SAN DIEGO — Kimryn Rathmell, director of the National Cancer Institute, gestured toward the screen and asked an audience of clinicians, researchers, and patient advocates what they thought they were looking at. Projected behind her was a patchwork of purple, red, pink, and blue squares.
Moments later, a larger-than-life image of Taylor Swift flashed in the middle of the pattern, and laughter rippled through the room here at the American Association for Cancer Research annual meeting as attendees realized they were staring at a poster of the singer’s “Eras Tour.”
“You’ve probably figured out this is a different kind of talk if you thought you were going to come and see the payline and what I’m thinking about budgets, where we’re making investments,” Rathmell said on Monday. “This talk is going to zoom out and just do a few thought experiments to see where we think we are headed, and to reflect on how this changes the way we do our science.”
In other words, Rathmell was here to talk about the past, present, and future “eras” of cancer research. She lauded a shift in the culture of science from narrow projects in siloed labs to interdisciplinary teams drawing on new technologies and data types. That’s a trend she stressed will need to continue — and she added that it will be essential to engage more people in the research process. Rathmell also celebrated a steady decline in U.S. cancer mortality rates, even as she acknowledged a concerning rise in cancer cases among younger adults.
“I am very optimistic,” she said. “The kinds of questions that we can ask today are just unparalleled. I think the way that people are willing to work together and work across boundaries has never been this strong or this committed.”
Rathmell’s remarks are among her first public comments as head of NCI, the oldest of the National Institutes of Health’s centers, and they come at a complicated time for the agency. NCI is poised to play a leading role in President Biden’s reignited Cancer Moonshot, an effort to “end cancer as we know it.” But the agency is grappling with a severely limited budget and the rising cost of biomedical research. Meanwhile, public trust in science is shaky, and a growing exodus of life scientists out of academia is raising concerns about the pace of new discoveries.
Biden appointed Rathmell in November to permanently fill the vacancy left when Monica Bertagnolli, NCI’s last director, became director of NIH. Rathmell previously served on NCI’s board and spent eight years at Vanderbilt University Medical Center researching kidney cancer genomics.
In a statement, Biden said that Rathmell embodied his ambitions to reduce the cancer mortality rate by 50% by 2047 and improve the experience of cancer patients. Rathmell offered her own interpretation of what that goal means: a future where the fear surrounding cancer is gone, and one where we understand both how to prevent cancer and, when necessary, how to manage it.
Rathmell pointed to a number of areas she believes will drive new advances in oncology, from artificial intelligence to a growing understanding of the microbiome and regulatory RNA molecules. NCI last year launched a mobile app dubbed NanCI, which uses AI algorithms to help connect oncology researchers with other scientists and relevant papers. And the center is involved in efforts to modernize clinical trials, including a new network to evaluate cancer screening technologies. But she added that the agency’s main contribution will continue to be funding innovative research.
That’s getting more challenging. Prior to Rathmell’s appointment, NCI had proposed that its budget for the 2024 fiscal year be increased to nearly $10 billion. The agency’s 2024 budget is instead $7.2 billion, which is $96 million less than its 2023 funding.
That money doesn’t go as far as it used to, as the cost of biomedical research is rising quickly. Case in point: NCI’s budget rose from $4.6 billion to $7.3 billion between 2003 and 2023, but the agency’s buying power dropped by $1.1 billion in 2023 dollars.
“We have to be really good stewards with it for the time being. Climates like this make us learn how to lean into other partners,” Rathmell said, citing AACR and the Society for Immunotherapy of Cancer.
In a statement issued on April 4, Rathmell acknowledged that the finalized 2024 budget “brings clarity and difficult choices,” particularly around the proportion of submitted grants that NCI will fund. The agency plans to fund the top 10% of R01 research project grant applicants this year, compared to 12% last year. The agency will fund the top 17% of grants for early-stage scientists, a rate unchanged from 2023.
Her statement acknowledged these rates are “disappointingly low.” They’re also headed in the wrong direction. NCI has said it aims to fund the top 15% of R01 grants by the 2025 fiscal year, “as we believe this is the minimum payline needed to maintain the strength of the field.”
The institute won’t be fully funding so-called non-competing grants, such as existing research projects in years two through five of a five-year grant. These projects will instead be funded at 95% of their full level.
While speaking with reporters after her talk, Rathmell said the agency is considering reducing its contractor expenses and overall personnel count, including the number of postdocs it hires. It’s unclear how deep any cuts would be. The agency’s total personnel count was nearly 4,400 in 2022, the latest year for which data are available.
NCI has stated that its 2025 budget would need to be nearly $11.5 billion to fully support its work. But Rathmell indicated in her April 4 statement that she’s aware that likely won’t happen and that “Congress will be navigating budget caps again in the next fiscal year.”
The scarcity of grant funding is contributing to a broader workforce challenge — the unprecedented exodus of life scientists from academia. Graduate students are increasingly eschewing postdoctoral work for lucrative jobs in the biopharma industry. About 54% of newly minted life science Ph.D.s in 2022 with a job lined up planned to work in industry, compared to 27% in academia, according to data from the National Science Foundation. The total number of biomedical postdocs in the U.S. has also dipped, and there’s growing evidence that these trends are causing academic science to slow or stall, leaving projects in limbo, grant dollars unused, and hypotheses untested.
“It’s very worrisome,” Rathmell said. “We absolutely need basic discovery science … we need people who are passionate about that to move into those fields and feel like that field is a career path for them.”
She added that supporting early-career researchers is NCI’s number-one priority. That’s why, despite the tight budget, the agency kept its payline for early-stage scientists above its general level for R01 grants.
“It really is the best time ever to be doing cancer research,” Rathmell said. “I just want to encourage young people to stay in this field, to choose it, to bring others along, and really enjoy it.”