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Can He Make America Healthy (and Trusting) Again? with NIH Director Jay Bhattacharya
01:16:41
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- [00:00]
A
In 2050, will we be going to Beijing, Boston, or a suburb of Nebraska for health care? And should we trust American public health? Because these days, every American seems to cite a reason not to. Whether it's the COVID 19 management, the MAHA health moment, or option C, all of the above. So today on Smart Girl, Dumb Questions, I'm your host, Naima Raza, and I'm in conversation with Dr. Jay Bhattacharya, who is the director of the National Institutes of Health or the nih.
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B
Well, a delight to host you here.
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A
Yes, we're actually at your building. We're at this beautiful campus of the nih, which I had not been to before.
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B
This is building one. There's actually FDR commissioned it.
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A
Really?
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B
Yeah. There's a picture of him giving a speech like 1939 or something. It's pretty neat.
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A
And there's a lot of construction happening right now here.
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B
Yeah. So we're building a. We have a hospital on campus that's focused on doing research. There's a lot of, like, amazing people around here doing incredible research.
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A
So, yes, no ballrooms. No ballrooms are being built.
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B
There's no ballrooms that I'm aware of.
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C
Smart Girl, Dumb questions. By the way, this is the Ballroom Free NIH Campus, where a lot of amazing health and science research has happened over the decades. Pretty cool, right? Except they gave me water to drink out of this red solo cup, and I'm like, come on, Bobby.
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A
Microplastics. I'm kidding. I mean, I sometimes do worry about.
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C
Microplastics, but Secretary Kennedy was not present. I showed up at the NIH in the midst of an unexpectedly newsy time for American health care. The Trump administration had just announced a major shift in the US Childhood vaccination schedule, now recommending that all American kids are universally vaccinated against 11 diseases instead of the 17 that had been previously recommended at the end of 2024. Now, you've probably seen this news, and it can be confusing. Some outlets talked about 18 to 11 because they include the seasonal shot for RSV. I've heard people say 15 or 16 to 11 because some of these changes were actually made last year. And then the White House shared this graphic, which I found. Well, we're going to get to that. Now, importantly, all these vaccines are still available, and they're still covered by insurance. They've moved from universal recommendation to something called shared clinical decision making, which we're going to get into. And it's states, ultimately that set the mandates. But we can't say that federal Recommendations don't matter. They do. And that's why some people are very worried, some health experts are very worried that this is going to lead to an uptick in childhood illness or hospitalization that's going to see lower vaccination rates across the countries and that there's going to be more distrust in the system. Meanwhile, the administration says that this is part of restoring trust in the system. Health has always felt like a political football in America. That felt true in the pandemic. That feels true now. That was apparently true in the 1980s and 90s. But I think most Americans want to understand what, what the science says, how these decisions are being made and who is making these decisions. So I was really looking forward to having a conversation with Dr. Jay Bhattacharya, who's the head of the NIH and a major figure in Maha. And we spoke not just about the vaccines, but about scientific breakthroughs, about the biomedical race with China, about what's going on with budget cuts and funding and all of that, and about GLP1s like Ozempic, which are being explored for their anti inflammatory and longevity potential. Is that going to be a magic bullet or is that just a bad band aid?
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A
You of course came to fame, I would say, during the pandemic era with the Great Barrington Declaration.
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B
To me, it's still shocking to me that it was controversial. It was basically in October 2020. Me, Martin Kuldorf, then of Harvard University and then Sunesha Gupta of Oxford University. She's one of the most talented epidemiologists in the world. We wrote a short document saying that we shouldn't have lockdowns as a way to manage the pandemic, that we should do a better job protecting the vulnerable older people. Covid posed a real risk to older people and that we shouldn't be harming children and others by locking down in ways that was going to cause sort of permanent damage to them. That was the way we managed all these other pandemics in the past. You identify vulnerable people, work on protecting them while not disrupting the lives of others.
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A
The time you were on faculty at Stanford, where he had been for decades. You've been in this role now for nine plus months for a long time. Before you were an academic.
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B
Yeah, I mean I was a Stanford professor for 25 years in the medical.
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A
So I wanted to get to that conversation around the pandemic. But first I just want to establish who you are because physician, scientist and economist, which is like a model, dancer, actor of geeks.
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B
I know about that. But yeah, I have an MD and a PhD in economics. I spent most of my career doing research in a whole bunch of topics in epidemiology and health policy, in health, economics, statistics, medicine, a whole bunch of. I mean, so the nice thing about having an economics degree and a medical degree is you can. There's a lot of really amazing, interesting, important topics that you can research and there's great tools to do it with.
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A
I mean, for most South Asian parents, it's sufficient to become one of those three things. But you just really needed to like, go for the strikeout.
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B
Well, just to be clear, I have an md, but I do research for a living, so I never practice medicine. So my mom is like, still to this day is like, jay, how come you don't see patients?
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A
So did you pursue a rest residency and then you left the residency or you didn't even pursue a residency?
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B
No. What happened was like I started my MD thinking I was going to be a doctor, a regular doctor. Realized I really missed research. Applied for a PhD in economics. Sort of did both together for a while. And toward the end of it, I realized I was doing like these clinics where, I mean, they're really great, like patients, you can talk to patients. It was actually really fun. But I found myself missing research and I didn't want to spend my entire life doing something you really should be the pinnacle of your careers, like learning how to take care of patients. And that should be all you want to do. I didn't want to be only partially present in that. I wanted to be.
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A
So you pursued your passion.
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B
Yeah. So when, you know, I never. Which was graphs, basically. Yeah, statistics, graphs, math.
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A
Well, I'm sure all of those things come in helpful right now. I want to get deep into the medicine of it. But we have to talk about some news because we're taping this on Tuesday, January 6th. And just yesterday, the President announced with yourself, Marty Makary of FDA, the Robert F. Kennedy Jr. The health secretary, et cetera. A new vaccine program for the nation. Changes to the vaccine program to the nation.
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B
Yeah, it's on you in some sense. Like it's okay. So what happened is that the President wrote a memo ordering Health and Human Services, the organization that Bobby Kennedy runs, to do a review of other countries vaccine schedules. And it's interesting, like when that report got written, it was really interesting to find that the United States vaccine schedule is a outlier.
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A
I want to talk about the kind of advertising of this. I'm going to show you this picture and if you're watching on YouTube, you'll see this as well, right? Did you see this? The 11 injections versus 72. This was from the White House's official account. So it shows two children and on the left side it says European country and it shows 11 indicators.
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B
The thing is, it's complicated because the question is, are you counting vaccines? Because some doses have multiple vaccines in them. So MMR, like measles, muffibella.
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A
I mean, so this says 11 injections. So it says. Just so people can follow along if they're just listening. European countries has 11 injections. United States, it says 72 injections. And the baby has like a halo of shots going into it.
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B
It's a striking figure.
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A
But.
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B
But the point is that the United States is an outlier. You can talk about. There's like disputes about the exact numbers.
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A
Yeah, can we talk about that? Because I think the marketing, like the, the headline is important because people look at that and they learn something from it. Because of our social media era that we live in.
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B
Well, I'll just tell you that is that the United States recommends more diseases be vaccinated against at earlier stages of child development than any other developed country.
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A
I think that's what the 11 is referring to in Europe. In Europe, you're inoculated as a child against 11.
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B
So you need to be careful because like in Europe, there's different schedules and different. And some places have more, some people have less. But the US Is an outlier against all of them.
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A
But it's an outlier in the sense that we were inoculating against 15 to 18.
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B
Are you counting diseases? Are you counting, like, for instance, for some vaccines you need multiple shots for the same disease. And some vaccines have multiple diseases covered in one shot.
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A
So it just, I tried to do like an apples to apples comparison of this.
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B
If you read the report, there's some discussion about this. So like, it's just, if those who are listening go take a look at the actual report.
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A
Say in a comparative European country, you have 11 disease states that you're going up against. In the US that was about 16. The number of injections then is more than that. The dosing is more than the injections because some injections have multiple doses, but comparing it's probably more like 70 to 30.
- [08:52]
B
Just sit back instead of talking about the technicalities of the exact number because you can just get arguments that are not. They don't actually mean much. The key question is what are the benefits? What are the potential harms for each decision that you're Making regarding your child. Right. And so the point is that in so many of our peer nations who have the same science in front of them, they make very, very different decisions and recommendations about how to manage that sort of, like, benefit, harm kind of calculation.
