Wafik El-Deiry, director of the Legorreta Cancer Center at Brown University, joined The Cancer Letter’s weekly podcast to discuss his recent guest editorial—and confirmed his candidacy for director of the National Cancer Institute.
This episode is available on Spotify, Apple Podcasts, and YouTube.
“NCI is a place where, truly, innovative, unique science and translation can and need to take place,” El-Deiry said on the podcast.
El-Deiry spoke with Paul Goldberg, editor and publisher of The Cancer Letter, and Jacquelyn Cobb, associate editor, about the opportunities he sees for a new NCI director under the Trump administration, and confirmed his candidacy for the role.
“I have been a candidate since December,” El-Deiry said.
“I think we all would like to see the NIH and the NCI shine and grow and have impact, ultimately, to help patients,” he said. “There’s clearly some waste and inefficiency and things that have to be dealt with to start to move in the right direction. But there’s also a need for subject matter expertise, and there’s a need for strong leadership and strong advocacy for cancer, and in the field of oncology at the NCI, and I think it’s urgent.”
Other stories mentioned in this podcast include:
- Wafik El-Deiry: An opportunity for Trump: Position U.S. cancer science to lead the world
- The Directors: Tom Lynch and Skip Burris on how NIH funding cuts imperil biopharma innovation—and cost patient lives
- Grilled by Congress, Kennedy defends NIH and NCI budget cuts, freezes, and RIFs
- Kennedy’s claims notwithstanding, NCI clinical trials are delayed, enrollments reduced
- Mace Rothenberg: First exhibit at Museum of Medicine and Biomedical Discovery to focus on the history of cancer research
The following is a statement from El-Deiry, summarizing his guest editorial and candidacy for NCI Director:
- The NIH and NCI budgets going back to 1938 have doubled approximately every 7 years (at least) which was in part just keeping up with inflation. The last budget doubling ended in 2003. In 2003, the NIH budget was $27B. By 2025, the NIH budget should have doubled 3-times so it should be $216B. Similarly, in 2003 the NCI budget was $4.592B, so by 2025 the NCI budget should be $36.7B.
- The resources of the US government have grown and exceed $4 trillion annually. U.S. healthcare spending grew 7.5% in 2023, reaching $4.9 trillion or $14,570 per person. As a share of the nation’s gross domestic product, health spending accounted for 17.6%. It is inexplicable what happened over the last 20 years of government funding for science.
- When adjusted for inflation, the NIH budget has been flat for 20 years, despite modest increases over the last few years. Now, the current proposal to cut the NIH budget by 40% ($27 billion budget), if adjusted for inflation, is equivalent to $14 billion in 2005 dollars (instead of $216 billion) and similarly for NCI which should be $36.7 billion instead of reduction to $4.4 billion.
- There is urgent need to reduce the burden of cancer. We will not get there by defunding U.S. science, a challenged workforce and pipeline. The Trump administration can seize the moment to restore greatness and global leadership in science. Trump will be able to fulfill his promise to the American people to boost US Science and cancer research to #1 while helping patients survive.
- With American Cancer Society predictions of over two million new cancer diagnoses and more than 600,000 deaths in 2025, and with nearly 20 million cancer survivors and their families, the impact of cancer is felt by voters among all political persuasions.
- Trump’s bold, disruptive, and transformational leadership can leave a legacy for generations to come.
- An NCI Director needs to be appointed without further delay. As Director of NCI, (per nomination by RFK Jr.), I will loyally support Trump to keep the America First promise he made to the American people. I will work to reduce waste, inefficiency and stagnation while pursuing truth and innovation to help prevent and cure cancer. The investments need to be discussed with President Trump through the established Bypass Budget that has not been effectively used in recent years, given where the current NCI budget should be based on historical trends.
This episode was transcribed using transcription services. It has been reviewed by our editorial staff, but the transcript may be imperfect.
The following is a transcript of this week’s In the Headlines, a weekly series on The Cancer Letter podcast:
Jacquelyn Cobb: This week on The Cancer Letter Podcast.
Paul Goldberg: … a confirmation that Dr. El-Deiry is, indeed, a candidate. I think there are three altogether that I know of, but my White House sources are not that good.
And we heard him say something very interesting, which is, “Okay, let’s just accept all of the MAHA language and let’s just do what we do well, which is cancer research, and make the world understand that we are the best and we can continue to be the best. And let’s just keep the faith.” And he certainly has the faith.
You’re listening to The Cancer Letter podcast. The Cancer Letter is a weekly independent magazine covering oncology since 1973. I’m your host, Paul Goldberg, editor and publisher of The Cancer Letter.
Jacquelyn Cobb: And I’m your host, Jacquelyn Cobb, associate editor of The Cancer Letter.
