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

Since 2012, there had been no increase in American life expectancy. From 2012 to 2019, literally it was it was well not literally almost entirely flat life expectancy and uh 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. uh in Sweden the life expectancy dropped in 2020 for and then came right back up in 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, is 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 and as scientists and we won't admit it. And they're not just pissed off, they're kind of like done. They I hear it all the time. And again, this isn't the health and wellness supplement taking, you know, uh, you know, anti-woke crowd. This is a big segment of the population that is 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. I just want to land that message for them because in part I'm here for them and get your thoughts on I know 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 uh against the lockdowns, against the mask mandates, against the vaccine mandates uh and against the sort of anti-scientific uh uh bent of public health throughout the pandemic. I've also argued that the scientific institutions of this country should should come clean about our involvement in very dangerous research that potentially caused the pandemic. The so-called lab leak hypothesis. Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life. I'm Andrew Huberman and I'm a professor of neurobiology and opthalmology at Stanford School of Medicine. My guest today is Dr. Jay Bacharia. Dr. Jay Bacharia is a medical doctor and a PhD and the director of the National Institutes of Health. Prior to that, he was a professor of medicine at Stanford University. And I should mention that he did all of his formal academic training at Stanford, his undergraduate, masters, PhD, and medical school training. Today we discuss the past, the present, and the future of publicly funded research in the United States. The National Institutes of Health is considered throughout the world the crown jewel of basic and medical research, explicitly because the basic and clinical research that it has funded has led to more treatments and cures for disease than any other scientific enterprise. Basic research is focused on making discoveries without any particular treatment or disease in mind when that work is done. It is absolutely clear however that basic research provides the knowledge base from which all treatments and cures for diseases are eventually made. Today Dr. Badachara shares his vision of which aspects of NIH are especially effective and which need revising and improvement. We discuss how scientific ideas are evaluated for funding and what can be done to create more funding for more ambitious projects leading to treatments and cures. This is a very timely issue because despite its strengths, the NIH has gained a reputation over the last two decades for favoring safer and less bold work and therefore leading to fewer discoveries. We also discussed what will be done about the so-called replication crisis. The replication crisis is as the name suggests the inability for certain findings to be replicated. Dr. Badachara shares with us new initiatives soon to take place that are designed to verify findings early and to incentivize replication. So the knowledge base built by NIH science is accurate. As some of you may know, Dr. Bacharia stepped into a very public role during the co9 pandemic when he co-authored the so-called great bington declaration which argued against lockdowns. He was also quite vocal against mask mandates and he addressed vaccine efficacy versus safety especially for young people. Those stances of course were very controversial and he explains the logic for his stance on those topics. That discussion leads into a very direct conversation about vaccines more generally not just co 19 vaccines but also measles ms rebella vaccines and the very public and controversial issue taking place right now about vaccines and autism. We also discussed drug prices and why Americans pay 10 times or more for the same prescription drugs sold in other countries and the relationship of that to public health. I want to emphasize that the issues we discussed today will impact everybody. If you're a scientist, they certainly impact you. If you're a physician, they impact you. And if you're young, if you're old, if you're a patient, if you're healthy, if you're American, or if you're outside the United States, they will impact you. Dr. Dr. Bacharia was incredibly generous with his time and his answers, directly answering every single question I asked. Nothing was cut. As a consequence, it's a lengthy podcast, but I felt it was very important to get into the nuance of these issues so that you, the listener, can get real clarity on where things stand and where they are headed. As a final point, my graduate student training, my post-doal training, and my laboratory, first at the University of California, San Diego, and then at Stanford, where it is now, were funded by the NIH. So, you'll notice throughout today's episode that I'm very impassioned by the issues at hand. At the same time, I strive to include questions that I keep hearing from my followers on social media and from listeners of the Huberman Lab podcast. Some of those come from ardent supporters of the NIH, and others, as you'll see, are more skeptical or even critical of the NIH. I strive to represent all those voices during today's conversation. I certainly have my own opinions and stance on many of those issues and I do voice some of those throughout today's episode but again I tried to be thorough and broad-encompassing as you'll see Dr. Badachara cares deeply about basic science and the future of medicine and health in this country and throughout the world. He is our appointed leader in this science discovery public health enterprise and I'm grateful to him for taking the time to share his vision and for his willingness to listen to the many and wide range of voices including those critical on these literally life- sustaining topics. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however part of my desire and effort to bring zerocost to consumer information about science and science related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. Jay Badacharia. Dr. Jay Badacharia, welcome. Thank you for having me, Andrew. I've been wanting to do this for a very long time. We are colleagues at Stanford, although now you've formally moved to Washington to be the director of the National Institutes of Health, but you've played such an essential role in shining a light on certain aspects of public health. Mostly that happened during the time of the pandemic related to lockdowns, vaccines, etc. We'll talk about that. But now you are in the chief position of directing research dollars and um the initiatives of what is arguably the most important health organization in the entire world, not just in the United States. So thank you for taking the position. Thank you for being here. And the first question I have is for those that are not familiar, what is the not just stated mission of the NIH, but what is the really essential mission of the National Institutes of Health? So let me start with the state admission because the state admission is something entirely worthwhile. It's it's it anyone who listens to it should say yeah we should do this. Uh it is that to support research that advances the health and longevity of the American people. And of course the research that we do doesn't just advance American health. It advances the health of the entire world. For a very long time, the NIH, the National Institute of Health, has been the premier biomedical organization supporting research. Um, that translates into almost every drug that you take. The NIH has had some role in developing almost every, you know, all the all the fights over, you know, what's what's the right thing to do to to to get good sleep, what's the right thing to do for your diet, the NIH has played some role uh and for uh American biio medicine, it's the essential institution. Um it it supports the uh the careers of a very large number of biomedical scientists around the world. Uh and and specifically my me I mean I I got NIH funding for most of my career. Uh I was a re reviewer for the NIH uh a scientific reviewer for for grants. Um it's an absolutely essential organization. Yeah, I agree. My lab um ran on NIH money primarily. Um so thank you taxpayers, American taxpayers. And I think for most people when they hear that word health and what you just said about the, you know, the mission statement for NIH, there is this assumption that most of the work being done at or funded by NIH is human clinical studies or even mouse studies that are testing a particular drug, a dose response curve, you know, what's the lethal dose of this, what's the halflife of that. But as you and I both know, much of what NIH does is fund basic research. Research for which we don't have any clear idea, maybe even the foggiest of ideas, that there could be a potential upside for human health. Things like what controls the pigmentation patterns of the noses of Doberman pincher dogs. I bet you we could find that grant. So when we uh maybe not anymore, but when we step back and we look at basic versus applied aka clinical research, what percentage of the NIH budget, which we'll talk about in a moment, is directed toward basic research and what percentage is directed toward clinical studies or the testing of some drug, what we call pre preclinical trials, testing in mice or non-human primates, etc. So there's big fights over exactly what that demarcation line is. So I'm not going to commit to a single number. What I will say is that a substantial part of the NIH portfolio appropriately focuses on basic science. Basic science meaning fundamental biological uh facts that that can be used in many many many uh drug drug studies other other research where you don't necessarily know specifically in advance when you're doing it what the what the applications are going to be. uh the NIH very appropriately funds that work uh especially work that's not patentable right because no drug company has an incentive to do that work and yet it's vital I just just let me give an example uh just to put some meat on the bone of it um of something that the NIH didn't fund but my but actually is within the mission of the NIH to fund have funded if it had uh let's just take the research that led to the understanding of the the the that the the structure of DNA as a double helix right? Met Watson, Crick, Rosalen, Franklin, those all those folks uh in in in England in in uh in like 1950s. Well, that work is not patentable. It's hard to imagine like someone like trying to patent the double helix structure of DNA, right? So, that means that it's not going to be uh in the interest of any specific company to to support those scientists that discovered that. And yet, it's vital to almost everything we do in biology. Right. Uh the NIH very appropriately funds that kind of work. Work that is not in the interest of any particular company to do it. Solves a market failure if if you think like an economist. Um uh the market failure is there's no incentive of the private sector to do that that kind of basic work. And yet that basic work really advances human health, right? In ways that are sometimes unpredictable. Uh and so it's it's it's correct and right that the NIH continues to fund that kind of basic science work as well as the applied work where you take the advances and say okay well does this here's a drug that might work uh to treat this disease right that's that also that kind of work also is appropriate for the NIH to fund um there's a interesting dividing line where uh the question is like what should be left to the private sector to do right so the private sector tends to fund large-scale clinical trials at sort of the tail end of of the development process. Um sometimes they'll fund earlier earlier earlier clinical trials. Um but the uh private sector has