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American Thought Leaders
Exclusive: Dr. Jay Bhattacharya on How the NIH Is Rethinking Autism, DEI, China Ties, and Gain-of-Function
01:30:18
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The US Invested in the Chinese biomedical research enterprise. Almost every single top Chinese biomedical research scientist of note was funded in some part by the nih. Many were trained in the United States.
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In this no holds barred interview with Dr. Jay Bhattacharya, Director of the National Institutes of Health, NIH, he answers questions about US China, research partnerships, gain of function research, COVID 19, vaccine injuries, and DEI.
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The Ticket to getting sort of extra, relatively easy funds was to promise to do DEI research.
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We also dive into controversies surrounding vaccines and autism.
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It's become a taboo thing to do, but it really should just be a research agenda.
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Here's how he's changing. The world's largest public funder of biomedical research. You're funding 10,000 new research projects a year. Wow.
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A
If you fund 50 projects and 49 of them fail, and the 50th cures type 2 diabetes, that's a successful portfolio. If every single project succeeds and all you get is 1000 papers published, I don't care. I don't want that.
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B
This is American Thought Leaders, and I'm Jana Kelik. Doctor Jay Bhattacharya, such a pleasure to have you on American Thought Leaders.
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A
Nice to be here. Jane.
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B
Thank you for taking the time to sit down for an interview where we kind of both agreed no questions would be off the table. There's a lot of thoughts out there about what's happening at the nih, what's doing well, what's going poorly. I wanted to kind of go through the roster and try to understand. Let's start here. How has the NIH changed? What have been the big positive changes at NIH this year?
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A
Well, you know, the NIH really hasn't had a change in leadership in decades. I mean, we've had new directors, but the fundamental structure and direction of the NIH has been basically the same until last year. And just in the past year, we've made tremendous changes on how we oversee biosafety, for instance, the kinds of things we fund. So. So the direction toward actually solving the chronic disease crisis of this country, how we evaluate whether we're successful, fundamentally change. We're no longer just focused on having research that publishes papers, but that we want those ideas to translate over to better results for Americans in terms of their health and their outcomes, the intellectual risks that we're willing to take on topic after topic, and then removing the political politic of science that existed, I think, for now, for some decades before, on topic after topic after topic, we've made tremendous advances. And really, I'm grateful that you get to let me tell that sort of story.
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B
Well, so you mentioned a whole bunch of things here, and each of them deserve a bit of attention. But let's talk about this politicization of science, because this is something we've talked about numerous times in the past. And you're saying that's actually changed. I'm not sure everyone understands or necessarily even believes that what's changed.
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Yeah. So over, let's say, the last 15, 20 years, the NIH incorporated into its agenda things I can only characterize as political agendas rather than scientific agendas. Probably the most prominent example of this is DEI diversity, equity and inclusion. So a chunk of the NIH portfolio went to projects that were focused on achieving some social objective rather than the health mission, which we actually have. Every single NIH employee had to write some, I can only call it a loyalty oath to DEI principles. And they were sometimes evaluated on the basis of their sort of sufficient devotion to the cause. There were, if you were the NIH funds, both research inside the NIH and then outside the nih. If you're a researcher outside the nih, the ticket to getting sort of extra, relatively easy funds was to promise to do DEI research. In looking at it, Jan, much of that research had no real scientific basis at all. I don't even characterize as science. Right. So I'll give you an example of the kind of things that we've worked very hard to deprioritize within the nih. Consider a project that says we're going to look at. We're going to ask the hypothesis the question structural racism is the root reason why African Americans have worse hypertension results or something. Right. That's hypothesis. The problem with that hypothesis is that there's no way to test it. If structural racism is the cause, then what control group can you have to test the idea that it's true? And even worse than that is that none of that actually translated over to better health for anybody, much less for African Americans. Those are political agendas that don't belong in a science agency. What I've done is I've ordered the nih, its funding apparatus, to focus because we absolutely have a mission to improve the health of everybody, including minority populations. But when you have a project that that is being proposed, first has to be very clear, actually has to be science. Everything has to be well defined. And then second, it actually has to have some chance of actually improving the health of some population or some people. I've seen all kinds of nonsense, Jan, talking about how we're not taking into account differences between people of different races or men and women. That's all nonsense. If it's scientifically important, we absolutely want to consider it. But the project has to be real science and potentially actionable in terms of improving health for people.
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B
Basically you're saying that there were kind of ideological or political projects that were getting NIH funding. I mean, that sort of summarizes the.
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Yeah, so for instance, if you had an existing NIH project, maybe it's some good science in some area at the end of the year, the NIH would often have some money left over. And so what would happen is the NIH program officers would go to the people who were doing these projects sometimes, often good science, and say, well, look, we have some money left over. If you propose a diversity supplement, meaning essentially some DEI add on that didn't actually wasn't actually good science, then you can get access to extra money for your research. It was basically a wasting of taxpayer money that had no chance of improving the health of anybody. And so we've gotten rid of all of that.
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B
One example that I'm thinking of that was kind of not necessarily race specific, but particular is the use of vitamin D supplementation for black American populations. With COVID if you had high vitamin D levels, you would be able to kind of deal with it and not get catastrophically sick or at a much higher rate and so forth. Right. But this was actually harder for black Americans because the vitamin D isn't because of the color of the skin, isn't kind of.
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I'm also brown too, so it's a little hard for me to get sufficient vitamin D levels.
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Right, but so, but that would be an example of something that's, you know, race oriented somehow that would make sense to study. Right. I guess that's what I'm saying. You're not saying that there shouldn't be any studies that have to do with race or ethnicity.
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Let me put it in a very clean way. Right. So the NIH's mission is to fund research that improves the health and longevity of people. And that means everybody. Specifically, it means minority populations. And of course, if you're going to do good science, you need to account for why some populations have worse health than others. So we're absolutely continuing to fund that kind of science because that kind of science has a chance of improving the health of everybody, including minority populations. What we're not going to do is fund ideological projects. Now the courts, we tried to get to sort of end all of these projects in the old portfolio, and the courts have forced us to restore some of them. But going forward, what we've said is that we're not. That we made clear what the priorities are. So the scientists of the country understand that if they want NIH support, they need to propose projects that will improve the health, that have the chance of improving health to people, rather than achieving some ideological end that should not belong at the nih.
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Before we continue. Right. You mentioned what the mission of the NIH was or is. Just explain to me what the NIH should be doing. What is its core function? I think there's a lot of misunderstanding around this.
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Yeah. So the court. I mean, people really do misunderstand this. A lot of people think the NIH runs public health in this country. In part, I can understand why, because during the pandemic, Tony Fauci, who was the leader of the National Institute of Allergy and Infectious Disease, a part of the nih, seemed like the face of American public health. But in fact, the NIH is not an agency that makes decisions or policies about public health directly. The mission of the NIH is to fund research, the biomedical research enterprise of this country that has as its focus the improvement of health and longevity of the American people. Now, that means if you think about where life expectancy has been over the last decade and a half, it's been flatlined. In fact, it collapsed during the pandemic. But life expectancy as of today is only a tiny bit higher than it was in the United States in 2010. Fifteen years of no life expectancy improved, real. No life expectancy improvements, and you have tremendous chronic disease problems. The NIH has funded research, real excellent research that has advanced our biological knowledge in genetics and cancer and a whole bunch of things, but that has not translated over for the typical American to better health. In that sense, it is not achieving its mission. But the focus of the NIH then, is on funding research, setting the research agenda. It's the single largest agency for public funding of biomedical research in the world, 85% of all biomedical research funding worldwide, including, like, foundations, public biomedical research funding worldwide, not including pharma, is for the nih.
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You're just reminding me of something that, of course, there's a lot of people that are very excited about getting access to this giant pot of cash. Right. And something that you talked about in a recent interview view was looking more carefully at cooperations with China, specifically under the auspices of the Chinese Communist Party, which is, of course, what all Chinese institutions are. Can you just comment a little bit on that? For me, sure.
