by Jocelyn Kaiser, Harold Varmus, the new but familiar leader of the National Cancer Institute, spent part of his first day yesterday

describing some of the ideas “percolating through my cerebrum” before an auditorium full of NCI staffers. Varmus said he plans to review all NCI programs, address “dysfunction,” and come up with a list of big questions that block progress against cancer.

Varmus, a Nobel Prize winner who directed the entire National Institutes of Health from 1993 to 1999, said he was carried back by a “profound affection for NIH,” where he began his career as a research trainee in 1968, and a desire to satisfy his “old envy” of institute directors who control budgets and “run the show” at NIH. Also, “I need a job” after stepping down as director of Memorial Sloan-KetteringCancerCenter in New York City, he said.

The nation’s cancer leader then laid out some principles. “Everything that we do and everything that we say will be based on evidence,” he said, an apparent reference to charges that in the past politics trumped science at NCI. He said he will support big-team science, but added that the “individual scientist … is an essential precept to remain faithful to.” Varmus, a leader of the open-access journal movement, said he will be “strenuous in my insistence” about ensuring access to data, research materials, and publications.

As for specifics, he will begin by overhauling NCI’s cooperative clinical trials system, making greater use of NIH’s clinical center, and working on ways to speed cancer drug approvals. Varmus expects to look at all programs in NCI “for problems that need attention” and will call on “external folks” to help improve them.

Reflecting on progress in cancer research, Varmus said that despite a few dramatic successes, “we must now honestly confront” a “paradox” frequently discussed in the press: “we have not succeeded in controlling cancer as a human disease.” He says some reasons are “obvious,” such as the need to teach community oncologists to test their patients’ tumors for mutations that studies have shown to be vulnerable to a particular drug. But he also wants to probe key unknowns, such as the link between obesity and cancer. Over the next year, Varmus wants to hold a series of meetings with experts to come up with “a defined list of provocative, answerable questions.”

Turning to practical matters, Varmus cautioned that the budget climate has changed since the “good times” when he was NIH director. “Don’t expect me to produce budget magic. Things will probably be tough for a while,” he said. He has already hired as his deputy director Douglas Lowy, who studies oncogenic viruses in the NIH intramural program. (Anna Barker, who was a deputy director under previous NCI Director John Niederhuber, leaves the agency in August.) Varmus also called for “informality,” saying he prefers to be addressed as Harold. And the former English student mentioned one of his pet peeves, imploring his staff to “never use ‘impact’ as a verb.”