tv The David Rubenstein Show Peer to Peer Conversations Bloomberg September 17, 2017 10:00am-10:30am EDT
♪ david: what was the human genome project? dr. collins: the entire instruction book for an organism. david: was it harder to discover the human genome or be appointed by two presidents? dr. collins: both have certain challenges. david: how long do think people can keep increasing their longevity? dr. collins: we can tinker with the biology. david: what is the single greatest health challenge the united states faces today? dr. collins: more people died of opioid overdoses than car wrecks last year. it is just unbelievable. >> would you fix your tie, please? david: well, people wouldn't recognize me if my tie was fixed, but ok. just leave it this way. alright. ♪
david: i don't consider myself a journalist. and nobody else would consider myself a journalist. i began to take on the life of being an interviewer even though i have a day job of running a private equity firm. how do you define leadership? what is it that makes somebody tick? dr. collins, thank you for taking time with us today. you are the 16th director of the nih, the only person appointed by two different presidents, you are initially appointed by president obama and subsequently president trump. so as a person who co-discovered , the human genome, was it harder to discover the human genome or be appointed by two presidents? dr. collins: [laughter] i guess both of those had certain challenges associated. i did not expect to being this decision after january 2017 , i knew about the history as
well of and directors appointed by the president virtually , always have turned over when there is a new president. somehow they made a mistake and kept me on. david: so did president trump call you up and say he knew you had done a great job? how did that come about? dr. collins: i got a call that said we want you to come to new york and meet with trump at trump tower before the inauguration so he can talk to you and get a sense of whether you are somebody might want to keep on, so i went in. david: so you went to trump tower? dr. collins: i did. david: you seem to be a man of simple taste i suspect you are , not a big shopper in trump tower stores before? dr. collins: you are quite right. i rode the bus from washington to new york for my interview. i suspect i may be the only person who rode the bus to an interview at trump tower. but there you go. david: i'm sure that is true. how was the interview? dr. collins: i had less than half an hour with the president-elect for him to ask me some questions. a few other people in the room, also, so i wasn't sure how it had gone. i showed up and did the best i could to answer those questions and waited to see what would happen.
david: so the country is relieved, that you have the job. you mentioned your family. you were raised on a farm? is that right? dr. collins: i was. david: you were homeschooled. dr. collins: homeschooled, not because my parents were religious in persuasion and all, but because they thought the county schools where i grew up in the shenandoah valley in virginia were not up to my parents' standards. my mother was incredibly gifted as a teacher and she figured out early on how to get the process of learning to be something wonderfully exciting, and that is the gift she gave me and my brothers, this excitement about learning new things, which i carry with me to this day. david: you did this until the sixth grade and then you went to school? dr. collins: i think my mom was tired of teaching these four boys at this point and figured, ok, public schools in the city of stanton are maybe up to a better standard, so i started going to public schools. david: you were a musician, you had a band, how did you come to that? dr. collins: my dad was trained as a classical violinist.
he and my mom met at yale, she was getting her masters degree, he was getting his phd, and they went and worked for eleanor roosevelt in the depths of the depression, working to help coal miners get back on their feet. this was in west virginia. my dad fell in love with the traditional music they would play, the coal miners particularly the fiddle. , we did not have a television. so what did you do after dinner? either my dad would read charles dickens out loud or we would get out instruments and play. if you wanted to be in the family, you better learn to play something. [laughter] david: did famous musicians come to your house? dr. collins: people would drop by. perhaps the best-known was a sullen 18-year-old who showed up, brought along by a more senior, experienced folk songwriter and singer. the young 18-year-old turned out was having his birthday in our living room. he sang a few songs and had a terrible voice and no social skills and i was quite sure he had no future at all.
that of course, turned out to be bob dylan. david: did you ever meet him again? dr. collins: i did. [laughter] david: did he remember you? dr. collins: no. he denies the whole thing. [laughter] it was quite a bit later, maybe 10 years. david: you went to the college of university of virginia where you were an academic superstar. dr. collins: i was a bit of a nerd. i got excited about science in high school. i should give testimony to the importance of having good teachers. in high school. what got me interested from science did not come to my family. no scientists or physicians. it was that course i had in 10th grade at lehigh school. from my teacher, john house. david: you then went to yale to get a phd in what? dr. collins: chemical physics. david: what is that? dr. collins: quantum mechanics, mathematical, physical science. david: ok, so your parents were proud. you have a phd from yale, and now you're ready to get a job, right? dr. collins: you would think so, wouldn't you? [laughter] david: what happened?
