Dr. Francis Collins, director of the National Institutes of Health, in June became the latest holdover to join the Trump administration from the Obama administration. The appointment comes as President Trump proposes slashing $8 billion, or roughly 20 percent, from Collins' agency, which oversees grants for medical research.
Congress has in recent years shown bipartisan support for increasing funding for the agency, so the cuts are unlikely to take effect. Still, the proposal concerned many in the scientific and medical community, and in budget hearings, Collins has been asked by lawmakers how the cuts would affect his agency.
In an interview with the Washington Examiner, Collins spoke about the proposed cuts, about NIH's ethical approaches to research and about his Christian faith.
Washington Examiner: Is there anything that you can share about encouraging signs you have received from the Trump administration regarding your agency?Collins: I think it was a bit of a challenge in terms of the budget proposal for next fiscal year, and that is certainly something that caused alarm in the biomedical research community, both in the public and the private sector. Realizing that, the administration pulled together on May 8 a very important meeting at the White House, inviting to that meeting some leading academics as well as meeting scientist CEOs in the private sector, in biotech and pharma, as well as myself and the acting commissioner at the Food and Drug Administration. We had a two-hour meeting to go through why it is that biomedical research has been so successful in the United States, why we are the envy of the world in terms of the productivity of the enterprise and how important it is that that ecosystem, which depends on NIH-funded basic science and then applications to result in clinical products from the private sector, has been such a great successful mix of skills, talents, and outcomes. That was a discussion that was heavily attended by high-level administration figures, including the vice president, including Jared Kushner and Ivanka Trump, including Reed Cordish [assistant to the president for Intragovernmental and Technology Initiatives], who helped organize it. It had a pretty significant impact that seems to be continuing over the course of the last couple of months in terms of trying to assess, "What could this administration do to make sure that this American success story continues, and maybe even is enhanced?" I've been quite encouraged by that, and with the opportunities to have conversations with the president and other high-ranking White House officials about that. As the meeting broke up, we were invited to go to the Oval Office and meet with the president. And Ivanka subsequently tweeted about that and included a photo, which was also a pretty significant indication of the seriousness with which the Trump administration is taking this as a real opportunity.
Washington Examiner: It sounds as though the conversation is ongoing.
Collins: Yes. And an area where I have found myself very engaged with the president and with other administration leaders is on the opioid crisis. NIH is the supporter of basic research to try to identify better means of treatments for those who have addictions, but also to develop new, non-addictive pain medicines that could take the place of opioids. We are very much in that mix of efforts to try to turn around what is clearly a major public health crisis. I have had lots of support from the White House in also reaching out to industry to encourage real partnership between NIH and industry in this crucial space, and I think we are making real progress on that.
Washington Examiner: Medical research appears to be a bipartisan issue. What have you seen change politically in terms of the attitudes that come from Congress regarding funding for medical research?
Collins: Congress has identified this area as something of considerable importance, and this seems to be the case from both parties and from both chambers. I particularly want to mention Sen. Roy Blunt, R-Mo., who chairs the Senate subcommittee that oversees NIH, and Rep. Tom Cole, R-Okla., who chairs the health subcommittee. Both of them have been out to NIH, brought their colleagues with them, gotten engaged in very substantive conversations about what the research opportunities are, and have come to a conclusion that this is not a government cost; this is a government investment. They have gotten very well-schooled in the economic arguments as well as the medical ones. Those are pretty compelling too: Every dollar that NIH invests in research returns more than $2 in that first year into the local economy. If you want to consider the way in which this also stimulates economic activity in the private sector, it's probably more like an 8-to-1 return over the course of subsequent years. This is one of the best investments the government can make. Of course, we don't think of it usually as an economic benefit; we think of it as a medical benefit. That's why I'm excited about the state of medical research as a physician. This is a really remarkable moment in terms of making rapid progress, whether you're talking about cancer, diabetes, Alzheimer's disease, rare diseases or common diseases. We are at a particularly exciting moment, scientifically, in terms of the ability to make rapid progress. Those members of Congress, many of whom have been out to visit, have really learned about this issue and have become very well informed. If you sit in on one of our appropriations hearings, those are very substantive conversations that really get into that kind of level of detail about medical research opportunity that is quite gratifying. I can't say enough about how much I think the Congress has really done their homework here to appreciate why this is such an important issue for consideration at a time where everybody is worried about the budget.Washington Examiner: What would happen to your agency if the budget cuts were to take effect?
Collins: We have an amazingly broad portfolio. With a cut as was proposed in the president's budget for fiscal year 2018, of approximately 20 percent, there would be no way to protect any part of that from some kind of effect. We obviously are capable, and are doing our best every day to identify priorities and we would apply those as one needs to. But with that deep a cut, there would be no area that we could actually keep from sustaining a significant downturn. That would just slow down a lot of things that right now have the potential to go very quickly. It would certainly come in a way that would be difficult for the investigators out there, in all 50 states, who are the people we are counting on to make these discoveries. We have seen already, since 2003, a steady deterioration in the ability of individuals who send us their best ideas to get funded. That traditionally was about one out of three grants that we could fund, and more recently it's been 1 out of 5. Certainly, a very deep cut in a single year would drop that profoundly. When we give a grant, we give it for a period of about four years, because that's about the cycle time for science. But that means we've made a commitment to that grant for four years. So that we have a sudden downturn in the budget, we still have to pay the grants that we had given in the year before, so the impact in that year of the sudden downturn would be even more dramatic than you might think if this was done simply on a year-by-year basis.
Washington Examiner: During the Ebola crisis, you said that if it hadn't been for budget cuts to your agency that a vaccine would exist when it happened. What other discoveries are we close to, that could be pushed further away if the NIH budget were to be slashed?
