is in getting those individuals back to the families of those families can claim death and have some income where they have none at all. >> i've been trying to to -- and we are near the end of that time. i suspect there are more questions and there are people at the microphones. my own e-mail is available easily on line and i'm sure all of my colleagues academic e-mails are available on line and i would be happy to take follow-up questions either at lunch or the e-mail subsequently and i suspect i speak for all of us and i'm sure i speak for all of us and saying thank you for listening to us for the last three and a half hours. [applause] ..

>> sunday night at 8 on cspan's q&a. >> over the next two hours we focus on the mission and role of the national institute of health. we will begin with the director. in a half hour, the head of the institute of allergies. and then director of the human gen genome were project and then the national institute of cancer and mental health.

>> the work over the years has been counted for break-through in aids and mental health. we will learn more about the work and people behind the scenes including dr. collins. we have live video from the nih. let's start with basic questions. what is the goal of nih? what is your objective? >> they are the biggest research of biomedical science in the world. we want to understand how life works at the detailed levels and apply that in terms of coming up with new insights to prevent and treat disease. >> we support tens of thousands of grants across the country

conducted by the world's most cutting-edge scientist in the united states who are working on cancer, aids and other drugs. we are on a roll but there is a bit of an issue with the cuts. >> let's learn about the history. your roots date back to the late 1700s. but you were formed in 1887 as part of the department of health and human services. what is your budget and how many people work for nih? >> the current budget is about $29 billion. the number of people that work on the campus is about 17,000. most of the work is done by grants we give to the institutions across the country and globally.

85% is spent there in the universities where you are hearing about medical breakthroughs. >> how long have you been with nih? >> i came here 20 years ago, steve. asked to come lead the human genome project. in 2003, they laid out all three letters of the dna instruction book with a profound implications. i got called to serve as the director four years ago. >> what makes a good researcher?

>> being curious, willing to take risk, seeking out innova innovative approaches, and a compelling desire to help people. that is why scientist do what they do. many working long hours for less income they could achieve in other sectors, but determined to make a difference for the world. >> can you talk about how you work with comparable agencies around the world? >> i will be in london next week and around the table is the ceo's of the agencies that account for 90% of public funding of research. we will share our experiences and developing new collaborations. >> how do you make sure there are no silos and you are trading information and research and there is an effort with counter

parts in europe and asia? >> science doesn't work in silos. disciplines that used to be disti disti disting distinguishable. they knocked down a lot of silos. we are determined to have no barriers between research. so people in the heart, lung and blood institute work with diabetes and cancer instituted. there has never win been a time of such promise, but things have never been this constrained either. we will lead and stand up for

open access and the data we generate ought to be accessible to others. >> the funning and impact of -- funding -- sukwequesteration an how has it impacted what you are doing or will be doing in the year ahead? >> this is the paradox where we are never seen a more exciting time for science, but it is as a difficult mome -- moment -- in terms of the science. the budget went flat and inflation at about 3% per year has been eating away at the purchasing power. and on march 27, we lost $1.5 billion that would have gone to research on a wide variety of areas the public cares about.

and that money disappeared. that means we are now down about 25% in purchasing power for research over what we had ten years ago. the combination of what has been happening and the sequester has serious consequences. if you are seeking to pursue a bold idea about cancer or diabetes, how do you get funded by the nih? write a grant, put your best ideas in there, we have a rigorous process to identify what the most promising ideas are in the pool and then we make the decision to fund the best grants. we have been able to fund about a third traditionally. because of the deteariation only

15% of them are getting funded. that is a let down for those s missing the cut. they are thinking about giving up or moving to another country. this is a serious problem and wakes me up at night. are we at risk of loosing this generation of scientist? if we lose these scientist they are not coming back. >> we are spending 2.5 hours at nih. we will get to calls as we learn more about the agencies. the budget is $31 billion and the research going on my medical professional at nih, but i want to talk about the peer research that takes place in all 50 states at colleges and universities. how does that work and how did you identify where you funnel the money? >> this is conducted by a

process of rigorous peer review. many of the grants are unsolicited and sent in my scientist who have a great idea and see nih as the way they will be able to pursue that. we give the best shot we can. but unfortunately, right now, 6 out of 7 will be turned away because we are in such a tough spot. we try to identify areas where science is really ripe for further exmroploring. we say we are interested in a vaccine for aids so if you have idea send the grants. that is how we steer the ship. but that depends on the scientist being bold and

innatui innovative. >> dr. collins is the director of nih. you called the disease of dna cancer. it is disease that you know that has impacted every american battling the disease or having a friend or loved one who is battling cancer. where are we in cancer research and what are the big hurdles next >> the it is one of the areas of greatest excitement and promise. you will hear from the director of the national cancer institute and noble prize winner and he can tell you more about this. but the technology is putting us in a position to read out what is driving a cancer in each individual. it is going to be different depending on which person is being analyzed. we know the pathways that are

involved in taking a good cell down the road to becoming malignant. drugs are being targeted that target the precise area. this is smart bombing. we are not faur far away from the point where individuals will have their tumor analyzed and chose from a menu of their th r therapy that is likely to work >> sam is joining us from mary land. go ahead. you are on the air. >> thank you so much first of all for coming on and agreeing to talk to us about the important of nih. i am an early career scientist

and researched my ph.d over the summer. want to talk about the concerns i have. i was watching many friends in my graduate program have to wrap up their programs and stop the experiments they were working on in order to move forward with the way grants were being lost from different labs. i have left the area of research and i am pursuing a career in science policy and working with research america. i was wondering if you have suggestions for us early career scientist. how should we move forward because it is going to remain tough even if we reach a deal at the house?

>> samantha, you are the voice i am more concerned out. i am glad you are mayoving to policy because we need people there. but i think there are people who would like to continue to do research and are finding it challenging to identify the path forward for them to do so. at nih we are doing everything we can and increasing the grants bridge the post doctor programs and making it possible for people filling out their first grant to only compete against each other. we have to recognize this is a

historic downturn, the case of nih support and the support is strong across parties and houses in the congress, that if we could just get past this very difficult time for the nation f fiscally we should be able to get on the path again. i am hopefully that will we will find next week an opportunity to begin to get past what has been a stalemate in decisions that gets us become on the footing where sequester can be pushed back and we can put this on stable footing. if you care about health, for yourself or families or friends, if you care about the economy, because what we do is a wonderful support of the economy with a remarkable return on investments in the grants going

out we get a two fold return in the first year. this case is so strong that i think ultimately it has to win. i would say to the young scie e scientist, hang in there, we mean get through this. >> nih has the world's largest hospital and more than 23,000 unique patients in 2013. i want to follow up on sam's point. you said the neuro science is the last frontier of medical research. how so? >> the human brain is the most complicated structure in the known universe. there are 86 billion neurons and each has a thousand connections. and the ability to be able to make sense out of that has seemed out of reach for most of

the time that we have been studying neuro science is biology. and the president announced the human brain initiative and work to figure out how the circuits in the brain work. that is an amazing frontier to think about. we can measure what happens with individual neurons and we can take images of the whole brain. but the space in between, which is where a lot of the real-time action is happening is out of our reach. i believe the brain initiative over the next ten years or so,

and this is a long term investment, we should be able to figure out he we process things and how cdo you lay do you knowa memory and how can you use that to prevent other diseases. we know of many brain illnesses, but the information about how the brain works isn't sufficient to take advantage of the interventions. >> we will focus more on cancer research. but this says does nih spend the same amount of prostate cancer as breast cancer research? >> i don't have my numbers, but that is public information. we do invest in prostate question.

