Improving Science & Restoring Trust in Public Health | Dr. Jay Bhattacharya

26:40So right the the here's the the way that the economics of this work. In order to get fixed cost support, you have to have brilliant scientists like you that can win NIH grants. If you don't win NIH grants, Stanford doesn't get the 550. But in order to attract brilliant scientists, you have to have the infrastructure where the scientists can do their work. So it's a ratchet. So in order to have the money, the infrastructure support, fixed cost support, you have to have scientists. In order to have the scientists, you have to have the the infrastructure. It's a ratchet that essentially makes it so that we concentrate the federal support for the money to select few universities.

27:24They're winners and losers. And so the scientific infrastructure of the country is concentrated in relatively few universities, mainly on the coast. And they're brilliant scientists in other places that are not at those to select few universities that have trouble getting NIH grants, even though they're brilliant scientists. It draws the federal support away in a structure that essentially says lots and lots of states, lots and lots of institutions are going to have trouble getting the infrastructure support that they need in order to have the scientists come there. So that's the basic economics of the way indirect costs actually work.

28:08And so question, is that the right structure? There's also questions about, you know, like so for instance, your science involves, your basic scientists, your science involves lots and lots of fixed costs, right? The radioactive disposal, all the stuff. The research I did, you know, epidemiology, health policies, statistics, it's basically a computer, me with a, with a, with a disk hat and a computer, I can hire some, you know, bio -stats, they should help me or, or, you know, All that a carpet lab. Yeah. And so like, do the universe, does the university need the same indirect cost support to support my fixed cost as it does yours?

28:47And the answer is obviously no. And yet, that's the structure we currently have. Right? So, there are policy questions to be answered about, are we, have we structured the indirect cost support in the right way? Are we inducing the right incentives? Right? Can the American taxpayer be sure that we're auditing the use of the indirect cost in appropriately. Those are the policy questions I think that are issue in the indirect cost fight. Again, I won't get into the litigation. I'm just not allowed to actually comment on that. So I wanted to abstract it to a higher level because I think the policy question is not should the federal government support universities to do this kind of research, to have sort of the facilities questions, how should it be distributed across the country, to what extent should the researchers get it versus the administrators get it.

29:38And then on the back of that, there's also other research institutions that have very different indirect cost recovery rates for the same university. So I think Gates Foundation is, I don't know, the exact number, like 15%, something on that order whereas NIH is 50 % to the same university. That looks funny. The question is sometimes I've heard, Well, while the Gates Foundation puts more of the money into the directs, right? So maybe they'll charge you for the rental cost of the building or something. I don't exactly, but I'm very familiar with foundation versus an age money, and it differs by foundation.

30:20But typically, a university, and I've been at two, I'm tenured at Stanford, but my lab started off at University of California, San Diego, or a public university, typically when foundation money comes in, the university imposes a minimum of about 8 % administrative costs just for handling, like just to do the paperwork, to pay the admins that do the handling. There's something very important in what you're bringing about. There are actually two issues. I want to backtrack to one issue to make sure that people really understand this, because I realize that some of this might sound a little bit down in the weeds, but it's just so important.

30:54And the first thing that I really want to draw up from earlier in our conversation is you pointed out that the current model of NIH is that tax payer dollars pay for the basic research and for the exploration of whether or not the findings from that basic research will benefit disease. If there's any technology, device, drug, whatever, that is brought to the public through the private sector. Put differently, the taxpayers fund the research and development, but they don't capture any of the upside from the private companies that make money selling you the SSRI, selling you the not hopefully someday novel Alzheimer's treatment.

31:42We don't yet have a satisfactory treatment for Alzheimer's as we'll get into. So the general public who are not basic scientists, In other words, if I take off my hat as a basic scientist and I say, yeah, I'm a taxpayer. I give a significant amount of my income to the state of California and to the federal government. I like science. I certainly would like to live a long, healthy life. And I hope some of that science helps me do that. But I'm going to have to buy back the results of what I paid for. That's where I think a lot of the general public sit. And I'm not saying they don't like appreciate and respect science and scientists.

32:19but to any rational person, don't need a degree in economics to say, that kind of sucks. I'm paying an end made worse if I want to read a paper that was published with the work that I provided from my tax dollars. I have to buy that from the journal. By the way, that changes in July. Okay. I mean, this is a huge issue. That's one of the decisions I made. Yeah, it's a $34 anymore. Listen, I've been grateful to publish in Nature and Science. You know, these are like super bowl rings for scientists. I'm sure it's part of the reason I got tenure at Stanford. And I'd great fun doing the work. And I believe in the work.

32:58It stood the test of time. But were I not an employee of Stanford that pays for the subscriptions to those journals? I have to buy the work back using my tax dollars that funded the work. So this is crazy. It is like me giving you the money for the supplies to build a home. I get to, you get to live in the home. I don't even get to see the home. I have to purchase a ticket to see the home. That's how irrational it is from the perspective of somebody who's just not understanding the pipeline and they should have basic applied research. So let's just, I wanna return to that briefly because this relates, in my opinion, directly to IDC.

33:38So that's a crazy picture for anyone that doesn't understand how one piece relates to the next, relates to the next And now that I'm in public media, I'm public facing, what I've come to learn is that the general public is very smart. Max Delbrick was right. Assume infinite intelligence and zero knowledge, but it's very hard for people to connect more than two or three dots. They're busy. So we could talk all day about how this leads to that leads to this, so they're on the brick on the wall model and then there's this treatment. And they're like, I'm paying for this stuff and I can't even read the paper about it.

34:10let alone glean the positive benefits without paying out the nose. Yeah, so so a couple of things. Let me go backwards because you had two two two major issues brought up. So first, the journal thing, the my predecessor Monica Brignoli, as the who was the NIH director, the Nationalist of Health Director before me, she made a decision, a really a great decision, essentially to say if the NIH supports the scientists work. And then that work leads to a journal publication. That publication ought to be available free to the public immediately upon publication. You're not allowed as an IT fund scientist to publish in a journal that doesn't have that as a policy.

34:53That policy was due to go into effect in December of this year. I think it's a great policy because I agree with analysis entirely. If the American taxpayer pays for the research, why shouldn't the American taxpayer be able to read the research for free? Because they already paid for it. Why did they pay second time on the back end after the research is published? And it's not like it's free if you're a university employee. The university has to purchase a very costly subscription to the journal in order to, before a faculty member to read the papers. Now I'm lucky enough I can access pretty much any paper in the world, but that's because Stanford spends millions and millions of dollars.

35:30And it's made worse. I forgot the one real stinger in this. When you publish a paper, you use taxpayer dollars to pay the journal. That's correct. Thousands of dollars to publish it, then they sell it back to the general public. Nature charges $12 ,000 for the major. These are just good, but okay, so. So that's a racket. Right. Yeah. Sorry, I realize I'm talking more than I'm asking questions. No, no, this is, I mean, I'm agreeing with you. So like, so I, the, uh, Monarch Britain early, the previous anti -structured in December of this year was the, the, the, the, the, the, the, the, the, the, the, the, the, the policy that those papers have to be able to the public for free.

36:09I made a decision, one of my first things I did was I said, why wait till December? Let's just do it in July. Great. Thank you. And so starting in July, that what you just said will no longer be the case. The Americans and everybody will be, have access to the papers that the Americans are already paid for from the, their, their NIH funded. for free. Thank you. On the behalf of, literally, this isn't a political same on the behalf of myself and every other American citizen. Thank you. We've been paying for this research forever and I've had to pay to get it back. I mean, it's not like journal editors make that much money, but the journals make a fortune.

36:43So, like, Millen Press, El Salvador, I've done my homework on this. We're talking billions of dollars in income. And the marginal cost of publishing now is effectively zero, but you put it online, right? And there's some costs for maintaining the web page and all that, and there's some editorial staff, but like the level of investments that the public have been making for the NIH, then be asked to pay $30, $50, $100 for the papers itself that are published, I mean, it's just insulting. And actually, it impedes the progress of science because it makes it so that there's this barrier where regular people can't get access to the things that the scientists are talking about.

37:26There's this public transparency aspect of it. Where the scientists ought to be engaging with the public about their ideas. The idea is that we are just living in this ivory tower and only we get to decide what's true and false and then we imposed it on the public during the pandemic. We saw the folly of that model. So it's, I think a small step for it, but an important one. I think you're being humble, and I'd like to point out that I think it's a big step forward because it's not just a token to the public for all their dollars over the last, hold us the NIH. 100 and some years. 100 and some years.

38:04It's really what should have happened a long time ago. So thank you very much. and I guess thank you to Monica as well for initiating this, but thanks for accelerating that. I think when people start to understand how the NIH works a bit, and they understand this IDC thing, this indirect cost thing, the question comes to mind, how much of the cost of running science at a university, public or private university should the public be responsible for? I mean, that's a kind of really interesting question. Yeah, I mean, I think so let me tie it back as you said. These are all interlinked topics. Let me tie it back to something else you just said earlier, which is, okay, so the NIH funds your work.

38:48Your work then results in maybe not necessarily you, but somebody else who uses your work to like create a product that they patent and they make a lot of money off of. They sell it to the public. Like, at least indirectly or sometimes directly, those patents are funded by American taxpayers. Well, the NIH also has a big intramural program. It's like a scientist who work directly for the NIH. They make some advances and sometimes those advances result in patents, right? So, and those patents then result in products that are sold that above marginal cost. So the question is by again, by American taxpayers.

39:30because the patent protects entry into those markets. So the question is, how much should the American taxpayer be funding for this kind of work? Should there be private actors to be allowed to make money off of this research, the American taxpayer funded? And the question, as an economist, I'll say, the question is complicated. And the reason it's complicated is you might say, okay, well, they should not be a patent at all, right? It shouldn't be patent at all. There was a law called the BIDOL Act in the mid -80s. I can't forget the exact date. That essentially said that NIH funded works ought to be patentable.

40:14The reason was that it's the last mile problem. Like you have some fantastic basic science research that has some like fantastic biomedical results that there's no way for to patent, right? Then there's no interest to develop into a product that then advances health. The wisdom of the Bidol Act was to say, well, look, if you allow there to be patent on the last mile, then now we've created a commercial interest to take the basic science advances and translate them into something that actually benefits people. Now, the price is going to be higher, at least, while the patent is still in place. But then eventually, the patent go away.

40:55and then the price of the thing will be available to the public at large to accelerate the transition from the basic science investments we make to things that actually benefit the public very directly. That's the, so in a sense, there's a trade off there, right? So you're trading off the fact that for a while, there's products funded by the American taxpayers that are at higher prices than it would be in a purely competitive market for the fact that you get more rapid access to the benefits of that investment. So that's the basics trade off at that play. And that's why I say it's complicated.

41:29When I joined UCSD and when I joined Stanford, I signed something saying, if I make a discovery here that translates to an important device or drug, that the university is going to capture some of that upside. And Stanford is a place where there's, let's just say a history of people going into biotech and to neurotech. And because of the influence of the engineering school, Well, there's actually a great joke about Stanford that a former president of Stanford told me, which is there's only two kinds of Stanford faculty, Stanford faculty with companies, and Stanford faculty with successful companies.

42:04Discussion for another time. But it's commonplace for faculty at Stanford to have companies to split their time between the university and their companies. But most places, like most of the NIH grants that I reviewed when I was on study section reviewing grants. Most of the great work I would hear about at meetings came from people at universities who were really focused on charting the cell types in the retina, understanding the activity patterns in the brain during sleep and how it relates to neuroplasticity. Very few of them were involved with companies in a serious way, let alone had their own companies.

42:40So for the taxpayer, who make up the majority of our listenership, giving money to universities and the universities are spending that money, making discoveries, I think most of the time that the university and the scientists who do that work are not capturing the upside. The general public isn't capturing the upside. They're actually paying for the upside. So it's a little bit like the journal situation. That's why I brought that up. It's a little bit like the journal situation all over again, where we're, as taxpayers, funding a lot of this, and then have to buy it back over and over again. Okay, so there's one other, one other complication about the United States versus the rest of the world.

43:21So let's just put that aside for just a second. Let's get back to that. Before I get there, I want to say in response that in fact, when you take medication or when you have some health advice that actually works, often NIH research was somewhere in the path leading up to that involved. And there are huge returns to that, right? If you have a drug that treats your disease well, you know, you're a congestive heart failure and now you have a drug that allows you to live longer, more health in a way that allows you to live more fully. Or if you have diabetes and you slow the progress of the disease so it doesn't result in your kidneys failing, you're going blind or whatnot.

44:13Those are advances that are really worthwhile. Even if the price is higher than marginal cost, it still could be very worthwhile. You take metform and it's a very cheap drug now, but at once upon a time it was a patented drug and you prevent the type 2 diabetes. That's a big advance. That's right, for instance. Right, great. So, the value that you get from the NIH sponsored research then is potentially very, very high in terms of improving your health, even more than the marginal price for the drugs that you end up paying or the products or the advice or whatever it is. You're saying it was a good investment?

44:49Yeah, it was a good, even for the taxpayer, right? Now, I wanted to put aside the business about international, like, the US versus the rest of the world, now I want to bring that to the forefront. It is also true that American taxpayers and Americans pay somewhere between two to ten times more for the same product, the same drug product as people in Europe pay. Why is that? There's again a lot of complicated reasons around to do that, but I mean, just it's a very, very simple observation. There's something in economics called a law of one price, right? When you have one country's charging ten, there's a market in one country where the price is ten times more than for another country.

45:33What you'd expect is somebody to go buy the goods from the other country, from the cheap country, let's pay the cheap price, then go resell it in the country where there has a high price. And now what would end up happening is that you get an equalization of the price. So you get, you know, so as long as they're sort of like the capacity to like move across and you know essentially close this arbitrage opportunity through competition, you'd see those price differences collapse. And yet for decades, Americans pay two to ten times more for the same product, often made in the same manufacturing facility than Europeans do.

46:16And that, it's again, a complicated reasons why, but it has to do partly with the way that American health insurers interact with drug companies. Drug companies essentially use Americans as a way to fund their research and development efforts. That's what they say. The higher prices that we pay fund the last mile research that the drug companies do to test the new products. Are you saying the last mile research is the most expensive because it's the the stage for clinical? Yeah, the safety stuff though right before we go into humans at large. Yes We want to know that's the argument that they make that the drug companies make is that well Yes, the Americans are paying this high price.

47:00It's really worth it to do that And then they go to Europe and the Europe says well, we're not gonna we're not gonna pay those high prices We're going to charge you you If you're going to market the drug in France and Belgium and Germany or wherever, you can do it, but you're going to have to charge us, essentially, marginal costs. So if I understand correctly, the United States taxpayer is funding the late stage and most expensive research and development that the drug companies do, they sell the drugs to It's sort of allowed cost abroad to make it very cheap overseas. In other words, we are paying for the insurance, so to speak, that the drugs that are marketed in Europe and elsewhere are safe.

47:52Yes. So, the taxpayers in the United States are funding the basic research and the clinical late -stage research for the entire world. Yes, in large part. I mean, like Europe does have some institutions that invest in basic research. So it's not entirely zero. And there are of course private foundations to do it. But through the NIH, that's the single largest investment in basic science research in the world and through, and also applied research. And also by higher drug prices in the United States relative to the rest of the world, We are funding the phase three trials, all the research and development efforts that happen at the tail end of the research pipeline that the drug companies do.

48:41So essentially, American taxpayers are the piggy bank for the world for almost all of this research pipeline. Wow. Okay. What is being done to bring drug prices down in the United States? I heard this recently as a press release from President Trump that drug prices in the United States are soon to come down. Knowing what I know now, based on what you just told us, the immediate question becomes, who's going to pay for that late stage safety research? I mean, it's not expensive because it's fun to do expensive research. It's not expensive because they're still exploring the basic chemistry of these molecules or functioning of the devices.

49:22is it's expensive because you have to make sure that people aren't going to drop dead or form some other worse pattern of illness through the use of these drugs. And that means a lot of human subjects and many, many measures. It's not just one endpoint. Like did it lower blood sugar? It's like did it lower blood sugar? And also did you blow a gasket in here? You know, some capillary in a critical part of your brain. Yeah. So, I mean, this is a very expensive work. So it still needs to be done is what I'm saying. Who's going to pay for it? Okay, so let me just take a couple of cuts at this. So first, like that phase four surveillance, that happens after the drug's been marketed.

49:58That's typically the FDA that conducts that work. The NIH can fund some of it, but it's mostly the FDA that tracks the safety and efficacy of drugs in broader populations after the drug has been approved for use. So again, American Taxiors are paying for that. The phase three studies, the studies of large scale clinical studies to check the effectiveness of a drug, check the safety profiles of a larger population, that's typically drug companies paying for that, right? In principle, but then American taxpayers pay for that with higher drug costs. President Trump, in the last couple of weeks, issued an executive order essentially saying We have to make the other countries of the world pay their fair share of this.

50:47So he put an executive order in place with various mechanisms, if you want to be in talk about some of those mechanisms, that will reduce the difference in price between what the US pays and what the rest of the world pays. What likely happened is that Europe will pay a slightly higher price, again funding the research and development efforts to do that last mile of research. the U .S. will pay a lower price. And so the world will share that R &D burden more equally than we currently do. Currently, it's American taxpayers on whose shoulders that burden of R &D currently falls. What President Trump has said is that that's not a equilibrium that should hold.

51:26That there ought to be policies that allow us to equalize those prices. And the kind of mechanisms include things like including drug price discussions in trade negotiations. So the link to the terror policies he's implemented, allowing re -importation of drugs. So the idea is that, let's say I'm in Europe and I'm charging basically nothing for some drug and you're the United States. Someone can come to me by the drugs from Europe or Canada or wherever, bring them the United States, to resell them at a much cheaper price and make a little bit of money, but that then would equalize the price. And various other mechanisms are trying to bring the United States much more close to where the price of the rest of the world.

52:15It's not that the R &D won't happen. It's just that the prices everywhere will be equal so that the burden of R &D is shared more equally across the developed world. What is to say that these other countries will simply say, no, we're not going to absorb or more of the cost, people don't like to see prices go up. They're comfortable with seeing prices go down for obvious reasons. And I can think of one example, maybe not the most critically important example in most people's minds. There's a class of drugs that was released last year, or about last year called the Dora's. These are drugs that encourage sleep by suppressing the wakefulness mechanism as opposed to promoting the sleepiness mechanism in loose terms.

53:00They have much lower abuse potential than a lot of other sleep medications and given the essential role of sleep in mental and physical health for, you know, and I'm a strong believer that behavioral tools, sunlight, etc., are critical. But some people truly struggle with, you know, clinical grade insomnia and it's extremely detrimental to widespread. These drugs are very expensive, $300 a month or more in the United States. Knowing what But I know now just the idea that some of that $300, let's say, let's make up a number 200 of those dollars, is to cover the research costs so that in Northern Europe it can be available for $50 a month.

53:37That borders on upsetting for me. Yeah, it is upsetting. And I think I understand why President Trump issued that executive order. It's upsetting for me too. It makes no sense that the American taxpayer should bear the burden of this R &D expenditures when there are lots of rich countries in the world. Why shouldn't we more equally distribute it? The question is like, what will happen? It's how the drug companies respond to this executive order and how our allied nations respond to this executive order is open. Still, I don't know what it's going to look like. But what I can say is that the current equilibrium is not sustainable.

54:16The American taxpayers once they understand what's actually been happening. This is decades long. They're going to say no. Right? And so the way that it plays itself out, it's hard to project exactly. But what I do know is that every after the government is currently making every effort to make sure that those prices get more equalized. I think just take it from the perspective of a European citizen, right? someone's a French citizen or a Spanish or Portuguese or an English citizen. A citizen is great Britain. For them, allowing the prices more equalized in a way that so they share the burden essentially creates an interest of the drug companies to focus on the kinds of health conditions that they have.

55:12Most of the research now, since it's paid for by Americans, the drug companies are focused on problems that Americans have. It aligns the interests of the drug companies to think more broadly about what they should be investing in to include the health problems that Europe has. Is it true that I've heard this before, 90 % of the psychoactive drugs, like the antitip presents the SSRIs and related things. In the world are prescribed and consumed in the United States. I got another specific number, but it is a pretty substantial. I think as far as like drug profits go, I think it's like two thirds of three quarters of all drug profits are had in the United States.

55:59And are most of those for the sort of adderol and psychotropic type stuff? No, sorry, I don't know psychotropic is the correct term. Now I'm gonna get beaten up by people if I don't get this right, let's just say psychoactive, excuse me, I meant to say psychoactive drugs like SSRIs, which by the way, in my view of the literature, they're not always bad, but we hear that they are bad in some instances or many instances, but in, like for the treatment of clinical grade OCD, the SSRIs have been a tremendous tool. They have a curado CD in every case, but they've been a tremendous tool. So I don't want to make sure not to demonize them.