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A
Okay, so let's speak about them so people can make sense of them. So the flu and Covid vaccines for these kids, were those mandated before?
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B
Like, were they actually, the COVID 19 vaccines were.
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A
Well, for.
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B
For a period of time, yeah. I mean, they were. They were. They were subject to substantial mandates. I was part of a. That when I was. When I. Before I was at NIH director, I was served as an expert witness in many cases involving COVID 19 mandates. Opposing. Essentially opposing them, because I thought that. I think that. That those mandates did tremendous harm to public health. Like, they assert, they were premised on the idea that the COVID 19 vaccine was necessary to stop transmission of the disease.
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A
You're saying the mandates did harm, you're not saying the vaccine did harm.
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B
Well, you could imagine a COVID 19 vaccine rolled out in a very different way, in a sort of voluntary way where the emphasis was on, again, on who would it most benefit, like vulnerable populations, potentially older people, potentially, and not have it mandated. And, I mean, that's a whole completely different world. I think. I think that the level of distrust that we now see on vaccines generally is a product of the deep coercion disconnected from science that happened during the COVID pandemic era, specifically regarding the vaccines, but also the lockdowns and school closures and mask mandates and all this other stuff.
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A
I agree with you that the pandemic era was a huge galvanizer of distrust in the system. And I think a lot of people look back at that time and think, you know, what are the decisions we made and how did it. You know, I think also leaders in that time were trying to save lives.
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B
We talked earlier about the Great Barrington Declaration. The former head of the National Institute of Health, in response to having epidemiologist Francis Collins, in response to a. Was essentially a short document articulating the old way of managing pandemics, saying, don't harm kids. With three epidemiologists from Harvard, Stanford and Oxford. His response was to call for a devastating takedown of me and my colleagues, literally.
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A
He called for a devastating takedown?
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B
Yeah, he called for a devastating takedown. And he called us names. He called me and Martin and Sinetra fringe epidemiologists. I mean, it was essentially a delegitimization of anyone who disagreed on items that were like, obviously not supported by science. Like it was not true that the COVID vaccine stopped you from getting a spreading. Covid just wasn't. The data showed that past the first two months or whatever it was that they tried permanent. Same thing with the lockdowns. There was not evidence that the lockdowns were gonna get us to zero Covid. The evidence that on school closures was actually the opposite direction.
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A
So I wanna get to Covid in that part of the conversation. I think what you're saying is important in the sense that we should be able to have robust conversations with people who disagree.
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B
Right.
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A
And credentials.
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B
And that did not happen. That did not happen.
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A
Yeah. And I think the surprising thing and the reason I reached out to you is because I was surprised why academics at places I've studied, including Stanford and Harvard, et cetera, were not at least being able to engage in a conversation and why that conversation was happening less than, you know, now that conversation seems to be out there. It seems to be more in the mainstream. So I want to get to all of that. But first, but actually, let me ask you, the skepticism around vaccines doesn't just come from COVID and you would think the skepticism around vaccines is actually dangerous right? Now, when you look at like what happens, look at Texas and the measles epidemic, for example. Right. Do you agree it's dangerous?
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B
Yeah, I think that like a measles vaccine is a perfect example. The best way to stop the spread of measles is for kids to get vaccinated. It's a very, very important vaccine. It's not just Texas, by the way, it's the Canada has a huge outbreak now of. So does Mexico, a whole bunch of places. But yeah, I do, I think that in my professional career, I've been watching this now for a long time. The level of sort of distrust by regular people about public health and particular about vaccines is as high as I've ever seen it. And I think it is directly attributable to the way that experts and the scientific authorities behave during COVID And I.
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A
Think though there's also a sense of people take advantage of their opportunity. When the door opens, someone runs through. But you know, there are people who I think have seize the moment of distrust to try to sow distrust everywhere. Do you agree with that or say, don't trust those guys, trust me instead.
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B
I mean, that was true of the establishment during COVID I mean, I just, I think that the problem is that you need to have good faith engagement if you're gonna have make any progress in science or in public health.
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C
That's like, that's what I think struck.
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A
Me when I see this picture of this baby with 72 jabs and 11 jabs. And I understand this is coming out from the White House's page, not your personal page, but I think of it like we live in a world of so much marketing and if I scroll through my social media, which is where most people, millennials and Gen Z get their information these days, you just see these headlines. I scrolled one through one the other day, that was from the New York Post, it said, what your butt shape can tell about you. Scientists study this. And then you see these, like these moments, these memes, and we're kind of condensing information into this non nuanced format. Which is why I'm so grateful that you're taking the time to sit with me.
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B
I mean, I suggest people that are interested, they go read the report. Like the report tells you the full, to the extent it's there, all the full argument.
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A
So with the new recommendations, which the White House is calling the gold standard for child vaccines right now, let's talk about the ones that have just taken off the table really quickly.
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B
Okay, so first of all, just to set the stage, because it's not quite right to say taken off the table.
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C
Oh, that's true.
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B
Okay, yeah, so that's incorrect. So one is that all of the vaccines are still paid for. There's no change in that setting in that sense. Right. All of them are still available to everybody who wants them. So in that sense, there's no real change in the availability of the vaccines at all. So this is not about the vaccines being more expensive now or not available now? They're still available. They still have the liability protection.
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A
It's about shared decision making. I'm sorry, I misspoke. So this is about shared decision making. It's taking what was seen as recommended and making it shared.
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B
Well, still recommended, but it's recommended for like. So for instance, for most of the vaccines, actually, like for some of the key ones, especially the most important ones, like the MMR vaccine with the measles one, which we just talked about, is a tremendously important vaccine, polio vaccine, a whole host of vaccines, there's no change at all.
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A
So the five that there's a change, there's the COVID and flu and then hepatitis B. It used to be at birth.
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B
That was changed by the acip, the Advisory Committee on Immunization Practices. This action taken a couple of days ago, had no Effect on the hepatitis B vaccine. ASIP already recommended that it be moved from birth to two months.
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A
And with the exception of if the mother has hepatitis B, in which case they recommend it.
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B
Yeah, right.
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A
And then there were two other. The rotavirus.
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B
Yeah, there's no. I think there's a couple. So there's rotavirus and then meningococcus.
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A
Yes. Which is meningitis.
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B
Yeah, it's a meningitis.
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A
Okay.
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B
Yeah. And then I'm trying to. I don't have the report in front of me, but.
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A
But let's take those two. So rotavirus. The reason in the report it said, you know, it's down like by 90%. Like immunization has really reduced the level of children getting this kind of gastrointestinal illness.
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B
If you get rotavirus and you are living in a developing country, for instance, in India, where I was born, there are a lot of child deaths. Dehydration after you have gastrointestinal disease. The issue there is the management of the patient. Right. So if you have oral rehydration therapy, which is like essentially a 3 cent salt, and you give the child this oral rehydration therapy, you reduce child deaths by tremendous amount for the same disease in this country. You don't get child deaths from that because essentially those children get care. So the pattern of disease is very, very different in developing countries than they are in developed countries. So this says like, if your child is in a high risk environment. Right. Then we recommend that you get it. If you don't, if it's not a high risk environment, then parents can make a decision together with doctors.
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A
And then the meningitis, the same thing. Like if you're going to go live in a dorm, you should probably get this vaccine, Right?
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B
Yes. I mean, that's exactly. In fact, that's what Denmark does. Right. So they say that for meningitis vaccines, actually there's multiple strains of meningitis. There's one that affects little babies and there's one that affect like adolescents more and young adults more. So the recommendation is again, if you're in a high risk environment. So again, so if you're going to college for the first time, you probably should get it.
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A
Yes, I think that was recommended when I went.
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B
And it's still the recommendation.
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A
It's still the recommendation. Or it might even be required in certain dorm living environments.
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B
I believe there might be. It's possible that some states or some institutions require it, but the federal government doesn't mandate vaccines.
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A
Okay. So this is really Helpful nuance like this conversation explains much better than the photo I saw of 72 versus 11.