we invest as you know in breast cancer research. both are important diseases and great strides are being made because of the ability to nail down at the dna level what is driving those cancers >> our guest is dr. collins. claud is joining us from arlington, virginia. >> good morning. i had a disease when i was a child that had never been diagnosed and in 1959 i went to nih and they kept me alive for the next 30 years with more test and interesting thing is i live closer to nih than many of the people that work there so a problem comes up and i was over there. and 30 years ago, i was taken care of. and in 1989 i had a heart transplant and here i am 54

years later and the fact i am alive is owed to nih and some of the doctors over there. >> wow, claud, that is an amazing story. i get to hear similar ones from people that come to the clinical center. this is the largest research hospital in the world. a few steps away from where i am. 240 beds but all of the patients are on research protocols. we consider this to be the house of hope because people come here when medical practice failed to find an answer for them and they come to see if research can offer something. amazing things have been done here and your story sounds like one of them. we have still many people who

are out there after many years of medical evaluation have not arrived at a diagnose about what afflicts them. we have a program called the undiagnosed disease program and you can have records and scans and test and dna sequencing. and a team of 30 experts pour over all the details and about half of the time they come up with an answer. and some of the time that leads to a dramatic intervention that makes a huge difference in their lives. we are on the cutting-edge and the hospital is an amazing place to see what goes on. all of the doctors that work there are dedicated and could make way more money somewhere else, but they believe this is their call to publix --

public -- service. >> how big is the campus? >> several acres and about 60-70 buildings and 17,000 people who work on the campus. it is like a small down. they have their own fire department, hospital and an amazing group of talented and dedicated people. 5,000 of them have doctor degrees in science. almost any area of science you are interested in there is somebody on the campus in the top ten nhled in the world. >> and do believe the brain has the ability to next problems at a cellular level?

>> the mind body connection is being revealed. take diabetes which is a disease my lab works on. we used to think it was it problem with the pancrease not making enough glucose. but the brain is a huge part of the circuit. and we learn about that and the hormonal influences is the closer we get to understanding the disease. we should never think of the brain being isolated in your head and not connected to what is going on. it is an eco system. >> jennifer is here on the independent line. >> good morning. i am a mother in florida. i have two children one of which

you were speaking of. i am the mum of a two-year-old who is undiagnosed and we have been all over the place and we have done full testing for genes and she is a child they don't understand. my question is where all of the issues that are happening with the funding one thing i get intimidated by is the lack of interest from public funding for rare diseases. is there additional funding put aside to protect the researches when there is less interest? >> what is your daughter's condition? >> she is blind, has progressive hearing lost and has lost 6%. she has a lot of issues. they have found she has recessive genes but they have not been able to locate exactly

what is going on with that. and they really are at a loss. we have been all over the place. she is in stanford research right now also. and harvard. but they have not got an incl c. >> you are telling a story that would pull at anybody's heart strings of what you most go through every day dealing with all of the challenges and not having a clear answer about what is happening and therefore no one is able to predict what the path may lead to going forward. this is just the thing we would like to do better with. i am glad you are connected with a lot of those wonderful institutions. in terms of the rare diseases, yes, we feel that is a strong m mandate. they don't get much commercial interest, but if you consider

all of the people with rare diseases and add them up, there is about 7,000 of them. 25 million people in the united states are affected with a rare disease. that is a lot of people. unfortunately, of those 7,000 rare diseases, their only affective treatments for about 500 of them. a mandate we feel is trying to fill the gap. we are learning about the cause, but then there is a valley of death knowing the cause and knowing the answer. we have a program for the rare and neglected diseases that i started two years ago and it aims specifically at trying to find a path across the valley of death for rare diseases. working with universities and small businesses and whatever it takes. we are dedicated to that.

and the clinical center, the 40 bed research, about hal of the patients have rare diseases because this is the only hope they have of getting answers to a disease that is not common and most of the doctors have never before seen a case. >> this mofrng we a-- morning - are focusing on the health institute. $800 million spent for breast and $257 for prostate cancer. can you give us a sense of how much money was spent ten years ago on all of the research and where you are at today? approximately. >> ten years ago the total budget was slightly less than it is now. $27 billion and we are at the$2

billion. but with inflation, there is about a 20% cut particular with the sequester hitting us hard. that sequester meant about 700 research grants that we were on the brink of awarding and had scored in the top echelon of the grants we received and we had to turn them down. which of those grants might have been the next breakthrough in cancer? which investigator might have gone on to win the noble prize but has now been discouraged and is giving up. that turopportunity is gone and that is heart breaking. we have to turn this around. >> martha from brian, ohio. good morning. >> good morning. it is nice to talk to someone who understands the importance

of science in our world. i have been a type one diabetic since 1964. i am perfectly healthy and take care of myself. and i understand the brain's impact on the disease. i really do. and doctor, i want to ask you is there anyone at all, because i think i can help the diabetic community, is there anything i can talk to at nih? i have tried to get through before and i have had very little luck because i think i can help the diabetic world right now with my knowledge of the disease since 1964. >> well you are a remarkable example of just how well people can do that they can care of

themselv themselves. you have had that diagnose for 50 years and there are virgin individuals like yourself that do well with the long-term disease in terms of what it does to kidneys and eyes and folks like you are of interest in trying to figure out what you are doing that is effective. i am sorry you cannot get anyone to respond to the help. but i would encourage you to d so. niddk is the name of the department that handles that. please sent in a query and see if you can get a response

because your story sounds interesting. >> i want to conclude on a final point because you have discussed the cutbacks. what about private medical research? where is that? who is doing it? how does that impact what you do at nih? >> we depend on partnerships with private businesses and industry. this is an eco system where everyone needs to work. bill gates was here on monday and we had an interesting day discovering new ways we can work together on hiv aids and tb and child health and variety of other things. with the private sector and industry, if we are going to say success in -- to see -- in developing diseases, partnership

is the only way it will happen. we don't make pills. the industry has the next step in the pipeline to kercar bring over. we are working with industry because of the promise and the need. >> as we focus on the work of nih, thanks for beginning the program and we appreciate you allowing us to come in and explain what you do. >> i hope people will stick around and listen to the directors for specific areas of research that you will find exciting. >> that is infectious diseases rblg,

