NCI Director Reflects on His First Year in Office—and Outlines “Shared Ambitions” for the Years Ahead
Marking "one year, 15 days, and zero hours since I was sworn in as director of the NCI," Dr. Harold Varmus took to the podium of Lipsett Amphitheater July 27, 2011 for a town hall meeting and an "opportunity for me to take stock."
Speaking to Institute leaders, scientists, and numerous other staff members, Varmus noted recent interviews that have appeared in Nature, Science, and The Cancer Letter, in which he has been asked specific questions about his leadership of NCI. "Today," he said, "I'm going to interview myself, and I'm going to ask only two questions… What have we accomplished in the last year? And what are my hopes and objectives for accomplishing things in the next few years?"
Varmus spoke about five accomplishments, which he termed "team efforts or efforts by others at the NCI… in whom I take personal pride."
The first accomplishment of note, Varmus said, is about people—appointments to key positions. He noted three senior deputies: Dr. Douglas Lowy; Dr. James Doroshow, who recently became deputy director for clinical and translational research; and John Czajkowski, NCI Deputy Director for Management. In addition, he recognized two key advisors—Ed Harlow, who is on leave from Harvard, and Rick Borchelt, who works on media relations and communications activities—along with Dr. Barbara Wold from CalTech, who will temporarily head the new Center for Cancer Genomics; Dr. Ted Trimble, from the Division of Cancer Diagnostics and Treatment (DCTD), the acting director of the new Center for Global Health; Dr. Joseph Tomaszewski and Dr. Jeffrey Abrams, who are managing the operations of DCTD; and Dr. David Heimbrook, who was recently appointed chief executive officer of SAIC-Frederick, which operates a Federally Funded Research and Development Center in Maryland, on NCI's behalf. Finally, Varmus announced his intention to name Dr. Barnett "Barry" Kramer, who until recently headed the Office of Disease Prevention for NIH, as the director of NCI's Division of Cancer Prevention.
The next accomplishment Varmus noted is familiar to all who work for NCI: coping with a reduced budget. The NCI, he said, has worked well—internally and externally—to "maintain its functionality and to keep up the numbers of new grants" at a time when all components of the NCI have had to take "haircuts": reductions of between 1 percent and 5 percent in their budgets for the year.
Third on the list of five accomplishments was the enhanced use of tools for the oversight of programs, particularly external experts who may validate existing programs or suggest improvements. In particular, Varmus spoke of the evaluation by the Institute of Medicine of the clinical trials system, which has resulted in a reorganization of NCI's Cooperative Groups.
The fourth accomplishment Varmus highlighted was management of the unexpected, including the finding from the NCI-sponsored National Lung Screening Trial that low-dose helical scanning had reduced mortality from lung cancer by 20 percent among current and former heavy smokers.
The final item on the list of accomplishments was new activities. Varmus highlighted the goals of the new centers for global health and cancer genomics, and he reiterated his enthusiasm for NCI's so-called provocative questions initiative.
Provocative questions—and the hope that there will be some answers for the initial list of 20 or 25 questions—also topped Varmus' list of "shared ambitions" for NCI for the next several years. To take just a few examples, those questions include: How does obesity contribute to the incidence and mortality of cancer? Why do some commonly used drugs, like aspirin, appear to reduce the risk of cancer? How do some neurological diseases, such as Parkinson's disease, confer protection against cancer?
Next, Varmus addressed the need to incorporate molecular understandings of cancer into cancer control. "I'm not just talking about the obvious," he said. "I expect to see a pretty dramatic revolution in epidemiology… defining cancers by genetic subsets. I expect to see molecular tools brought more forcefully into the realm of cancer diagnosis… talking about ways to discriminate among early lesions and pre-cancerous lesions that may have malignant potential…"
Third on Varmus' list for the future was global health, with some new points of emphasis. "What I'd like to see happen over the next couple of years is an accepted integration of research on cancer into the menu of what constitutes a global health initiative for this country. This means not simply treating more people in poor countries for cancer. It means improving our traditional epidemiology by which we determine which cancers are most common in which countries, broadening the strategies for prevention in developing countries, identifying opportunities and the means for affordable treatment."
Fourth, Varmus said NCI needs to become better prepared to adapt to budget uncertainties. The Institute, he said, will need to think about grants, perhaps moving some toward shorter durations with less money, which "some would argue, encourage exploration and more innovative proposals…" Also, he said, some awards to NCI's most outstanding investigators—both new and more experienced—could be extended to seven years to 10 years, "to create a feeling of stability in the scientific community…" Also important, he emphasized, must be training programs, particularly to "improve the quality and number of people who come here to work in this magnificent Clinical Center."
The final shared ambition Varmus highlighted was about development of a greater sense of public trust, "that NCI is making progress against cancer, spending its funds wisely, is acting in the public interest from many points of view, with respect to the way in which we conduct science."
Varmus noted that Dec. 23 will mark the 40th anniversary of the signing of the National Cancer Act of 1971, which will prompt reflections on progress. "I'd like to think we could improve the perception of the culture of science, by emphasizing some of the things we do at the NCI that reflect a strong commitment to collaboration… by enforcing the idea that we are sharing our data and our resources and promoting open access to published work."
"My first plunge into cancer research occurred a year before the National Cancer Act, over 40 years ago," Varmus said in conclusion, "so I am able to bear witness… to the remarkable transformation of cancer research… We have a responsibility to make that change known to the public."