By Matthew Bin Han Ong and Paul Goldberg
The National Cancer Advisory Board and the Board of Scientific Advisors jointly adopted a resolution to allow the institute to continue its use of the controversial Title 42 program to recruit and retain staff members.
The two boards met and sat at the same table June 25, for the first time in NCI’s history.
This largely symbolic joint action of the two boards comes at a time when critics in Congress have once again begun to eye the program used by NIH to pay some staff members more than the federal GS pay scale allows.
NIH institute directors, including NCI’s Harold Varmus, are Title 42 employees. This makes them, technically, consultants, critics have said. The program was established in 1944 to enable NIH to hire special consultants, usually part-time or full time on a temporary basis. It became widely used as a pay system five decades later.
Reliance on Title 42 appears to be a crucial aspect of Varmus’s overhaul of NCI.
This isn’t a new Tea-Party-conservative issue. Title 42 has been criticized by members of Congress for over a decade.
Four days before the BSA-NCAB meeting, at the June 21 hearing of the Subcommittee on Health of the House Committee on Energy & Commerce, several House members raised questions about Title 42, suggesting that they may impose legislative limits on its use.
The issue also came up in May at a hearing of the Energy & Commerce Subcommittee on Oversight & Investigations. At that hearing, NIH Director Francis Collins said that 24.8 percent of NIH employees were compensated under Title 42.
Addressing the two advisory boards, Varmus said that Title 42 is an “an essential tool for including and retaining strong scientists,” adding that efforts to restrict its use would “put us in too tight a box.”
The threat of enacting new measures to limit the use of Title 42 comes during a time of deep financial woes at NCI, and suggests that not only will NCI staff members will have to do more with less, but also that these high expectations may fall upon the staff members who may not be the best in their field.
Internal rules, in place for the past several years, compound the recruitment problem. NIH institutes can offer Title 42 positions to officials at levels as low as division directors. Positions below this level can still qualify for Title 42, but only after a national search fails to produce an appropriate candidate. This is known as the “exhaustion clause.” A search of this sort can take six to eight months.
For Varmus, recruitment has been particularly difficult, as his efforts to restructure the institute threaten to place institute divisions under interim leadership with severely limited chances of finding new permanent leaders.
Varmus is even changing the way NCI solicits advice.
Having the two boards meet together made it difficult to use the conference table usually used for advisory committee meetings. That table seats about 40, and it’s a tight fit. The combined meeting brought together 60 people, causing some board members to find seats in the audience.
While the boards have to remain technically separate, Varmus has said that, in recent years, their meetings have been largely duplicative. Now, the groups will meet jointly once a year in June.
“I’m working with Building 1 [the Office of the NIH Director] to see if we can have a larger room built here with a bit of a bigger table, but maybe we’ll wait a year or two and see when these joint meetings actually work out,” Varmus said at the meeting.
NCAB consists of 18 members appointed by the president. Six of the group’s members have to be representatives of the “general public,” which can include politicians or experts in law, policy, or economics. The board’s duties include reviewing grants, contracts, and cooperative agreements issued by the institute.
BSA has 35 members, all of them experts appointed by the NCI director. The board’s function is to “provide scientific advice on a wide variety of matters concerning scientific program policy, progress and future direction of the NCI’s extramural research programs, and concept review of extramural program initiatives.”
A Broader Problem
In addressing the two boards, Varmus said the recruitment problem confronting NCI is deeper than Congressional challenges to Title 42.
The root of the problem is the general lack of respect for federal employees, he said.
“It’s important in public discourse to stress the significance of these jobs, the difficulty that we have in an agency like the NIH or NCI of attracting talent away from the industry and academia, where much higher salaries are paid, and where the need to move with some dispatch of doing recruitment,” Varmus said.
“It’s time for all of us, in our roles as government employees and government advisors, to talk about how important it is to serve our country and to make sure these institutions represent the very best of what America is about—and that they are given proper accord in the press and the public debate,” said Varmus. “I think it’s outrageous that people are viewing government workers—who are doing great things with great intellects and insufficient salaries—aren’t given proper credit.”
When NIH is unable to attract and retain strong staff, other sectors are adversely affected.
“People think I’m just being self-serving, they don’t think that academia in particular, even industry, has any vested interest in having great people work in government,” Varmus said. “In fact, these guys on the outside have a huge interest in having talent in the NIH, and saying that is important. I’m not hearing it enough, I’m not hearing it from the administration, either.