mental health and cancer. alan is joinings from arizona. >> i would like to talk to a doctor. can i call back? you know? but, i mean if you can i would like for you to ask the head research that was giving regarding the cancer percentage in india and during the seminar you had on the man mentioned the tum tumor --tumeric -- was a part of their diet and attacked the

blood supply of the cancer. it would be nice to ask the next person coming out regarding, you know, natural medicines and minerals and any of those things that could be helpful. >> we will bring that up in the next hour because we will talk with the director of the national cancer institute. next from pennsylvania. nancy, good morning. welcome to the program. >> my daughter was in continually pain as an athlete and was finally diagnosed at the national institute of health with a genetic disease. but i also wanted to talk to dr. collins about the kansas cancer research being done at md

anderson that folks on a radio attack of cancer cells. wondering if someone in the future might mention that vme. >> we are familiar with the work from kansas to focus on that and we will bring that up as well. thank you for the call. rose, democrats line, good morning. >> thank you for taking my call. i want to speak out for the animals that are being used in research. i think the test are redundant. a lot of information can be gained by computer simulation and that sort of thing. if animals have to be used to gain knowledge in this area then the information should be shared throughout the different institutes rather than doing

test over and over. no body is talking about that and i want to speak for the animals. >> thank you for the call. again, all morning we are at nih and we want to welcome back the head of the infectious disease department. let me begin by asking what questions you are asking yourself and researchers when it comes to these diseases? >> one of the prevailing issues that we have to face is really the fact that with infectious diseases there are those that are established and we can predict what the domestic mortality would be and we have a robust research program to develop diagnostics and vaccine and therapeutics.

and then we are faced with the constant threat of new emerging infections. this we could not predict. we were faced in 1981 when the first kasz cases of aids were recognized. and we had to address that from a public standpoint and today that has evolved to one of the most devastating pan ddemics. and then there is sars or the mrsa disease that are threatening now. we are on guard and being able to respond scientifically so we can develop treatment. so when i refer to this that is the challenge of the diseases

cht . >> this story is getting attention and concern by college stupidi students and parents is the m e menengitmen menengitis outbreak. how is it treated and diagnosed? >> first of all, the diagnose is clinical that can be confirmed by lab data. you are referring to two outbrea outbreaks. it is as a bacteria that can be devastating when a person is stricken and gets ill with it. one of the students at the university of california had a terrible complication of requiring amputation of their feet. the reason for that, even though it is a disease of the brain,

the lining of the brain, it also can have a replication of the bacter bacteria. the critical way to address this, there are treatments for it, antibiotics, but prevention by vaccine is the best way. we vaccinate people going to college with the vaccine, but there are multiple subtypes of this. the one that is stricken the students in princiteton and san barbara are in the sub-class b and it isn't in the vaccines. so what is happening and it will be happening in the couple days through the collaboration of the

cdc and fda that the the students in the dorms are going to get vaccinated by special permission from the fda and cdc with this vaccine that contains the b subgroup. it can be devastatindevastating. there are only about 500 cases of this per year in the united states. 160 of those are of the sub-group b. so it isn't something that is widespread, but it is devastating when you get the n mini outbreaks. >> are there warning signs? what should an individual be on the lookout for? >> the early symptoms are fever, headache, sti

headach headach headache,. the information is that it is spread by close contact and that is why the most vulnerable people are in confined spaces like a dorm or barracks with soldiers and marines. it is spread by saliva. so very strong recommendation is don't share food or avoid where possible kissing and close contact which is the think that spreads the disease >> wane is joining us from washington, d.c. >> thank you for take my call. i am the president of the humihn

mane society and we are atept -- attempting to drive the animal safety program and we want to commend the rigorous nih efforts in recognizing that chimps are not necessary for invasive experiences. and dr. collins worked hard with the science to examine the question and they are beginning the process of transferring the vast majority of chimps in labs to sancutaries. i want to thank him. >> did you want to respond? >> very good point that is made. we are sensitive to the humane

aspects on animals. research on animals is aessentil to the health of the world. but you have to be humane. it is clear that experiments were done on chimps are experiments we are looking for other ways and found other ways to get the same answer without necessarily using the chimps. >> this is tweet who wants to know what standard protocol allow testing in one country to be taken in another country cutting the cost from time to drug market? >> the answer is yes. but you have to pay attention to ethics. it has to wind up with a result

that could be beneficial to the country in which you are conducting the experiment. so doing them in a nation where if you got a result it would not be relevant to the nation is considered unethical. you can do an experiment in a foreign nation that would benefit the nation and ad here to the highest principles. you cannot exploit other nations and use them in an experimental way that doesn't have a benefit for them. >> the director of the national institute of health allergy and infectious disease. we have another call. >> i am a retired physician and trained across the street from

nih and have respect for that institution. my question talks about lyme disease. there is a lot of talk about whether in fact there is such a thing as lyme disease. >> well there is certainly a disease called lyme. it is a disease you get from a tick bite. it is the organism. it is named after an nih scientist who discovered what it is. if you get this disease, it is treatable by antibiotics. the caller is talking about the fact that there are situations where someone has what has been called chronic lyme where months and months after a tick bite or

acute infection that an individual has persistent symptoms. the concern is what is the approach and proper diagnose. many are undiagnosed and many are over diagnosed. the question is what is the therapeutic approach with regard to therpy. there is recommendation for long correspondence of anti-biotics which is not proven to be successful. but lyme disease does exist. >> do you know why people get asthma? can you respond? >> well, that is a complicated issue that has to do with environmental and genetics. as it is part of a response to a

particular antigen that most of the population is exposed to, it could be like a pollen, where it would not bother many people/most people. but in those with are predisposition to asthma, it triggers a release of chemicals and the response is that the lower airways, or the part of the lung that allows the air come through and constrict. asthma is a disease of constricted airways. and the normal response to the c constriction that doesn't allow the free flow of air in and out of the lungs. and that is why you have the tip wheezing sound.

the air is trapped in because of the constriction. why people get it? a lot is genetic and a lot is combination of environmental and genetic. >> what is your background and why did you decide to stay at nih? >> the decision to stay here was easy for me. i have finished by internal medicine at the training after going to medical school there. and after several years of training and internal medicine, i wanted to do a fellowship combined in infectious disease and being immune. i did clinical and basic research and fell in love with the concept of diskofcovery and science that has to do with help.