56:32So I don't know the specific numbers for psychoactive drugs, but as it industry as a whole, it's the United States that drives drug company profits, that pays for drug company profits. I think it's like two thirds or three quarters, I forget the exact number of these American problems. So it's obese, are they obese? Are you related to this? Yeah, so obesity, depression. I mean, a lot of the obese, I mean, the United States is, I think Mexico is now above us, but for a long time was the most obese nation in the world, your big nation in the world. So the disease is related to obesity. Now, admittedly, the European countries have those problems too, but just to a lesser degree.

57:18The drug companies, their research and development efforts naturally go to where they're making the most money. And so what this will end up doing is it'll align the drug company incentives to focus on the problems the Europeans have at a slightly higher at higher levels than the Americans have relative. Now these are all rich countries. So it's not like there are unique diseases that happen in Europe that don't also happen in the US. It's a question of relative levels of investment, right? And so, you know, I don't think that's necessarily bad. Like an excessive investment in just the things that Americans have at scale don't necessarily translate to better health for Americans.

57:59Right, so you can see this in since 2012, there have been no increase in American life expectancy. From 2012 to 2019, literally, it was almost entirely flat life expectancy. Whereas the European countries had advances in life expectancy during that period. During the pandemic, life expectancy dropped very sharply in the United States, and only just last year did it come back up to 2019 levels. In Sweden, the life expectancy dropped in 2020, and then came right back up by 2021 -2022 to the previous trend of increasing life expectancy. Whatever those investments we're making as a nation in the research are not actually translating into meeting the mission of the NIH, which is to advance health and longevity of the American people.

58:48We've had some tremendous biomedical advances that have now allowed us to treat diseases that were previously untreatable, but which is great. That's a good thing. But it's not actually as far as the broad health of the American public addressed the chronic disease crisis that we face or address the crisis in longevity that we face. The next generation of kids, our kids, are likely to live shorter, less healthy lives than we have lived as parents, as American parents. And I think that that I think is an indictment on this entire industry. We focused on managing illnesses and treating illnesses and trying to hold on, especially chronic diseases and as a result, and we're failing at it, right?

59:40Europe on the other hand is seeing expanded life expectancy. This, I think, this change of trying to equalize drug prices, aligning our portfolio of NIH investments to meet the health needs of American people. it's a long needed corrective. Yes, if we'll succeed, I hope so. That's the reason I took this job. I'd like to take a quick break and acknowledge our sponsor, AG1. AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens. As somebody who's been involved in research science for almost three decades and in health and fitness for equally as long, I'm constantly looking for the best tools to improve my mental health, physical health, and performance.

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1:02:44Right now levels is offering an additional two free months of membership when signing up. Again, that's levels .link spelled, of course, l -i -n -k slash huberman to get the additional two free months of membership. Well, I really appreciate that you explained so clearly what's going on with this drug price differential and who's paying for it. I was not aware of that. Perhaps I should have been, but I was not aware of that. And as we talked about a little bit earlier, most of the general public, even the science and engineering mathematics trained, they can connect to her three dots, but they're also very busy.

1:03:15And the general public, like I said, I believe are smart, but it has to be spelled out very clearly the way you did for people to really understand. I'm a healthy economist, actually. Right, well, I think, and I mentioned that my introduction, but I think it is very important for people to understand that you look at things through the lens of science and medicine, but also epidemiology and economics. There's a saying in laboratories, which is that just adding more money doesn't improve the science, but it certainly allows you to take bigger risks in service to health and discovery, and without money, no science gets done.

1:03:53I mean, no money, no science. You can't pay graduate at students, postdocs, et cetera. I don't want to spend too much time on the structure of basic laboratories, although that's my leaning. I could spend hours talking to you about what's gonna happen with the universities, et cetera. We'll come back to that, but there is one piece that we opened up earlier that I think it's important that we close the hatch on, which is the notion of indirect cost being now, well, depending on litigation, but level to a lower number, 15 % if the administration has their way back to the variable rates, depending on the university if this lawsuit has its way.

1:04:31And here's what I hear a lot to just put in the simplest of terms. Stanford, Harvard, UT Austin, big universities, often the private universities, have big endowments. So money that's been given by donors, some might have come in through tuition. It's been invested. They sometimes will spend the interest, but as you and I both know, No university likes to spend the endowment. Just like no one really likes to spend their savings. People like to spend the interest they make on their investments from their savings. Nobody likes to spend their savings. Universities included. The general public tells me all the time, not just on X, but on all platforms and whenever I interact with the public.

1:05:10Why should we pay for research at these universities that have these large endowments? To which I say, now it's true Stanford has a very large endowment, Harvard as well, UT Austin and other places, but many universities, fine universities, superb universities throughout the United States do not have extremely large endowments. And as you pointed out, there's excellent work, important work, I should say, being done those places. So to cut the IDC to 15 % for everybody, I can see where I'd say, well, why don't they just dip into their savings, the endowment? But if you're, I'm not going to name names, but if you're at a smaller public university, in particular, in certain areas of the country, not on the coast, unless you're like a washew in St.

1:05:52Louis, or UT Southwestern, and they got riches. From honest, they have a lot of money. There isn't a savings account to go into. The buildings don't look the way they do it, these other universities. You don't have these impressive lawns and thousands of gardeners, which were so blessed to have at places like Stanford and Caltech that have tons of money. So to cut the IDC across the board for everybody isn't just sort of trying to restore order to the to the rich I do think it potentially punishes the less wealthy universities and important research I say that in service to them and frankly just Being at Stanford it wouldn't be right for me to be like I have 15 % will dip into the savings It doesn't and quite work that way if you're at a public university Well, I think you're you're hitting on the exact policy question the right policy question the question is how should the federal investment in fixed cost of research be distributed?

1:06:48Right now, it's distributed in a very unequal way, where the top universities have access to that money because they have scientists that can win NIH grants. It's a funny thing, because if you think of it as like a fixed support for the fixed cost of research, you have to have scientists who are good at getting support for the marginal of cost of research in order to get the fixed cost of research. But if they're fixed, why would you do that? Why wouldn't you have the money go more equally spread across, right? The endowment money is another more complicated question. I think that endowment monies often are like focused on particular projects.

1:07:31There are restrictions on it, but you're absolutely right. That it does make a buffer for some of the bigger universities that allow it to like survive the vicissitudes of NIH funding or the economy, more so than for the university that don't have that endowment. But from the federal perspective, the key thing is, how should the funds be distributed across the universities? There's a program called Ideas program that the NIH, the National Tribal Health has. And I apologize so I don't remember the acronym, but I'll tell you what it does. It says, for research institutions in the 25 states that are in the bottom half of the distribution of NIH funding, it gives them a leg up and being able to get access to this federal funding for the for the for the FixCost of Research.

1:08:15I think that's a great program because what it does it says look, the federal government shouldn't just be funding the top universities. It doesn't make sense from from from the point of view of trying to get the the biggest bang for the buck in scientific knowledge. Just like a just a very narrow, like this is not an narrow thing, it's like an important thing. I think scientific group think happens when scientists are all just on the coast, and you only scientists interact with the scientists already agree with you. Giv graphic dispersion of scientific support allows more richer conversations about science that allows different scientific ideas to develop just simply because it's more geographically dispersed.

1:09:02It combats scientific group thing. There's other reasons too, as you said, like other excellent scientists in universities that aren't in the Stanford's Harvard or whatever. If you gave them a environment where they could do their work, they would have to make tremendous advances. I think for lots of reasons it makes sense to do that. I don't want to comment on the specific 15 % or subject litigation. I will say that the key policy issue was exactly the thing you said. How should the money be distributed that for fixed cost of research across the universities? Like one system, you can imagine, would be where different universities compete on costs.

1:09:43So a university that's able to more inexpensively provide square foot of lab space, fully supported with radioactive disposal and all other stuff, maybe the NIH ought to be giving money to that university more than a university that has to provide it at much more expensive rates. That's not the current system, but you can imagine a system like that. So I think this fight over this 15%, it's a great time now to rethink how the NIH and the federal government supports the research infrastructure of the country. It's for the first time in, like I think in 40 years, it's now part of the public consciousness, this thought.

1:10:28And I don't think I've not seen anybody who says that we shouldn't have federal support for universities. The question is how should it be structured and to what extent? Those are, I think legitimate questions for public policy debate. Yeah, well before moving on from funding and the relationship between tax dollars and universities, I want to ask one more question, then we'll move into issues of public health specifically. But having been on study section, I realized I never explained what study section is. Study section is when a group of scientists convene used to be in different cities or virtually, and they review grants.

1:11:06Typically the people who review the grants are expert or near expert in a given area, typically three primary reviewers, a bunch of people vote on the grant. And to make a long story short, whether you get money to do research from the federal government, aka the taxpayers, is voted on by a jury of your peers. This has distinct advantages, in my opinion, because real experts or close to experts are evaluating your work, and they either have to advocate for it or they actively try and kill it. From the perspective of a reviewer, you're given 12 grants and you know that only three of those can be funded or so.

1:11:46And so you literally have to advocate for the one or two that you feel most strongly about and you Find ways to legitimately make sure that the other grants are not scored as well and You evaluate each one on the basis of its merits But you go into those study sections knowing like goodness like this grant I sure would like to see this one of this other work is kind of pedestrian It's kind of like like all the others now. This is a great model in principle However, you talked about group think. It lends itself very well to people who are very good at grant writing, which is important, grantsmanship is important, continuing to get money.

1:12:27And in particular, new ideas, ideas that are outside the vein of what a researcher has been doing for the last five, ten years, promoting the idea of doing new ideas, of chasing new concepts, new hypotheses. It tends to make science move very slowly and very incrementally. So that's one issue. However, I realize I'm weaving two questions. But what you described before, the majority of science that's funded at these universities on the coast as is geographic, a fact, group think, a fact, what about the rest of the country in these other places? The study sections, the people who review the grants, intentionally include people from throughout the country.

1:13:10It's related, in fact, I think to the distribution of the electoral bodies and people who lobby in Congress. So in other words, there's no study section on a given topic, say Alzheimer's, where you don't see people from the coast, but where you also don't see somebody from the Midwest, somebody from the Desert Southwest, there's always been geographic coverage in the people who decide which grants get funded. So I just, this is a historical component here, but so the question is a very straightforward one, which is given that a jury of peers decides what gets funded. That checks off the box of, are they experts?

1:13:54Yes, more or less. But it also means that nothing really that new can get funded. Yeah, I mean, I think you've hit on a real problem, which is, I think, let me contrast with Silicon Valley, right? So in Silicon Valley, you're an angel investor of EC or something, and you're venture capitalists, and you invest in a portfolio of 50 projects, and 49 of them fail, and the 50 it succeeds, it becomes Google or Apple or something. That's a very successful portfolio. The process of how we, the NIH, review grants embeds in it a certain conservatism in a desire to make sure that every grant that's funded succeeds.

1:14:46You can have a portfolio where every grant succeeds, but then the portfolio as a whole is not as productive as it ought to be. Because how do you make every grant succeed? Well, you just fund incremental work that you know will work. We call that turning the crank. There was a professor at the Salt Institute, a superb institution down at San Diego said to me, you know, two kinds of science. There's a kind of science where you really test a really bold hypothesis and most of the time it will be wrong. But if you hit something, it's apt to be spectacular, maybe even open up an entire field, maybe cure a disease.

1:15:21This has happened before many times over. Or Or there's the science that will get you funded where you turn the crank. You look at a different protein in a pathway that is marginally interesting, but is predictable in terms of its ability to create papers, students think papers, post -docs, things. Most of them don't want to go on to be lab heads, so they just kind of need papers in a PhD. And you learn something along the way and hey, you might stumble on something really interesting. But it's kind of like stand on one foot, stand on the other, spin around. and without money there is no science.

1:15:55So you could understand why people would be incentivized to do this kind of more incremental, I'll just call it pedestrian, kind of like really they're showing this again. You go to the meetings, it's like they've been doing this stuff for like 15 years, but they keep their NIH grants. And then at the end they go, they were funded for 30 years. I've had this when people brag about having the same grant for 30 years, I just go, oh my goodness, that's, you should be embarrassed. You, now how about seven different grants over the course of 30 years? and tell me that one of them led to something interesting.

1:16:25But don't kid yourself into thinking that having a grant and RO1 that lasted 30 years with five renewals, it's like, I look at a lot of those careers of some of my senior colleagues, and I'm like, you made the interesting discovery in the third year of the first iteration of the grant. The only thing you've proven is that you can, that tenure keeps people around too long. This is coming from a tenure professor. Yeah. So, what's - Well, it's formally a tender professor until recently. But you gave it up by choice. I did. We should do that. OK, so before the pandemic in 2020, it was actually for a decade before, I've been working on measuring the innovativeness of the scientific portfolios.

1:17:06I had a paper that was published on the eve of the pandemic asking how innovative is the NIH portfolio in particular? Oh, my. And so let me just describe the methodology because it's easy to understand, right? So take every single published paper, published in biomedicine in 1940, take all the words and word combinations in it and just list them, okay? Then you do the same thing for all the papers published in 1941 and subtract off all the 1940 words in word combinations, which are left with the unique words that were introduced into the biomedical literature in 1941. You do this for 42, 43, 44 into 2020 and what you get is a history of biomedicine.

1:17:54It's in, it comes right out of the words that were actually published. And you can do this because computers, right? And so you take, so you have an age for every single idea that was introduced in biomedicine that just comes out of this automatic process. You go back to the papers and ask how new are the newest ideas in the papers when they were published. Right, so just to take a concrete example, polymerase chain reaction in 1982, 83 was a new idea. And so if you were Kerry Mellis publishing a paper with the words polymerase chain reaction in 1982, that's a paper that's relying on new ideas.

1:18:33If the newest idea in your paper in 2020 is It polymerizes chain reaction. Well, that's an idea that's almost 40 years old, 40 plus years old, right? And now it's in the method section. Barely, right? Because it's just like zero ox, right? You just barely mention it, right? So the point is that you can use this method to ask how new are the ideas in every single biomedical paper that's ever been published. So we did that, named like Holly Mika Pakalin at University of Waterloo. We asked, and then we asked, for NIH, funded papers, has the age of the ideas in the paper shifted over time? And the answer is yes.

1:19:17Papers that were published in the 1980s, with NIH support, tended to work on ideas that were one, two, three years old. Papers published in the 2010s were working on ideas that were seven, eight years old. At the same time, in the 1980s, the age at which you could win a large grant at the NIH. They're called RO1s, and you know, and you didn't all about that, but like the reason why these large grants are important is because they are the ticket first to getting funding so that you can actually test your ideas and do the experiments you want to do, but also they're the ticket to getting tenure at fancy universities.

1:19:56In part, I should say because RO1s, these large grants carry large amounts of IDC indirect costs. Let me put it differently. If a professor comes to a university and does absolutely groundbreaking work, but does it entirely on foundation money, which carries very little indirect funds to provide to the university, there's a chance they'll get tenure, but very small chance. It's professors that have RO1s stand a much higher probability of getting permanent employment at that university, called tenure. There are ways to lose tenure, but in principle it's academic freedom. tenure was never really about a job for life.

1:20:42It was really about the freedom to explore ideas. There's facilities in that. There's facilities in that. But I think it's so important for people to understand. And so much so that when I heard about this, perhaps reduction in IDC to 15%, my first thought was, whoa, that's a big cut. My second thought was, who will get tenure and who won't get tenure? Now it will have to be based on the merits of the work. Now there is a correlation, right? People who just spectacular work tend to get grants, people get grants tend to get more money, and then you can explore more, et cetera. And the dirty secret in all the RO1 stuff is that everybody knows that the R1s are used to fund the next bout of research, but what you propose in an R1, sorry to break it's work that's already completed.

1:21:27This is the inside secret of every scientist. Oh, every scientist, because you want to say, look, I can do this. I mean, I've had R1 support also. Yeah, you show them the preliminary data. This is what I'm going to do for the next five years, but the dirty secret is, this is what I already did for the past five years, I get the money I do the next thing. This is the shell game that every scientist learns to play. Because otherwise, as you say, you get it in the neck, which is grant speak for your done. You fire, you have to, can't take students or postdocs, you got to fire your technicians, you close your lab, and you become what's called dead wood.

1:21:59So there's a game that's being played, and it's not a dirty game, but it's this kind of like, like kind of don't ask, don't tell game. Everyone knows that people are doing this, and look, scientists are good people. I want to be very clear. They're just trying to survive. Most scientists, I think, I believe most scientists are trying to get it right. I think the local culture can contaminate things and this grant, this need to be funded. I grant you most of them. Okay, yeah, and you know, I'm here in part as an advocate for the public and in part as an advocate for the science community. I can't split myself.

1:22:32So, I'm so my major, I've been doing it for a very short time. But with lower IDC, who will get tenure? I mean, who will get tenure? What's it going to be based on? Yes, I mean that background is really helpful, but but but here's a fact In the 1980s the age at which scientists won their first large grant R01 was mid 30s Okay, I got mine. Let's see. I started my lab when I was 35. I got mine at my first R1 I got when I was 37 right that started my lab in 2011 right in 2011 to 2020 that you were young for R01 I was yeah, right? It's a typical scientist within the mid -40s for the Fourth of the Gethiferster.

1:23:11I didn't have a family. I worked 90 hours a week. So, the point is that young early career scientists take much longer now to be able to get support to test their ideas out than they did in the 1980s. This is important for innovation because it turns out that this is another paper that I published before the pandemic. It turns out that it's early career scientists that are most likely to try out new ideas in their work, in their published work. Right, so, in fact, this is depressing, but for me is with a man with gray hair, but like it's monotonic, like the first year after your PhDs when you're most likely to have newer ideas in your papers, and then every year after that, for every single year of chronological age, the age of the ideas you tend to work on tends to increase by about a year.

1:23:57Well, the late Ben Barris, my postdoc advisor and beloved colleague at Stanford who unfortunately passed away in 2017, He used to say, he was 60 when he died, roughly, he used to say he's like, nobody does anything after they get full professor. And I was like, that's crazy. We have Howard Hughes investigates. People will let Winnoe, but he goes, all the critical work is done early. I said, what about you, Ben? You're there. He's like, oh, yeah, I'm done. You know, there's before he knew it was dying. You know, I mean, this is the dirty secret because when you're young, you're hungry. Given the space from your previous mentors, you are, you're going to go for it because because you have to go for it.

1:24:34And if nothing else comes of today's discussion, already a lot has come of today's discussion, I wanna put in a really strong vote for encouraging, I'm gonna catch so much heat for this, but the older labs talk about funding the next generation of science while taking most of the pie for themselves. I really believe like if I could just, I'm not gonna beg, but I am going to. No, you don't have to beg, I mean, this is the, we need young labs to be funded. And this is an open door. Yeah, thank you. In my Senate testimony before I became an ice director, this is a major initiative I want. I think the early career, let me put it probably two sharp points on it.

1:25:18So right now what we do is we take the careers of young scientists and effectively put them at the service of older scientists, more established scientists, so the early career scientists are essentially doing the work of the older career scientists. So you have to have post -doc one, post -doc two, post -doc three before you have any chance of getting an assistant professor job where you could get, test your own ideas out. Essentially, the labor of young scientists is devoted to the ideas of older scientists in the current system. That wasn't always true. And the NIH has played a role in that.

1:25:57It's, and it's part of the reason why we have had essentially the sort of more incremental progress than I would have hoped for. You know, when I did my PhD, did my MD in the early 90s and then into the mid 90s, I had envisioned a career where there would be huge advances in science that I would spend my entire career thinking about and chasing, right? And there have been some huge advances. But frankly, I have this sense that there have been fewer of them that I would have wanted that expected as a 1990 version of me. Especially in the biomedical sciences. Because I think we see the expansion of AI, we see the expansion of computer science, et cetera.

1:26:38I could not agree more. I actually think some of the programs, like the Post -Back Programs at NIH, I don't want to destroy this program by saying this, but these are where people finish college and they decide to go two years of research before they decide to go to graduate school. This in my mind delays and kind of drains the initiative of a lot of... There's nothing more beautiful than someone graduating college who's still excited about biomedical science. Taking that energy, usually they don't have a lot of other commitments yet. I think we should fund them so they can have a healthy life.

1:27:10They don't need to have a lavish lifestyle, but a healthy life. And spend as many hours as is reasonable in the lab making discoveries to get through their PhD, be, do like, it used to be a short post -doc, start a lab, and hit the ground running in their thirties, and get major funding to be able to test new ideas. It's not just the Silicon Valley model. It captures everything we know about brain plasticity. Their brains are so plastic, they're full of energy, they're full of dopamine, naturally. And I'm not saying that everyone past 60 is like dead wood, old wood. There's some amazing work being done at the, but it's very top heavy.

