Lasker Awards Luncheon

Harold Varmus
President and Chief Executive Officer
Memorial Sloan-Kettering Cancer Center

September 21, 2001
New York City

In Sunday's New York Times the economist Paul Krugman observed that last week's disaster was not just a tale of villainy; it also reflected what he called "something…amiss with our political philosophy: we are a nation that is unwilling to pay the price of public safety." He was referring specifically to our national neglect of airport safety procedures, leaving them in the hands of the private airlines and thus "relying on the private sector to do the public sector's job." But he also cited Laurie Garrett's recent book that recounts declining support for surveillance against infectious diseases---the naturally occurring kind, not just bioterrorism. Krugman wondered if our neglect of "global public health" has left us "as vulnerable to an attack by microbes as we were to an attack by terrorists." "One of the key lessons of last week's horror," he concluded, is "there are some things on which the government must spend money, and not all of them involve soldiers."

At least for the short run, terrorism has reawakened America's need for reliance on its government---for leadership and reassurance, for rescue efforts, for restoration of destroyed property, for reinitiation of commercial life---and inevitably for retaliation. But it remains to be seen whether these extraordinary events signal a reversal of the disturbing, lengthy trend that Krugman describes---a trend in which our citizens have shown a dwindling enthusiasm for the use of Federal powers to pay for, perform, or regulate many of the activities that are supported by central governments in many other parts of the world.

Nearly all of us in this room are involved in medical research, one of those few activities for which both our political leaders and the public have endorsed the Federal government's financial responsibility. The government's efforts, conducted largely through the National Institutes of Health, have been especially laudable, because they are designed not just to produce new methods to control disease, but also to foster basic discoveries about biological systems and to train new scientists who come from the United States and abroad. In these respects, our commitment to the NIH and to science generally represents perhaps the most visible way in which we as a nation finance what has come to be called a "global public good."

The Lasker Prize Luncheon has been an annual opportunity to celebrate this healthy relationship between the Federal government and medical science. Usually the winners have had sustained support from the NIH, and this is again true for at least two of this year's recipients. Usually several leaders of the NIH come to lunch, although the uncertainty of air travel has restricted the number this year. And usually a government leader speaks, although this year you have had to settle for a has-been.

Despite the traditional strengths of the relationship between our government and its scientists, there is the potential for tension and even conflict. Those who run governments and spend public money are understandably prone to seek justification of their investments in results that directly and quickly improve the lives of their citizens. For that reason, strong discipline is required for elected bodies to continue to fund basic research, with its sometimes distant benefits for health and the economy. The scientists who depend on Federal funds need equally strong discipline to avoid overpromising practical results that may not be forthcoming---and that may not, in any case, be appropriate goals for academic investigators. Furthermore, the government is run by politicians who are elected---and often want to be re-elected---at two, four, or six year intervals. These time lines are incompatible with the kind of science most of us do, because the timing of discoveries is difficult or impossible to predict, and many of our studies culminate in practical advances only after many years or, sometimes, decades.

These tensions between government and science were apparent in the many news stories that appeared nearly daily---until Sept. 11---on human embryonic stem cell research----an endeavor made possible by the scientists and discoveries that we celebrate today. Last month, a time that now seems very long ago, I was asked to speak here today about President Bush's new policy that now determines Federal funding of such research. This is no longer an appropriate time to parse the President's decision. But it is fair to make two observations about the decision and its impact in the context of the relationship between government and science.

First, the compromise that restricts Federal funding to work with cell lines made before August 9th may solve a political problem on a short time line (one or a few years) but it is incompatible with the realities of doing science on the longer time line that most of us must live with. I believe it is fair to assume that this aspect of the policy will eventually be changed.

Second, and more troubling, has been the excessive focus on practical, therapeutic aspects of the research. To a certain extent, this is a natural outcome of the understandable emphasis all of us have placed on the very real treatment possibilities in the ethical and political debates. But an unintended and unfortunate result has been a neglect of that part of the work that we generally do best----the open-ended efforts to discern principles of biology.

Human embryonic stem cells offer an unprecedented opportunity to study all aspects of human development---helped by new tools that have emerged from the human genome project. The results may, of course, include recipes for making therapeutically useful cells. But they are also likely to take us to unimagined realms of understanding and application. Only in this way will Federally funded scientists fulfill the potential for discovery made possible by the pioneering work we are honoring today.

What I am arguing for is an effort to keep government-supported research attentive to fundamental discovery, with the broadest possible consequences for the entire world. I believe that, even amidst current woes, our society needs to acknowledge, to maintain, and even to enhance its commitment to such "global public goods"---discoveries about the natural world, the training of scientists, and improvements in the public's health.

I would like to conclude with a few comments about public health---not just about the potential impact of basic research on the health of the American people, but also about the importance of large scale attacks on disease exemplified by Bill Foege's vaccination efforts or by the better monitoring of microbes advocated by Laurie Garrett. These activities too, like basic research, must operate on a long time-scale to achieve their benefits; they may therefore lack the political appeal of short-term attacks on military targets. But they are at least as necessary for creating a better and a safer world.

Near the end of the year, for instance, a World Health Organization Commission will issue a powerful report on economics and health. It will describe how a handful of medical conditions, all amendable to partial or complete control in advanced countries, undermine the health and economic condition of the world's poorer countries; how paltry a share of the world's financial resources is dedicated to improving health; and how relatively modest increments in support could help achieve the economic and political benefits of better health.

As we enter the difficult next phase of national recovery, let us remember Paul Krugman's conclusion: "There are some things on which the government"---all governments, I would say---"must spend money, and not all of them involve soldiers."

Thank you and good afternoon.