EP. 30: MAN OF SCIENCE, MAN OF FAITH

Sep 28

WITH FRANCIS COLLINS, MD, PhD

The leader of the Human Genome Project and former Director of the NIH shares his spiritual journey and the moral mission of his scientific work.

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Episode Summary

The Human Genome Project was a 13 year long international effort to map and sequence all of the genes in the human genome. Leading this ambitious endeavor was Dr. Francis Collins, who was also Director of the National Institutes of Health from 2009 to 2021. His work has had a far-reaching impact on our understanding of diseases and the development of new therapies. In addition to being one of the foremost physician scientists of our time, Dr. Collins is also well known for his bold defense of his Christian faith and for his steadfast promotion of dialogue between science and religion. His book, The Language of God, was an international bestseller. In this episode, Dr. Collins joins us to share his remarkable path in medicine, the origins and evolution of his faith, and his perspectives on the moral mission of medicine.

Francis Collins, MD. PhD is an American physician-geneticist noted for his discoveries of disease genes and his leadership of the Human Genome Project. He was the director of the National Institutes of Health from 2009 – 2021. He made important contributions to many areas of molecular biology, genetics and medicine. Before being appointed director of the NIH, Collins led the Human Genome Project and other genomics research initiatives as director of the National Human Genome Research Institute (NHGRI), one of the 27 institutes and centers at NIH. Before joining NHGRI, he earned a reputation as a gene hunter at the University of Michigan. He has been elected to the Institute of Medicine and the National Academy of Sciences, and has received the Presidential Medal of Freedom and the National Medal of Science.
Dr. Collins has also written a number of books on science, medicine, and religion, including the New York Times bestseller, The Language of God: A Scientist Presents Evidence for Belief. After leaving the helm of NHGRI and before becoming director of the NIH, he founded and served as president of The BioLogos Foundation, which promotes discourse on the relationship between science and religion and advocates the perspective that belief in Christianity can be reconciled with acceptance of evolution and science, especially through the advancement of evolutionary creation.In 2009, Pope Benedict XVI appointed Collins to the Pontifical Academy of Sciences.
In this episode, you will hear about:
• A close personal look at Dr. Collins’ career, leading to his directorship of the Human Genome Project - 1:56
• The mission and implications of the Human Genome Project - 10:02
• The cultural upheaval that has occurred during Dr. Collins’ lifetime and the way popular culture tends to pit science and faith against each other - 15:25
• The origin of BioLogos and its mission to foster a community that strives to harmonize science and Christian faith - 24:47
• A brief discussion of Intelligent Design, a movement that aims to prove the existence of God through science, and how it differs from BioLogos - 28:26
• Dr. Collins’ reflections on the reconciliation between his faith in God and the human suffering he has witnessed throughout his career - 32:42
• Advice on finding meaning and fulfillment in both life and work, and how community can help combat burnout - 40:38
Henry Bair: [00:00:01] Hi. I'm Henry Bair.

Tyler Johnson: [00:00:03] And I'm Tyler Johnson.

Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?

Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are, by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.

Henry Bair: [00:01:03] The Human Genome Project was a 13 year long international effort to map and sequence all of the genes in the human genome. It was one of the most ambitious and exciting scientific research endeavors in human history, with wide ranging implications on our understanding of diseases and the discovery of new therapies. Leading the project was Dr. Francis Collins, who was also a director of the National Institutes of Health from 2009 to 2021. In addition to being one of the foremost physician scientists of our time, Dr. Collins is also well known for his bold defense of his Christian faith and for his steadfast promotion of dialog on the relationship between science and religion. His book, The Language of God, was an international bestseller. In this episode, Dr. Collins joins us to share his remarkable path in medicine, the origins and evolution of his faith and his perspectives on the moral mission of medicine.Francis, it's truly an honor to have you with us today. Welcome to the show. You've had such a long, winding and incredibly accomplished career that our intro did absolutely no justice in explaining. I think it would be helpful in framing the rest of our conversation. If you could trace your journey for our listeners. What have been the major waypoints along your trajectory throughout training and career?

Francis Collins: [00:02:22] Nobody could say it was a linear pathway. When I was in college at the University of Virginia, the only thing I was really interested in was science, and specifically the science of chemistry. I'd gotten excited about chemistry in high school from a very talented teacher, and I figured, okay, that's it. That's what I'm supposed to do. So I majored in chemistry, took every chemistry course I could, and a lot of physics and a lot of math. I avoided humanities because I thought they were squishy, and I avoided biology because I thought it was messy. So I was rather narrow horizons at that point. And finishing my college degree figured, Well, what do you do next? You go get a PhD and guess what? Chemistry. So I went off to Yale and I was mostly interested in quantum mechanics and thermodynamics, the sort of mathematical side of chemistry and physics. And I enjoyed that for the first year or so. And then I began to sort of have this dawning feeling that maybe there were other things going on in science that were pretty interesting, but I had avoided them. And I took a course in biochemistry just to see what that was all about. And I was totally blown away because I had this sense that biology was just going to be descriptive. There weren't going to be any organizing principles. I just had to memorize a lot of stuff and there weren't going to be really interesting science to be done. And I discovered I was completely wrong about that.

