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Decoding Cancer

— A conversation with Harold Varmus, MD, who received the Nobel Prize in Physiology or Medicine in 1989

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"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on , , Amazon, , , and .

A pivotal development in the history of cancer research was the discovery that cancers can arise from mutations in genes already present in normal, healthy cells.

Joining Henry Bair and Tyler Johnson, MD, in this episode is , who shared the in 1989 with his colleague, J. Michael Bishop, MD, for this discovery. Their work has enabled scientists to explore why certain cancers develop in the human body and how we can develop better cancer treatments that target these genetic mutations.

In addition to his pioneering research, Varmus has served as director of the and the National Cancer Institute, of Memorial Sloan Kettering Cancer Center in New York City, and an advisor to the U.S. government, the World Health Organization, and various other foundations and academic institutions.

Over the course of our conversation, Varmus describes his groundbreaking research, approach to institutional leadership, and his advocacy for the democratization of scientific knowledge through his role in the founding of and the .

In this episode, you will hear about:

  • 2:56 Varmus recounting how his broad educational interests led him to pursue a medical career
  • 8:48 How working at the National Institutes of Health drove Varmus's passion for research and the trailblazing path his career took
  • 16:35 A summary of Varmus's research on retroviral oncogenes, which led to major advancements in cancer diagnosis and treatment
  • 27:13 How Varmus became involved in the politics of science after receiving a Nobel Prize
  • 30:28 Varmus's mission while he was director of the National Institutes of Health and his perspectives on the elements of effective healthcare institutional leadership
  • 32:37 A discussion of open access publishing, a mechanism of distributing the results of scientific research online for free

Following is a partial transcript (note errors are possible):

Bair: Dr. Varmus, it's an honor to have you with us here today. Thank you so much for being here and welcome to the show.

Varmus: Thank you.

Bair: So there is so much for us to explore. Throughout your career, you have been a researcher, educator, science communicator, policymaker, and more. But first, I'm hoping you can take us back to the start of your career. In particular, I know that you dedicated a lot of your higher education to the study of English literature. That's fascinating for me, since I studied medieval Celtic and Anglo-Saxon literature during college. So, tell us about your path to medicine. What was the beginning of that path? Did you know, even as you were reading Beowulf, that you wanted to embark on a medical career?

Varmus: Well, college wasn't exactly the beginning. Of course, we're not going to go back to conception, but we might go back to childhood. I grew up as the child of suburban New York parents who exhibited a trait that's pretty extraordinary in America. They were the children of immigrants. All four of my grandparents were immigrants, and yet they got to go to Ivy League colleges and did work in health professions.

And I grew up with a default position, which was to become a doctor because my father was a doctor, my mother was a psychiatric social worker. They exhibited those great traits of generosity and public service, and that was sort of in our bloodstream as we grew up. But along the way, especially through a summer as something called the Putney School summer art camp, and later in my experience as an undergraduate at Amherst College, I got exposed to a lot of other things.

You describe my career as being very broad. There were different kinds of activities, but all of it turned out eventually to be in the biomedical sciences. But when I was growing up, I suddenly got exposed, especially in college, to a lot of other fields of interest. And one of those, not the first, but one of the first, was English literature. And as you say, I majored in it. I went to graduate school in literature for a while. That's where I read Beowulf and in Anglo-Saxon.

And those were all important experiences. But then the story gets more complicated, because I wasn't a totally happy graduate student, and I decided that other college classmates were having more fun and were more inspired doing medical school studies. And I decided to give medical school a try after all, with a very different kind of ambition than I ultimately developed, and that I thought I would go to medical school, in part because it seemed to open the doors to lots of directions.

And I was interested in psychiatry, partly because of my extensive readings of Sigmund Freud, and in part because I thought at that time I wouldn't agree with this. Now that psychiatry could open up important windows into the understanding of literature, I don't credit that approach too much anymore. But at the time it seemed like an attractive way to go. A lot of doctors became writers later in life, W. Somerset Maugham and many others. I like being a student and I was interested in spending more time as a student and not joining the Armed Forces, which was on the horizon then. This was the early days of the Vietnam War -- going to medical school and seeing if it took and if it allowed me to go through a door that I did or didn't appreciate was open to me at that time, that seemed like a reasonable thing to do.

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