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I mean, I think we have to be very careful about how we fund research relationships with China, especially post pandemic, where it seems pretty clear to me that we've that the NIH in particular funded research in collaboration with China that was actually quite dangerous and may indeed have led to the pandemic. We have to be very, very careful about that. I think for the past two decades, maybe two and a half decades, the NIH and the United States had a relationship with China that was especially like in 2000-2010, but much more friendly. The US invested in the Chinese biomedical research enterprise. Almost every single top Chinese biomedical research scientist of note was funded in some part by the nih. Many were trained in the United States. So we invested heavily in that post pandemic. And especially given the geopolitical circumstances we are in now, it looks in retrospect, like particular it wasn't all that wise an investment. And at the same time, there are legitimate reasons to worry about industrial spying and a whole host of other concerns. And so we have, as a country a legitimate interest in protecting our investments in the biomedical research enterprise. There's a real look inside the Trump administration now. We'll just focus now on making sure that we don't invest in. In countries of concern in the way we had, including China, that our investments on foreign research collaborations are audited well, overseen well, and serve the interests of the American people. It's really important that people understand that that doesn't mean we're pulling back from the rest of the world. Research requires there to be international collaboration. There are scientists in Europe, in South America, all over the world that are legitimate scientists. And research collaborations with American scientists would produce better advances than if you didn't have those research collaborations. Science is a worldwide enterprise. At the same time, the way that we interact with these and support these relationships needs to be much more secure than it has been. And that's something that actually is a big success. Over the last year, we've reset our relationships with the rest of the world, our scientific relations with the rest of the world, at least as far as biomedicine goes, so that we can have those collaborations without the worry that we're going to produce another Wuhan.
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Well, so flesh that out how you've made this reset. That's fascinating. I mean, you're saying across the board.
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Yes. Yeah. So the traditional way the NIH has funded research collaborations across the world is the NIH will fund a domestic researcher or some domestic institution. That domestic institution then will issue a subaward to some foreign institution and that the collaboration, essentially the money flows from the NIH to the domestic institution, then to the foreign institution, and the domestic institution had the sort of obligation to oversee and audit the foreign institution. Right. So in the case of Wuhan, what happened was that the NIH funded an agency or an organization called Ecohealth Alliance. Ecohealth alliance had a subaward relationship with this Wuhan Institute of Virology. And when all of the pandemic happened and the NIH had an interest in getting the lab notebooks of what exactly was studied In Wuhan, the EcoHealth alliance essentially delayed reporting at all about what it knew, what had happened, and then ultimately said, oh well, we don't control Wuhan Institute virology, we can't get the lab notebooks. That is an unacceptable structure. If American taxpayer dollars are going to go to some foreign institution, then we should be confident that we, the Americans have a auditing relationship that allows us to get access to the kinds of things that we normally have access to for a domestic institution that we fund.
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Which will never happen in communist China, just for the record. Right.
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Well, I mean, any place where that can't happen, we're not going to fund them. Right. We're not going to fund those relationships, those research relationships. So what we did is we put a new sub project system, replaced the old subaward system with sub project system. So now you can have the domestic institution and the foreign institution can have a research relationship. That's fine. But if NIH funded, then both of them have to have direct auditing relationships with the nih. And so then the NIH then can shut off money to the foreign institution. If it's not cooperating, it can do auditing. It has to have that structure. It's called a sub project system. It's one of the first things that I did ordered when I first got in. And so that that means. And when there is these foreign collaborations, in addition to making sure that the auditing system, auditing structure is right and so we can oversee it more safely, I also put in two new requirements for this kind of these collaborations. One, that if you're going to have a foreign, if you're going to do work outside the United States, you have to justify it by showing that that work would be much more expensive or prohibitive to do in the US Than it was outside. So for instance, there's some diseases and conditions that are much more prevalent outside the US and so easier to study outside the US that would be A reason why you would want to study it, but then two, that the knowledge gained actually would benefit Americans. Of course, the knowledge gained may benefit the whole world, but it has to at least benefit Americans as well, since it's American taxpayer dollars going to it. So that's the new way that we're dealing with the world. We encourage foreign collaboration, but on a safer, auditable way in a way that where it's justified to do the work abroad rather than in the United States. And with an output, research output can be reasonably expected to benefit Americans.
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So just to comment on the Chinese situation, which I'm very familiar with for a whole lot of reasons, there's a doctrine of civil military fusion which is one of the top priorities of Xi Jinping and his regime, which kind of guarantees that any type of research which has a military potential, even that that is explored in the institution. Because there's no institution within China that's independent of the Communist Party. They're all, you know, either directly work, working under their auspices, or co optable at a moment's notice as necessary. Right. So I mean, it's just, it's, it's very interesting what you're describing because I'm kind of wondering, given what you've just described, would it, will it be possible to do any research with Chinese entities if. Because I just don't see any Chinese institution legitimately saying I'm going to give you audit access. Why? Because it will say, well, sorry, we can't do that. It's a state secret. It goes against our laws, it goes against our rules.
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That's what we hear from them. We won't allow that research to happen.
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Well, but they could also kind of lie and pretend that they're going to give you audit access and collect the cash and do some research and then give you fake books afterwards.
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I mean, it's, I mean, this has happened.
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This is not a theoretical how much.
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I can say, but I mean, I think this is something that is of intense interest to the Trump administration. It's not just the nih, but all across the government to make sure that the way that we interact with China do not leave the United States vulnerable to that kind of manipulation, intellectual property theft and so on. If it's not possible to have the criteria that I said earlier for research projects with the Chinese institutions, then we won't have those research projects.
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I mean, and I don't want to beat the dead horse here, but it's of great interest to me what you just said, because I'm kind of Advocating for ending research collaborations at the transplant industry because of this, what I call killed to order situation. Title of the book I'm just coming out with. But so, but what you're describing, the structure already exists to, you know, unless you know, you. Presumably unless institutions can demonstrate they're not doing something like, you know, on demand organ sourcing from prisoners of conscience, you probably wouldn't follow, continue with those research.
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Collaborations like basic bioethics, that we are not followed by the institutions that, that are proposed for collaboration, that we will not collaborate with them. I mean, the institutions have to have the kind of standards that Americans expect for human subjects, protection for human rights as far as the research is concerned. We've structured the requirements for foreign collaboration so that if you have an institution like you're describing, it'll be very difficult for them to get support from the United States or at least from the nih.
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Not wanting to be the dead horse, but the Nature article, they have said that NIH is ending all international collaborations. Almost. I think that was the headline last year.
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At some point it was ridiculous. I mean, I was working on designing this policy about resetting how we oversee foreign collaborations. And then you have this Nature piece, as you say, Jan, in a top journal, highly prestigious, actually funded in large part by user fees from research papers published by the Chinese researchers, and they're falsely reporting that we're ending all foreign collaborations. It was absolutely astonishing. I think, like, and a lot of the scientists across the world get, and certainly United States get their news from places like Nature and Science about what's happening in the scientific world. And to see this absolute falsehood propagated as if it were true, when in fact what we're trying to do is a thoughtful reset of our interactions with the rest of the world in a way that allows those collaborations to happen safely and protect the interests of Americans was astonishing to me. I still can't wrap my mind around. I also used to admire Nature and Science magazines as top scientific journals that had a devotion for the truth. But what I've seen is, at least in their news reporting, I've seen none of that devotion to the truth.
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So they didn't ask you for comment.
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For that piece that was published without any comment. For my part, one of the things.
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That you mentioned at the beginning of the interview was talking about how moving away from research for just research sake, but research that will actually have results within the mission, if I understood of the NIH as you've described it now, so. So how is that actually manifesting?