Francis Collins: [00:03:58] The molecular biology revolution was starting to appear and it made me realize maybe I am on a path that's not going to sustain me and I better think about a bit of a change in course. So what to do? There were various options, but I took the most drastic one, which was to quickly get my PhD and then go to medical school, which is not something I had thought about much at all until then. So sort of surprising, the admission committee thought that this was a good way to describe my motivation, but they did let me in and I ended up at the University of North Carolina as a medical student and really found that, yeah, this is what I was looking for. Yes, it was science, but it was interesting science and it was about people. And I felt a little lonely as a physical chemist, and this was a chance to resolve that as well. And within the first few months of medical school, I discovered this field of medical genetics where the study of DNA and mutations in DNA could be really relevant to people with diseases like cystic fibrosis or sickle cell disease. And I thought that's how I can put it all together. That is mathematical. It is digital, but it's also medicine and it's also about people. And so there in about 1973, I figured that's my calling. I'm glad I found it. It took me a little while and probably took a bit more time than a more linear pathway would have offered.

Francis Collins: [00:05:27] But I don't regret any of those steps. I learned a lot along the way about science and about scientific rigor and about thinking about questions quantitatively. I went all the way through medical school. I decided I loved internal medicine, so I moved into residency also in North Carolina in internal medicine and then felt like I really got to learn the science of molecular biology that I've really only read about. My PhD in quantum mechanics isn't helping me a lot with how to use a pipette. So I then got a fellowship at Yale for three years in the Department of Human Genetics, which was partly clinical and mostly research, and really learned how to do what you do if you're going to try to be a research oriented molecular geneticist interested in human disease. And that was an intense and at times terrifying experience because it was clear to me how little I really understood about what I had decided to do with my life. But ultimately, it began to click. And then finally, out of all that, I emerged for the first time with a real independent job as an assistant professor in Ann Arbor at the University of Michigan, setting up a lab to try to track down the causes of genetic diseases for which we didn't have a good answer. That's a bit of a long narrative and it only gets me to 1984, but maybe you want to go further or not.

Tyler Johnson: [00:06:54] Yeah, well, I mean, you can choose the level of detail, but I still think it's helpful just as a framework on which to hang the rest of our questions. So so you arrive at the University of Michigan, your assistant professor, you're looking for the, as you said, underlying explanations for diseases that were known to be genetic but otherwise poorly understood. And then just what we're sort of the the big stops from that point until now.

Francis Collins: [00:07:15] Well, my lab set up to try to track down what might be the very subtle genetic misspellings for diseases like cystic fibrosis, Huntington's disease, neurofibromatosis. We worked on all of those and ultimately did find those answers. But, boy, it was a struggle back then. And I became more and more aware if we're really going to do this on any kind of scale for even more difficult problems, we've got to understand more about the genome because we're just feeling our way in the dark. So when the genome project was being discussed as a possible national international effort, I was a big proponent of it. What I didn't expect is that I would be asked to come and lead it, but that's what happened. And I arrived at NIH in 1993 to try to steer this just getting off the ground enterprise, which although a lot of people who were not around then may be surprised to hear, was not widely embraced by the scientific community. In fact, there were some pretty strong opponents feeling that this was just unworkable. We're never going to be able to read out 3 billion letters of the DNA sequence, and it's going to take money from everything else that could be better spent. So why are we doing this? And I had to be prepared to defend the effort while maybe not being that sure myself that they weren't right, because this was an incredibly bold initiative to say we were going to do this and do it in 15 years.

Francis Collins: [00:08:38] That was a wild ride over those years, trying to pull together the best and brightest scientists to invent new technologies and then apply them not just to the human genome, but to other model organisms to see how it would work. But ultimately, because of the talents of about 2400 scientists in six countries, all agreeing to labor together and not worry about who is going to get the credit. And with me as sort of their field general urging the troops forward, we got it done. And that was remarkably gratifying achievement. So that by 2003, which was two years earlier than expected, we had a very good draft. It wasn't complete because there's nasty parts of the genome like the centromere and telomeres that only just now are getting rid out. But we had the parts that most people were really interested in in a very nicely, qualitatively and quantitatively defended version of the genome that everybody could use. And we had made it clear all along that this was for the world. This was not for somebody to own. So the sequence was being released almost daily with no patents allowed, which was, I think ultimately one of the most significant aspects of the whole project was this ethical decision that this is not going to be owned by anybody. This is our shared inheritance.