1:27:45And of course, no one wants to give up their lab. I know people in their 70s and 80s, they don't know what to do if they retire. They think, I don't care. Get a hobby. Let the next generation in. Actually, there's one good result. One result that was, maybe a little bit comforted, was in this paper that I did with Mika Pakalin on age and the trying out of new ideas. That is that teams of young scientists, first author, Raltely Young, teaming with a mid -career or later career scientists as a senior author, that combination is most likely to try out newer ideas in their work. It's like you kind of need the...

1:28:23So keep the old folks around. By the way, I'm turning 50 in September, so I'm nearing these numbers. I'm still a young man. All right, well I've, plenty, I'm very passionate about this, in part because some of my former graduate students and postdocs are now professors at universities, working extremely hard on extremely interesting questions, but I know they would be pursuing even bolder questions related to immune system function and autism related to visual repair to cure blindness. I mean, these are not trivial issues that they're trying to pursue. They deserve, and their peers deserve, the majority of the taxpayer dollars for discovery, because I think that they're in lie, the discoveries.

1:29:02And there is this culture and academia of people kind of pinning awards on each other as you go up the ladder. So those awards are nice, a good friend of mine. Just was, he's a member of the National Academy of Sciences. He called me. I said, congratulations. I was like, this is fantastic. And he said, it feels good, but like, you know, I want to be in lab. I want to be in clinic. I mean, that's what's important. The titles are in the end, they're meaningless. I've seen so many colleagues die. Like, their offices get cleaned out within a week. They're gone. And so the discoveries that young scientists make with tax dollars, to me, is the most important and beautiful thing that can happen.

1:29:39I mean, it will soon migrate into a discussion about public health, but I'm so relieved to hear A, that journals are going to be accessible to the public and B, that you feel this way about young scientists because I get nothing against the old. I'm not an ageist, but let's face it, youth is when discovery happens. I think the spring that's back to something you brought up earlier and I haven't yet addressed, which is how we evaluate science at the NIH, right, these study sections. They're inherently, as you alluded to this, they're inherently conservative. Right? So just to put a real fine point on it.

1:30:16So I think in the 2010s, there was a policy that in order to be on an active member of a study section, standing member of these review panels, you had to have an active RO1, a large grant, an active large grant. Think about that, right? So I am a scientist, I'm really well accomplished my field. I have a large grant by every measure of scientific success. I'm a success. And I'm sitting judging young scientists pitching their ideas, some of which, if they're turned out to be true, maybe undermine my ideas. I mean, it's really hard to like open your brain and say, okay, I'm going to support a project that might undermine my entire career.

1:31:02I mean, everything we know about cognitive bias supports what you're saying. There's another aspect too, which is, you know, letting go of one's own ideas, especially if you're funding and your ability to pay your people depends on them as tricky. There's another kind of, this is not just inside ball. If you're on study section, your grants are evaluated differently. A lot of people are on study section because you get what's called a special, where people you know and you know who they are, a small team of people that generally like you and you like them, you even can suggest names for who's going to review your grant.

1:31:38Being on study section helps you get grants. You have to get one first in the open water of grant study section, but I hope what people are starting to understand is that the system isn't corrupt, it's just structured in a way that doesn't favor bold innovative change. And those words, bold innovative change are thrown around a lot. I was part of the National Alliance to Tutes Audacious Goals Initiative. we get into a room every year, we'd sit around. How are we going to theorize? What are we going to do about pigmentosa, macular degeneration? And then everyone went back to doing the same work they were doing before.

1:32:10And so a lot of times these phrases get thrown out there, websites get put up, and like, nothing changes. When I talk to the public about science, there's a couple of modes. Like, what now post -pandemic, a lot of it is purely cynical. But there's another mode of thinking about scientists that are just sitting around thinking deep thoughts, making big advances. But in fact, what you're saying, and I agree with is true, it's not entirely cynical, but like the fact is that there's a sociology to science, right? So I'm trying, there's a sort of like a careerism inside science. And sometimes it can lead to good, right?

1:32:43You know, if you're a competition with other scientists to like make the next big advance, but sometimes, but I think in the current way we structure incentives in biomedicine, very often we discourage that kind of sharp innovation. We encourage, essentially, incremental advances. So, yeah, I have a safe scientific career for the rest of my life, rather than take a big scientific risk that where, like, I might fail, but if I succeed, I, you know, like your macular generation, I cure type 2 diabetes, you know, or whatever, right?

1:33:23The structure of this, essentially, if you want to, like, put it down as like the key problem is that in biomedicine, academic biomedicine, we are too intolerant to failure. If you have a big idea that doesn't work essentially or out, that's not true in Silicon Valley. Silicon Valley, a failed startup doesn't mean that you can't get another draw at trying to make a successful startup. right? Silicon Valley does not punish failure that sharply and that is the key to a success. Whereas in biomedicine, the current version of it we have now, we punish failure way too sharply. I completely agree and I should definitely point out I never had trouble getting grants.

1:34:12So I'm not coming to this with any cynicism. I moved on to podcasting and I still teach and closed my lab out of a joy of what I'm currently doing. It wasn't that I couldn't fund myself. I did see excellent grants get killed. I also saw some excellent work progress. I definitely agree with this analysis that you did. Thanks for doing that paper. I'll take a look at it. We'll put a link to it that work in early in one's career tends to be the really innovative stuff. There's just something about the younger brain that is more ambitious. It's a higher risk taking. And unfortunately now there's so much pressure to get funding for IDC reasons and to get tenure that oftentimes young investigators will lean toward the more pedestrian torn the crank type of science, get tenure and then think they're going to, they're going to go do something, but typically there's something bigger.

1:35:02I am very relieved to hear that young investigators, young scientists, new ideas are going to be prioritized. Hopefully through the, where it really matters, like brass tax, like I think early career R1s should be bigger than late career R1s. It should be inversely related to the size of a laboratory. I think smaller universities should get a bigger piece of the pie. I do. If the work is up to par, right, you don't just want to give them money just because. But I imagine if R1s were, I don't know, 50, 75 % bigger for new investigators. Maybe they weren't four years or five years. Maybe they were six years.

1:35:40You could really take a run at something. Or multiple things. And then maybe older investigators who've had grants for a while, you don't want to turn them out to pass you too fast, you want to pivot them slowly, I'm kind of joking. But maybe there are ones should be smaller and they should be more selective about what they're doing because with a lot of grants top heavy in the older generation, they can kind of just spread it around. Well, that postdoc went back overseas and that didn't work out. I hear about a lot more kind of quiet exit type failures. As opposed to we tried really how we thought this signaling pathway was going to be the thing, it wasn't close that hatch pivot quickly the next thing.

1:36:19There's a few things. I mean, one of the nice things of being the NIH Director, there's lots of smart people who've given me fantastic suggestions, especially for this specific problem, which I think is the key, probably the most important thing I'm going to be dealing with, that plus the replication crisis we've talked about. And I'm not sure exactly what the exact portfolio of things we do will fix this, but we have to support young scientists, early neuroscientists, we have to punish failure less. And we have to change the incentives around so that people want to test the big thing, the big thing that translates into advances for some of the most intractable health problems we face.

1:36:58And if we don't do that, the NIH, we're gonna look back and say, well, the NIH portfolio of investments to the American tax reform may have not paid off, just from a macro scale. I mean, you can frankly say this for the last, at least since 2012, we had had no increase in life expectancy in the United States. The NIH portfolio in that sense did not pay off. I have heard, and I think it was the former director of NIH in a public forum at the end of last year, it was November of last year, I tuned in for that, said that we've developed more treatments to extend the life of older people, or at least to limit their suffering somewhat.

1:37:36So cerebral vascular disease, cardiovascular disease, things related to dementia, small differences to keep them alive longer. But the real dearth of meaningful treatments sits around younger populations who are dying deaths of despair or whose health is in really just in a dire condition due to obesity, diabetes, and mental health issues. So in other words, young people are getting sicker earlier and staying sicker. and older people are getting sick but holding on to some remnants of health longer and most of the treatments are geared toward the older population. Is that true? Yeah, that's true.

1:38:16That's exactly right. That's a terrible situation because it essentially is not preparing for the future. Right, so what we have is a system, as a sick care system, the advances we've made have allowed people to say sick longer. It hasn't translated a longer life, right? It's just, it's, there was a hope I think when I first started doing research in 2001, in population aging, there was this idea of a compression or morbidity. That is, you live long a long life and the time you spent really sick and disabled was compressed at the very end of your life. Rather than spending a long time disabled and sick and you die, die after having spent like a decade or more very sick, the idea was that we're, which we have advances in our cultures as produced results so that you live a long life and you only spend a few months really sick at the end of your life.

1:39:08That hasn't panned out, right? That is in fact, we have very little increase in life expectancy. And for many, many people, unfortunately, a very long period of time in a state where the quality of life is not that high, not that good, right? dementia, chronic disease, leading to diabetes, leading to all kinds of kidney failure, macular degeneration, you name it, prophycalascular disease, heart disease. You end up with a situation where all of these amazing biomedical advances that we've had over the last decades have not translated to actually improving the health and well -being and longevity of the American people.

1:39:50I think that the biomedical infrastructure, research infrastructure, the country has to translate over four results for real people, for the American people. Otherwise, people can ask us, why are we doing what we're doing? You can't just be that we're doing cool things. I mean, nothing we're not doing cool things. A lot of cool things are getting done. But if they don't somehow eventually translate over, again, I don't mean to distinguish which basic science work, I think basic science work is really important, but eventually it has to translate over, or else people will say, well, why have we made these vast investments?

1:40:27The key thing is, if we're not actually improving health as a result of the research we do, then we haven't accomplished our mission, right? The research agenda of the NIH, as we've talked about, it's like we talked about, you know, international relations as determining in part what scientists work on, you know, for drug pricing. We talked about how politics determines the agenda of the scientists work on, right? So you talked about HIV, right? So the political focus on HIV led to the vast investments the NIH has made in HIV, with some positive effect, actually a lot of positive effect. And then also the sociology professions, the scientific profession, These are all complicated things that result in the portfolio.

1:41:16But if the portfolio ultimately doesn't meet the health needs of the American people, then it's not doing what it's supposed to be doing. Part of my job is to make sure that it does meet those health needs. The Make America Healthy Again movement, that's what it's asking for, that the health institutions of this country actually meet the health needs of the people where they are. And in the large part, we've not successfully dumbed that in this country for decades. Otherwise, we wouldn't have this major chronic disease crisis we're currently facing. And so that's, you know, it's a complicated question.

1:41:50It's not like, you know, it's not just solved by funding one grant or making the specific decisions. It's about the incentive, this system at large, to focus on,

1:42:03to create incentives for this so that scientists turn their ingenuity toward those health needs rather than just just advancing their careers incrementally. I'd like to take a quick break and acknowledge one of our sponsors, Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar. Proper hydration is critical for optimal brain and body function. Even a slight degree of dehydration can diminish cognitive and physical performance. It's also important that you get adequate electrolytes.

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1:43:46This is a perfect segue for a discussion about the replication crisis. It's a perfect segue because up until now and still now, the independent investigator model for those that aren't familiar is Andrew huberman gets hired as a assistant professor who might get tenure at a university and then the so -called Huberman Lab before it was a podcast, it was also a actual laboratory space, physical space, has to come up with a set of ideas that hopefully pan out. You get funded for, you get tenure and then you can pursue new ideas. But it's an independent kind of startup of its own. My neighbor, Tudor is down in hallway, works on something else.

1:44:29One of the major issues I believe that led to the so -called replication crisis is that it is very difficult, even with the best of intentions for two laboratories, to do the same work in an identical way. Five minutes longer on a countertop at room temperature might change an antibody that could lead to a different outcome. I mean, there are so many variables. The solution to this is collaboration. Instead of having independent investigators, you have clusters of laboratories, hopefully distributed throughout the country, working on the same problems, collaborating. There are grants of this sort, but here's the problem, as you point out, it's a sociological issue.

1:45:08The graduate student in my lab needs a first -author paper if they want to eventually get their own lab. The postdoc in another laboratory doesn't want to be a middle author with 20 other authors. To continue to flesh out the world of science with scientists, the independent investigator model works, those independent laboratories are naturally going to come up with different answers. Talk about the mid -meetings, and maybe there'll be some convergence of ideas. But wouldn't it be beautiful if laboratories collaborated to try to solve important problems related to public health? And everyone was incentivized through perhaps not easier, but more plentiful funding to do the research.

1:45:51salaries that these people can live on reasonably while they're graduate students and postdocs, and maybe even laboratories that are more structured around a problem so it's not called the Huberman Lab. It's called the laboratory for curing blindness, and there's another laboratory for curing blindness at WashU, and another one in University in Illinois, and we all collaborate, and we try and cure blindness as opposed to making it all about the the principal investigator, the independent investigator. The rock star model of science kind of works and it kind of is part of the problem in my opinion.

1:46:26I agree through about collaboration in the following sense. So science is a collaborative process. But the incentives within science that for individual advance can often lead to sort of a structure that elevates careers without necessarily producing truth. So let me flesh this out. We tactfully put. Okay, so there's a colleague of ours at Stanford named Johnny in the 80s. He wrote a paper in 2005, absolutely brilliant scientist. I think it's the most highly -sited scientist living scientists in the world, right? So he's, he wrote a paper in 2005 with the title, why most published biomedical papers are false.

1:47:13I mean, when you make a title like that for a scientific paper, it better be convincing. And in just a few pages, it's an utterly convincing paper. And it's not because scientists commit fraud, that's not the reason behind it. Because science is hard. It's exactly in the heart and exactly the way you just said Andrew. So you publish a result. You believe it to be true. You have some statistics, significant results. at some level, we say p equals 0 .05, what does that mean? That some percentage of the time, even though you believe the result is true, it's been peer reviewed by your colleagues. The peer review actually doesn't involve, as you know, the peer reviewer is taking your data, re -running your experiments, it doesn't mean any of that.

1:47:57They just read your paper, look for logical flaws, didn't find any, and then they recommend the editor to be published. So the peer review is not a guarantee that it's true. You have some statistics significance that say this your data meet. Even with that, some percentage of the time the published result is going to be false. Now if you think of science, a priori is hard. Any result that you publish is most likely going to be a false positive result. Next so -called negative results aren't incentivized. They're very hard to get a good paper published for showing that something isn't true. It happens.

1:48:37I had a paper published in science, which argued that at least one aspect of a theory was not true. It was a very prominent theory. Turns out other aspects of that theory were true. So sometimes it happens, but no self -respecting graduate student or post -doc who values their life is going to say, I want to go in and try and disprove the hypothesis of one of the more famous people in the field. In fact, I didn't set out to do that, just so it happened that's the way it landed. And no one shows up in graduate school and says, you know, I love these papers. Let's replicate them. Yeah. Right. So let's get back to that.

1:49:11Because you're absolutely right about the incentives. But before we get to that, the incentives would analyze that. Just put a fine point of the nature of the problem. The published biomedical literature, something that I've searched basically every day for the last 30 years, 40 years. Oh my god, 40 years. That published biomedical literature, most of the time that I'm reading papers in that literature, the papers I'm reading, even though they say their result is true, is likely not true. Look, I had a professor in medical school once told me, as one of my favorite professors, You told me, look, half of what we're teaching you was false.

1:49:51Well, okay, so I'm glad you're pointing this out. I asked a very prominent neurosurgeon, perhaps one of the most prominent neurosurgeons in the world. I said, what percent, someone else asked him, but I was right there. What percentage of information medical school textbooks do you think is false? And he said, half. And then the second question was, what do you think the implication is for people for human health? And he said, incalculable. Right. Exactly. And that's true of the biomedical literature as well, right? So the published peer reviewed biomedical literature Is not reliable is the bottom line so a lot of what the things that we think we know with even with some fear degree of certainty are probably not true And you know the question is like which half Well, we don't answer that question.

1:50:36There's probably a mix parts of papers are probably true in other parts are not Right, it's not like all the papers from one well there are those labs, but they don't last long and this is done even with pure goodwill and no fraud at all. And the reason is, the combination of the fact that science is hard and the incentives we created for publication. Right? Those two together mean that the scientific literature is, the biomedical scientific literature is not reliable. I've talked with drug developers who tell me that they, before they make vast investments in a phase three randomized trial, even phase one or phase two trials, studies, they conduct independent replication efforts of the basic biomedical literature to see if it actually is true.

1:51:24Now those are private replication efforts so that the drug developers know which parts of the literature are true and false, but the scientific community at large doesn't know. We've set up a system of publication that guarantees that much of what we think is true is not true. That's a major problem for science. And it's linked to this idea that you have to publish or you're out. It's linked to this idea that if you fail, if you publish failure, you're out. It's linked to this sort of reward that we give to scientific volume, like the number of papers we publish, and scientific influence. That's what citation counts are.

1:52:11There's a number of, I'm sure you know of the Sandra, so I'm explaining to the folks who are listening, something called the H index. It's if you go to a site called Google Scholar, every scientist listening to this, I'm sure has gone and looked at their Google Scholar page, they have a little card at the top right that essentially looks like a baseball card to me. And it has a few statistics, and if you're not a scientist, you won't necessarily know what those statistics are, but what they are, things like an H index is, So if you have an H index of 10, that means you have at least 10 papers published in a peer -view journals that have 10 citations each, but you don't have 11 papers with 11 citations each.

1:52:55So in order to get a high H index, you have to have both a lot of papers and a lot of citations through those papers. It's a funny number because like you can imagine just to bring back Watson and Crick, imagine and watching and clicking the only paper they ever published was the structure of DNA. Good paper. The W. Let's say it has a million citations. Not peer -reviewed, but good paper. It's a fantastic paper. And was never peer -reviewed. Right. But a million citations, and imagine it was their only paper. Well, they have one paper with at least one citation, but they don't have two papers with two citations.

1:53:26So their H index is one. Or you could have a million papers in the journal of irreproducible results, each with one citation each, and you have one paper, at least one paper with one citation, but you don't have two papers with two citations, so you're indexes one. Or you could write a lot of reviews because reviews get cited like crazy. Okay. So now what you have then is an incentive for scientists embedded in Google Scholar that says, look, you have to publish a lot of papers, you have to have a lot of influence because that's what a citation is. It's a measure of influence. You go to scientific meetings in order to sort of shop your ideas around, right?

1:54:08And so we reward scientists for the influence that they have and we reward scientists for the volume of papers they publish. What we don't reward scientists for is honesty about their failures. We don't reward scientists for pro -social behavior, like you suggested, but where you collaborate, you share your data openly and honestly. In fact, we punish scientists for that. Right? So right now, if somebody comes to me and says, I, Jay, I want to replicate your work. I've trained myself not to think this way, but it's really hard not to, given the structure we're in, I'm going to think of that as a threat.

1:54:46What if they don't find what I've found? Now, I'm a failure, right? The failure to replicate is seen as a failure of the scientist, rather than the fact that science is hard, and it's difficult to like get results that are true, even with the best of will. And we punish scientists for that. So we essentially reward scientists for a set of things that creates incentives for the replication to have crisis to happen, I see. So the solution to the replication crisis is to address those things, measure the pro -social that scientists could do. Recreating incentives away from simply influence and volume.

1:55:30I'm not saying you shouldn't reward influence and volume. I'm saying you should reward a fuller set of things. It's like in baseball, you reward a hitter for home runs, but you don't also measure strikeouts. Well, you're gonna get a lot of strikeouts and not necessarily, you may get a lot of home runs, but that may be bad for the team in total. right? So you want a full set of statistics, measuring the things you want to read, you actually want scientists to do in order to solve the problem, right? So let's say we had statistics that said, look, do you share data with others in your published research work?

1:56:12And we have that as among the baseball statistics we put in Google scholar, right? Let's say we ask, is your work subject to replication? Actually, if your work is subject to replication, you have ideas that are worth, looking at by other scientists, that's a success no matter what they find. How frequently do you publish your false results? Results that turn out to be not true, right? Imagine we had those statistics, we would have a fuller picture of what scientists, like the capabilities of scientists, their outcomes of scientific work, and we reward the pro -social things that would solve the replication crisis.

1:56:51And so what you have now is a real problem that's not been addressed. We've known about this not for decades, but it not been addressed adequately. There have been a number of efforts by the NIH over the last several couple of decades to try to address it, but it hasn't solved the problem. Well, I feel like the issue that really cracked this open, the general public might have heard of the so -called replication crisis, is this idea that there were some findings in the field of Alzheimer's research that were false, but they were wrong potentially for the wrong reasons. Scientists, you learn it's okay to be wrong for the right reasons, meaning your measurement tool was inaccurate, but it was the best you had at the time and you thought it was accurate, you know, better tool comes along, you get a different measurement, new result, I guess you were wrong for the right reasons.

