photograph courtesy st. jude children’s research hospital
Dr. James Downing
We included a profile of Dr. James Downing in the July 2014 issue of Memphis Magazine, the very month he was named the new CEO of St. Jude Children’s Research Hospital. The world has changed over the last 11 years and we wanted to catch up with the renowned research scientist.
I imagine the last decade has flown by. What have you learned about yourself since being named CEO in 2014?
What I’ve learned to appreciate is that everyone changes as they go through life, as they age. Your perspective changes. The energy and short-term urgency of youth gets replaced with, hopefully, wisdom and long-term views. As a young man, it was playing baseball or doing science. Now, it’s leading and mentoring the next generation. I find myself focused on things I would never have done as a young man.
I don’t drink scotch anymore, but as an analogy I’ll offer this. My taste for scotch evolved over the years. I was at a neurobiology seminar and a man was talking about taste receptors, and how they change as you age. Some disappear and others emerge. That’s why your palate changes. Some of that is the wiring of your brain as you go through experiences. Where you can provide the most value changes as you age. I’m okay with that.
St. Jude’s expansion under your leadership is remarkable to the naked eye. But beyond the new buildings, how is the hospital different today than it was when you assumed your current position?
We started seeing our role differently as an institution. We started realizing that we could do things that nobody else could do. We needed to expand our look. We had this mothership in Memphis, but we were much more than that. We are collaborating with affiliates and other centers across the United States. We had our International Outreach Program. We needed to expand significantly.
Our vision is to be a global institution. We’re going to impact the way kids are treated everywhere in the world, and we’re going to be known everywhere in the world. We’re going to be asked to be a part of discussions on all issues affecting kids with catastrophic diseases, no matter where it is. We can provide input that nobody else can. It’s that philosophical shift. This is where the science occurs and where we develop concepts, but we constantly look outside. We need to assemble everybody to work together, to change the way medicine is practiced.
We have the most incredible fundamental science in the world occurring on this campus. The Structural Biology Department. The new Department of Imaging Sciences. The Center for Cryo-Electron Tomography. This is giving us new insights into normal biology and disease pathogenesis. It’s allowing us to think of new ways to treat these lethal, catastrophic diseases. It’s bringing people who don’t work on pediatric cancer into thinking about pediatric cancer. We bring all these teams together — and they’ve said it’s the best meeting they’ve been to in their lives — and it’s happening on this campus.
We’ve expanded into new diseases. We began to understand some of these rare neurodevelopmental diseases. We understand what the mutation is. Could we start treating those? We could build the best program in the world here. So we developed the Pediatric Translational Neuroscience Initiative. The first patient ever treated in utero (for spinal muscular atrophy) was done here at St. Jude. The child is several years old with no symptoms. So we’re looking at other diseases that we can do that for.
photograph courtesy chengusf / dreamstime
How did the pandemic impact St. Jude, and are there lingering effects?
It helped us consider where we can provide value in understanding infectious diseases that other places can’t. We think it’s that biology interface. The pandemic was a horrible event. We learned a lot about Covid-19 and risk to kids with cancer and disruption and chemotherapy, and we conducted studies in repositories and registries across the world, and you know, essentially, we’re able to develop guidelines on how to treat these children and what to watch out for.
The [Trump] administration has shown a total disregard and lack of understanding of what role science plays in the United States, and in the health and economy of the people who live in the United States.
In some respects, it had a positive impact on the institution, because it brought people together. The world may be in turmoil around us, but we have a responsibility to these kids, and kids like them everywhere. How do we learn from this? How do we disseminate that information?
We developed our own testing and screening protocols. We were able to prevent spreading from patients to employees, or from employees to patients. [The pandemic] was not a good thing, but we learned a lot from it. We went through it as a community and came out stronger because of that. We have playbooks that we can utilize if something like that ever occurs again. A lot of our workforce was remote, but we kept them engaged and informed.
Have you been able to stay active with research in your administrative role? How do you balance the two?
At a certain point, you’re no longer playing baseball. You’re managing baseball. At a certain point, you’re in the general manager’s office and not even managing the game. I’ll continue to work [after retirement], but it won’t be back in the laboratory. It will be where I can bring the most value to the institution.