Henry Bair: [00:10:02] What did it mean to you to have led such a monumental effort? What is it you hoped this project could bring to the world?

Francis Collins: [00:10:11] It was breathtaking to be able to see this emerge, although people think maybe there was just a moment where all of a sudden one day there it was, but it wasn't like that. It was accumulating day by day by day. And it took a long time to say, Yeah, I think we've pretty much got it now. But the surprises that were emerging from the analysis were really quite remarkable. I mean, something as simple as how many genes are there in the human genome. People had estimated numbers wildly across the range, but nobody estimated the number to be as small as it was. Only about 20,000 protein coding genes, which was a big surprise, must be very efficient. And what they do, I guess we're having this conversation. Right. So lots of scientific excitement about this, lots of joy and the trial of trying to manage a program across country lines with hundreds of scientists, but mostly just incredibly gratifying that people saw this as something they wanted to be part of it. Talk about a team. It was amazing. And also for me as a person of faith, this opportunity to be reading our own instruction book, previously not known by us, but in my faith, previously known by God. That was pretty amazing as well, to have this sense that there's something here that's a bit more than just a G and T. There's something a bit profound about looking into the essence of our own human biological selves by having this script in front of us.

Tyler Johnson: [00:11:50] So I want to make an observation and then take on take off on a different line of questioning based on what you were just talking about. You know, the observation I once read a great line. This was talking about the fall of the USSR and the and the fall of the communist regime in Eastern Europe. I once read in an essay that you can tell things that were of truly great historical magnitude because with time they come to have seen inevitable when they most certainly were not. And I feel a little bit like that about the unraveling of the human genome. Right. I mean, as a practicing medical oncologist, we just take for granted every single day in clinic comparing the genetics of my patients tumors to what are thought to be the, quote unquote, normal human genome. Although, as we as you know better than I do, what exactly is normal has come to become a very complicated question. But the point is just to say that that reference manual, if you will, that you and your colleagues produced during that time has just become so much a part of the air that we breathe as oncologists and every other kind of doctor, that it's almost hard to imagine that the world was ever without it, or that, as you put it, that there was any controversy about whether it would be useful or meaningful. Because the I mean, virtually every advance in medical oncology, which just happens to be my area of expertise over the last 20 to 30 years, would have been impossible if not for that signature achievement that you and and all of your colleagues were able to realize, all of which, I guess is a way of acknowledging the magnitude of the achievement and also saying thank you, you know, to you and your whatever. You said 6000 colleagues on behalf of all of the many, both doctors and patients who benefit from that now.

Francis Collins: [00:13:36] Oh, thank you. That's very kind. And there's another law that maybe is related to the one you just quoted about inevitability. And this is the first law of technology that when a technology is invented that appears to be significant. The almost universal tendency is to overestimate its consequence in the short run and underestimate it in the long run. And I think that's exactly what happened with the genome that we're crazy statements made a year or so after the sequence was made available that, you know, everything is going to change tomorrow and you'll go to the clinic and your doctor will be treating you in a way that you never would have thought possible. Obviously, the cycle times a little longer than that to figure out how to use this script for benefit. But now, as you say, as an oncologist, how could you imagine delivering the kind of care you want to for people with cancer without having this information about what are the genes in their particular tumor that are driving those good cells to go bad? And how can that help you choose the optimal therapy? It's almost hard to imagine that you feel at all comfortable about being an oncologist if you didn't have that.

Tyler Johnson: [00:14:44] Yeah. And it's funny because, you know, Siddhartha Mukherjee and others have started to argue now that that we may eventually arrive at the point where the genetic framework for understanding the origin of tumors will become so dominant that it will overthrow what is currently the reigning framework, which is where did the tumor start? Right. Right now we talk about breast cancer and colon cancer and what have you, but it may be that eventually we come to see that that was a very primitive way of understanding what a tumor was and how it was going to act. And that really what matters the most are the genetic underpinnings, although that is still complicated and in progress. But before we talk more about that, though, I want to move back to something that you brought up a moment ago.

Tyler Johnson: [00:15:25] Your career, as you mentioned, has spanned from the seventies to the twenties, basically half a century. And that time has been a time of great societal cultural upheaval in the United States. Right. We've gone all the way from the Reagan revolution and the ascendant Religious Right and Moral Majority in the Reagan years and all of that up through the New Atheists with Richard Dawkins and his cohort and then up to a place now where we both see that a significantly larger-all-the-time proportion of people do not claim affiliation to a religion and to a place where I think there is a wide distrust, especially of organized religion, really, of any religion to some degree, but especially of organized religion.

