David i dont 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 president s, initially by president obama and subsequently President Trump. As a person who codiscovered the human genome, was it harder to discover the human genome or be appointed by two president s . Dr. Collins both had challenges associated. I did not expect to still be in this position after january 2017 because i knew the history of nih 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 did President Trump say he knew you did 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 end are 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 i suspect you are not a big shopper and 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 a trump interview. David im 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 wasnt 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 the country is relieved, i think, you have the job. You mentioned your family. You were raised on a farm . Dr. Collins i was. David you were homeschooled. Dr. Collins homeschooled, not because my parents were religious, but they thought the county schools where i grew up 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 . I think my mom was tired of teaching these four boys 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, how did you come to that . Dr. Collins my dad was trained as a classical violinist. He and my mom met at yale, they went and worked for Eleanor Roosevelt in the depths of the depression. They were trying to help coal miners get back on their feet. My dad fell in love with the traditional music day would play, particularly the fiddle. We did not have a television. What did you do after dinner . My dad would read Charles Dickens out loud or we would play. If you wanted to be in the family, you better learn to play something. David did famous musicians come to your house . Dr. Collins people would drop by. The bestknown was a sullen 18yearold who showed up, brought along by a more senior, experienced folk songwriter and singer. The young 18yearold 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 turned out to be bob dylan. David did you ever meet him again . Dr. Collins i did. David did he remember you . Dr. Collins no. He denies the whole thing. 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. 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. David you then went to yale to get a phd in what . Dr. Collins quantum physics. David what is that . Dr. Collins Quantum Mechanics, physical signs. David your parents were proud. You have a phd from yale, and now youre ready to get a job, right . Dr. Collins you would think so, wouldnt you . David what happened . Dr. Collins i was 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 attention. I was feeling lonely and like what i was pursuing in terms of Quantum Mechanics and secondorder 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 you got your medical degree . Dr. Collins i was trying to figure out how 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 . 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 codiscovered it . Dr. Collins good question. What is the genome anyway . It is the entire construction book written in the language of dna for an organism, so we humans have a genome, and so do other living organisms. Ours is pretty big. If you think of dna as a language, it is an interesting one. It has four letters in its alphabet. 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. 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 here and there of dna information, but the whole thing loomed in front of us like an Impossible Task because of 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 this 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 dont really know the language, it will take a while to figure it out. What has happened now has been transformative 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 had a sampling of it eight years ago. 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 id 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, im 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 40s, so we have dramatically expanded that. Is human life extendable beyond 100 . It is not clear that if we dont 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 analyzes dna, and particularly looks at places where there are differences in your dna and mine, because that is interesting stuff if youre 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, and then it travels down a long tube in this mass spectrometer and it is measured by its electrical wave and tells you what was the actual dna sequence. 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. Lets 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 in massachusetts which taught us what the risk factors were 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. We know about statins 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, homo sapiens, the average Life Expectancy was 20. Today 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. Around 1900, average lifespan in the United States was late 40s, so we have dramatically extended that. Is human life extendable beyond 100 . It is not clear that if we dont 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 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 thats 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 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 dont 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. 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 . Is it the right drug for this person . The whole idea of correlating drug response with genetics is ripe for exploration. 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 you 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. Alzheimers disease will be something you read about in a history book, and cancer will be a rarity. That is not out of the question. 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 16yearold smoking pot in his bedroom and never comes out, because you have to did 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 important decisions about questions based on evidence, and i never considered there might be evidence supporting the idea that there really is a god. But, oh my gosh. There is a compelling, intellectual, rational basis for faith, which i had totally missed and assumed it did not exist. 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 dont do it anymore . Dr. Collins i do. I ride my motorcycle to work many days. It is a Harley Davidson king classic. It is a beast, and it gives you a certain sense of 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, then 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, doesnt it . Growing up on the farm, my parents were not opposed to religion. They did not think it was relevant. 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. I was agnostic. By the time i got graduate school, i was shifting to be an atheist and i was not too comfortable keeping quite 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 assume 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 . Isnt this just a perfect example of year rationality . They told me, no, there is a 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 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 this was all wrong and that i could stick with my agnosticism, but ultimately i realized i couldnt 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 your view would be 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 its much older, so how you reconcile those two strands of thought . Dr. Collins a lot of people are tripped up by what they interpret as a conflict to between a literal interpretation of genesis 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 recent arrival on the scene. Go back and read Saint Augustine in 400 a. D. He was obsessed with what genesis is trying to tell us. He would have been the first to say that this literal interpretation is unjustified based on the original language and the way in which the audience for the original genesis 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 written in the way that had a lot of ambiguity and insisted it had just one interpretation, so i wrote a book about a lot of this perceived conflict. For me, there never has been what i know as a scientist, where if youre going to asked me a question about nature, science is going to be the way to get the answer, but also somebody interested in questions science cant 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 couldve gone into the private sector and made a great deal of money . 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 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 that would have been and a manageable a few days ago. If you want to spend your time working hard, but feeling you made a contribution to help people suffering, this is the great way to do it. And money alone is probably not going to give you that same satisfaction. Jackson hole, ecb president mario draghi joins janet yellen and a warning against rolling back financial regulations. How big is the bill for Investment Research and who foots it . 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