“NIH will only be as good as the people we have,” Varmus said. “We have great people here now, but I can tell you that there are people I’m trying to retain at a time when they are being offered considerably higher salaries, and in some ways, a simpler life, in which travel is unrestricted, you don’t have to write a request for permission to hold a workshop that costs $20,000, which is a new edict that just got imposed on us, where you can serve coffee at meetings, all kinds of things that make life reasonable.”
In the midst of massive restructuring, NCI has been unable to fill some key vacant positions, which require “salaries we can’t afford to pay or aren’t allowed to pay,” Varmus said.
The institute has at least three big jobs to fill. The first is director of the NCI Division of Cancer Epidemiology and Genetics. The current director, Joseph Fraumeni, Jr., is retiring after half a century at the institute.
“It’ll be 50 years in a couple of weeks,” Varmus said. “Like many of us old-timers, Joe came to the NIH initially as a member, as a commissioned officer of the Public Health Service in 1962, no surprise, and has served in many distinguished capacities as the organizations around him changed their names and structures, and he’s been the director of the DCEG since 1995 and has done a remarkable job.
“Many people around the world think his first name is Li, but he and his partner discovered the important Li-Fraumeni Syndrome that has been an object of great interest. But apart from that, Joe is known for remarkable leadership in an organization that is still going incredibly strong. Just in the last few weeks there’s evidence of the effects of radiation on pediatric populations, on the effects of diesel fumes on cancer causes and reclassification of diesel fuel and many other things that probably influenced the approach the nation takes to cancer control and understanding cancer.”
After Fraumeni retires, the division will be headed by an executive group headed by Margaret Tucker, director of the Human Genetics Program. The group’s other members will be Stephen Chanock, chief of the Laboratory of Translational Genomics, and Robert Hoover, director of the Epidemiology and Biostatistics Program.
Meanwhile, NCAB member Jonathan Samet, director of the University of Southern California Institute for Global Health, will head a committee that will consider reconfiguring the division, said Varmus.
NCI also needs to hire a director for the Center for Cancer Genomics and a director for the Center for Biomedical Informatics and Information Technology.
While Fraumeni’s successor will qualify for Title 42, the other two positions would qualify for higher pay only after NIH exhausts efforts to find a candidate willing to work for GS-15 wages—that is, between $123,758 and $155,500. Title 42 staff members can be paid as much as $375,000 per year.
“You are all aware that I started [the Center for Cancer Genomics] just after getting here, to try to bring together our many initiatives in cancer genomics, and after a search that didn’t lead to a permanent director, I was gratified to have my friend Barbara Wold, a professor of the lab at Caltech, a well-known geneticist, come on sabbatical for over a year,” Varmus said.
“But years end, and Barbara will be going back to Caltech in October, so we are going to have to be undertaking a search to fill her position,” he said. “This is a resumed search, but resumed under new bureaucratic conditions that require that filling a position viewed as lowly by some of my superiors requires some advertising first as a GS-15.
“This is patently absurd. We’ve done that, we have to exhaust the possibilities. Think about what you would have done at your own universities in you were faced with this you would advertise it as a more reasonable employment condition.”
The top job at CBIIT became open after director Kenneth Buetow resigned under pressure late last year. The center has been led by interim director George Komatsoulis.
“We have a search in the early phase, going through what we call exhaustion, because running informatics for a place like this is a huge job that requires tremendous expertise across a range of scientific topics,” Varmus said.
“Nevertheless, we are being beaten up by small-minded individuals who think that this should be a GS-15 position, and I’ve thought that this is an important position in the government, and if we don’t have experts doing these jobs, we are screwed.
“Let’s face facts and realize that doing searches in government is no longer easy.”
The Specter of Sequestration
NCI is assuming that the budget will remain flat in fiscal 2013 and the government will continue to operate on continuing resolutions, Varmus said.
The institute will fund the same number of research project grants, roughly 1,100 to 1,200.
“We’ve discussed the kinds of the changes that could be made at our institute retreats and we’ve had a very careful budget review with each division director trying to identify places where some reductions and spending and changes in program support could occur, but the effect on RPGs will be more or less, will be negligible in my view in 2013,” Varmus said.
The worst-case scenario appears to be budget sequestration.