How has artificial intelligence impacted research and treatment at St. Jude? And what future role do you see for AI in the battle against childhood cancer?
Machine learning languages are the backbone of AI. We started using machine learning languages back in 2002. When we were doing the early gene expression profiling, we had massive amounts of data and there was no way to look at it. We started using neural networks and support vector machines.
There wasn’t the computer power to use [machine learning languages] and there wasn’t the massive data to use them on. Those have coalesced as the internet became available and all the data became available. People are worried, “It’s changing everything.” Well, not so much. We’ve been using this as a tool all along. We started the Data Science Initiative. We have computational biology, biostatistics, and structural biology. All that is massive data. We have a workforce of data scientists more than 1,000 people strong to integrate this into an interactive ecosystem. We want to be a leader in the application of data science to biologic discovery. That will impact medicine.
It’s like, is ChatGPT really going to replace journalists? I don’t think so. AI won’t replace experimentation in a million years. We know so little about the biology of normal cells. AI can’t extrapolate from the data we’ve generated and tell us how it actually works. And there’s new technology to explore, to develop. AI is a tool to help us think things through. There’s a good article in The New York Times that asked if it’s a transformational tool or an incremental tool. It may be an incremental tool. There’s always hype with new technology.
In 2014, you told us, “You don’t necessarily have to be first; you just have to be right.” We live in a rather rushed society today. How can we apply proper patience to science and research as we fight disease?
The attention of the general populace is shorter and shorter. The knowledge base is more fractured. People want absolutes: It works or it doesn’t work. “Masks don’t prevent infection because people are still getting infected.” Science and medicine need to become better at explaining. We all need to take a longer view. There’s this idea of instant answers and solutions. It’s like people saying, “We’re going to end cancer.” That’s not even possible.
People listen to what they want to listen to, and it comes from a thousand different sources. Every single one of those sources is warped by an opinion or belief. The hope is in the next generation. I hope kids stop when they hit the college years and realize they need to learn something. There’s way too much noise. Right now, it’s a war between competing outliers.
The Trump administration doesn’t seem to prioritize medicine or research. How can St. Jude best coexist in the age of Trump?
The administration has shown a total disregard and lack of understanding of what role science plays in the United States, and in the health and economy of the people who live in the United States. I don’t think they can be educated. I think Congress can be educated, and I think the American people can be educated, and I think they’re going to stand up and say, “We won’t stand for this.”
I think [the current administration] is going to do lots of damage before that occurs. We can communicate facts. We’ll do what we can to talk to senators and let them know that this is critical. If they cut the NIH [National Institutes of Health] indirect funding, we lose money. If they cut the overall NCI [National Cancer Institute] NIH budget, we will lose money. It’s substantial dollars and so, we worry about that. We watch that.
We live in the premier ecosystem in the world, and it’s required for us to make progress on pediatric cancer, on adult cancer, on infectious diseases. Disassembling that to save money is not the right thing to be doing. We have the greatest biomedical research enterprise in the world. Every country knows that. We have the greatest science infrastructure in the world. We do this in the context of a global ecosystem. The decisions being made right now are destructive. Slowly, people are recognizing how destructive they are. Damage will be done.
We have a strategic plan that’s six years. But the things we do during those six years will take another ten years to materialize and bear fruit. You’re talking about 15-to-20-year cycles. If you just stop [funding], it doesn’t get initiated the next year when money comes back. We’re seeing a decrease in the number of people going into biomedical sciences at the graduate level because they’re threatening students from outside the country. We’ll see how it plays out. Let’s hope some sanity plays a role.
St. Jude does wonders for Memphis, and on an international scale. How is Memphis good for St. Jude?
By and large, Memphis is a nice place to live. We recruit people from all over the world, people who come in and say, “There are nice neighborhoods, there are good schools, lots of activities.” And it’s easy (and inexpensive) to participate in these activities. There are good restaurants, good theater, good music.
When I ask [new employees] what they like about Memphis, they generally say it’s the people. People stop and talk to you. Someone recently told me he met more people — and developed more relationships — in the first couple of months here than he did in seven years at Stanford. It’s a diverse population; people come from all over the United States. You can find whatever school you want for your kids and they can get a great education here.
