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NIH Director Francis Collins: A Trump Fave or A PlaceHolder? And Does it Matter? (Part One)

Hillary Johnson

We are temporarily interrupting our Numerology series for a news update on the status of Francis Collins, NIH director since 2009.  In an unusual move, the new administration has asked the director of the NIH to remain on the job--for now.  Is Francis Collins a darling of the far right? All signs point to “Yes.” Nevertheless, other candidates are eager to succeed him. Does his popularity have anything to do with his religious beliefs?  Quite possibly. Lastly, if Collins should stay, will it make a difference to M.E. sufferers? The story, in two parts:

On January 19th, just 24 hours before Francis Collins' resignation from the job of NIH director became official, Donald Trump decided to keep Collins on the job--for the time being.  The specific phrase used by an NIH spokesperson to describe the transaction was "held over," suggesting Collins' future at NIH is far from certain.  As far as NIH staff are concerned, however, Collins is neither "acting" nor "deputy." He remains officially "director" on the NIH website.  As a press agent inside the office of the director described the arrangement in an email, "Collins continues to lead the agency at the pleasure of the President."  In theory anyway, only the deciders in the White House have the inside track on whether Collins will ride out all four years in a Trump administration or be asked to step down in favor of any of several other contenders.  

Directors of both the NIH and the Centers for Disease Control are political appointees and are required to submit their resignations at the end of every administration.  Indeed, both serve at the will of the president.  Rarely are CDC and NIH directors asked to remain when a new president assumes office. Unlike the secretary of the Department of Health and Human Services (DHHS), however, they are not vetted by Congress, as was former Republican congressman Tom Price, Trump’s choice to head that agency.  They do, however, require confirmation by the Senate.  Because Collins went through a Senate confirmation process in 2009 when he was appointed to his post by Barack Obama, he will not be required to run that gauntlet again. 

CDC's director Tom Friedan, who like Collins was nominated by Obama in 2009, did not fare as well. The Trump administration accepted Friedan's resignation and his deputy, Anne Schuchat, a CDC veteran of 30 years, was named acting director. 

The last time an NIH director remained on the job at the behest of an incoming president was in 1960; James Shannon held the directorship from 1955 to 1968.  The shortest tenure for an NIH director was three years, when the late Bernadine Healy, the only woman to serve as NIH director, ran NIH from 1991 to 1993. 

Collins is fairly unique among scientists, given his status as a born-again Christian. His outspoken mingling of Christianity and evolutionary science could make him a desirable choice to the hard-right conservatives who surround Trump.

At least three other candidates are rumored to be under consideration for the NIH post, however, according to STAT, an online magazine that reports on health and medicine as well as government policy. Two are Congressman Andy Harris of Maryland and Dr. Patrick Soon-Shiong, a “biotech billionaire.”  Both Harris and Soon-Shiong, like Collins, have met with Trump.  Harris is a former anesthesiologist who participated in NIH-funded research while at Johns Hopkins University; he opposes human embryonic stem-cell research and--no surprise--is a staunch opponent of the Affordable Care Act. He has said he would like to realign NIH spending with diseases that afflict the greatest number of people, citing Alzheimer’s.

Soon-Shiong, a South African native, is said to be the "richest man in American medicine,” with a fortune estimated at $9 billion.  He is a surgeon, biopharma executive, entrepreneur and philanthropist.  He has met with Trump twice and has proposed that Trump name him the American health care “Czar,” allowing him to oversee the entire health care system and other aspects of American medicine, including “winning the war on cancer.” 

Yet another man rumored to be under consideration for Collins’ job is Stanford epidemiologist John Ioannidis.  Some may know Ioannidis for his famous article in which he suggested that the findings in most scientific studies are probably wrong.  Ioannidis told Nature that “If they (the Trump administration) call, my first priority would be to make sure there are no strings attached in promoting any anti-science ideas,” specifically, Ioannidis added, research exploring whether vaccines are related to autism. Given that the only medical topic in which Trump has expressed specific interest is precisely that line of research, one wonders how long Ioannidis will remain in the running if indeed he is still a candidate.   