We’ll be bringing you the latest stories, groundbreaking research and critical conversations shaping oncology.
Paul Goldberg: So let’s get going.
Jacquelyn Cobb: Good morning, Paul. How’s it going?
Paul Goldberg: Oh, life is good. There’s a lot of pollen in the air in Washington, and I’m just realizing that breathing is optional.
Jacquelyn Cobb: Optional.
Paul Goldberg: You can blow it out your ear.
Jacquelyn Cobb: Oh, of course. That’s how it works.
Paul Goldberg: Yeah.
Jacquelyn Cobb: It’s totally fine.
Paul Goldberg: As long as you enter your routines, breathing becomes…
Jacquelyn Cobb: Yeah. All right, Paul, I would say maybe it’s important, but I’m not going to fight you on it. You got-
Paul Goldberg: No, I’m older.
Jacquelyn Cobb: You’re older, wiser, you know really what-
Paul Goldberg: [Inaudible 00:02:00].
Jacquelyn Cobb: All right, I will dive into our headlines for last week. Our cover story highlighted another episode of the directors, which is a special segment of The Cancer Letter podcast. This time, Tom Lynch of Fred Hutch and Skip Burris of Sarah Cannon talked about how to navigate the uncertainty facing the field of oncology and biomedical science right now.
We had a huge story. It was over 6,000 words that me and Claire did where we, basically, covered the back-to-back congressional hearings at which HHS secretary Robert Kennedy Jr. defended the NIH and NCI budget cuts funding freezes and RIFs. Basically, it was funny. Claire took one and I took the other and we melded them together.
So, it was definitely a labor of love on our end. There’s a lot to check out in that story, so, definitely, peruse at your leisure, I would say, because there’s a lot of content in there.
And then, there was so much content, in fact, that we pulled a specific thing out where I wrote a story about a patient named Natalie Phelps, who has become a very central figure in the controversy over the dysfunction the Trump administration’s RIFs and budget cuts have brought to NIH and NCI.
And at the HELP committee hearing on May 14th, Kennedy said that Phelps was medically ineligible for the trial that she had been purported to have treatment delays. It was an NIH trial, clinical trial, and the Washington Post and other media outlets covered the fact that she had, basically, faced delays in her care.
And basically, Senator Patty Murray and Kennedy went back and forth a little bit, and I was able to talk to the principal investigator of the trial, Steven A. Rosenberg about Natalie, and he told me that while she is technically medically ineligible right now, her lesions are too small, she’s basically still being evaluated for inclusion in the trial in the future. And regardless, almost all of his patients, including Natalie, if she becomes eligible face, at least, a month long delay in treatment because of the RIFs.
So, that was a really good story to have, really nice to provide extra context to sort of the back and forth between Kennedy and Senator Murray.
And, finally, we had a guest editorial by Mace Rothenberg about the first exhibit at his Museum of Medicine and Biomedical Discovery, and a guest editorial… Excuse me, a guest editorial by Wafik El-Deiry, about how President Trump has an opportunity to position the US cancer field to lead the world. And that’s the story we’re going to dive into today.
Paul Goldberg: Well, rather than having us summarize what Dr. El-Deiry wrote, why don’t we just ask him to tell us about it? He happens to be right here, so let’s ask him. Dr. El-Deiry.
Wafik El-Deiry: Hey, how are you?
Paul Goldberg: Doing great. How are you? Thank you for joining us.
Wafik El-Deiry: Thanks for having me.
Paul Goldberg: So, your story that we just ran got into the history of funding of NIH and NCI. What do you see as the trends, and also, more importantly, what do you see today? What can be done? What is to be done?
Wafik El-Deiry: Yeah. So, having a chance to review the history was really eye-opening for me. I have been in the field for coming up on 30 years, and most people in my generation, contemporaries who’ve been doing research for many years are certainly aware of the NIH doubling ’98 to 2003, and we generally have little knowledge of what happened before as far as government investments.
Post that doubling, most people have thought that, wow, this is great, they doubled the budget. Then, we sort of accepted the idea that, well, they just didn’t plan ahead in terms of what would happen with the larger workforce and that there wouldn’t necessarily be more doubling after that.
And we generally accepted that not too many questions asked, we’ve suffered for years with the flat budgets and the competitiveness and so on. So, going back, essentially, to the 1930s and seeing what happened for 65 years before the last doubling, revealed that there had been many, many doublings all along every seven years.
In some periods, the budget would increase tenfold in a 10-year period. Early on, the NIH budget increased a thousand fold at some point.
Paul Goldberg: Well, that was the Shannon years, and that was kind of one of those great moments that people still long for. But more importantly, right now, I guess the first question that’s really kind of an elephant in the room is are you a candidate for the NCI job? Is your candidacy active?