Tyler Johnson: [00:16:11] And I think there is among the popular press in the popular consciousness, there's this idea that you can choose between being scientifically rigorous or even just cognitively rigorous, or you can be a person of faith. But if you try to have both of those things in the same person, they are, if not completely mutually exclusive. It is at least the case that you have to, as a person choosing, you have to have less of one if you're going to have more of the other in equal proportion. And yet your life and work and writings and everything else very concretely argue against that. And so I guess I'm just wondering, as one of the preeminent scientists really of the last half century, how is what is perceived to be an inherent conflict between scientific rigor and deep, thoughtful faith? How is that not the contradiction in you that most of popular culture seems to assume that it should be?

Francis Collins: [00:17:17] Well, I appreciate the chance to talk about that, because it's something I care about a lot. And this is a case where most of popular culture, I think, is missing a great opportunity for something that could be really wonderfully expanding of one's horizons. Let me be clear. I did not grow up in a faith perspective at all. My family was not that interested in religion. I was an atheist by the time I was in graduate school, and I would have been quite happy to side with Dawkins or others of that ilk, like Christopher Hitchens or or Dan Dennett or folks who were known as the New Atheists. And then I went to medical school. And in medical school, as you know, the idea of life and death is no longer an abstraction. It's in front of you every day. And you see sometimes really wonderful, good, honorable people who are afflicted with terrible diseases that we, despite our advances in medicine, are not able to save them from. And you imagine yourself in that situation, how would that feel? Have I really thought about what it means to be alive? What does it mean to have a purpose? Why am I here? How did this all start? Anyway, pretty soon you're into some deeper philosophical questions about why is there something instead of nothing, and is there a creator behind all of this that might explain how it all came into being in the first place? So I started to wrestle with those things, and particularly so because I had a patient who I was fairly attached to, sort of a grandmotherly character.

Francis Collins: [00:18:54] I know as a medical student you weren't supposed to get attached to your patients, but I wasn't always good at that, who had a very deep faith that was clearly important to her as she was facing the end of her life. And who asked me one afternoon unexpectedly, Well, Doctor, what do you believe? And I had no answer. And that started me down a journey to try to understand, well, why do what appear to be a reasonably thoughtful, intellectually mature and rigorous thinkers manage to also be believers in God? How does that work? I kind of thought I would just strengthen my atheism, but to my surprise, I discovered there was actually a lot of rationality to this and atheism was the least acceptable of the options because it basically declared a universal negative. Which scientists aren't supposed to be able to do because you don't have universal access to all the data. And over the course of some two years, somewhat kicking and screaming, I found myself moving more into the perspective of a deist that there needed to be some kind of supernatural force behind the natural world. Otherwise, how did it ever get here? And then became more aware of indications in my own behavior and my own thinking that maybe this might be a creator who cared about me. And through many ups and downs and looking at the world's religions and trying to understand them, ultimately encountered the person of Jesus as a remarkable figure who I had thought was a myth, but who turned out to be about as well documented in historical terms as anybody of that era.

Francis Collins: [00:20:36] And again, with a lot of resistance on my part, I became more and more compelled that this was not just sort of a nice thing. It was true. It was true for me. And I became a Christian at age 27 at that point, already down the path towards becoming a medical geneticist. So in answering your question, how do you do both of those things? There were people who predicted that it was not going to be possible. And as I began talking about my newfound faith in one paragraph and about the excitement I had and experiments I was doing on DNA and the other, they said, You know, young man, this is not going to work. Your head's going to explode. It never happened. And I began to realize that, as you said, modern culture has proposed that these worldviews are always going to be in conflict. They're wrong. At least they're wrong. For me, you have to think about what each is bringing to the table in terms of insight, in terms of truth. You don't go to the scientific laboratory to try to answer the question, why is there something instead of nothing? At least I don't think you could effectively do that.

Francis Collins: [00:21:44] And you don't go to church to ask the question, exactly how does the Golgi apparatus work? You have to have a good sense about which kind of question you're asking. And science tends to ask questions that start with "How" And faith tends to answer questions that start with "Why." And I was interested in both of those, and I still am today. Frankly, I think we got into a mess in the United States because until about 160 years ago, scientists and people of faith were often the same people. And there seemed to be a wonderful opportunity here for harmony and complementarity. But then things began to separate. Certainly Darwin had something to do with that, but not maybe as much as many people think. It also became a bit of a cultural battle between people who didn't understand each other's perspectives. So we got to the point where in many Christian societies, science became suspicious because it was considered to be populated by people who are atheists, who are trying to do everything they could to destroy the spiritual perspective that others might be interested in. And that is still there today. Why is it that the strongest resistance to COVID vaccines of any group is amongst white evangelicals, of which I am one? It's an echo of this distrust of science which has been there all along. So I felt a certain passion about trying to do something about this. And I wrote a book now 15 years ago called The Language of God, which tried to bring together the joy of doing science together with the joy of pursuing truth through faith perspectives, and how I didn't see those at all as conflicting or that there had to be a firewall between them.