an incentive to fund those kinds of studies because that gives them exclusivity patents things. So why should the the taxpayer pay for that when there's already private actors that that are willing to pay for that? So there's a there's a this interesting dividing line. um you want the NIH work to be translated to so that patients can have it. That means the private sector has to be involved to some degree. Certainly has to be using the the the products of the NIH um uh research. But that dividing line is fuzzy and controversial. Same thing with between basic and applied. Um as I said earlier, it's the f there's huge like almost religious course over where that where that dividing line is. Are you a basic scientist or are you an applied applied scientist? Um so I and all the numbers like don't make sense to me exactly given that religious war but the fundamental thing which is we have to fund basic work that I I believe in pretty strongly. Well as a basic scientist yeah I'm not a clinician um but I worked on clinically relevant issues in my lab related to restoration of vision in blinding diseases like glaucoma like related to anxiety etc. I also know that we have some beautiful cases as you pointed out of basic research leading to important I will say cures to serious diseases and there was no thought at the beginning of that basic research that the outcome would be related to human health. just briefly mention a couple. Um I want to ask more questions than I want to speak but um my scientific great-grandparents David Hub and Torson Weasel did the early work defining the structure and function of the visual system first in cats then in monkeys. Eventually it uh was clear the same was true of their findings in human work and early plasticity changes in the visual system of say there was a cataract or a droopy eyelid or a divergent eye strabismas or convergent you know so what we call crosseyedness and things of that sort and we know on the basis of that work that children need corrective surgeries early or else the brain is forever blind to the perfectly fine eyeball if the eyes aren't correctly aligned. Okay. In other words, the the old practice of, oh, you don't want to put kids under anesthesia, it's too risky, etc., the work of hub visas saved the vision of millions and millions of children in the US and abroad. People with cataract have those cataracts removed early and on and on. And I would also say as a second example that much of the basic work on cell biology that took place in the second half of the last century, you know, where are the mitochondria, what's in the mitochondria, electron microscopy, let's let's talk about all the folds in the mitochondria, let's talk about the gold, all that basic cellular biology that is the stuff of textbooks was, as we say, necessary, perhaps not sufficient, but necessary for the development of essentially every existing cancer treatment. But the cell biologists that did that work weren't thinking about cancer until much later in that work. So those are ju just two examples that I would argue NIH had funded a tremendous amount of. And the reason I'm setting it up this way is because I think nowadays, part of the reason you're here is that we are potentially looking at a redirecting of a significant amount of the research dollars that taxpayers provide to the NIH and the NIH to labs away from basic research, which understandably has some people concerned. That said, in order to translate things from the lab to the clinic, we also need to think about translational work. So, I just put that out as kind of an offering uh to elaborate. Andrew, I have no intention of of implementing that uh of shifting the balance between I think as I said basic science work and applied work are both tremendously important parts of the NIH portfolio. Uh and the question is to me is what's scientifically important and interesting uh in terms of uh in ter in terms of accomplishing the NIH mission which is again advancing the health and and longevity of the American people. Both basic work and applied work can uh contribute to that mission. uh and and and in fact in fact I think any uh largecale scientific uh uh institution that seeks to support the the mission that the NIH has has to have both in it. uh so I don't have any intention of gutting basic scally I'm a I do epidemiology health policies uh health economics u statistics um that's very very applied but I have great admiration for my colleagues like you who do basic science work I think it's what advances and fuels the next generation of advances uh so it's uh it's not it's going to stay part of the NIH mission as long as I'm the director thank you I and many others will be very relieved to hear that answer I I think there is this fear that uh the new administration is going to eliminate basic research somehow and replace it with only applied research and clinical studies and that somehow and this is not my belief that there's going to be u some private interest related to that and it's all going to get co-opted in some kind of um cloudy way. I what I'm hearing from you is that is not the direction that NIH is going. That is not uh in fact I've not heard anyone inside the administration tell me to do that or suggest that as the appropriate path. I just I mean everyone I've spoken to about my vision has said yes, that makes sense. Great. I'd like to take a quick break and acknowledge one of our sponsors, David. David makes a protein bar unlike any other. It has 28 gram of protein, only 150 calories, and zero gram of sugar. That's right, 28 gram of protein, and 75% of its calories come from protein. This is 50% higher than the next closest protein bar. David protein bars also taste amazing. Even the texture is amazing. My favorite bar is the chocolate chip cookie dough. But then again, I also like the new chocolate peanut butter flavor and the chocolate brownie flavored. Basically, I like all the flavors a lot. They're all incredibly delicious. In fact, the toughest challenge is knowing which ones to eat on which days and how many times per day. I limit myself to two per day, but I absolutely love them. With David, I'm able to get 28 grams of protein in the calories of a snack, which makes it easy to hit my protein goals of one gram of protein per pound of body weight per day, and it allows me to do so without ingesting too many calories. I'll eat a David protein bar most afternoons as a snack, and I always keep one with me when I'm out of the house or traveling. They're incredibly delicious, and given that they have 28 g of protein, they're really satisfying for having just 150 calories. If you'd like to try David, you can go to davidprotein.com/huberman. Again, that's davidprotein.com/huberman. Today's episode is also brought to us by 8LE. 8LE makes smart mattress coverage with cooling, heating, and sleep tracking capacity. One of the best ways to ensure a great night's sleep is to make sure that the temperature of your sleeping environment is correct. And that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about 1 to 3°. And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about 1 to 3°. Eight automatically regulates the temperature of your bed throughout the night according to your unique needs. Eight has just launched their latest model, the Pod 5. And the Pod 5 has several new important features. One of these new features is called Autopilot. Autopilot is an AI engine that learns your sleep patterns to adjust the temperature of your sleeping environment across different sleep stages. It also elevates your head if you're snoring and it makes other shifts to optimize your sleep. The bass on the Pod 5 also has an integrated speaker that syncs to the EightLe app and can play audio to support relaxation and recovery. The audio catalog includes several NSDR non-sleep deep rest scripts that I worked on with Eight Sleep to record. If you're not familiar, NSDR involves listening to an audio script that walks you through a deep body relaxation combined with some very simple breathing exercises. NSDR can help offset some of the negative effects of slight sleep deprivation, and NSDR gets you better at falling back asleep should you wake up in the middle of the night. It's an extremely powerful tool that anyone can benefit from the first time and every time. If you'd like to try eight, go to eight.com/huberman to get up to $350 off the new Pod 5. Eight ships to many countries worldwide, including Mexico and the UAE. Again, that's eight.com/huberman to save up to $350. I'd like to talk a little bit about um something that most people perhaps are not familiar with in terms of its acronym, but um is a very important issue, which is this notion of IDC, indirect costs. So, my lab ran on NIH grants for many years, and my lab and other labs would apply for grants. If we were fortunate enough to get one of those grants funded, we might receive, let's say, a typical grant would be a million dollars over the course of four years. So 250 a year for four years, but then in addition to that, my home university, Stanford, would get some percentage above that, not a percentage of that million. I would still get the million to spend on mice, antibodies, graduate student salaries, etc., But some percentage of that 1 million and I think at Stanford it's roughly 50 x% you know so let's say another 500,000 would be given to the university for so-called indirect costs. This is not something that just happens at Stanford. This is typical of every single NIH grant that I'm aware of. and the indirect costs pay in principle for administrative handling of the grant and the uh you know the the various uh infrastructure things related to the mouse care um keeping the lights on having a janitor empty the trash at night these sorts of things IDC as it's called has become a hot button issue for two reasons one as soon as the new administration came in the Trump administration came in in uh this uh just this last year they cut the IDC rate across the board, not from say 55% at Stanford, other places were 75%, some places were as low as 30%. They said, "Nope, we're not paying this stuff anymore. The National Institutes of Health, in other words, the taxpayers will pay up to, but no more than 1515% above any given grant." I'd like your uh thoughts on that because this weaves into some bigger issues uh that relate to a lot of the sentiment that you know why should taxpayers be paying for these universities to run especially when universities some not all have large endowments. Right? So actually I just preface my remarks by saying that um there was litigation against that 15% which uh essentially said the government couldn't impose that 15%. So it's been blocked. Yes. Uh so the right now the the rates are whatever they were. They're not they're not not they're not the 15% based on that court order. Um I can't comment on the litigation and I can't comment as a result of I'm now a member of the government. It's like I'm not allowed to do that. But I want I do want to talk about the broader issues related to indirect costs. Uh and I want to put it in a a broader context. Right? So the context is this right? So in in the mid40s uh uh Vanver Bush who was like one of the main science administrators in the United States he he made he made a an argument that the the federal government should partner with universities in in uh organizing the scientific infrastructure of the United States that that the universities were tremendously important parts of the scientific infrastructure and the federal government had an appropriate role in supporting the universities of the country to do scientific research. of interest to the American people. Right? So the indirect costs kind of structure came out of that that commitment. Um and frankly it makes sense to me, right? It it it's appropriate that the federal government have some role in deciding how to support the universities of the country to to be organized around research that's that is in the American interest. Um the question is how uh the question is how how much should it be how