Washington Post- Conversations: NIH Director Francis S. Collins | Friends of Cancer Research

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Washington Post- Conversations: NIH Director Francis S. Collins

Last week, before the health-care bill passed the House, Francis S. Collins, director of the National Institutes of Health,

 met with The Washington Post's editorial board and a group of newsroom reporters and editors. Collins, 59, is a physician and scientist who helped guide the Human Genome Project to completio n. He has led the NIH since last summer and oversees its 27 institutions and centers, 18,000 employees and budget of $36 billion (including stimulus funds).

Collins is also known for his 2007 book, "The Language of God: A Scientist Presents Evidence for Belief." He responded to questions about his Christian faith, health-care reform and genetic testing. Here are excerpts from that interview.



-- Rachel Saslow

Q What are you glad to see in the health-care bill?

The most significant thing is comparative effectiveness research. We've been doing a lot of that for many years, although it wasn't necessarily called that. We've certainly been comparing treatment A with treatment B to see what works best. An example is the diabetes prevention program, which taught us that if you're tipping over into diabetes, you're better off with diet and exercise than you are with medication.

What do you think are missed opportunities?

It could be a long list. I suppose we all hoped to see more of an emphasis on understanding how incentives for providers play a role in the cost of health care. That seems like the big area where we could have seen a lot of potential cost savings, and perhaps we will yet.

After you got your genome analyzed, what lifestyle changes did you make?

Diabetes turned out to be high for me. My lifetime risk, by this test, is in the neighborhood of 30 percent. . . . I got this information nine months ago and realized I'm not that lean or athletic, so I finally got involved in taking care of myself. I work out three times a week, and I've lost 22 pounds since last summer. I'm glad. It makes me feel better.

Now you might say, "Collins, you should have done that anyway. Did it really take a DNA test to get you to pay attention to good health practices?" Well, maybe it shouldn't have, but in my little anecdote here, it did get my attention. It's a reminder that we are all flawed at the DNA level and have the risk of some disease lurking in the future, and if we can do something about it, maybe we should.

What does that tell us about the usefulness of genetic testing?

It's going to be extremely interesting to see how it changes the landscape for personalized medicine. And particularly when it comes to pharmacogenomics, by which I mean picking the right drug for the right person at the right dose for the right time.

How does the United States perform these days compared with other countries in terms of medical research and scientific advances?

I think we are still seen as right at the leading position, but not by much. Ten or 15 years ago, there was a big [gap] between us at the top and the next notch down. Not anymore. Europe has certainly come up quite strongly. The steepest curves are coming from China and India and Brazil, to some extent, who are increasing their investments year by year at a much steeper slope than we are. We've been effectively flat in our support of biomedical research for quite a while.

How much of your budget is shaped by how effective the cancer lobby or Alzheimer's lobby is, as opposed to science?

So far, we have been very fortunate that the earmarking tendencies that have struck other government agencies have not happened much at NIH. The Obama administration has made it clear that cancer and autism ought to be priorities for medical research, and we totally agree. There are remarkable scientific opportunities in both of those areas. But I've not been given a number by [the Office of Management and Budget] or the White House that says, "You will spend this amount of money on cancer and autism."

Have the people at the NIH adjusted to having a believer in their midst?

I think anybody who has worked with me previously at NIH over the last 17 years would tell you that's not something that has influenced my scientific decision-making, so I think we're okay.

Forty percent of scientists are in fact believers, so it's not like I'm this complete wacko. It's just one of those things that's generally not talked about, and I guess I have disturbed some of those that don't share that belief by talking about it. The stage has been occupied mostly by the extreme voices, coming from really shrill atheist pronouncements that science makes God no longer relevant or, on the other hand, fundamentalists pounding the Bible and saying science must be wrong because it doesn't agree with their interpretation of Genesis.

Surely most people don't think either of those are right, but they haven't heard much about what are the alternatives that could, in an intellectually satisfying way, put these worldviews together. All I try to do is say there's a way to do that.