NIH director Dr. Francis Collins (r) welcomes Dr. Harold Varmus back as 14th director of NCI. Varmus was also the 14th NIH director.

“One of the attractions [of coming back] of course is working with old friends, in particular with the new director, Dr. Francis Collins,” Varmus said.

Collins said it is “a great personal pleasure” to welcome Varmus back to NIH. “What a remarkable day this is, and what a remarkable leader we have with us—in my view the best person on the planet to take the reins of the National Cancer Institute…this is going to be a glorious good time.”

Varmus cautioned at the outset that he was “not going to be setting out a full agenda here in any detail—please, no reading of the tea leaves.” But he did clarify why he chose this moment to come back after more than 10 years as president of Memorial Sloan-Kettering Cancer Center in New York.

“There is no better time,” said the 40-year veteran of cancer research, “to lead the nation’s cancer research efforts…we have a portrait emerging of all the cancers. We know the parts and how the parts interact…It’s these opportunities that create the most profound incentive to take the helm at this time.”

Varmus said he also wanted to satisfy “an old envy of institute and center directors, something I call ‘IC envy.’ When I was the director here in the nineties, I felt I had very little control over scientific program and I didn’t really have any money to spend…The ICs ran the show and they largely still run it.”

He also confessed to “a profound affection for the NIH,” calling the agency “the most glorious manifestation I know of what government and democracy are capable of doing.” Varmus remembered arriving at NIH in 1968 as a clinical associate. “I was brought into this incredible family of scientists and clinicians…My life was completely transformed.”

Varmus meets with attendees of the recent NCI Town Hall at an informal reception in Bldg. 45 On his left is his wife, Constance Casey.

A final reason for coming back? “I need a job,” he said. “I like to work and, hey, this looks like a great job.”

Varmus outlined three basic principles for his directorship, the first of which unifies the others: “Everything that we do and everything that we say will be based on evidence.” He also emphasized the importance of the individual intellect: “The great achievements in science that I’m aware of have almost all begun with an individual scientist, a lone explorer…having an unexpected idea.” Lastly, a sense of community is essential, including free and open dissemination of knowledge and generosity in sharing ideas, materials and methods. “This is especially true for work that is supported by the government, hence by taxpayers.”

Varmus called for the repair of a number of “things that are obviously dysfunctional in the system, not that it’s anybody’s fault” including NCI’s clinical trials system, which was the subject of a critical Institute of Medicine report earlier this year; an underutilized Clinical Research Center; and the cancer drug approval and regulation process.

Varmus said a working group of the National Cancer Advisory Board is drawing up suggestions for him, which will be included in a report due in September. “I think we’re mainly in sync,” he said. “I am looking at all NCI programs, and looking as I go for problems that need attention,” he continued, adding that he expects to enlist outside advisors in the process.

Varmus then described a paradox confronting the cancer research community: “Despite the extraordinary progress we’ve made in understanding the underlying defects in cancer cells…still it has to be acknowledged that we have not succeeded in controlling cancer as a human disease… Why have we not succeeded at the level that we aspire to?”

He said, “We need to think a little bit more clearly about how we frame the questions that we’re trying to answer.” For example, it is not understood why cancer cells die if scientists interfere with the expression of an oncogene. Better therapeutics depend on having that kind of knowledge.

There is also an association between obesity and certain cancers, he said, but the research questions that could define the link have “not been succinctly defined,” he said. He plans to stage a series of cross-disciplinary meetings to define “provocative, answerable questions” that will move the field forward.

Varmus addressed a packed Kirschstein Auditorium.

Varmus also wants to put cancer more prominently on the global health agenda, expand NCI’s drug development and make more extensive use of health information technology, especially as it relates to comparative effectiveness research. “We need to think about ways to get new knowledge more quickly into the practice of oncology,” he said.

Calling for more outside collaborations, he noted, “NCI is a very strong place, but it is clearly not self-sufficient…It’s not standing proud and alone, fighting its own wars.” He applauded NIH’s closer ties with the Food and Drug Administration and said that NCI must also partner more closely with the Centers for Disease Control and Prevention, non-governmental organizations, scientific societies, advocacy groups and industry.

“We cannot succeed in controlling cancer without strong connections with industry,” he said, noting that potential financial conflicts of interest pose a manageable problem.

He concluded with a candid assessment of his personal style: “Cancer is a serious matter,” he said, but seriousness doesn’t mean there is no room for humor or enjoyment. He prefers informality in personal relations, he said. “My first name is not Doctor—I like to be called Harold.”

Taboo for him are such things as unclear communication, clichés, euphemisms, using the word impact as a verb and employing abstractions such as “Bldg. 1 said…” or “The White House said…” He also recommended avoiding the phrase, “NIH is already doing it” or “This is the way we’ve always done it.

“Orders don’t have to be followed unless they’re right,” he continued. “It’s the government, not the military. Let’s question things rather than just follow them.”

Varmus warned that it is unlikely that budgets will double as they did under his NIH directorship. “Don’t expect me to produce budget magic,” he said. “Things will probably be tough for awhile…We can’t expect a budget turnaround overnight, but we can do a better job shepherding the considerable funds we already have.”

He named NCI vaccine expert Dr. Douglas Lowy as his “alter ego” and said he would soon name a number of other new deputies. “Joy Wiszneauckas will be the portal to my calendar…and the portal for ideas and responses is Harold.Varmus@ nih.gov.”

Varmus also thanked outgoing NCI director Dr. John Niederhuber, who has taken a laboratory position within the institute. “John has been very helpful during the transition and I’m very pleased to have a chance to thank him publicly for that.”

During a brief Q&A session before an informal reception, Varmus disclosed that, as he did during his NIH directorship, he will maintain a laboratory, although it must obey “what some call Varmus’s Rule”—it can’t be within his own institute.

“I will have a lab at NHGRI,” he said. “[NHGRI director Dr.] Eric Green has been very welcoming.” The lab in Bldg. 50 will be staffed by 4-5 postdocs who are expected to arrive by September.

“I can actually see the lab [on the fifth floor of Bldg. 50] from my new office [on the 11th floor of Bldg. 31],” he quipped. He expects to visit the lab several times a week.