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B
Stacks on a bay. I think just to be like, the motivation behind the change is because of the collapse in trust in public health. Right? Public health. The way it has addressed vaccines during COVID masks, Plexiglas lockdown, school closures, business closures, church closures, all. It was just. You have to trust us. We have the answer. We are the science. You have to believe us. This is a attempt to say to the public, look, we're looking at. It's essentially an act of humility. We're looking at what other countries are doing and recognizing that American public health does not have a monopoly of the science. That in fact, other countries manage the same problem very differently and frankly, they have better child health outcomes than we do. Denmark, for instance, mandates no vaccines. The UK mandates no vaccines. So the kind of coercive model of public health which has led to this moment of distrust, that's led to. To uptake of MMR vaccines, going from 95.7% to 92 point. Okay, I'm gonna get the numbers wrong, but 92.7%, like a 3 percentage point drop, doesn't sound like a lot, but it's what's led to the outbreaks of measles by focusing attention and the recommendations on the most important vaccines. Saying this with an act of humility at the basis of it, that's how you restore trust.
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A
Why isn't that the focus then, in the messaging? Why isn't the messaging. Look, we've done this review, and these are the things that.
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B
This is the messaging I'd be giving. I mean, like I was you, I've been giving this kind of messaging for a long time now and part of the administration. Right.
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A
So of course. But why isn't the marketing that meme. You know, why instead of not seeing 72 jabs into a small child, I.
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B
Mean, why do you recommend closing schools for. For in 2020? Like, why did the right.
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A
You know, I'm just saying, I just.
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B
Think that, I mean, people make people oversimplify science all the time. Like, I just, I think, I think you're. I think the key question is, like, what's the reality? And the reality is that with this change, we are making our schedule more in aligned with what the rest of the world developed world does.
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A
I understand what you're saying on the mandates, and I also, I always struggle with this idea of the US and peer nations because the US famously loves to be peerless. And when you look at a lot of other developed countries, they have a couple of things that the United States doesn't have. They have one, public healthcare provision in some way, shape or form.
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B
And two, just so we're clear, so kids in this country have coverage, right? So like we have Chip, we have Medicaid that covers poor kids. And if you're saying like, okay, if you have kids that don't have coverage, does requiring more vaccines for those kids make it easier or harder on parents? The logic of what you just said doesn't make sense.
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A
No, I'm not talking about the vaccines in general. I'm just talking about this idea of peer nations in general.
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B
Let's talk about this specific thing.
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A
I want to say the other part of this. The other part of this is that there's not necessarily a shared kind of culture and that's outside of public health. That's just in the United States there is a sentiment of American dream. A lot of people came here as immigrants, they were persecuted. There's a kind of general distrust that happens in our environment. And so I'm not advocating for mandates, by the way. I'm asking a question. Does the US really have peer nations when it comes to healthcare writ large?
- [22:08]
B
Yeah, it absolutely does have pure nations. Like we can learn from many other countries and what they do, the science about diseases. It's a human science, right? To say the United States can't learn from other countries. Somehow, like Americans are different for other humans. It's not true.
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A
No. Their public health system is different. That if we give everyone the chance, is everyone going to still get vaccinated or not?
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B
Okay, let me just be blunt about this. What you're saying is that the government should distrust Americans and the choices they make.
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A
I'm not at all saying that.
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B
No, no, that's the implication of what you're saying, right, because you're saying, like, because Americans are unique where other nations trust their citizens with these decisions, with shared decision making and like sort of no mandates, Americans are in a position are so unique that they can't be trusted. I'm not disagree with you.
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A
I'm not seriously disagree. I think most, I mean, I think the whole idea of the.
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B
If you're saying this as a strong man, that's fine. I'm not advocating. But my point is the implication of that argument, if you take the premise seriously, is that Americans can't be trusted.
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A
Whereas Danish people can't or whatever.
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B
Right? So that makes no sense to me.
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A
That's not what I'm saying. I think that there is.
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C
It just.
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A
It's like, how do you create a culture? I'm asking a different question, which is can we create cultures that actually breed kind of more trust over time?
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B
Yes, we can. But you have to do it by actually trusting people. Right. You have to show acts of humility. You can't say, oh, we are the same. And if Bobby Kennedy comes along and asks a question, I won't even debate you. Right. I think that this sort of authoritarian public health is guaranteed to breed distrust.
- [23:44]
A
Yes. What really would be helpful is to un memeify the conversation. And I think what I would like to do with you, Dr. Bhattacharya, is like, run through some of the headlines and talk beyond the headlines of what these things actually mean and where we are. Here's headline one that shook me. It's the longevity reversal and Gen Z and Gen Alpha. And you've talked about this, you've said this is the first time in modern history, I'm paraphrasing you here, that the next generation will live shorter, less healthy lives than their parents.
- [24:16]
B
That's the shocking prospect. But if you look at the numbers, the United States has had no increase in life expectancy since 2010. There was a collapse during COVID and now we're back to 2019 levels. And I mean, it's just flat. When I was a young researcher, the question was the research question everyone wanted to know. The answer is, why does life expectancy keep increasing? Right. And it was something I just took for granted. Our peer nations have had continuing increases in life expectancy. For Americans, it's flat. Our kids are less healthy than we were as kids to some extent. And certainly the prospect is that their kids will be less healthy if we keep going these same trends. There's higher rates of obesity, higher rates of autism for kids, a massive chronic disease crisis. And of course, for adults, it's the same for a different set of diseases. You know, metabolic disease, type 2 diabetes, Alzheimer's disease. On condition after condition after condition, Americans are in worse health than the previous generation of Americans were at the same age.
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A
Is ozempic going to change that? Because that study came out in 2023. Ozempic obviously has been kind of made more widely available since that date. Is Ozempic a magic bullet?
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B
I don't know if it's a magic bull. I mean, there was actually a decrease in the prevalence of obesity for the first time in decades last year, I think. But the point is we have seen rises in body weight continuously for decades. And I Think last year was the first decrease. So it's possible. I mean, it depends. There's a lot of uncertainties about those chronic disease trends. I don't know a magic bullet necessarily will. I mean, because I think the thing is, the outcome is a very multifaceted thing. I don't believe it's only metabolic disease. It's at the root of it. And if it is only metabolic disease, does Ozempic solve all of the consequences of metabolic disease in the same way? Necessarily. Just because you were obese and then you have Ozempic and you're no longer, does that mean that you're metabolically as healthy as you were once upon a time? Or if you'd never. And, you know, you regularly exercise and ate right and all that? I mean, I think there's gonna be lots and lots of questions, I think, that can come up. I do think it's a call to action, though. Like, we now have a clear focus with the Make America Healthy Again movement on trying to solve now this to solve this chronic disease problem. I mean, I don't want my kids to be less healthy than I am. Not at all. Yeah. And I want them to be healthier than me. I want them to live longer than me. And I think we need to think about policies that are going to make that come about, both in medicine, science, and generally.
- [27:00]
A
Do you think there'll be a time like Fast forward to 2050 where we'll all be taking. Where everybody will be taking Ozempic?
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B
That seems unlikely that everyone will take it. I mean, there's people who like exercising and eating well. And I mean, if we have a shift in our culture where eating well and regularly exercising becomes more like the norm, then maybe people won't want to take Ozempic. You know, ozempic means essentially what it does is makes you not hungry.
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A
Yeah.
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B
And so that means you want, like, you won't maybe you enjoy food.
- [27:32]
A
But they're like, they're changing all the Ozempic now. It's gonna be available in like a pill version. And then they're trying to make it so that it doesn't reduce your muscle mass. And so they're kind of innovating. It's really interesting to me because again, I'm like, oh, wow. It feels like we might have a real problem in our food supply and the way we eat and our culture around health, but now we have a demi more in the substance, a magic injection or bullet to fix this for us.
- [27:56]
B
I don't believe in magic, so I do Think that this is a real advance.
- [28:01]
A
It's probably good for a scientist.
- [28:02]
B
Yeah, I do think it's a real advance. I think with almost every technology, there's always things you haven't thought of and things that will happen that you don't expect. And so I don't think that thinking about it as a magic bullet is never the right, the right thing. Like imagine it was free. What would happen? Like, I imagine people would overdose on it. There are issues with it. It's not for everyone. There are side effects to some people. Some people can't tolerate it. And again, I don't know what the long term effects are of a large populations of people taking it. Again, I think for some people, it's really, really useful. So I don't mean to say don't take it at all, but I'm saying there's nothing in the magic bullet.
- [28:46]
A
It seems like from where I sit in the culture, it seems like it's getting more and more mainstream where I have conversations almost every day with people who are starting to microdose it and take. So it's really. I think it's becoming a real generational shift, particularly in the millennial generation.
- [29:01]
B
There's certainly financial incentives for that to happen.