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Yeah, So I think some scientists and some people think about the NIH as an engine for publishing scientific papers. Like I fund a researcher and I evaluate that researcher on are they successful by, did they fund, did they write a paper in Science or Nature or Cell or New England Journal of Medicine or something?
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Right.
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But that is not actually the measure of productivity we care about. The measure of productivity we care about is did the funding for that researcher result in scientific ideas that advance the field where they were in new important directions? Did it lead to better health cures, treatments, longer life for people with conditions that afflict people all across the country? There are real health problems in higher rates of diabetes, higher rates of mortality from a whole host of conditions, chronic conditions that we've, you know, that even if they don't kill you, they end up making your life much worse. And we need to solve those problems. We need to address those problems. And the NIH research then should be evaluated based on how well do they do in solving those problems. Like how well do they contribute to solving those problems. One of the things that I've, I'm most excited about, again, has been underreported is how we allow. The NIH is a complicated institution. There's 27 centers and institutes focused on all different parts of human health. There's a National Health, National NIAID would.
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Have been one of those. Yes.
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Naid, National Institute of Allergy, Infectious Disease, nhlbi, National Institute of National Heart, Lung and Blood Institute, nci, National Cancer Institute, all of these are part of the nih. Huge organization with lots and lots of institutes focused on different aspects of human health. Now, the way that many of these research institutes would make funding decisions, we get 100,000 applications every year from scientists around the world, but mostly in the United States applying for money from the NIH. And we can fund, you know, 8, 10, 12,000 of them, new ones a year. Typically, these projects last multiple years, maybe four or five years. So we have as a whole, I think we fund 50, 60,000 total projects. But 10,000, let's say 8 to 10,000. 8 to 12,000 new ones every single year. Okay, so 100,000 applications a year, and we got to pick 8 to 10,000 of them. The way that this happens, that's a high hit rate.
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Actually, I should, I want to apply for NIH.
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8 to 10% feels high to me. I was an NIH funded scientist myself before I was an IH director. And it doesn't feel high to. Okay, it doesn't feel. It doesn't feel high to research Anyway, so, but the point is that we have an obligation to pick the very best projects. And the question is, how do you do that? Well, the way you do that is to start anyways is you have to have scientific review, peer review of these 100,000 applications. So tens of thousands of of researchers across the country volunteer their time to review the 100,000 applications. They're called study sections. I used to be a member of study section for decades actually. And it's kind of grinding work. You have to review the thing and then give it a rating. The way we used to ask the reviewers to rate it would be on five criteria. How important is the area? How significant is the project? Is the project innovative? How strong are the methods of the project? How good is the investigator? And then finally, how good is the institution? And then to be an overall score that it turns out correlated very strongly with the methods. How good are the methods? Much less strongly with how innovative the ideas were. The NIH over the last decades have become much more hidebound and conservative in the set of projects they would fund, much less. I did a scientific project a few years back where I estimated how old were the ideas in NIH funded research. The way you do that, just to talk very quickly, is you can look at all of the published research that's published in 1940, get all of the words in it, then look at all the same thing in 1941 is subtract out all the 1940 words and phrases and you're left with all the new words, ideas that were introduced in 1941, 42, 43, 44. Then you go back to all the papers and you ask how old are the ideas in every single paper? And so with that method, what we found was that in the 1980s, the typical NIH funded research was funding with papers published by NIH funded research were funding ideas that were like 0, 1 or 2 years old in 2000 teens, 7 or 8 years old. The focus was on can the project succeed? Rather than if it succeeded, would it revolutionize your field? And what happens is then you get all the peer reviewers give their scores, there's an overall score which correlates heavily with methods. And then the institutes, they get to choose among the projects that come in, which they're going to fund. They would have a pay line, many of them, and the pay line would say, okay, if we have so much money and we'll fund all of the top scoring projects above the pay line, and then everything below gets not funded. Problem with that is that if the score correlates very heavily with the methods and not very heavily with innovation, then you're underfunding highly innovative projects. So I put a system in where we get rid of pay lines and instead the Institutes have an obligation to look at all of the information with the peer review and then make decisions about the portfolio of projects they fund, where the evaluation of how well the institute and the institute directors are doing is based on does the portfolio as a whole succeed rather than does each and every single project succeed? Right. So I don't care if you fund 50 projects and 49 of them fail and the 50th cures type 2 diabetes, that's a successful portfolio. If every single project succeeds and all you get is, you know, a thousand papers published but no improvement in human health, I don't care. I don't want that. I'm much more interested in allowing the Institutes to take intellectual risks, to swing for the fences, to solve the chronic disease problems of this country, to reverse the life expectancy, flatlining. It's a big, big difference than how we used to evaluate research.
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B
I mean, it's absolutely fascinating. And it again, sort of highlights how you set up incentive structures, dramatically alters how, let's say, bureaucracies. It sounds like this is a pretty massive bureaucracy. You're describing the scale of it. I'm fully beginning. I'm more beginning to grasp, as you're describ, how many of these, you know, you're funding 10,000 new research projects a year. Wow.
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On that order.
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B
Massive, right?
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Yeah, I mean, it is massive. I mean, and so no single human being can oversee, like, be familiar with every single piece of it. It's not humanly possible. That's why you have the structure. It's a bureaucracy. But the way you make cultural change happen in a bureaucracy is by shifting the incentives around and painting a clear vision of where we the bureaucracy to be. A lot of amazing people work at the nih. You just need to set the incentives right, and then over time, the right things will happen.
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B
So we started talking about gain of function research, and this is sort of a popular topic when it comes to Dr. Jay Bhattacharya. You know, there's a kind of a commitment. You know, this administration, your administration, came in to power with an agenda to end gain of function research. So for starters, where are we at with that?
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A
We made a lot of progress, and the White House is still working on a formal policy. But actually, can I back up just to set the stage for this? So there's a few things One is, what is gain of function research and why would anyone want to do it? So that I think is important to understand. And then second, how should you regulate it so that dangerous projects that have the risk of catastrophic harm to human populations never happen? So let's do that in stages, right? So first, gain of function research by itself is not necessarily a bad thing. Dangerous gain of function research is necessarily bad. Let me, let me. It sounds like I'm making too fine a point of distinction, but let me just give you an example, right? So human insulin, which is used to treat diabetes, is often produced by taking a bacteria and then giving it a gene that allows it to produce insulin. And you cook the bacteria up and it produces insulin. That's a gain of function. That bacteria didn't usually used to be able to produce insulin, but the genetic manipulation makes it able to produce insulin.
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B
Right? And now you can create large amounts.
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A
Of insulin for use inexpensively. Right? So that is, that's completely legitimate and we don't want to get rid of that. Right, because diabetics depend on having availability of the availability of insulin. On the other hand, going into the bat caves of southern China, bringing a virus out of the. That never. That never had previously infected any human, or maybe, maybe one or two at most, bringing it into a lab in a huge city in China with poor biosafety protocols and then manipulating it to make it more transmissible among humans. While that's a gain of function, that's a dangerous gain of function that should not ever be supported, should not ever be done. There's a distinction between gain of function and dangerous gain of function. That's really important to know. We want to make it so that there's never any support or interest in doing that kind of dangerous work ever again. That's the policy of the administration. The president signed an executive order in, I think in April or May, I think it was of 20, 24 or 5, where he said that the policy is. I wholeheartedly support that policy. I think that is a very, very wise policy. The question is, how do you implement it? How do you create the incentive so that this sort of research doesn't happen again? So let me go backwards again because I'm sure people are listening, are asking why on earth would anyone support such a research program in the first place? Bringing the viruses out of the bat caves and so on. It arose out of a utopian vision by certain scientists that we could prevent all pandemics if we are allowed to do this kind of research. The idea was now, going back probably two decades, that certainly a decade and a half ago. If we can go out into the wild places, capture every single virus or pathogen that's out there, bring it into the lab, and then test it to see if they have some chance of infecting humans. If they're close in evolutionary space so they have a chance of making leap into humans, then we should prepare in advance for all of them that are close. But how do you tell if they're close? Well, you do that by making the viruses or the pathogens more pathogenic, seeing if they infect human cells by making them more pathogenic. How much manipulation do you have to do before it infects human cells? If it's only a little, then we should prepare for that. If it takes a lot or it's not possible, then you can just ignore it.