1:57:35But you're not fudging data, you're not hiding data. There is this idea that in the field of Alzheimer's research that somebody might have fudged data, made up data and that the field kind of went along with it. That's not my understanding of what happened. My understanding is that somebody fudged data and then nobody went back to check the primary data in that paper. And as a consequence, many years down the line, a number of subsequent findings were nested on a false finding and the whole thing tumbled like a house of cards. More or less. The process you just described is the replication process playing itself out, right?

1:58:10So you make investments built on a house of sand, on a foundation of sand. And you eventually get fancy drugs that are supposed to prevent you from getting the disease that you're trying to prevent. In this case, prevent you from being able to, you know, prevent you from like progressing until you can't remember the name of your kids and you can't live a normal, you know, to full life as your memory goes away. The drugs don't work for those things. And you question is why they're built on the best science going all the way down. It turns out the best science all the way down is not replicable.

1:58:45The fraud aspect of it is actually not even the most important, but it's not the most important part of it. It's almost just an afterthought. Ask yourself, why have there been so many scandals brought down the former Stanford president? The NIH, again, just within Alzheimer's, there was a director neuroscience who had, who apparently had a hundred or more papers with his Photoshop fraud. So the question is, why have so many prominent scientists been brought down in where they're like work has been shown to be fraudulent? It's not a moral failure on the part of any individual scientist. The structure of incentives we created produced those up, those behaviors.

1:59:32We created them as what yours. Yes. Yes. We've said you will get advances in your career if you publish a lot of papers and have a lot of influence. And if you admit that you were wrong about something your life is over. Your career is over. Yes. I think one of the most beautiful things in science was when Linda Buck co -recepting at the Nobel Prize with Richard Axel for the discovery of the molecular structure of olfactory receptors retracted, I think was three papers from her laboratory. A postdoc either was sloppy or fudge data. She retracted the papers because the papers were wrong. People told her this stuff doesn't replicate.

2:00:08Not only did it not hurt her career, it helped her career. She was right about the olfaction work that got her the Nobel Prize, but she was willing to admit a mistake. Someone in her laboratory made a mistake. Ergo, she needed to retract those papers. What happened in the case of our former colleague, but still, well, you're not at Stanford anymore, was... Let's just put it this way in every major laboratory that's publishing at a phenomenal rate. Inside the field there is always discussion. Postdocs talk, graduate students talk constantly. And people know that work is solid and other work like there's something to just get said at meaning.

2:00:47It's like, no, nobody believes that. When somebody says, and that gets passed around so that no one follows up on it. But it's rare that somebody goes and whistle blows the way that those papers got whistleblown. And then the right thing to do in my opinion is you correct or retract the paper. If you make a mistake, you correct the mistake. There are ways to do that. People publish corrections all the time. Or you retract the paper if it's wrong. I think that the system, as you pointed out, has made it feel very dangerous for scientists that are approaching the pinnacle of science, like within reach of Nobel Prizes, winning laskers, winning International Awards as it was the case in all these instances that they could admit that they were wrong.

2:01:30Andrew, it's all up and down the system. Imagine you're post -doc and you have to get your paper retract - you retract your paper. You're essentially starting over a leaving science. Yeah, you're leaving science. It's existential. The problem of fraud and science then is a symptom of the broader problem of the replication crisis rather than the main driver of it. Right. So the right solution then is not root out the fraud. The right solution is change the incentives of science so that we as scientists engage in pro -social behavior, pro -social in this case meaning behavior that rewards truth rather than rewards volume and influence alone.

2:02:11Music to my ears, how do we, how is NIH going to do that? So we were talking about the innovation crisis. That's a much more complicated crisis. This one actually I think is doable within the context of the NIH. I think you have to do three things. So first, you have to make it a viable career path to engage in replication working creative ways. To some extent, there's some of this with like meta -analysis. Meta -analysis is the science of analyzing the scientific literature to ask whether what the scientific literature is a whole says about a particular question, right? That's what meta -analysis is.

2:02:48And so there are people who make career on metanalsis. And so that's in a sense a kind of replication work. Studying studies. Yes, studying studies, right? But it's really difficult to make a career out of doing replication work as a general matter of science. You can't win a large grant at the NIH currently where you say, I'm going to do metanalsis. I'm going to do replication work. which means then you're not going to get tenure at a top university, because you can't win the large grant that you're required to get in order to win. So you're not going to focus on an application work as a young scientist, even if you were very good at it, even if you could think creatively about a duet at scale.

2:03:32But it is discovery, right? Like I think we need to reframe it, right? Replication is kind of a dirty word. I shouldn't be, but years ago when a gene arrays first became available where you could look at gene expression in cells or tissues. Now you do single cell sequencing and you can do deep sequencing and this is really evolved. None of those dare I say are experiments. You're not testing a hypothesis. They are hypothesis generating experiments. You get a bunch of genes and you go out one's much higher in the cancer cell and that one's much lower and an on cancer cell. I think I'm going to go do like a knockout of that gene or over express that gene.

2:04:09I mean, that's testing hypotheses. But there is work that's necessary, but not sufficient. And what you're describing in terms of meta -analysis, aka replication, maybe should be recast simply because branding matters, which shouldn't, but it does, and incentivize it as discovering whether or not discoveries are actually discoveries. What's more important than that? Yeah, essentially saying, is the scientific literature true? like assessing the truth of the scientific literature. That's what that is. And that's a real fundamental actual advance, right? Exactly the way you say. But we don't reward it.

2:04:51The NIH doesn't reward it. That will change. Well, drug companies, it occurs to me, should be incentivized to do it because it will save them perhaps. They do it. But perhaps they won't have to do it as extensively because if the work that they're getting down the funnel has been checked multiple times by multiple laboratories. They have an increased confidence that molecule A, B, or C does A, B, or C. Sure, they'll test it again because they're about to put dollars behind it. No one wants to put dollars behind something that they aren't absolutely sure is true. But you like the funnel to be narrower.

2:05:24Yeah, I mean, and right now they test it. They do the replication work. Broad companies, before they make those investments, do the replication work, but it's private. So the only they know which results are true and false in the literature. So if the NIH does it, the knowledge about which results are true becomes public, which makes the entire scientific literature much more reliable as a basis, not just for drug discovery, but also for individual behavior. Which health behaviors should I, I mean, what food should I eat to make myself healthier? Well, that... No one can agree on that. I know.

2:06:01but the reason why? You can only agree on what you shouldn't eat. And even there. Yeah. I mean, I shouldn't eat the Skittles with the total hunger. I heard that process foods are bad, but the other day I saw, you're not gonna believe this, but there's a kind of a emerging movement in one sector of the media, that the demonization of highly processed foods is a conspiracy theory, which is like, like if that, but that's a perfect example of what we're talking about more generally, which is that language matters. You can throw something in the trash bin very quickly by calling it a conspiracy theory until somebody Makes or a group makes the effort to bring it out over and over again and determine if it indeed is you can also Throw something in the trash bin very quickly If you just call it just a replication study or a so -called negative result a negative result says this particular pathway Molecule mechanism etc is not doing what we hypothesized it would and And that's a real advance enough scientific knowledge.

2:06:58Absolutely. Without question. So the reason why we don't have consensus on what the right thing to eat is because the scientific literature, well, first it's a more complicated question than just science. But like part of it is that the scientific literature around is not replicable. But replicable. And those studies are really hard. Yeah. People to eat the same things. No, I, I, you know, people are, people are, right, sneaking skittles, people lie about what they people are. I don't like skittles. I was always, I was on more of an M &M person just for the record, whatever, just leave that aside.

2:07:27Well, it's clear that the new administration, both champions, healthy, unprocessed foods, but everyone's in a while, you'll see one of them can continue. I've cut down the skill since I've joined the Mahamu movement, whatever it's all, I mean, whether they're the M &Ms. Okay, so let's go back to the, we're talking about how do you fix this, right? So one is you give large grants to people in the scientific community who do replication work in creative important ways, scalable ways. You farm out to the scientific community the question of what results in the scientific literature really need replication, the key sort of rate limiting step kind of results that we need to know if they're true to advanced science and advanced human knowledge about questions of health, right?

2:08:15So you reward large scale, large grants for scientific scientists. So now all of a sudden their status is lifted compared to where they were before, which is down in the basement. Well, there soon be an institute or a set of grants set aside specifically for meta -analyses to resolve this, to help resolve some of this so -called replications. I'd like to do that. Fantastic. I don't think you'll get any pushback on that. However, every dollar spent one place is a dollar not spent elsewhere. Yes, but at the same time, making the entire scientific literature more liable is money well spent. That is my belief as well.

2:08:51Second, you have to have a place where you can publish this work. Right now, if you send your replication result to a New England Journal of Medicine or Science or Cell or Nature, they will not look at it at all. The NIH can stand up and will stand up a journal where these replication results can be published and made searchable in an easy way so that you have some scientific paper you ask yourself, is this something that other people have found? You can go to the scientific journal that we're going to stand up. You can search it very easily and ask where are the other papers that look at the same question and what do they find and get a summary of it.

2:09:31This is a little bit like community notes on X. In a way, but it's the scientific literature producing the community notes. These are formal papers with method sections and credentials. Yeah, not just anyone doing this work. It's part of the community of people that are looking at this question in rigorous ways, right? So the point is that you'll have kind of a Cochrane collaborative. Cochrane is this group in the UK that the grave scientific evidence on a whole bunch of different health questions in a way where they elevate rigorous randomized control studies is the highest level of evidence.

2:10:08and then, and of one kind of studies, the lowest level and a whole bunch of things between. And they'll produce reports and say, well, there's weak evidence suggests this is true. There's excellent evidence suggests this is true. There's no evidence suggests one way or the other on this. They're very, very nuanced in summaries. You should be able to do that, but with the published replication work as the core of it. Right? And a scientific journal put out by the NIH, a high profile journal will then make publishing replication work a high profile scientific high prestige scientific activity. And the journal could also publish negative results.

2:10:46I tested this idea and it didn't work. Published in the journal and now it's discoverable. It's no longer the threshold of you have to have a statistical significant result in order to get your result published. You just published the result because it's interesting and true even if there's a negative of results, right? The journal then that the NIH will stand up will plug a hole in the literature where we don't reward where we punish failure. Instead we would reward it where the constructive failures are published and communicated to the scientific community at large. We reward replication work, all right?

2:11:23So, fund replication work, create a place where it's publishable and essentially rewarded. And then third, this is probably the most important. Measure pro -social behavior by scientists. Make it part of the suite of statistics we use to measure scientific productivity. Not just publication, not just influence, but also do you share your data? Do you, is your work, has it been subject to replication? Do you cooperate with those replication efforts? Do you yourself engage in replication efforts of others? and make that part of the suite of statistics we measure for scientists to measure their productivity.

2:12:02And now all of a sudden replication becomes something you want to participate in, even if you yourself are not doing it. Fundamentally alters the culture of science so that rewards truth, scientific truth is determined by replication, right? by independent research teams rather than influence. It's hard to think about as scientists. We think about scientific truth as where you published it in New England Journal or you published in Science, Cell, or Nature, or whatever, that's truth, peer -reviewed papers. But in fact, the ground truth of science is determined by something really much more humble than that, it's by replication.

2:12:37We need to reward the things that produce the ground truth rather than the things that reward just pure influence. And we don't do that. It's hard and it's almost impossible to sign just the grown up in a community of people that reward influence as the primary measure of success to think what it would be like if we were to reward truth. But I think if we do these three things, it'll be completely transformed the nature of signs. Why would you want to commit any fraud? You're not going to get a reward for it. Yeah, you get a published paper. You might even be a top journal, but no one's going to replicate it.

2:13:11You want to share your data with people because they'll find out that you committed some fraud. all the incentives to commit fraud will just dissipate. It'll be liberating for scientists to be able to focus on the things we actually care about, which is learning about the world, true things about the world, the things that the reason why we went into science to begin with, rather than this sort of like competitive process of trying to get climb up a ladder that doesn't necessarily produce any truth. Amen to all of that. I feel very blessed that I had a graduate advisor who said, She said it was wild.

2:13:47She unfortunately passed away young as well, but she said, you know, why would any scientists make up data? It's crazy, right? You're trying to figure out what's true. So that essentially means they're willing to lie to other people about their data into themselves in some sense, right? The other thing is I'll never forget revising a paper with her. And I remember thinking like, oh, we have this, and she said, whatever we do, we can't give the reviewers what they want. And I thought, that's a weird statement. all you ever hear is, you know, you got to give the reviewers what they want. But it's a very dangerous statement.

2:14:20And the reason she was saying, don't give the reviewers what they want is you have to stay, you know, wholeheartedly committed to what you know and observe to be true. And you were closest to the data, so you would know. The other thing that I learned from her and this relates to what you're saying is that it not only is okay, but it should be encouraged to publish papers in an array of journals. You know, I think the pressure to publish in high profile journals in order to get a really great job is so great that it leads some postdocs, as it did in some of the cases we were talking about earlier, to either make up data or to throw away data that didn't fit in order to please the boss, then the boss gets pulled into it, then the boss tries to dissociate.

2:15:00This has been going on for so long. I feel very blessed that I was encouraged to publish some papers if they had a chance in science in nature, but other papers in fine journals like the journal neuroscience, where the accuracy and in some sense the volume of data was also encouraged. You could put a lot more data there, but now with online publishing and electronic formats, there's no limit to the amount of data you can put. So you can no longer use the excuse, well, you know, the high profile journals, you'll only can have four figures. So I think everything you're saying is very reassuring and should be reassuring to people.

2:15:33It's music to my ears, frankly. And I think it will be music to the ears of graduate students and postdocs who feel this immense pressure to make a major discovery, to make the lab head happy so that then they can get promoted to getting a job. Because most of the job process is powerful PIs, picking up the phone and saying, I've got this postdoc, you should hire them. That's like, it's a lot of it. It's not all of it, but that's a lot of it. So having an elder that supports you is huge. The other thing that I just am so relieved to hear is that the system has been around a long time and it sounds like from what you described it worked really well up until about the 90s, mid 80s, 90s, and that at some point something happened, something changed.

2:16:19And I don't doubt that scientific fraud took place a long time ago. There wasn't replication, but I feel like some of the pure essence of science that you were looting to earlier people tackling new issues, that there isn't really, it's more survivalist careerist now, than it is about the spirit of discovery, which is really about the spirit of finding out the truth. So any reflections on this notion that we're sort of in a more careerist mode of science. I think part of it is just the sheer funding levels have been so high. Well, I mean, over the line, there's just, I think over the pit time period you're talking about, there was a doubling of the NIH budget, there was all kinds of increases in the sheer volume of research.

2:17:01I think the way that we, I think it's worthwhile investments to have those investments, right? But to have such high volume relative to what we had in the 80s, to have such high levels of funding where we had in the 80s. Are you saying that we have too many scientists? No, nothing that. What I'm saying is that we have to create structures that are appropriate for the volume that we have. So that we produce in this volume, it's like a fundamentally different problem that we had in the 80s. So the structures that we had in the 80s, where we rewarded publication and peer -reviewed journals as the measure of success, it might have worked as a measure, as a way to create incentives for pro -social behavior in the 80s, but it doesn't work at the volume and the levels that we have now.

2:17:44And so we have to change the structures we have so that given this volume of investments People have the right incentives to have those those pro -social We have to change what to change how we think about we structure the incentives and science to create the kind of pro -social incentives that we once had All right now that we're through the easy stuff. Let's get to some of the harder stuff You have a tough job my friend. Let's talk about some of the recent changes in an H funding that most people have heard about and then we will segue to to the barbed wire topics of vaccines and lockdowns. But before we do that, I heard, or at least my understanding was that when the new administration came in, they essentially went through and looked for the letters DEI and for the word transgender and basically halted or eliminate some lines of funding to particular labs.

2:18:40I also saw on social media and I didn't validate this, that some studies that were focused on transgenic, not transgender, but transgenic mice, which is a very common tool in biomedical research, got flushed in that process so that maybe it wasn't a clean vetting of transgender versus transgenic. Look, every administration, every person makes mistakes, so I'm not trying to highlight like mistakes, but I think this blew up. And it would be great because you have an opportunity here to reach a lot of people to just sort of clarify what the rationale of eliminating grants that had a DEI or transgender component was.

2:19:26And then we can talk about this, what appeared to be a mistake. Yeah, so first let me just talk about the mistake. First, most of this happened before I became an IStrictor, There's like early April's when I started I think much of the when did you start April's second? All right, so don't come after jay for anything that happened prior that it was actually quite frustrating to be on the outside looking and going I can I can just look yeah, they were waiting for you to step in so you could take responsibility anyway So they could blame you for something you know, I don't mean to say like I you know like this I'm still like responsible for like like addressing this going like going forward so So I don't actually don't know specifically about transgenic.

2:20:08That's obviously a mistake. The transgenic mice are a key tool for discovery. If that was cut, I think we might have been a wording in a public address from the present. I don't know that they actually eliminated grants simply for studying transgenic mice. I know that grants focused on, look, years ago I said sex differentiation in the brain and body. So not all studies where you give a male, rodent estrogen or a female rodent testosterone are studies of transgender biology You're those hormones are active in both sexes and you know correct a lot of grants that you can imagine that they got flushed that were Studying hormones and sex my sense that there were some false positives like this And we've worked I've worked very hard to make sure that those are corrected like there's a appeals process I've set up so that that research that we're stuck in this with the false positive, there's a, we restore a whole bunch of grants like this.

2:21:01Right. Where they were, what's good science, but it got caught up in this DI kind of, the focus on like refocusing the NIH portfolio away from sort of politicized ideologies and more toward things that actually advance health. So let me, let me just address DEI specifically, okay? Okay. First, this is really important to me. In my own research, I focused a lot on the health and well -being of vulnerable populations. A lot of my research is focused on the health and minority populations, and there are legitimate scientific questions that have that where somebody's race, sex, matter pretty fundamentally to the biology.

2:21:44And so, of course, as the NIH, we have to be able to look at that. Yeah, some mutations only exist in certain races or I mean breast cancer and the brach mutation more common much more common in women. I mean you can't. Can't you look at how this stuff doesn't exist? Correct. And so like that's part of science and the NIH absolutely supports that kind of research still despite all of the changes in DEI. So I want to give you another example of an NIH success is the research on sickle cell anemia, right? So the research on the strategy, this gene editing strategy essentially is to switch the cells so that they express the fetal hemoglobin rather than the adult hemoglobin that has this problem that causes a sickling.

2:22:35That's a fantastic result that's going to, I think, result essentially in a cure for sickle cell anemia. Amazing. Right? So amazing. And that's a thing that affects African -Americans much more frequently than it does white Americans, just based on the genetics of the things. So the NIH has in the past and will continue in the future to focus on research that advances the health and well -being of minority populations. It absolutely must. If the mission is to improve the health and longevity of the American people, that includes people, African Americans, it includes Native Americans, it includes women, it includes minorities, it includes people of all different sexual orientation.

2:23:19All of that is still part of the portfolio of the I think is something where, just to give you a sense of this, right? So in 2020, I was quite upset with Stanford with the way that it was, that we can talk about this maybe later in the podcast or a different podcast. But I'd gotten grown disillusioned with the academic freedom kind of that, that I as a scientist enjoyed a Stanford despite being a 10 -year professor. And so I applied for, for, for job outside of Stanford. applied to the university and one of the things they had me fill out, essentially, was a DEI, a loyalty oath, right? Where you had to say, essentially, you're a commitment to the DEI ideology, which was, I mean, just maybe we put up, as you would say, a finer point on it, just because, I mean, I think these words, you know, these words, diversity, equality and inclusion, I think, or equity and inclusion are, you know, their words, but what are, So what are they really talking about?

2:24:26You're committed to having a lab where you include a certain number of people of different backgrounds or is it just sort of saying, I care about these groups. The key thing is race essentialism. That what makes you you is your race first and foremost. There may be other things about you that matter, but the most important thing about you is your race and nothing else matters of the same scale. Right? That essentially is the heart and soul of the dea. So just to give you another, again, a concrete thing, the idea that structural racism is responsible for the health outcomes of the minority populations primarily.

2:25:01That now, if you think about that, you say, well, maybe true, you may think it's true, you may think it's not true, depending on who you are, what you're listening to. But all I say is that I cannot think of a scientific experiment to do that would in principle falsify that idea. Now, I can think of experiments to do that would say, they'll look, minorities are more likely to live in food desert, so the food they get access to easily makes their health worse. That's a scientific hypothesis. You can test it. You can imagine the result being not true or true depending on the data you find, right?

2:25:35That's a scientific question. That's not DEI. That's a scientific question about the health outcomes of minority populations. You can test scientifically. Whereas the idea that structural racism is responsible for the health outcomes of the the minority population country, that's not actually scientific in the same sense. You mean there isn't a clear variable to focus on? Well, there are a lot of variables that could support or refute that idea. I don't think so. I think the problem is one of the demarcation between what is science and not science. I think it's like a structural, so like if the Karl Popper had this demarcation, is a philosopher of science in the 20th century, probably one of the most important philosophers of science in the 20th century.