- [29:04]
A
Okay, financial incentives. By that you mean the pharmaceutical companies would like everybody to be microdosing the product. There's a second kind of headline that we all that we hear often. And I want to unpack a little bit, which is what you just said right now. Life expectancy in the United States hasn't really changed in the last decade. Plus kind of since 2010, 2011, 12, we've seen this kind of mark of Americans living to about 78, 79 years old. So why is it that. Is it possible that we just hit a max? No, because our quote unquote, pure nations are outliving us.
- [29:41]
B
Yes. The life expectancy continue to go up there in other countries.
- [29:45]
A
And is there a good indicator, beyond life expectancy, of quality of life?
- [29:49]
B
Yeah, I mean, there's this notion of compression and morbidity where the idea was that you live longer, but the years you spent disabled are at the very end of your life and they're shorter. There's only fewer and fewer of them. I mean, actually I was working on research on that in the 90s and early 2000s, and they're measures of quality of life built around avoiding that state of disability at the end of life. And there's things like Alzheimer's disease that rob you of your quality of life pretty fundamentally. Like Your ability to remember the names of your kids or to have the relationships that were meaningful to you start being harder to do. I mean, there's other measures of disability that we want to avoid. Like type 2 diabetes leads to limb amputations, for instance. There's a whole host of things that go along with chronic disease that are not just shorter lifespan.
- [30:47]
A
Right. So on here I was trying to figure out, well, is that true for everybody? But then I saw this study that was done about income. And I think the study was actually maybe partly funded by NIH because it was actually free to me on jama, which I think is a change that you and your predecessor under the Biden administration had made to make NIH funded research free now for everybody. Correct?
- [31:06]
B
Oh, I know this study. Yeah.
- [31:08]
A
Yeah. So Rod Chetty at Harvard and others did this study that looked at your percentile of income basically and your longevity of life. And what they found, a headline of this is that the richest American men live 15 years longer than the poorest American men. And the richest American women, the top, top 1%, live 10 years longer than the poorest 1%. And then if you look at survival rates as well across various disease states, you'll also see that kind of distinction in wealth. How do you think about that? Like can we even. So moving from that question of do we have pure nations, do we even have one nation?
- [31:45]
B
Yeah, we have one nation. I mean there's rich and poor in the nation. I mean, it's unfortunate fact that you that poor people live shorter, less healthy lives than richer people. That's been true of every nation on the face of the earth forever.
- [31:58]
A
Do you think this is going to go up now with the kind of advances that we're seeing in longevity and off label use of Ozempic or other things like that?
- [32:06]
B
Well, okay, let's just stay on it, but Ozempic. And let's take your premise that Ozempic will solve the life expectancy.
- [32:12]
A
It's not my premise, it's a question.
- [32:14]
B
The premise that you advance as a hypothetical. Right? So let's a take, take that as given and let's say that's true, let's say that hypothetical is true. Then it's just a question of price, Right? So if the price of access to that kind of therapy is low, then the life expectancy difference between rich and poor will shrink. If it's high, then it'll get bigger. Like I did a study once looking at the effects of antibiotics, the development and discovery and the dissemination of antibiotics in, in post War Italy. And what we found is that it collapsed life expectancy differences or mortality differences between rich and poor parts of Italy. Right. So because antibiotics are available cheaply, it addressed a major problem that was more prevalent in the poorer provinces of Italy than in the richer provinces. And so not only did it extend life by sort of curing bacterial illnesses, but also shrunk life expectancy difference or mortality differences between, between rich and poor.
- [33:17]
A
It's an interesting study. I feel like Italy's always, obviously, famously, Putnam's Bowling Alone is comparing the north and south of Italy. I feel like Italy's always the destination for these kinds of studies. Probably because academics like hanging out in.
- [33:28]
B
Italy, maybe actually did not get to go to Italy for the study.
- [33:30]
A
But no, yeah, you're doing something wrong.
- [33:33]
B
Almost certainly.
- [33:34]
A
No ballroom, no going to Italy.
- [33:35]
B
What are you doing?
- [33:36]
A
The third headline that we see a lot in American healthcare is this idea that we pay double what other countries pay for lower life expectancy outcomes. So this comes to this idea of expense versus effectiveness. And this chart that you, you've probably seen a million times in your life, which will flash up again on the screen, shows per capita expenditure on healthcare versus life expectancy. A lot of the peer countries, Italy, Japan, France, Canada, you see bunch in a certain place and then you see the US living shorter lives.
- [34:04]
B
And yeah, we spend about, I think it's like 18% of our GDP is on healthcare.
- [34:08]
A
Yeah.
- [34:09]
B
And our pure nations spend about 10, 11, 12% of GDP on healthcare. So that's like the difference between $1 5 versus $1 in 7 or 8. And so that's a big difference. And their results are better, Right? They get higher, they get lower rates of chronic disease, lower expenditure on health, and frankly it's bankrupting us.
- [34:38]
A
So why is that happening? What is your best understanding of why that happens?
- [34:43]
B
That's a very complicated question. I wrote a textbook on this theme. So I mean, if you want go, if you want the nuanced answer, go read my textbook.
- [34:50]
A
If you want to read a textbook.
- [34:52]
B
It'S a very exciting textbook. So just some of the give us the one minute. I don't know, it's possible to a one minute version. I think fundamentally the way that we deliver healthcare and healthcare markets are incredibly inefficient and the incentives in the system are to provide services that provide very low marginal benefits on the margin. Like on average it's productive, but at the margin it's very non productive. And as a result we spend a lot of money on things that don't produce Better health for people. And frankly, in health care reform debates, all of the focus has been, especially from the left, you've seen this focus on access to care and no attention whatsoever on the cost of care. All of the access to care debates I've seen as a health economist over the last several decades have happened in part because the access problems happen in part because the cost of care is so high. If the cost of care is per unit were the same as it was in some of the other peer nations, then the access problems would be much easier to solve.
- [36:02]
A
Isn't it a chicken and egg thing? Like some people say, oh, the cost is so expensive, that's why it's exclusionary or prohibitive. And other people would say your access is such that the cost is becoming too expensive.
- [36:13]
B
I don't understand the opposite direction. The first direction makes sense to me. Whether you favor public or private provision, when you have a high price, there's going to be less demand for the thing. Right. I think we have a health health care market in pharmaceuticals, in physicians, in hospitals and long term care and a whole host of like sort of the provider side of the market for the same good charges way more than you would get charged in Denmark.
- [36:42]
A
I had an ACL surgery here and my bills for it were about $130,000. Of course insurance paid and I paid my co pays or whatever, or Maybe it was $80,000, I can't recall. My friend had the same exact procedure done at Cleveland Clinic privately in London. 5,000.
- [36:57]
B
Can I, can I modify what I said earlier? Because I'm going to correct myself and agree with you on the opposite side. When you expand insurance, you also, unless you take active steps, reduce the incentive to have lower costs.
- [37:10]
A
Exactly. That's what I think is the chicken and egg.
- [37:13]
B
So let me. So yeah, I agree with you about that. So it's. But I don't think that the solution is lack of access. So I don't. Because that's why I was pushing back on the chicken and egg side of it. I think the solution is interventions in the market to reduce the sort of capacity for market power to charge higher prices, have more competition in markets, would be the right way to do it.
- [37:38]
A
Yeah, I don't know. When you're done with Dr. Bhattacharya's textbook, you can check out the first episode of this show, which is called Can Billionaires Save Us? And I talked to Mark Cuban about the opacity of our healthcare system and, and basically ask him the question, if capitalism and unfettered Capitalism maybe fucked healthcare. Can it unfuck the system, as he likes to say, through his cost plus drugs, et cetera. Sorry, I will try not to.
- [38:03]
B
I'm just so shocked. I have no idea. No, I'm just kidding. I think the thing is, if you think about the way that markets work, if they're working well, they have to price the right thing. The problem with healthcare markets right now in the United States is that they price the wrong thing. They price the service you receive rather than the outcome you want. Right. So like, and a lot of the good healthcare reform ideas about healthcare markets have to do with changing what we price, like changing what we pay for.
- [38:41]
A
Are you opposed to public health care, like provision, like in terms of like a national single payer system or.
- [38:47]
B
I mean, I'm in favor of Medicaid. I mean, I think Medicaid is really important. I'm in favor of Medicare. So no, the answer is no, I'm not.
- [38:51]
A
But for the general population, not just Medicaid and chips, that's a lot of the population. Yeah, but I'm asking you like, do you think, I mean you're sitting here with all the economic and the studies.