and also with the atmosphere here at nih. i wasn't back to new york and -- went -- and it is a great place. the discovery and interaction and communication is something we joke around, but it isn't a joke. i would do it for nothing if i had the opportunity. >> we appreciate the chance to talk to you and others. and show the audience the research that is going on there. this past week a president talking about aids as part of world aids day and another hundred million in aids research. here is what the president had to see. i want to get your reaction. >> on worlds aids day two years ago, i announced an additional $35 million for the aids drug assistance program that helps

people pay for live-saving medication. at one time the need was show great that over 9,000 people were on the wait list. we vowed to get the numbers down and i am proud to announce we have cleared the wait list and are down to zero. [ applause ] >> we'll work to keep it down. so we are making progress. but we are all here today because we know how much work remains to be done. here in the united states, we need to keep focusing on investments to communities being hit hard including gay and bisexual men, african-american men and latinos. we need to keep up the fights in the cities. and keep pursuing breakthroughs. i am pleased to announce

research at nih. we will redirect a $100 million into the project because the united states should be at the forefront into how to put hiv into long-term remission or eliminate it completely. >> the president earlier this week as you know discussing additional funding for aids research. how close are we to finding a cure for aids? >> well, i think you have to look at the situation of a cure. it is impossible to predict how far we are away. people are confused with ending the aids epidemic and getting people on treatment.

curing is a sustained remission without the need for therapy. that is a goal that is not going to be easy. but one of things you don't want to get confused with is even though we don't have a cure, the advances that have been made by the therapy is nothing short of breath-taking. in the early 1980s, when i started taking care of aids patients, after the discovery of the disease, the survival rate was 6-8 months and 50% of patients were dead within six

months. it was terrible for us taking care of them and terrible for the patient and family. now if a person comes in in their 20s and is newly infected and you start them on the combination of drugs that have been developed you can predict they will live an additional 50 years. that is an advance through science, clinical work and intervention. the cure, mainly being able to tell someone you can come off the medication, is something we are aspiring for and you heard the president talk about redirecting money is a good thing. i was right there by the president when he made the announcement at the whitehouse.

that is something that is going to be difficult to predict if and when we will get there. >> i want to go back to callers, but can you explain what is the global fund. >> the global fund is a multi lateral organization of countries that donate into a fund. it is called the global fund to fight aids,tb and malaria. it is an organization that is based in geneva and countries put into the funds that get partnerships with high burdens of these diseases to treat, prevent and care for people with those diseases. the united states of america is the largest by far funder of the global fund. we put in 1/3 all of the money

that goes in. the global fund is a major component of how we address these disease. and there is the president's relief of aid and that was started by president bush which puts in billions to address the treatment of hive infected individuals. we had the replenish meeting where representatives came from all over the world to make pledges for the amount of money they would be putting into the fund over the next new years. >> our next caller is from texas. good morning, tom. >> hello steve. i am interested in the disease

called adult leukemia. it started when i was seven i had a cousin die of juvenile leukemia. and my wife lost a close friend at 61. and then she just about 3-4 later she lost her cousin who was 53 and he spent a year at md anderson. they said he was making progress and then he was again. i saw a two hour nova and it was talk about progress they were making with the seniors down at md ander s eanderson. they pulled on old drug and changed the process. >> we will talk to the director of the national cancer institute

so that issue will come up. but can you respond? >> there have been advances made in the treatment of leukemia. the treatment of childhood leukemia is now a cure in a high percentage of children who get that. leukemia as you get older has multiple different types. there is one particular type in which a single drug can actually block a particular component of a genetic defect in the cell that leads to the leukemia. that has turned out to be a cure for what was a devastating leukemia. there is a broad spectrum of leukemia and each has a difference nuance regarding treatment. >> ni

>> nick, good morning. >> the reference to using computers with research and doing it in animal studies that are redundant. they would do that, i am sure, if they good. it cost money for animals, house, feed, care for them. employees have to take care of their health and that is money they are not directed to the research, but to the care of the animals. so rest assure if they could use a computer they would. and animal studies are supposed to be redundant to make sure they are safe. ... response? guest: certain animal studies are necessary. if you can substitute for an animal study and other reproach -- another approach, that would be preferable.

dowe mentioned, when you that, you have to do that to the highest standards of animal care. ) one of our objectives is to look at the money nih -- host: one of our objectives is to look at the money nih spends, $31 billion, out of that, 4.5 center is spent at the for allergy and infectious diseases. from hyattsville, maryland. caller: two quick questions. there was a little on this earlier. the mix of politics and scientific research and the on- again off-again kind of thing. administration changes and stem reproductive or research, that kind of thing. themuch money is wasted by starting and stopping of that

kind of thing? econdly, to dream a little -- the idea of there being a 15 member medical panel that would actually have a huge voice in government to counter the politicians when it comes to medical research and the practicality of money spent for this research or that research. even into engineering and infrastructure and that kind of thing. i will take the response off the air. jeremy.ank you, guest: first of all, it is important to point out that the nih, throughout the years, has benefited greatly from bipartisan support within congress and by multiple administrations. unfortunately, we are at a situation now that you heard from dr. collins, in which our budget has been flat for at

least 10 years. then we were hit with the devastating effect of sequestration this year, which needs to be reversed if we are going to get back on track to what we can do for the country and the world in the arena of biomedical research. about how muchd money do you waste when there are political issues that allow you to start and stop something. not much. we are disturbed when issues that relate to some sort of ideology get in the way of what is important for science and health for the nation and the world. luckily, we have not had a lot of fat. we have people who are very much in favor of what we do. we have been very fortunate to have, for the most part, not always, total, universal support for what we do. the judgment about what we do is left up to us. two final fauci,

points. there have been developments in the research with genital herpes. what have you learned? guest: the real challenge we are having is with a vaccine that would be effective for genital herpes. there are treatments that can suppress the recurrences. one of the issues with genital herpes, you can get an acute attack and it can go into remission temporarily. ofn you get outbursts relapses of infection. that is very troublesome to the people who are infected. we have good treatments. the treatments have done much better than the vaccine research. as with many sexually transmitted diseases, we have not had overwhelming success. we have had a disappointing failure in a tight -- in a type short whilecine a

ago. we have new initiatives in bethesda and with our grantees throughout the country in different universities to put another really good, full-court press on trying to develop a good herpes vaccine. what isfinal question, the outlook for the upcoming flu season? guest: the upcoming flu season -- we have a seasonal flu every year. right now, there is nothing that looks particularly different than what we have seen in previous years. sometimes you have a very early start to the flu season. it generally peaks around january or february. we tend to get over it by the end of march and the beginning of april. you start to see some cases trickle in. seasonseeing a typical now. mostly light activity across the country. a couple of states like texas and mississippi have heavy activity. above thatyet gone

threshold level. it seems to be relatively on target for a typical flu season. as we have learned over the years, the one thing we can say about the flu is that it is unpredictable. if you look at the charts that come out from the cdc, it looks like the beginning of a typical flu season. is the director of the nih's allergy and infectious disease center, one of 27 facilities. thank you for being with us. 10 years after the completion of the human genome project, we will check in with dr. eric green, director of the institute at nih. calls on thisur topic. chris from maryland. good morning. nih, under the current sequester and you mentioned flat budget, it is time that with 27

institutes that they operate not as separate universities in terms of their i.t. infrastructure. they should start thinking about how to pool and manage those i.t. resources to reduce redundancy and have more they confederated, internal approach. be usedthe assets can broadly and cut costs to the taxpayer. host: sam, georgia. caller: good morning. good morning to the doctor. i recently was diagnosed with multiple myeloma. supposedly, i am a candidate for stem cell research. what i want to ask the doctor is, what exactly -- why do they call that multiple miley,? -- multiple myeloma?