should it be structured you know in what way uh those those are the key policy issues that we're really talking about. We're not talking about how should there be uh some federal support for the universities. The question is how let me just step back and talk about like the the the current structure the way it works uh because it's really non-intuitive right. So there's there's uh so first you're you're a brilliant scientist. You apply to the NIH, you get, you know, a grant that gives you a million dollars a year. I'll just just to make a clean number, right? So a million dollars for the next five years. The federal government is going to give you money to to run your lab and do all this kind of stuff. Um you you work at Stanford. Stanford has a 55% indirect rate. So that's uh on top of the million dollars a year the administrators at Stanford then will get $550,000. Right? So that's uh so for the for your million dollars of work, the taxpayers will pay $1.5 million roughly to Stanford uh a year, right? So that's um now that as you said correctly that that that that half a million dollars will go to the fixed cost of doing research, right? the stuff that's like not specific to the your you know like the lab the lab you're running the the the people you have to hire to do the the work that you propose but the fixed cost the building the the the maintenance the uh you know the uh the the all the all the stuff it's got to take the biohazard stuff away all that stuff and it's not just you like there are other folks who are like using the the same material like radioactive materials and so it can support many many research projects not just one right so it's it's funding that kind of work right so and again that's a legitimate use of that money. Um the so right uh the the e the here's the e 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 right if you don't win NIH grants Stanford doesn't get the 550 right 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 right so in order to have the money the infrastructure support fixed cost support. You have to have have scientists in order to have the scientists, you have to have the the the infrastructure. Uh it's a ratchet that essentially makes it so that we concentrate the federal support for the money in the uh to to a a select few universities. There are winners and losers. And so the the the scientific infrastructure of the country is concentrated in a relatively few universities mainly on the coasts. uh and they're brilliant scientists in other places that are not at those select few universities that have trouble getting NIH grants even though they're brilliant scientists. It it's it draws um the federal support uh away in a in in in a structure that essentially says uh 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. U so it's it's that's the that's the basic economics of the of the the way indirect costs actually actually work. Uh and so the question is that the right structure uh there's also questions about you know like so for instance your your your your science involves your basic scientist your science involves lots and lots of fixed costs right the radioactive disposal all all this stuff the research I did you know epidemiology health policy statistics um if it's basically a computer me with a with a data set and a computer I can hire some you know biostatisticians to help me or or we call that a carpet lab Yeah. And so like do do the univers does the university need the same indirect cost support to support my fixed cost as it does yours? And 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 we can the can the American taxpayer be sure that we're auditing the use of the indirect cost in the appropriately? Those are the policy questions I think that are an issue in the indirect cost fight. Um again I won't get into the litigation. I'm just I'm not allowed to actually comment on that. So I so I wanted to I wanted to abstract it to a high a higher level because I think the policy question is um not should the federal government support universities to do this kind of research to to have sort of the facilities. question is how should it be distributed across the country? Uh h to what extent should the researchers get it versus the uh the the the administrators get it. uh and then on the on the back of that there's also other research institutions that have very diff different indirect cost recovery rates for the same university right so like uh you know I think Gates Foundation is I don't know the exact number like 15% um something on that order whereas like the NIH is 50% to the same university that's it it looks funny the question is I mean sometimes sometimes I've heard well uh well the uh the uh Gates Foundation puts more of the money uh into the directs, right? So that maybe they'll charge you for the the the rental cost of the building or something. I don't I don't know exactly, but I'm very familiar with foundation versus NIH money and it differs by foundation, but 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, a public university. Typically when foundation money comes in there's the university imposes a minimum of about 8% administrative cost just for handling like we're just to do the paperwork to pay the admins that do the handling. There's something very important in what what you're bringing about there. There actually two issues. So I want to backtrack to one issue to make sure that we um 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. The first thing that I really want to um draw up from earlier in our conversation is you pointed out that the current model of NIH is that taxpayer 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 Al Alzheimer's treatment. We 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 gonna 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, but to any rational person, you don't need a degree in economics to say that kind of sucks. I'm paying and and made worse, if I want to read a paper that was published with the work that I provided for my tax dollars, I have to buy that from the journal. By the way, that changes in July. Okay. Yeah, that's a huge issue. That's one of the decisions I made. Yeah. So, $34. Listen, I've been grateful to publish in Nature and Science. You know, these are like Super Bowl rings for for scientists. I'm sure it's part of the reason I got tenure at Stanford. And I had great fun doing the work and I believe in the work. It 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. This is crazy. This 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 of of basic to applied research. So let's just I want to return to that briefly because this relates in my opinion directly to IDC. So 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, I'm in media and public facing. What I've come to learn is that the general public is very smart. Max Dbrook was right. You know, 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 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, let alone glean the positive benefits without paying out the notes. Yeah. So, so a couple of things, let me go backwards because you had two two major issues you brought up. So, first the the journal thing. Um uh the my predecessor Mon Monica Bernnoli as the who was the NIH director the national health director before me she made a decision a really a great decision essentially to say if the NIH supports a scientist's work and then that work leads to a journal publication that uh that that publication ought to be available free to the public immediately upon publication. You're not allowed as an NI funded scientist to publish in a journal that doesn't have that as a policy. Uh that policy was due to go into effect in December of this year. I think it's a great policy because I agree with your analysis entirely. If the American taxpayer pays for the research, why shouldn't the American taxpayer be able to read the research for free? Uh because they already paid for it. Why do they pay a second time on the back end after the research is is, you know, 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 for 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 and 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 like the major it's good. So it's uh but okay so that's a racket right? Yeah. Sorry I I I realize I'm talking more than I'm asking questions. No no this is I mean like I'm agreeing with you. So like so I um the uh Monica Bertnoli the previous NIH director in December of this year was going the she made a policy that those papers have to be available to the public for free. I 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. Americans and everybody will be have access to the papers that the Americans are already paid for from the that if they're NIH funded uh for free. Thank you. On the behalf of literally, this isn't a political statement. On the behalf of myself and every other American citizen, thank you. We've been paying for this research forever and have 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. So, McMillan Press, Elsavier, 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. It's just you put it online, right? And there's there's I mean yeah there's some some cost for maintaining the web page and all that but but or the and there's some editorial staff but like the the the the level of investments the public had been making for the NIH uh to then be asked to pay $30 $50 $100 for the papers itself that are published. I mean, it's just insulting. Uh, and it 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 this to the the things that scientists are talking about, right? There's like this public transparency aspect of it. Um, where the science scientists ought to be engaging with the public about their ideas, right? The idea is that we are just live living in this ivory tower and only we get to decide what's true and false and and then then we impose it on the public. during the pandemic, we saw the folly of that model, right? Uh so it's it's I think a small step forward, but an important one. I think you're being humble. Uh and I'd like to point out that I think it's a big step forward because it's not just a you know a a token to the public for all their, you know, dollars over the last how old is the NIH? And some years and some years it it's really what should have happened a long time ago. Thank you very much and I 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, you know, 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 uh so let me tie it back, as you said, these are all interlin topics. Let me tie back to something else you just said earlier, which is uh Okay, so the NIH funds your work. Your work then uh results in uh uh 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, right? They sell get sell to the public. Uh at least indirectly or sometimes directly, those patents are funded by American taxpayers, right? Uh well the NIH also has a big intramural program but it's like a scientists 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 that are sold uh that at above marginal cost and and then and so the question is like by by again by American taxpayers because the patent protects uh you know entry into those markets. So, 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 like have uh to make to make money off of this this this research the American taxpayer funded? And and the question as as an economist, I'll say the question is complicated. And the reason it's complicated is you you might say, okay, well, there should not be a patent at all, right? Shouldn't be patent at all. um the the there was a law called the by Dole act in the mid 80s I can't forget the exact date uh that essentially said that NIH funded work ought to be patentable and the reason was that it it's the last mile problem like you have some fantastic basic science research um that has some like fantastic uh uh biomedical results you know that that uh that there's no way for patent right then there's no interest to develop into a that then advances health. The the the wisdom of the BOLO act was to say well