Scientific American

The Nobel Prize-winning biologist Harold Varmus is a master researcher and a canny politician. Daniel Kevles considers the Obama adviser's vision for restoring the dignity of public science. The Art and Politics of Science Harold Varmus WW Norton & Co Dh100 The presidency of George W Bush was, on the whole, an unhealthy time for public science in America. Funding was part of the problem: the Bush administration's devotion to tax cuts and penchant for expensive wars took away from federally-funded research and development, especially in areas not crudely linkable to national security. But what distressed scientists most was the regular dismissal of authoritative scientific evidence. Of course, every administration refracts scientific advice through a political lens, but the Bush administration raised the practice to unprecedented levels. At times it was nakedly partisan, subjecting potential appointees to political litmus tests. Far more disturbing, it persistently censored, distorted and manipulated policy-relevant scientific information and counsel, usually because it conflicted with its go-it-alone foreign policy or its fealty to the religious right and corporate supporters.

Examples are legion, and they exist at every level of decision-making and influence. For international observers, the most offensive instances were those in which disregard for objectivity poisoned foreign policy. Bush scrapped the international Anti-Ballistic Missile Treaty for the sole purpose of building an expensive national missile defence system, despite the long-standing prediction of scientists and engineers that it could not work. He repudiated American participation in the international effort to combat global warming, announcing in March 2001 that the United States would no longer abide by the 1997 Kyoto Protocol on the emission of greenhouse gases. The first President Bush had signed the agreement in Rio de Janeiro in 1992, but his son feared it would harm the carbon-spewing American economy. And though Bush eventually acknowledged that global warming was occurring, his administration cast systematic doubt on the broad scientific consensus that it is caused by human actions. The breaking of Kyoto infuriated the world's leaders: Bush was in effect asserting that the United States, which then emitted one-quarter of the world's greenhouse gases, had the right to pervert the atmosphere covering every other nation.

In February of 2004, the Union of Concerned Scientists issued a statement declaring that the Bush administration had, to a greater extent than any previous American presidency, "disregarded the principle that the contributions of science to public policy decisions must always be weighed from an objective and impartial perspective". When the President's science adviser, John Marburger, a Democrat and respected physicist, responded to this line of criticism by saying he knew of no "administration policies that are in conflict with science", he was written off as a mere apologist. Eventually, the statement criticising the administration was signed by some 8,000 scientists, including 20 Nobel laureates.

One of those 20 was Harold Varmus, who had served as director of the National Institute of Health (NIH) for most of the Clinton administration, and thereafter as director of the Memorial Sloan-Kettering Cancer Center in New York City, one of the world's leading institutions in its field. Given his past position, Varmus watched the Bush administration mangle science policy and hamstring research with perhaps even more dismay than most. He wrote his new memoir, The Art and Politics of Science, partly in the hope that the story of his experiences in science, policy and the intersection of the two would be of use to whoever would guide the nation after the 2008 presidential election. Now it certainly will: on December 20, 2008, Barack Obama announced the appointment of Varmus, who had advised him during the election campaign, as co-chair of his Council of Advisors on Science and Technology.

The Art and Politics of Science is an engaging read, fascinating as a memoir of Varmus's personal and scientific journeys, revealing in its account of his stewardship of the NIH. The book is like the man - honest and clear-eyed, thoughtful and outspoken, always good company, with more than a frequent touch of humour and self-deprecation. Varmus attributes much of his success in life and science to having "been dealt some very good cards". The first good cards came from being born into a comfortable, educated family on New York's Long Island. After college he enrolled in a PhD programme in English literature at Harvard, but he soon switched to medicine, lured by the excitement of studying the body. In 1968, at the end of his medical residency, he opted to spend two years doing research at the NIH, then an appealing haven from service in the Vietnam War, which Varmus "fervently opposed"; he and his fellow refugees from the conflict called themselves the "Yellow Berets". It was at the NIH that Varmus first developed his desire to understand the causes of cancer - in part because his mother had been diagnosed with the disease.

He drew another fortunate card from the deck when, in 1970, he joined the staff of the University of California San Francisco Medical School as a collaborator of Michael Bishop. The immediate goal of their first project was to determine how a microorganism called the Rous Sarcoma Virus provokes cancer in chickens. This involved the dauntingly difficult task of detecting whether, after a chicken was infected, the virus's small complement of genes was present anywhere among the thousand of chicken genes. Varmus and Bishop were aided by the work of colleagues at several institutions in the West Coast Tumor Virus Cooperative, which they helped form. By the mid-1970s, their findings led them to the speculation, confirmed within a few years, that viruses are not actually required for the genesis of cancer - that in many organisms, including human beings, the disease is caused by the perversion of normal genes into oncogenes, genes that enable cells to generate tumours.