are there any breakthroughs? host: we will check in later with the head of the cancer institute. i will bring that up with the doctor. where have you gone for treatment? --ller: i am in the pa system in the va system. it has been very good so far. host: kent. good morning. caller: i think all these nih people missed opportunity. he talks about enjoying his job that he would work for free. during the government shutdown, that would've been a great opportunity for those people to just go ahead and report to work. because they love their work and want to help people. i am being facetious. host: jerrod, florida. good morning. --ler: how are you going doing. host: there is not a doctrinal

line, go ahead. what is the difference between the hiv virus and aids? is aids a disability? what are the differences between the hiv virus and aids? full-blown aids. is people with full-blown aids, is it a disability? host: i would direct you to the website, nih.gov. you can click on the division of infectious diseases and get more information with regard to your situation. joan, georgia, good morning. to ask i am calling about a disease that my daughter has. she has an infectious disease.

really was very painful. she had to get special antibiotics. she also has been diagnosed with lupus and or another disease. they were not sure. her bones are dying. i am wondering if these are they are or if separate and should be treated separately. your thank you for sharing story. you can get more information at nih.gov. we continue with our look at some of the leading researchers at nih. the director of the national human genome research institute. dr. evergreen. thank you for being with -- dr. eric green. completion of the this project. what is it and what have you learned? guest: the human genome project

was this effort that went on from 1990 to 2000 three. it was a very large, international project. it had a fit at school, -- it had a focused goal to sequence the human genome and read out all the letters of human gni. use that information as a foundation for understanding important features of human biology and to learn more about human disease. thatrticular, the aspects relate to heredity. that project ended in 2003. it was a successful and set up a circumstance for us to begin to use genomic information and tools of reading out dna to better understand the role that the unit plays. -- the role that dna plays. a lot has happened over the last 10 years. it has been slowed down because of some of the budget constraints. host: as you look at a risk

factors for any condition that individuals may face and you study his or her dna, what have you found out? every disease has at least a genetic influence if not an overt cause. there are differences in our dna that lead to getting a disease or giving some statistical risk. diseases, it might cause -- a single little letter -- a single difference might cause a disease. we have learned a lot because we have organized to do studies that allow us to take thousands withoutiduals, with and a disease like hypertension or diabetes, and study the dna of those individuals. to figure out which letter areerences in our dna associated with getting the

disease. that is giving us insight about what can go wrong in human biology to lead to a disease. it starts to give us some ideas about how to move forward in developing new drugs. eventually, we are hoping some of these things will lead to diagnostic opportunities to treat people using information about their own genome. host: i want to come back to that. looking at the numbers. nih's budget of $31 million. the research at the human genome research institute is about $513 million. guest: that was before sequestration. we went below $500 million after sequestration. host: what can you expect in the year ahead? guest: we don't know. we are operating on a continuing resolution that gives us last year's level until january. there is a possibility of

additional cuts that would be devastating. host: a couple specific issues in terms of dna. when a child leaves the hospital, can you determine whether or not that child is more predisposed to sudden infant death syndrome or diabetes or alzheimer's? the long-term view is will we be able to take an outant at birth and read their genome and learn about not only what uses -- what diseases they might be at risk for work later in life. how their genome might make it so that a particular drug would be a good or bag drug, or what the

might be. how we respond to medications is a scripted in our genome. right now, every baby in america has genetic testing for a small number of genetic conditions for which there can be early intervention. so you know what to protect that child or how to handle the care. that is only a few dozen conditions. now we know the genomic basis for thousands of words uses -- thousands of rare diseases. we are very interested in the will the futureiwl be like when it becomes straightforward to sequence a genome and have that information available for routine care starting when they are infants. this year, we launched a program in collaboration with another -- another nih institute at nih to develop a program that would allow us to

study exactly what you described. were only able to find it at half the level we planned. host: what would you tell congress? wonderfuly have been and investing in genomics beginning with the human genome project. been very insightful and recognizing that the u.s. could be a leader in genomics. a field that is incredibly exciting and explosive. they have been wonderful in seeing accomplishments bearing fruit. we are finding ourselves with our feet on the break. we cannot fund the research we know needs to be done to really see these clinical advances come to fruition by using genomic information. host: talking with dr. eric green, a graduate of the university of wisconsin and washington university in st. louis. background as a

graduate student, i did not work on dna or genomics. in medical school, i got an 1987, the year genomics was talked about for the first time. i never heard the word genomics in medical or graduate school. doing my clinical training, it was at the time when a lot of discussion about the idea of sequencing the genome. i saw the diagnostic opportunities that could someday come to be when you could get knowledge about individual patients, genomic information. i thought this was too exciting to pass up. as a trainee in pathology, i got a chance to participate in the human genome project from day one. now i find myself at the other end, seeing the project

completed after 13 years. i am very fortunate to be directing the nih institute created by the u.s. congress explicitly to lead the nih's effort any human genome. host: silver spring, maryland. good morning. caller: doctor, how far has the research and finding treatments for lupus gone? 2012, research companies in rockville announced a breakthrough in that direction. what is the update? guest: i don't know the specific update about lupus. thatve an institute at nih focuses on autoimmune diseases. you can get information at their website, nias. what i will tell you about a disease like lupus and rheumatoid arthritis and what isne diseases,

happening in genomics is it is giving us opportunities to develop studies where large numbers of individuals are being studied. there able to look at all dna differences that they have versus individuals who do not. betweenlop associations particular regions of the genome risk forgetting that disease. there is some incredible new insights coming out. for many autoimmune diseases. ,e do not understand completely but when i compare this to where we were 10 years ago and our knowledge of where to look in our dna for differences that might confer risk for diseases like lupus, it is spectacular. i think we can really expect between now and the end of this decade remarkable advances. host: whether it is medical research are critical -- or criminal investigations, dna

plays a part. how did we find out about the and i -- about dna? goes back research many years. incremental insights about the terry material -- about hereditary material. was thekthrough hereditary material. one of the most famous years ago, wes 60 are celebrating that this year. 1953n jim -- in 1953, jim watson and francis crick described the double helix. it is the most significant discovery in biology in the last century. it was the double helical structure that made us understand how it was dna

carried all biological information from generation to generation. since the 1950's, it has been better technology, new insight. learning how to clone dna and sequence the letters of dna. figuring out how to develop strategies to read all the dna of an organism. in other words, to sequence a genome. director guest is the of the national human genome research institute at nih. tom, new jersey, good morning. caller: dr. green, am i right in understanding that with all the talk about people associating their disease with their genes, geneticave a predisposition to some problems. but it is our behavior that allows that the disposition to express itself and manifest the

disease? guest: is more complicated than that but you make an important point. talking a lot about genomics and we, this is what i do when focus on. i do not want to leave you with that everything we do is scripted in our dna and there is no influence. there are other influences. the reason we talk about genomics is because we have had a remarkable technological surge in our ability to read out the and i -- read out dna. you make a great point. some of these things give us a predisposition. that does not mean we are going to get the disease. the environment, behavior, social aspects of life, all of these things influence it. it is the interplay, especially for more common diseases, hypertension, diabetes. we know that there is an interplay.

