Thursday, October 4, 2012

Negotiating science in politics (Books - The Art and Politics of Science by Harold Varmus)

Before taking off for points east, I read The Art and Politics of Science a sciency memoir by Harold Varmus, whose Nobel Prize-winning work helped reveal the connection between viral oncogenes and cancer.  Dr. Varmus ran the National Institutes of Health (NIH) during the Clinton presidency and now heads Memorial Sloan-Kettering Cancer Center, one of the leading research and treatment facilities for cancer in the world.  It is his success in the combined realm of science and policy-making that made me most interested in reading this swift-moving, easy-going account of a singularly impressive career. Owing to my backlog of posts I will attempt to keep this brief.

The mechanisms Dr. Varmus uncovered contributed to our understanding of how mutations to genes after birth, that is the kind of mutation that results from exposure to radiation or a carcinogen, can lead to a cancer.
The responsible mutations consist of no more than a single change affecting one nucleotide in the DNA sequence, and almost always at a few characteristic sites in the gene, altering a specific portion of a ras protein.  The consequences of such a small change are nevertheless devastating: one altered nucleotide changes one amino acid in a protein, irreversibly producing hyperactive behavior by the protein, driving the cell into a cancerous state.
But Dr. Varmus was interested not in alarming us with the seeming simplicity of this cascade of events, but in how the information might be useful to doctor and patient.  His political involvement began with educating law makers and the general public in understanding genetics and molecular medicine so that they might be disposed to support research on cancers,the HIV virus, and their treatment. From this, he graduated to heading the NIH, a federally funded Amercian research institution with approximately 25 separate institutes, funded to the tune of approximately $10 billion, during the Clinton years.

What I appreciated most about Varmus's account of his time in Washington, was that he spent less time tooting his own horn and more time telling us how he dealt with the problems.  This allowed the reader insight into how the political process intersects with science.

I remember getting a call from Leon Panetta, then the White house chief of staff, telling me that I was expected to repudiate some of the panel's recommendations, in particular any that might permit the use of federal funds to create embryos for research purposes. I refused to reject the recommendations of my panel summarily.  I was not fired, as the tone of Panetta's call had threatened.  But on December 2, a few hours after the panel's report was approved by my advisory council and officially released, the White House issued an executive order, signed by the president, prohibiting the NIH from supporting any studies that entailed the creation of embryos for research.
The controversy over stem cell research raged during Varmus's tenure at NIH and makes for fascinating reading.  The chapters on science publishing and global science initiatives were equally informative on two topics on which I have read relatively little.  I greatly preferred Varmus's accounts of his political and leadership roles to his chapters on science.  Not only are there are fewer accounts by persons having served in such positions, but Varmus's writing about onco-genes is less elegant.  In negotiating the difficult balance of telling us too little to understand complicated mechanisms or overcomplicating his description so that non-scientists cannot follow it, I felt Varmus gave us too little.  This may be because I am a scientist and wanted more, or because, having just read Siddhartha Mukherjee majesterial The Emperor of all Maladies, I have experienced such an effective combination of the human story of cancer patients with a cogent treatment of the contemporary science of cancer.  It is perhaps unfair to compare Mukherjee and Varmus because Mukherjee devotes much more space to the science and does not bear the added burden of writing an autobiography. All in all The Art and Politics of Science works effectively as an informative and readable memoir of an influential scientist who is knowledgeable about and influential in a broad set of scientific and cultural arenas.

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