dr. collins: here i was as a graduate student working late at night and there was a guy a floor above me working in the lab on dna. the more i read about it and talked to him about it and read articles about it, the more excited i got. this is an area of science ready to burst forward with all kinds of potential. frankly, i was feeling a bit lonely and a little bit like what i was rescuing in terms of quantum mechanics and second order differential equations that nobody could solve -- maybe that was not going to be my way of making the world a much better place and maybe there was something else i could do. david: so you got your medical degree? dr. collins: i was trying to figure out how do i put this all together as a medical student, my appreciation and love for digital information and mathematics, which is what i got out of physics, and figure out where does it all come together? with this messing -- messy thing called medicine. it came together in genetics. dna is digital information. it is something you can compute on. it is also fundamental to life
and medicine, so by the time i was halfway through my first year as a medical student, i knew i wanted to be a geneticist. david: let me talk about something you did that brought you to national fame and attention, the human genome project. what was it and why do we care about you having co-discovered it? dr. collins: good question. what is the genome anyway? it is the entire construction -- -- instruction book written in the language of dna for an organism, so we humans have a genome, and so do other living organisms. animals, plants, bacteria, they all have a genome. ours is pretty big. if you think of dna as a language, it is an interesting one. it has four letters in its alphabets, which we calla, c, g, and t. they are abbreviations for chemical bases. our genomes are 6 billion of those letters. 3 billion from mom and 3 billion from dad. that is a lot. although it is pretty amazing to contemplate that information and it seems to be sufficient to build a human being from a single cell.
when the genome project was started in 1990, we had little snippets, we knew very little. of dna information, and the whole thing loomed in front of us like an impossible task because our technology was nowhere near up to the ability to read that number of letters in any kind of measurable time. david: why is a person watching better off because we have this, or any human being better off because we have mapped the human genome? dr. collins: there are many questions about that. the whole thing got finished in 2003. there were some silly comments about medicine will be transformed in the next two weeks because of this. of course not. 6 billion letters that you do not really know the language of, it will take a while to figure out. what has happened now has been since then transformative since , then in medicine and particularly in cancer. cancer now if you develop that terrible disease, you want to know exactly what misspellings have happened in the genome of those cancer cells that are causing those good cells to go
bad, and that is a transforming capability that is affordable because of the genome project and has changed everything in the way we approach the diagnosis and treatment of cancer. david: today, anybody can have their human genome mapped for $1000. dr. collins: a little bit less. david: have you had yours? dr. collins: i have not had the whole thing read out, but i had a sampling of it. it was about eight years ago, when i was writing a book about personalized medicine and wanted to use myself as a guinea pig. i learned some things in the process of doing that about my own future risks that i found useful. one thing i learned is that my risk of diabetes was substantially higher than the average person based on my genetic inheritance, and that was a shock because that is not something that runs in my family. but my family are athletic people, so maybe they managed to avoid it. that was a point when i was not
athletic. i was indulging in too many muffins and honey buns and not doing exercise, and that was enough to motivate me to change all of that and lose 35 pounds and get an exercise program. i am a different person now than i would have been if i'd stayed on that path. david: muffins and honey buns are not healthy for you? [laughter] that is what you are saying. dr. collins: they are not healthy for anybody, i'm afraid. david: how much longer can people keep increasing the longevity? dr. collins: if you look around 1900, the average lifespan in the united states was late 40's, so we have dramatically expanded that. is human life extendable beyond 100? it is not clear that if we don't tinker with biology that we will get much beyond that point because there does seem to be a program here of limited lifespan, and frankly evolution cares about that. you have to get one generation out of the way so the next one has its chance. ♪
♪ david: dr. collins, in addition to being the director of the nih, you maintain your own lab at the nih in genetic research. dr. collins: particularly focused on diabetes and aging. david: what am i looking at? dr. collins: this machine basically analyzes dna, and particularly looks at places where there are differences in your dna and mine, because that is interesting stuff if you're trying to understand risks for diabetes. you see that flashing light? that spot has dna in it from a person, and the flash is a laser that blasts the dna into the gas phase and then it travels down a long tube in this mass spectrometer and it is measured
