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Conversations: NIH Director Francis S. Collins

What does that tell us about the usefulness of genetic testing?

It's going to be extremely interesting to see how it changes the landscape for personalized medicine. And particularly when it comes to pharmacogenomics, by which I mean picking the right drug for the right person at the right dose for the right time.

How does the United States perform these days compared with other countries in terms of medical research and scientific advances?

I think we are still seen as right at the leading position, but not by much. Ten or 15 years ago, there was a big [gap] between us at the top and the next notch down. Not anymore. Europe has certainly come up quite strongly. The steepest curves are coming from China and India and Brazil, to some extent, who are increasing their investments year by year at a much steeper slope than we are. We've been effectively flat in our support of biomedical research for quite a while.

How much of your budget is shaped by how effective the cancer lobby or Alzheimer's lobby is, as opposed to science?

So far, we have been very fortunate that the earmarking tendencies that have struck other government agencies have not happened much at NIH. The Obama administration has made it clear that cancer and autism ought to be priorities for medical research, and we totally agree. There are remarkable scientific opportunities in both of those areas. But I've not been given a number by [the Office of Management and Budget] or the White House that says, "You will spend this amount of money on cancer and autism."

Have the people at the NIH adjusted to having a believer in their midst?

I think anybody who has worked with me previously at NIH over the last 17 years would tell you that's not something that has influenced my scientific decision-making, so I think we're okay.

Forty percent of scientists are in fact believers, so it's not like I'm this complete wacko. It's just one of those things that's generally not talked about, and I guess I have disturbed some of those that don't share that belief by talking about it. The stage has been occupied mostly by the extreme voices, coming from really shrill atheist pronouncements that science makes God no longer relevant or, on the other hand, fundamentalists pounding the Bible and saying science must be wrong because it doesn't agree with their interpretation of Genesis.

Surely most people don't think either of those are right, but they haven't heard much about what are the alternatives that could, in an intellectually satisfying way, put these worldviews together. All I try to do is say there's a way to do that.

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