genetic predisposition but in terminal contributions. -- but environmental contributions, what you are eating, how much you exercise. i want to emphasize that genomics is a key part of this puzzle but it is not the only part. host: from maryland, william is joining us. dr. eric green at nih. -- i wasy question is in vietnam and i can't malaria. i stayed in the field house for three months. when i came back to fort brag, i had a relapse. i am having problems. i cannot hear that well. warts growing out of me. the va cut the amount. -- cut them out. what kind of side effect or long-term effect is this? host: can you adjust that? thet: dr. fauci would be

expert on that. this is an infectious disease. i would refer you to the institute that he runs to get the sort of insight. what i will tell you to make the point about a disease like malaria, it is a complicated infectious disease. it involves not only the arial parasite, it involves mosquitoes and vectors that carry the parasite. -- of course,s there are humans. there are three genomes interacting. the human genome, the mosquito genome, and antimalarial malarial-- and the parasite genome. the pools developed for human genome -- the pools developed to read the human genome can be

dna. to read mosquito we are learning about the interactions of different genomes. that is advancing our knowledge about infectious diseases. int: what about advancement prescriptions you might get? could it be tailored to individuals based on dna? guest: this is an incredibly exciting area to look for in the coming years. is already here and now, it is called pharmacogenomics. i talk a lot about diseases. there are differences between that canls' genomes influence how we metabolize or respond to medication. in medical school, i remember being taught that you try a patient and give them this

medication. if it does not work, go to a different one. the reason it does not work in half the people is because those individuals have different genomic variants that make it so they do not metabolize the drug well. we are learning about which genomic differences by a role in whether you are a good responder or a dad responded to an medication. or that you does it at a different level. the fda requires labeling on over 100 medications were they say genomic information might be relevant for prescribing this. to grow withgoing time. it is a standard of care for getain medication to genomic information before deciding whether to give them that medication or what dosing to use. host: gordon, wyoming. caller: good morning.

thank you for c-span and thank you for your service to humanity, doctor. i hope nih is getting funding from private sources and government. i hope that would be the case. maybe you could talk about that. tom mentioned behavior. i have heard that strenuous exercise can actually produce interferon, and antiviral and anti-carcinogen naturally produced through exercise. me take those questions separately. do private companies give money to the nih? that goes on.of we also have the foundation for nih, a private foundation that raises funds. there are many collaborative projects done with nih researchers and the foundation.

i will also tell you, dr. collins talked about this, and works with-- nih many private sector entities. both in the country and around the world. the ecosystem of biomedical research is one where nih plays a major role. almost the center of the universe for research. we do this in close partnership with the private sector and with our own foundation. as well as other funding agencies. the question about exercise and how exercise has been shown to result in the production of chemicals that are important for fighting infection, absolutely. doctor and your other health-care professionals are always say how important exercise is for keeping your weight where it should be. people who exercise tend to be healthier for lots of reasons. some of which we understand and

many of which we do not. boston, new hampshire. charles for dr. eric green from nih in bethesda. caller: hello. .hank you for your research we appreciate you and everything your staff are doing. my questions are the following. where can the general public go and have a dna test? how much is the test? what are the ethics? i will wait for your answer off- line. guest: those are some terrific questions. to recognize is we have the capability of reading out the complete genome of an individual in a day or two. ende wnant end to sequencing, it would cost

several thousands of dollars. the question is should we be doing that and in which cases. so much of what my institute does and what my staff thinks about and develops and researchers is trying to create youruture to answer questions more precisely. just because we can do something, we are not ready to do it on a large scale. there are circumstances where this makes sense. you will hear next from the head of the cancer institute. there is excitement around using the ability to read out dna by reading out the dna of tumors and figuring out better ways to treat patients with cancer with genomic information. there are examples like red genetic diseases where this are genetic -- r diseases where this makes sense. an individual that we do not know what is wrong with them.

it makes sense to read out their genome and figure out what is wrong with them by looking at dna. i -- looking at their this -- these are situations were getting the genome situation makes sense. in 10 years, there will be more scenarios where this makes sense medically. the question of where people can get dna tested, there are companies that do direct to consumer demand -- direct to consumer genetic testing. you will find various companies that offer that. nicely last part went with your second question. there are a lot of ethical issues and maybe some legal and social issues around what the advantages and disadvantages are of having individuals going out and having their dna analyzed when you do not have a health-

care professional there to interpret that. there are good arguments on both sides. some companies have generated a lot of interest in genomics and have helped to educate individuals about the importance of dna and the genome as part of their medical care. at the same time, it is not entirely clear what information is useful to patients in the absence of being cared for by a physician or pharmacist or a nurse or another health care professional. these are things we're grappling with. our institute takes this very seriously. we study the ethical, legal, and social implications of genomic hand-in-hand with the supporting these studies. many issues need to be considered if we are going to use genomics is part of routine medical care in a sound and safe way. host: our last question is from mary ann would bridge -- in woodbridge, virginia. caller:

good morning. thank you for your research. is your research leading to dna --ng able to predict sometimes it will skip a .eneration or so it would be interesting to see if your research can or will eventually lead to being able to predict this. host: thank you. would like to sort of managed expectations here. right now we can read out people's genome sequence and make some predictions about certain diseases they might get. in some cases we could say with near certainty that they will get something. but in most cases it is a percentage.

as current evidence would suggest, you have a greater risk of getting this or that. there are many other factors for many of these diseases that play a role such as environment and other social components of your life. i think with time this will grow. but some of the most fruitful contributions of genomics will be in areas that are much more whether oriagnosing not an individual will be a good responder or bad responder to a medication. certain diseases for which we know that genetics lays a very major role. but i am cautious in predicting the future where we will read out somebody's genome sequence and be able to put down every disease they might get and when they will get it and with what certainty. it turned out to be very collocated. we will gain some insight. host: the director of the national human genome research institute, part of the nih.