2:26:23He had this demarcation criteria that said, look, is your scientific hypothesis in principle falsifiable? So the structure of the atom involves certain hypotheses about what you can and can't observe about the momentum and the position of an electron, a particular time. I'm kidding, is that like what's falsifiable? Now there's falsifiable questions you can do an experiment that an principal could have falsified the Heisenberg idea, right? Versus, for instance, 40 in psychology. He made the point that there was in principle no scientific experiment that was outside the system so that you could falsify the thought for a new idea.

2:27:05Everything inside the system was, so it's not scientific. Yeah, I see exactly where you're coming from. I will just push back a little bit in service to the conversation, which is for descriptive work in science. There's no hypothesis. Billions of dollars of NIH money went to gene arrays, single cell sequencing. Those were hypothesis generating experiments. Could you falsify those experiments? Okay, a given cell. Let's say a cancer cell and a non -cancer cell from the same tissue express gene list A and gene list B. Could you falsify those lists? Well, you could run it again and get a different list, but at some point you're running statistics on those, and did you falsify the first one?

2:27:46Not really. So just anything descriptive, like an electron micrograph, for instance, of a nerve cell. You see lots of stuff. Wow, the mitochondria there, the vesicles are there. Now I get a more powerful microscope. And I look and I go, oh, what I thought was one thing is actually two things. Did I falsify it in some sense? Yes, but I actually just separated it with a better tool. So a lot of descriptive science upon which like many of the great truths rest including the double helix, right? Crystallography to find the double helix structure. It's still a double helix thing, I think goodness as of this morning.

2:28:17I think it's still a double helix. No one's proposed different yet, but most science isn't subject to this idea that you could like just falsify it with a counter hypothesis or I would say a lot of science doesn't quite work that way. Now what you're describing is a merge of sociological phenomena and and scientific principles. And so maybe I'll just pose the question a little bit differently in an area that falls squarely in your court. Up until I think pretty recently, maybe still now, but I think this was eliminated. If I had a grant from the NIH, and someone was potentially coming to my lab who was an underrepresented minority, I could call up my program officer.

2:28:55That's not a parole officer, by the way, but they're kind of similar in that they control a lot of your life. And I could say, hey, listen, I've got a terrific young scientists come into my lab, I don't even need to say that. I'd say, hey, I've got a scientist who wants to come to my lab that's an underrepresented minority. And they would say, great, we will now add funding to your grant specifically to fund that person. I mean, they have to be what we call above the bar. They have to be capable of doing the work, etc. That has been eliminated. I'm neither advocating for that nor fighting against it, but that's something that lay lands squarely in your camp.

2:29:29And it is clearly DEI. It's not a question of whether or not they're the best person for it. It's just more taxpayer money, specifically to fund a researcher who would not otherwise have the opportunity, that's key, because they are an underrepresented minority. Okay, so you have two items there. Let me address them both. I think it's up to you. So the question about like hypothesis driven science, so like inductive versus deductive science, the NIH funds both, and it should fund both, right? So the idea of a scientific project demonstrating differences based on race or some other variable that's biologically relevant for some health outcome without necessarily having a hypothesis, that is good science often.

2:30:16Women get breast cancer more often than men. So there's nothing wrong with that and there's no policy NIH not to fund that now. In fact, the NIH still funds and we'll continue to fund exactly that kind of science, right? because it's still science, it's part of the scientific method. Whereas purely structural racism causes your health problems for minority, I don't believe it's science. That's more of a psychology question than a bioscience's question. I don't even think it's a psychology question, not a scientific psychology question. I don't think it's science. I think it fails the demarcation problem.

2:30:51Again, that's not a fossil fossil. So there's no problem then with hypothesis driven science. And if it's actually sort of focused on health problems that matter, rather than just purely trying to demonstrate sociological outcomes that are outside the purview of the NIH to try to address. Okay, so let's leave that aside. Before we do, there's an old saying that I learned from a very famous, excellent scientist, also deceased. He used to say, all my advisors are dead, so the joke in my field is you don't want me to work for you. Oh my gosh, okay. But I didn't have to deal with competing with my mentors, and I did not have to deal with disappointing them or pleasing them.

2:31:35There you go. But I would do anything to have them back. Truly, they were wonderful people. I was very blessed. But there's a saying, which is a drug is a substance that when injected into an animal or person produces a scientific paper. Which is basically to say that there are many things that when you, many studies that when you introduce a variable, you're sure to get a difference. Like if I want a paper, I give a drug to a person and I measure the amount of rapid eye movement sleep because basically every compound alters rapid eye movement sleep, usually for the worse. It's kind of while the aspirin will do it.

2:32:12You know, I don't want to discourage anyone from taking aspirin, but it's so easy to tease out effects when you just introduce a dramatic variable. So I think that's what you're referring to. Yeah. And it's not junk science. But it's not it's not great science. Yeah, I mean, so like right for instance that you don't have a control group You're like okay, what's the here? Just you're looking for differences. You're probably your favorite. Yeah Okay, so let's just leave that aside some of its good science some of its not good science some of its not science The DEI shift has been in terms of like funded science has been to try to exercise from the portfolio things that are purely Ideological boom doggles can you give me an example of some of these grand titles because I'm that that no longer exist I don't want to signal a single anybody out.

2:32:54So I don't want to do that. But just sort of a general flavor. I mean, I'm having a hard time. I mean, structural racism is the cause of worse cardiovascular disease in African -American populations. Okay, bug something like that. That would be an example. It's not actually a specific example. Again, I don't want to point to any specific medical example. No, it's a thematic example. Yeah, exactly. So that would be an example. Right? So, now let's talk about the support for underrepresented minorities and the set of sides. The position of the administration is that we should follow the civil rights laws of the country.

2:33:30Civil rights laws of the country say that we shouldn't be discriminating against people based on race. When you have an institution like the NIH that essentially says, we're going to consider your race when we decide whether we're going to give you support. You can understand why for a large part of the American public, they say, well, why are you doing that with their tax dollars, with their tax dollars, right? And actually, I should say, like, from the perspective of a minority student, it's actually quite condescending. Like, I believe, very fundamentally, based on lots and lots of experience with some excellent students I've had, that minority students are often, if they make the right investments in, like, the time and effort they put in, they can become, have become excellent scientists.

2:34:16There's no barrier to that in the scientific. There's only barrier of the structural problems with the incentive scientists had to make those investments in young careers and so on. But those are common across race. I think that if you solve those problems so that we invest in young scientists, not just at the level of the, you know, whether like competing for NIH dollars, but even before, where everyone has access to those kinds of resources that the URM scientists used to, used to, differentially have. First, you're going to end up with better, a set of scientists that actually are more capable.

2:34:56And you're also going to have minority scientists represented proportionally to the, the kind of desire that people have to become scientists. There's no field of human endeavor where you say, well, I have to have exactly the right proportion of race. I mean, if that's the true, then what you have to have is Indians and Chinese represented all the time. That's like almost 3 billion people of the, what they eat, billion people of the earth. You don't, the, the, the, the, the, the, the, the, the, justice isn't that. Isn't that kind of like race, essential list representation. Justices, are people who want to make the investments to become scientists have the capacity, the resources that we, as a society providing it so they can become excellent scientists?

2:35:46Right? That has to be the case, right? And we're not, by shifting the investment portfolio toward this race -essentialist thing, all that matters is you are underrepresented in minority. It doesn't matter if you're an excellent scientist, it doesn't matter so much, it may matter some, but that's not the key thing. It doesn't matter if you have a fantastic idea that challenges entire fields. All that matters is what's your race. It moves the emphasis in science away from what really matters in science. Like what are your ideas? Are they advancing human knowledge? Are they translating into health for like a large populations, are they true?

2:36:33Are you working in things that advance our knowledge and reliability of the entire scientific literature? I mean, those are the things that matter really for scientists, right? Why are we caught up then in this idea that somehow we can address, I mean, a data is going to be very, very clear. There are real problems that minority populations have faced based on the history of the country. They're real injustices that have happened as a consequence of them. But we're essentially asking the scientific institutions of the country to somehow solve these deeper problems of essentially cosmic injustice in ways that we don't actually have the capacity to do.

2:37:14And then in some ways, they distort the investments we make and be caused large chunks of the American people to distrust us. Say, look, you're not really focused on the things that really will improve my life. if you're interested in sort of cosmic justice rather than actual science. I think it's the right thing to do to say let's focus on the mission. The mission is how do we advance, how do we make investments in research that advance the health and longevity of the American people? And I don't believe there's any place for this sort of race essentialism in it. So you've talked about the DEI topics, slash issue from the perspective of which science does or does not get funded.

2:38:00Okay, so testing race as a theory, a non -falsifiable theory is not something that the NIH is going to continue to support. We are also discussing DI in terms of which scientists get to be called scientists and which ones get funded. I suppose the universities decide who they hire and then NIH plays a major role in deciding who gets funded. So if I understand correctly, as now, the funding of a given grant can't have anything to do with somebody's racer background, to which I say, why not just make it blind to who the investigator actually is? Now I realize when people write grants, they say, previously we've shown, or my lab does this, but why not just eliminate identity entirely and just say, what is the best proposal on the table?

2:38:47Let's fund those proposals. When we talked about earlier, we talked about early career scientists and providing support to them that's essentially along the same lines. So we're saying, we're going to deemphasize the track record of scientists in deciding what, which scientific projects to fund. That's essentially what we're saying when you say we're going to fund early career scientists because early career scientists tend to have less of a track record. I agree with that. And I think the key thing is the ideas. Are the ideas powerful? Are they promising? Are they worthwhile in terms of being able to translate to improved health for populations?

2:39:26So I don't know what is possible to get rid of some elements identity. Like you kind of want to make sure that they've had training as a scientist. Sure, well they could check some boxes. I'm not here to solve every aspect of the mechanics. But I guess we've relevant identity, like relevant. Like your race is not relevant to whether you have excellent scientific ideas. I've learned from people of all races scientific ideas that have changed how I think about the world. And it doesn't matter, the race was not the key element in deciding whether they knew at a great idea or not. What was really mattered was the idea.

2:40:05Now it may be the case that some people have, based on their background, will have an an idea more likely have an idea, an idea in a particular field than a different, some with different background, right? So allowing people of lots of different backgrounds to have their say matters, right? But rather than focusing on the race, focus on the idea is the idea important? Is it likely to translate and improve health for populations? Well, having sat on a fair number of study sections over the course of like more than 10 years, either as an ad hoc or regular member, I don't recall. ever feeling in the room or anyone explicitly saying, we need to fund this grant because it comes from somebody who's an underrepresented minority.

2:40:48There were grants that came from underrepresented minorities. Some of which are terrific grants, and some of which didn't get funding because they weren't as terrific. So are you telling me, and it's been a little while for me, not a long while, but that there has been a recent pattern. I'm not trying to, you know, see the question, but are you telling me that some grants were getting funded And specifically because of the identity of the person writing the grant, I always thought grants were funded or not funded on the basis of the science in them. And I never saw that to not be the case. I mean, I think the markers of that that were increasingly emphasized.

2:41:22You already mentioned one, actually Andrew. You said like you could call up your program officer and say, look, I've got a great post doc who's a URM, which essentially means a minority. And would you like to fund them? And the answer would be yes. No, there was a pool of money. It was always a, it was a, if, no, actually ran in the other direction, it was well communicated from NIH that if we had someone who was underrepresented minority, who wanted to join on our grant that there was additional money to be had. That was a, there was a state, I think there was a website it told us this and, you know, okay, well, it's clear that NIH is at stance now in the new administration.

2:42:05It's clear where their stance on DEI is. I am relieved to hear that grants that might have been caught in the filter of this recent change can be that did not qualify for what you're describing that there's an appeal process. Because I think that shocked some of us in the science community. We're like, oh my goodness, it could be terrific grants. It just got the axe. Yeah. So there's an appeals process to fix that. But I think, let me just make an analogy to something that happened during my career. I think it was around 2010. The NIH put out a priority statement that said they were not going to fund health economics research, more or less.

2:42:47It was in the wake of Obamacare. There was a whole fight over cost effect in this research. and cost -effectors' research became this like political football, where, and the United said, look, we're not going to find this kind of work anymore. Actually, impacted my career. I've sent some of the work I'd done previously, had to do with like the relative cost -effectiveness of various drugs or whatever. And so the question was, so I had to like, I had to pivot away from that research if I wanted research, research, support from the United. I should actually impact my career quite negatively. There's priorities.

2:43:21And the thing is, I don't want to argue the wisdom whether that was right or wrong to do. I personally think it was wrong, but let's just leave that aside. I think the thing is, it's normal for the NIH to put out priorities that reflect the social circumstances that are around us. Here, I think what we have is a shift to priorities that focus on the quality, the ideas, the science is done rather than the racial identity the people doing the science. And I think fundamentally it's more healthy both because we'll end up having a set of scientific ideas that are more likely replicated and more likely be able to translate it into advances for health.

2:44:05And also it's better from a sort of social point of view because it deemphasizes things that are irrelevant to the progress of mostly irrelevant in terms of the progress of science. It shouldn't matter if you're a minority student, a very promising minority student, or if you're very promising non -minority student for the NIH to support you. Both should get support, and it shouldn't make any difference whether you're minority or not. For the American public at large, I mean, a lot of there's a sense of unfairness, right? Why are you, let's move aside from the United Nations, move to Harvard University and the case that it lost over the admissions.

2:44:53I'm sure you remember this case, where Asian students were found to be at a disadvantage in admissions to Harvard. They had actually the facts of this case are really shocking. So what happened was Asian students who applied to Harvard and non -Asian students would be evaluated by alumni interviews, where the alumni would evaluate their personality. Asians and African -American kids were both had roughly the same average my personality score as evaluated by an interview with alumni. Then the Harvard admissions officers would find similar kinds of scores based on essentially personality. But the admissions officers had never met the kids.

2:45:39And Asian kids routinely had much lower personality scores than African American kids that applied. That's what led the Supreme Court to say. That was an illegal act of discrimination by Harvard against Asian kids. I think this focus on race, I can understand it because we have a history where race has been a... pain and suffering and injustice in this country. Legacy of slavery that goes back centuries, we have laws against discriminating against African -Americans in the Jim Crow laws. We have this painful legacy of the slow progress and civil rights that goes back generations. So I understand that that's the backdrop of, I'm not naive about that.

2:46:37What I'm saying is that these kinds of scientific, these kinds of, like using the NIH to solve that problem is an inappropriate use of taxpayer funds. And actually I think it makes things worse for those problems than better. And in particular, and for me, as the director of the NIH is the most important thing, it It doesn't allow me to meet my mission. The mission is to support research that advances the health and longevity of the American people, all of the American people, whether you're minority, whether you're American Indian, whether no matter who you are, we should be doing research that advances your well -being.

2:47:16And that means to me, I shouldn't be using the NIH for the sort of cosmic justice purposes is the four which the NIH is poorly suited, but instead we should be using the NIH for the purpose. It is well suited, which is to advance science that it advances the health and well -being of the American people. I can see the parallels to something like the space program where the space program is incentivized to try and figure out the best way to meet the specific goals of the program that year and in subsequent years. If the public thought that taxpayer dollars were being and diverted according to a social justice issue in order to try and advance the space program in that way as opposed to getting onto Mars or whatever it is.

2:48:01Maybe that's a bad example. It's so specific to Elon, but you get the idea. So it's very clear based on what you said that you believe that the best way to serve everybody in the country in terms of health and longevity is to make the discoveries, verify those discoveries and then distribute the devices and therapeutics for those discoveries and behavioral tools that will allow for the health of all Americans. And anytime someone says all Americans, it sounds like a political statement, I realize that. But, and to leave aside social justice issues in root to that goal, that's what I'm hearing.

2:48:37Yeah, I mean, except to the extent that the social justice issues can be articulated as clean scientific hypotheses that actually matter. right? So like you know race differences in biological variables. In fact the matters certain mutations run in certain populations. So certain advantages. Right. The annihilations still supports that kind of research. But again that's in service of the scientific goal not in service of some social justice goal that the NIH is ill suited to achieve. Yeah somebody who worked on vision science for many years glaucoma is much much more common and in darker skin races, there's certain areas of the world where glaucoma is at at outrageously high percentage of the population.

2:49:20And it's not lost on people that there's a genetic and heritable component and some of the treatments might be need to be tailored to those specific populations. My grandfather went blind from glaucoma. So get your pressure checked everybody. Take your drops, get your pressures checked. I'd like to pivot slightly to some issues related directly to public health. We have a kind of fork in the road here as to whether or not we focus on issues of public health from the recent past for which you became best known, aka COVID and the lockdowns, or whether or not we focus on public health issues that are more relevant now.

2:50:00I was told by many many people who are not scientists but care a lot about science, that, quote, until the scientific community acknowledges two things, they don't want to give another dollar to science. Those two things are won the replication crisis. We talked about this. And by the way, I think your plans to deal with that are fantastic. I love this idea. And I think many students and postdocs will be excited to be part of the correction process that will evolve science. And the second one is an admittance of error in our past. I want to be very clear not to protect myself. I have plenty of work to do no matter what, but these are not my words, but the words were the scientific community did us wrong.

2:51:00The lockdowns were one thing about masks, then told another, we got a kind of looped deloop of foggy speak politico messaging about vaccines and what they did do or wouldn't do. And basically, I hear from a lot of the general population, not just people on the MAGA, MAHA, whatever you want to call it, but also a lot of stated Democrats and people are or truly in the center, that they lost trust in science and scientists, and they will not consider restoring that trust until scientists admit that they made some mistakes. And it took me a while to hear that message because I'm like, hey, listen, I have friends trying to cure blindness, cure Alzheimer's, use brain machine interface to cure epilepsy and get paralyzed people to walk.

2:51:49And you're talking to me about something that happened, but I finally had to just stop and listen, and because they kept saying we don't care. And so it's almost like big segments of the public feel like they caught us in something as scientists and we won't admit it. And they're not just pissed off, they're kind of like done. I hear it all the time. And again, this isn't the health and wellness supplement taking anti -woke crowd. This is a big segment of the population. There's like, I don't want to hear about it. I don't care if labs get funded. I want to know why we were lied to or the scientific community can't admit fault.

2:52:29I just want to land that message for them because I'm hard on here for them. And get your thoughts on what you think about, let's start with lockdowns, masks, and vaccines, just to keep it easy. And what do you think the scientific community needs to say in light of those to restore trust? So first, let me just say, I don't think I'm the NIH director unless that were true, unless what you said is true, otherwise I'm not the NIH director. So I was a very vocal advocate against the lockdowns, against the mask mandates, against the vaccine mandates, and against the sort of anti -scientific bent of public health throughout the pandemic.

2:53:13I've also argued that the scientific institutions of this country should come clean about our involvement in very dangerous research that potentially caused the pandemic. The so -called lab leak hub. Right, so let's just stay focused on lockdowns and just to... I want to make the scientific case that they were a tremendous mistake. And that was known at the time they were a tremendous mistake. And let me just focus on one aspect of it. We'll get broadened out to other lockdowns. Just the school closures. Right? So what the public at large now sees is that American kids, especially minority kids, are two years or more behind in their schooling.

2:53:58We decided during the pandemic that children ought to learn to read as five year olds or six year olds remotely from Zoom. We decided that in -person schooling didn't matter anymore. My kids in California were kept out of school, public school, for a year and a half. If they saw the inside of a classroom, it was with plexiglass separated from their friends eating lunch isolated alone. right? The message to American school kids was essentially, your school doesn't matter, your future doesn't matter. American public health embraced that entirely. In Sweden, they didn't close schools for kids under 16 at all.

2:54:46That was not a policy of the Swedish, understagnall, the head of Swedish public health explicitly made that a priority. In the summer of 2020, the Finns and the Swedes compared their results The fans had closed schools in the spring of 2020 and the Swedes had not. And they found there was no difference in health outcomes for COVID. The teachers in the Swedish schools actually had no worse outcomes than other workers in the population. And on the basis of that evidence, and the fact that we know that closing schools harms the future health and well -being of kids, even short interruption school.

2:55:35We knew that for a fact based on a vast literature that existed before the pandemic. Many schools around Europe opened up in the fall of 2020. The scientific evidence was abundant and clear, even by late spring 2020, that the closure of schools and kids was a tremendous mistake. And yet, when I wrote the Great Branch in Declaration with Sunetra Gupta of Oxford University and Martin Kool -Duff of Harvard University in October 2020, I faced vicious attacks by the scientific community and the medical community for being unscientific about school closures. Were there threats to your job at Stanford?

