Interviews

Health

Harold Varmus, Nobel Prize in Medicine 1989

"I worry about how we invest in science"

To defend health as a global problem is not an utopia. To design health policies that deal with illness and its prevention in global terms is not at all ridiculous. It is not, at least, for Harold Varmus, scientific pioneer in the research of oncology, which awarded him the Nobel Price for Medicine and Physiology in 1989, and leader of initiatives like the Public Library of Science that enhance the positive side of globalisation. After having worked as a Director of the American National Institutes of Health (1993, 1999), Varmus in 2000 took on the presidency of the prestigious Sloan-Kettering Cancer Centre (MSKCC) in New York.

Xavier Pujol Gebellí | 8 september 2009

Give me an irrefutable reason to give health a global dimension.
When we speak about global problems the first thing that comes to mind is climate change or access to decent food and water. The same happens with health, a problem which we see today that has no frontiers and that can not be solved only by local actions or by taking on an individual area.

"We should rather think about what resources we are using and how we use them"
Harold Varmus

Therefore, we also have to take global decisions with health.
Then again, it is true, we have advanced a lot, especially in our western world, but the same has not happened in developing countries. Even though some of them are developing their science, I am not at all sure that we are doing the right thing.

What are we doing wrong?
I worry about how we invest in science in developing countries, how we deal with the big problems of the planet. We should rather think about what resources we are using and how we use them.

That means that the problem is not correctly raised, what would you suggest?
Personally, I would like to see the administration of my country, the United States of America, actively participating in resolving these problems, in particularly if, as it happens with the environment or the economy, we deal with health as a global problem that affects us all.

What would be, in your opinion, the first step?
We have to revise the politics concerning investments in global health. One has to pay more attention to the definition and establishment of health policies, prevention plans and the development of therapies and pharmaceuticals. Thus it is possible to improve the science and health systems of those countries which right now lack sufficient means.

The last years do not seem to have been fortunate in your country in dealing with the problem from this point of view. Will things change?
Like many colleagues, I have been very critical with the decisions that have been taken in the United States with regards to science, culture or health; in my own country and at a global scale. In any case, one has to ensure that the investments make sense; one has to ensure that the money is distributed in a reasonable way.

We have to tackle health as a global problem that affects as allI remember you were especially critical with the Bush administration.
My opinion was shared with the majority of scientists. As medical scientist I worry about the health from a global point of view and I think that we could do a lot more to improve health conditions in the poor countries. A good way is to allow them to develop by themselves and facilitate the task as much as possible.

What would be reasonable?
Even though it is important, in health not everything is cancer. There are other illnesses and other areas that require resources. We would not talk about the health system if we lose sight of mental health or maternal health, both crucial in prevention; or if we forget to invest in new vaccines. Some international organizations, like the one from Bill and Melinda Gates, are doing a great job in this field. Through these we can guide scientists to the big problems of global health.

In a way you are saying that we have to rethink the organisation and budgets of science.
That is part of it. The first question that the Gates Foundation asked when they started their programme on global health was to define the real problems that need to be dealt with so that scientists and doctors can offer their best results.

And what was the conclusion?
To finance any project one has to meet a certain criteria: scientists of both rich and poor countries have to work together.

What is the initiative?
At the Gates Foundations a programme was created to address the big health global health issues. The objective was to define them and make them competent to the people to solve them. In a first phase they suggested 14 big themes which we had to increase up to 44 due to the avalanche of applications we received. The Gates Foundation invested in the same initiative close to 400 million dollars to support these projects. We built collaborations between scientists in poor and rich countries and we redefined essential concepts in global health.

Has it worked?
It is still early to say if the financed projects have had satisfactory results. But I sincerely believe that we are going in the right direction. The first step has already been taken: multinational teams have been put together to tackle problems that require local knowledge and international resources. In some way, we are facilitating the communication and exchange of knowledge from different experiences.

Another change that is looming on the horizon is the one related to the publication of scientific results…
If we want to do international science we will have to make sure that the whole world can have access to that knowledge. To publish in good journals is possible without great difficulties for a good team in New York or Barcelona. But that dos not happen in many countries in Africa, South-America or Asia, in which, globally, the access of contents of major impacts is limited by the costs. The Internet is making a huge change possible. One way to advance is to ensure free access to the information from developing countries.

How do we make that possible?
Access to information is fundamental in terms of competitiveness and problem solving. Our response is Open Access. The initiative we are currently driving is PloS (Public Library of Science).

Is this initiative a war against the classic editorial world?
No, it is a different method to confront publications. To publish at the highest level implies right now an editorial cost that hinders research by scientists with limited resources. Or they do not allow the access of good groups with good results; and not only in those journals with the highest impact. It happens far too often even with specific or medium standard ones.

Building new bridges

Harold Varmus (Long Island, 1939) spends his time on multiple tasks. On the one hand, he is president of the Memorial Sloan-Kettering Cancer Centre, the prestigious health centre of New York from where some of the most promising research is launched as well as new oncological treatments. On the other hand, he maintains an active lab in the same centre where he develops animal models for the study of lung cancer. His objective is to understand how a “gene activates the machinery to transform a healthy cell into a cancerous one and how from there it ends up becoming a tumour”. In the same way, he is looking to establish, “as fast as possible”, a connection between the lab and the patient. At a practical level, he points out, that what he is trying to establish is to “build new bridges with a more modern science”. “There is new knowledge that is helping us to develop new science in health”, insists Varmus.

But that is not all. Simultaneously, he supports programs of specific training in cancer research in collaboration with the Rockefeller University. “Scientists are getting older”, he says. “The average age at the NIH is 42 years; too much time is taken to reach stable positions to carry out acceptable research”. Like this it is difficult to produce “quality science”, he says. Varmus knows what he is talking about. During the time he was at the front of the NIH, with Bill Clinton as president of the United States, he managed to double the budgets for research in health and opened new and promising ways which later proved to be very effective. Today, he laments, “the budgets are declining”. “Science has new requirements that are not met correctly,” he states.

The situation could change with the arrival of Barack Obama to the Presidency of the United States. For the moment, he has agreed to join the presidential advisory committee to tackle one of the greatest challenges raised by the U.S. president, to create a universal health care system in his country. The objective he is trying to achieve is to maintain a visible connection between health and research policies and development, both essential elements to reach fruition.

His work is complimented by his dedication towards global projects. PloS is one of them. And his participation as adviser in foundations and research centres is another one. From there he tries to launch programs that join scientists in projects that deal with problems across borders. Once again, building new bridges.

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