- [39:00]
B
That you've done, do you think that.
- [39:01]
A
Part of the reason why our peer countries do better is because they have it across their lifetime and not just.
- [39:06]
B
Okay, so which countries are you talking about? Japan and Germany, which have like this Bismarcking system they have. Well, they have. I mean it's actually much more like the United States.
- [39:15]
A
What is your opinion?
- [39:16]
B
I mean, I think that if the debates over who should provide care are a, are dead end and it ends up in positions where you just have these like political fights that lead to nonsense, they're impractical.
- [39:28]
A
But in an ideal hypothetical world, I.
- [39:30]
B
Think ideally if you address the price of care, then the universality of coverage would solve itself. Right. Whether it would be via private provision or public vision or a mix maybe mix is the most likely way. That's much less interesting to me than the price of care, which is the root problem.
- [39:46]
C
Hang tight for a second, we'll be right back. I want you to use this break to share this episode with someone you think would enjoy or benefit from it. And leave a comment to tell me what you think. Can we restore trust in health and science? Is azempic going to be some kind of longevity game changer? And when it comes to this chicken and egg question, how do you think about healthcare reform? Is it about driving down costs and through more competition like the director is describing, so that we can have more access? Or is it about expanding access, like, say, a UK where the NHS has the buying power and the reach to really drive down healthcare costs? Or is it something else entirely? And if you want to know what Mark Cuban thinks, you should check out that episode, which is 2 below.
- [40:25]
A
But first, finish this one. The state of US healthcare workers right now includes morbid obesity, rising mental health crisis, extreme excursion of costs of care, which we've just spoken about, rises in youth cancer and young cancer, young chronic disease, particularly in midlife, public distrust. Yet you only have a budget of $48 billion and shrinking, I believe.
- [40:49]
B
Not shrinking.
- [40:50]
A
Well, there are proposed budget cuts to.
- [40:52]
B
That, but they're actually happening. Right. So.
- [40:54]
A
Because Congress will stop them.
- [40:55]
B
Well, Congress has stopped them. The Senate's proposing a 1% increase, actually.
- [40:59]
A
Yeah, but they were proposed by the President.
- [41:03]
B
They haven't happened.
- [41:04]
A
Okay. Are you worried about further proposals of.
- [41:06]
B
Budget cuts you saw this year, like the Congress? I mean, I get to. This is part of my job, is I get to go talk with members of Congress on both sides to understand what they want from the NIH or their desires for the NIH. And there's pretty widespread support in Congress for the NIH. It's not an accident that Congress is proposing a 1%, Senate's proposing a 1% increase. The House is proposing no change in the budget.
- [41:29]
A
Where did the budget proposal. Because the budget proposal for 2026 from the President included a 40% reduction. Where did that come from?
- [41:36]
B
The office of OMB. No, they proposed it before I got in. But I mean, the thing is, we have a $2 trillion deficit. I can understand why someone who's like building a budget would say, well, every part of the government has to take some hit. But the reality is the NIH is a very productive investment. And I think most people in Congress, the vast majority of people in Congress on both sides of the aisle recognize this. That's the reason. And it addresses a real need for the American people. We need better research to reduce the cost of care. Right. So to address the chronic health needs of the country. The nih, in some sense, is a solution to the budget deficit.
- [42:15]
A
Yes. And in that sense, this $48 billion that you've got to spend with a 1% incline. Now, what. What is the top priority or what are the three top priorities for you?
- [42:28]
B
So, I mean, one, I want to make America healthy. Can I really do that? I mean, I think addressing the health needs of the country through research is the top priority for me. We already talked about some of the metabolic syndrome and other conditions. Let me just talk about one we haven't talked about right now. So last year there were about 40,000 people that got HIV and that's a big difference.
- [42:55]
A
40,000Americans got HIV last year. Yes, Even with prep and everything that exists.
- [43:00]
B
Wow, 40,000Americans. I think actually we're talking in 2026. So when you say last year 2024, I mean 2024. Yeah. So still not updated that we're in 2026 yet, but yeah, so 2024 there were 40,000.
- [43:13]
A
We're all Internet buffering in the first days of 2026. Yeah.
- [43:19]
B
40,000Americans got HIV. Right. In late mid 2024, there was a new drug that was approved by the FDA called, actually it was approved in 2025 called lencapavir. And it is a long acting prep drug. A prep drug is a drug that will prevent you from getting HIV even if you're exposed. Long acting, meaning a single injection prevents you from getting HIV for six months. And very likely, yeah, it acts effectively like a vaccine. It's not a vaccine, but it protects you against becoming infected with HIV even if you're exposed. And it's approved for six months. But I suspect it lasts a year based on some of the preliminary data I've seen. And there's other long acting prep where you take a pill and it protects you for a month. I mean, there were in 2024 and 2025 tremendous advances in HIV prevention. And we already have on tap a whole suite of drugs that if you do get hiv, will lower your viral load to near zero, essentially turn HIV into a chronic disease, so you're no longer going to die from aids. It's tremendous. Right? So, but think about that. We have a drug that prevents you from getting it if you're exposed for long periods of time. And we have a way to reduce viral loads in near zero. We have what we need to reduce the transmission of HIV to near zero in this country. And so what I'm going to do with the NIH is we're going to do research on which populations need this the most, what kind of interventions with these existing technologies. So that in 2019, President Trump issued a challenge to the country, said, look, let's eradicate HIV in this country by, or reduce transmission to near zero by 2030 with this suite of drugs that we have and research on how to sort of deploy them, and good public health, good trust in public health, we actually can achieve that goal by 2030.
- [45:16]
A
Wow. Okay. That's decades in the Making that right from the 1980s till now, that's the outcome of lots of NIH studies and lots of academia, et cetera. I imagine that's gotten us to this point. What is the next big leap? It seemed like there was a lot of.
- [45:32]
B
I want answers for. Yeah, I want answers for Alzheimer's. Let's figure out how to actually prevent it and reverse it. I want answers for autism. I want answers for als. I want answers. We already have a treatment, a cure for sickle cell anemia.
- [45:48]
A
Really?
- [45:48]
B
Yeah.
- [45:48]
A
Oh, I didn't know that.
- [45:49]
B
It's incredible to me, it looks like we said there's no magic, but I'm telling you, it looks like magic to me right now.
- [45:54]
A
You're believing.
- [45:55]
B
The thing is, it's a cell based therapy and it will literally cure a patient of sickle cell anemia, a disease that causes pain, crisis.
- [46:05]
A
Feels like an adult person can be cured of their sickle cell and kids.
- [46:09]
B
Yeah. So like. And it's based on gene editing technology.
- [46:14]
A
This is out there. It's in the market.
- [46:16]
B
It costs $2 million, $3 million. So I want to invest in research that lowers the price of that so that everybody has access to it that has sickle cell anemia.
- [46:26]
A
Is research the answer or is regulation the answer to get prices down?
- [46:29]
B
Yeah, I mean, it's a new therapy. It costs 2 million. I mean, the marginal cost.
- [46:33]
A
They need to recoup their R and.
- [46:34]
B
D. Yeah, well, it's not just that. It's like the marginal cost of actually making the cell is complicated and high. Right. So I want. I want to invest in technology that reduce the price of that, developing those cells.
- [46:45]
A
What's the next thing that you think is going to have a breakthrough? You listed, I mean, you were kind of like Oprah. You want a car, you want a car, you want a car? Everyone gets it. But what's the next one that's going to.
- [46:54]
B
I think I'm really actually quite optimistic about Alzheimer's. There's a colleague of mine, a former colleague of mine at Stanford, who did a study a couple years back of a shingles vaccine, an old shingles vaccine called Zostavax. You're too young to have gotten it, but I got it. In fact, it wasn't a very good shingles vaccine because it didn't prevent shingles for very long. The new shingles vaccine, Shingrix, prevents it for much longer. My colleague Pascal Gatzinger did a study where he looked at. Actually, I think it was Denmark again. And they had a strict age threshold, like you had to be above some age in order to get it. And so he did this difference in difference kind of study and tracked people for many years. It turns out that if you got the zlostavax vaccine and you on the right side of the age threshold, you're 20, 30% less likely to develop Alzheimer's symptoms.
- [47:50]
A
Everything else is controlled and that kind of stuff.
- [47:51]
B
There's a difference in difference, like comparing people who were 49 versus 50. 50 year olds got those Zostavax the 49 year olds didn't because there was that strict.