by its molecular weight, which can tell you what the actual dna sequence was. david: give me one or two examples of where you funded it and it became a very helpful to the health of individuals. dr. collins: sure. there is a long list of examples. let's take what has happened with heart disease. death rates from heart attack are down by 70%. why is that? part of that is the framingham study which we funded in massachusetts which taught us what the risk factors are that you could interfere with. we did not know how important hypertension was and how critical it was to treat it. part of this is drugs -- statins, the most commonly prescribed drugs these days. why do we know about them? it is because of basic science research done 30 years ago by nobel laureates brown and goldstein figuring out there was
, a critical pathway that controls cholesterol. and that you could interfere with that with the development of a particular drug. david: when humans emerged from caves 200,000 years ago or so, they were homo sapiens, the average life expectancy was 20. more or less. today, it is more or less in the developed worlds, maybe around 80, so we have increased our life expectancy by four times. how much longer can people keep increasing their longevity? dr. collins: so much of that happened in the last hundred years. if you look around 1900, average lifespan in the united states was late 40's, so we have dramatically extended that. is human life extendable beyond 100? it is not clear that if we don't tinker with biology, that we will get much beyond that point because there does seem to be a program here of limited lifespan, and evolution cares about that. you have to get one generation out of the way so the next one has its chance, but we are getting pretty smart about understanding the molecular
steps in aging, and maybe if we think it is a good idea, we might figure out how to achieve that kind of extension by tinkering a bit with biology. david: on heart disease, do think it is possible to eliminate all heart problems completely by diet, exercise, and statins? >> heart disease has a strong genetic component. if you are somebody in the family that has heart disease, that could apply to you. cholesterol is a big risk factor. if your cholesterol is above 200 and maybe even below that, reducing it reduces the likelihood of a heart attack, and so it is worth doing, so more and more people are getting this recommendation about statins. it is particularly important for somebody who has had a heart attack and is not one to another, to get on a statin and manage their cholesterol tightly. that is one of the reasons why people are living longer. david: what is the single greatest health challenge the united states faces today? dr. collins: right now it is the opioid crisis.
i am spending a huge amount of my time working with the director of the center of drug abuse. we have been to the white house several times and have a strong effort underway to work with the private sector to develop and implement quickly nonaddictive painkillers, because opioids are pretty effective for treating pain. we need something else that's not going to kill people. we can speed that up with help from the fda. if you look at what the current health crisis around us, that is around us, that is number one. more people died of opioid overdoses than car wrecks last year. just unbelievable the way this has come so quickly. david: five years or 50 years from today, what will this machine look like and what will we know that we don't know today? dr. collins: five years from today, these machines will not be used much anymore because they will be so cheap to sequence the entire genome for $100 that you would not bother to get subsets of the information. just do the whole thing, and it will be cheap and accurate.
the information five years from now, more and more people will have this done, their genome will be in their medical record. when they need a drug for some particular condition, the doctor will look at their dna and say is this the right dose for this person, or is it the right drug for this person, that whole idea of correlating drug response with genetics is a field ripe for exploration. and in five years, we will see a lot of that. 50 years from now, i suspect most babies will have their genome sequenced at the time of birth and that will be a way in which it can be planned how to make sure they get the best possible nutrition and medical care that they need, and we will have used the information to prevent an awful lot of diseases. i hope alzheimer's disease will be something you read about in a history book, and cancer will be a rarity, i hope. that is not out of the question. we are on that path. david: there has been a discussion about designer babies. is that a dangerous thing or not? dr. collins: with the ability to do gene editing, people are talking about this.
i am uneasy about the idea that we are smart enough to manipulate our future children in this way. most of the things that people talk about wanting to manipulate, like intelligence or athletic ability, are controlled by hundreds of different genes. the ability to do this accurately will not be reliable. plus, a lot of it is environment, child rearing. i often imagine this yuppie couple who want to have a designer baby, so they dial in all the things they think will make this kid a musician, first chair in the orchestra, and will be quarterback on the football team, and they forget to do the child rearing, so they end up with a sullen 16-year-old who is smoking pot in his bedroom and never comes out, because you have to do that part, too. david: how have you transformed yourself from an atheist or agnostic to a christian? dr. collins: i realized i was a scientist, i was supposed to make decisions about important questions based on evidence, and i never considered there might be evidence supporting the idea that there really is a god.