look if you allow there to be patent on the last mile then now there's we've created a a commercial interest to take the basic science advances and translate them into something uh that actually benefits people. Now the price is going to be higher at least while the patent is still in place. Um but then eventually the patent go away and then the price will the thing will be available to the public at large to accelerate the transition from the basic science investments we make to uh things that actually benefit the public very directly. That's the that so it's in a sense there's a trade-off there, right? So you 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 kind of would be in a in a purely competitive market for the fact that you get uh more rapid access to the benefits of the of of that investment. Right? So that's that's the basics tradeoff at at play. That's why I say it's complicated. Well, when 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, uh that the university is going to capture some of that upside. And you know, Stanford is a place where there's let's just say a history of uh of people going into biotech and to neuroch and um because of the influence of the engineering school. There's actually a great joke about Stanford that a former president of Stanford told me that which is there's only two kinds of Stanford faculty. Stanford faculty with companies and Stanford faculty with successful companies. A discussion for another time. But it's common place 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, you know, 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. So for the taxpayer who make up the majority of our our listenership is giving money to universities and the universities are spending that money making discoveries. I think most of the time the 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 uh complication uh about the United States versus the rest of the world. So, let's just put that aside for just a second. Um let's get back to that. Uh before I get there, I want to say in response that that uh that that in fact when you take a medication or when you have some health advice um that actually works often the NIH research was was somewhere in the path leading up to that uh involved and there are huge returns to that. Right? If you if you have a a drug that uh that that that treats your disease well, um you know, you you know, congestive heart failure and now you have a drug that that that that allows you to live longer, more health, you know, in a in a way that allows you to live more fully or or uh if you have uh you know, diabetes and you you slow the progress of the disease so it doesn't result in your kidneys failing, your your going blind or whatnot. those are those are advances that are really worthwhile and uh even if the price is higher than marginal cost it's it still could be very worthwhile right so you take metformin it's a very cheap drug now but once upon a time it was a patented drug and you prevent this the progress of diabet type two diabetes that's a that's a big advance right for so um the value that you get from the NIH sponsored research then is potentially very very high in terms of improving your even more than the marginal price for the drugs that you you end up paying or the or the products or the advice or whatever it is. Right? So you're saying it was a good investment for the taxpayer even even for the taxpayer. Right? Now I I wanted to put aside the the the business about international like the US versus the rest of the world. I now I want to bring that to the forefront. It is also true that American taxpayers and Americans pay somewhere between two to 10 times more for the same product, the same drug product as people in Europe pay. Why is that? U there's again a lot of complicated reasons around to to to do that. But let me just is a very very simple observation. There's something in economics called the law of one price, right? When you have one country's charging 10 uh there's a market in one country where the price is 10 times more than for another country, what you'd expect is somebody to go buy the goods from the other country uh from from the the cheap country. Let's pay the pay the pay this the cheap price then go resell it in the country that has the high price. Um and now what would end up happening is that you'd get an equalization of the price. you'd get uh you know so that as long as there's sort of like the capacity to like move across um 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 10 times more for the same product often made in the same manufacturing facility uh than Europeans do and that it's again a complicated reasons why but it has to do partly with uh 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. Right. That's what they say. The higher prices that we pay fund the 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 four clinical safety though right before we go into humans at large? Yes. Um we want to know if anyone's going to drop that. That's the argument that they make that the drug companies make is that well uh yes the Americans are paying this high price. It's really worth it uh to do that. And then they go to Europe and Europe says well we're not going to we're not going to pay those high prices. uh we're going to charge you you you can you if you're if you're going to market the drug in our in in France in Belgium in in uh in in Germany or wherever uh 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 latestage and most expensive research and development that the drug companies do. They sell the drugs to us at a premium and they use the difference between the real cost and the uh sort of allowed cost abroad to make it very cheap overseas. In other words, we are paying for um the insurance so to speak that the drugs that are marketed in Europe and elsewhere are safe. Yes. So the taxpayers in the United States are funding the basic research and the clinical late research. Yes. for the entire world. Yes, in large part. I mean like Europe does have some institutions that that that that invest in in uh you know that in basic research. So it's not entirely zero and there of course private foundations that do it but through the NIH that's the the single largest investment in basic science research in the world and through and and and and also applied research uh and also by by higher drug prices in the United States relative to the rest of the world. we are funding the the the the phase three trials the all the research and development efforts that happen at the tail end of the research pipeline um that the drug companies do. Uh so which when so 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 latest stage safety research? I mean, it's not expensive because it's uh fund to do expensive research. It's not expensive because they're still exploring the basic chemistry of these molecules or or functioning of the devices. 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 end point like did it lower blood sugar? It's like did it lower blood sugar and also did you blow a gasket in your you know some capillary in a critical part of your brain. So I mean this is a very expensive work. So who it still needs to be done is what I'm saying. Who's going to pay for it? Okay. So, um, let me just take a couple of, uh, cuts at this. So, first, um, like that that phase 4 surveillance that happens after the drug's been marketed, that's typically the the FDA that conducts that work. The NIH can fund some some of it, but it's mostly it's mostly the FDA that tracks the safety and efficacy of drugs in in broader populations after the drug has been approved for use. Um, so again, American taxpayers are paying for that. uh the phase three studies the studies of largecale clinical studies to see to check the effectiveness of a drug check the again like safety profiles of larger populations um that's typically the drug companies are paying paying for that right uh in principle but then American taxpayers pay for that with like higher higher uh drug costs uh President Trump uh in last couple weeks issued an executive order essentially saying we have to we have to make the other countries of the world pay their fair share of this. So um he put an executive order in place with various mechanisms. Maybe if you want we can talk about some of those mechanisms um that will reduce uh the difference in price between what the US pays and what the rest of the world pays. What will likely happen is that Europe will pay a high a slightly higher price again funding the research and development efforts to do that last mile of research. Uh the US 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 uh that's not that's not a equilibrium that should hold that that there ought to be policies that allow us to equalize those prices. Um uh and uh the kind of mechanisms used uh include things like uh including drug price discussions in trade negotiations. um the the sort of the tariff linking it to the tariff policies he's implemented um the allowing reimportation of drugs. So the idea is that uh let's say you're uh I'm I'm in Europe and I'm charging basically nothing for some drug and you're you're in the United States. Um someone can come to me, buy the drugs from Europe or Canada or wherever, bring them in the United States, resell them uh at a much cheaper price and and you know make a little bit of money, but that that then would equalize the price. and various other mechanisms to try to bring the United States much more close to where the price of the rest of the world. It's not that the R&D won't happen. It's just that the prices everywhere will be more equal so that the burden of R&D is shared more equally across the the developed world. What is to say that these other countries will simply say no, we're not going to absorb more of the cost. People uh don't like to see prices go up. Um they're comfortable with seeing prices go down for obvious reasons. Um, and I can think of one example, maybe not the most critically important example in the in most people's minds. There's a class of drugs that was released last year or about last year called the Doras. These are um drugs that encourage sleep uh by suppressing the wakefulness mechanism as opposed to promoting the sleepiness mechanism in loose terms. Um, they 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 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. It's widespread. These drugs are very expensive, $300 a month or more in the United States. Knowing what 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 cost so that in Northern Europe it can be available for $50 a month. I mean, that borders on upsetting for me. Yeah, it is upsetting. Uh, and I think I understand um why President Trump issued that executive order. It's upsetting for me, too. Like I it makes no sense um that the American taxpayer should bear the burden uh of this R&D expenditures when you know there are lots of rich countries in the world. Why shouldn't it be more equally distributed? Uh the question is like what will will happen? It's um how the drug companies respond to the executive order and how our our allied nations respond to the executive order is open still. I don't know the I don't know what it's going to look like. But what I can say is that the current equilibrium is not sustainable. right? The American taxpayers once they understand what what's actually been happening, this is for decades long, uh they're going to say no. Right? And so the way that it plays itself out, uh it's hard to project exactly. Uh but what what I do know is that um every effort the government is currently uh is making every effort to make sure that those prices get more equalized. Um I I think just take it from the perspective of a of a uh a European uh citizen, right? Some someone French citizen or or or Spanish or or or Portuguese or or English citizen, right? for you know cities of Great Britain for them uh raising allowing this 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 most of the research now since it's paid for by Americans the the