- [47:58]
A
So that should be. Sorry, pardon my French, but it's like this.
- [48:00]
B
I'm so shocked by your language. I know.
- [48:02]
C
The shitty shingles vaccine.
- [48:04]
A
Let's make it alliteration.
- [48:05]
C
The shitty shingles vaccine is actually a.
- [48:07]
A
Potentially interesting potential way to prevent Alzheimer's prevention.
- [48:12]
B
Yeah, I mean, I think there's gonna be like, I mean, who knows? It's hard to predict what the outcome of scientific studies are going to be, but one's allowed to be optimistic. And here I think I am fairly optimistic.
- [48:23]
A
So it sounds like you want to invest in a lot of moonshot kind of or like a lot of innovative research that's going to break through in.
- [48:28]
B
Yeah, we need to actually address the problems that we have.
- [48:31]
A
And let's talk about. So let's take this outside of the US Be humble and peerful. How's China doing on all of this kind of research? How is their biomedical research looking right now vis a vis Americas?
- [48:43]
B
I mean they're. If not the number, they're a real competitor to us. Like they have invested a tremendous amount in their biomedical research enterprise. We've invested a tremendous amount in their biomedical research enterprise. Enterprise. And they have, if not the. It might even be the leading nation in the world in biomedicine.
- [49:01]
A
So China, you think, sorry, say that.
- [49:03]
B
You think China, they might be the leading nation in the world in biomedicine biomedical research. It's possible. I mean, I think the United States.
- [49:08]
A
Is better than the United States. It's possible.
- [49:10]
B
And I mean like, depends on what your measure of better is. Like, I mean if you're counting like publications or whatnot. I mean, I think the question, like those kinds of questions really only get answered X post. So there are other advances that they have with. Will they be more or less important in some qualitative way? Ex post. So it's hard to say. But the point is they have tremendous investments in biomedical medical research and they are making real advances in biomedicine at Levels that look like, to me, like they're quite impressive.
- [49:43]
A
Okay, so say in the year 2035, a very wealthy medical tourist has cancer. They can go to Boston or Beijing. Where are they gonna go in 2035?
- [49:51]
B
Yeah, that's what she started with.
- [49:52]
A
Yeah.
- [49:53]
B
So biomedical research and where to get treatment are two different things.
- [49:56]
A
Okay.
- [49:56]
B
I mean, I assume that the way that you. That the translation of these biomedical advances to treatment of people in China will be much more unequal than it is in the United States. It's hard to, like, project forward from the advances in treatment, the advances in scientific advances to advances in treatment and translation. I mean, it's hard. It's really. That's. That's really hard to say. But the issue is actually a different one. The issue is, like, where's the center of gravity for science in biomedicine in 2035? It could be China. Right. It could be that the ideas that they have are so exciting and interesting that people will want to look there.
- [50:39]
A
They're already wooing a lot of. And when you said we've been investing in China's biomedical enterprise, you mean that a lot of Chinese researchers have trained here.
- [50:47]
B
Almost every single top biomedical scientist in China was trained in the United States. Not. There's some exceptions where you haven't retained. No, we retained. A lot of folks stayed, but a lot of people left. And there's also good evidence that essentially there's industrial scale espionage. So with the Chinese, biomedical enterprise is in part fueled by what we do here, because the protection of American intellectual property rights is less than it ought to be.
- [51:14]
A
Yeah, it used to be that they want to know how to make a Ford. I mean, no one really needs to know how to make a Ford, but maybe they want you to have something on Fords.
- [51:21]
B
What's wrong with Fords? I like Fords. My first car was a Chevy. It was a great car.
- [51:25]
A
A Volt. A Volt?
- [51:27]
B
No, it was not a Volt. It was a Chevy. 1976 Chevy Impala, which I absolutely loved. Big Blue, we called it.
- [51:33]
A
But it used to be that they wanted to know how to make a car. And now it's kind of like, how do you.
- [51:37]
B
So, for instance, now if you are going to get some. You have cancer, and there's some cell therapy available for the cancer. What will happen is you get the cell. Cell's taken out of you here. The cells then get sent to a Chinese lab or factory. The modifications cell take place in China, and then they're shipped back here.
- [51:56]
A
Okay. So that's actually supply chain national security risk in some ways.
- [52:00]
B
Of course, they get to keep all of the sort of genetic modification data that's been. I mean, there's a whole host of problems with that kind of supply chain. So we actually, as the United States, we face a tremendous challenge from the Chinese.
- [52:15]
A
Yeah. And is it a top priority, like in rooms. Are you sitting down with the secretary and with the president to talk about? This is a war rooming China Health edition happening in D.C. i have not.
- [52:26]
B
Spoken with the president directly about this, but I have spoken with the secretary about this and others. I know that the president is aware of this. I know that his science advisor, his main science advisor has spoken about this, and I assume he's spoken about this with the president. But when the president hired me, one of the things he wanted was to make sure that the United States stayed the leading nation in the world in biomedicine.
- [52:46]
A
Okay. And right now it sounds like you're saying. Because what you started to say but didn't say was that if China is.
- [52:50]
B
In China, there's a real challenge. We have to take this challenge really seriously. I think of in other places I've talked about is the Sputnik moment. It really is a Sputnik moment for us. We need to start taking seriously the Chinese challenge. And I mean, I think partly the. The like. If you look back at the last few decades in biomedicine in the United States, there have been big advances. Like, I don't want to, like, downplay it.
- [53:16]
A
Yeah. You just told us of huge advances.
- [53:18]
B
Like, huge advances. And I think that those investments have been really, really worthwhile from a sort of, like, purely theoretical point of view. And some of it's translated over better lives for patients. But we haven't done as well as we could have. Right. So, like, there's huge replication problems in our science where, like, we publish papers. Half the scientific literature in cancer biology and basic cancer biology isn't replicable. Independent teams look at the same thing. They'll find the same answer because they're.
- [53:47]
A
Not bothering to do the work. I know this has been something that you've cited when it comes to, like, Alzheimer's research in particular. There was a replication problem. People had done a lot of research.
- [53:54]
B
Alzheimer's is like, we're talking about in psychology, in cancer biology. And I can feel it.
- [54:01]
A
Is there, like, a rush for people to. So the replication problem, just for people following along, is that basically studies happen and then. And then they get cited over study, over study, over study, over Time, maybe even medicines are developed out of these studies. And then someone might look back at the Alzheimer's amyloid research and say, hey, this isn't actually reproducible. And so what's happening in that example?
- [54:21]
B
I think what's happening is bad incentives. So the incentives are, if you want to advance in science, is for to publish your work in a top journal. A top journal. You send it to a journal and it's sent to a couple of peer reviewers. The peer reviewers don't replicate your work work. That's not their job. Their job is to read the paper, see if there's logical errors, see if they want you to check something you didn't check or whatever. But they don't ever get to see your data, have your data. They just get to see the report that you gave in the paper. Peer review is a poor substitute for replication. And you publish your paper in a top journal. You publish enough papers in top journals, you get to be a fancy professor at Stanford University or something. And you don't. Yeah, and you don't. And then like maybe a few years later someone fails to replicate your work, but it's like it's, you know, it doesn't. There's almost no return to replication.
- [55:16]
A
So are you building in like a safeguard where everything has to be replicated? Like wouldn't that, wouldn't this.
- [55:21]
B
I don't think you, I don't think you want every. I mean, I think what you want is the most important claims to be subject to replication. Like so. And you want the scientific community to determine what those most. What is most important. Right. So like the things that are rate limiting, where if it turns out X post to be false and you've built a huge sort of like set of results on top of it that would collapse. You kind of want to make sure that that thing that you're building, the huge infrastructure on top of is true.
- [55:48]
A
Is there ever something that you don't like that you don't. For example, there's this question, I know you just. The NIH has just approved, I believe, a budget for studying the etiology of autism. And the etiology of autism is different from the. So etiology means what causes something. And epidemiology is not just.
- [56:09]
B
Is the range of who gets, who has the condition.
- [56:13]
A
Okay, so. And the NIH just has put out funding for research that will help understand the etiology of autism. There was a good piece in the Washington Post about this recently as well. About what we know and don't know.
- [56:26]
C
There's also Been this question that people.
- [56:28]
A
Have around vaccines in autism. And there was this big Danish study that happened. There was a Danish researcher who looked at 650,000 children right. Over the course of their lives.
- [56:38]
B
2003 study. Yes.
