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May 2017

SMU Commencement Weekend, Part 3 - Commencement Address

SMU was fortunate to have NIH Director Francis S. Collins as its 2017 Commencement Speaker. And if you only have 3 minutes to spend on this post, then use them watching this hilarious YouTube video of Dr. Collins's guitar serenade to the graduates at the end of his address. 

If you have more time, you can watch his entire Commencement speech below. (This was before the latest federal budget was known, with its proposed 20% cut to the NIH budget, so don't expect any allusion to that.) It was thoughtful of Dr. Collins to acknowledge Congressman Pete Sessions in the audience and his support for biomedical research. I loved his point about SMU as a place where ideas are freely debated and civil discourse is part of the fabric of the institution - so true! 

One thing I loved about the speech is that Collins (I'll drop the Dr. for the rest of this post) didn't take himself too seriously, and not just because he played the guitar at the end. He admitted, for instance, that he didn't recall what the Commencement speaker said at his own graduation from the University of Virginia in 1970 with a degree in chemistry. 

I enjoyed how he talked about his meandering path to his present situation: at first he thought he was going to be an academic, then he discovered biology and went to medical school (UNC), and in 1992 he was asked to lead the Human Genome Project. This was, he was quick to add, before people thought it would work. He was appointed NIH Director by President Obama in August 2009 and expected to resign under the new President, but his resignation letter was rejected. (It is customary for people who have been appointed by the previous president to prepare their resignation letter, since the new president usually wants to make fresh selections.) This all seems a bit dry when I write about it now, but Collins was a wonderful speaker so his account of how he got to where he is now after graduation was a lot more engaging than it reads. 

He had three main messages for the graduates: 

  1. Be prepared for dramatic changes, whatever field you're in. Embrace it, and embrace that other doors are going to close.
  2. Your path is not always going to be smooth. Are you prepared for that? Collins's darkest hour was twenty years ago, when it turned out that a talented graduate student in his lab had been fabricating data. This became a New York Times front page story that required retractions of several scientific papers. Collins also talked about the heartbreak of seeing kids afflicted with progeria (premature aging) die, such as Sam Berns. 
  3. Clarify your definition of success, making the difference between resume virtues and eulogy virtues. (He mentioned The Road to Character by David Brooks.) Discover your True North and don't forget to have some fun! This made a great transition for his moment at the guitar. ("Music has a way of ruining otherwise dignified experiences.")

This Commencement speech will be hard to beat. I can't wait to learn who will be the 2018 SMU Commencement speaker.


SMU Commencement Weekend, Part 2 - Panel Discussion

Francis-S-CollinsIn the symposium given at SMU in honor of NIH Director Francis S. Collins, our 2017 Commencement Speaker and honorary degree recipient, Dr. Collins discussed 10 exceptional opportunities in biomedical research that might come to fruition within ten years.

Before going over his top 10 list, he pointed out that N.I.H.'s mission is to both "seek fundamental knowledge about the nature and behavior of living systems" as well as "the application of that knowledge to enhance health, lengthen life, and reduce illness and disability, and remarked that Texas received over $1bn in FY16. He also discussed statistics that suggest N.I.H. money has been rather well spent: (a) cancer death rates are now falling more than 1% per year, while each 1% drop saves $500bn. (b) cardiovascular disease death rates have fallen more than 70% in the last 60 years, and (c) HIV therapies now enable people in their 20s to live to age 70+.

On to his list of 10 exceptional opportunities. In ten years, we might have:

  1. advanced our analysis of individual human cells, which will help understand many disorders like lupus and rheumatoid arthritis,
  2. developed tools to identify new brain cell types and circuits, to help diagnosis, treatment and prevention of autism,
  3. identified those at risk for Alzheimer's before signs appear. Dr. Collins showed brain cells of six members of a family in South America known to be at risk of hereditary Alzheimer's, 4 with the amyloid gene carriers and 2 without, the six members are in the 35-39 range and Alzheimer's in their family has tended to have onset when people reached their 40s, and those brain scans showing the amyloid build-up in the 4 people at risk were breathtaking - Dr. Collins also mentioned that a possible reason why Alzheimer's treatments may not have been successful so far is that such treatments may have targeted people whose disease was too far advanced, but there is real hope if we are able to take action before the onset of symptoms. This is critical because the amount of money required to take care of the growing Alzheimer's population by 2050 will be equivalent to two Department of Defense budgets if we don't do anything.
  4. developed effective treatment for spinal cord injuries.
  5. optimized and widely distributed an artificial pancreas for diabetes. This is actually not that far in the distance since the FDA approved in September 2016 the first hybrid closed-loop system to track changes in blood glucose levels and provide precise doses of insulin.
  6. generated new organs from induced pluripotent stem cells.
  7. created a universal influenza vaccine. The idea is to teach the immune system to attack the invariant stem of the virus (instead of the head, which varies from year to year), in order to provide immunity to all flu viruses. We are overdue for a worldwide flu pandemic, so a universal influenza vaccine would be critical in mitigating such a pandemic's consequences. 
  8. deployed genomics, neuroscience, structural biology to uncover new targets for treatment of pain. The U.S. are in the middle of an opioid overdose epidemic, and 80% of people who ODed got started with a legitimate prescription for pain treatment, and some of those then switched to heroin, which apparently is very cheap, when OxyContin or similar was no longer readily available. (The prescription for the pain medication may be for 30 days, but people might feel very lousy when they stop, so they try to continue a little while longer, and when they really can't get a prescription renewal, those who are addicted switch to heroin.) There is a critical need to develop non-addictive pain medicine.   
  9. accelerated immunotherapy and other advances through the Cancer Moonshot. Dr. Collins discussed the case of Emily Whitehead in PA, who had a type of childhood cancer for whom traditional treatments had not worked, and who was saved thanks to immunotherapy.  
  10. actualized the potential of precision medicine through the "All of Us" research program, which aims at enrolling 1m Americans for a long-term research study combining data science, genomics, Electronic Health Records, technologies and patient partnerships. You can learn more about it at joinallofus.org

Gene editing, which could have made the top 10 list, was discussed in the Q&A. 

Additional topics discussed in the Q&A were (I wish I could provide details on all of them, but this post is already long enough):

  • the WaPo op-ed by Eric Lander of the Broad Institute and Eric Schmidt of Google "America's "Miracle Machine" is in desperate need of a miracle"
  • Dr. Collins's meeting at the White House two weeks ago with senior WH officials and heads of industry and academia to discuss how to best foster a productive relationship between government agencies, corporations and universities regarding scientific research (following by a short meeting with the President afterward), and especially NIH's Accelerating Medicines Partnership, which was launched in February 2014 with the goal to "transform the current model for developing new diagnostics and treatments by jointly identifying and validating promising biological targets for therapeutics" in 3 disease areas: Alzheimer's disease, type 2 diabetes and autoimmune disorders (lupus and rheumatoid arthritis). Dr. Collins also mentioned Parkinson's as a current focus, and said that cancer might get added soon. 
  • the need for an interdisciplinary approach to many of those problems, and the potential of computational biology. 
  • the issue that over 60% of drugs now coming on the market first originated from academic research - why should N.I.H. fund this work if big pharma reaps the rewards? Dr. Collins talked about the National Center for Advancing Translational Science established in 2012 and the role of the Bayh-Dole Act in encouraging universities to file for patents, which also means that the N.I.H. holds no claims to those discoveries. 
  • drug pricing, which the N.I.H. has no role in.
  • the issue of drug-resistant bacteria, when a drug can take 12 years to be developed and a bacteria can take 2 years to become drug-resistant, the related need to limit the prescription of antibiotics, and the fact that biopharma can make a lot more money developing, say, cancer drugs.
  • Dr. Collins's book on "The Language of God" and his personal faith. He said he still gets emails almost every week, especially from young Christian students, who have been homeschooled and then are presented with the evidence for evolution in their first biology course in college and suddenly put their faith back in question. He said he wasn't a believer in college, only became at 27 in medical school, and insisted that science and faith aren't mutually exclusive.
  • diabetes. 80m people in the U.S. are pre-diabetic, but diet and exercise with a coach has been proved to lead to a 58% reduction in transition rates to the diabetic stage. There are data privacy issues because it is generally agreed that you should not have your genome used against you for jobs and health insurance. Interestingly, a bill about wellness programs currently under consideration could threaten that because some of those programs ask for DNA analysis and if you refuse, they're allowed to charge you a premium that is 30% higher than the premium if you had accepted.
  • the need to do healthcare more efficiently, since about 30% may be wasted now due to improper testing etc.
  • the future of healthcare, about which Dr. Collins mostly said (as a response to an audience question) that his crystal ball was rather cloudy, and that most people agree that kids who get sick should be able to get health care.       
  • The Q&A ended with the question about science funding, which was the topic of my previous post.

You can read SMU's release about N.I.H. Director Francis S. Collins being chosen as 2017 Commencement Speaker here. It is so exciting for SMU but also speaks volumes of its national reputation that we were able to attract such a high-caliber speaker to Dallas. I feel really blessed to have heard Dr. Collins give such an informative talk at the symposium and am looking forward to his Commencement speech tomorrow.  


