Francis Collins announces his agenda

There's a report in this week's Nature of Francis Collin's announced agenda for the NIH ("Collins sets out his vision for the NIH", Elie Dolgin, Nature, published online August 18, 2009). Collins has defined five areas of 'special opportunity':

Collins, who headed the National Human Genome Research Institute in Bethesda from 1993 to 2008, made the case that investment in biomedical research creates jobs and offers quick economic returns. Looking ahead, he said that the agency should devote more money to "five areas of special opportunity". First, to applying high-throughput technologies in genomics and nanotechnology to discover the genetic bases of diseases including cancer, autism, diabetes and neurodegenerative disorders. Second, to developing diagnostics, preventative strategies and therapeutic tools through more public–private partnerships. Third, to reining in the costs of health care with comparative-effectiveness research and personalized medicine. Fourth, to expanding research into diseases affecting the developing world. Finally, to increasing budgets and investing in training and peer review to achieve a predictable funding trajectory for the research community.

So, this answers the question we posed here and here about how much emphasis Collins will give to genetics -- it's not a surprise that his first priority is genetics and technology, as his lenses are made of DNA. But, it also answers another question we posed about whether he will also emphasize health issues related to poverty, and apparently neglected diseases are on his agenda as well.

That's a good thing. Francis also tried to reassure those who had raised questions about his religious beliefs. Since he is a master at convincing Congress to give him more (and then more) money, and since he identifies a range of appropriate projects, it seems very unlikely that religion will be any sort of problem or issue with his leadership of NIH.

It's easier to predict now how skewed toward genetics his agenda will be. He is a firm believer in the molecular approach to disease not just that genetic mechanisms are involved in disease--which they surely are, in essentially all except trauma and lightning strikes, but also that natural variation in genotypes is a major factor in variation in individual disease occurrence.

It's this that we think is questionable, especially in regard to the common diseases that are mostly, and manifestly more affected by environments than by genotypes. It's clear that a lot of money will be spent, and we think wasted, on 'personalized genomic medicine' in relation to these disorders. Indeed, he has a book coming out next year on personalized medicine.

Meanwhile, many diseases, and small subsets of almost all diseases, truly are genetic in that the variation hugely increases risk that is only affected by lifestyle factors in minor ways. We think that the best way to invest in genetics is to mount an appropriately genetic assault on these. Hopefully he'll see that that is done.

But, he'll be an effective advocate for the NIH, and one has to wish him well, especially if he works to help implement universal health care.