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Interviews

Harold Varmus, President of the Memorial Sloan-Kettering Cancer Center and Nobel Prize Laureate in Medicine or Physiology, 1989.

"I am concerned about how we are investing in science"

Putting forward health as a global problem is not wishful thinking. The design of health policies that address illnesses and their prevention worldwide is not at all crazy. At least not for Harold Varmus, a pioneering scientist in cancer research and recipient of the Nobel Prize in Physiology or Medicine in 1989. He has also played a leading role in initiatives such as the Public Library of Science that enhance the positive side of globalization.

After serving as Director of the US National Institutes of Health (1993, 1999) he took over the Presidency of the prestigious Memorial Sloan-Kettering Cancer Center (MSKCC) in New York in 2000. We spoke with him during a recent visit he made to IRB Barcelona.

Autor: Xavier Pujol Gebellí - 6 November 2008

Can you give me one conclusive reason why health should be a global issue?

When dealing with global issues what first comes to mind is climate change or access to proper nutrition and water. Health is the same kind of issue in that it knows no borders. It cannot be addressed at the local level and can’t be dealt with at the level of the individual.

So global decisions should also be taken regarding health.

Yes, but they should be well thought out. It is true that much progress has been made, particularly in the Western world, but this has not been the case in developing countries. Although some of these countries are making efforts to promote science, I am not sure that we are going about it the right way.

What are we doing wrong then?

I am concerned about the investment policies we are making in science in developed countries; about how we deal with important global issues. We should reflect upon the resources we are using and how we use them.

Which means that we are not using the right approach. What would you propose instead?

I personally would like the US Administration to actively participate in finding solutions to these problems; in particular, we should address health as a global issue that affects all of us, just as we do for the environment or the economy.

What would be the first step?

We should review our investment policies in global health. We should pay more attention to the design and implementation of health policies, prevention programmes and development of therapies and drug programmes. This is the way we will be able to improve health systems and science policies in those countries that lack resources.

For the last few years, US policy makers have not seen the problem as such. Do you think things will change?

Along with many of my colleagues, I have openly criticised certain decisions made in the US regarding science, culture or health that affect my own country as well as the rest of the world. In any case, we have to make sure that investments are meaningful and that funds are reasonably distributed.

What do you mean by “reasonably”?

Though cancer is serious, it is not the only issue in health. There are other diseases and other research areas that need resources. We shouldn’t forget mental health or maternal health, which are both key issues in prevention programmes. We also need to continue to fund research on developing new vaccines. Some worldwide organisations, such as the Bill and Melinda Gates Foundation, are doing a great job in this direction. They are helping guide scientists to the most urgent issues in world health.

I assume you mean that current science policies and budgets should be reconsidered.

In part, yes. At the Gates Foundation, what they first did when setting up their Global Health Program was to define what were the real issues to tackle so that scientists and doctors could achieve the best results.

What were the conclusions they came up with?

That funds would only be assigned to a project if researchers from rich and poor countries worked together.

Did it work?

It’s still too early to know whether these projects have had good results, but I sincerely believe that we are on the right path. The first step has already been taken: multi-national teams have been set up to address issues requiring local knowledge and international resources. We are somehow facilitating communication and knowledge transfer through different points of view.

There is another change on the horizon regarding the publication of scientific findings...

If we want to do science globally, we need to ensure that everyone in the world has access to knowledge. It’s not to difficult for a good research team from New York or Barcelona to publish in a good science journal, but this is not the case for groups in many African, South American or Asian countries, where access to the most important content is generally restricted due to financial reasons. This is changing, though, thanks to the Internet. One important step forward is to ensure free access to information in developing countries.

How can this be done?

There are two ways to do it. One would be to set up digital public libraries like PubMed Central. The problem with this, though, is that access to articles published there is often delayed due to publishing policies. The solution is Open Access. We are now promoting a new initiative called PloS (Public Library of Science), and there are several other similar projects underway. Access to information is essential for competitiveness and problem solving.

Is this a move against the conventional publishing world?

Not at all, it is just a different way to handle publications. Nowadays publishing at the highest level involves editorial costs that hinder research carried out by scientists with limited resources. Even good groups with good results can be prevented from publishing - and not just in journals with high impact. It also happens in specialist journals with average standards.