As Physician And Senator, Bill Frist Tries D.C. Balancing Act

Interviewer: Thomas W. Durso Editor's Note: Bill Frist is the only United States senator ever to hold a medical degree. The Tennessee Republican was trained as a heart and lung transplant surgeon and is a former biomedical researcher at Vanderbilt University. Without any prior political experience, he ran for the Senate in 1994 and won 56 percent of the vote, defeating a three-term incumbent. In his short tenure, Frist has emerged as something of a science spokesman among politicians. With Republicans controlling both houses of Congress, he holds key science-related committee positions, chairing the Commerce, Science, and Transportation Committee's Subcommittee on Science, Technology, and Space, and the Labor and Human Resources Committee's Subcommittee on Public Health and Safety. In the latter post, he is overseeing the writing of the National Institutes of Health's reauthorization, a process that raised the hackles of some scientists during its most recent go-around in 1993. The Senate in late May voted 98-0 to support a nonbinding resolution cosponsored by Frist that called for a doubling of NIH funding over the next five years. Associate Editor Thomas W. Durso recently sat down with Frist in the senator's Capitol Hill office to chat about NIH reauthorization, the difficulties in balancing greater science funding with fiscal responsibility, and the relationship between scientists and politicians. PRESCRIPTION FOR FISCAL HEALTH? Bill Frist, the only physician in the Senate, heads the subcommittee that will write the National Institutes of Health's reauthorization bill. He says he wants to see how NIH sets its research priorities. Q I'm sure our readers would love to know what they might be able to expect out of the NIH reauthorization. A We'll be having a series of hearings. The first one is in terms of prioritization. One of the biggest frustrations that has been manifested to me in the last two years that I've been here is the lack of understanding by my colleagues on how science is prioritized within individual organizations. . . . We have to be accountable to the scientific community in the same way the scientific community has to be accountable to us. So we're going to look internally, with NIH and others, [to see] how they prioritize, and then ask my colleagues, how do we prioritize based on that information? We kick it off with the [hearing on] NIH process for setting research priorities [described previously], and then [hearing number] two, principles for allocation of federal funds and setting research priorities. And then, number three, impact on academia, research community, and private industry. The fourth [hearing will address] public input into the NIH decision-making process-again, coming back, broadly using NIH as a model, because we are reauthorizing that, looking at how science and medical research is prioritized. Q Given your background, you have a much greater insight into these issues than many of your colleagues. Do you have a sense of how the prioritization should be? A I'm very careful not to inject my personal views, at least early on, in this hearing process. I tend to go back in the broader sense on three principles when I look at this reauthorization process. . . . [First,] what is the science [and] what is good science? [Let] good science speak for itself, outside of the political arena. That immediately cuts through partisanship. The second principle is that of accountability. That really depends on things like oversight-how much time do we have in terms of oversight, as the United States Congress? How much time do we have to look at the overall process itself, instead of looking just at numbers that come through? That argues for really stepping back and giving ourselves more time, in the United States Senate, to review the science as it comes forward. Right now, there's very little of that time; therefore, by default, we end up [focusing on] the latest disease. The third principle is, how measurable are the results? And that really takes that long-term, as well as short-term, view. The tendencies among many politicians today is to look shorter-term, to look at what the latest polls show, to survey people and see what means the most to them right now. I argue that when you take the much longer view, and that comes from my experience with science, the great breakthroughs do come through-many times serendipitously; many times out of just straight, basic science; and many times not till 10 years or 15 years after an initial project was begun. Q There is some consternation among our readership that your colleagues here don't fully understand how the whole scientific process works or how the funding process works. Can you hope to educate your colleagues in that regard? Or is that up to the scientists? A Scientists many times come to me and say, "This is the problem. You, Bill Frist, Senator Frist, only scientist in the United States Senate, really need to fix it." My message to scientists is that we together need to fix it, that we need to pull out the public aspects of science. The ability to communicate the importance of science has to come from the scientific community. I surely can facilitate that, and can set up the forum in the United States Congress, so that it can be adequately and fairly presented in a balanced way, and I see my role more to set up the structure through which that communication can take place. . . . Superimposed on all of this is the limited resources that are going to be available in the future. And that's driven by another issue: the overall growth of entitlements, which, given the trends of the last 30 years, is going to continue to squeeze out research and development. I say "squeeze