This calamity—a $1.2 trillion cut—may occur in January, unless deals are made to cut federal spending. Both defense and social programs would be subjected to across-the-board cuts.
“The current estimate is that sequestration could affect NIH to the tune of about 8.5 percent of our budget,” Varmus said. “That, of course, is an astronomical amount if you consider that only a fraction of our budget is uncommitted each year so without changing other things dramatically, the number of grants we could issue in the next year would be about half the normal number, and since our success rate at the moment is around 14 percent or 15 percent, that means assuming the normal number of submissions, our success rate would be down around 8 percent.
“Totally unacceptable situation,” Varmus said. “Arguably, if the current situation is unacceptable, that would be bad.
“We have many friends in Congress who are unhappy about this and would like to find some way to protect the NIH if sequestration should occur,” he said. “How that would happen is certainly unclear. Any member of Congress you deal with is interested in trying to protect the NIH if this dire move should be encouraged.”
It’s difficult to imagine how sequestration would affect the NCI funding of investigator-initiated grants.
Now, grants scored at the 7th percentile or better receive funding automatically. The rest fall into the zone of uncertainty,” where they are subjected to another review, which often involves the institute’s top leadership (The Cancer Letter, May 4).
Provocative, Timely, and Other Big Questions
NCI Deputy Director Douglas Lowy said that 50 to 60 applications will receive as much as $20 million in funds to focus on Provocative Questions, Varmus’s signature program at NCI.
These R01 and R21 awards will go to the 24 questions picked from a pool of 750 applications, amounting to a success rate in the range of just under 8 percent.
Fifteen percent of the applicants were invited to face-to-face meetings with reviewers.
Two such meetings were conducted: one for R01 applications, and another for R21s. “We are still in a preliminary phase,” Lowy said. “We hope to be able to make awards in the very near future, following the concurrence of the NCAB.”
The RFA will likely be reissued, Lowy said. “In terms of going forward, we are planning to reissue the Provocative Questions, and it is yet to be determined the precise number of questions, how many of the current are questions will be retained and how many new questions will be added, and the dollar amount may actually go up somewhat,” Lowy said. “The initial one was slated at $15 million, and we are actually proposing to fund something closer to $20 million, and the renewal perhaps would be at about that level. This actually is consistent with the recommendations of the BSA when the Provocative Questions Initiative was presented.
Varmus said the reviewers considered the applications in-depth. “The decision to send applications on to the face-to-face review was not made simply by averaging three, four, five scores—but that we’d also like to identify applications that received a couple of good scores, maybe one or two not so good, or even bad,” Varmus said.
Since the RFA was designed to invite creative thought, the institute assumed that “some highly novel applications might not have fared so well at the hands of some reviewers,” Varmus said.
On July 18, NCI will convene a retreat, where Varmus intends to propose a new funding mechanism, called Timely Questions.
“How do we get pressing new issues that the NCI, cancer community, is facing into a fundable form and greater dispatch?” Varmus said, describing the program. “I’ve been frustrated by the slow motion of our administrative processes. By the time we actually get grants rolling, four years have gone by and I find myself with less hair than I had before, so it’s very irritating.”
Also, the retreat will focus on creating incentives for people to serve on NCI’s peer review groups, “getting discussion here last time about carrots and sticks—incentives vs. requirements, that I would like to change the attitude that folks have in the scientific community towards service of this kind, which is more like serving on the New York jury: once and not again,” Varmus said.
Another topic of discussion will be the new role of NCI and the institute director in the overall efforts to combat cancer.
“One of the things I’ve been thinking about is the extent to which the NCI, and especially the director of the NCI, can and should serve as the director of the Nation’s Cancer Program,” said Varmus.
The NCI director is designated as the head of the National Cancer Program by the National Cancer Act of 1971.
“It is increasingly unclear to me what it means to do that, because the NCI does not sponsor the majority of cancer research in this country,” Varmus said. “If you add voluntaries, and the advocacy groups, and industry, and institutional commitments together, NCI does not fund the majority of the work, when we have a lot of great things going on in other domains, whether it’s the Howard Hughes Medical Institute, or Stand Up to Cancer, or work sponsored by cancer centers out of their own philanthropic resources.
“So how does the NCI play a role? Well, I think one of the things we can do is to convene and we do a lot of convening, you’re all familiar with the provocative questions workshop, and some other workshop we held on team science and some other things.”