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In response to queries from reporters in the weeks after the election, NIH’s Collins seemed pacific on the matter of whether he would be reappointed director of the $32 billion NIH, noting that if he was not asked to remain as director, he would either return to his lab at NIH, which studies the genetics of diabetes and aging, or try something else, though he would not speculate on what that might be.

NIH Director Francis Collins, DHHS Secretary Tom Price and CEO of the NIH Clinical Center James Gillman

According to a report in Science by Jocelyn Kaiser on January 19, however, the reality was slightly different.  “Collins has been campaigning to keep his job,” Kaiser wrote and, in fact, she reported that Collins had made the pilgrimage to Trump Tower in New York City the week before, on January 11th, to lobby the president-elect for the NIH directorship. Trump met with Rep. Andy Harris the same day.

It’s hardly a secret that Trump’s appointments to high level government positions have rocked many federal agencies to their core.  Former Georgia Republican Tom Price, whose agency, DHHS, oversees the NIH, is anti-abortion and pro-gun, would like to see Medicare entitlements cut and has been one of the most vocal opponents of the Affordable Care Act.  Price has also been a long-time proponent of defunding Planned Parenthood and supports the right of insurance companies to deny women insurance coverage for birth control.  Price is, of course, Collins’ boss. Working in Collins’ favor is the fact that he appears to have strong support among far-right, powerful Republicans in Congress.  On December 2, 2016, four of them signed a letter to Trump urging him to keep Collins in place. 

Oklahoma’s senator Tom Cole, who sits on the senate subcommittee that appropriates money to the NIH, was one.

Roy Blunt, a Missouri senator who was one of two “masters of ceremony” for Trump’s swearing in and who has called for the Senate Intelligence Committee—of which he is a member—to investigate the relationship between Trump and Russia (as opposed to engaging an independent special prosecutor), was another.

Michigan Rep. Fred Upton, chair of the House Energy Committee who agrees the earth is warming but denies that greenhouse gases are the cause, was the third.

Tennessee senator Lamar Alexander, another Affordable Care Act opponent, was the fourth.

In addition, Collins has been a good friend of the ultra-conservative, one-time presidential candidate Newt Gingrich for two decades.  The latter was reportedly on a short-list of three candidates to serve as Trump’s vice president (Chris Christie and Mike Pence were the others.) Although Gingrich was not invited into Trump’s cabinet, he was one of Trump's top campaign advisors and for several weeks was a surrogate for the president on cable TV news. 

In December of 2016, Collins was interviewed about the possibility that he would remain at NIH and his friendship with Gingrich at the yearly World Economic Forum, an annual gathering of political and business elites, in Davos, Switzerland.  He said Gingrich had befriended him 20 years earlier at Davos and that he had remained friends with the Republican ever since.

"I have had interactions with Newt every few weeks, and that includes since the election. It’s my routine," Collins told another news source in December 2016.

Gingrich is about as colorful a politician as one could hope for.  A thrice-married congressman from Georgia, he was the House Speaker who led the Republican charge to successfully impeach President Bill Clinton.  Afterward, he was charged with ethics violations by his House colleagues and eventually resigned from Congress.  He has since admitted to having an extramarital affair with a House staff member twenty years his junior while leading the impeachment effort. He divorced his second wife to marry her.  The affair was unrelated to his ethics violations, which involved lying. Gingrich’s first wife, whom he wed when he was 19, had been his high school geometry teacher.  She was 26 at the time of their marriage. He has had a lifelong fascination with dinosaurs and space travel.  He converted from Southern Baptist to Roman Catholic in 2009.

Newt Gingrich

The derivation of Collin’s right wing support likely springs in some part from his intellectual leadership in the evangelical Christian cosmos.  Collins scientific bona fides have never been in question: he led the prestigious $3 billion Human Genome Project for the NIH in the 1990s and also discovered genes that predispose to cystic fibrosis and other diseases.  However, he is simultaneously an influential and popular born-again evangelical who lectures and writes books that studiously blend the gospel of Christ and evolution, a philosophy generally referred to as “creationism"--a fundamental conviction that faith in Christ and a belief in evolution are not exclusionary.  It's a philosophy that hard-righters likely find not merely appealing but vanishingly rare in a scientist of Collins’ standing.