2:56:15Yes. And that like real threats or real threats. So just people saying we're going to take away your job. Okay, in March of 2021, I was part of a roundtable with Governor DeSantis, a policy roundtable, where he asked me whether there was any evidence that masking children had any effect on the spread of the disease. And the answer is, there's not a single randomized study that looked at kids. The US was an outlier in recommending that kids as young as two years old get masked. In Europe, like 12 was the age. There were no studies. In response to that, a hundred of our colleagues signed a secret petition, essentially effectively asking the President of the University of silence me.

2:56:53Were you contacted by the University of Administration? No, I found out about the petition from a couple of my friends who leaked it to me. And then I went to the press and said, look, this is, you should go ask the President about this. And then he had to say that he had his melee mount statement about academic freedom, but but also essentially that it's really important that we obey public health authorities or something. So like political, like boilerplate speak. Yeah, and in 2020, I'd been subject to all kinds of sort of attacks on me. I mean, just, I don't know, we relitigate this history, but I'll just say that Stanford failed the academic freedom attempts.

2:57:32It didn't hold a scientific conference on COVID with alternative viewpoints, with viewpoints that were anti -lockdown until 2024, when I organized it. Even though I asked to have a conference in 2021 and 2022. But your job security wasn't threatened in a direct sense. No, no one came along and said, hey, like, quiet down or else you're going to lose your job. So that's since you had academic freedom from the fall. That's not true. So I was asked to stop going on the press in 2020. I was at, I was by the dean of the University of the Medical School. Right? I was, my academic freedom was pretty directly threatened.

2:58:08I wrote and published a study on measuring antibodies in the population. The study that now replicated dozens of times around the world. And I was essentially ordered to redo that study. They interfered even before I had put the paper in for publication. Then, when I say they, I mean the administration of the medical school. I mean, my academic freedom is pretty directly attacked. And I brought a piece with the House Stanford Failure of the Academic Freedom Test. You can go read about, read it if folks who want to read about it. And I don't want to relitigate the past or anything. No, I ask, listen, I'm not trying to dig for dirt.

2:58:49I ask because, well, I never saw a petition cross my email path. I did see a petition pass my email path about Scott Atlas, who was in our department of radiology as a physician, as you know, and was appointed Trump's coronavirus task force head of Trump's coronavirus, task force. And then there was a petition basically asking him what to take away his job. I don't know what it was, but that passed through. But I see a lot of petitions passed through my email and this, everyone he knows and the press has pointed out. I'm not great at emailing communications. But I guess the reason I ask is academic freedom means many things.

2:59:26Like can you tweet what you wanna tweet? I guess I'm gonna call them tweet anymore. At the time, could you tweet what you want to tweet? could you continue to do the science that you were doing? Could you continue to collect a salary? It sounds like you were able to keep your job, but there was some pressure to not communicate your ideas. Is that about right? Yeah, I mean, or there's a threat to my job as well. I think that the issue here is one of like, okay, imagine what a universe, there's a sense of like positive and negative academic freedom. A negative academic freedom means there's no active attack on me and my capacity to do work.

3:00:01I think Stanford failed that as well. Like there was an active attack on me. So for instance, there was a poster campaign all around campus with my face on it. Essentially accusing me of killing people in Florida for advising President to say, Governor DeSantis, that there was no evidence that masking children benefited anybody. Right? And essentially, it was a threat. It was like, at the same time, I was getting death threats from people. The former head of the NIH age, wrote an email to Tony Fauci, four days after we wrote the Great Branch in Declaration, calling for a devastating take down of the premises of the Declaration.

3:00:36And then that resulted in essentially press propaganda pieces, the New York Times and elsewhere. Essentially, mischaracterizing what the Great Branch in Declaration said, which was to protect older people better and open schools. Let kids go to school. Essentially, mischaracterizing is in a propaganda's way, we're saying we wanted to let the virus rip. And that led to death threats against me. Same time there's this poster campaign, all around campus, I called the campus police, I told the department of the folks in the department of the medical school that this was happening, and their response was to send me to a counselor to reduce my online presence.

3:01:20So Stanford absolutely failed during the pandemic. Like in 2020, the former president, John Hennessey, approached me wanting to look, organize a discussion, like some sort of like panel, where different perspectives about how to manage the pandemic, lock down elsewhere, could be had. And even he couldn't get this organized. Hennessey couldn't know. And I could. And I could. And I could. And I could use one of the most beloved presidents of Stanford. I have tremendous admiration for him. But the pressure was absolutely enormous. Like the fact that he approached me at all was actually a credit to him.

3:01:54He's one of the few officials at Stanford who approached me during the pandemic to try to allow me to have, I mean, you know, I might have been right or wrong. It turns out I was right, but in principle, that with Stanford should have had those debates in 2020. We had prominent faculty, people like Johnny and Edie, Scott Atlas, and others, Michael Levit, who were opposed to the lockdowns, and yet we couldn't get a hearing. Yeah, I love it. reach out to me at one point. I've been criticized before, with this podcast, I mainly focused at that time on, we launched in 2021 on a ways to deal with anxiety, circadian rhythm, sleep, but because people were dealing with those issues, I'm not a virologist, so I couldn't talk about virology or epidemiology.

3:02:36But Andrew wasn't on you to put us on a platform. There was on the Stanford University administration to organize discussions and debates on the on the most important topics of the day. And that included in 2020, where school closures the right approach. I read comments enough and get calls and emails that I do read enough to know that when people hear this, their minds will go to questions about like what is the incentive financial or otherwise for Stanford to not allow you to have these discussions. Or let's broaden the discussion for any university for that matter, right? I mean, Stanford's not the only university on the planet.

3:03:14for a panel, a discussion about these issues to be held. But we have a health policy department. What's the purpose of it, if not to like, and panel the most important debates about health policy of the day? So, what do you think was going on? I mean, the vaccine technology was developed at multiple sites, right? I think Stanford had something to do with the development of the technology. There were other universities that were involved in the development of the technology as well, right? And I think in the back of this conversation, I know what's buzzing. Let's just be direct here. You and I were, it was, there was a vaccine mandate at everyone that, this is 2020.

3:03:522020. A bit, right. But eventually there was a vaccine mandate. If you wanted to keep your job, unless you had a religious or other, what was a medical reason, religious or medical reason, you were told you had to take the vaccine. People did what they did, some people did, some people, I know colleagues that falsified cards, I know that colleagues, they got nine vaccines, everything in between, right? But there was a there were mandates. So to be clear, you were opposed to the lockdowns. Yes. And you were opposed to vaccine mandates. Were you also vocal about that? Yes. Because that's even I mean, that's even I was an expert witness in a number of cases on the vaccine mandates, including one that reaches Supreme Court and overturned the OSHA vaccine mandate.

3:04:35So yeah, I mean, I was, I was locally opposed to the vaccine mandates. I was of the local depots to the mask mandates. On the lockdowns, I was, I was vocally opposed to school closures. I emphasized the harm that the lockdowns did to the world's poor, right? So in April of 2020, there was a UN report that calculated that 100 million people would be subject to starvation as a consequence of the economic dislocation caused by the lockdowns. I was opposed to that. I think the idea that the lockdowns were the right strategy, well they're unique in world history of having lockdowns at the scale we had.

3:05:14And there were no part of previous pandemic plans where such a lockdown of such a length of such a scale, no part of any previous pandemic plan or any previous pandemic management experience. And it was very clear to me with my background in health policy that we were going to harm the poor, We were going to hunt children and we were going to hunt the working class at scale was the lockdowns worry luxury of the laptop class That's what I was advocating at the time The university wasn't just Stanford you're right, but the in fact there were almost no universities that that in panel these kinds of Discussions into 2022.

3:05:57So what do you think happened? Do you think that there was a fear? I'm not I'm not but seeding the question, leading the winners, whatever. But do you think that there was a fear among the academic and science community that if anyone, if it were allowed for people to speak out or consider different aspects, the positive or negative about lockdowns or vaccine mandates, that somehow their existence would be at risk, like that this got to an issue bigger than the lockdowns and bigger than vaccines, because I do. I think that this whole issue was really a question of whether or not we consider scientists experts.

3:06:38The word expert has become a very touchy thing. Like, who gets to be called an expert? Who designates which experts are really the experts? I mean, it's all, you know, all you have to do is accuse someone of misinformation and suddenly their expert card is taken away even if they hold a position in a given area that they've... I've been a tenured faculty member at Stanford for school medicine for decades. I've been a full professor with a long scientific back in the history of published papers in some of the top medical journals, the top statistics journals, the health policy journals, and so on, economic journals, and that wasn't enough.

3:07:17The problem is like you have, okay, let me just say one version of this that you can go, there are other aspects of play for like for instance, I think people were genuinely scared scientists, were genuinely scared for their own mortality, especially in the early days of the pandemic. And that clouded the way they thought about. So she says that a lot of older scientists, I'm not trying to pick on older, but there are a lot of them. Yeah. And older people were dying more. I'm sure. Yeah. I mean, that was actually the most important epidemiological fact about COVID was that it was this very steep age gradient in the mortality profile.

3:07:53Young people low mortality risk. Older people, much higher mortality risk. What was the rate of mortality among people, 70 to 85 years old, roughly? Five to 7 percent, someone in there. Okay, so not a trivial number. No, it's huge, like one in 20 to one in, you know, one in 18 or whatever, 14. And that was due directly from COVID itself, not some, some, some, Yeah, especially in the endemic, right? So, okay. So, but I want to leave aside the personal fear, although I do think that play a tremendously important role in the thinking about scientists. Especially since scientists as a class tend to be part of the laptop class, right?

3:08:30People who have the economic resources to shield themselves from, for extend a period of time without any threat to their livelihood. That's not true for most of the world, but that's true for scientists. So let's leave that aside. Let's just focus on what I think was a core dynamic, right? So there's two norms, two ethical norms in science. And they were, they were, they competed with each other. In science, free speech is an absolute must. If you have an idea that's different from mine, you should be able to express it. And then we can, you know, we can test each other's ideas out. We can maybe devise an experiment to decide between us and whatever the experiment says.

3:09:16We'll say, okay, you're right and I'm wrong and I'll buy you dinner or something, right? That's good. That's how science advances. Like through this kind of like this process of people talking to each other, having free speech, the ability to come up with ideas and articulate them, defend them is absolutely fundamental to the progress of science. Public health has a different ethical norm. Public health has an ethical norm of unanimity of messaging.

3:09:47The ethical norm has as its moral basis that the communications the public health puts out are grounded in consensus science. So for instance, if I was a former professor at Stanford, I'd go out and say, and the director of the NIH, I'd go out and say, smoking is good for you. Well, I've committed an ethical sin. I've done something really deeply wrong because the scientific basis for the idea that smoking is a terrible thing for you. It really harms your health in concrete ways. That's, I mean, that's like rock solid in science. So the idea that I, as a person who works in public health, shouldn't go out and say smoking is good for you, that has a good ethical basis rooted in science.

3:10:39The idea that closing schools is good for you. The idea that you wearing a cloth mask prevents you from getting COVID. The idea that immunity after COVID recovery doesn't exist. The idea that the vaccine will protect you from getting and spreading COVID forever. None of that was rooted in science. And yet, the public health authorities of this country decided that they were going to force the same kind of ethical approach. They have sort of ethical constrictions on those topics as they do to smoking. When you say none of it was rooted in science, are you saying the science was mixed or there was literally no evidence?

3:11:19No, there's literally no science. So for instance, the idea of the cloth masks prevent you from getting and spreading respiratory diseases. There were dozen randomized trials on flu before the pandemic and there was a Cochrane report like looking at the literature, the ran on masking and influenza. And it concluded that the evidence was weak at best that these kinds of cloth masking at population settings actually prevented anyone from the spread of influenza. I heard a number of people say like, what's the big deal about wearing a mask? There was also that argument. It's not the same thing as a vaccine.

3:11:56It's like, it's a mask. We could argue over inhaling excess carbon dioxide. You're not getting smiles. You're not social intro. Listen, I'm just opening this up for sake of consideration. So why did the masks become such an issue? Was it because it was a mandate? Is that what it's really about? So that mandate mattered. But I'll say that they work harms, some of which were recognized, some of which were not. So like, for instance, I heard from parents of autistic kids that the where that the or I'm sorry hearing impaired kids that the that the mask wearing impaired the ability of the kids to learn to lip read right so it seems logical yeah um I heard um but he but it's also true that you would if you adopt and it embrace public health messaging that's self evidently not rooted in science you're going to undermine the public trust in science and in public health I will say based on these voices that I hear from a lot, that's what they're asking for.

3:12:56They're asking for the exact message that you're delivering now, which is, I'll stay at differently. They wanna hear the scientific community say, we messed up. Yeah, and we should, we should actually say that. So for instance, you wear a mask while you walk into the restaurant, you sit down to eat and you take your mask off. And that protects you from getting in spreading COVID -How. Like everyone could see that. They don't need to be assigned to see that was obviously ridiculous public health messaging. It was a weird time. And let's just say, could this public health messaging be dangerous?

3:13:34Well, yeah, imagine someone who's 80 years old, they have a lot of chronic conditions. It's the height of the pandemic, like July 2020 or something, or June 2020. And they're told, if you wear a cloth mask, you're safe. They go out in public and take risks that they otherwise would not have taken on the idea that they're safe wearing a cloth mask and they get COVID. The recommendation, not rooted in the science, actually could end up killing people and probably did. So it's not none of these things are just basically, well, it's low cost. I mean, it may be low cost to somebody who's not particularly, I mean, particularly bothered by mass -coring, but they can still never, the less, end up causing harm.

3:14:22I think it kind of did. Why weren't there panels of scientists as opposed to one individual, Tony Fauci? By the way, I invited him on the podcast, did not get a response. This was a long time ago. I thought if I was going to hear about it, these issues from anybody at that time, it made sense to contact him and he apparently wasn't interested. We would have of course done it remotely. Why wasn't there a panel? So my feeling is when you have an individual, it changes the whole discussion. But when you have a panel that looks kinda like the United States, and this isn't for like diversity reasons per se, this is about just a collection of smart people, this way better than one person, always, in my opinion, and they could come to some sort of consensus or maybe even disagree publicly.

3:15:14I think panels would have been better. Well, I think, let's leave aside Tony Fauci, because I think he was a very important figure, and of course was a basically a major spokesperson for the public health point of view. But there was essentially a group thing at scale. It was impossible to organize a panel with the kind of diversity of opinion that was needed. They were million or more, I know this from the set of people who signed the Great Branch Declaration, tens of thousands of scientists and doctors who disagreed, but they were afraid to stick their head up for fear of getting chopped off.

3:15:55There's not an accident that Stanford didn't allow a scientific panel with this kind of point of view about the efficacy of lockdowns until 2024. right? The idea was that we needed to have unity -mative messaging. And if you had prominent professors, it's Stanford, Harvard, Oxford, or elsewhere, saying that the lockdowns were a bad idea, which they were, right? Then you were going to undermine public compliance with the orders that were being put out. You know, just like just a quick quick diversion. How do I know the side that the lockdowns are a bad idea? If you look at, if you ask, which country had the lowest all cause excess deaths in all of Europe?

3:16:45All cause excess deaths, more meaning deaths from all causes, excess meaning given how many, given the age structure of the population, how many people would to die would you have expected, even if there wasn't a pandemic versus how many there were. which country in Europe had the lowest all cause excess deaths? It turns out it's Sweden. It didn't follow the lockdown. So the lockdowns were not a necessary policy in order to protect human life. And they weren't sufficient to protect human life either. So you had sharply locked on countries like Peru that had tremendous deaths. So the lockdowns were neither necessary sufficient and they caused collateral harm at scale to the poor, to the working class, to children that we're still paying for, that we still, that people are still suffering from the long tail of the log.

3:17:37For years in the United States, from 2020, 2021, 2022, the deaths from overdoses of drugs were like in 100 ,000, 100 ,000 people died a year. This past year was 80 ,000, we declared success. We went down 20 ,000, before the lockdowns, It was maybe 20 ,000 deaths a year, and that was a catastrophic failure. So the problem here is that the scientific community embraced an ethical norm about unitary messaging, and then enforced it on fellow scientists, and then it cooperated with the Biden administration to put in place a censorship regime that made it impossible even for legitimate conversations to happen.

3:18:23Like so after the vaccines, COVID vaccines came out, there were community of people who were legitimately vaccine injured. The Biden administration went to Facebook and told them, especially ordered them, that you need to shut down that the patient groups that are discussing the vaccine injuries or else what? The threat was usually implied or also essentially destruction of your company. The president Biden goes on to national TV says, and he has completely right to do this. He has the right to do this as president to say, Look the Mark Zuckerberg is killing people. He did that. He actually did that.

3:18:56And then he, and then quietly behind the scenes, they pressured Facebook to censor patient groups that were discussing their vaccine injuries, even private groups. And no one was putting their stuff out on X then called Twitter. X did the same thing, right? So I joined Twitter in August of 2021. My first thing I posted was the Great declaration. The day I joined Twitter, I was put on a blacklist to suppress the spread of my ideas on Twitter. And almost certainly that. That's confirmed. I mean, I'm not questioning the validity of what you're saying. I saw it with my own eyes. But I was confirmed by the so -called Twitter files.

3:19:34Yeah. So the Twitter went Elon bought Twitter. He opened up the databases, invited me to go see them at the Twitter headquarters. I saw my own eyes. I saw my face and said, there were blacklist on it. Which meant what, that when you would post no one would see your post? Well, it was a shadow band. It was a trends blacklist. So yeah, I was a shadow band. I didn't know I was on this. So it just made sure that only my followers, strict followers would see the post and nobody else had any chance of seeing it. I mean, the whole reason I joined Twitter in the first place was to engage with people that didn't know my ideas.

3:20:09And the blacklist made sure that my ideas were not seen by those people. So this is part of the reason why I think podcasts like the Joe Rogan podcasts were became such a lightning rod for this discussion. What's interesting is that, remember they used to put a little tag on podcasts, you know, it would say this may contain misinformation, what they forgot, whoever was it imposing that because I don't think it was from the podcast houses themselves. But whoever directed that the federal government. Yeah, forgot about the 90s when there were explicit lyrics and albums And they would say warning contains explicit lyrics and everyone goes and clicks on those or listens to those They sort of forgot human psychology.

3:20:55That's the beauty of the American people. We are we like rebels. Yeah, exactly It's so pinhead is almost unimaginable like we basically the public health authorities of the country and the and the and the and the and the And the government around it decided that it knew best that it was going to control the conversations of the public at large, essentially propagandize them. The real question is why. And people are probably thinking, ask them about big pharma, ask them about the amount of money that Tony Fauci was made. You hear these theories, right? But most biomedical scientists running labs at universities aren't going to make a dime from pharma.

3:21:38Most, if you saw their salaries, most people will be unimpressed by those salaries. If you look at the salaries relative to their hours worked, you would be even less impressed. So sure, some people stood to get really rich, but I can't imagine that's the reason. So the question becomes why? Why all this suppression? Why all this group think? What were people so darn afraid of? I think just put yourself back in 2020 -2021. I think that, well, again, I'm not naive. I do think monetary factors played a tremendously important role. I don't think they were the central reason. I agree with you about that.

3:22:16I think the central reason is that the scientists that supported the censorship efforts, the scientists that embraced the sort of omerta around opposing lockdown that supported that, essentially the vilification of fellow scientists who disagreed with them, were doing it because they thought they were doing good. They thought they were doing good. Yes. I think essentially what happened was that rather than thinking like scientists, they were thinking like propagandists. In this case, they were public health propagandists. They thought that their job as scientists was to echo public health propaganda rather than act like scientists and ask questions about the messages that the public health authorities were putting forward.

3:23:02I'm going to push back a little bit in fairness. Perfectly valid hypothesis, and you were at the center of this, and I wasn't. But many of these people are very, very smart people. I mean, we can talk about universities as like these places, but these are places made up of people and while not everyone is brilliant to these places, some of them are truly brilliant people. And they are, dare I say enough, on a sort of a left -brained -ish spectromy type phenotype, where they're not pulled into emotional issues the same way that we might think they are. And so it's hard for me to imagine that really smart people would join a dialogue that didn't consider all aspects.

3:23:46And yet that's exactly what happened, Andrew. Like think about that, right? So like, I mean, I've thought about that quite a bit. I don't think it had anything to do with being smart or not smart. I think there were a lot of really smart biologists in the Soviet Union. When Lysenko got to the told Stalin that Mendelian genetics was a capitalist plot and that Lysenko was the way forward. A lot of excellent biologists for fear of not wanting to be sent to Siberia kept their head down and said nothing about even in areas where they were like directly in their field. So it was fear of being ostracized and shared and by one's community.

