The former director of the National Institutes of Health talks politics and science with Undark.

Five Questions for Harold Varmus

As an undergraduate at Amherst College, Harold E. Varmus wrote his thesis on Dickens and ran the student newspaper. But in the 55 years since then, he has pursued quite a different calling: cancer research. After winning a Nobel Prize for his findings on how viruses can cause cancer, he soon entered the turbulent realm where science meets politics.

Varmus has served as director of the National Institutes of Health under President Bill Clinton, head of Memorial Sloan Kettering Cancer Center, and, from 2010 to 2015, director of the National Cancer Institute under President Obama. He is currently a professor at Weill Cornell in New York and a senior associate at the New York Genome Center. He is the author of “The Art and Politics of Science” and an informal adviser to Hillary Clinton’s presidential campaign.

For this installment of the Undark Five, we asked him about the 2016 election, his experience as a political adviser, and the difficulty of helping politicians and the public understand the pace at which science moves. Questions and answers have been lightly edited for clarity.

Undark —  How would you rate the level of science discussion during this presidential cycle? Do you think voters care whether the candidates articulate positions on scientific matters?

HAROLD VARMUS — I’ve worked on lots of campaigns, dating back to the first Clinton-Gore campaign in 1992, and almost every campaign since then. Science and technology rarely rise to the level of discussion of other things that are obviously of greater importance to many more people: economics, jobs, foreign policy, and so forth. But if people who asked questions in the presidential debates raised some issues about science and technology, I think people would understand that the nation’s future is very closely tied to science and technology.

We now have candidates who differ dramatically in their willingness to support science, to take advantage of what science has to offer, and take different positions on controversial issues like climate change, evolution, and other things. I do think that there’s an opportunity to show very substantial differences in the approach that the candidates take to evidence-based positions and to examples of what science and technology can do.

In this campaign, as in others I’ve been involved with, science and technology have yet to have a major impact on the proceedings. Answers to questions sent by interested advocacy groups to the candidates tend to be fairly careful, but it’s not clear how influential they’ll be. They’re read by the science and technology community, and that community is not a trivial one. There are somewhere between three and five million people in the country who consider themselves to be scientists or technologists or in some way connected to scientific enterprise. They’re a big voting bloc.

UD —  Nearly half of the U.S. population does not accept the basic science of evolution, according to a recent Gallup Poll. A similar percentage believes humans activity is unrelated to global warming. A 2014 survey found that the average American can correctly answer just 6.5 out of 9 basic science questions — roughly a C-minus performance. And American views on genetically modified foods are wildly at odds with those of the vast majority of scientists. What are your views on the state of scientific literacy among the American public and its relevance to a functioning democracy?  

HV —  Talking about public scientific literacy always ends up being a misconstruction because the public is very heterogeneous. I think the overall level of scientific literacy is not as high in the U.S. as it is elsewhere, but we have many people who are enthusiastic fans of science. When we run science fairs in New York or Washington or other places, hundreds of thousands of people turn up; if you ask people whom they respect, scientists still get very high marks. So the conspiracy theorists and those who pooh-pooh scientific work on climate change or on medical research, I think, are a distinct minority.

Talking about scientific literacy is a very difficult thing. By the measure of some physicists, I’m sure I’m not viewed as particularly literate even though I know a little bit about black holes. So you have to decide what you mean by scientific literacy and how many people need to reach a certain level in order for the country to set appropriate policies and funding plans. Those are questions that I think are often not given enough attention.

UD —  You’ve spoken about depending on “champions” in Congress to back science, technology, and medicine. Has it gotten easier or harder to lobby for funding for that kind of research, and what do you do to try to convince politicians?

HV — It’s no harder to make the case. The case is still a very powerful one, and I have yet to meet someone in Congress who is going to say they don’t want to support biomedical support and the NIH. They all want to support it. But what limits the funding for the NIH, the reason the NIH’s budget has declined in constant dollars by about 25 percent over the last decade, is that we’re living through a period of economic stringency, and money for public goods has gone down. There’s a limitation on what people want to spend. If you’re a deficit hawk, you’re not going to be advocating for increased spending, even for NIH. It makes it hard to win. It’s not hard to get people to nod in assent and say, “I wish I could do more for you.” But success is the result of a combination of factors: effective case-making and an economic situation in which people feel that they can make significant allocation to the causes that are important, productive, and ready for expansion.

UD —  You’ve said that we’re finally reaping the benefits of decades of research on cancer and that investing in basic research has helped get us here. How do you explain, to politicians and the public, the pace at which science moves?

HV — I don’t think I would have said we’re “finally reaping the benefits.” But I would say that we are now seeing the dividends from a certain kind of science that was begun 40 years ago. On the other hand, we’ve been making significant progress against cancer for many, many years with chemotherapy and the understanding of the detrimental effects of tobacco and quite a lot of other things. So it’s not as though improvements in cancer prevention and treatment have not occurred before now. What I would say is that over the last 10 years we are reaping the benefits of an investment that was begun in the ’70s to understand cancer at the genetic level. While I don’t believe those benefits have been fully realized yet, we have come a long way. I see a focus on the development of targeted therapy, the diagnostic potential of genetic tests, and new advances in immunotherapy. The benefit of all those investments in science is a story that takes a long time to realize.

How do we teach people about this? It’s a long, hard, expensive process. It begins with schools, and it can be developed by the creation of documentary films about research. I think the filming that PBS had last year of Sid Mukherjee’s “The Emperor of All Maladies” had an educational effect on hundreds of thousands of people. I think efforts like that, and things on the web, can be incredibly useful.

Everybody gets sick, everybody gets old. When that happens, people go to the internet to try to understand more about disease. Intelligent webpages can make a difference in teaching folks about how we got to know what we know. Generally, what you’re actually looking for is the current state of knowledge, but I do think there’s an opportunity for scientists and people who care about science to expand a webpage’s information by explaining at least a little bit about the ways in which we came to know things: what kinds of questions were asked, what kind of basic science was done, who did the science, who paid for it.

A source of common frustration for people at the NIH is to realize that in general the public doesn’t understand that the money that goes into the NIH ends up supporting scientists whose work has widespread public benefit and that the advances that occur can frequently be traced back to discoveries that were made 10, 20, 30, 40 years earlier. That’s actually the kind of investment that needs to be continued. There is understandable pressure to do work that will lead to a better preventive or cure for disease in the next year or two, but that is, in general, an unrealistic aspiration. We need to maintain the investment in basic sciences as well as the sciences that are closer to clinical application.

UD —  Scientific American recently made an unprecedented political statement when it challenged Donald Trump over his attacks on science. If you had the chance to influence a voter considering Trump, what would you want them to know about the implications of his statements on issues like energy and climate change?

HV — I don’t really know what Donald Trump’s position is. I think that’s very hard to read. He’s said incredibly stupid things on a talk show about the NIH, claiming that it was in terrible shape. I think that he probably doesn’t know anything about the NIH, and I don’t expect him to have an informed opinion. I do think that it’s important that we have someone in the White House who understands what these agencies do and realizes the importance of what science produces.

It’s really difficult to say anything credible about Donald Trump’s positions about issues that are as complex as foreign policy, or science policy, or science funding. I don’t think he pays any attention to it.