the drug companies are focused on problems that Americans have it al it it aligns is the in interest 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 anti-depressants, the SSRIs and related things um in the world are prescribed and consumed in the United States? I got no other specific number, but it is a pretty pretty substantial I think um as far as like drug profits go, I think it's like twothirds or threequarters of all drug profits are are are had in the United States. And are most of those for the sort of aderall and psychotropic type stuff? No, the whole Sorry, I don't know if psychotropic is the correct term and I'm going to I'm going to get beaten up by people if I don't get this right. uh let's just say psychoactive excuse me I meant to say psychoactive uh drugs like SSRIs which by the way in 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 SSRI have been a tremendous tool they haven't cured OCD in every case but they've been a tremendous tool so I don't want to I want to make sure not to demonize them uh so I don't know the specific numbers for for for psychoactive drugs um but I but um as an industry as a whole, it's the United States that drives drug company profits, that pays for drug company profits. I think I I think it's like 2/3 or 3/4. I forget the exact number. And so what are these American problems? So it's obese are they obesity related issues. Yes. Obesity, depression. I mean those are a lot of the uh obese I mean the United States is is uh I think it's like Mexico is now above us, but like for a long time was the most obese nation in the world. Um you know big nation in the world. uh the the uh the the so like the diseases related to obesity. Now admittedly the European countries have those problems too but just to a lesser degree. The 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 it'll align the drug company incentives to focus on the problems that Europeans have at at slightly higher at higher levels than the Americans have relative. Now these are all rich countries. So it's not like uh there are unique diseases that happen in Europe that are that don't also happen in the US. It's a question of relative levels of investment, right? Uh, and so, you know, I I don't think that's necessarily bad. Like the the like an excessive investment in just the things that Americans have at scale don't necessarily translate to better health for Americans, right? So, you can see this in the in since 2012, there's been no increase in American life expectancy. From 2012 to 2019, literally it was it was well, not literally almost entirely flat life expectancy. And uh 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. Uh in Sweden, it the life expectancy dropped in 2020 for and then came right back up in 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. Right? It we've had some tremendous biomedical advances have now allowed us to treat diseases that were previously untreatable, but which is great. That's a good thing. but is not actually as far as the the broad health of the American public address the chronic disease crisis that we face or address the crisis in in longevity that we face. Uh the next generation of kids, our kids are likely to live shorter, less healthy lives than we have lived as parents uh and and as as as American parents. And I think that that's uh that that I think is an indictment on this entire uh entire industry like we focused on managing illnesses and treating illnesses and try to hold on uh you know especially chronic diseases uh as and as a result uh and we're failing at it right Europe on the other hand is seeing expanded life expectancy um this I think this change of of trying to equalize drug is aligning our our portfolio of NIH investments to meet the health needs of the American people. It's a long needed corrective. Uh you asked if will it succeed. I hope so. That's that's 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. I discovered AG1 back in 2012, long before I ever had a podcast, and I've been taking it everyday since. I find it improves all aspects of my health, my energy, my focus, and I simply feel much better when I take it. AG1 uses the highest quality ingredients in the right combinations, and they're constantly improving their formulas without increasing the cost. In fact, AG1 just launched their latest formula upgrade. This nextgen formula is based on exciting new research on the effects of probiotics on the gut microbiome, and it now includes several clinically studied probiotic strains shown to support both digestive health and immune system health, as well as to improve bowel regularity and to reduce bloating. Whenever I'm asked if I could take just one supplement, what that supplement would be, I always say AG1. If you'd like to try AG1, you can go to drinka1.com/huberman. For a limited time, AG1 is giving away a free 1-mon supply of omega-3 fish oil along with a bottle of vitamin D3 plus K2. As I've highlighted before on this podcast, omega-3 fish oil and vitamin D3 K2 have been shown to help with everything from mood and brain health to heart health to healthy hormone status, and much more. Again, that's drinkagg.com/huberman to get a free one-mon supply of omega-3 fish oil plus a bottle of vitamin D3 plus K2 with your subscription. Today's episode is also brought to us by Levels. Levels is a program that lets you see how different foods affect your health by giving you real-time feedback on your diet using a continuous glucose monitor. One of the most important factors in both short and long-term health is your body's ability to manage glucose. This is something I've discussed in depth on this podcast with experts such as Dr. Chris Palmer, Dr. Robert Lustig, and Dr. Casey Means. One thing that's abundantly clear is that to maintain energy and focus throughout the day, you want to keep your blood glucose relatively steady without any big spikes or crashes. I first started using levels about 3 years ago as a way to try and understand how different foods impact my blood glucose levels. Levels has proven to be incredibly informative for helping me determine what food choices I should make and when best to eat relative to things like exercise, sleep, and work. Indeed, using Levels has helped me shape my entire schedule. I now have more energy than ever, and I sleep better than ever, and I attribute that largely to understanding how different foods and behaviors impact my blood glucose. So, if you're interested in learning more about Levels and trying a CGM yourself, go to levels.link/huberman. Right 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/Hubberman, 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 that as we talked about a little bit earlier, most of the general public, even the science and engineering, mathematics trained, they can connect two or three dots, but they're also very busy. And 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 I'm a health economist. Well, I think I and um I mentioned that in 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. Uh you know, there's a saying in laboratories which is that, you know, just adding more money uh 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. I mean no money, no science. You can't pay graduate students, postocs, etc. I don't want to spend too much time on the the structure of basic laboratories, although that's my leaning. I I could spend hours talking to you about what's going to happen with the universities, etc. 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 uh indirect costs being now well it's pending litigation but leveled to a lower number 15% if the administration has their way um back to the variable rates depending on um the university if the uh this lawsuit h has its way. Um and 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, right? 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 why 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 uh public university in in particular in certain areas of the country, not on the coasts, unless you're at like a Wu in St. Louis or UT Southwestern and they got riches, if I'm 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 at these other universities. You don't have these impressive lawns and thousands of gardeners, which we're 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 um 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 being at Stanford it wouldn't be right for me to be like oh yeah 15% will dip into the savings. It doesn't doesn't 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 the question is how should the federal investment in in fixed cost of research be distributed? Um right now it's distributed in a very unequal way where the top universities have access have access to that money because they have scientists that can win NIH grants. It's a funny thing because like if 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 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 more more equally spread across, right? Uh the the um the endowment uh money is a is another is another more complicated question. Uh it I think that that um endowment monies often are like focused on particular projects. there restrictions on it, but you're absolutely right that that it does make a buffer for some of the bigger universities uh that allow it to like survive, you know, the vicissitudes of of of NIH funding or the economy uh more so than for uh universities that don't have that endowment. Uh the but from the federal perspective, the key thing is um how should the f the funds be distributed across universities? There's a program called IDEAS uh program that the NIH, the National Institute of Health has, and I apologize because I don't remember the the acronym, but I'll tell you what it does. It says for um research institutions in the uh in in the 25 states that are in the bottom half of the distribution of NH funding, it gives them a leg up in being able to get access to this federal funding for the for the for the fixed cost of research. I think it's a great program because what it does it says look uh the federal government shouldn't just be funding the top universities. Uh it it doesn't make sense from from uh from the point of view of of trying to get the the the biggest bang for the buck in scientific knowledge. Uh just like a just a very narrow like this isn't a narrow thing. It's like an important thing. Um I think scientific group think happens when scientists are all just on the coasts and they and you the only scientists you interact with are scientists already agree with you. Geographic dispersion of scientific support uh allows uh more uh richer conversations about science that allows uh different scientific ideas to develop um just simply because it's more geographically dispersed. It it combats scientific group think. There's other reasons too as you said like that other excellent scientists uh in universities that aren't on the in the you know like the Stanfords Harvards or whatever um that that if you gave them more a environment where they could do their work they would have you make tremendous advances right so I think for lots of reasons it makes sense to do that um I I don't want to comment on the specific 15% of them are subject to litigation uh I will I will say that the key policy issue is exactly the thing you said how should the money be distributed the four fixed costs of research across the universities. Uh like one system you can imagine would be where where like different universities compete on costs, right? So uh a university that's able to more more inexpensively provide you know square foot of lab space uh fully supported with you know radioactive disposal and all their stuff. Maybe the the NIH ought to be giving money to that university more than a a university that has to provide it at much more expensive rates. Right? that that's not the current system, but you can imagine a system like that, right? So, um I think this fight over this 15% um it's it I think it's it's a great time now to rethink how the NIH and the federal government supports the research infrastructure