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B
Right.
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A
It's essentially a triaging kind of operation. First butterfly collecting all the pathogens in the world, trillions and trillions. Not possible to do all of them, but you can certainly pay people to make a good start. And then after you've identified which ones are most likely to make the leap, you prepare countermeasures in advance, vaccines, antivirals and so on. Stockpile them, even though that virus has never made a leap into humans at that point stage of the project. Right. So the vaccines you prepare will never have been tested against humans. The countermeasures you prepared will never have been tested in humans for the efficacy against the pathogen.
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B
Sounds like a great business model.
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A
It is a great business model, or was. But if it ever does happen to make a leap into humans, the irony is that evolution is very difficult to predict. I know you have evolution biology experience. You can tell me this firsthand. That means is that when it makes the leap, the countermeasures that you prepared against an earlier version of the virus may have nothing, no efficacy whatsoever against the virus that makes the leap, the actual leap. It's a foolish playbook for utopian playbook. But that was the justification for doing this dangerous gain of function.
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B
Well, and some, a number of scientists I've spoken with have basically believe that this explanation that you just offered is more just like a cover for actually doing bioweapons research.
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A
It's so much of this work has dual is. Dual use is the term of art. Right. So that, yeah. Now the US Is a signatory to the Bio Weapons Convention. The US does not do offensive bioweapons research. But other countries, who knows, this research, as we found during the pandemic, can backfire very, very easily, where even just doing research on these pathogens can end up hurting your own country. And the idea that you need this for biodefense, well, if the biodefense effort ends up hurting your own country also, that also makes little sense. It's pretend biodefense because you're producing countermeasures for a thing that may not actually that when it makes the leap, may not have anything to do with what you prepared for. And so it's either way, it's an agenda that doesn't deserve support. And yet for the last two and a half decades, large parts of the western world, the Chinese government and others wholeheartedly jumped onto this idea that we could prevent all pandemics using this utopian vision.
- [37:35]
B
I mean, this fascinating. And so, you know, makes you wonder, you mentioned before how this sub granting system worked, right? That basically EcoHealth got a grant and then EcoHealth offered money to the Wuhan Institute of Virology through this sub granting process. And you know, I guess like how I keep sort of thinking to myself, I have some theories about this, but like how is it that the NIH end up funding what's obviously a military lab because of the civil military fusion doctrine and to insert fuel and current cleavage sites into bat viruses to make it highly transmissible to human beings? Right? Like that's what I'm. So how does that happen?
- [38:21]
A
It happened because the civilian justification for it was this utopian plan to end all pandemics. That's the just. In 2011, Francis Collins, the head of the NIH at the time, and Tony Fauci wrote an op ed I think it was in the Washington Post, essentially arguing that this kind of research program was warranted even if it had the risk of causing a pandemic because the knowledge gained would have been worth it. A flu risk Worth taking was the title of their op ed. They justified that kind of research program based on this utopian vision. It's hard to justify actually. Can we go back just a second? Because you asked a question earlier that I think is really important to understand. How do you regulate dangerous gain of function? What is dangerous gain of function? How do you regulate it? How do you. The analogy I like to use is to again to nuclear, nuclear weapons, nuclear power. If you go back into the early 40s, you had a physicist named Enrico Fermi who launched the nuclear age by starting the first nuclear chain reaction on the squash court at the University of Chicago. It was a true story. But before he did that, he did a Calculation of what was the probability that this chain reaction would engulf the world as soon as he launched it, right. And he's a great mathematician as well as a great physicist. The probability is pretty close to zero. Then he did the experiment. That's the right framework for thinking about how to regulate dangerous gain of function.
- [40:01]
B
I just want to comment on this, right, because it's kind of an amusing thing to. I mean, deeply troubling and amusing thing to think that he actually thought it's possible that this chain reaction will just go on forever and basically create the end of the world. Let me explore the likelihood of that. I don't want to build on this too much for it, but it's just.
- [40:28]
A
Wow, science is very, very powerful. There are things that actually can cause catastrophic. I mean, like I think Covid demonstrated to the whole entire world of the power of science gone wrong. So you have to be careful. You have to regulate, you know, science for science's sake without any controls, potentially poses existential risk to the world. And so you need a regulatory structure with incentives in place that make sure that those kinds of experiments don't happen. So that's the philosophy that I think the White House is working toward for the regulation of dangerous gain of function. The idea is that you have to have first a notion of what that risk is. Like, someone has to do a calculation of is there a positive probability of the experiment engulfing the world, you know, like Enrique did? And then you have to hold that person or those institutions responsible if they don't report it up, if they don't do that calculation, if they falsify that calculation. And then second, you have to make sure that they're an independent body checking that calculation. And if at any stage you find that someone's proposing an experiment to do something that engulfs the world, then you just say, no, you're not going to fund it. You're not allowed to do it. That's the basic philosophy. If a researcher says, oh, gosh, I'm going to go to the bat case of China and pull out a virus and then make it more transmissible, then they are going to be responsible for doing a calculation. What's the probability of it causing a worldwide pandemic? The institution where they're working, university or lab, is also going to be responsible for doing that calculation. Then when the NIH receives that proposal or other agencies within the United States government receives that proposal, they're also going to be required to decide whether there's any chance, finally, it's Going to go to a third party board who's filled with experts whose job it is to do the calculation Enrico Fermi did and then decide. The previous way that the NIH and the US government regulated this kind of work was a sham. There was a board populated not just by the nih, but by other parts of the government. But the process for sending proposals to that board for that evaluation was complete sham. I think in the history of it, I think three or four projects between 2017 and 2024 ever got sent up for evaluation. And certainly the project to tinker with the coronavirus, they never got sent up. That meant the problem was not the board itself, but the process for creating incentives to do that calculation at the institution level, at the investigator level and at the funding agency level. The new project, the other thing that they did is they would have lists of, of pathogens that are known to cause human harm. Ebola, mers, whatever. And if you're working on something on the list, then there would be some chance of getting it sent up. But the virus that causes Covid, if it was a result of this dangerous gain of function experiment when it was pulled out of the bat cave of China, was never on any list. You need a calculation, a risk calculation, not a list based calculation. And so the White House is working on a policy, I think that solves all of this. In the meantime, we have paused 40 some grants. Projects that to us look like that should go to the board. I'm not saying all of those 40 are dangerous gain of function. The designation dangerous gain of function should be made by the independent board. But while we're waiting for the policy, I don't want to fund a project that has any risk at all of causing catastrophic harm. So we've sort of erred on the side of like pausing projects until the new policy comes in place.
- [44:44]
B
So bottom line, when it comes to dangerous gain of function research as you've now defined it, is there any chance that the NIH is supporting any of it anywhere at this point in your mind?
- [44:57]
A
I think no. The answer is no. We've done a pretty comprehensive. Now, if it's possible that there's somebody somewhere has like defied my orders about this, and if we do, we'll come down hard on them. But my understanding is that we have done everything we possibly can, gone above and board, so that even projects that are probably not dangerous, if there's any chance of it being dangerous gain of function. We paused while we're waiting for the final White House policy to come up. By the way, much of this has been really, really fundamentally misreported. It's been quite frustrating actually to by outlets that don't seem to have any understanding whatsoever about policy making process. The need for incentives, the need for the incentives to be right. It's not just I can say I need to ban all dangerous gain of function, but if there's no structures in place to enforce it, to put penalties in place for people and institutions that don't abide by it, nothing will come of it. Right. The key thing is that the structures and incentives. And that's what the US government's been working on the last several months.