Francis Collins: [00:23:33] And then I thought that actually the laboratory could be a cathedral, not just a laboratory, and that science could be not just a great detective story, but even if what you're studying is creation, maybe this is a form of worship. And that book got a lot more attention than I thought it would. It was mostly writing it for four or five people, but it continues to get me emails every day. And basically out of that came the sense that there needed to be a place where this kind of civil discourse about science and faith could happen amongst people who are curious and wanted to go a little deeper. And that led to the founding of Biologos, which you can look at on the web today. Biologos.org, which is got a wealth of participation of deep thinkers, all of whom are struggling in various ways with aspects of how this fits together, but seeking answers that are really in many ways inspiring. So that whole community, I think, has become much livelier in the course of the last 15 years or so and is a bright light in the midst of what otherwise is a pretty difficult cultural situation. In our country.

Henry Bair: [00:24:47] So you've already mentioned your book, The Language of God. In it, you offer four possible responses to the conflict between the theory of evolution and faith in a higher power. These four responses are atheism, agnosticism, creationism, intelligent design, and biologos - which is science and faith in harmony. Before delving into each of these responses, you offer a rather forceful statement writing "Each of us must come to some conclusion here and choose one of the following positions when it comes to the meaning of life. Fence sitting is an inappropriate posture for both scientists and believers." As you've already described, biologos is not just a worldview, but also the name of an initiative that you created. Can you tell us more about what biologos is?

Francis Collins: [00:25:45] I founded Biologos back in 2008 with a small group of other people who shared this hope of finding a broader way to emphasize the complementarity and the harmony between rigorous science and serious Christian faith. Shortly after I founded it, I had to resign from it because I was asked by President Obama to become the director of the National Institutes of Health. And there are all kinds of rules about what you can and cannot do in that kind of a presidentially appointed position. Biologos went on to flourish. Some would argue because I got out of the way and they might be right and basically became a recruitment opportunity for lots of thinkers who wanted to find a community where they could have this kind of conversation. If you go to the website, you will see that one of the first things put up there, which is now curated regularly, is about 30 to 35 of the most frequently asked questions by people who are trying to figure out how can this all fit together? How can you both believe in evolution and also believe in the Bible? Probably number one question. I think that's got actually some really good answers and you'll find them there. Other questions about age of the universe. How do we really know? How does that fit with Genesis one and two? Lots of questions about bioethics and where did that where does that come from? But it's just a wonderful place to go and see how really thoughtful people have been deliberating about these issues, many of them for a long time, but maybe not in a way that's been so visible and Biologos puts on various face to face gatherings which bring people together for really interesting conversations, I'm always excited when I can go to those. And have recently put out a curriculum for Christian high schools and Christian home schools that tries to provide the really rigorous information about physics, chemistry and biology, including evolution in a way that could be utilized in those curricula without being used as an attack on people of faith, which it often is, showing the harmony instead of the conflict. So right now, the head of Biologos, Dr. Deb Ozma, astrophysicist, trained at MIT, former chair of astrophysics at Calvin, has really led this whole enterprise into a really powerful position here to try to help people work through the struggles, which are a good thing to work through, about how you can be both a person of faith and a person of science, and find that those enrich each other and don't conflict.

Tyler Johnson: [00:28:26] Now, I just want to clarify one thing that I think may be helpful and important for some of our listeners, which if I if I get this wrong, you can correct me where I make mistakes. After the rise of the New Atheists that you mentioned at the beginning of the 21st Century, Richard Dawkins and Christopher Hitchens and the like, there was then the rise of a in some well, a very small scientific niche. There was a rise of a sort of countermovement, which you mentioned briefly the intelligent design school of thought, which basically what they tried to argue, especially probably most prominently Michael Behe and some of his colleagues, was that there were certain instances of what they called irreducible complexity, that they tried to make biochemical and evolutionary and bio statistical arguments, that you could actually prove the existence of God through biochemical means by demonstrating. For instance, their famous example is that the eye is irreducibly complex and never could have come about through evolutionary means. But my understanding is that bio logos generally and you personally are not. The argument is not that science can prove the existence of God along the lines of the intelligent design thinkers, but rather simply that, as you were saying earlier, that science and faith are asking different kinds of questions and that we should allow each of them room to breathe and then look for ways that the answers can come harmoniously. Which is not to say that there is no evidence for the existence of God. And you talk very eloquently in your book how the beauty that you see in the biochemical processes that allow for evolution to happen are paradoxically actually their own argument in your eyes for the existence of God, because the beauty that underlies the processes is its own testament to a loving creator. But. But that that is different from what the intelligent design thinkers say. Did I get that about right?