♪ david: you also are a motorcycle enthusiast. dr. collins: i am. david: is that safe? dr. collins: no, it is not. [laughter] david: as somebody who cares about health, how do you justify that? dr. collins: yes, that has been a question asked regularly. david: i am not the first person? dr. collins: no, my mom started this. i became a motorcycle rider in college because it was a cheap way to get around. i stopped riding motorcycles when my kids were little because i did recognize the safety issues. david: you don't do it anymore? dr. collins: i do. i started again. it is wonderful. david: do you do it still? dr. collins: i do. i ride my motorcycle to work many days. it is a harley road king classic. it is a beast, and it gives you a certain enjoyment of life that is hard to come by other ways. david: talk about another part of your life. when you were younger, if not an atheist, you were agnostic. how did you transform yourself from being an atheist or agnostic to somebody who is a committed christian? dr. collins: it seems like an
odd story, doesn't it? growing up on the farm, my parents were not opposed to religion. they did not think it was particularly relevant, so i had no religious background. i got to college, those conversations in the dorm about what did people believe. i did not think i believed in any of it. so i was an agnostic. by the time i got graduate school, i was shifting to be an atheist, even more and i was not , too comfortable keeping quiet as somebody was talking about the supernatural. it is all about nature and how you study it and describe it. then i went to medical school, and that third year of medical school where you are thrust out on to the wards and are sitting bedside with wonderful people whose lives are under threat and many who will not survive, you realize your own thinking about life and death has been pretty unsophisticated compared to the reality of what these people are facing. i realized i was a scientist and was supposed to make decisions about important questions based on evidence and i never
considered whether there might be evidence supporting the idea there really is a god. i just assumed the answer was no. that was a bit unsettling, but it seemed like something i should not ignore, so i began asking those people i knew who were believers, how can you do this without checking your brain at the church door? isn't this just a perfect example of irrationality? and they told me, well, actually no. there is a pretty profound rational basis for faith. you might start by reading cs lewis. i had never heard much about cs lewis. picking up some of the things he had written, particularly mere christianity, made it clear to me, oh my gosh, there is a compelling intellectual, , rational basis for faith which i had totally missed and assumed did not exist. it took me a couple of years of fighting against that, trying to prove that this was all wrong and that i could stick with my
agnosticism, but ultimately i realized i couldn't and that it was so compelling. i had to figure out which of the ways of understanding god is going to be the one that i can make the most sense out of. after many considerations of various faith traditions, ultimately the person of jesus appealed to me in a remarkable way as a historical figure, not a myth, who had answers to questions i needed answers for, and whose life, death, and resurrection seem to be remarkably well documented. david: so your view would be for example that what is in the , bible is allegorical, not to be taken as absolute fact. in other words, the bible would say maybe the earth is a couple of thousand years old, scientists would say it's much older, 5 billion years old, so how you reconcile those two different strands of thought? dr. collins: a lot of people are tripped up by what they interpret as a conflict between a literal interpretation of genesis one and two, and what
science teaches us very convincingly about the age of , the universe, almost 14 billion years, and the age of the earth, almost 5 billion years, but that idea there is a conflict, is a fairly recent arrival on the scene. if you go back and read saint augustine in 400 a.d. who was obsessed with what genesis is trying to tell us. about our origins. he would have been the first to say that this literal interpretation of 24 hour days is absolutely unjustified based on the original language and the way in which the audience for the original genesis one and two stories would have interpreted it. somehow we particularly in the united states over the course of the last 150 years have taken something that was clearly wasn't written in the way that had a lot of ambiguity and insisted it had just one possible interpretation. so i wrote a book about a lot of , this perceived conflict. because for me, there really has never been one between what i know as a scientist, where if
you're going to ask me a question about nature, science is going to be the way to get the answer but also somebody , interested in questions science can't answer, like is there a god and why am i here. david: what recommendation would you make to young people about what they should do with their careers, and have you ever thought about you could've gone into the private sector and made a great deal of money? given your brainpower? dr. collins: it comes down to what do we hope to do in that brief time we are on the planet. what are we going to assess our contribution by? right now, i would say medical research is very much near the top of the list opportunities people have because it is such an exciting time. we are making progress at a pace now, there would have been unimaginable a few decades ago. if you want to spend your time working hard, but feeling you made a contribution to help people who are suffering this is , the great way to do it. and money alone is probably not going to give you that same satisfaction. ♪
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