- [46:12]
B
Yeah, but what about other agencies? And so this is the other question, like something like inner function. It's not obviously purely an NIH thing. I can think of other agencies which it directly affects. And so like how do we. And the White House does have a executive order around this obviously. So I'm just, how does that work? Because there's so many different agencies, so many different players. Can something slip through? Right.
- [46:39]
A
Well that's why you need a White House policy and that's why you need a comprehensive policy that's uniformly applied across the federal government. It's not just a NIH thing, as you say, Jan. And that's exactly what the White House and the Office of Science Technology Policy has been working on. A comprehensive policy with buy in from every single part of the federal government. And it's, I mean I just never been in government before, but before, before last year. But I'll tell you, it's a little slow and frustrating to make sure that everyone's at the table, everyone understands what's going on. But it's actually been partnering to watch I think a lot of, a lot of, a lot of goodwill across the federal government to make sure that we don't anywhere fund any of this kind of work. A desire to abide by the President's executive order because we saw what happened during COVID Nobody wants that to happen again. We just need to have the structures and incentives in place. So it doesn't.
- [47:29]
B
Now we were talking about the politicization of science and it's just something I'm remembering here. You know, one of the things that sort of shocked me to the core early in the pandemic, apparently it changed me actually, I think was this Proximal Origins paper that was published in a Nature sub journal by, you know, a number of incredibly successful scientists. Right. Famous even scientists. And the paper basically said this is absolutely a natural origin. It makes no sense to consider a lab origin. I feel like there hasn't been really major consequences of something like this, which was, you know, kind of life changing for so many millions of people.
- [48:10]
A
Yeah, I mean, I think that that paper absolutely did alter the public conversation about the possibility of dangerous gain of function as a potential, a lab leak as a potential reason for the cause of the pandemic. And people who were legitimately concerned about the lab leak hypothesis essentially got smeared, marginalized, censored at scale because of that paper. And sort of like the dominoes that get tipped over. And if you go look at the emails, FOIAed emails publicly available now from some of the authors of that paper, they were actually skeptical that it wasn't a lab leak. They thought it might be a lab leak.
- [48:54]
B
Right, exactly.
- [48:56]
A
Misrepresenting themselves as well as the scientific evidence. And you had top scientific officials from around the world, leaders of the funding agencies like Jeremy Farrar, the Wellcome Trust, Francis Collins, Tony Fauci, a whole host of others who lent their support to this effort. And many of them didn't put their names on the paper. Essentially they were ghost authors. The whole episode is a dark moment in the history of science. We'll look back on it that way. And the publishing agency that published it is going to have a black mark on its record forever. A lot of the mystique of nature or science or whatever. It comes from a real track record of publishing real important advances in science, identifying them, propagating them to the people so people would know about them and then it could build on them. The reputation, though, forever is going to be scarred by this. Essentially embracing a cover up of the possibility of a lab leak for something so consequential as Covid, which affected the life of and of literally every single human being on earth negatively.
- [50:12]
B
It just, you know, it's just kind of sad. You know, one would think that, that at least they could retract it or something like that. They still have at this point. Yeah, but anyway.
- [50:22]
A
But even the retraction wouldn't be enough, right? I mean, so what? Everyone knows it's. Everyone, most, most everyone understands that it's false, that it was a cover up, that. And so at this point, this late stage, they retract. There needs to be fundamental reform in how scientists communicate with each other. Right. This idea that you can have a trusted gatekeeper, an editor of science, an editor of Nature, who gets to decide what science is worth listening to. They send it to some peer reviewers that are anonymous. The peer review themselves are never published. And therefore, because it's published in science, because it's published in Nature, therefore it's true, that everyone must agree that is true is ridiculous. Right? The whole structure needs to be changed. Specifically, the way that we decide what scientific ideas are true and false needs to be reoriented more toward reality rather than what we've had for the last some decades.
- [51:18]
B
So exactly in this vein, you're kind of leading into one of the things I really do want to talk about. And this is something that your peer back at some Stanford, John Ioannidis. Professor John Ioannidis pointed out through a whole lot of work that there's this replication crisis in science where someone finds a result and someone else tries to kind of replicate it, which is the basis of science, basically. Right? You have to be able to replicate a finding and then it becomes real as opposed to an aberration or something, in many cases just doesn't exist. It's a foundational issue. I mean, it's almost hard to fathom for the layperson like myself looking in thinking, how do we even get stuff done if there's. I forget what the numbers are, but some huge portion of papers are simply not replicable, meaning that the findings are not good or not useful, even from the perspective of advancing scientific understanding of things.
- [52:22]
A
Professor Enidis, John. He wrote a paper in 2006 with the title why Most Published Biomedical Research Findings are False. The reasoning is not because of fraud or anything like that. It's because science is hard and the publication structures that we have in place do not do a good job of distinguishing true from false. You said that replication is the core basis of deciding what's true in science. That's an epistemological position, as I completely agree with epistemology, the study of knowledge. Right. So how do we know what we know? But the reality is how we know what we know now in science isn't related to replication, it's related to are you published in a top peer reviewed journal? That's what determines truth sociologically, what determines truth in science. That's the structural problem.
- [53:11]
B
But one would hope there would be strong, you know, but there isn't correlation there. Right?
- [53:17]
A
That's the problem, there isn't. So like since John published that paper in 2005, 2006, there have been empirical evaluations of in field after field after field, looking at some of the top published papers in peer reviewed journals like Cancer Biology, in Psychology, in Neurobiology. And what they find is that when they attempt to do the replication of these peer reviewed published papers, 40, 50, 60, 70, 80% of those papers do not replicate. Or the effect size is much larger than the replication finds, or the methods aren't described clearly enough so that no replication is even possible. The data aren't shared. There are a whole host of findings that give empirical bite to John's theoretical observation that the standards that we used for truth and science are too lax. And of course, then there's also the twin problem of like, if you have a negative result, you all publish it, right? Not interesting. Replication studies don't get well.
- [54:19]
B
But also it also makes it, from everything you've told me before, less likely you'll get funded again. So that's something you're gonna avoid, right?
- [54:27]
A
So it's analogous in some ways to the situation that existed prior to the first scientific revolution. The first scientific revolution, the epistemological power was in the hands of high ecclesiastical authorities to determine physical truth. The sociological understanding was physically true. Do the moons of Jupiter move? Was in the hands of essentially the Vatican. The first scientific revolution was it took that power to determine physical truth out of the hands of this high authority and put it in the hands of people with telescopes. The situation today is analogous. You have the power to determine truth being decided by a relatively small number of powerful journal editors, cartels if you will. And what needs to happen is a second scientific revolution where that power is displaced from there to the hands of people who do replication work. Essentially democratization of science, or the ability to decide what's true or false in science. The NIH has the capacity to induce that second scientific revolution that's not going to work toward the next few this year. There's three major things that I think need to get done. So first we start, we need to start funding and supporting people who do replication in clever ways. And it's not just replication narrowly of already published papers, but reproducibility. So for instance, if I approach your problem in a different way, do I get a similar answer? Does the result you have generalize? If you have a replication study that fails to replicate, that doesn't mean the first study was bad necessarily. It's just a reason to investigate why the replication fails. It advances science. Right. And this points to a really important thing. We should be thinking about this as science as a collaborative thing. And the solution is to improve that. Collaboration across scientists is. It's. I said democratization of science rather than as a policing thing. Where we're going to find your, oh, you published a paper. I'm Going to force you to retract it because you were wrong. It's not a policing thing. It shouldn't be anyways. So we have to fund replication, but let the scientific community decide which scientific projects are worthy of replication need to be replicated. Sort of the rate limiting step ideas. The government shouldn't decide what needs to get replicated. Scientists themselves should. If there's a really, really important idea, if it's true, science will move one direction. If it's false, science will move another direction. Well, those rate limiting step ideas are the ones that ought to be replicated. And we'll fund scientists to do that. We'll create a cadre of scientists to do that. Second, you have to have a place to publish your replication studies. Right now, scientific journals, science will not publish replication studies generally. They'll just reject them out of hand for the most part. Nature will reject them out of hand for the most part. And so you have to have a place where you can publish them. And that's something the NIH can do. Within the National Library of Medicine, we can stand up a journal where you can deposit your replication work. There has to be limited gatekeeping for that journal, so the author of the study being replicated can't say no. But there should be peer review and it should be open so that people can see the scientific discussion that's happening around that paper and that replication effort. And you have to, you have to tie that replication, those replication studies to the scientific literature itself. So when you do a search for a paper, it pops up. There should be a replication button. You click the replication button, there's an AI summary of the related replication work, and you can click and see each paper itself and decide for yourself whether you believe the result or not. It changes the locus of power to decide what's true. Away from journal editors and top journals to the replication, to sort of scientists looking at the same thing. And it'll fundamentally transform science. Just that one replication button will transform science. And then finally you have to start measuring because what we want is we want scientists to collaborate with one another. People shouldn't be looking over their shoulder worried they're going to be replicated. They should want to be replicated because no one's going to believe them unless their work is subject to replication. It's actually an honor to have someone.