Francis Collins: [00:30:14] Yeah, you did. Intelligent design leaders. And you mentioned Michael Behe as one of them. There are a few others, although it's not a large community, I think we're offended by the idea that evolution alone could account for humanity. I think that was probably the wrong hill to try to die on because I think evolution has incredible abilities to deliver complexity over a long periods of time. And in my view, as a somebody you might call a person who believes in a god behind the whole activity, who basically set all of the appropriate parameters in motion at the beginning for evolution to take place. Why would you want to make it even more necessary for God to intervene along the way? I think the intelligent design God is too small. Because it says God had to step in in order to make complexity like the eye or the bacterial flagellum, which is another famous example come into being, because evolution just wouldn't have been able to achieve that. There are too many parts that have to work together before you get a benefit. Well, we know the eye has actually developed in evolutionary time, Last I counted about seven independent times, and you can see in each instance what the steps were that provided a little bit of benefit to those early steps, maybe just beginning with a light sensitive cell and then forming into something more like a cup and then a cone and ultimately resulting in an eye, which happens over and over again if you give enough time.

Francis Collins: [00:31:49] So I.D. I think despite their good intentions, I think fell into the problem of being a god of the gaps, saying, if we can't right now, explain how the 32 proteins, I think that's the right number in the bacterial flagellum came together to make this little outboard motor for a bacterium. Well, then God must have done it. And unfortunately, those arguments often end up reducing faith, not increasing it, because science comes along and goes, well, actually, we can see how that happened. So I.D. Is still out there. There's still people pushing it forward very strongly. It's well funded. But I think as a viable means of convincing people with intellectual curiosity and sense of really wanting to have rigorous answers, that you can put science and faith together. It doesn't really work.

Henry Bair: [00:32:42] We have spent a lot of time talking about the intellectual underpinnings of the reconciliation between religion and science. I would like to revisit something you mentioned earlier and explore a more personal aspect of your faith. You mentioned being a relative latecomer to Christianity after witnessing the beauty of the human body and the intricacies of molecular biochemistry. During your medical training. But in medicine, you also see a lot of suffering. For instance, I was raised as a Christian but am now more comfortable with agnosticism, primarily because I could not find a personally satisfying answer to theodicy. Theodicy, for those who might be unfamiliar, is the problem of evil. That is, if there is an all powerful and all benevolent God, then why is there evil and tribulation in the world? Francis Have you struggled with this dilemma during your career? How do you witness suffering and reconcile that with your faith and go on with your work?

Francis Collins: [00:33:48] Well, it's a very, very important question. And I do wrestle with this and I don't have an easy answer. And if anybody tells you they do, I think you should be a little skeptical. I mean, the argument goes like this. If God is all powerful and all loving, why does suffering happen? Does that mean God isn't powerful enough to stop it or doesn't care? The challenge, of course, with that kind of question, which has been asked by people ever since people started thinking about faith and suffering, is that in any given instance, it's a little hard to sort out exactly what this all means. Certainly, let's accept the fact that a lot of human suffering comes about because of things we do. Choices that people make. If somebody is terribly injured in a car crash where one of the drivers was drunk. It's hard to say that was God's fault or that God should figure out how to intervene every time a human being makes a freewill choice that is going to be harmful to themselves or others. But that's maybe the easiest part. What about a child with cancer? You can't say that anybody made that happen. Certainly not the child. I don't have easy answers to that. I've studied the people who thought deeply about it.

Francis Collins: [00:35:10] I've read Dietrich Bonhoeffer. I've read C.S. Lewis book The Problem of Pain, which is probably the best thing I've ever read on this. And I still come away somewhat uncertain. Part of it has to be, though, that if you are a believer in God, you recognize that what you are aware of in your own daily experience is not the whole story. There's a lot of other aspects of who we are as God's children that is still a bit beyond our ability to recognize. We see through that glass darkly and don't always understand the significance of who we are and where we're going. I do know one thing which I do lean upon sometimes when I see suffering and I can't understand it in my own family or in a patient I care about. I know that I worship a God who understands suffering because of Jesus death on the cross, the most unimaginable form of physical suffering. So I don't have to explain why that's awful. I don't have to somehow let God know, Hey, you're not really paying attention here. That's of some comfort. But again, I don't have an easy answer to that question, nor have I found somebody who does.

