A conversation with the Nobel Laureate and President of Rockefeller University.

Paul Nurse: Creativity is the core of great science.

I am Paul Nurse and I’m President of Rockefeller University.

The training and also the way of actually carrying out the profession is quite different between a scientist and a doctor, understandably so. That’s not a criticism of either side; it’s just how it is. So then we mix two sorts of people like this together, in the same activity, and we expect them to work together, it’s like mixing somebody who only speaks English with French and assuming that it is going to work, it won’t.

So what do we do about that? First of all recognize the problem and analyze it. And then secondly, we have to deal with it. We have to get the two types of individuals to understand their differences, to see where they are coming from, to realize why they have differing views, and how they can perhaps work best together.

Do you think any of us in the biomedical profession take the slightest bit of notice of trying to do that? It smacks of Sociology and stuff like that. We don’t. But this is something where we really need to think in the future.

Have I applied it successfully in my own work? My own work has tended not to involve directly medicine, so I’ve not being exposed with my own research in that way. But I have seen it many times in my colleagues, and because I’ve led research institutions, and I’ve done my best to, at the very least, get mutual respect on both sides of that divide.

I actually think we need a much more professional approach on that problem. I would say it’s key for greater success in this area.

Question: How can we improve preventative medicine?

Paul Nurse: Prevention is really important. It’s often not given the airtime it should by the scientists themselves because it’s quite a difficult subject to study and often requires very long-term trials, sometimes over decades, with large numbers of individuals before you can get good statistical results. It doesn’t fit in well with a normal scientific career. If you got a PhD of four years, say, knowing that you’re participating in a study that takes 20 years to carry out, it just don’t fit. It’s quite difficult to do good work in some cases in this area.

It’s also a very complicated issue. We all know of individuals who’ve smoked 40 cigarettes a day, who live till 90. But of course we know that if you do smoke 40 cigarettes a day on average in the population, your life expectancy can be reduced 15 or 20 years (I forget exactly the number). So, it’s a hugely negative impact upon your health, even though certain individuals may actually survive that.

Understanding the interaction between the impact of environment with genetics, is really crucial in getting good preventative advice out there. But, this makes these epidemiological studies, that’s population-based studies, as their called, even more difficult, because you’re not only then trying to simply control for whether an individual is exposed to a particular environmental impact, such as the sun or tobacco or whatever, which is difficult enough in itself, but you’re also saying we need to subdivide the population up according to their genetic make up to get good results. And we may not even quite know how to divide them up and which particular variant of genes are important.

These are difficult problems but we are beginning to get into the territory where we can perhaps address them. Maybe that will help us put to rest a lot of the quackery that can go round advice about prevention. I would really like to see that because there is so much nonsense published out there. The media like it because it’s relatively easy to understand, and it’s a scare story.

If we ask questions like, “Is butter good or bad for you?” I can never remember because what was the last thing I read about it? Usually the reasons that we, as a public, get confused about such matters are that are reported are actually pretty small, and it all depends on the context of the trial, let alone the genetic make up the individuals involved in it. And we get blown around like a weather vane by just the latest report which is often made to be rather sensational.

I see this being rather slowly developed, because the studies have to be so long-term, and we’re not yet in a good place for looking at the interactions between genetics and environment well. But I think it’s really important because if we can give good advise to individuals about what their lifestyle is, that’s going to have the big impact.

Question: How important is measuring outcomes?

Paul Nurse: Measuring outcomes, particularly in cancer, is actually crucial because if you make incorrect assumptions in the way you’re doing analysis, things go bad rather quickly actually because you get statistics that show certain cancers, or certain diseases, are dramatically increasing, when it may be only that we are diagnosing them better, and then everything goes wrong in trying to think about it.

What I think about this public health issue is that by having better diagnosis, I have talked a little bit about how you can use molecular tools to get better diagnosis, which I think will classify disease better, by using more modern techniques and applying them in sensible ways, I believe we are likely to get better information upon which public health statistics can be acquired. I do think it’s important because that public health information is going to be important for the population-based studies that are necessary to understand prevention better, the genetic effects and environmental effects. If we have imprecise information there, we’re going to get deeply misled. And, once again, will give rise to quackery because people will read, maybe allergies have increased tenfold or something, and then they say this is due to pollution or whatever, because this is how the way people think when in fact it may have nothing to do with that, and we get campaigns in favor of certain approaches which is simply totally misplaced.

One example, which was really close to a tragedy, was the so-called “triple jab” for immunization of young children against several diseases. There was very flawed research which suggested that giving the three vaccines together would cause autism. This was barely taken seriously by the clinical community because the data was not very good. But because it got such public support, this changed the way immunizations were being carried out, and then led to a rise of the very diseases that you’re trying to eliminate. That’s a consequence of not reporting properly the data that you have, because autism was seen to be on the rise, in particular circumstances, when in fact it was simply being diagnosed better and it appeared at a certain time in life when these inoculations were given.

Accurate information about disease and disease onset is crucial for good prevention and good heath care delivery.

Question: What is the single greatest threat to global health?

Paul Nurse: This will be a strange answer but it’s: arrogance that we think we know what to do.

There’s a variety of diseases out there which are of significance to global health, the infectious disease, but also in more westernized nations, issues to do with cancer, obesity, heart disease and the like.

I think the biggest challenge is arrogance. We still do not know enough about these diseases. We still do not know how to deliver care in the most effective way. Even though there is quite a lot of money sometimes aimed with very benevolent intentions, we think of institutions such as NIH investing in diseases in the developing world, of Gates Foundation, the Welcome Trust and the like. But often we do not know enough about the disease or how to deliver it in our own more advanced societies, let alone in underdeveloped communities in Africa.

We have to accept that we don’t know the answers and put more input in to how we deliver that than simply thinking we can go to Tanzania and put a hundred million dollars there and solve the problem, because often it ends up simply not dealing with the problems.

So I think it’s arrogance at all levels, both in not understanding the nature of the disease, and thinking all the basic research has been done, it has not. It’s thinking that we now know how to treat it in particular ways, often high tech ways, but perhaps not the most effective ways, we should do get better treatments, we still don’t know that. And then trying to apply it in countries where there isn’t 24 hours electricity every day, so you can’t refrigerate samples and so on, means you have to take a completely different approach to how you deliver medicines and health care.

Arrogance is my number one bogey in this. That’s what we have to get rid off.