You have contributed to many milestones. Do you have a philosophy about what enables us to achieve breakthroughs?
I’m not sure I can put my finger on it. I’ve been fortunate because I’ve been in the right place, the right situation, a bunch of times and that’s worked out really well. Now, I do feel I had a prepared mind and, as Pasteur said, “Fortune favors a prepared mind.” I was fortunate to meet the right people on several occasions – Bruce Roe who had just spent his sabbatical in Fred Sanger’s lab and brought back those sequencing methods, Lee Hood at Caltech who developed so many new technologies, Jim Watson and others. You have to be in the right place at the right time, but you also need to have some vision and a pretty good idea of how to take the first steps. That combination leads to breakthroughs
What about funding for research? Are we about where we should be?
We’re not anywhere near where we should be. Right now we’re in a terrifying situation in the United States with regard to the level of federal research funding, and we haven’t been where we need to be for years. There was a period during the Clinton years in which a bipartisan decision was made to double the NIH [National Institutes of Health] budget. And that allowed an explosion of research, including much of the work in cancer genomics that has taken us so far down the road to better treatments. The reason we completed the Human Genome Project in the 2000s and applied genomic technologies to many diseases was because of the research budget that funded so much fundamental work. That budget has declined in recent years and, as a result, discoveries have started to fall off now. There is a lot of amazing stuff we can do – so much that will translate into better outcomes for patients. To not be doing the kind of research we could be doing, and making discoveries for patients, it’s just wrong.
And as sequencing for clinical diagnosis expands, is funding available?
Right now it’s difficult to get insurance companies to reimburse for sequencing-based assays. Test costs are relatively high – though not as expensive as an MRI, for example – and insurance companies have a lot of competing costs. I would argue that if you sequence the genome of a leukemia patient, for example, the cost of sequencing pales in comparison to the cost of a bone marrow transplant, hospitalization, and potential lifelong treatment to manage immune response. If you had sequenced that patient, you may have found that they likely would have responded to a targeted therapy, and that a costly and dangerous transplant was not really indicated. We need to develop a better understanding of the value of testing relative to treatment so that insurers might realize the benefits of genome-based testing.
In your career in genomics, is there a single most gratifying project you worked on?
I feel like our original work on AML, acute myeloid leukemia, was particularly important because it showed very clearly how genomics represented a powerful new approach to understanding the biology of a deadly disease. That work started to make a difference in how everyone looked at the application of genomics to cancer. So that’s pretty satisfying. And then being able to move a lot of that work into the clinic. These days, the most exciting thing for me is not just to publish another paper or get a grant, but to be able to say, “Hey, here’s another story about a patient whose genome we sequenced, and they’re alive now and probably wouldn’t have been if we hadn’t been able to do that.” That’s a game-changer. It’s hard to not feel fulfilled.
ABOUT DR.RICHARD K. WILSON
Dr. Richard K. Wilson, executive director of the Institute for Genomic Medicine at Nationwide Children’s Hospital in Columbus, Ohio, and professor of pediatrics at the Ohio State University College of Medicine, earned his Ph.D. at the University of Oklahoma, one of the first Sanger sequencing laboratories in the United States, then did post-doctoral research at the California Institute of Technology, a hub for new sequencing technologies. In his 23 years as director of Washington University’s genomics institute, Dr. Wilson played key roles in the sequencing of the first animal genome, the Human Genome Project, the first study to sequence the genome of a cancer patient and discover genetic signatures relevant to the pathogenesis of the disease, the Pediatric Cancer Genome Project, and numerous other breakthroughs in research and diagnosis, as well as the exploration of rare and unknown diseases. He also co-founded a biotechnology company, Orion Genomics, applying genomics to human health and agriculture.