SMU Commencement Weekend, Part 1 - Funding Scientific Research

Francis-S-CollinsNIH has some groundbreaking ideas to transform science in academia. Read more to learn why. First, the background: tomorrow is Commencement at SMU and NIH Director Francis S. Collins will deliver the Commencement address as well as receive a Honorary Doctor of Science. Three other outstanding individuals will also receive honorary degrees - astrophysicist Francis Halzen of UW-Madison, arts philanthropist Nancy Nasher and New Testament scholar E.P. Sanders (read more about them here). Yesterday and today at SMU saw several remarkable events featuring those awardees.

For this post, I want to focus on the last one, which was a panel discussion involving NIH Director Francis S. Collins, SMU Provost Steven Currall, SMU Professor Pia Vogel and UT Southwestern Medical Center President Daniel Podolsky. Dr. Collins made a presentation about science discoveries that he hopes will happen within 10 years, and then took part in the panel discussion, and finally took questions for the audience. The most interesting one was the last one, about the funding of academic research in science.

Dr. Collins cited a 2014 New York Times op-ed by Andy Harris, Young, Brilliant and Underfunded, that pointed out that most of the Nobel Prize winners and other notable scientists came up with their breakthrough ideas between the age of 35 and 39, "yet the median age of first-time recipients of R01 grants, the most common and sought-after form of N.I.H. funding is 42 while the median age of all recipients is 52. More people over 65 are funded with research grants than those under age 35." 

This was after a comment by Dr. Collins about the N.I.H. having gotten better at funding early-career researchers by putting them in their own, separate pool if they have never received N.I.H. funding before, but not better at funding mid-career researchers, who report getting "squeezed". The aging of science's principal academic investigators is also problematic for the long-term vigor of the field. 

This helps put his next remark in context: according to Dr Collins, recent data suggests the productivity of a N.I.H. principal investigator begins to drop after the third concurrent grant, and that if rules were put in place that reassign funding dollars from those 4th or more concurrent grants, N.I.H. would be able to make 900 extra grants to early- and mid-career researchers (I suppose those grant amounts would be smaller than the grants of the "big shots" but he did not discuss that). He made it clear that they would be for grant proposals that fell just short of funding under the present rules - grant proposals that deserved funding but could not be funded due to insufficient funds.

The other transformative concept Dr. Collins talked about was of "early-independence awards" to help young PhDs skip post-docs and get them "unleashed" earlier, so that they can be creative and make independent groundbreaking discoveries earlier. Not everybody needs a post-doc. What I found most staggering about it is that the fields of engineering and management, where you did not use to need a post-doc to get a faculty position, have slowly become so risk-averse (reluctant to hire just-graduated PhDs in case they don't manage to become independent) that they have aligned themselves more and more on science and now it is quite usual to do a post-doc before obtaining a faculty position, and now that science has led us into a three-stage academic model of PhD/post-doc/faculty position, it is moving away from that. So maybe engineering and management will return to their old ways too.

I think it is particularly welcome for science to develop ways to bypass postdocs because faculty members in science often have lower pay than their colleagues in management or engineering, in addition to often having longer time-to-completion in the PhD program, so they can't easily make up for their lost wages once they are on the faculty. Some even take 1 or 2 years before they apply to PhD programs to work as lab techs (when they plan to go into experimental fields). Others take 2 postdocs before they go on to faculty positions.

All in all we are looking at talented scientists who, in the current model, first become independent Assistant Professors around the age of 35, which is (1) really late to start giving some stability to scientists, and can help explain why many prefer careers outside academia, (2) the low end of the 35-39 age window for the breakthrough discoveries by Nobel Prize winners or equivalent discussed above. You can't really expect brand new Assistant Professors to make that level of discoveries within months of their first faculty position. And of course not everyone will end up a Nobel Prize winner or equivalent, but that's not a reason to needlessly discourage people from staying in academia. There is a case to be made that the thinkers most capable of transformative innovation aren't necessarily always the ones well-established research behemoths but may well be, sometimes, researchers at less well-established institutions. Their ideas deserve to be given a chance too.

My next post will summarize the rest of the panel discussion.


SMU Maguire Center Commemorative Coin

MaguireCoin I recently joined the Faculty Advisory Committee of the SMU Cary M. Maguire Center for Ethics and Public Responsibility, and was thrilled to receive a gorgeous commemorative coin for the 20th anniversary of the center (pictured left), on my very first meeting with the committee to boot. I also have an active research grant from the SMU Maguire Center, about which I hope to write more soon.

While ethical issues have become prevalent today, they were not nearly as important in 1997, and it is exciting to be part of an organization that saw the writing on the wall before anyone else did. We had an amazing conservation about topics for the next SMU Maguire conference, all related to ethics (obviously), and I can't wait to see which ones are selected to be part of the conference in a few months. The SMU Maguire Center is quite a unique place to belong to. 

Cary M. Maguire is a SMU trustee emeritus. You can find out more about him here.