- [59:06]
B
Replicate it means it's relevant and important, your work.
- [59:09]
A
Exactly. And so right now people view it as a threat. You don't reward people for good sort of good pro social behavior by scientists. What do I mean, by pro social behavior. Do you share your data? Do you share your code, your tissue samples? Do you write your papers in a way that it invites replication with methods so clear, no secret sauce, you just. The methods are so clear that anyone can try to do the replication themselves. Are your papers even subject to replication? That should be. All of these should be measured. And this is something I'm working on at the nih, at the scientist level, at the institutional level, and so that institutions that are good at that kind of, sort of scientific behavior will be rewarded. If you measure it, it'll happen.
- [59:54]
B
So one of the things that I've been hearing about a lot is that you're basically cutting a whole bunch of funding to some of these institutions, maybe for the reasons that you've been describing here. So just what is the status of granting? Right? How is it. Clearly there's been change. Are a lot of grants being canceled?
- [60:15]
A
The short answer is that last year the Congress gave US something like $48 billion for funding, and every single dollar of that went to funding research Funding has not been cut. It's just a false narrative that somehow, again, propagated by places like Science and Nature and their news organizations. What has happened is the set of people who are receiving support may be different than were. So we're not funding DEI grants. We've tried to fund newer ideas, like more innovative ideas. And that means that it's going to be different. People will get the grants than otherwise are normally used to getting the grants. There's a big priority in mind to make sure that we fund early career scientists. For the last two decades, three decades, the NIH has funded researchers that are older and older and older. The age at which you get your first large Grant from the NIH went from your mid-30s in the 1980s to mid-40s today. But it's also the case that a lot of the newest ideas, the most innovative ideas, come from early career researchers. And so it's a huge priority of mine to make sure we fund them.
- [61:31]
B
So basically, it is changing. You're saying you haven't cut funding, but you've redirected funding substantially?
- [61:38]
A
Yes. Okay, we've redirected funding toward the priorities I've been talking about. The thing is that people aren't used to change in this space. And the most powerful scientists are the ones that are most used to getting funding over and over and over again are complaining that there's uncertainty about this. And so you hear people in science and nature, again, you see these stories about how all American scientists, a whole bunch of American scientists are leaving the country. It's ridiculous. It's ridiculous. You have a couple of anecdotes. It's still the fact that the NIH is the number one funder of public biomedical research in the world. 85% of all public research funding for biomedicine comes from the nih, including foundations, including investments by foreign nations. I just saw a story about how Macron, the President of France, bragged about he's going to fund a 30 million euro program to attract 40 scientists. I mean, 30 million euros is a tiny, tiny fraction of what the NIH spends on scientists. The United States is still the very best place in the world to do science and certainly the best place in the world to do biomedicine. All of these stories are essentially political stories. They're exaggerating because they are upset that the priorities which have changed, it's no longer just to fund the scientific enterprise for the sake of funding science. Instead now it's funding the scientific enterprise to produce better outcomes and health for the American people.
- [63:13]
B
And from what I've seen, more money is also going to the non elite institutions or the kind of non sort of top Ivy League.
- [63:22]
A
Well, I would love to have that happen. There needs to be some fundamental changes the way that we fund the institutions for that to happen. That's something I want to work with Congress and to make happen. I think like the top 20 programs receive like somewhere between a third and a half of our extramural funding every year. I mean, it's a pretty substantial fraction concentrated in a few places. That needs to change. So one of the things I've been doing the last year is I've been traveling around the country, visiting scientific institutions in the middle of the country. I've been to University of Alabama, I've been to University of Oklahoma, I've been to Kansas. I've been to a whole bunch of places. And what I found is that there are scientists there that are absolutely brilliant, that there are institutions there that want to invest in science, make biohubs, kind of like what we have in Massachusetts or Boston, available everywhere. And yet they have difficulty getting what is a biohub. It's like a concentration of companies and researchers and others focused on certain areas of biomedicine. So often there's often pharmaceutical and company investment in them, but also a thick research enterprise often funded by NIH money. So what they want is, and they're like poised to do it, but they have difficulty getting NIH money for that purpose. And I'll tell you what's the real root problem here. So we have these programs to try to direct money to them, but if they're just sort of. They're important programs like the IDEAS program, but they're. But they don't change the fundamental economic dynamic that leads to an underinvestment in these research institutions. The dynamic is this. If you want to win facility support for your facility, the way the NIH works, you have to have researchers there that can win NIH grants with their project ideas, brilliant researchers that can win the competition. And then attached to that money you'll get what's called indirect costs. Right, which are supposed to go to.
- [65:37]
B
Funding for indirect costs.
- [65:38]
A
Yes. So the direct costs are for the project themselves and then attached to it, if you win that, you get the indirect costs. The indirect costs are supposed to fund the facilities, the square foot of lab space, the cryo electron microscopes, or whatever equipment you need.
- [65:53]
B
Okay, let me just jump in. You're talking here about a number of these elite institutions being really unhappy about the change in the indirect cost structure because they're losing a bunch of overhead money that they would be getting. This is what you're talking about.
- [66:08]
A
Well, so there was a proposal put out early in the administration to lower the indirect cost recovery rate that was enjoined by the courts. This is related to that problem. But actually the root problem isn't the money. The root problem is the concentration of where we send our resources as to support facilities. Right. So that indirect cost, what they're supposed to do is supposed to use it to pay for upkeep of lab space and all this other stuff. Right, but it's attached to winning grants. If you don't have amazing scientists who can win the grants, you're not going to get the facility support. But in order to attract excellent scientists to your institution, you have to have excellent facilities. You see the problem? It's a kind of catch 22 that guarantees that our funding from the NIH is going to be concentrated in relatively few institutions. I think the whole state of Florida gets roughly on the same order of what Stanford University gets from the nih. So what I want to work on is essentially to introduce market competition for the indirect costs, the facility support cut the link between the indirects and the directs. Scientists will still compete with each other for their support for their ideas, but the institutions themselves will compete with other institutions for the facility support. We already do this for some things like National Cancer Institute center of Excellence designation, the Clinical Translational Programs. There's institutional competitions. We should broaden the range of institutional competition. And the key thing is introduce essentially market elements for that competition so that if one institution can provide a square foot of lab space more inexpensively than another institution, well, they'll have a leg up in winning the institutional support and then allow researchers to take their grant money and go where the facilities are. I'm telling you, I've heard from young researchers across the country tell me they have difficulty getting square foot of lab space to do their research in some of the top institutions because it's just crowded. Imagine that they were in college sports. Now there's this name, image, likeness thing where the institutions compete for excellent players through the portal. Imagine a portal like that for scientists, for sports stars and where the institution that won the institutional support for lab space competes for the scientists to come there and do their work. It would democratize science. Actually. What it would do is it would unleash scientific ingenuity across the country and it would also combat the problem of scientific groupthink. So you have a few hubs of only a few places where all the NIH funded scientists are. They tend to think alike. If you have it geographically dispersed, you have less problem with that.