thank you for being with us. .uest: thank you so much host: in a moment we will turn our attention to advancements in cancer research with dr. harold varmus. unemployment at seven percent, the lowest since november 2008. we will be talking about this and subsequent "washington journal" programs. when we come back, we continue our conversations with some of the leading researchers at nih. >> after war, things escalate so quickly. in a moment that seems so loving, he can turn and flip and be so out of control. this was one of those days. them seeing aith hidden handgun and saying what is the deal, and he said i just

wanted to sell it. pressures.many she just held the gun. he went into the room and came out with a shotgun and really tried to jam it at her. sheried to get her so that would pull the trigger and kill him. as i described in the book because she wanted to. >> it is only half the story. following the man of the u.s. army's second battalion 16th in history. sunday at 8:00 on q&a. fordom age eight, betty knew she wanted to do something with dance puget put on skits led to herand that studying at the school of dance in vermont. these are some of her notecards. this is her organizer during

this time. she carried this with her to vermont, back to grand rapids, off to new york where she studied and worked for the , and theneling agency back to grand rapids again. so you will find a host of things in it that you would find in just about any organizer. rushers on dance costumes. one of her sketches of a costume for one of the dance routines she wanted to put on. choreography notes that she made for different dance routines. there is a wealth of material in lovethat talks about her for dance and how deeply she was involved in it, especially in early years. >> our program on first lady betty ford on our website c- rstladies or saturday at 7:00 p.m. eastern.

our series continues live on monday as we look at first lady rosalynn carter. "washington journal" continues. host: just outside of washington, d.c., in bethesda, maryland is the national institutes of health, including 27 separate institutes and centers. they conduct research in various disciplines of biomedical science and neuroscience. dr. haroldlive his varmus, director of the national cancer institute inside the building we looked at a moment ago. dr. varmus, appreciate you being with us. in nearly 1970's, president nixon declared a war on cancer. how are we doing today? guest: first, richard nixon signed the national cancer act, but he did not call it a war on cancer. many others did. cancer is a deadly disease. it affects nearly over a third of our population. it is a major cause of death, the number two cause of death in the country. to say how we're doing is a

question that requires many complex answers. because cancer is not a single disease. hundreds if not thousands of diseases that are characterized by, we now know through the efforts we have made here, it is a disease tossed by changes in our chromosomes. it is a disease of the genome. that is what you have been hearing about from eric green. we're making progress overall. annually report to the nation about progress against cancer, measured by the best metric we have, the h-adjusted mortality rate. over the last decade, overall there has been a 1.5% decline in age-adjusted cancer mortality. however, we would like progress to be faster. for some cancers there has been much less progress than for others. able tocancers, we are cure or control the disease in a very effective and essentially

pain-free way. but for other cancers, we have made much more limited progress. it is a mixed bag. but the one thing that is particularly relevant for today's conversation is that we have such a greater understanding of this set of diseases than we did 20 or 30 or 40 years ago. there is tremendous hope for making yet faster progress if we are given the resources and have the personnel to carry the research out. host: looking at the numbers, nih and the annual budget is about $31 billion. just over $5 billion goes to the national cancer institute. >> it used to. it is under $5 billion now because of sequestration. host: that is my question, how is sequestration affecting the budget? guest: i call institutes, we took over a five -- over a 5% cut.

we had a ticket of budgets that were essentially stable and corrected for inflation, but those are declining. like ever -- like every other institute in the nih, we are operating with the same level of resources we had in 2000. what we have done at the national cancer institute is to try to modulate the effect of these reductions, both long-term and short-term with sequestration last year, by trimming across the board and preserving the number of new grants we can issue. this is not a policy that can be carried out forever. we had to protect our investigators last year. we do not close down the most important projects, obviously. we have to trim at the edges and keep people going. we recognize there are other sources of money from institutions, from philanthropy,

from other societies, from industry, and we are not the sole funder. frankly, we can move a lot faster on many fronts if we had more resources. the talent is out there. the questions are there. the background information tells us what we should be doing next year at all these things are in this very robust thatprise is something would yield awards, i am convinced. host: i want to go to a couple numbers from your institute. 65.8%, that is the percent of those who survived cancer five years and beyond. can you explain? guest: can i explain what? host: that is a very high number and encouraging news. guest: it is. those numbers have to be looked at fairly critically, but we think one of the great pieces of evidence that indicates that we are making progress, in addition

to the best metric of all which is the age-adjusted death rate, but one other way of looking at this is i measuring a five-year survival rate. it is clear that that is an imperfect measure. one reason is that if you diagnose a cancer earlier and do not produce any real effect on the cancer, you still may have an improved five-year survival because of diagnosing a disease which still runs its course at an earlier stage. so this number is subject to some criticism, but it is a measure and an important measure because it tells us that there are a lot more people in the country today, around 13 million , who are cancer survivors, who have had a cancer diagnosis and are now coping with life as individuals who have had an experience being treated for still and are, of course,

after five years remaining at some risk of occurrences of cancer. this creates a lot of problems pays attention to. what attitudes people take, what they do to prevent occurrence, predicting it earlier, preventing second cancers, and what individuals who have a cancer and have been treated for it and what they need to think about with respect to employment and insurance and other aspects of life. host: there are an estimated 1.6 million cases of cancer each year according to the nih look over this year in 2013, and about 580,000 deaths as a result of cancer. i want to get to some of the most common types of cancers. prostate and breast cancer, and estimated number of cases between 230,000 and 240,000 cases in 2013 are estimated

death among prostate cancer patients, around 30,000. around 40,000 for breast cancer. why we have a high percent of cancer rates in these two areas, at very low rate in terms of estimated deaths. just go -- guest: it is true that we are quite effective in giving long life to people who are diagnosed with breast and prostate cancer. in part, that is because we have protection tools. sometimes those reduction tools , whatus to see a change we call a lesion or area of abnormal growth which might not have caused the patient any difficulty even if they had not been treated. one difficulty dealing with the numbers when one counts the incidents as well as the mortality of her haps prostate cancers is there are many early or diagnoses of

abnormalities that might not to cancers.sed one of the problems we face at the cancer institute, one we're looking at with special programs at the moment is how we distinguish damage that is detected early but would never cause the patient any real difficulty if left untreated from those early abnormalities cancer.ld lead to there is a large fraction of dndividuals who are diagnosed as being a cancer patient, and the numbers tell us to include a lot of people who would never ofe been ill or had a risk lethal cancer if the disease had been left untreated. how we distinguish between those who have something to worry about seriously and those that do not is one of the challenges

that we are trying to address with new molecular tools we use in the clinic. host: if you can compare that to one of the leading causes of cancer deaths local lung cancer. this year an estimated 228,000 cases and more than half, 160,000, estimated deaths as a result of lung cancer. guest: there are differences and also differences in the mode of detection. you are aware that there is a new method for detecting lung cancer earlier than before. at the national cancer institute, over about seven years, we carried out a large study called the national lung screening trial in which 53,000 methodused a new imaging . that method has now been shown by rigorous controlled study. out by the nci to reduce lung cancer totality in heavy smokers, people at high risk of

the disease between ages 55 and 75 by about 20%. that is a significant number. it does not compare favorably with the health benefits of not smoking. nevertheless it is going to lead and has led in the past to early diagnosis, and i think some of those early diagnoses will be abnormalities that might not have lead to lethal cancers. but the study shows that this method can detect some lethal cancers early and reduce the fertility from lung cancer -- the mortality from one cancer. likely once the official report is filed that there will be recommendations for all insurers, including medicare, to cover this method.

