BETHESDA, Maryland-When Richard D. Klausner, MD, became director of the National Cancer Institute in 1995, he took over an agency with low morale and internal conflicts that had angered some influential members of Congress and drawn critical assessments from several outside review panels.
BETHESDA, MarylandWhen Richard D. Klausner, MD, became director of the National Cancer Institute in 1995, he took over an agency with low morale and internal conflicts that had angered some influential members of Congress and drawn critical assessments from several outside review panels.
During his tenure, Dr. Klausner improved morale, mended relations with Capitol Hill, instituted a number of needed reforms, set new directions for NCI’s research agenda, and articulated a vision for conquering cancer that was easily understood by the cancer community and layman alike.
Shortly after announcing his resignation as NCI director to become president of the new Case Institute for Health, Science, and Technology, Dr. Klausner talked with Patrick Young, ONI’s Washington Bureau Chief. In last month’s issue, Dr. Klausner explained the research focus of the new Case Institute. In this interview, he discusses his experiences at NCI and the future of biomedical research, particularly the pathways of discovery in cancer.
Oncology News International: As you leave NCI, what gives you the most satisfaction as having been its director?
Dr. Klausner: There were many things, but mostly it was having both the opportunity and the platform to articulate, formulate, and stimulate, and the almost intangible feelingat least from the feedback I’ve gottenof energizing, motivating, and actually inspiring the cancer community. I feel I was part of a really amazing time. The science was fantastic. We thought about new things; we had the resources to initiate many of them. To have been part of a really energized science was incredible.
ONI: What do you regard as your greatest accomplishment as NCI director?
Dr. Klausner: I feel best about the spirit of the Institute and the articulation of a vision for cancer research. I think we got a chance as a community to talk about new ways of relating this institution to the research community and to the patient community, and how people work together in consortia to achieve cancer research.
ONI: Were there any failures?
Dr. Klausner: There were things I would have liked to have had happen that didn’t happen and which turned out to be very difficult to do, such as really expanding the participation in the research enterprise. We’re still having pretty much the same discussions and facing the same challenges that we talked about 6 years ago. I’m not sure that I view that as failure. I just see a lot of unfinished business.
ONI: How is NCI’s relationship with industry different now than 6 years ago?
Dr. Klausner: We have made a lot of progress, particularly with new industriesbiotechnology, of course, but also the information and communications industries. Again, this is all part of opening things up and linking science to products and to applications.
The Institute had good relations with the pharmaceutical industry and has expanded them with the attempts to make the clinical trials system open and to engage industry with academia and government in research platforms, access to new agents, and the development and application of new technologies. I think it has been quite productive.
ONI: In many ways, NCI sets the agenda for cancer research. As you leave, what do you see as the major priorities of cancer research in the next 5 years?
Dr. Klausner: From my own perspective, the major priorities of cancer research are those that we laid out in our bypass budget. One of the reasons we went to a 3-year conceptual budget, which is still too short, is to articulate major priorities and major opportunities in new areas. The course we have charted in the last 6 years is very much the course I see the cancer research community taking for the next 5 years.
ONI: What does that 5-year course include?
Dr. Klausner: Well, the interaction of genetics and the environment for one. Another extraordinary opportunity is the discovery and development of new imaging techniques that will predict both the clinical course of cancers and their response to interventions.
Others are developing molecular signatures of cells for new diagnostic and therapeutic approaches, and discovering, developing, and testing preventive and therapeutic agents that target molecular changes in cancer cells.
We could save tens of thousands of lives by gaining a better understanding of what causes tobacco use and addiction, and applying this knowledge to prevention and treatment. And we must never overlook the importance of improving how we communicate with people to effectively provide useful cancer information to everyone who needs it.
ONI: Sen. Dianne Feinstein recently said she expects a cure for cancer within her lifetime, yet with our aging population, it is projected that cancer will replace heart disease as the leading cause of US deaths. Is the potential for cancer control overstated? Are we up against a biological fact of life?
Dr. Klausner: The probability of getting cancer (and dying from it) is a biological fact of life, but there are also reasons to be optimistic about reducing that probability.
Some things are hard, as we have seen. We have sort of plateaued on the drop in smoking levels, for example. But we have cured certain cancers, and we continue to improve things incrementally and periodicallyand hopefully more rapidlyto find cures for additional cancers.
I have never been optimistic that we would find a cure for cancer. There are too many differences, too much complexity to this set of diseases we call cancer. I have always avoided predictions because the nature of what we do, the business of discovery, makes prediction fraught with difficulties.
ONI: These are rather unsettled times. Will Congress complete the 5-year effort to double the NIH and NCI budgets?
Dr. Klausner: As far as everything I see and hear, I think there is an intention to do that.
ONI: And when the dollars plateau and there is no longer the 13% to 15% increase each year, then what is going to happen to biomedical research?
Dr. Klausner: Well, of course, we will then be sitting on a much larger biomedical research enterprise. So we will be, by definition, more productive, although not necessarily more efficient.
It is difficult to predict what is going to happen, but there is no question it will be somewhat more challenging and harder, especially during the transition from growth to less growth, if that’s what we have.
It will be harder during that transition to initiate new things. There will have to be a lot of work to shore up the continuity of funding for ongoing research and to make sure that young people come into the system.
That is going to be a real challenge as we build large expectations, a larger research enterprise, and new buildings to fill at universities. It is going to be a challenge to maintain the momentum and harder to initiate new ideas at the level that we have been able to maintain these last several years.
ONI: We’ve increased training programs for cancer researchers. Do we risk having a glut of young cancer scientists unable to get jobs?
Dr. Klausner: The answer to that will, of course, depend on the level of funding.
ONI: Do the multitude of cancer advocacy groups help or hinder the NCI director?
Dr. Klausner: I have found them very helpful. What I have seen over these 6 years is a gradually improving relationship between the advocacy groups and the NCI. It was not uniform, but it kept getting better and better.
We found a terrific symbiosis, a working relationship that was very collaborative, especially for disease-specific planning and for a dialogue on the very complex interface between specific disease needs vs the general scientific needs that will affect all cancers.
ONI: What advice would you leave for the next NCI director?
Dr. Klausner: Do not be afraid to be open, to invite people in, to hear arguments, to continue to challenge the community and be challenged by it. It is important to have a deep and scientifically robust planning process that can be defended. And I would say, try to enjoy the job because there are tremendous things to be enjoyed, despite the pressures.