Friday, July 17, 2009

Francis Collins and the NIH

Francis Collins, long-time director of the US National Human Genome Research Institute (part of our National Institutes of Health), is reported to be President Obama's choice to be the next NIH director. This is a curious choice and it is receiving comment from both Nature and Science this week (not to mention many blogs), and for good reasons.

First, on the surface it suggests a complete and total victory for the genetic view of life. That might have been fine for the Genome Institute, but seems much less so for NIH overall, because many if not most problems in both medicine and public health are not about genes or genetic variation (though they involve them at least indirectly) but are about environments, many kinds of therapies, prevention, and so on. One doesn't have to ignore the fact that genetics is certainly fundamental to life, and that molecular biology will become increasingly important, to know that (for example) most common diseases have little to do with genetic variation in any sensible way. Forcing things through a genetic conceptual lens will distort them, and root them in glamorous technology rather than concept or accountability for results.

As director of NHGRI, Dr Collins did a lot of things that can be praised and others that can be criticized. First and foremost among the former, perhaps, are that he nobly and successfully struggled to keep genome sequence and variation data in the public domain. But he also directly or indirectly intimidated other NIH agencies to get into the genome game, or even to contribute to NHGRI efforts. That did, and still does, coopt funds that could be used for other things instead. Partly, Francis rode a fashion, partly an explosion of genuinely new and important knowledge, and partly the Washington money game.

The other issue is Dr Collins' brand of Christian fundamentalism. He says he had a conversion experience, and believes in a 'personal' God and he's written a book about it. In the US context, that has implications for policy, not all of them good (and not all of them Constitutional, perhaps). He has done medical missionary work in Africa, as we understand it, but we don't know what kind of missionary work. If it was out in the sweaty hinterlands where people really need help, then he deserves and should get all the praise that is available for being consistent with the basic Christian principles that not all Christians follow (to say the least).

But a personal God intervenes in the world, and that is inconsistent with all the precepts of science. For example, one never expects experiments to be affected by God (or by prayer). Does he, or should we, pray for God to cure a loved one's disease? Science rests on the assumption that the world is a strictly material place to be understood in terms of its universal laws (like gravity, chemistry, etc.). And Dr. Collins clearly asserts that religions should basically not make scriptural claims about the world, because science will show that they are wrong. But what, then, is a personal God? These seem like incompatible views, which can be worrisome for someone in a position of science leadership in our culturally cloven society.

And what about evolution? What are his views of human origins, and the genetic relationships we bear with other species? Was that process mechanical, or God-directed? It makes a difference in how we interpret our own variation (not to mention racial variation), the differential impact of the 'curse' of disease, and the relevance of animal models. If humans are not 'just' genes, is that because God made us unique? If so, should we be licensed to torture animals in research? We do have to say that the NHGRI did not get involved in religious entanglements during Dr Collins' stewardship, but it is certainly fair to ask these things, as they have potential policy implications--especially if a fundamentalist chunk of the country will expect it.

Like grilling of a prospective Supreme Court justice, one would like to know how all our health needs will be addressed, not just one particular component of them. That will be of interest to those who are not just in genetics. Likewise, the religious aspect of Dr Collins' life is at least potentially relevant in our society, especially because genetics is inextricably and properly understood in the context of evolution; regardless of his view on evolution, religious literalists may expect him to use religion to filter research and policy decisions.

Supreme Court justices sometimes play the political role desired by those who appointed them, which is a shame since courts should be as objective as possible in the realities of human society. But sometimes they surprise. Dr Collins could go either way -- who can say? He could use his Christian religious beliefs to foster all sorts of health improvements for the needy here and abroad, rather than (as most genetics does) for the privileged. He could help international medical services (like Doctors Without Borders), a kind of US contribution to a medical Peace Corps. Or, he could stay close to his genetics worldview, narrowing the field directly or by bureaucrats being intimidated or chameleon-like in their struggle for cuts of the NIH pie.

In fact, there is no danger whatever that genetics research is going to be neglected; there are far too many commercial, academic, and bureaucratic careers that depend on it. We need to support basic genetics, but, for cost reasons, that should be done through NSF not NIH. But if anything is to be neglected it would be the work on the therapeutic approaches to hundreds of truly, seriously genetic diseases, and much less on the huge genomics studies aimed at genetic prediction or common diseases (like the targets of GWAS and biobanks); those are public-health scale approaches yet quart size Cokes and fries, not genes, are the major public health problems.

How Dr Collins will do will be interesting to see.

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