- [56:39]
A
Just like longitudinal data on MMR on autism. Yeah. And MMR. And what did they find in that?
- [56:44]
B
They failed to find a link.
- [56:46]
A
And so something like that, that is reproducible and we can trust in that study.
- [56:51]
B
Okay, so the question of like what should be reproduced. Interesting scientific questions like first what should be reproduced is a science policy and also policy question. If you have claims that are not widely believed, even though scientists believe them, then from a public health point of view, it's worth doing reproduction in that area, supporting replication in that area. This is a hypothetical thing. The Etiology of Autism project as a whole. The main focus of that has been to apply expose omics methods and a whole bunch of range of other methods.
- [57:24]
A
It's very broad methods.
- [57:25]
B
So it's, it's a different thing. You're just asking the narrow question of that. MMR and autism, the question of ought one subject those kind of studies to replication to me is a public health question as much as a science question.
- [57:38]
A
Like should we invest in it?
- [57:40]
B
Yeah. Because if people don't believe the answer, then I believe the only real way to do this is like a good faith attempt at replication to do it again. Yeah. To see, not just specifically with those same data, but like in other settings with other circumstances, do you find. Tend to find the same answer answer. Right. If you approach it the same question from a different point of view, do you find the same answer? That's how science generally advances is by consilience. Like you have different approaches and different people, different ideas aiming at the same parameter. If the same answer comes up over and over and over again, then you have a lot of confidence in it. Right. I think that's that. And whether you should do that or not for a question is a public health question and it's a science question.
- [58:19]
A
What is your public health answer to that specific question?
- [58:21]
B
For MMO and autism, I think it's unlikely that there's a link. But I do also see a lot of people that disagree with me in society at large and I want to provide answers to that.
- [58:34]
A
Are there scientists who disagree with you? Like reputable scientists?
- [58:37]
B
Okay, when you say reputable, I don't know what you mean.
- [58:39]
A
I mean people are limited.
- [58:41]
B
So some people have. Some people say that. If you disagree with what I just said about the link between MMR and Autism that you're automatically by definition, not reputable.
- [58:50]
A
Okay. A scientist, let's just say scientists.
- [58:51]
B
So it's just like saying she have to be really careful here. Right. I just. And I'm seeing a loss of confidence by the public at large, evidently in the reduction in the percentage of babies that get the MMR vaccine. Right. So the answer then isn't to say, look, those people are not reputable. The answer is to do science in good faith, to try to address the questions that they have in their head.
- [59:13]
A
Or to like bring out the past science and explain it in a way that helps make sense of it. Right. Like if the science already.
- [59:19]
B
I think you should do good science.
- [59:21]
A
It'll take a long time to do this again, to study something.
- [59:24]
B
That depends on the methods. I mean, you could use existing data potentially and ask the question again. It depends on. There's a whole things you have to ask about the validity of the science, but that's different than should you ask the question at all. And one more thing. On the replication, you focused on autism and vaccines. But I want to just emphasize it's in field after field after field after field that you have this replication crisis. Crisis. Cancer biology. Right. So drug developers, they will conduct their own private replication efforts before they decide whether to invest in development of a drug. Cause they don't trust the published biomedical literature. It's a major problem because they have.
- [60:08]
A
Financial stakes in place. They're not just getting tenure or.
- [60:10]
B
And of course they know what parts of the literature. False and true. That's a trade secret.
- [60:14]
A
It's a trade secret, yeah, of course. So one day. So for the Alzheimer's study that couldn't be replicated, for example, was it the pharmaceutical companies that broke that, that understood that was the case?
- [60:22]
B
I mean, that's a whole nother complicated. There's a book by Charles Pillar, doctored, which is a really interesting book. I mean, I think the entire field actually sort of went down a path and it was based on essentially a fraudulent set of results that people took as true. In field after field after field. If there's replication crisis, there is insufficient returns to doing replication. Right. So if I. Yeah, the incentive career. Exactly.
- [60:51]
A
Unless you're a Nova vartis or someone, then you have an incentive to figure out.
- [60:54]
B
Yeah, you have some incentive.
- [60:55]
A
Right.
- [60:56]
B
So but like let's say even, let's say you, you invested a lot in developing a drug that you based on the old, the, the, the faulty theory, and it only sort of doesn't, kind of doesn't work.
- [61:07]
A
I Mean, so it's like that bad shingles vaccine. It's like you kind of keep giving.
- [61:10]
B
It to people because, because you want to make up the. But so the point is like it, it creates pathologies down, down the. So I want to solve that problem at the nih. Right. We can give incentives to people do replication work actually more. I want, I mean, essentially a second scientific revolution. I want replication to be the standard for deciding whether a claim in science is true or false in biomedical sciences. So for instance, you ask me about the Chinese biomedical sciences, I don't know how much of it replicates. Neither do they. Right. And they're not making that public. What I'd like to see is, I'd like to see when you publish, when you're searching for a study, you know, some reporter goes and searches for study. They, they, they find the study and there's the replication button in PubMed or wherever you click it and all the related relevant replication studies pop up, maybe with an AI summary to say what it's what it says. And you can click on buttons, you see each, each study yourself.
- [62:01]
A
Yeah.
- [62:02]
B
Replication should become the standard of truth. Not is it published in a top trial?
- [62:05]
A
I can see the app that you're going to create when you leave this current job.
- [62:07]
B
No, I think we'll do it with this job, actually.
- [62:09]
A
Oh, really?
- [62:09]
B
That would be published.
- [62:11]
A
I'm being told we don't have a lot of time. What is the actual. Can we, can we do. Can we stretch to 15? If we could keep you till 45, I would be very happy.
- [62:20]
B
40. All right, let's do 40.
- [62:21]
A
Okay, let's see. Okay, so there's a question right now, and you talk about the downstream impacts of things. There's a question about funding because there's been a lot of pushback on some of the changes in research that are happening at nih. I believe there was like a Bethesda proclamation.
- [62:34]
B
Well, they wanted to like have more DEI fund it again.
- [62:37]
A
Well, I mean, we can get to that. But there have been, I mean, I.
- [62:39]
B
Tell you, like, I met with them because they wrote some petition and I've met with them and what they wanted was more dei.
- [62:45]
A
Okay, well here we're not going to fund that.
- [62:47]
B
I mean, I don't think that was very productive research. It didn't translate over to better health for people.
- [62:51]
A
Well, here's a question for you. The funding, like there's a conversation around research pipeline in the United States and whether or not if there's less money for research because there have Been, but there isn't. Hasn't there been changes to the pay line from 20% to 5% for various research for cancer research?
- [63:10]
B
I mean 20% was like in the 70s or something. I mean it's been for decades since we had a 20% pay line. What we have done is we've removed the pay lines. When you send a proposal into the nih, there's a study section which are peer reviewed peer reviewers that will grade your proposal. I served as a peer reviewer many decades. They grade the proposals on a whole bunch of bases including are the methods strong? But they tend to emphasize the methods rather than how innovative is the proposal idea. They tend to actually tend to downgrade things that are really innovative. And so we've removed pay lines and we've allowed the institute directors to select promising. It's kind of like a vc. I would like to have researcher institute select select projects. If they pick 50 promising projects and 49 of them fail and the 50th cures Alzheimer's, that's a successful portfolio. Okay, right. So that's what we've moved away.
- [64:12]
A
It would be like a venture capitalist.
- [64:14]
B
I mean, to some extent, I guess a little bit.
- [64:15]
C
That hasn't always.
- [64:16]
A
There's a lot of companies that are publicly traded right now who are overvalued in their VC stages.
- [64:20]
B
But you don't need all the companies to succeed. You just need one in your portfolio to be Google. And you have a successful portfolio. I think if you are asking every single project to fail, the portfolio as a whole will fail because you will end up picking projects that are too conservative. I did work a few years back asking how old are the ideas supported by NIH funded research. In the 1980s, the NIH was funding research that was 0 or 1 years old. In the 2010s it was funding research that was 7 or 8 years old. We need to fund cutting edge frontier research.
- [64:55]
A
There's also been conversation about moving away from the elite university architecture of funding. Is that something that is a priority of yours?
- [65:01]
B
It absolutely is.
- [65:02]
A
And what does that mean?