This finding was revolutionary. At the time, cancer was treated exclusively with chemical poisons applied to the whole body (whole-body application is why chemotherapy usually makes people feel awful). But precise knowledge of what has gone haywire in a cancerous cell laid the groundwork for "rational" targeting of the disease. Even now, 20 years after Varmus and Bishop won the Nobel Prize for their discovery, blunderbuss chemotherapies remain the rule; the line between empirical breakthrough and widespread practical application is rarely straight or short. But Varmus expects, quite reasonably, that the future lies with therapies that inhibit specific oncogenes. One such therapy, Gleevec, is already available: it is taken as a pill, is highly efficacious in five different cancers, and causes only mild side effects.

Varmus's Nobel brought him into the world of science policy via advisory committees and the like; he enjoyed it, and jumped at the chance to head up the NIH when asked. During the Clinton years, the institute enjoyed strong support from Congress, which regularly increased its budget above the president's annual recommendation. Varmus was a popular, admired director. Unpretentious with staff and straightforward with politicos, he wore khakis, kept his collar open and made a point of eating often in the agency's cafeteria. An avid biker, he was well-known for regularly pedalling the 12 miles from his Washington home to the NIH campus in Maryland; in 1994, he was named Montgomery County Commuter of the Year.

Of course, managing a sprawling $11 billion agency involves more than being a nice guy on a bike, or even being a brilliant scientist. It means being a politician: deciding how a finite amount of resources should be allocated - then arguing with people who have different views on the matter. In this sense science is always political, always caught up in a broader discourse about what ought to be done. One of the tragedies of the Bush years is that "the politics of science" came so often to mean the distortion of scientific findings for political ends.

Varmus is intimately familiar with just how impoverished the public discourse on science presently is. So he is sure to make clear the baseline conditions he takes to be essential for optimal science policy-making: merit rather than partisanship in appointments, open-mindedness rather than rigid, religiously-motivated restrictions when defining options, and a commitment to relying only on objective conclusions (not distortions of same) when making science-related decisions. These are simple principles, unexceptional prescriptions against know-nothingism that only require articulation now because Bush violated them so often and so casually.

In addition to these basic precepts, Varmus puts forth several nuanced and compelling examples of how the thinking of scientists can influence basic policy decisions. For example, Varmus's NIH came under criticism from Congress for spending more on Aids than on heart disease, despite the fact that heart disease killed 20 times more Americans each year. Varmus defended the inequality of expenditures as perhaps only an authoritative scientist could. First, he noted that Aids, unlike heart disease, was an infectious, easily spreadable threat to public health in many parts of the world. Second, and perhaps less intuitively, he argued that the incidence and cost, both human and financial, of particular diseases are only "crude tools for deciding how to spend research dollars appropriately". It makes more sense, he explained, to place budgetary bets on research programs that might reveal basic biological mechanisms and the ways that these mechanisms fail. Mindful of how he and Bishop came to discover oncogenes, he notes here that far-flung, relatively slow-moving investigations of the biology of yeast, worms, flies and mice can yield as much practical knowledge of human biology and disease as studies of human cells. In the end, the budget was a political decision, but a deep understanding of the art of science helped make it a good one.

On March 9, at a White House press conference with Varmus and others on stage, Obama announced a Presidential Memorandum intended to restore "scientific integrity to government decision-making", and to ensure that his government appoints science advisers "based on their credentials and experience, not their politics or ideology". The President explained that "promoting science isn't just about providing resources - it is about protecting free and open inquiry... free from manipulation or coercion, and listening to what [scientists] tell us, even when it's inconvenient - especially when it's inconvenient."

So far, so good: Obama wants to listen to scientists instead of shutting them up or telling them what to say. This does not, of course, settle the question of what ought to be done next: that's politics. Varmus, expressing his own commitments on that front, wants to put global health high on Obama's agenda. He finds it deplorable that the United States gives less foreign aid (in terms of percentage of GDP) than any other of the 22 most developed countries in the world - and that only 12 per cent of that aid goes toward public health initiatives. He notes with admiration the efforts of philanthropies, most notably the Bill and Melinda Gates Foundation, to fill the gap, but remains convinced that the American government should do a great deal more, incorporating global health science into its broader foreign policy aims.

With an eye to Bush's Emergency Plan for Aids Relief (one of his administration's few scientific success stories), Varmus has already called for the allocation of $15 billion to the NIH by 2012 for research into diseases that afflict the Third World. He has also specifically instructed American scientists to build more cooperative networks with their counterparts around the globe. Perhaps most ambitiously, he advocates the creation of a Global Science Corps that would place scientists from advanced countries in laboratories in developing countries.

On May 5, Obama - perhaps responding to a high-ranking White House aide, perhaps to Varmus, perhaps to both - proposed that the United States undertake a broad, $63 billion, six-year programme of global health. "It is fair to say," he told a reporter late in March, "that most Americans believe that we are lucky people. Even though we're in the middle of a terrible downturn at the moment, we lead much better lives than somebody who is struggling in an African village, and we have an ethical responsibility to do something about that. It doesn't take a lot of our time and money to make a big difference." Neither a mastery of politics nor a Nobel Prize in biology is necessary to possess the moral conviction that helping people is right, but we should take heart from the fact that Harold Varmus has all three.

Daniel Kevles, a historian at Yale University, is currently completing a history of innovation and intellectual property protection.