable set of independently authorized and independently financed set of institutes and centers. And it creates a managerial problem for anybody trying to run the NIH.
If any of us were going to start the NIH again, we'd build something that had maybe five or six units. A scientific management review board is about to begin discussing how the NIH should be organized. There are advantages to this fragmentation: namely, the strong advocacy for the different institutes, which definitely has had a role in increasing the NIH budget. But I do think that a more sensible way to organize the NIH could be envisioned, and hopefully will be achieved with time.
4. One of the things that I didn't read about in the book was the Clinton health-care reform package. What should be the NIH's role in reform?
Varmus: Well, I didn't write about it because I wasn't involved. That was one of the failings: that a rather narrow sector was called upon in the initial discussions. The Clintons certainly learned from that experience, and would not do it the same way now. I fully expect that the President's Council on Science and Technology will take an interest in this question, because health-care reform is such an integral part of what President Obama views as the future of the country.
5. What do you tell students who are trying to carve out a career in science?
Varmus: There's no doubt that what we have is a competitive system. You do have to explain to people, honestly, that the system can be rough on those who don't live up to their promise. Nevertheless, there is enormously exciting stuff to be doing in science. The experience of being in a lab is so different from the classroom experience, everybody should have a go at it. Everybody who feels they have some talent in science and some inclination toward it should have a chance to have that experience.