I am writing this on my phone in a Penn Medicine conference room, still feeling the buzz that follows a good lecture, the kind where a room full of teenagers stops fidgeting because they sense, correctly, that they are being told something profound. The first two sessions belonged to Dr. Carl June and Dr. Bruce Levine, the two men most responsible for turning a patient’s own blood into a living drug. The third session belonged to Dr. Drew Weissman, who won a Nobel Prize for figuring out how to slip messenger RNA past the body’s defenses, and who used his hour with our Germination Project fellows to describe a future in which that same trick reprograms immune cells inside the body, no manufacturing plant required. And underneath all of it, on every phone in the room, was a headline none of us could quite look away from: several hundred miles south, in a Senate hearing room, Dr. Anthony Fauci was invoking his Fifth Amendment right rather than answer Senator Rand Paul’s questions about the origins of a pandemic five years gone.
These two events are the same story, told from opposite ends.
Let’s talk about the science, because the science is the part worth believing in. Dr. Levine walked us through the nine steps his lab uses to turn a bag of a patient’s blood into an engineered T-cell therapy, a process that, as recently as 2016, still took nine days in the lab and an average three weeks from vein to vein. Dr. June and Dr. Levine showed us the patient who started it all: a photograph from August 2010 of a balding man in a hospital bed, and beside it, a slide of his bone marrow biopsy before and after treatment, dense with leukemia, then clean. That man, Bill Ludwig, lived cancer-free for more than a decade after everyone else had given up on him. June’s and Levine’s own lists of what’s now approved worldwide filled an entire screen: Kymriah, Yescarta, Breyanzi, Tecartus, Abecma, Carvykti, Aucatzyl, and a growing roster of Chinese, Indian, Spanish, and Korean-made equivalents with names like relmacabtagene and satricabtagene, evidence that this is no longer an American invention alone but a genuinely global one.
Then Dr. Weissman took the floor and, in the gentle, unhurried way of a man who has already won the biggest prize there is, described where the field goes next: lipid nanoparticles engineered by companies like Capstan, functionalized with a targeting antibody so that mRNA payloads go straight to a patient’s own T cells and instruct them, in vivo, to become CAR T cells. No leukapheresis, no bioreactor, no nine-day wait. A 2022 Science cover, and a 2025 paper on using the same platform to reprogram fibroblasts in a damaged heart, made the point without him needing to: the technology that built the Covid vaccine in eleven months is now being aimed at cancers and cardiac injury alike. He was careful, too, to show us the discipline that has to accompany that speed. We saw a slide on the international call to extend the moratorium on heritable human genome editing until at least 2035, because, as the slide put it, off-target effects and mosaicism carry irreversible, multi-generational risk that the field has not yet earned the right to take.
That carefulness is the thread that ties the morning to the afternoon to the news out of Washington. Levine devoted a full slide to something that troubled him more than any funding number: nine criteria the International Society for Cell & Gene Therapy uses to define an unproven cellular therapy: unclear scientific rationale, insufficient safety data, payment for experimental treatment dressed up as a clinical trial, etc. He put up old headlines: a stem cell clinic in the Netherlands promising cures for multiple sclerosis and ALS; a woman telling a reporter, in a quote that has clearly stuck with him for years, that she didn’t know the science behind her miracle cure and didn’t care. That is the other face of a moment when trust in institutions is fraying, not just federal budgets in flux, but patients desperate enough to pay strangers for what real scientists spent forty years failing honestly to build.
And so, a few hundred miles away, Dr. Fauci sat before the Senate Homeland Security Committee this morning and declined, more than a hundred times, to answer questions from a chairman who has spent years promising to see him prosecuted. I will not adjudicate that hearing here. Americans of good faith disagree sharply about what Fauci got right, what he got wrong, and whether five years of scrutiny constitutes accountability or a vendetta. What I will say, because the data says it plainly, is that the erosion people assume has happened to public trust in scientists has not, in fact, fully happened: an Annenberg Public Policy Center survey this past February found 69 percent of Americans still trust vaccine scientists a moderate amount or more; statistically identical to trust in scientists generally, and on par with trust in the police and the military. The public argument is louder than the public’s actual verdict. But the argument has consequences regardless. Since last year, the Department of Health and Human Services has rewritten the charter of the CDC’s vaccine advisory committee, trimmed the recommended childhood immunization schedule, and seen a federal judge in Massachusetts block much of it as unlawful, a ruling under appeal as I write this. Whatever one believes about who is right, the machinery that decides which vaccines your child receives has spent this year in genuine, court-adjudicated dispute. That is not a healthy environment for the next Carl June, Bruce Levine or Drew Weissman to grow up in.
Which returns me to funding. The same AACR Cancer Progress Report that celebrates a 34 percent decline in the U.S. cancer death rate since 1991, 4.5 million deaths averted, 18.6 million Americans living today as survivors, also documents an NIH budget fight this year that saw a proposed 40 percent cut narrowly rejected by Congress, and a cell-and-gene-therapy venture capital market that has sat flat near $2 billion annually since 2022 even as the broader biotech sector rebounded to $38 billion. June’s own slide on the cost of the cure he helped build, roughly $500,000 for a commercial CAR T infusion in America, against $50,000 in India, $97,000 in Barcelona, and as little as $30,000 through a Brazilian point-of-care partnership, is not a story about greed so much as a story about what happens when a therapy this good gets invented in a system this expensive to build things in.
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I immigrated to this country in 1983, believing that America’s genius was its patience, its willingness to fund the improbable thing today because it might become the indispensable thing in thirty years. Sitting in that Penn Medicine room today, watching a Nobel laureate describe curing heart disease with the same molecule that ended a pandemic, and watching, on the same afternoon, a different kind of hearing play out on cable news, I understood that patience and trust are not the same virtue, but they depend on each other completely. You cannot fund a two-hundred-year project, Coley’s toxins in 1891, checkpoint inhibitors discovered decades before Allison and Honjo’s 2018 Nobel, CAR T cells that took from 1989 to 2010 to reach a patient’s bedside, in a country that has stopped believing its scientists are working in good faith. And you cannot rebuild that belief by shouting at the people who built the last cure about the mistakes, real or alleged, made during the last emergency.
The Germination Project fellows in this Penn Medicine conference room today will not remember the exact NIH appropriations figure from this fiscal year, and they shouldn’t have to. What I hope they carry out of it instead is what June, Levine, and Weissman all separately, wordlessly agreed on: that the therapies curing children now began as failures funded by people who would never meet the patients they eventually saved, and that the surest way to make sure nobody funds the next one is to convince a nation its scientists cannot be trusted.
Dr. Fauci may spend the rest of this year fighting a subpoena. Dr. June, Dr. Levine, and Dr. Weissman spent this Wednesday teaching Philadelphia’s next generation of leaders how to build a cure instead. Both things are happening in the same country, on the same day. I leave it to you to decide which of the two stories we should choose to fund.