of the country. Uh it's it's for the first time in like I think in 40 years, it's now part of the public consciousness. uh this this this this this thought and I don't think I' 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 we'll move into issues of public health um specifically. But having been on study section, I realize I never explained what study section is. Study section is when a group of scientists convene um it used to be in different cities or virtually and they review grants. Typically 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. the the from the perspective of a reviewer, you're given uh you know 12 grants and you know that only three of those can be funded or so. And so you literally have to advocate for the the one or two that you feel most strongly about and you find ways to legitimately make sure that the other grants are um 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 and 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, it you talked about group think. It lends itself very well to um people who are very good at grant writing which is important. Grantsmanship is important. uh continuing to get money and in particular new ideas, ideas that are outside the vein of what a researcher has been doing for the last 5 10 years from promoting the of doing new ideas of of chasing new new concepts, new hypotheses. It it tends to make science move very slowly and very and very incrementally. And so that's one issue. However, I realize I'm weaving two questions, but there's what you described before that that the the majority of science that's funded at these universities on the coast as is geographic effect, group think effect. What about the rest of the country and these other places, the study sections, the people who review the grants intentionally include people from throughout the country. It's related in fact I I think to um the distribution of uh the electoral bodies and and people uh 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 uh desert southwest that there's always been geographic coverage in the in the people who decide which grants get funded. So I just um 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 yes more or less but it also means that nothing really that new can get funded. Yeah, I mean I think you you've hit on a a real problem um which is I think it let me let me contrast it with Silicon Valley, right? So in Silicon Valley um uh you're you're an angel investor or VC or something and you're venture capitalist and you you invest in a portfolio of 50 projects and 49 of them fail and the 50th succeeds it it becomes Google or Apple or something that's a very successful portfolio. Um the process of how uh we that the NIH review grants embeds in it a certain conservatism in uh a a desire to make sure that every grant that's funded succeeds. You 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 a professor at the Sulk Institute, a superb institution down at um in San Diego uh 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 if you hit something, it's apt to be spectacular, maybe even open up an entire field, maybe cure a disease. This has happened before many times over. Or there's the science that will get you funded where you turn the crank. You you uh look at a different protein in a pathway that is marginally interesting but is predictable in terms of its ability to create papers. Students need papers. Posttos need papers. 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. So you could understand why people would be incentivized to do this kind of more incremental, I'll just call it pedestrian kind 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 we 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? Yeah. And tell me that one of them led to something interesting, but don't kid yourself into thinking that having a grant, an 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 like Well, I was for I was formerly a tenure professor until until recently. But you gave it up by choice. We should um Okay. So uh before the before the pandemic in 2020, it was for actually for a decade before I'd been working on measuring the innoviveness of scientific portfolios. Um uh I had a a paper that was published on the eve of the pandemic asking how innovative is the NIH portfolio in particular. And so so like let me just describe the the methodology because it's it's it's easy to understand, right? So take every single published paper published in biio medicine in 1940. Take all the words and word combinations in it and just list them. Okay? Then you do the same then you do the same thing for all the papers published in 1941 and subtract off all the 1940 words and word combinations. What you're left with are the unique words that were introduced into the biomedical literature in 1941. You do this for 42, 43, 44 into 2020 and what you what you get is a history of biio medicine. It's in that comes right out of the words that were actually published. You can do this because computers, right? Um and and so uh you take so you have an age for every single idea that was introduced in bio medicine 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, uh just to take a concrete example, polymerase chain reaction in 1982 83 was a new idea. Um and so if you were carry publishing a paper with the words polymerase chain reaction in 1982, that's a paper that's relying on new ideas. If the newest idea in your paper in 2020 is polymerase chain reaction, well that's an idea that's, you know, almost 40 years old, 40 plus years old, right? And now it's in the method section barely. Right. Right. Uh because, you know, it's just like Xerox, right? You just you barely mention it, right? So, um uh the point is that uh the point is that like the the uh you can use this method to ask how new are the ideas in every single biomedical paper that's ever been published. Um so we did that me and my colleague Miko Pelin at the University of Wateroo we we we asked 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. Papers that were published in the 1980s with NIH support tended to work on ideas that were 1 2 3 years old. Papers published in the 201s were working on ideas that were seven eight years old. Uh at the same time in the 1980s the the age at which you could win a large grant at the NIH they're called RO1's you know I mean I mean you know all about that but like folks but the like the reason why these are 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 uh getting tenure at fancy universities in part I should say because RO1's 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. 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. It was really about the freedom to explore ideas. Turns out there's some some subtleties in that. There are some subies in that. But but I think it's so important for people to understand. 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 do spectacular work tend to get grants. People who get grants tend to get more money and then you can explore more etc. And the dirty secret in all the RO1 stuff is that everybody knows that the RO1's are used to fund the next bout of research. But what you propose in an RO1, sorry to break it to every it's work that's already completed. This is the inside secret of every scientist. Oh, I every scientist because you want to say look I can do this. I mean I' I've had R1 support also. I mean you show them the preliminary data. This is what I did. 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 you're done. You fire your you have to can't take students or posttos. You got to fire your technicians. You close your lab and you become what's called dead wood. So there there's a game that's being played and it's it's not a dirty game but it's this kind of like how about 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 that local culture can contaminate things and this grant this need to be funded. I'll grant you most of them. Okay. I 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. Andrew 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 RO1 was mid-30s. Okay. I got mine let's see I started my lab when I was 35. I got mine at my first RO1 I got when I was 37 but I started my lab in 2011. Right. In 2011 to 2020 that that you were young for RO1 funny right? It's a typical scientist within the mid-40s for before they got their first start. I didn't have a family. I worked 90 hours a week. Right? So the point is that young early career scientists take much longer now to be able to te 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. Um it turns out that it's early curious 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 it's monotonic like the the first year after your PhD is 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. Well, the late Ben Baris, my postoc adviser and beloved colleague at Stanford who unfortunately passed away in 2017. He used to say he's like 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 investigators, people that wouldn't know 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 this is before he knew he 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 you have to go for it. And I, if nothing else comes of today's discussion, already a lot has come of today's discussion, I want to put in a really strong vote for encouraging I'm going to 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 I'm not gonna beg but I am going to No, you don't have to beg. This is we need we need young labs. This is this is an open door. This is something I've I've I've um in my Senate testimony when I beca like before I became an IC director. This is this is a major initiative I want. I mean I think that early career let me put a like a probably too too sharp a point on it. Right. So right now what we do is we we take the careers of young scientists and and effectively put them at the service of older scientists more established scientists so that the early career scientists are essentially doing the work of the older career scientists like so you have to have postoc one posttock two posttock 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. Um that wasn't always true. And and the NIH um has played a role in that. It's be and it's part of the reason why we have had essentially this sort of inc more more incremental progress than I would have hoped for. uh you know I when I did my PhD and did my MD in the early 90s and then and then the in the into the into the mid 90s I 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 than I would have want expected as a as a a 1990 version of me especially in the biomedical sciences because I think we see the expansion of AI I we see the expansion of computer science etc. I could not agree more. I actually think um some of the programs like the postback programs at NIH I don't want to destroy this program by saying this but these are where people uh 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 look 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 they 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 do like it used to be a short posttock start a lab and hit the ground running in their 30s 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 still 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 topheavy. And 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 they'll I don't care. Get a hobby. Let the next generation in. Actually, there's there's a one good result. What one result that was u uh made made me a little bit uh uh comforted was uh in this paper that I did with Miko Pelin on on age and the trying out of new ideas. And that is that teams of young scientists, first author, relatively young, uh, teaming with a mid-career or later career scientist 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 So, keep the keep the old folks around. By the way, I'm turning 50 in September, so I'm nearing these numbers. You're still a young man. All right. Well, I have I have plenty of I'm very passionate about this in part because some of my former graduate students and postocs 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 