- [69:11]
B
I mean, fascinating. Absolutely. Something that just strikes me, actually. So one of the kind of big criticisms of how we ended up getting our policy so wrong around the COVID pandemic is that too much influence of large pharmaceutical companies. I mean, did that just. I'm oversimplifying a little bit, but that's too much because there's some of their money goes into the system. There's these kind of rotating doors between people who are working for nih, then going for a pharma and going back.
- [69:46]
A
What's more, FDA NIH is less of that.
- [69:49]
B
Okay, okay, that's good to know. I mean, I'm talking as someone who's not an expert in this realm, but there's also all these NIH scientists getting royalties, for example, which would incentivize them to keep using certain types of products that might not be as good as other things that could be funded. Just this whole kind of world of financial incentives that might go against all these amazing things that you're talking about. Is this being addressed and if so, how?
- [70:17]
A
Yes, I also am very concerned about this. The key thing is transparency. Right. So I think, you know, if you have an idea that comes out of the NIH and then a pharmaceutical company uses that idea to make a product that improves the health outcomes or cures some disease, that's not a bad thing in and of itself.
- [70:40]
B
No, it sounds like a great thing.
- [70:42]
A
Yeah. The bad thing is when you have researchers who have conflicts of interest and don't report them, people don't know about them because transparency, then I think once you understand, understand what the funding structures are for any particular researcher, well then you understand what the conflicts of interest are. So you can, you can better evaluate what they're saying. It doesn't, Just because there's funding doesn't from a pharmaceutical company doesn't mean that the science is bad. That's not the way it works. But you do want to understand when you are reading some piece of research, was it funded by some pharmaceutical company? Whether the research is funded by a pharmaceutical company. Right. Or other. Other entities, including the nih. What I'm working on is a, is a. You know, actually, so let me just step back just a bit. If for doctors in this country there's a, there's a website, you can go and type your doctor's name into it and then you can find every single dollar they got from pharmaceutical companies over the last n years, 10 years. I'm not sure exactly the time frame, but like for n years, every single dollar. Did they go to a pharmaceutical company dinner or lunch? Did they, you know, did they get a, do they get a grant or, or some sort of like stipend from far as it's all reported for every doctor in the country. There should be something similar for researchers. And that's some, that's something I'm working toward that transparency I think will help solve the problem you're addressing.
- [72:09]
B
Fascinating. You know, one of the problems that we had during the pandemic, as I'm thinking about this, is that there was this sort of very. The powers that be were very determined to deploy a technology that was, let's say, not ready for market would be a nice way of putting it. Based on the research that I've seen and I'm talking about specifically this MRNA type gene therapy, vaccination, what safeguards exist to prevent something like that from happening and maybe around this specific technology also.
- [72:49]
A
Well, so of course the NIH does not approve or not approve products for market. We fund research. It's not doing surveillance of the safety of those. That surveillance is in the hands of the FDA and the cdc. It's not recommending anyone take or not take those products. Again, that generally is in the hands of the cdc. The NIH is not in that sense a policing with that kind of public health power. What we do is we Fund research. And that research, how it gets used may depend on other parts of the government. And I think with Marty Makary, who's a fantastic FDA commissioner, a good friend of mine, I have full confidence that they're reforming to make sure that the kinds of problems that led to that came out of the sort of the experience with the MRNA vaccination in the process of being addressed, not just for that, but like more broadly, while at the same time allowing new products that are innovative still nevertheless be approved when they actually are safe and effective. I think that that kind of reform is happening, but that's in the power of the fda, not in the power of the nih.
- [74:07]
B
What about, you know, because there was such a mass vaccination campaign with a product that, you know, tens of thousands, hundreds of thousands of people were injured in this process. What work is the NIH doing in terms of research to somehow help these people? Because, you know, just from my own experience, my wife and I made a film about this, right. These people were, even though in some cases they were supported a bit by, but mostly just completely gaslit and just know your issue doesn't exist. Right. So how are you approaching this?
- [74:43]
A
Well, you're absolutely right. There were absolutely like a lot of the patients who were vaccine injured were gaslit into pretending as if they didn't get injured or that somehow their symptoms are all in their head or something. Actually, this is part of a broader phenomenon where you have patients with conditions that are poorly understood, where the medical system will gaslight you. Telling you it's a psychological issue rather than a physical issue. It's gonna make you think that you're crazy because you have symptoms that you just, you know, you know you have, but you can't convince anyone else to do anything about it. Vaccine injuries, one of them. Long Covid me, cfs, Lyme, chronic Lyme disease, a whole host of these conditions where it just fits a very similar pattern. The key underlying thing is that there isn't excellent science to guide decision making for clinicians or anybody else for patients. And I've made sure that people know at the NIH that I'm very interested in investing in answers for patients for all of those vaccine injury, Long Covid me, cfs, chronic Lyme. We need to get better answers. The gaslighting happens because the, you know, if you're, let's say you're a doctor and you see a patient, you have no idea what's causing their condition, right? Because the scientific literature doesn't have an answer, you're going to be. Unless you're an amazing doctor who's really good at, you know, sort of being honest and compassionate, you're going to be wanting to like, move on to the next patient. And it's really, really unfortunate. The answer is to get good answers, right? So invest in research on treatments, on underlying physiology, physiological causes, basic biological knowledge so that those patients actually can. The doctors and the caregivers for those patients will treat them correctly.
- [76:46]
B
But is NIH doing this for people that have been COVID vaccine injuries against huge number of people, relatively, we have.
- [76:54]
A
Investments in that and we're going to have more investments in that this year for all of those conditions. I think patients deserve an answer and I'm definitely interested in finding, I would love to know myself even like autism. Take that for example. Right. We've invested a tremendous amount of money in trying to understand the etiology of autism because there's millions of families around the country that have children that they would love to be able to help. But we don't really have great answers both for the cause and how to sort of reverse whatever problems there are. And of course, there's a whole range for autism. There's a whole range of phenotypes ranging from very, very severe autism to much milder. And so you can have different answers and different biology.
- [77:45]
B
It's.
- [77:46]
A
We need to have better science underlying all of these conditions. And that's something I'm investing in to make sure that the next generation of folks who have these conditions will have better answers provided to them.
- [78:02]
B
Just come to think of it, I remember watching moments from a hearing that you were at, and these are very, just to be fair, extremely high pressure moments where someone's trying to get you to say something that you'll regret later. But I believe you said that, you know, you're unaware of a situation where a single vaccine causes autism. I believe that's something that you, that you said. And I just, I wanted to give you an opportunity to just talk about this question because I've seen, I've looked at a bunch of literature now. I feel like, I feel like there seems to be a link right from the, from the, and again, I'm not, I'm not an expert.
- [78:43]
A
I don't agree. Right. I've read this.
- [78:45]
B
Right.
- [78:45]
A
I've read parts of this literature also. Right. So let me just start from the, like, step backwards just a bit. And we have this huge increase in autism prevalence. And in my reading of scientific literature, I've seen several, many different hypotheses. For why this has gone up. And every time I talk to somebody who's an expert in the area, they give me yet another hypothesis.
- [79:11]
B
Well, it's likely a combination of factors, right?