Members Rotating off the Boards
The following members have rotated off the BSA:
• Christine Ambrosone, professor of oncology and chair of the department of Cancer Prevention and Control at Roswell Park Cancer Institute
• Michael Caligiuri, CEO and director of the Ohio State University Comprehensive Cancer Center.
• Sanjiv Gambhir, the Virginia & D.K. Ludwig Professor of Cancer Research Chair in the Department of Radiology; professor in the departments of Bioengineering and Materials Science & Engineering; director of the Canary Center at Stanford for Cancer Early Detection; and a member of the Bio-X Program at Stanford University.
• Mary Hendrix, president and scientific director at Children’s Memorial Research Center and Medical Research Institute Council Professor at the Lurie Comprehensive Cancer Center in the Feinberg School of Medicine at Northwestern University.
• Timothy Kinsella, research scholar professor at the Warren Alpert Medical School of Brown University and the Department of Radiation Oncology of Rhode Island Hospital.
• James Omel, education and advocacy volunteer at the International Myeloma Foundation; volunteer at Multiple Myeloma Research; and a volunteer at the Leukemia, Lymphoma, Myeloma Society.
• Stuart Schreiber, Morris Loeb Professor and director of Chemical Biology at the Broad Institute of Massachusetts Institute of Technology and Harvard University.
• Victor Strecher, professor in the department of Health Behavior and Health Education at the University of Michigan School of Public Health.
The following members have rotated off the NCAB:
• Bruce Chabner (rotated off, but stays until appointment is made), director of Clinical Research at Massachusetts General Hospital Cancer Center.
• Anthony Atala, director of Wake Forest Institute for Regenerative Medicine, professor and chairman of the department of urology at Wake Forest University School of Medicine.
• Donald Coffey, the Catherine Iola and J. Smith Michael Distinguished Professor of Urology and professor of Urology/Oncology/Pathology/Pharmacology and Molecular Science at John Hopkins University School of Medicine.
• Robert Ingram, General Partner of Hatteras Venture Partners.
• Judith Kaur, medical director of Native American Programs at Mayo Comprehensive Cancer Center and a professor of oncology at the Mayo Clinic.
• Karen Meneses, professor and associate dean for research of the School of Nursing at the University of Alabama at Birmingham.
The National Cancer Advisory Board and the Board of Scientific Advisors jointly adopted a resolution to allow the institute to continue its use of the controversial Title 42 program to recruit and retain staff members.
The two boards met and sat at the same table June 25, for the first time in NCI’s history.
This largely symbolic joint action of the two boards comes at a time when critics in Congress have once again begun to eye the program used by NIH to pay some staff members more than the federal GS pay scale allows.
NIH institute directors, including NCI’s Harold Varmus, are Title 42 employees. This makes them, technically, consultants, critics have said. The program was established in 1944 to enable NIH to hire special consultants, usually part-time or full time on a temporary basis. It became widely used as a pay system five decades later.
Reliance on Title 42 appears to be a crucial aspect of Varmus’s overhaul of NCI.
This isn’t a new Tea-Party-conservative issue. Title 42 has been criticized by members of Congress for over a decade.
Four days before the BSA-NCAB meeting, at the June 21 hearing of the Subcommittee on Health of the House Committee on Energy & Commerce, several House members raised questions about Title 42, suggesting that they may impose legislative limits on its use.
The issue also came up in May at a hearing of the Energy & Commerce Subcommittee on Oversight & Investigations. At that hearing, NIH Director Francis Collins said that 24.8 percent of NIH employees were compensated under Title 42.
Addressing the two advisory boards, Varmus said that Title 42 is an “an essential tool for including and retaining strong scientists,” adding that efforts to restrict its use would “put us in too tight a box.”
The threat of enacting new measures to limit the use of Title 42 comes during a time of deep financial woes at NCI, and suggests that not only will NCI staff members will have to do more with less, but also that these high expectations may fall upon the staff members who may not be the best in their field.
Internal rules, in place for the past several years, compound the recruitment problem. NIH institutes can offer Title 42 positions to officials at levels as low as division directors. Positions below this level can still qualify for Title 42, but only after a national search fails to produce an appropriate candidate. This is known as the “exhaustion clause.” A search of this sort can take six to eight months.
For Varmus, recruitment has been particularly difficult, as his efforts to restructure the institute threaten to place institute divisions under interim leadership with severely limited chances of finding new permanent leaders.