- [65:03]
B
I mean there are great scientists all across the country and there's great desire to do science. I've now visited a whole bunch of places. I've visited Oklahoma, I visited Alabama. I think I'm headed to Iowa. I've been to Montana. And there are amazing scientists with great ideas. And what they tell me is that when they apply to the NIH often sometimes they'll move from like I had a scientist who moved from, from Harvard to Tennessee. He's like, well, I sent in this basically the same application. I got a worse score in Tennessee than I did when I sent it in as a Harvard professor.
- [65:34]
A
So wait, is this like DEI for like University of Nebraska at Lincoln?
- [65:39]
B
You wouldn't want to call it that. It's not dei. I think it's the wrong thing. I think identifying highly impactful ideas, promising ideas that have a chance of actually advancing the health of people no matter where they are, is a major priority for the nih. I wouldn't call it dei. I'd call it merit based funding of research. Like you want great scientists no matter where they are, to get research dollars.
- [66:03]
A
We spoke at the top of this conversation about the Great Barrington Declaration. The challenge of having conversations at that time, I don't know a lot about science and health, but I know something about foreign policy. And in foreign policy there's this idea of the failure of the last analogy, right?
- [66:16]
B
Like you go to war, generals finding the last war.
- [66:19]
A
You go to war and Somalia because you think it's Rwanda. And there's also groupthink, like Bay of Pigs was a disaster. Cause everyone kind of agreed with what was happening. How are you avoiding that right now? Because you were excluded by your description in the conversation of the pandemic early on and Shadowbann on Twitter and there was a lot around that. How do you not hold onto that and become that person that shuts out another point of view.
- [66:42]
B
I mean, I don't have all the answers in science. I think to me, the most important reason I took this job was to help advance the health of the American people. And if I decide that I am the science and I'm going to authoritatively say this is good, this is bad, or this is right, this is wrong, I won't be able to do that. The science depends on self correction, on correction, on people checking each other's work. It depends on humility. It depends on. And so the thing I actually want to accomplish, which is support science that advances health of people, I can't accomplish if I do what you just said. Right. I think the problem, the reason why we had bad outcomes during COVID is that you had a few people that decided that they knew about Plexiglas, about masking, about vaccine mandates, about school closures, about topic after topic after topic. And because they did not allow self correction, they got everything wrong. And now people don't trust scientists and they don't trust public health, they don't trust medicine.
- [67:41]
A
They got everything wrong.
- [67:42]
B
Yeah, they got almost everything wrong.
- [67:43]
A
Do you think that those people went into public health? Like, for example, I've interviewed Dr. Fauci. Right. Do you think he got into public health to help? Like when he got into public service 40 years ago? What was.
- [67:54]
B
I don't want to speculate about.
- [67:56]
A
You've kind of come out and spoken against the prosecute Fauci.
- [67:58]
B
Yeah, I don't. I don't want to talk. I don't know specifically about his. His situation. I'll just tell you that. That I think when someone is in a leadership position like I am in science, to act in an authoritative way essentially undermines science, and it'll undermine my main goal, which is to help make Americans healthy. I think that is way more important to me than getting my way in science. If people come to me with science, that changes my mind on something. I'm gonna celebrate that.
- [68:28]
A
When's the last time you had a disagreement? Your boss, Secretary Kennedy?
- [68:30]
B
We disagree all the time.
- [68:32]
A
What is the last disagreement you had on something?
- [68:34]
B
There's. I mean, there's. We talk about all kinds of topics. I mean, like, the kind of disagreements we have have to do with scientific questions, have to do with policy questions. He's respectfully listens. He gets. He makes decisions based on that.
- [68:46]
A
Does he defer to you on the scientific side?
- [68:48]
B
On some things, yeah.
- [68:49]
A
And then right now. Right now, there's a bit of a vacuum in NIH in terms of. There's. I think it was 11 to 13 of the directorships have to be filled. Of the 27 we're open to, like, hiring.
- [69:00]
B
Right now, we're hiring. Those are all open positions. If you're an excellent scientist and want leadership, please apply.
- [69:07]
A
Are you seeing people vote for their feet because they disagree with this administration?
- [69:10]
B
No. We're seeing lots and lots of amazing people applying to those positions, but they're.
- [69:13]
A
Still not filled because.
- [69:15]
B
Because I have to vet them.
- [69:16]
A
There's a lot of people the government shut down at all.
- [69:20]
B
Normally those positions take a long time to fill. Like, we've been moving at very fast rate to try to fill them. You're going to start to see next month's some of them get filled.
- [69:27]
A
I end every episode of Smart Girl Dumb Questions, asking my guest a question that they don't have the answer to. So you named a bunch of studies, et cetera. What is a question that you don't have the answer to, Dr. Bhattacharya?
- [69:37]
B
I don't know how to put this. I think I want to restore trust in the public's trust in science. I Have a faith that if we can address the health problems that people have and reverse the life expectancy problems, address the chronic disease problems, that we can do that, that. But I don't know for certain that that's going to be enough. I think scientists, we need to come together and remember what we're in this for. Right. So I don't know, I mean, I think, I hope that that's enough. And that's been my focus and it's going to continue be my focus. But I don't know how to get scientists to come along with us on this. What I've seen is a lot of scientists essentially entrench themselves and oppose the changes that they've seen, seen because it's not the way they're used to doing things. And I don't know if I can get them to come along. I hope I could, but we'll see.
- [70:29]
A
So can we restore public trust?
- [70:31]
B
Yep.
- [70:32]
A
Yeah. That's a big question. Thank you so much, Dr. Bhattacharya, for joining us today. I really appreciate your time.
- [70:36]
B
Thank you.
- [70:36]
A
And your patience. Thank you. Sorry to.
- [70:39]
C
Sorry to hear that. Here's my big takeaway and I want.
- [70:44]
A
To hear yours too.
- [70:45]
C
Every time we spoke about the sun and the research, I felt like I was learning more. And then when the conversation veered to politics or personalities, I felt like I was learning less. So the great unlock for trust in science and health, which as the director said is so important, I think it's about stripping out the party politics from all of it, which I know is pollyannish and impossible. But we will never have trust. If we cap an audience at 50%. Whether it's blue or it's red, it's just not going to work.
- [71:12]
A
And, and so I think we have.
- [71:13]
C
To make science and health purple again.
- [71:15]
A
We have to mishpah.
- [71:17]
C
We're gonna mishpah, guys. That's the acronym. It's kind of like maha. I appreciated that Dr. Bhattacharya made the time and extended the time for us to have that back and forth where we could discuss and push and try to understand and sometimes misunderstand each other. I think we need more of those long form conversations. And obviously I also love textbooks. I really liked when he was talking about the textbook.
- [71:38]
A
I mean, I love a textbook, but.
- [71:39]
C
The reality is that we live in this meme generating and meme consuming culture where there isn't that big a difference sometimes between what's marketed or what's messaged and what's reality. I mean, the director himself spoke about that. We have all these studies between the MMR vaccine and autism to disprove the link, but people don't believe it. So we have to do those studies again. Right? The messaging or what they have seen or read has become a reality. So that's why I worry. It's not about oversimplifying science. It's about misleading messaging that risks sowing even more distrust. And that's particularly problematic when it comes from our government, no matter which party is in power. I also think that there are lots of causes of optimism in that conversation. I mean, the breakthroughs that we're having in things like sickle cell disease and hiv, I mean, I know about any of that. And what decades of research can do to change a thing. I mean, talking about Alzheimer's and if we could solve that is amazing to think about. I also am very interested in the shift towards chronic illness. Like, I do want to know the etiology for all of these things, for autism, for why we're seeing more cancer, for even why we have distrust. We should do an etiology and also an epidemiology study on that. That would be a good use of taxpayer money. And I'm also optimistic about this bipartisan support for science and health in Congress which, you know, is pushing back against these proposed budget cuts. And I guess the big question I leave this with, that I don't know, is with this kind of big agenda shift, how do you not throw out the baby with the bathwater? I think it has to do with having a culture of hearing people out and disagreement, dissent. And that's where Dr. Bhattacharya started. So I hope that stays alive in a world, world of party lines and all of those things. I hope we can have more data driven discussion about science and also settle science and message it right. It is so important because otherwise we're all gonna have to move to Beijing in 2035. Guys, that's it for this episode of Smart Girl Dumb Questions. I'm Naeem Araza. This episode was produced with Dana Belut and Desta Wonderad. It was edited by Darlena Chiem and mixed and engineered by Johnny Simon. The theme music is by David Khan. And we'll see you next next week for Smart Girl Dumb Questions.
- [73:47]
A
Less politics.
- [75:02]
B
Sam.