- [79:14]
A
Yeah. And it's very different because it's obviously a very heterogeneous condition where there are some kids who are very non verbal, very clearly some biomedical underlying condition that is causing it probably environmentally induced with some genetic susceptibility. I don't know, it's really very complicated. And then there's like kids who are, who are high functioning. Verbal maybe have some social awkwardness but otherwise are integrated into society. Well. And so the biology there is going to be very different. And I'll tell you, I don't know the answer. I don't understand how people can so confidently say they know what the answer is for a biological condition that is so heterogeneous and so many different hypotheses. That's the way I've been approaching it. Now, on the question of vaccines in autism, there have been some research in some areas that are, that for instance the measles vaccine, the MMR vaccine and autism, there are I believe, high quality studies. Now people will argue with me, fine, I'll grant that there may be problems with the studies that I'll say, but to me, to my eye, for the MMR vaccine, they're honest attempts to try to ask whether MMR vaccination causes autism and they fail to find a link for the kind of study that I think is plausible or high quality. Now again, if people disagree, then I'd say let's fund the next study that advances on it for other vaccines. There actually isn't this kind of rich literature when people ask do vaccines cause autism? I think it's a poorly formed question. The question is, do our particular vaccines, do they cause autism one at a time? And then also we have a whole schedule where we give lots of vaccines over certain periods of time and different, you know, different delays and different schedule. Right.
- [81:14]
B
And, and these cocktails have not been studied at all.
- [81:17]
A
Well, it's very difficult. There's like a 2 to the N problem. Like if you n vaccines you're giving, there's two to the n possible combinations. And it's really difficult to study something that, where you have that many different combinations. It's a scientifically challenging problem and that's hard to study. In fact, in my understanding is that that's not something that has been addressed. So do vaccines cause autism is a poorly formed question. Do I believe that we know that There are some vaccines that cause autism. The answer is I don't think that's true. Do we know for a fact that every single vaccine in combination is given doesn't cause autism also? I don't know that we know that. So, I mean, these are things that are worthy of research and something actually like, generally it's not like it's become a taboo thing to do, but it really should just be a research agenda. I believe very strongly that based on the balance of risks and benefits, that some of the infectious diseases that we're vaccinating against most, in fact all of them that we're recommending vaccination against, are important to vaccinate against because the infections, these themselves, I know, cause problems. Now it may be that for some kids with different kinds of susceptibility in different areas, there's going to be some risks and you have to take that into account. And so there should be sort of a shared decision making kind of thing for vaccinations.
- [82:41]
B
Right. As indeed has been the, you know, the sort of the direction the administration has.
- [82:46]
A
Yeah. Like there's very few, like most, most European countries, these vaccination decisions are not mandated. Instead they're shared decision making with, with the public essentially trusting public health. Because public health isn't trying to force you to do something which is give you what's known and not known. I think that that to me is the right paradigm for thinking about vaccination because I do believe, as I said, the measles vaccine is a good example of this. It's vital, I believe, that most kids get the measles vaccine. For most kids, it would be a good thing for their health. Does that mean I want to force anyone to get this if they don't want it? No, the answer is no. I think it should be shared decision making and allow people to make decisions.
- [83:28]
B
Does it somehow reduce the efficacy if people make the choice for their kids to not do it for the overall population? Because this is like, this is what I understand to be the kind of the issue, right. That we have this kind of odd white lie culture where there's, you're supposed to believe that there are no problems with vaccines at all and then people will basically make sure their kids are vaccinated. But if they knew that there's even a very small chance of sort of a problem, they might not do it and that wouldn't be right.
- [84:03]
A
Well, it turns on a scientific question, right? Does the vaccine that you're considering reduce or eliminate the risk of your getting and Spreading that disease. Right. So for the measles vaccine, you get that measles vaccine, you're not going to get measles. Very likely. There may be some very, very rare exceptions. And you're not going to spread measles. Right. So you're getting the vaccine will have benefit for others, this herd immunity. Same thing with like actually having, you know, same thing with like some other vaccines. Other vaccines, you don't have that. Like with the COVID vaccine, you got COVID vaccine, you could still get Covid and you could still spread Covid. Right. And so you have two different situations, one where there is a public benefit, one where there isn't.
- [84:50]
B
But the question is, with not getting it, does that have a negative public.
- [84:55]
A
Well, I mean, again, it depends on a scientific question. Does the vaccine stop you from getting and spreading the disease designed to protect you against. Right. So for measles, yeah. If you're not getting it, you are now at risk of getting and spreading measles with the COVID vaccine. No, you're not. You're equally at risk of getting. You're roughly equal. I mean, there's no appreciable long term benefit in terms of reducing the probability of getting Covid or spreading Covid. And so like, it's just a scientific question to answer that question. But that doesn't mean that the right way to deal with vaccination is mandates. Right. So I'm going to repeat, most European countries do not have vaccine mandates even for the measles vaccine. And nevertheless they have relatively high uptake of the measles vaccines. Why is that? It's because the public trusts the public health authorities to do the right thing. Not to coerce them, not to lie to them, not to like, induce them to do things that they wouldn't otherwise want to do, but trust the public to make the right decisions with good advice from their doctors for their kids. I think to me that's the right way the public health ought to be conducted. And yet you're absolutely right, Jan. A lot of public health has been, well, you must. If you don't do this, we're going to lie to you about what the benefits and harms are. We're going to suppress and censor people who raise questions. American public health essentially has earned distrust. I think that's the situation we're in. And now do we have answers? Just to be blunt, do I have answers to all of these questions? The answer is no. The job of the NIH is to fund research so that we get answers for people to the questions that they have. Even if some people think that the question's already settled, if there's a lot of the population that doesn't agree with, then in my view, the right respectful thing to do is to, rather than just to censor them or argue with them, to marginalize them, is to provide more better scientific answers to the questions.
- [86:58]
B
That they have and possibly be. Discover that you're wrong. Yeah, right, right. Thank you for taking the time to, you know, there's, there's a whole host of other questions that I want to ask you, but I think maybe we'll. I'll save them. Maybe you'll come back. Hopefully you'll come back for another go sometime in the future. But in the meantime, a final thought as we finish here about just kind of where we're at and where we're heading with the nih.
- [87:28]
A
Well, I think that it's a brand new NIH in so many ways. And I have always loved the NIH before, even with his problems, served as the engine for biomedical scientific discovery that's led to cures. Almost every single piece of knowledge that doctors use now to manage patients have NIH investments over the last century somewhere at the heart of it. But I think sometime in the last couple of decades, the NIH became much more of a staid institution, not willing to take intellectual risks. But on the other hand, it was willing to take risks on dangerous gain of function and other utopian agendas, social agendas like dei that it had no business really engaging in. I think the NIH, now under my leadership, under President Trump's leadership, and with Secretary Kennedy looking over, is focused on actually addressing the chronic health problems of this country, reversing the flatlining of life expectancy and making good on its mission, which I think everyone should get behind. Research that improves the health and longevity of the American people, in fact, the whole world.
- [88:46]
B
And just as a kind of opinion that, I guess is just that I remember you were popularizing this idea recently that research done by the NIH that showed that, you know, ADHD can be dealt with with better sleep. I mean, basically that's what I saw, which sounds attractive and hopefully is the case. Right. And so this is, you know.
- [89:08]
A
Well, there was, so. Yeah, that was, that was a kind of interesting. It's just a new result that just popped up on NIH funded research shows that the way that some drugs like that are used to treat ADHD work previously were thought to like, hit attention centers in the brain, make you more attentive. But in fact, what they do is they hit wakefulness centers. Now, the next step from that is that's something that needs more research. But, like, is, well, for some kids, why give the drug at all if maybe you could instead have better sleep and then you get the wakefulness centers more naturally sort of in the right state rather than with the drug? It's not affecting attention centers of the brain as was previously thought. That's the result. Interesting biological result with practical potential. Practical implications that do need more research to follow up on.
- [90:00]
B
Well, Dr. Jay Bhattacharya, it's such a pleasure to have had you on.
- [90:03]
A
Thank you, Jan. So good to talk.
- [90:05]
B
Thank you all for joining Dr. Jay Bhattacharya and me on this episode of American Thought Leaders. I'm your host, Jan Yekelik.