Varmus is even changing the way NCI solicits advice.
Having the two boards meet together made it difficult to use the conference table usually used for advisory committee meetings. That table seats about 40, and it’s a tight fit. The combined meeting brought together 60 people, causing some board members to find seats in the audience.
While the boards have to remain technically separate, Varmus has said that, in recent years, their meetings have been largely duplicative. Now, the groups will meet jointly once a year in June.
“I’m working with Building 1 [the Office of the NIH Director] to see if we can have a larger room built here with a bit of a bigger table, but maybe we’ll wait a year or two and see when these joint meetings actually work out,” Varmus said at the meeting.
NCAB consists of 18 members appointed by the president. Six of the group’s members have to be representatives of the “general public,” which can include politicians or experts in law, policy, or economics. The board’s duties include reviewing grants, contracts, and cooperative agreements issued by the institute.
BSA has 35 members, all of them experts appointed by the NCI director. The board’s function is to “provide scientific advice on a wide variety of matters concerning scientific program policy, progress and future direction of the NCI’s extramural research programs, and concept review of extramural program initiatives.”
A Broader Problem
In addressing the two boards, Varmus said the recruitment problem confronting NCI is deeper than Congressional challenges to Title 42.
The root of the problem is the general lack of respect for federal employees, he said.
“It’s important in public discourse to stress the significance of these jobs, the difficulty that we have in an agency like the NIH or NCI of attracting talent away from the industry and academia, where much higher salaries are paid, and where the need to move with some dispatch of doing recruitment,” Varmus said.
“It’s time for all of us, in our roles as government employees and government advisors, to talk about how important it is to serve our country and to make sure these institutions represent the very best of what America is about—and that they are given proper accord in the press and the public debate,” said Varmus. “I think it’s outrageous that people are viewing government workers—who are doing great things with great intellects and insufficient salaries—aren’t given proper credit.”
When NIH is unable to attract and retain strong staff, other sectors are adversely affected.
“People think I’m just being self-serving, they don’t think that academia in particular, even industry, has any vested interest in having great people work in government,” Varmus said. “In fact, these guys on the outside have a huge interest in having talent in the NIH, and saying that is important. I’m not hearing it enough, I’m not hearing it from the administration, either.
“NIH will only be as good as the people we have,” Varmus said. “We have great people here now, but I can tell you that there are people I’m trying to retain at a time when they are being offered considerably higher salaries, and in some ways, a simpler life, in which travel is unrestricted, you don’t have to write a request for permission to hold a workshop that costs $20,000, which is a new edict that just got imposed on us, where you can serve coffee at meetings, all kinds of things that make life reasonable.”
In the midst of massive restructuring, NCI has been unable to fill some key vacant positions, which require “salaries we can’t afford to pay or aren’t allowed to pay,” Varmus said.
The institute has at least three big jobs to fill. The first is director of the NCI Division of Cancer Epidemiology and Genetics. The current director, Joseph Fraumeni, Jr., is retiring after half a century at the institute.
“It’ll be 50 years in a couple of weeks,” Varmus said. “Like many of us old-timers, Joe came to the NIH initially as a member, as a commissioned officer of the Public Health Service in 1962, no surprise, and has served in many distinguished capacities as the organizations around him changed their names and structures, and he’s been the director of the DCEG since 1995 and has done a remarkable job.
“Many people around the world think his first name is Li, but he and his partner discovered the important Li-Fraumeni Syndrome that has been an object of great interest. But apart from that, Joe is known for remarkable leadership in an organization that is still going incredibly strong. Just in the last few weeks there’s evidence of the effects of radiation on pediatric populations, on the effects of diesel fumes on cancer causes and reclassification of diesel fuel and many other things that probably influenced the approach the nation takes to cancer control and understanding cancer.”
After Fraumeni retires, the division will be headed by an executive group headed by Margaret Tucker, director of the Human Genetics Program. The group’s other members will be Stephen Chanock, chief of the Laboratory of Translational Genomics, and Robert Hoover, director of the Epidemiology and Biostatistics Program.
Meanwhile, NCAB member Jonathan Samet, director of the University of Southern California Institute for Global Health, will head a committee that will consider reconfiguring the division, said Varmus.
NCI also needs to hire a director for the Center for Cancer Genomics and a director for the Center for Biomedical Informatics and Information Technology.
