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A Q&A with Francis Collins, director of NIH

Washington Post Live editor Mary Jordan talked to leading experts on how the United States can best advance medical innovation on September 13. Here are some highlights of the conversation .

Mary Jordan: 

In ten years, how will the annual check-up be different?

Francis Collins: 

In ten years and with this cost coming down, complete DNA sequencing should be at that point in the hundreds of dollars, maybe even less.  It will be very compelling, I think, to have that included as part of the medical record.  Your annual check-up will involve the usual questions about how you [are] managing your lifestyle decisions appropriately.  But they’ll be influenced by what we know about you based upon the hereditary material that mom and dad gave you, which may say you’re at higher risk than the average person for colon cancer.  Or you’re at lower risk for some of these conditions that we normally do a lot of screening for. That’ll be quite useful.

In addition, in that general check-up you’re having, I think there will be a lot more available to you in terms of tools that you can use to practice better wellness.  I’m a big advocate of the ways in which the use of mobile health applications is going to empower people to have a better shot at maintaining their own health. 

 

Mary Jordan: 

Tell us what you’re most excited about that’s coming out of your labs?

Francis Collins:  

What am I excited about – cancer.  Cancer is at an amazing juncture.  We have - because of this ability to read the letters of DNA - learned how to look at a cancer cell and tell you every single reason why that good cell went bad. 

We knew about cancer genes going back 30 years, but we only had a limited perspective on the complete menu.  Now, with this approach, we can see the whole thing.  There’s something about a comprehensive approach that really changes the way in which you approach a problem. 

We have actually been able, with hundreds of lung cancers and hundreds of ovarian cancers and hundreds of brain tumors to do complete genome projects.  We have now a very good snapshot of what exactly are the common ways that a cell in one of those places decides it’s going to grow when it shouldn’t.

Now, what does that do to help you?  Well, first of all, immediately, it tells you that a particular type of cancer is not just some monolithic condition.  They have different responses to therapy.  We didn’t know that before. It also gives you an idea for some of those individuals that the standard therapy you might give for that person’s cancer is a wrong thing to do. 

This new generation of targeted therapies for cancer is starting to look pretty exciting.  Every company that’s out there is building on that now and racing with each other to come up with this next generation of drugs which will be both more specific and effective and less toxic because these are not the carpet-bombing kinds of drugs.  These are the smart bombs. 

 

Mary Jordan:

Do you have enough money to do the research you want?

Francis Collins: 

No.

 

Mary Jordan: 

What do you need?

 

Francis Collins: 

Do we have enough money for any of the research we’re doing?  We’re not limited now by ideas.  We are not limited by talented scientists to pursue those ideas.  We’re not limited really by universities and their capacity to do research.  We are limited by resources. 

If you come to NIH today with your best and brightest idea and you’re a young scientist who’s trying to get your lab up and going, and you’re the person who’s going to break open some area of medical research that needs it - Alzheimer’s, diabetes, influenza, whatever - what’s your chance that grant is actually going to get funded? Seventeen percent. 

           

Mary Jordan: 

What worries you the most about when you think about America’s ability to continue advancing medical innovation? 

 

Francis Collins: 

What wakes me up is worrying about this latest generation of scientists.  They have put themselves into this exciting arena.  They have gone through years of training in college, in graduate school, in post-doctoral fellowships.  They are full of ideas inspired by what’s possible, remarkably capable to bring different disciplines together in a way that wouldn’t have happened.  They’re trying to get their research underway and they’re having a really tough time.  That wakes me up.

We come up with as many programs as we can think of to try to provide support specifically for that vulnerable group, but it’s not enough. They’re going to leave the country, go somewhere else, or pick another career.

That is a loss of unimaginable magnitude.  We are at risk in this country of having that happen on a scale that has not happened before.  Which really puts us in a terrible position as far as living up to the promise of the future that we can see as emerging.

           

Mary Jordan

Since I asked you what you’re most worried about, I’ll just close with asking you what you’re most hopeful about when it comes to America’s ability to innovate in medicine?

 

Francis Collins:

 This is going to be a glorious 50 years.  The next half century, we are going to answer questions that were unthinkable in just the recent past.  We will.  This is really what I dream of as a physician.  We will find the ways to prevent and treat and cure dozens, hundreds of diseases for which people are still waiting for hope for that to happen.  We can do that and we can do that together.  We can do that based on a really rigorous science.  We can do that with international partners.  We can do that by putting public and private together in new partnerships.  We can do that.

Click here to read more about and watch highlights from the conference.

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