The NIH Director
Earthsky's "Clear Voices for Science" with Dr. Francis Collins (8 Minute Interview)
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Dr. Francis Collins: We are the National Institutes of Health, Our goal is to try to improve the health of the Nation, and of the world and to try to give more people the chance to live full lives without being interrupted by health challenges.
Deborah Byrd: You are listening to geneticist and physician Francis Collins, and this is EarthSky’s “Clear Voices for Science.” Dr. Collins is the current Director of the National Institutes of Health, also known as the NIH, which he said is the world’s leading supporter of biomedical research with an annual budget of $31 Billion.
Dr. Collins spoke with the EarthSky’s Jorge Salazar about the work of the NIH and about how this organization provides basic data relevant to health care reform in the United States.
Jorge Salazar: Dr. Collins, welcome to EarthSky's "Clear Voices for Science."
Dr. Francis Collins: It's great to be with you today.
Jorge Salazar: You took office in August of 2009, as Director of the National Institutes of Health. Tell us about this organization. What is its role in our American society, and what does it have to do with the health of people listening to this today?
Dr. Francis Collins: The National Institutes of Health is the largest supporter of biomedical research in the United States; in fact, it’s the largest supporter of such research in the world, with an annual budget of $31 billion. We support hundreds of thousands of scientific researchers at institutions all over the country that many of them, you would have heard of — Harvard, Stanford, University of Michigan on down that list. When you hear of a break through that’s happened in biomedical research in one of those institutions, it’s extremely likely that it was supported by grant funding from the NIH. We also support research overseas, and particularly in areas where things that we could not do within our own borders are still important to learn about. We support grants of that sort as well, and about 10 percent of the dollars in the NIH budget support what’s called Intramural Research, most of that here on this on this 300 acre Bethesda campus where I am speaking to you from.
Jorge Salazar: What is your vision for the NIH, and what do you want to accomplish with medical research in the next five years and beyond?
Dr. Francis Collins: The NIH has a dual mission; to support fundamental basic science to understand how life works at the most detailed molecular level, but then to also apply those discoveries about biology for medical benefits. We are the National Institutes of Health. Our goal is to try to improve the health of the Nation and of the world, and to try to give more people the chance to live full lives without being interrupted by health challenges. And that means we are interested in all diseases, all age groups, all of the things that might get in the way of a healthy life for each one of us. So, we work in areas of prevention as well as in areas of coming up with new ideas about treatment.
My own view of the next five years is that we have exceptional opportunities in five areas and those are going to be heavily emphasized in the coming years as far as setting priorities. The first of those is to apply some of the very new and very exciting high throughput technologies, to get a comprehensive understanding of how life works and how sometimes things go wrong and disease occurs. Many of those come from genomics, the study of the human genome, all of the DNA, and I had the privilege of leading the Human Genome Project previously. And the way in which these observations are empowering us to really understand hereditary contributions to all diseases is breathtaking, and we have a great opportunity now to do that with imaging, with nanotechnology, as other kinds of high throughput technologies with computational approaches to understanding biology. We can go from having snap shots about biology and medicine to having really comprehensive views that are going to change the landscape in dramatic ways for cancer, for autism, for diabetes, on down that list. So that’s one theme.
A second one is to take those basic discoveries and push forward as aggressively as possible towards the development of new treatments, and particularly to catalyze partnerships between academic investigators and the private sector, to lead to those new therapies that people are waiting for, for a long list of diseases that currently we may have something to offer, but it’s not what we really hope for.
A third area is the science of Health Care Reform. We are clearly, in the United States, attempting to re-engineer our Health Care system to result in better outcomes and lower costs, but we need data so that the decisions that are made are based on evidence. And NIH, by running clinical studies to look at what works and what doesn’t work, can inform that in really important ways.
A fourth area is global health. Global is not the opposite of Domestic. We are in a flat world now, it is in our own selfish best interest in the U.S. to understand global health, but it is also part of our altruistic national personality to try to reach out to those who are suffering from diseases like malaria and tuberculosis, and come up with better strategies.
And finally, we need to focus on the health of the biomedical research community, making this kind of science attractive to young people who are interested in what kind of career they might want to follow, making sure they have the support to be welcomed into this arena so the next generation can get on board with the phenomenal opportunities that lie in front of us. It’s a great time to go into science, and we want to be sure we are both recruiting the best and brightest, and then giving them the kind of training experiences and opportunities to do innovative research that they deserve.
Jorge Salazar: What role should the National Institutes of Health take in improving health care for everyone in the U.S.?
Dr. Francis Collins: So, NIH is a fundamental contributor to the future of health care in the U.S. by making discoveries about the causes of illness that allow us a better chance to prevent and treat disease, and once therapies have been designed, to try to figure out exactly how successful are they, and especially in circumstances where they appear to be more than one approach to a disease, which one works better for which person. That’s called comparative effectiveness research, and NIH has been doing this for many years, but are being asked now to do even more of it in order to inform the health care reform decision-making. Take diabetes, for instance; we know that people who have developed higher than normal blood glucose may be on the way towards full-blown diabetes, and there would be a great desire to try to intervene at that point and avoid that outcome. NIH ran a study a few years ago to look to see what’s the most effective way to do that. Would a medication successfully prevent that or would diet and exercise be sufficient? Interestingly, the diet and exercise approach turned out to work better than the medication, and reduced the likelihood of converting to full blown diabetes in those who engaged in that diet and exercise program, by more than 50 percent. A very exciting finding that can now be implemented across the board to prevent a disease that we all know is extremely common these days, and also causes a great deal of difficulty in terms of its consequences.
Jorge Salazar: You have spoken of the need for the U.S. to engage the rest of the world more in helping to control human diseases. Tell us more about your thoughts on that.
Dr. Francis Collins: We recently held a meeting to bring together all the groups that support research on global health to see where are the areas that are not well covered, where are the emerging areas of challenge. One of the conclusions is that the most rapidly growing cause of morbidity and mortality in the developing world is actually non-communicable diseases, things like diabetes and cancer. Obviously, infectious diseases are still a scourge for many parts of the world, things like malaria, things like tuberculosis and some of these other parasitic diseases that have gotten less attention. And we should be working very hard on those, but many of the diseases we think of as those of Western society are now being imported, sadly, into the rest of the world, and needs our help there as well.
With climate change, I think we should also realize that some of the conditions that we have considered as being relegated to certain parts of the world — like Dengue Fever, for instance — are becoming more common in areas that might ultimately affect people who live in the United States. Julio Frenk, who's now the School of Public Health Dean at Harvard, makes the point that global is not the opposite of domestic; that these are intertwined in ways, and they will be from now on because we live in a global society. And if we are interested in American health, we have to be interested in global health too.
Deborah Byrd: You have been listening to Dr. Francis Collins, Director of The National Institutes of Health, or NIH, based in Bethesda, Md. To subscribe to this and other free science interview podcasts, visit the subscribe page at www.earthsky.org. I am Deborah Byrd; EarthSky is a clear voice for science.
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