um you know visual repair to cure 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 there in lie the the discoveries and there is this culture in academia of people kind of pinning awards on each other as you go up the ladder. Some of 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 feels good but like you know it 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. I mean, it we'll 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 got Nothing against the old. I'm not an aegist, but let's face it, youth is when discovery happens. But I think I think the let's bring this back to something you you address brought up earlier and um and I haven't yet addressed which is how we evaluate science at the NIH, right? These study sections um they're inherently as and you alluded to this, they're inherently conservative, right? So, uh, just to put a real fine point on it. So, um, I think in, uh, in the 2010s, there was a policy that in order to to be on a active member of a study section, standing me member of these grant review panels, you had to have an active RO1, a large grant, active large grant. Um, think about that, right? So, I am a scientist. I'm really well accomplished my field. I have a large grant. Uh, by every measure of scientific uh, success, I'm a success success. Um, and now I'm sitting judging young scientists pitching their ideas, some of which if they're turn out to be true, maybe undermine my my ideas. I mean, it's really hard to like open your brain and say, "Oh, okay. I'm going to I'm going to support a project that might undermine my entire career." I mean, everything we know about cognitive bias um supports what you're saying. There's another aspect too which is you know um letting go of one's own ideas especially if your funding and your ability to pay your people depends on them is 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. Being on study section helps you get grants. You have to get one first in the open water of 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 Eye Institute's audacious goals initiative. We'd get into a room every year. We'd sit around, how are we going to cure blindness? what were we going to do about pigmentotosa, macular degeneration? And then everyone everyone went back to doing the same work they were doing before. And so there a lot of times these these phrases get thrown out there, websites get put up and like nothing changes. When I talk to the public about science um like there's there's a couple of modes like one now post pandemic a lot of it is just purely cynical but like there's another mode of like thinking about scientists of just like sitting around thinking deep thoughts making big advances. But in fact what you're saying and I agree with is true and it's not entirely cynical but like the the fact is that there's a sociology to science right so I'm trying I'm there's a there's a sort of like a careerism inside science and sometimes it's it can lead to good right you know your competition with other scientists to like make the big ne next big advance but sometime but I think in the current way we structure incentives in biio medicine very often we discourage that kind of sharp innovation we We encourage essentially in incremental advances. So I have a safe scientific career for the rest rest of my life rather than uh take a big scientific risk that where where like I I might fail but if I but if I but I if I succeed I you know I cure macular degeneration. I I cure uh type two diabetes. I you know or or or or whatever, right? Um the the um the structure of this essentially if you want to like put it down as like the key problem is that in biio medicine academic biio medicine we are too intolerant of failure where if you if you have a a big idea that doesn't work essentially you're out. That's not true in Silicon Valley, right? Silicon Valley, a failed startup doesn't mean that you you can't get another draw uh at the at the you know at trying to make a successful startup, right? You Silicon Valley does not punish failure that sharply and that is the key to its success. Whereas in biio medicine and the current version of it we have now we punish failure way too sharply. Yeah. No, I I completely agree and um I should definitely point out I never had trouble getting grants. So, 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. Um 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 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 uh more ambitious. It's it's a higher risk takingaking. And unfortunately now there's so much pressure to get funding for IDC reasons and to get tenure that often times uh young investigators will lean toward the more pedestrian turn the crank type of science, get tenure and then think they're going to they're going to go do something but typically or something bigger. I am very relieved to hear that young investigators, young scientists, new ideas um are going to be prioritized hopefully through the where it really matters like brass tax like um I think early career RO1's should be bigger than late career RO1's. It should be inversely related to the size of a laboratory. I 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 RO1's 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. You 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 pastor too fast. You want to pivot them slowly. I'm kind of joking. But maybe their R1 should be smaller and they should be more selective about what they're doing because with a lot of grants topheavy in the older generation, they can kind of just spread it around. Well, that posttock went back overseas and this that didn't work out. And I hear a lot about a lot more kind of um uh quiet exit type failures as opposed to we tried really hard. We thought this this signaling pathway was going to be the thing. It it wasn't. Close that hatch, pivot quickly to the next thing. There's there's a few things we could I mean there like one of the nice things of being uh the NI director there's lots of smart people who have given me fantastic suggestions for especially for this specific problem which I think is that the key probably the most important thing I'm going to be dealing with that that plus the replication crisis which maybe we'll talk about right and I'm not sure exactly what the exact the exact portfolio of things we do will fix this but we have to support young scientists early career scientists we have to punish failure less and we have to change the incentives is uh around so that people want to test the big thing the big thing that translates into advances in in for for some of the most intractable health problems we face. Um and if we don't do that the NIH we're going to look back and say well the NIH portfolio of investments the American taxpayer made have not paid off um just from a macro scale. I mean you can you can you can frankly say this for the last at least since 2012 we have had no increase in life expectancy in the United States. the NIH portfolio in that sense did not pay off during I've heard and I think it was the former director of NIH in a public forum at the end of last year was November of last year I tuned in for that uh said that we've developed more treatments to extend the life of older people or at least to limit their suffering somewhat. So cerebrovascular disease, cardiovascular disease, uh things related to dementia, like small differences to keep them alive longer. But the real der of meaningful treatments sits around younger populations who are dying, deaths of despair or whose health is in uh really just in uh in dire condition due to obesity, diabetes, and and mental health issues. So, in other words, young people are getting sicker earlier and staying sicker and older people are um 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. That's exactly right. That's a terrible situation because it essentially is not preparing for the future. Right. So, what what we have is a system as a as a sick care system. The advances we've made have allowed people to stay sick longer. um it hasn't translated longer life right it just it's um there was a hope I think when I first started doing research in 2001 there uh in population aging um there was this idea of a compression of morbidity that is you live long a long life and the time you spent really sick and disabled was was was compressed at the very end of your life uh rather than spending a long time disabled and sick and you you you die after having spending like a decade or more very sick the idea was that that that where uh which where we have advances in our culture has produced results so that you uh you live a long life and you only spend uh you know a few months really sick at the end of your life. um that hasn't panned out right that is in fact we have uh uh very little increase in life expectancy and for many many people unfortunately a very long period of time in in a in a state where they're they're uh their quality of life is not that high not that good right uh dementia uh chronic disease leading to uh you know say diabetes leading to all kinds of of of you know kidney failure macular degeneration you you name it peripheral vascular disease, heart disease. Um, you end up with a 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. Um, I I think that uh that the biomedical infrastructure, research infrastructure of the country has to translate over for results for regular for real for real people for the American people. Otherwise, people are going to ask us what why why are we having these why why are we doing what we're doing? It can't just be that we we we're doing cool things. I mean, not that we're not doing cool things. A lot of cool things are getting done, but if they don't somehow eventually translate over, uh I don't again I don't mean to distinguish 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? The key thing is um if we're not actually improving health as a result of the research we do then we haven't accomplished our mission. Right? That's the and um the research agenda of the NIH as we've talked about it's very it's like we talked about uh you know international relations as determining in part what scientists work on it you know for in drug pricing. Um, we've talked about how politics determines the the agenda the scientists work on, right? So, you talked about HIV, right? So, the the 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. Um and and then also the sociology of professions, the scientific profession determining these are all complicated things that result in the portfolio. But 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 that it does meet those health needs. The the make America healthy again movement um 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. uh and um in large part we've not successfully done that in this country for decades. Uh otherwise we wouldn't have this m major chronic disease crisis we're currently facing. Um and so that's you know it's a complicated question. It's not like you know it's not just solve by funding one grant or making the specific decisions. It's about the incentives of the system at large to focus on on on uh an uh on on uh on to create incentives to to for the so that scientists turn their ingenuity toward those health needs rather than rather than 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. The electrolytes, sodium, magnesium, and potassium are vital for functioning of all the cells in your body, especially your neurons or your nerve cells. Drinking element dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes. To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of element in about 16 to 32 ounces of water when I first wake up in the morning. And I drink that basically first thing in the morning. I'll also drink Element dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes. Element has a bunch of great tasting flavors. I love the raspberry. I love the citrus flavor. Right now, Element has a limited edition lemonade flavor that is absolutely delicious. I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon. Again, I