A decade after becoming the National Cancer Institute's 13th director, surgical oncologist and laboratory researcher , 78, is far from retired.
He's currently executive vice president at Virginia's and serves as CEO of the (ITMI). He's also a professor of oncology and surgery at , and is deputy director of its .
He told ľֱ that he's able to serve two institutions that are clinically competitive in some regions because his work with the Hopkins research network is as an unpaid volunteer.
Although his institute at Inova is not a formal part of the system's -- one of the emerging hybrid academic-community cancer centers reported in ľֱ -- he said that ITMI is highly supportive of its growth and goals. He also noted that a relationship between Inova and a respected academic institution was being negotiated and should be announced in the near future.
ITMI -- part of the -- applies genomic and clinical information from individuals to develop personalized health care, according to Niederhuber, who was recruited in 2010.
"When I was still leading the NCI, Inova [a large community-based health system headquartered in northern Virginia] was interested in knowing what it needed to do to go to the next level to be more competitive with Hopkins to the north and Duke to the south, and asked my advice," he said.
He explained that it would be necessary to develop more of a research brand so that the system would be seen as involved in discovery and could effectively recruit more researchers from the academic world for clinical, translational, and genomic research. And, eventually, he added, it would be advantageous to have a medical school.
Niederhuber said that after he had stepped down as NCI director but still maintained a laboratory there -- which focused on the relationship between the microenvironment and tumor cells -- he was asked to join Inova but wasn't certain if it was the right move for him because he'd spent his entire life in academic settings.
But Inova was persistent and after its board approved a business plan around genomics, what had started out as a 75% commitment evolved into a full-time job by 2011. Today ITMI has three divisions: genomic biology; medical genomics; and a clinical laboratory for genomic medicine.
Innovating at Inova
Niederhuber said that when he started, Inova did not have a very active cancer program but did have a huge fetal maternal medicine program, with more than 20,000 deliveries a year throughout its network of hospitals.
"We built a program around that activity, and when the standard genomic testing that was available wasn't able to clarify a change in a baby's genome or explain an alteration or anomalies that were present, we had a protocol in place."
He said that families that were interested and consented were studied in depth through whole genome sequencing of the mother, father, the newborn with issues, and sometimes other siblings, grandparents, and aunts and uncles to build a whole genome sequence tree of information, which sometimes was able to resolve some of these difficult cases.
He added that when asked about the program he often explains that very little is known about how the genome actually functions or works, and through observing complicated cases a little more insight about how the genome functions is gained each time.
Commenting on federal funding for cancer research, Niederhuber said that we have to find innovative ways to use the money we have more effectively and efficiently. He noted at the global cancer research summit hosted by that it was necessary to democratize cancer care for all patients.
He said that with more and more information becoming available through science and longitudinal studies, the challenge in medicine was to assemble this information and train the next generation of physicians to be able to process it effectively within nanoseconds to the point of care.
"Physicians of my generation stored information in the backs of our heads, but now with the heavy flow of available information [from and other big data systems] we need to be comfortable using it as intelligently as possible when interacting with patients."
He sees this as a new paradigm for practicing medicine and mentioned an apt analogy made by former astronaut .
At a recent workshop, Bagian, director of the , explained that when an astronaut went up in a spacecraft there were many people with diverse expertise in the control room supporting and feeding information to the pilot.
Niederbuber said that this is a new model for medicine: "We have to train a lot of people who can sit in the room like in Houston and not give care or make therapeutic diseases but feed [collective] information to a trained physician who can make the decisions and deliver the care."
NCI Days
Niederhuber also reflected on his days at NCI, which he joined in 2005 when he was recruited as deputy director for clinical and translational sciences by then-NCI director Andrew von Eschenbach, MD.
He was then a well-decorated clinician and academic researcher and administrator: chairman of the and a former president of both the and the .
Niederhuber said he had arrived at NCI about a week before Hurricane Katrina struck Louisiana.
He recalled that, soon afterward, acting FDA commissioner, was confirmed as permanent commissioner only to be dismissed two months later in a scandal involving ownership of stocks in companies the agency regulates.
"Andy called me into his office and said he'd received a call the night before asking him to run the FDA. He asked me if I'd take over managing NCI while he was at the FDA, saying he didn't know if it would be permanent or short term."
For a while von Eschenbach retained both his NCI and FDA positions simultaneously, and Niederhuber was given the title of "chief operating officer" of NCI, which he explained had to do with government pay issues related to titles.
But eventually Niederhuber was named acting NCI director and during the summer of 2006 was officially appointed by President George W. Bush. One of his challenges was distancing himself from his predecessor's promise to "eliminate suffering and death from cancer" by 2015.
When asked about why he had been reluctant to respond to press inquiries throughout his tenure, he said that he and other colleagues often felt if "we hear that someone's calling from the press, we'd run as fast as we could the other way," but he also conceded that often had a lot to do with the government handlers at the time.
Nierderhuber continued as NCI director until July 2010, when President Barak Obama appointed , to succeed him. He told ľֱ that he might have continued in office longer if not for another government scandal.
"It's an interesting story," he said, explaining that people with close ties to former Senate Majority Leader (D-S.D.), wanted Niederhuber to stay on as NCI director after Obama took office in January 2009.
Obama had nominated Daschle as Secretary of Health and Human Services, but Daschle had to pull out over a controversy involving his income taxes.
"When Daschle fell off the radar, my advocates lost their contact, and so my resignation was accepted," he said.