Tyler Johnson: [00:36:24] And just to be clear, Francis, I you you mentioned this sort of briefly in the evolution of your faith. A couple of questions ago, but to be clear, you don't just believe in a sort of vague force. You know, that was once at work in the universe eons ago and sort of put in place the natural laws that govern the way that DNA coils together and whatever else. But you actually believe in a personal being who is invested in the happiness of individual people and who is willing to be attuned to and responsive to the needs of individual humans. Is is that correct? Or did I overstate that?

Francis Collins: [00:37:09] No, you absolutely are correct. I pass through that deist phase that you started off with. They're sort of the God of Einstein. And that is a place where anybody who studies the laws of nature. Kind of has to go when you see the way in which our universe follows these beautiful mathematical laws and is fine tuned to make something interesting possible in ways that defy explanation. You sort of have to say there was some kind of amazing intelligence who must have been a pretty good physicist and mathematician that put this all in place. Otherwise it doesn't work. But then. Okay, that's fine. What about me? Does it matter at all to that creator that I'm here having this conversation with you? And that was a much harder hill to climb. But ultimately, what affected me, although it's not a proof we talked about earlier, I don't think God intended to give us proofs. What did affect me is this whole concept of good and evil, which is pretty profoundly important in every faith and certainly in my faith at Christianity. So what is that about? What is what is the explanation for the fact that every human society that's ever been recorded in any kind of way had this clear sense that there's something called good and there's something called evil? Now, they interpreted it differently in terms of which actions fall into which category, but they always agree, yes, there's good and there's evil and we're supposed to do the good stuff. And if we do something bad, we try to make an excuse why it was really good and what is that all about? So the evolutionist would say, Well, that's just wired into you by evolutionary forces.

Francis Collins: [00:38:49] And I can see that if you're talking about being good to your neighbors and to your family because they have the same DNA you do. But how about the sort of most radical form of altruism where you feel it's the right thing to sacrifice yourself, maybe even to die for somebody you don't know because it's your calling? What's that about? Is that just a misfiring, as Richard Dawkins would say, or is that something pretty profound? I don't know the best way to explain that in purely natural terms. And I also would say to the atheist and Dawkins has admitted this is an argument that troubles him a bit. If you're going to argue that good and evil are nothing other than an evolutionary phenomenon, then we've all been hoodwinked into thinking that they matter. And we should all just admit that and basically say the heck with it. We're not going to be bound by those arbitrary rules anymore because we're now so smart that we understand this came to us by some other evolutionary means. Nobody wants to go there. If you really still believe that good and evil matter that they have some significance beyond who we are or even beyond what the universe is about, then you have to sort of wonder, what's that about? And is that a signpost not just to a deist God, but to a theist God who cares about humans, about love, about beauty, and about what's good and what's evil?

Tyler Johnson: [00:40:08] Yeah, it's it's kind of, I don't know, maybe ironic, but Yuval Noah Harari, who I think of as sort of a new, new atheist or I post a new atheist, I don't know what you call his school of thought, but one of the points that he's very honest about in his book is that people like Richard Dawkins want to tear down the entire moral construct, really, of Western society and then say and so therefore we should all be secular humanists. But of course, it begs the question, well, why should anybody be anything if there's really no ultimate moral framework than secular humanism is no better than anything else.

Francis Collins: [00:40:37] Exactly.

Tyler Johnson: [00:40:38] Let me, though, ask you a question. Much of the impulse behind this podcast is a search for meaning. And in particular, it's our effort to help our fellow health care practitioners to find meaning in what they do. And on the one hand, you can understand that impulse in the context of what in medical circles we often call the crisis of burnout. Right, which is a super well recognized, very heavily discussed phenomenon, especially over the last ten years. Not that it wasn't there before, although it's arguably worse now, but just that we've developed a new vocabulary and a new openness in discussing it. But I also feel like there is a in Western culture, over the last 20 or so years, there has been a broader cultural, what we might call disenchantment or disillusionment with life. Right. There's this sense of purposelessness, of moral drift. And I feel like there's a sort of a collective questioning of kind of what does it all mean or why is it all worth it? Right. And we've seen a huge surge in depression and loneliness and suicide and a number of other things. And so I guess all of that is a way of asking you if we wanted to birth into the Western world a renewed sense of meaning of being able to tap into something larger than ourselves. What do you think would be the most important ways that we could do that culturally and individually? Because I think those also there are important. Echoes of the answers to that question for what needs to happen in the medical community or scientific community as well.