While Fraumeni’s successor will qualify for Title 42, the other two positions would qualify for higher pay only after NIH exhausts efforts to find a candidate willing to work for GS-15 wages—that is, between $123,758 and $155,500. Title 42 staff members can be paid as much as $375,000 per year.
“You are all aware that I started [the Center for Cancer Genomics] just after getting here, to try to bring together our many initiatives in cancer genomics, and after a search that didn’t lead to a permanent director, I was gratified to have my friend Barbara Wold, a professor of the lab at Caltech, a well-known geneticist, come on sabbatical for over a year,” Varmus said.
“But years end, and Barbara will be going back to Caltech in October, so we are going to have to be undertaking a search to fill her position,” he said. “This is a resumed search, but resumed under new bureaucratic conditions that require that filling a position viewed as lowly by some of my superiors requires some advertising first as a GS-15.
“This is patently absurd. We’ve done that, we have to exhaust the possibilities. Think about what you would have done at your own universities in you were faced with this you would advertise it as a more reasonable employment condition.”
The top job at CBIIT became open after director Kenneth Buetow resigned under pressure late last year. The center has been led by interim director George Komatsoulis.
“We have a search in the early phase, going through what we call exhaustion, because running informatics for a place like this is a huge job that requires tremendous expertise across a range of scientific topics,” Varmus said.
“Nevertheless, we are being beaten up by small-minded individuals who think that this should be a GS-15 position, and I’ve thought that this is an important position in the government, and if we don’t have experts doing these jobs, we are screwed.
“Let’s face facts and realize that doing searches in government is no longer easy.”
The Specter of Sequestration
NCI is assuming that the budget will remain flat in fiscal 2013 and the government will continue to operate on continuing resolutions, Varmus said.
The institute will fund the same number of research project grants, roughly 1,100 to 1,200.
“We’ve discussed the kinds of the changes that could be made at our institute retreats and we’ve had a very careful budget review with each division director trying to identify places where some reductions and spending and changes in program support could occur, but the effect on RPGs will be more or less, will be negligible in my view in 2013,” Varmus said.
The worst-case scenario appears to be budget sequestration.
This calamity—a $1.2 trillion cut—may occur in January, unless deals are made to cut federal spending. Both defense and social programs would be subjected to across-the-board cuts.
“The current estimate is that sequestration could affect NIH to the tune of about 8.5 percent of our budget,” Varmus said. “That, of course, is an astronomical amount if you consider that only a fraction of our budget is uncommitted each year so without changing other things dramatically, the number of grants we could issue in the next year would be about half the normal number, and since our success rate at the moment is around 14 percent or 15 percent, that means assuming the normal number of submissions, our success rate would be down around 8 percent.
“Totally unacceptable situation,” Varmus said. “Arguably, if the current situation is unacceptable, that would be bad.
“We have many friends in Congress who are unhappy about this and would like to find some way to protect the NIH if sequestration should occur,” he said. “How that would happen is certainly unclear. Any member of Congress you deal with is interested in trying to protect the NIH if this dire move should be encouraged.”
It’s difficult to imagine how sequestration would affect the NCI funding of investigator-initiated grants.
Now, grants scored at the 7th percentile or better receive funding automatically. The rest fall into the zone of uncertainty,” where they are subjected to another review, which often involves the institute’s top leadership (The Cancer Letter, May 4).
Provocative, Timely, and Other Big Questions
NCI Deputy Director Douglas Lowy said that 50 to 60 applications will receive as much as $20 million in funds to focus on Provocative Questions, Varmus’s signature program at NCI.
These R01 and R21 awards will go to the 24 questions picked from a pool of 750 applications, amounting to a success rate in the range of just under 8 percent.
Fifteen percent of the applicants were invited to face-to-face meetings with reviewers.
Two such meetings were conducted: one for R01 applications, and another for R21s. “We are still in a preliminary phase,” Lowy said. “We hope to be able to make awards in the very near future, following the concurrence of the NCAB.”
The RFA will likely be reissued, Lowy said. “In terms of going forward, we are planning to reissue the Provocative Questions, and it is yet to be determined the precise number of questions, how many of the current are questions will be retained and how many new questions will be added, and the dollar amount may actually go up somewhat,” Lowy said. “The initial one was slated at $15 million, and we are actually proposing to fund something closer to $20 million, and the renewal perhaps would be at about that level. This actually is consistent with the recommendations of the BSA when the Provocative Questions Initiative was presented.