Wafik El-Deiry: I have been a candidate since December. I was vetted early on in December and January. And then, there was a silent period, we didn’t have an NIH director. And then, Jay Bhattacharya was confirmed in early April, and I recently heard from the administration and had a conversation last week with them about the possibility. So, as far as I know, I’m a candidate, and I think a serious one at that.
Paul Goldberg: From what I understand, there are three and you’re one of them. So…
Wafik El-Deiry: You know, I’ll say that my thinking at the moment is what does a new director face, and what makes it exciting and why would anybody want to do this? And from my point of view, it’s worth it if one can impact on the future in a meaningful way. And for me, that’s about the national investment in cancer research and science.
In that regard, looking at the history of investment, going back into the last century, I really couldn’t tell you what happened over the last 20 years why was it flat and not keeping up with inflation even. And now, facing major reductions, it really doesn’t make a whole lot of sense.
And so, I think there’s an opportunity. I think there’s a good opportunity, big opportunity for the Trump administration to seize the moment, look at what’s been happening. If you are serious about America First and leading the world in science and technology and medicine, and that includes cancer, then, you have a chance to do something truly transformational.
And I think it’s a good idea to bring this out before a director is appointed, because I think that is going to be the challenge. I think being in such a position without having these issues out in the open sort of ties your hands, you know? What can you do at that point?
There’s clearly work to be done and issues to be addressed before the government will invest in more—in the NIH and in the NCI—but I think there really needs to be a path towards that.
Paul Goldberg: So far, we’ve seen cuts and morale that has been plummeting throughout the federal government. Can you reverse that? Would you try to? Money certainly would help, but that’s not what’s in the budget. It’s not what’s in the budget proposal for the administration. So, how do you go from this to this, from the low to the high?
Wafik El-Deiry: I think it’s going to have to be a gradual process with a path towards what we would all like to see. I think we all would like to see the NIH and the NCI shine and grow and have impact, ultimately, to help patients. Everybody’s affected by cancer. It doesn’t matter what your political persuasion is. There’s clearly some waste and inefficiency and things that have to be dealt with to start to move in the right direction. But there’s also a need for subject matter expertise, and there’s a need for strong leadership and strong advocacy for cancer, and in the field of oncology at the NCI, and I think it’s urgent.
I think many months have gone by, and part of the urgency is what we deal with in the field of cancer, with over 2 million diagnoses this year, more than 600,000 deaths and with a number approaching 20 million survivors and their families, that’s a lot of people in the country, who vote, who are touched by cancer. And again, it affects everybody.
We heard over the weekend about former President Biden, we need more research, we need more prevention, the cures, and we really have a lot of work to do and we need to get going.
Paul Goldberg: Well, it needs somebody in charge who has a scientific vision right now, and who understands the whole field.
Wafik El-Deiry: Well, you know, the NCI is a complicated place with an intramural program, program at Frederick, the extramural program, the cancer centers program, various programs of research excellence like the SPORE program and the program project grants, and the investigator grants and new grants. It’s evolved nicely for years. I mean, it’s been developing for decades, and it’s quite well-developed.
It’s really a model for many things, in translational science and in clinical trials and in collaboration among institutions, and I would say an impact.
Paul Goldberg: Well, that’s actually one of those places where you can actually see it on the population level. There is impact from the National Cancer Program. It’s silly to say otherwise.
Wafik El-Deiry: Well, there’s still a lot of people diagnosed and dying of cancer every year of common cancers, so, yes, many exciting things have happened, but we do need to be purposeful and to address the burden of cancer moving into the future.
I personally think precision oncology is a great opportunity to do that. I think more studies of the causes of cancer and ways of detecting cancer early when it’s curable. And, of course, there are many things that are easy to impact on the burden of cancer. As the American Cancer Society has pointed out, things we eat and our habits. There are ways we can improve the incidence of cancer that represent low-hanging fruit, and it’s, in part, about execution to achieve those things.
But I also think the NCI is a place where, truly, innovative, unique science and translation can and need to take place. And I learned that from site visits at the NCI, where people have, in the past, reflected upon that, what should we be doing here? What’s the opportunity of having an NCI? And it’s really about doing things that nobody else can do.
Paul Goldberg: Yeah. Well, it’s wonderful to hear your views on this, and we hope something comes of it soon, because what we are both seeing from our coverage right now, it’s, NCI may not be in the free fall, but it is sort of a gradual fall in terms of morale, direction, loss of vision, and all it needs is the vision and the direction, and that’s that.