3:24:33And it took just a few examples. Like so you mentioned, I think I mentioned earlier Scott Atlas, who was a colleague of mine and friend. In 2020, the faculty senate of Stanford voted to censure him. Stanford has a history of censuring three professors ever in his history. One was a man named Edward Ross who was a, who was a eugenicist in the early part of the 20th century, he was one of the leading eugenicists in the country and Jane Stanford hated him and worked to get rid of him from the faculty. He was fired. He was. Or resigned or left. I'm not sure exactly, but he was let go. I think it was a system professor.

3:25:15Then Bruce Franklin, who was an English professor at Stanford, I think he worked on science fiction. He was an anti -vietnam or a war activist and he brought essentially a terrorist group to campus. And he was given, he was like just like, there'd been like massive public focus on it. So he was given a chance to like defend his points of view. Eventually was like censored by the Stanford. For being anti -Vietnam War, for bringing the terrorists on the campus. Yeah, I mean, bringing terrorists on the campus in bad. Well, in any case, there was gonna do process around both of those things. Like they got their say.

3:25:47Scott, his major sin was the advice advised president Trump during the pandemic. And he advocated for keeping schools open again, consistent with what was happening in Sweden, and for protecting older people better, because they were a higher risk of dying if they got COVID. That was his sin. They were seeing next to President Trump. And that led the faculty center of Stanford to something that happened taken back to issue a censure of him that has, if you look at it, religious language. They declared him a nathema. They effectively excommunicated him. His family essentially was ostracized by their neighbors.

3:26:27He lives on campus. It was an absolutely disgusting act. It meant not just at Scott, but generally to send a signal to anyone who agreed with Scott to keep their head down. And it succeeded. Not too over, right? He was formerly the medical school as a head of neuro -radiology. He was a very accomplished scientist and has a textbook on Newark, leading textbook on Newark theology. For a decade, he'd been an advisor to presidential candidates on health policy. So he understood from a broader point of view, he also comes from a working class background. So he was guilted by adjacency. Yeah. But it was aimed at silencing opposition to the lockdowns and it worked in large part.

3:27:13I can't, I can't, I like lost count of people from inside Stanford and around the country you would write to me saying, I'm glad you're speaking up on these issues. Please keep it up. I don't want to do this because I don't want to risk my job. Well, you weren't to completely alone. So Levitt has a Nobel Prize. And you had some buddies who were pretty smart and pretty powerful. I mean, they don't give Nobel prizes to anybody. No, Mike, Mike is incredible. I'm just a very brilliant man. But Stanford in that sense was better off. We had a sort of underground that opposed the lockdowns, very prominent scientists like Johnny and Evie's, Michael Levitt, Scott.

3:27:51There were people at places like Harvard and Oxford, Harvard, there was Martin Kool -Dorf at Oxford, there was Sinatra Gupta, there were folks all over the world.

3:28:02But institutionally, the universities of the world made it almost impossible. You had to essentially decide, and this is what I decided in 2020, that I did not care about my career anymore, that I owed it to the people who were being harmed by the lockdowns to speak up more than I ordered to myself to preserve my career. And that's why I continue to speak even after, even with the death threats, even with the vilification, and even with, essentially, the failure of my own institution to protect my academic freedom. I did decide I was willing to give all of that up, and that's why I kept speaking.

3:28:37So given your experience and given this thing that I hear that, you know, people want to hear scientists admit that they are at least sometimes wrong, maybe not even a specific instance in which they're wrong, will the NIH perhaps you be making a statement on behalf of scientists? I mean, you have the opportunity to address the entire world. Here, you're doing some of this, obviously, but will this be part of the messaging of the NIH? We need to revise what we think of when we talk about academic freedom. We need to revise what we actually do. And, you know, God forbid there's another pandemic.

3:29:18We need to really be ready for the kind of discourse that is going to unify people as opposed to divide people. You know, after a patient dies, often in a hospital, there'll be a conference where the doctors who manage the patient will say, will bluntly say to each other, often beyond closed doors, what went wrong. And the goal isn't to actually point fingers, the goal is to figure out what happens so you don't make the same mistakes. We haven't really had that conversation as a country or as a world over the pandemic. And yet the harm from it still persists. I think what I would love to do as an instructor is, I mean, I want to reform the scientific community so that the values that I thought it had, which is the values of free discourse and academic curiosity, those are central to our, the way we function going forward.

3:30:21We wanna make sure that those values are at the center because you can't do science if you don't have that, right? So you just think about science in the Soviet Union under Lysenko, right? There was no real biology going on if you couldn't say Mendelian genetics was real. No, I actually can imagine that the small scale example that I'm familiar with of a laboratory meeting where you discuss someone's data is the perfect microcosm for what we're talking about. Where you sit back, someone presents their data, and the idea is to challenge the data. The idea is for everybody to try and punch holes in it, makes helpful suggestions, and sometimes, sadly, at the end of that meeting, you end up sitting there with a post -doctor graduate student, and you're discussing what the next project ought to be because that one is just an utter failure, or you're discussing something much more interesting than you ever thought was possible in the data set that neither of you could have thought of because you needed some fresh eyes on it.

3:31:23But you can't have a culture in a laboratory where people can't oppose the the person in quote -unquote in charge. I mean this is so important. If you can't tell the the lab head no that's I think you're wrong. If you can't say that the lab can't progress. The culture of American science has gotten away from that ideal. In fact, ironically, weird thing, on small matters, you can have that kind of discussion, but on large matters, you cannot. And that actually isn't an affim of the science. That actually means that we cannot assign to suggest the most important questions of the day without fear of essentially getting our heads cut off.

3:32:07We had this conversation by DEI earlier. Wasn't it uncomfortable? I felt myself being uncomfortable saying what I believe is true because I know that's one of those issues where as a scientist, if you start talking about it, you better talk a particular way or else you're going to get your head chopped off. Yeah, I mean all these topics are uncomfortable, frankly. In part because I see them through a lot of different lenses. The audience lens, my role as a basic scientist, my role as a podcaster, the quote unquote, field of podcasters completely transformed this kind of discussion and public health.

3:32:45It's really healthy. We can have these conversations openly in a public. I mean, maybe I'll get my head chopped off again, but like you know, because once you've had it once, so I think you're safe here that I mean, maybe I'd have to remind you, you are the director. It is, it is an incredible thing if you really think about it, right? Given your position in 2020 and 2021, 22, 23, so you're now at the top of the pyramid. It is I believe your intentions are pure and good. I do. I think it's important to have checks and balances, but I really believe that you want to do right by people. I feel that's a felt thing.

3:33:20But yeah, it's a remarkable arc that you're now in the position to make major decisions for the entire enterprise of science. What I would love to do is I would like to make the lives of scientists who disagree with me easier. I want them to be able to disagree with me. I want to create a culture of science focused on developing truth rather than obeying higher, like top tops of hierarchies. If I can accomplish that, that would be a major thing in my view. Well, I think that's a magnificent subvision for the NIH. I think it's super important that all voices are heard. It's kind of interesting we have these discussions about diversity and inclusion, but like all voices need to be heard in the context of analyzing data.

3:34:03And certainly the revision of the entire structure of the science enterprise as you point out is sociological. It's financial. There are a lot of different aspects to this. Vaccines are a very hot button issue these days. In part because Bobby Kennedy has been associated with the anti -vax movement. I've heard him say with his own words that he's not anti -vax, but he's suspicious or very concerned about certain vaccines. Let's just start with a very basic question. You're an MD. Do you believe that there are any vaccines that are useful? Yes. Okay. Well, I think it's just, let's build up from there.

3:34:50Do you believe that some vaccines save lives? Yes. Okay. Many vaccines save lives. Do you believe that some vaccines that are given to children save lives? Yes. Yes. Do you believe that some vaccines are known to be harmful and yet still given? Let me say the specific one. I think the COVID vaccine for children in particular, I don't think it's not beneficial for kids. Not? But you said not net beneficial. Does that mean it's harmful? Net harmful. You believe that the COVID vaccine is net harmful for, especially for young men. Can you define the age cut off there? We can argue about this. Like there's a scientific, but I think it's pretty clear that.

3:35:31I don't know, some between age 12 and 30 or something for boys and young men, the COVID vaccine is probably net harmful. Again, with boys who have no other underlying conditions and all that, there's not obese. No heart condition. Well, I mean, even obese, you have to like look at the numbers. I mean, there's lots of debates and fights over this in scientific literature. So I, like, I hesitate to like actually give you a specific ASTR. I think just as a general matter, there exist groups for whom the COVID vaccine was net harmful, specifically young men. Do you think there's any reason to think that the adjuvants, essentially what the vaccines are suspended in, not the vaccines themselves, are potentially harmful?

3:36:16I've heard this. I don't, I am personally not aware of any strong evidence for it. I think these are the kind of things that ought to be investigated, but it's very difficult to investigate just because of the sort of like political or around vaccines where if you ask, if you really do investigate it and find something that the public authorities don't like, you're going to have trouble. I think they're, I don't know the answer to that question. From a scientific point of view. Let's start with COVID vaccine and dig a little further into that. The COVID vaccine was promoted, slash mandated, certainly was mandated at Stanford, but was promoted as the best line of defense for avoiding infection and reducing the symptoms of infection and reducing the probability of death.

3:37:08That's what I heard. What is the evidence for or against that statement now, given what we know, about who took it, who didn't take it, and transmission and death rates. Okay, so can we go back to December 2020? Sure, because then I'll answer your question, I promise. Answer all the other questions you're asking. So in December of 2020, there were a couple of really important randomized trials published regarding the COVID mRNA vaccines. Can you describe what one of these looks like? I'm not trying to sell your role here, but some people get vaccine, some people don't get vaccine and you look at who gets sick and who lives and who dies?

3:37:50Yeah, basically. So the large scale randomized trials flipped to coin said 20 ,000 people, I forget exact numbers, get the vaccine, 20 ,000 people get a placebo or something, you know, placebo like. And then you follow them for a certain number of months and you ask which groups more likely to get COVID. I have a diagnosed version of COVID, which groups more likely to die, which groups more likely to be hospitalized. And if the vaccinated group is less likely to get COVID, you report that. If not, then you report that. They were randomized trials then published for several high profile vaccines that were used during the pandemic in December of 2020.

3:38:37I thought it was November of 2020, right? So the mRNA vaccines from a journal advisor, the Johnson & Johnson vaccine, the AstraZeneca vaccine, probably the four most important ones in the, in using the England and the United States, or you'd grapefruit in the United States. Europe. Okay, so what did those studies show? For the mRNA vaccines, in fact, all of these studies, they were run, these are studies that were done, again, randomized, high quality studies, large numbers of patients, but they were tracked for about two months. Right? So you can't say from the randomized trials in December 2020, what's going to happen after two months?

3:39:25Because the trials themselves only tracked patients for about two months. What they showed was that among patients who had never before had COVID, because they excluded them from the analysis of efficacy, among patients who had never had COVID before, the patients who were randomized to the vaccine had lower rates of getting COVID in those two months, sorry, symptomatic COVID in those two months, then the people who were randomly signed with placebo. Okay. The mRNA vaccines had more deaths in the treatment arm than in a placebo arm, but the size of the samples were such that you couldn't say that that was a statistically meaningful result.

3:40:16Okay. I couldn't say it, right? Because it's, and that made sense. The death rate from COVID was something like, you know, three, four out of a thousand. You would have had to enroll populations of, and the, and the hundreds of thousands or millions in order to get a significant result about deaths. And age range really matters here. Yeah. So the vaccine trials tended to focus more on younger people. It had some older people in it, but it didn't, I, if I had designed the trial, what I would of RU4 is to have the older population more represented because that's who was dying from COVID and then having the prevention of death or hospitalizations the primary endpoint.

3:40:57Instead the endpoint was prevention of symptomatic COVID for two months. Okay. Now they didn't ask whether you got COVID actually because they're people who got COVID and never had any symptoms. right? So they didn't ask in the trial about prevention of transmission. They could have, right? So for instance, the people who were in the placebo arm, you could ask whether their household members had COVID at higher rates than the household members of the people who in the treatment arm. You compare the household members and ask. They didn't ask that. So what could you infer from the trial. You can infer that for two months, people who had the vaccine were likely to have much less likely to get COVID for those two months, symptomatic COVID for those two months.

3:41:49That's all you could say. You couldn't say they reduced death rates because it didn't actually in the point estimate. And there was not, again, any statistically significant difference. In the AstraZeneca and the J &J vaccines, if you combine those, it turns out that you actually did get lower death rates in the vaccinated arm than in the placebo arm. J &J vaccine had lower death rates, statistically significant once you combine the trials. Was the J &J vaccine and mRNA vaccine as well as an adenovirus vector vaccine? And it was the single shot. Yeah. And it was like the AstraZeneca vaccine, similar technology, adenovirus vector vaccine.

3:42:22Okay. But again, those were only two months long. And the death rate difference was like, you know, it's hard to get not to. It was not statistically powered to find one, although it happened to find one in the adenovirus vaccines, not the adenovirus vector vaccines. And then marina vaccines couldn't say from the randomized trial one way or the other. Okay, so that's the information base we had in December of 2020. I wrote an op -ed in December of 2020 with Sinetrogupta, where I argue that that is sufficient to say, we should give the vaccine recommend that older people get the vaccine, but that we shouldn't give it necessarily young people.

3:43:06The reason was that young people died at very low rates relative to young older people from when they got COVID. And so the thing you're protecting them from was a less of a risk to them than was for older people. And so the benefit harm calculation was would tilt toward if you have something that's a big threat and you have something that is known to prevent for two, if you're a friend symptomatic infection, then it probably prevents death in the older population. I can't say that for sure from the trial, but I can extrapolate that extrapolation, right? Seemed like a reason we'll extrapolate in December 2020.

3:43:42Then it makes sense to give it, even if there are side effects, which are not known in the trial. The trial is only tens of thousands of people. If you give it to billions of people, you're gonna find that side effects that you didn't know about, right? So, but there are these unknown side of it, but it seems like based on the benefit harm expectation, older people, it makes more sense to give it to. Whereas the younger people, the benefit harm calculation runs in the opposite direction. There are unknown harms. Some harms, actually, you saw in the trial itself, but you don't know once you give it to billions.

3:44:16And the benefit's small. So what I wrote is you should recommend it for older people and then lift the lockdowns. That's the op -ed arrow. And we're publishing the Wall Street Journal. Instead, what Public Health Authorities decided to do was to take the vaccine and say that we could use it to eradicate COVID. They implied it. They didn't exactly say that, but they would say things like, well, if 80 -70 -80 -90 % of the population gets the vaccine, then we will have achieved herd immunity. as if it were some permanent state, rather than a transitory state having to do with the fraction of the population, they're currently in the universe.

3:45:01That's a herd of communities. It is a clear mathematical construct in epidemiological models of disease spread. They were, the public health authorities were talking about 70, 80%, we're using it as essentially a synonym for disease eradication, which is not. was this message only in the United States or was this message kind of uniform across the world? Yeah, now just consider the, I don't know if she's uniform. Like for instance, I don't think Sweden never mandated the vaccine. With the exception of Sweden, I just saw a few other places. Because for one public health science system to collaborate in it in this, let's assume that the public messaging was they were about a bit out over their ski, so to speak.

3:45:48But for Northern Europe to do that, and for Brazil to do that, and for Australia to do that, sounds like there had to have been a collaboration of kind of massive scale. It's a little hard to imagine everyone collaborating in some sort of secret agenda that extends across international borders. Which is not back in December of November 2021, the news about the vaccine came out, right? It was like a sense of joy that we've been a liberal, like the science had delivered us from this deadly plague. It's definitely exciting. Yeah, and so like, and there was this sense of hope, right? That, that, that, that, that sort of like, large numbers of people around the world, I think shared.

3:46:30Public health authorities shared that sense of hope. But they, but that, I think partly led them to extrapolate far beyond what the data actually showed. and make promises of the public that were not in the randomized data that were available at the time. The companies that made these vaccines, are they American -based companies? I think AstraZeneca is a UK company, J &J is an American Pfizer, I think is an American company. Yeah, a MIRC. Or some reason I thought MIRC was over. Moderna has German roots, I think. I'm not sure. BioNTech is German. Moderna is American. I'm not sure exactly. Because many of the people that are suspicious about vaccines or skeptical about vaccines argue that it's all financial incentives.

3:47:16I mean, it was a lot of money generated from the billionaires were created out of this. And a lot of, in fact, the NIH is collecting patent royalties on the licensing for the technology that went into the vaccines. Still now. Yeah, but project warp speed the development of the vaccine a K project warp speed was a Trump Program, right president Trump authorized the program in order to Accelerate the development and testing of the vaccines. I remember seeing him getting the the injection on the news So I think people forget that because of maha and this sort of assumption that vaccines and maha are are diametrically opposed.

3:47:59In some sense, you know, Mahas and Bobby Kennedy are to my knowledge is first time that anyone's forcing a look at vaccines with the kind of level of detail that they are doing yet or going to do it. People assume that the Trump administration is not aligned with vaccines, but the Trump administration initiated project work to be correct. Yes. Yeah, I think The idea that Bobby or President Trump is anti -vaxxers ridiculous, frankly, at odds with what the data actually show. OK, let's go back to the COVID vaccine, because I think the story is really important. Public authorities on the basis of an extrapolation that they should not have made decided to essentially promise the public that if they got the COVID vaccine, they would not ever get COVID again.

3:48:51That was the implicit public health messaging. You can become free. Just take this shot, you become free. You no longer have to worry about lockdowns and mask mandates or whatnot. It very quickly became clear that that was not true. So I remember seeing the outbreak of cases in Gibraltar, which was like 95 % vaccinated. And I was looking at why it's Gibraltar. I think they were using the AstraZeneca vaccines. Why are they seeing this huge spread of COVID? I saw data from, I forget which country. It was mostly using the Chinese vaccine, the Sinopharm, which had a more traditional technology. Again, with a huge outbreak of cases in like February or March of 2021, that is real.

3:49:46country after country, they've been heavily vaccinated, seeing large outbreaks of cases. And that meant that the extrapolation was false, that the vaccine was going to stop you after two months from getting COVID, and spreading COVID was not true.

3:50:04Instead of acknowledging that fact, public health officials decided that the problem was the unvaccinated and they embrace the idea that you have to force people to get vaccinated for the public good. So they double down on there. And they're like July, August 2021 that the the the the Biden administration decided to use OSHA to use CMS OSHA is the the safety safety. And then there's than their CMS, the Center for Medicare and Medicaid Services, to mandate the vaccine for populations that they had control over. And when we talk about mandates, were there criminal charges or civil charges if somebody didn't get it?

3:50:51Just lose your job. Yeah, just lose your job. I recall at Stanford, there was an insistence that everyone get vaccinated, but that if people had religious reasons to not get vaccinated, or some special health reason that they could essentially not get it. Stanford made it difficult to not get vaccinated, but possible. Like if you had religious exemptions, they made it possible. Other universities made it much more difficult. So for instance, my colleague and friend Martin Koldorf, who was a tenured faculty member at Harvard University, got fired because he didn't take the COVID vaccine, even though he'd already had had COVID and recovered.

3:51:27He is currently still fired. So there were consequences for not getting it? Because we hear this word mandates, right? But I don't recall anyone coming around in my house like, you know, and insisting, I just recall that if I need to go a certain place, I needed a vaccine card signed. And so I mean essentially a widespread restriction on your basic liberties, civil liberties. That was the consequence, including potentially your employment. In other countries, or even worse, like so Canada, you couldn't go on public transportation. You couldn't fly if you weren't vaccinated. You couldn't go to a restaurant if you weren't vaccinated.

3:52:06That's true in the New York City, by the way. Yeah, to bring a vaccine card. Yeah, and if you could did now one, you couldn't go in. Essentially, the regime was essentially to ostracize people who decided that they didn't want or need the COVID vaccine, even though the scientific evidence was that there was no scientific evidence that demonstrated that if you had the COVID vaccine, you were less of a threat to other people as far as spreading COVID, then if you hadn't had the COVID vaccine, specifically for people who had already had COVID and recovered and weren't vaccinated, actually, there was quite good evidence from studies in Israel, especially that you were less of a threat for someone who never had COVID in which vaccinated some three or four or five months since the vaccine.

3:52:52Evidence out of Qatar showed a pretty sharply sharp reduction in the efficacy of the vaccine against getting COVID by four or five six months after the vaccination. And what if any evidence was there that the COVID vaccine, any of them, caused any specific harm in adults? Right. So in young men specifically, like adults as old as 35, 40 years old, there was evidence of heart inflammation, myocarditis. Transient myocarditis? Yes, but also severe microditis and post the vaccine. I mean that was clear evidence. Why just boys do we know? I don't fully understand the biology of that. A reason to do sex -specific studies.