Varmus said the reviewers considered the applications in-depth. “The decision to send applications on to the face-to-face review was not made simply by averaging three, four, five scores—but that we’d also like to identify applications that received a couple of good scores, maybe one or two not so good, or even bad,” Varmus said.
Since the RFA was designed to invite creative thought, the institute assumed that “some highly novel applications might not have fared so well at the hands of some reviewers,” Varmus said.
On July 18, NCI will convene a retreat, where Varmus intends to propose a new funding mechanism, called Timely Questions.
“How do we get pressing new issues that the NCI, cancer community, is facing into a fundable form and greater dispatch?” Varmus said, describing the program. “I’ve been frustrated by the slow motion of our administrative processes. By the time we actually get grants rolling, four years have gone by and I find myself with less hair than I had before, so it’s very irritating.”
Also, the retreat will focus on creating incentives for people to serve on NCI’s peer review groups, “getting discussion here last time about carrots and sticks—incentives vs. requirements, that I would like to change the attitude that folks have in the scientific community towards service of this kind, which is more like serving on the New York jury: once and not again,” Varmus said.
Another topic of discussion will be the new role of NCI and the institute director in the overall efforts to combat cancer.
“One of the things I’ve been thinking about is the extent to which the NCI, and especially the director of the NCI, can and should serve as the director of the Nation’s Cancer Program,” said Varmus.
The NCI director is designated as the head of the National Cancer Program by the National Cancer Act of 1971.
“It is increasingly unclear to me what it means to do that, because the NCI does not sponsor the majority of cancer research in this country,” Varmus said. “If you add voluntaries, and the advocacy groups, and industry, and institutional commitments together, NCI does not fund the majority of the work, when we have a lot of great things going on in other domains, whether it’s the Howard Hughes Medical Institute, or Stand Up to Cancer, or work sponsored by cancer centers out of their own philanthropic resources.
“So how does the NCI play a role? Well, I think one of the things we can do is to convene and we do a lot of convening, you’re all familiar with the provocative questions workshop, and some other workshop we held on team science and some other things.”
Members Rotating off the Boards
The following members have rotated off the BSA:
• Christine Ambrosone, professor of oncology and chair of the department of Cancer Prevention and Control at Roswell Park Cancer Institute
• Michael Caligiuri, CEO and director of the Ohio State University Comprehensive Cancer Center.
• Sanjiv Gambhir, the Virginia & D.K. Ludwig Professor of Cancer Research Chair in the Department of Radiology; professor in the departments of Bioengineering and Materials Science & Engineering; director of the Canary Center at Stanford for Cancer Early Detection; and a member of the Bio-X Program at Stanford University.
• Mary Hendrix, president and scientific director at Children’s Memorial Research Center and Medical Research Institute Council Professor at the Lurie Comprehensive Cancer Center in the Feinberg School of Medicine at Northwestern University.
• Timothy Kinsella, research scholar professor at the Warren Alpert Medical School of Brown University and the Department of Radiation Oncology of Rhode Island Hospital.
• James Omel, education and advocacy volunteer at the International Myeloma Foundation; volunteer at Multiple Myeloma Research; and a volunteer at the Leukemia, Lymphoma, Myeloma Society.
• Stuart Schreiber, Morris Loeb Professor and director of Chemical Biology at the Broad Institute of Massachusetts Institute of Technology and Harvard University.
• Victor Strecher, professor in the department of Health Behavior and Health Education at the University of Michigan School of Public Health.
The following members have rotated off the NCAB:
• Bruce Chabner (rotated off, but stays until appointment is made), director of Clinical Research at Massachusetts General Hospital Cancer Center.
• Anthony Atala, director of Wake Forest Institute for Regenerative Medicine, professor and chairman of the department of urology at Wake Forest University School of Medicine.
• Donald Coffey, the Catherine Iola and J. Smith Michael Distinguished Professor of Urology and professor of Urology/Oncology/Pathology/Pharmacology and Molecular Science at John Hopkins University School of Medicine.
• Robert Ingram, General Partner of Hatteras Venture Partners.
• Judith Kaur, medical director of Native American Programs at Mayo Comprehensive Cancer Center and a professor of oncology at the Mayo Clinic.
• Karen Meneses, professor and associate dean for research of the School of Nursing at the University of Alabama at Birmingham.