Wafik El-Deiry: I think it needs to be stabilized and it needs advocacy and it needs pushback where things that are happening don’t make sense. And I don’t think that anybody intentionally is trying to do harm. I just think that it takes more closer oversight of what’s happening and working with the administration to make sure that things aren’t done that, then, have to be reversed, that what happens is more precise.
Paul Goldberg: Absolutely. Well, thank you so much.
Wafik El-Deiry: Thank you for having me. You know, it’s an exciting time what’s happening in the field, and I think so many things are possible with AI and with insights into the biology of cancer. And we have such amazing people who work at the NCI and at our cancer centers all around the country. It’s really a very special community.
As a cancer center director, whenever I’m at meetings with my colleagues, it’s a very special group of individuals who are always looking for ways to collaborate rather than compete. You don’t see that very much in the world of science, or in other professions, but that’s what we have here.
Paul Goldberg: Yes, it is definitely what I’ve been seeing for the past 30 years. So, yeah. Again, thank you so much.
Wafik El-Deiry: Thank you, Paul.
Paul Goldberg: So, Jacquelyn, what have we just heard? I think it’s kind of, what I’ve heard is A, a confirmation that Dr. El-Deiry is, indeed, a candidate. I think there are three altogether that I know of, but my White House sources are not that good.
And we heard him say something very interesting, which is, okay, let’s just accept all of the Maha language and let’s just do what we do well, which is cancer research and make the world understand that we are the best and we can continue to be the best, and let’s just keep the faith. And he certainly has the faith.
Jacquelyn Cobb: Yeah.
Paul Goldberg: So, yeah, it was wonderful to hear that. What did you think?
Jacquelyn Cobb: I thought it was great. I thought it was really nice how he’s sort of… Like you said, he’s accepting what’s happening right now. He’s accepting the potential insight that the administration is suggesting, like the focus on prevention and things like that. But I definitely appreciated that he basically called for increased stability or renewed, or restored, excuse me, restored stability to NIH and NCI.
Also, of course, love that he is a proponent of increased funding. Obviously, I think we’re a little biased, but increased funding will, definitely, help the situation right now.
Paul Goldberg: Yeah, we’re a little biased. I think we have always believed, as a publication, that funding for good peer-reviewed research is better than not funding good peer-reviewed research.
Jacquelyn Cobb: Absolutely.
Paul Goldberg: In that sense, it’s not really… Yeah, you can call it bias, you can call it…
Jacquelyn Cobb: Yeah.
Paul Goldberg: … editorial direction, but it does come with peer review, so…
Jacquelyn Cobb: Of course.
Paul Goldberg: And it should be as rigorous as possible. But it is interesting to hear him say all of this. He’s also really acknowledging that there is a need to stabilize the airplane and land it. And, you know, certainly, it needs a pilot.
Jacquelyn Cobb: Absolutely.
Paul Goldberg: Actually, the third thing that was not really said… Well, no, he does say it, we haven’t heard from patients yet. That’s why your story about Phelps, the patient, is so important.
Jacquelyn Cobb: Yeah. I would’ve loved to do more. We covered… The hearing was on Tuesday? Was it Wednesday? Something like that, and it was just, we didn’t have enough time to make it a bigger story. But, I mean, we’ve said this every podcast, I think, but we are definitely prioritizing patients and reaching out to them and stuff like that. So, 100%, we’re also-
Paul Goldberg: Yeah. Maybe, we should actually have a patient on this podcast every now and then.
Jacquelyn Cobb: Yeah, that would be wonderful.
Paul Goldberg: As soon as we can arrange it.
Jacquelyn Cobb: Yeah. Yeah.
Paul Goldberg: Or parents of a patient, since we’re getting more into pediatric stuff now, and I think pediatric patients, that’s a horrendous tragedy if they’re, indeed, getting harmed by this lack of a pilot.
Jacquelyn Cobb: Yeah. Yeah, that’s definitely coming, a story on that’s definitely coming. We just want to make sure we do a good, proper job. So… Yeah. Next week-
Paul Goldberg: Yeah. We don’t know whether this is actually a lack of a pilot on this plane, or whether this is bombing of an airfield.
Jacquelyn Cobb: Yeah.
Paul Goldberg: Actually, I’m not certain about what’s actually going on. I’m just seeing things go badly right now.
Jacquelyn Cobb: Yeah. Yeah. For sure. But like you said, I mean, like the directors talked about this week, there’s really just so much uncertainty right now. We really don’t know how it’s all going to play out, and that’s, obviously, causing its own chaos. There’s definitely a lot to cover in the future as well about how things actually land, like you’re saying, like how things actually play out and stuff.
Paul Goldberg: All right, well, I think another week.
Jacquelyn Cobb: Thank you, Paul.
Paul Goldberg: Great time to be a journalist.
Jacquelyn Cobb: Another week.
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