out" because, by the year 2012, if we don't do something, and we don't change the growth of entitlements, all moneys that are spent on research and development, and infrastructure and roads, and education, and national parks, and environment-all of those moneys will be gone, and all of the taxpayer dollars coming in are going to be spent on the entitlements and interest on the debt, with no money left over. People need to recognize that, especially the fact that the research moneys are decreasing in today's dollars; yet the value, we know, is very real. Q You mentioned earlier the need to convince your colleagues here that science is a long-term investment. How do you convince the American people of the same thing? A The realities today are that politicians listen to the American people, broadly going back to this polling and surveying that goes on. . . . Therefore, I think our scientists and research community have to come forward to the members of Congress, but ultimately [they] have to make their case to the American people. Thus, [the people] sitting at home, back in Tennessee tonight, they are going to be [choosing between] two things, . . . . entitlements, meaning Social Security, welfare, Medicare, Medicaid, pensions-that's promised-vs. technology development and science. They might look over and see the television set and say it's a nice television set, and it's going to be better in the future, but what's competing with that is my Medicare benefits, that Social Security check. When it comes down to the two, the person sitting at home, the public, our senior citizens, are more likely going to opt for the entitlements. That puts an increasing burden on us to educate the public broadly, through the press, through the media, in Congress through our floor speeches, the leadership of this country-where people see how important it is. That's the education of the public. Secondly, we have the responsibility to do something about the entitlements here and now. Q You recently had Ian Wilmut, head of the Scottish team that successfully cloned an adult sheep, in front of a public health and safety subcommittee hearing. His announcement of the cloned sheep has certainly raised all kinds of ethical issues, as well as brought to mind some of the thornier discussions of recent years, such as embryo research and fetal tissue research. How do you think that's going to play out in the coming months with NIH reauthorization? A The reason I held hearings immediately on the cloning issue are several-fold, but one is because I think it is a good model to approach what will be coming with increasing frequency. That is, the tough ethical challenges in technology and science, which are advancing with an increasingly shorter and shorter half-life. I addressed this in great detail with heart transplantation and lung transplantation, a field that was new, evolving, initially very frightening to people, but that we worked through with what I think is a great deal of success. But it's taken 20 years to do that. That approach was: Look at the science, look at the bioethics, and actually bring a bioethical decision-making process and framework to the table, before any public discussion, long-range payouts, and so forth, really in that sort of three-tiered approach, before jumping in and making public policy. Public policy, for the reasons we talked about earlier, [is] colored oftentimes by emotion, of not just the public servant, but the constituency at large. So repetitively, I will come back to good science as the foundation in these broader policies. . . . I think that once we get this framework set up, we'll be able to deal with the broader issues of embryo research, fetal research, which had been contentious in the past [and] have involved a lot of emotion. If we can get that framework of coming back to the science and to a disciplined way of thinking about it, I think we'll be able to handle all of these issues which are going to come forward in the future. Ordinarily [they] come up every three or four years, but now they're going to start coming every year. Q Would you support such embryo and fetal-tissue research? A I think we need to be very careful, again, and look at each in terms of the bioethics. As we go back and look at the reauthorization and look at the appropriation, go back and look at what the implications are using 1997 science. I was not here when it was last addressed three years ago, but I'm well aware of, again, the emotion that was involved. I will take a whole fresh look at it, set up the committees to take a fresh look at it, using a disciplined approach that will hopefully move us away just from the emotions, and come back to good science. Q Sitting in that chair, you're not just a medical researcher and a surgeon, you're a politician and a person. How much of that plays into how you'll handle those issues? A Oh, I think a great deal. I got into this business because it's only through public service and politics that you can accomplish the large changes that do influence the future of this country. I mean good for science as well, but for somebody like me-and I am a great believer in the democratic process, of the openness with which we develop these issues. The challenge of leading and walking through the ethical issues, the social issues, the rhetorical issues, the political issues, is a challenge which I'm very excited about. And that's what makes this country great, I think, is that such discussions and deliberations can be carried out, that the public trust can be guarded. That is my goal as we, over the next two years, really develop this framework to look at these issues.

As Physician And Senator, Bill Frist Tries D.C. Balancing Act

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