‍Collins converted to Christianity in medical school.  At the time he was a self-described agnostic 27-year-old. His transition was bolstered by his reading of C. S. Lewis.  In addition to writing children’s fantasies like The Chronicles of Narnia, Lewis was also a “Christian apologetic” who sought to defend Christianity on historical, evidentiary grounds. 

“My life was turned upside down” by reading Lewis’ influential work, Mere Christianity, Collins has said. 

Over the years, the 66-year-old Collins has spread a gospel inspired by Lewis’ ideas and, like Lewis, is today frequently characterized as a Christian apologetic.  In 2007, Collins published The Language of God: A Scientist Presents Evidence for Belief.

That same year, he created The Biologos Foundation.  There are differing philosophies or degrees of “creationist” belief, but currently the Biologos website states, “We affirm that the Bible is the inspired and authoritative word of God. We also accept the science of evolution as the best description for how God brought about life on earth.”

Collins is a member of the National Academy of Sciences.  In 2009, Pope Benedict XVI appointed Collins to the Pontifical Academy of Sciences.

During a discussion orchestrated in 2014 by the Huffington Post on the subject of "theistic evolution" at the annual Davos event, Collins said,

"If you are a believer in God, it’s hard to imagine that God would somehow put this incontrovertible evidence in front of us about our relationship to other living organisms and expect us to disbelieve it. I mean, that doesn’t make sense at all. So as soon as you kind of get over the anxiety about the whole thing, it actually adds to your sense of awe about this amazing universe that we live in, it doesn’t subtract from it at all.”

Breibart News, the notorious right wing website founded by Steve Bannon, Trump's top White House strategist and former campaign manager, reported on the 2014 debate and in fact has published several stories over the years featuring Collins in a flattering light. 

Collin's stance on abortion is nuanced and relatively liberal. Not infrequently, he has found himself in a tight spot with evangelicals as a result.  Typical of the conflict is this comment, which appeared in a discussion on a Christian website Touchstone in 2009 after Collins' appointment as NIH director: 

“Collins needs to come clean. Either he upholds the dignity of human life or he doesn’t. If he does, and he accepts the nomination to head the NIH, then it seems that he is deeply compromised as a professing evangelical Christian. If he does not, then the evangelical community needs to know. For his appointment to this position has the potential to cause great harm in the way of moral confusion to many unsuspecting evangelicals as long as his views on nascent human life remain veiled behind a cloud of sophistical rhetoric.”

Collins has antagonists in the scientific community, as well, but those criticisms have nothing to do with his religion.  In December 2016, University of California at Berkeley biologist Michael Eisen urged Trump to replace Collins, accusing the latter of

"...systematically diverting funds from investigator initiated projects in favor of  “big science” projects conceived in and managed from inside the Beltway...The model for these initiatives is the well-regarded Human Genome Project. However Collins, who headed this project in its final years, learned all the wrong lessons from this effort, focusing on central planning and control, and the generation of massive datasets, while ignoring the importance of technology development. Hence his signature projects as NIH director have been ill-conceived and wasteful of precious research funds."

Eisen has a point.  Last December, a University of North Carolina blog, Translational Research, reported that when Collins was asked what project in NIH's current portfolio most excites him, Collins named the Precision Medicine Project.  This "...unprecedented study of national health," as Collins described it, seeks to enroll one-million Americans, mining each applicant for demographic and medical data, ultimately including maps of their genomes.  "With a million people you’re going to have 80,000 to 100,000 diabetics, for example," Collins said, "and if you want you can offer to those folks an opportunity to test out some new biomarker for diabetic control."

End of Part One

Next:  Should M.E. sufferers care whether Collins remains director of NIH?

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