Collins: Virtually everything that we support with a very deep cut would be affected. That would include an effort that Dr. [Anthony] Fauci [director of the NIH's National Institutes of Allergy and Infectious Diseases] is leading to try to develop an influenza vaccine that would work for all possible strains of the flu. This would be an incredible advance because it would [cover different strains and] get us away from the annual flu shot, which we all recognize doesn't always work as well as we'd like. It would also put us in a much better position to be prepared for this overdue, really serious influenza pandemic which could be lurking out there somewhere. Dr. Fauci just had a major gathering of all the experts a few days ago to look at the potential here for that, and there was a lot of sense that, scientifically, it's time to pull out all the stops and go for that universal influenza vaccine. But that's a big investment, and it would go more slowly if we were in a difficult budget circumstance.
Washington Examiner: You've said during the course of this conversation that you still believe the future is very bright for biomedical advancement. Can you share your thoughts about why you believe that's the case?Collins: It's because science, and life science, has just been advancing at a breathtaking pace. Some of that comes from the genome project and the ability to look at DNA and RNA quickly and at low cost. It has made so many things that were impossible now quite achievable, with all kinds of implications for our understanding of disease and how to treat it. Imaging has come along in a much more impressive way so that we have the kind of detail about human individuals as well as things as simple as cells or proteins that we could not previously have been able to previously imagine happening at this time. The whole stem cell evolution, where we learned how it's possible to take a skin biopsy from somebody, and basically turn those cells in the skin into some other kind of cell that person might need, for instance for a transplant. That's been absolutely breathtaking and has come along quite recently. We have new technologies that allow the possibility of editing DNA, which causes anxiety if you're talking about actually editing embryos, which I think at the present time we absolutely should not do. But you could do this in a fashion that would be ethically completely comfortable. For instance, editing the bone marrow cells of someone with sickle cell disease and curing their illness, which I think we might be able to do in the space of half a decade if we really apply all these techniques that have emerged. We have a whole revolution that has appeared in terms of bringing together cancer and immunology to understand how it is that you can activate the immune system to go after cancer that it ought to be able to recognize but often the cancer has managed to evade that surveillance. And we are learning how to turn the immune system back on. All these things [are] happening. I have this amazing job of being able to look out at this entire landscape of biomedical research and see ways in which we can speed up those discoveries that are coming up in all different directions, and make these advances relevant and beneficial to the public as quickly as possible.
Washington Examiner: Some House members a couple of months ago sent a letter to the president raising concerns about some comments you have made in the past about stem cell research and a form of cloning, calling Trump to appoint someone to oversee the NIH whose "principles align with your pro-life values." Do you have a response to some of the concerns raised in the letter?
Collins: There were some aspects of the letter that I think were not quite scientifically accurate in terms of the terms that were being utilized, such as "cloning." Certainly, I would welcome the chance, as someone who is certainly myself probably closer to the pro-life position than most of my scientific colleagues, to explain why I think NIH's current position on stem cells is actually about as ethical as one could imagine if you just look at the details of how it is that we're conducting it. But obviously, these are circumstances that tend to raise a lot of ethical emotions, and it's not always been easy to have those conversations in a way that gets into the level of detail about the science that would help the situation be more clear.
Washington Examiner: PETA came out this year supporting budget cuts to the NIH, saying that cutting testing on animals would achieve significant savings. What can you tell us about where animal testing stands?Collins: I think NIH is very focused on making sure that animal studies are done in the most ethical way possible, but also very convinced there are things we can learn from animal studies that will help people with terrible diseases that we otherwise can't quite learn. We are certainly moving a lot of the kind of research that we used to do in animals into other systems, particularly with human cells that can be grown in a laboratory in a fashion that causes no pain to anybody and doesn't result in such a great need for animals. But animals are still crucial to our understanding of how biology works. Anybody who has looked at the kind of oversight that applies to that I think will be impressed by how much attention goes toward any protocol that we fund that is going to involve animals for research. It has to have veterinarians and members of the public looking constantly at the conditions under which the animals are cared for and how we do everything possible to avoid the creation of unnecessary pain.
Washington Examiner: You've written about science and your Christian faith. How does it play a role in your work?
Collins: I find it very satisfying to have both a scientific and a spiritual worldview. I have never found those to be conflicting. I do think science is a wonderful way to learn about God's creation, but I also think that there are questions that I am fascinated by — and that most people are as well — that science is not well-equipped to answer, like: "Why are we all here anyway?" and "Is there a God?" and "What happens to us after we die?" Those are the questions that science can't really provide a whole lot of help for. And yet, as somebody who is a person of faith, those are some questions I want to spend time on as well. I have to say in terms of, does my Christian perspective influence the way in which I do science compared to other people? Maybe not so much. I think a lot of our ethical principles are the same, whether you're a Christian or someone who is an agnostic or atheist. We all tend to believe in such things as justice and equity and autonomy; those basic principles that have come out of bioethics. For me as a Christian, I also feel I have an opportunity to think about where those principles come from and why they do seem to be such a universal part of human existence as a signpost to a God who cares about what's right and what's wrong. Other people who don't feel the same way tend to share those same principles. I must say I think I have been very well-treated by the scientific community in terms of my being open about my Christian faith. There were a few anxieties about that when I first became NIH director. I haven't heard too much of them lately. It does give me an opportunity to maybe understand a little better when people write to the president about concerns about what's happening at NIH under my leadership. I can understand where that's coming from because I share some of that same community. I know what those senses are about whether we are treading into territory that really should be God's territory and not humans'.