hopefully we will see additional reductions in lung cancer mortality to add on to what has been achieved already by the dramatic reduction in tobacco use in this country, as well as improvements in therapy, surgery , and drug therapy. host: if you are joining us on c-span radio, our guest is dr. harold varmus, director of the national cancer institute. he has his masters from harvard and also studied at the columbia university college of physicians and surgeons. allen is joining us from new jersey. caller: it is a pleasure to speak with you. doctor, you have talked about st and prostate. the question i have relates to bladder cancer and the progress that comes and whether or not a treatment that is known as the

, if that is the state of the art and if it seems to be very, very promising with regard to eradication of bladder cancer? has proven to be an effective therapy for early- stage superficial bladder cancer. for more advanced stages, other treatments are needed. this may be a place to introduce a concept that i think we need to introduce some time in this half-hour, and that is the dramatic effect of our understanding of the human genome is having on our approach to the treatment of cancer. bladder cancer is among those that have been subjected to intense genetic domination over the last several years thanks to the development of the new tools that you may have heard about in the previous half hour with eric green. and we will have to be subdividing bladder cancer according to the damage that one

can see in the chromosomes of individual cases of bladder therapyo choose appropriately. there are presently chemotherapies used in the treatment of bladder cancer once surgery is no longer an effective tool, but we have not yet optimize the treatment of bladder cancer. unfortunately many people with advanced stages of the disease do die of bladder cancer. we believe that, as our understanding thing of the aggregates of genetic changes are better understood in individual cancers, bladder cancer being a good example, we will have much better tools of treating the disease and trying to keep it at bay. host: is melanoma a preventable type of cancer? esco melanoma can be at least partially prevented. the main tool is reduced exposure to the uv damage and sunlight. we know from molecular studies

is found in melanoma is a disease that varies dramatically among ethnic groups .n this country is much more frequent in the white population than in the african-american population. strategyain preventive is avoidance of uv exposure to sunlight. that being said, we have had advances in the treatment of advanced melanoma over the past few years. melanoma generally appears initially on the skin and and can be successfully treated with surgery in the majority of cases. but when the disease is advanced, it becomes a very difficult disease to treat. over the last several years, there have been new therapies based either on specific mutations that are quite commonly encountered in that disease or, and this is an

important development that has brought significant smoker through the use of what we call immunotherapies, modulation of the immune system so the immune system helps in troll the growth and even reverse the growth and size of melanoma tumors. these are major developments that illustrate the power of our new understanding of the immune system and the molecular changes that occur in our genome to try to control the disease. host: what is your background? your personal background, your experience over the years? guest: well, you want a brief bio? postcode yes. guest: i grew up on the south shore of long island. i was trained in english literature at harvard. then went to medical school. twoceived an important years of training at the national institutes of health where i currently am.

during that time, i learned to love basic research and understand the power of fundamental unfettered research to make deep discoveries that principles of biology. then i spent 20 years around the faculty of the university of california medical school in san francisco. nih director for about six and a half years during the 19 90's. ran a cancer center for a decade. now i have been here for three and a half years as the director of the national cancer institute . from stephen rynning is massachusetts with dr. harold varmus. caller: good morning. i have been recently diagnosed with a fast-moving skin cancer. it is not a melanoma. i believe it is a carcinoma, if that sounds right. it was removed and there was a

biopsy. now i will go back in to remove a little bit more of the tissue around it. is there anything in my biological, my genetic makeup? i would like to know that. i am really careful in the sun. so i am in the coasta the sun a lot, but i am careful and put sunscreen on. so i want to know about my genetic makeup. i do not want this to be a reoccurring thing. they doubted they could cut it out in one big shot, maybe they could keep me clean for some time. guest: first of all, let me say that i am sympathetic with your diagnosis. i am sorry you are having to go through this. but i am glad you are under medical care. sounds like you're getting good care. i cannot be directly to your situation. i would not do that on the air in any case and i do not know all the facts of your case.

i will say that with respect to your exposure to the sun, you should not feel that you are responsible for your cancer. if everybody were to protect themselves from sunlight, the incidents of melanoma and other skin cancers would probably go down. but-- it would go down, there are natural error-prone u fence that occur during the growth of our cells that make it very unlikely we will ever be able to get rid of cancer as the disease that affects many different organs. smoke ore did not exercise vigorously, avoided alcohol, avoided obesity, avoided somewhat. still, cancer is going to be with us. in a sense, it is a product of the way in which our cells work. making mistakes when cells

divide an inch in sick variation of our system. in that sense, cancer is a very deep disease that affects the fundamental properties of how cells are engineered. but there are effective ways to .ontrol the disease like yours you're in headed -- inherited case is notthis common. but there are individuals who may be at high risk because they carry an abnormality in their genes inherited from a parent that predisposes them to certain kinds of cancers. most genetic changes that drive cancers are changes that occurred during one's lifetime. they made it a result of the

errors that go on when our dna is copied in our cell divide or it may be the result of exposure causing substances radiation thatv causes genetic changes. it is a mixture of events that lead to cancers, some inherited, more occurring during life, and i think as long as you are in the hands of a competent physician who understands some of these rents a polls -- some of these principles and has experience in the treatment of the kind of cancer you are dealing with the, i think you will be in good shape. host: a tweet -- over -- are we over diagnosing cancers like prostate and breast cancers? guest: in a word, yes. the difficult part is knowing which cases are being overdiagnosed. the numbers indicate, especially

in the case of prostate cancer, which is no longer recommended by the task force for routine screening, perhaps in exceptional cases, has led to many diagnoses that lead to simply notthat are helpful and not lifesaving but damaging, resulting in loss of sexual potency, loss of bladder continents, and the deficits of treatment are currently outweighing the benefits. so that test is no longer recommended. the numbers are pretty clear that the overdiagnosed of early breast cancer happens in many cases as well, and there are a number of things that are being thertaken to try to improve situation clinically. from the point of view the national cancer institute, the

thing we are trying to solve is the question of how we can take these early abnormalities and tests to kinds of distinguish between those that are likely to evolve into life- threatening illnesses and those beniare simply the nine -- gn abnormalities that would not cause serious symptoms or life- threatening situations had they not been detected. we're talking with leading researchers about their areas of expertise at the nih. dr. harold varmus is the director of the national cancer institutes. al is joining us from cambridge, ohio. caller: good morning. it is a pleasure to be able to talk to a doctor out here after working for 40 years at a good job but cannot seem to ever get to talk to a doctor. you have to make an appointment

and describe your problem to a nurse and then get worked on by the doctor and no discussion at all. this is not ase substitute to going to your physician and being personally treated. heller cho i understand. if you things. you put so many things out on the table, it is hard to get it republican duncan who called for a nuclear strike against iran here two days ago. truey, moving on, isn't it that cancer has only been out there that we know of for the 300 years? and don't we need the sun to make vitamin d for our bodies? guest: first of all, cancer has been around for a very long time . a book was published not long ago called "the cancer and theho,"