3:53:38And I'm in favor of that. It can pass up the opportunity. Interesting. So was there any evidence that the vaccine had long -term detrimental effects that we're still looking at now. You know, you hear this stuff, you see it circulating. You hear more about lung COVID. We should talk about lung COVID, but is there any evidence that the vaccine cuts long -term issues for people? I think that likely that there's some people who have particular immunological responses or There's also evidence that the production process for some of the vaccines involved using DNA plasmids, which may persist in producing some of the products of the vaccine.

3:54:27I'm not actually, frankly, not. I mean, I've looked at the literature and there's a lot of controversy around the literature and have not made up my mind fully on the extent of it. What I will say is that it's very difficult to ask questions about long -term effects of a vaccine just generally. You can't run a randomized trial, that's done, right? That vaccine trial was terminated where the placebo arm was vaccinated in January of 2021. And so you're not going to tell from the randomized studies about the long -term effects. So now you're left with observational studies where you need to like have a real control group constructed properly.

3:55:09And it's been difficult to get the public health authorities who were supposed to do this to actually do this at scale. I've seen some of this. Like I think the FDA put out a report of babies getting the vaccine having epilepsy or seizures at slightly higher rates. It was a report in 2022. There's claims online I've seen about cancer, but I haven't seen anything where they've done, they're very careful. People have done careful control groups. I don't know. I'm not leaving out the possibility. I'm just saying that the kind of studies that I would like to see done, bigger studies that have control groups, even in observational settings, it's hard to find them in the literature.

3:55:51And whatever they're in the literature, they seem to get attacked. Sometimes for reasons that make sense, sometimes for reasons that don't. It's very difficult to address this from a purely scientific point of view, because the literature itself seems like it's poisoned. Do you believe long COVID is a real thing or is this something that people have constructed for some other? No, I think it's real. I think there's, so I do think that the extent of it is again unclear, but it's very clear that there are some. So, for instance, I've saw a study, I think it was in 2021 from France, where they looked to people who previously had COVID and previously never had COVID.

3:56:32And among kids, and then they were measuring subsequent long COVID rates after, in fact, at long COVID rates, comparing the match people who previously never had COVID versus who did. And in kids, the rates of measured long COVID, which back in that study I think was like, did you have one of some number of symptoms in the WHO list of long COVID symptoms, three months after the COVID infection, the match study were roughly the same rate for kids. But for adults, it was higher for the people who had COVID before. Then, I mean, so I don't know the exact rate, but it's certainly a real phenomenon.

3:57:12I mean, I've met people who've had it, same thing with vaccine injuries. Like I've met people who have vaccine injuries, who report having had concrete discrete injuries after they've been vaccinated. And I believe them. I mean, I think that I generally tend to believe patients when they say things about themselves, and especially when they have no incentive to disemble about it. Yeah, so I think that these are real phenomena that we need to address with open minds. Well the NIH and or CDC be making public statements about some of what you just described that the messaging around vaccines was in your view inaccurate.

3:57:51Well, I'm still saying this. And I've been saying this. I think that, but in your new, I mean, you're saying it here and we hear you in your new role, like at the level of a country of 300, well, some million people like, hey, folks, we've looked at this and I wasn't in charge then, but here's the deal. I mean, I, in my role, have to focus on stuff going forward more than, I mean, the past, I think, is worth addressing, but it has to be a broader look than just me coming on, saying my opinion about it, this podcast is fun, but that's not the purpose is, so I'll just give you a specific thing. My colleague, Marty McCarrie, who runs now the, is a commissioner of the FDA, he has issued a new framework for evaluating COVID booster shots.

3:58:42So rather than just requiring to show that the COVID booster, the new variant COVID booster or whatever it is, in the future, produce antibodies in either in lab animals or in humans in order to approve the vaccine for use. Now, going forward, the boosters have to show some efficacy against preventing COVID and preventing deaths and hospitalizations in order to get approved. That's an evidence -based framework to say, to essentially say, if you're gonna sell the vaccines, at least show in humans that it actually works for something we care about. If you produce antibodies and it doesn't translate to reduction in morbidity or mortality, then why recommend it?

3:59:27Or why prove it? Some people might want to take the vaccine to reduce symptom severity. Not just to avoid death. There's now at this point, there's not evidence, if you've already had COVID and recovered, there's no evidence that it would do that at this point for the boosters. I mean, again, like I want to distinguish, that's why I wanted to start which is summer 2020. This was like, you know, we knew about these large scale studies from the vaccines that were new. And we knew what I wanted to distinguish what we knew and didn't know. The boosters are a different vaccine. And they don't have the same large scale studies behind them.

4:00:02They've been approved on the basis of relatively small scale studies asking whether they produce antibodies. Not things that clinically matter to people. Is it going to prevent me from getting sick? is it going to prevent me from being hospitalized? It's going to prevent me from dying. The boosters don't have that kind of evidence behind it. And so I think it's just a couple weeks ago, the FDA decided that it was going to ask the manufacturers to produce much better evidence for the boosters before it was going to approve them. It shouldn't just be a routine thing. This is not a flu shot. The framework, the regulatory framework the governs flu shots are based on decades of experience with flu vaccines.

4:00:50Are you a fan of the flu shot? I mean, I've had lots and lots of flu shots in my life. Really? Do you get it every year? Generally, yeah. And it's designed to guard against most of the most common strains of flu that year. Yeah. I mean, sometimes they guess wrong. It doesn't do much. And sometimes it gets right. And it does better. But I generally have been gotten, I mean, I don't think I got it last year. Too busy, I guess. But you don't, it sounds like you don't have any specific safety concerns about the flu shot for otherwise healthy adults. Is that right? Yeah. I mean, as a scientist, I want the safety of these vaccines evaluated in a rigorous way.

4:01:25So I'm not, I wholeheartedly support that. And if the data show that they're, that outcomes, then I say that, right? But as a general matter, the flu shot, the technology used for it is, I mean, it's, it's a traditional technology that has a long history behind it. And the regulatory framework, well, I do think that like the production of antibodies is, I think that's actually still the standard for the flu shot. It makes some sense, right? The flu strain that circulates is a different one every year. And if you required this like long term clinical trial for the flu strain that's currently circulating, by the time you actually recommend it, it would be useless.

4:02:07Now, you can say that's true for the COVID as well, but we don't have decades long experience with the safety profiles and also the efficacy profiles. And the flu shot, it's hit or miss, right? Sometimes it works and sometimes it doesn't. We need an excellent universal flu vaccine, which there's so a lot of research to try to get. I think the key thing is, what I want to convey is, if you are in favor of vaccines, you You should not be treating this as a religious matter, where vaccines are good, and you believe that, therefore, you're a good person, vaccines are bad, therefore, if you believe that you're a bad person.

4:02:44You should be treating this the same way we treat other drugs that we recommend to the population at large. Evaluate the benefits, evaluate the harms in rigorous ways, including randomized studies, understand patient nuances. It might be right for some patients and wrong for others. If you're going to say something, don't extrapolate beyond what the evidence actually shows. Or else you risk losing the trust of the public, especially the public that would most potentially most benefit from the thing. What I'm arguing for is an actual honest evidence -based evaluation of vaccines. That's essentially what Bobby Kennedy is asking for.

4:03:26That's what he's asked me to do. not for vaccines generally, but for the COVID vaccine. That's essentially the policy. Now, the problem that we have in public health is that, as you asked me earlier about, do I think there are certain vaccines that are worthwhile and anything that answers, yes, I do think that. I think that if we have a public health authority that's gotten And it's so deeply wrong about this one vaccine, where people lost their jobs over it. People got injured and there were silenced over it. People essentially felt like they were made to feel, like you remember like in 2021, where people would disinvite family members from Thanksgiving if they were vaccinated.

4:04:20Yeah, or worse. People were kind of excommunicated from families and workplaces. Yeah, essentially we created a class of unclean people as a matter of public policy. You can understand why people who went through that would say, given that the vaccine didn't turn out to stop you from getting this bread in COVID, why should I trust you on anything else? That's where we currently are. The way forward isn't to force people to say, look, you must acknowledge how great science is on these other things. The way forward is to be utterly honest about what we know and don't know. And treat people as partners rather than as subjects.

4:04:59So when keeping with that, there's perhaps no issue more sensitive than the vaccine autism issue. My understanding of the current literature, as it stands, is that the Andrew Wakefield data, this British physician, who was really the first to popularize the idea that vaccines could, in his words, cause autism or were highly correlated with autism. Those data were essentially retracted by the journals. He lost his medical license, and my understanding is there was evidence of fraud that he was either made up data or contorted data. I've had guests on this podcast, including a colleague from Stanford, Karen Parker, who works on autism who verified that indeed the frequency of autism is vastly increased in recent years in ways that cannot just be attributed to improved sensitivity of tests, etc.

4:06:02One in 32 births is the current number. And so you can understand why parents who love their kids more than anything and would are understandably concerned about any possibility that vaccines could increase the probability of autism. My stance as a scientist is, well, if the data are robust that vaccines don't cause autism, then run a proper trial. The Wakefield data are clearly contaminated, if not outright, certainly by story and narrative. I mean, there's just no way that those data are going to be resurrected, did. And I don't think they should be resurrected, right? I mean, unless there's something I'm not aware of, he said too many things that weren't true.

4:06:51And whatever happened, you know, is history. So what is the evidence if any that a vaccine, some specific vaccine causes autism? And is the NIH and CDC and the I don't want to comment on the Wakefield situation because I don't know the ins and outs of it. That's what happened. He lost his medical license. Like we're talking about one study, right? I believe that replication matters. And so like there are, I think on the MMR vaccine, some excellent studies that failed to find a correlation Even though it's some of a medication or a causal link between MMR vaccination and brewery. MMO's V Tschildeed's real present for the kid for kids.

4:07:52And autism, there's a massive, Danish study that tracks patients who were vaccinated, kids who are vaccinated, matched with and similar patients who were not, Draxe them for a year, longer and the years and finds no difference. Okay, fails to find a difference in autism rates. There's people who, I mean, there's all kinds of, if you're looking on the online and elsewhere, there's all kinds of fights over that. But to me, that's pretty good evidence. You know, for the MRO vaccine. For some of the other vaccines, there's been less of a focus to ask whether it's Corley's vaccine. Such as polio vaccine?

4:08:36I don't know this literature or session comment, but I don't remember seeing a study specifically asking whether the polio vaccine is linked to autism. When I was growing up, every kid got the polio vaccine, measles, mumps, rebella, and a couple others. Like there were probably four or five vaccines, as I recall. I think that there's good evidence on the MMR vaccine that of failing to find a link with autism. There's, and I don't know the full extent of this literature, so I shouldn't comment too much, but what I've looked, I haven't seen quite the same level of evidence for some of the other vaccines failing, just haven't, again, they just haven't looked.

4:09:20As a general matter, I think it's an unlikely, just from a biological point of view, You are likely to be the main reason why you autism, the rise in autism, which is now well -documented that you talked about has occurred. So to me, the question then is thinking about autism, you're asking, you want to tell parents, answer for parents, well, what does cause it? What does has led to the rise in the prevalence of autism? The honest answer is, I don't know. You focused on what focused now on this constant conversation on just one potential Cause vaccines to me it's unlikely that they are the reason for the rise not in the cause of autism But there are many other potential hypotheses for the rise in the prevalence of autism that I've seen You know alterations the gut microbiome I've seen right noids for the There was a paper out of Poshko Rikusha's lab at Yale years ago looking at the migration of cells in the cerebrum cortex and developing fetuses, the primate fetuses, but it's a great model.

4:10:28And he was exploring the idea that ultrasound was altering cell migration, which may lead to changes in circuit connectivity. Never really got followed up on because that would be wild. He would be wild. He would be wild. I'm not suggesting that ultrasound causes autism, but there were a lot of interesting ideas early on that I thought ought to be explored. Well, so the point is that unless you know the etiology, it's very difficult to talk about the treatment. And of course, autism has a very wide range of clinical presentations. Right? You have kids who have some social awkwardness, but otherwise are well -adjusted.

4:11:07I've no problems, you know, think, you know, a sheldon from Big Bang Theory or something, right? Or many of our colleagues, maybe me, I don't know. And then you also have kids who have very of your disabilities, a lot of biologically driven co -occurring conditions, a praxia, difficulty toilet training for - That will never live on. Right. And so you have a very wide range of outcomes. It's very possible that biology is very different for folks along the spectrum. And unless you understand the ideology and might be different in ideology for kids in different parts of the spectrum, them, then you're never going to have good answers, both for prevention and also for therapies.

4:11:58So it's that question that Bobby Kennedy has asked me to answer or try to get an answer. And if the president Trump is asked to get an answer. And I think it's appropriate because if you ask me, what is, I mean, we just talked about vaccines as a potential cause. I think it's unlikely to be the cause. but you know, you can see my mind is open. For depending on the levels of evidence I've seen, now this is not my area, right, just I should say this. Like I'm saying this as someone is now like, we'll try to wait into it some just to get a sense of it. But as I've waited into it, it's very, very clear that there is not a scientific question, consensus answering the question of what causes the rise in autism?

4:12:40Or what is the etiology of autism? But it seems that encouraging a spirit of open discourse about these other potential causes, right? And I'm not suggesting, by the way, that ultrasound causes autism. I want to be very clear. But if you read scientific papers focused on brainwiring it, and you make the not -so -outrageous leap that autism has something to do with brainwiring, maybe gut and brain and a bunch of other things, but you come across a number of very interesting preclinical model hypotheses that hopefully we'll be tested at some point. Well, things, there's like environmental exposures to various kinds of chemicals, tens of thousands of chemicals in the environment.

4:13:25There's events that happen in utero, potentially. There's nutritional issues, potentially. I mean, I've seen a, you name the IPO, I mean, I'm just trying to weigh in this literature from somewhere from the outside. And it's just, it's, it's bewildering. I, I can't even imagine when a parent looking at this would look like. Oh, it's gotta be. Right. And to me, when there is no scientific question to an important thing that actually impacts self, the answer is, let's do excellent science on it. Now, the question that I've seen a lot of excellent science about how to manage autism, right? And lots of fights over, is it psycho therapy, the right approach, behavioral modification, is there's lots of fights over that?

4:14:10Do we address the co -occurring by biological conditions? How do we do with this at our stat? Is it different? I mean, I've seen lots of literature around that, which strikes me as more advanced and and sort of closer to the right, so answers all, again, there's lots of controversies even there. On the etiology of autism, it strikes me is that the literature is not all that far advanced, that there's lots and lots of competing hypotheses. The data are conflicting on many of them. I could give you my most promising one, but there would mean nothing, really. The right thing to do in that setting is to have an open -minded investigation to try to address this problem.

4:14:57And now, questions why haven't we had that so far? And I'll tell you, I think the reason we have not had the kind of open -minded, deep investigation by scientific community at large on the ideology that parents deserve, the kids deserve, is because it's dangerous to ask that question if you're a scientist. All of a sudden, you're going to be accused, often incorrectly of being an antivaxor, and that's the end of your scientific career. That kind of sort of suppression of scientific curiosity means that we won't have an answer to this question. Like, no, so, right, so what I've done is I've organized an initiative inside the NIH to address this question of the etiology of autism.

4:15:44Not limited to vaccines. No. wide -ranging, it includes basic science work, it includes epidemiological work, it includes environmental exposure work, it includes all and will bring together data sets that will make available to the researchers, will have a competition among scientists, just like the normal NIH way, with peer -review panels to ask who should who should get the awards? A lot of dozen or more scientific teams asking the question, what is the ideology of autism? We'll have that. I think that normally it takes a year or longer to set up a thing like this. Well, by September, we'll have a open competition for these scientific projects.

4:16:30And you can't brush science, but hoping within a relatively short period of time, who knows how long exactly, because science works. We'll have a much better understanding of the ideology of autism than we had at this current moment. Fantastic. I mean, just fantastic. I mean, regardless of where one sits on the vaccine discussion. On vaccines, I say one thing. Now, I don't want it as the NIH structure. I don't want to put my thumb on the scale on any part of these ED potential ideologies, right? As I already said, I'm not particularly an expert in this area. And so you're not going to put my thumb on the scale.

4:17:03Would we, not from the point of view of expertise? So it would just be the point of view of like I just happened to read the literature and I was impressed by xyz But if I were to put my thumb on the scale I think it would make it more difficult a for scientists to Ask the question honestly because they want to impress the anhydractor or something and then be for the public to trust The result at the end. I wanted open -minded so this is why like I I was asked well If you don't believe that vaccine these vaccines cause autism them. Why would you allow that people to ask that as a part of the research agenda?

4:17:36My answer is that a lot of people, especially in the public, that an even some scientist who disagree with me, and I want them to have their say. I want it on its conversation. I think that if you have an honest evaluation, you're not going to find that the vaccines are the primary reason for the cause of the rise in autism. You're going to be something something much more fundamental and complicated. But I don't want the results to be disbelieved because I put my thumb on the scale. I usually await the results of the unbiased studies. Yeah, I really do. And thank you for spending that time explaining what that initiative is going to look like.

4:18:20And I'm delighted to hear that it's not emphasizing one particular hypothesis. The other thing about the initiative is very important to understand. We're working with autistic parents. We're working with the autism community, right? It's a lot of times scientists, when they study things, we put ourselves above and we like it's like we're like examining Amoeba or something on a slide. When you do population research, you have to work with the communities that you're working to try to help. And that's exactly the spirit of this. We're going to work with communities of autistic kids and parents, and we're going to apply rigorous research methods with control groups and just the normal sort of high quality, the term of art nowadays, gold standard science.

4:19:09We're going to apply gold standard science to this and subject it to the same kind of replicability standards I want all science subject to. Can we expect that the National Institutes of Health, which indeed is a plural statement institutes, and IMAH, Mental Health, National Eye Institute, etc., will be restructured in some way in part to reflect the Maha movement, make America healthy again. And by the way, no one told me to ask that question. I'm asking out of genuine curiosity. There are these theories. I'm like, part of the, I'm not, I'm politically in a free agent. Because the budget is limited, it's not an infinite budget.

4:19:53Depending on how the IDC thing goes, there may be more or less money to devote directly to the laboratories around the country. And given that fixed amount of money, you can't do everything. I love the way you're encouraging innovative exploratory science that's rigorous with open discourse, but can we expect that the Institutes of the National Institutes of Health will take on some new names, maybe a new institute starting to emerge? I mean, it's really Congress that determines that. There's a process. The administration has put forward its suggestion for a reorganization. I think it's down to eight institutes from 27 or institutes and centers.

4:20:40Congress over the past decades have had several suggestions for how to do this. One of these things, I could focus my efforts on things that I think are going to big, big, big changes, where I could focus my efforts on like, reorganization efforts. I'll do what Congress administration asks of me. But for my point of view, we'll let that fight happen as it happens and we'll respond to it as it happens rather than like where I'm active. So I think the key thing is not the structure of the institutes to me. The key thing is the content of the research and the standards we hold ourselves to in the research.

4:21:19Those are the things I want restructured. That's really the fundamental question for me as an anti -structured. If I can accomplish some of the things we talked about during this podcast, having replicability be the core of deciding what scientific truth is. Refocusing the portfolio so that we enable early career scientists to test their ideas out. That we aim big for trying to address the key health problems that Americans face. If we can do those things, I'll consider myself a success. Well, Dr. Butticharia, you have a tall task and you're clearly ready for it. I want to Thank you for taking time out of your extremely busy schedule.

4:22:06Those aren't just words you are extremely busy to come here and have this discussion and to tackle head -on questions that we're not all easy questions. Some of them are quite difficult actually because there there's a lot of nuance, a lot of different lenses one can look through. It's clear to me that you're a data guy. You love data. And it's also clear to me that you like descent. maybe because you've been in the position of... That's been always true, right? Okay, well, yeah, it sounds like it's in your nature. I didn't know the younger you, but I love that you encourage descent. I do believe that great science emerges from discourse that includes sometimes even just outright arguments, provided it doesn't, you get physical or cruel, where they're aimed at getting at the truth, if it's possible, getting at the truth.

4:22:56And it's also very clear that you care about exploration. And I must say, especially warmed by your enthusiasm for protecting and promoting the science of young investigators, meaning in the first 10 years of having their labs, as well as trainees, I think I'm not trying to speak in nomenclature. This is so important. It's vital to keep your eyes open. important. And yes, there are some older labs doing some wonderful work, but even they will eventually retire and die. We all do. And the younger generation of scientists in the country, it's so key. And so I just really appreciate you coming here to share.

4:23:36I do want to check back with you in a year or two. See how things are going and science and public health really need you and to really get behind discovery and the mission statement of the NIH. So thank you for coming here today. You didn't have to do it. And I look forward to more discussion. Andrew, thank you so much for having me. Really a pleasure. Thank you for joining me for today's discussion with Dr. Jay Bhattacharya. To learn more about Jay's previous work and to find links to his current post at the NIH, please see the show note captions. If you're learning from Endoran join this podcast, please subscribe to our YouTube channel.

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