Francis Collins: [00:42:29] Well, it's a great question, and it is troubling to see the trends that have led to so many feeling as if the meaning in their life has kind of lost its clarity. And the frequency that people are falling into depression or even contemplating suicide has truly become quite frightening to see. And we have to really think about what are the cultural shifts that have led to that. And I think a lot of this, as you've touched upon, is the way in which we become unanchored from each other. The epidemic of loneliness, which Surgeon General Vivek Murthy has written about very compellingly, is a big part of this. Ironically, when we're about as connected as we've ever been on the Internet, we are in terms of our real relationships, the kinds of things that matter where you have somebody you're sitting down with, where you feel you're okay, just opening your heart. Those are harder and harder to find. And COVID, of course, has made the whole thing a whole lot worse. I don't have a prescription to write out for everybody who's going through that. I think everybody has to kind of seek out where they can find that sense of meaning and peace. I know it is for me something I find in my faith. That's why at 5:00 every morning when I get up, I'm usually starting there with the opportunity to reflect on what does my life mean in the consequence of the fact that Jesus walked on this earth and said some amazing things about what I was called to do? And am I in sync with that? And if not, how can I look at ways to make it more close to what I would hope, even though I know it always fall short? And I also think in the process of that, I am reminded to savor those experiences of beauty around me.

Francis Collins: [00:44:20] Which medicine does offer you because of the beauty of the human body and its complexity. And certainly as a researcher, I see that in a laboratory. And also, again, to cherish those relationships of the four kinds of loves that C.S. Lewis writes about, which are what gives you this sense of meaning and a lot of your daily going about things. And all of those things have taken a hit in the course of the last few years, especially for people like physicians who are stretched to the breaking point with the demands upon them, and they in many ways shrinking back of the aspects of medical practice that used to be the most rewarding and are sort of pushed aside by the need to see that next patient 7 minutes from now. So you have to find ways to strengthen your own inner self to counteract what is inevitably going to be a turn in the direction of feeling embattled and alone. But that requires the time to do that. And some people find that by other means, by meditation, which I think has taken a big upward swing in a good way, or by investing themselves in something that is not about yourself, but is about giving to others.

Francis Collins: [00:45:35] Of course, medicine does a lot of that in its own way, but it certainly won't happen by default or by becoming essentially victimized by what you're surrounded by. And if that's the way people are feeling, then it's time to figure out some other way to take your talents in medicine and bring them into a place where they would have more meaning. I will say one thing again that happened to me when I was feeling a little burned out as an academic investigator back in the earlier part of my career, before I ended up in the government, I decided to volunteer as a missionary doc in Nigeria and I did that for a couple of turns and it was frightening because there was so much I didn't know, but I found out it was also an opportunity not to feel like I had to know everything and it was inspiring in a way that's hard to put into words because of the encounters with people struggling in a very different culture and a very different society with similar issues, but sometimes approaching them differently, and their courage and their optimism and their ability to see through the usual sort of comments of a superficial sort into what really mattered. I learned a lot from those experiences, both about myself and about medicine and about my faith. Opportunities like that shouldn't be passed up.

Tyler Johnson: [00:46:56] You know, I think just to amplify what you were just saying, you know, obviously, the intent of this program is not to evangelize any particular religion or even religion at large. At the same time, though, I do feel like sometimes we as doctors can get into this stance where we almost feel like religion is not a thing that serious people take seriously or faith or any larger set of beliefs is not a thing that serious people take seriously. And so as a consequence, we issue that categorically because we think that it's, I don't know, beneath us or something to that effect. And I think that you're right that whatever that quest ends up looking like for an individual person, the quest is really important, right? Like the the allowance that we need to fit into larger communities and that having a bigger set of beliefs may matter in a fundamental way and may affect us in a way that nothing else really can. I think is something that we need to learn to re-embrace because we may have inadvertently left it behind in a way that can be really detrimental to our our mental and emotional health.

Francis Collins: [00:48:15] Totally agree. I think faith is either of no importance or it's a very enormous importance. It's not just of a little bit of importance that doesn't work.

Tyler Johnson: [00:48:27] Well, Francis, we we are so deeply grateful for the time that you've spent with us. You know, this, I think, has been a deeply meaningful conversation. And we especially appreciate you being so transparent when you're a person who already is so much in the public eye and makes so many weighty decisions. We just we want you to know that we really thank you.

Francis Collins: [00:48:47] Well, I appreciate that very much. And it's been nice having this conversation with you, Tyler and Henry. And I'm glad you're doing what you're doing to try to give a chance for people who are listening to think a little bit about these issues, which in the busyness of life often kind of get pushed aside for a time when you might have the time and then you never have the time. So I'm glad we had the time today.

Henry Bair: [00:49:08] Thank you very much, Francis, for taking the time again. It's been a true pleasure to speak with you.

Francis Collins: [00:49:13] Pleasure. It's nice.

Henry Bair: [00:49:16] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctors art sitcom. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.

Tyler Johnson: [00:49:35] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.

Henry Bair: [00:49:49] I'm Henry Bair.

Tyler Johnson: [00:49:50] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.