can't pick just one flavor. I love them all. If you'd like to try Element, you can go to drinkelement.com/huberman, spelled drinklelntt.com/huberman, to claim a free element sample pack with a purchase of any element drink mix. Again, that's drinkelement.com/huberman to claim a free sample pack. This 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 lab 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 two doors down in the hallway works on something else. Um, one of the major issues I believe that uh 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 antibbody 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. The graduate student in my lab needs a first author paper if they want to eventually get their own lab. The posttock 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 them at 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 uh funding to do the research salaries that these people can live on reasonably while they're graduate students and postocs 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 uh University in Illinois. And we all collaborate and we try and cure blindness as opposed to making it all about the principal investigator, the independent investigator. The rockstar model of science kind of works and it kind of is part of the problem in my opinion. I agree with you about collaboration in in the following sense. So um science is a collaborative process but the the incentives within science that that that for for individual advance uh can often lead to a sort of a a structure that that elevates um elevates careers without necessarily producing truth. So let me let me um let me let me flesh this out very tactfully put. Okay. Okay. So there's a a colleague of ours at at at Stanford named John Ian and Edites. He wrote a paper in 2005. Absolutely brilliant scientist. I think the most highly cited science living scientist in the world, right? So so he's he um he wrote a paper in 2005 with a title why most published biomedical uh papers are false. I mean when you make a title like that for a scientific paper, it better it better be convincing. And in in just a few pages, it's an utterly convincing paper. And uh and it's not because scientists commit fraud. That's not the reasoning behind it because science is hard. It's exactly and they're hard in exactly the way you just said Andrew. So uh you publish a result, you believe it to be true, you have some statistically significant result at some level uh you know if we say P equals 0.05, what does that mean? that that you know some percentage of the time uh the even though you believe the result is true. It's been peer- reviewviewed and uh by your colleagues the peer review actually doesn't involve as you know uh the the peer reviewers taking your data rerunning your experiments. It doesn't mean any of that they just read your paper looked for logical flaws didn't find any and then they recommended the the editor be published. So the peer review is not a guarantee that it's true. um you have some statist significance that say this this that your your data meet even with that some percentage of the time the published results going to be false. Now if you think of science a priori is hard uh any result that you publish is most likely going to be a false positive result. Ne so-called negative results aren't incentivized. very hard to get a good paper published for showing that something isn't true. It happens. I had a paper published in science which argued that at least one aspect of a theory was not true. Um 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 postoc who values their life is going to say, "Hey, I want to go in and try and disprove the hypothesis of one of the more famous people in the in the field." In fact, I I didn't set out to do that. It just so 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 because that's you're absolutely right about the incentives and that this is but this is the let's just before we get to that in the incentives we're talking analyze that just put a fine point on the nature of the problem. the the published biomedical literature, something that I've searched basically every day for the last 30 years, 40 years, my god, 40 years. Uh uh that that published biomedical literature mo most of the time that I'm reading papers in that literature, the papers I'm reading, even though they they say results their their result is true, is likely not true. Look, I had a professor in medical school once told me uh it was one of my favorite professors. because you told me, "Look, uh, half of what we're teaching you was false." Well, okay. So, I'm glad you're pointing this out. I asked a very prominent neurosurgeon, um, 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 in 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 uh people for human health?" And he said, "Incalculable." Right. Exactly. And that's true. the biomedical literature as well, right? So the published peer-reviewed biomedical literature uh is not reliable is the is the bottom line. So a lot of what the things that we think we know with even with some fair degree of certainty are probably not true. Uh and you know like the question is like which half well we don't know the answer to that question. It's probably a mix. Parts of papers are probably true and 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 right just and the reason is a combination of the fact that science is hard and the incentives we created for publication right those two together mean that the the the scientific literature is the biomedical scientific literature is not reliable um the the uh I've talked with drug developers who tell me that they they uh before They make vast investments in a phase three randomized trial or phase, you know, 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. Now those are private replication efforts so that so that the drug developers know which parts of the literature re literature are true and false uh but the public the the the scientific uh community at large doesn't know. We've set up a system, a 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 or you're out. It's linked to this idea that if you fail, if you publish failure, you're out. uh it's linked to the it's linked to uh this this sort of um uh reward that we give to scientific uh volume like the number of papers we publish and scientific influence that's what citation counts are. Uh there's a the number I'm sure you know this Andrew I'm explaining it to the folks who are listening something called an H index right? If you go to a site called Google Scholar, uh, every scientist listening to this, I'm sure, has gone and looked at their Google Scholar page, they have a little card at the 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 are things like an an H index is uh u uh it's okay. So if you have an H index of of 10, that means you have at least 10 papers published in the peerreview journals that have 10 citations each. But you don't have 11 papers with 11 citations each. So in order to get a high H index, you have to have both a lot of papers and a lot of citations to those papers. Uh it's a funny number because like you can imagine uh just to bring back Watson and Crick imagine Watson and Crick the only paper they ever published was the the structure of of of DNA good paper the double let's say it has a million citations not peer- reviewviewed 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 so their h index is one you 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 one citation so you but but you don't have two papers with two citations so your index is one or you could write a lot of reviews because reviews get cited like crazy yes okay so now what you have then is a is a is a uh incentive for scientists embedded in Google Scholar that says look uh you have to publish a lot of papers you have to have a lot of influence because that's what A citation is is it's a measure of influence. You go to scient scientific meetings in order to to to sort of shop your ideas around, right? You you um you and so we reward scientists for the influence that they have and we reward scientists with the volume of papers they publish. What we don't reward scientists for is uh honesty about their failures. We don't reward scientists for pro-social behavior like the sort you suggested but where you collaborate, you share your data openly and honestly. Um, 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 the structure we're in. Uh, I'm going to think of that as a threat. What if they don't find what I what I found? Now, I'm a failure, right? um the the the failure to replicate is seen as a failure of the scientist rather than the fact that science is hard and is difficult to like get results that are that are true even with the best of will and we punish scientists for that. So we essentially reward scientists for the for a a a set of things that creates incentives for the replication to h crisis to happen. I see. Right. So the solution to the replication crisis is to address those things, measure the pro-social things that scientists could do, recreate the incentives away from simply influence and volume. I'm not saying you shouldn't reward influence and volume. I'm saying you should reward a fuller set of things. It's like uh in baseball uh you know, you reward a hitter for home runs, but you don't also measure strikeouts. Well, you're going to get a lot of strikeouts and not necessarily you may get get a lot of home runs, but that not that that that that may be bad for the team, you know, in in total, right? So, you want a full set of statistics measuring the things you want to re to you actually want scientists to do in order to solve the problem, right? So, let's say we had statistics that said, look, uh uh do you share data with others in your published research work? And we have that as among the baseball statistics we put in in uh in in in in Google Scholar, right? Let's say uh we ask is your work subject to replication? Actually, if your work is subject to replication, you have ideas that are worth replicients, that's a success no matter what they find. Right? Do you p how frequently do you publish your false results or results that turn out to be not true, right? Um imagine we had those statistics. we would have a fuller picture of what scientists what like the capabilities of scientists the outcomes of science sc scientific work and we would reward the pro-social things that would solve the replication crisis. Um and so so what you have now is a is a is a real problem that's not been addressed. We've known about this now for decades but not been addressed adequately. Uh 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 that the issue that really cracked this open, the reason 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. They but they were wrong potentially for the wrong reasons. As a scientist, 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. Okay? because you were wrong for the right reasons, but you're not fudging data. You're not hiding data. That 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 is the replication price is playing itself out. Right. So you make investments built on a house of sand on a on a foundation of sand. Um, and you you you eventually get fancy drugs that are supposed to to prevent you from getting the disease that you're you're trying to prevent, you know, in this case, prevent you from being able to, you know, uh, prevent you from like progressing to where you can't remember the name of your kids and you can't live your live a normal you you know, it's a full life and is as you as your memory goes away. Um, the drugs don't work for those things and your question is why? They're built on the the best science going all the way down. It turns out the best science all the way down is not replicable. Um the fraud aspect of it is is actually uh not even the most it's important but it's not the most important part of it. Like it's it's it's almost just an afterthought, right? If ask yourself why have there been so many uh so many scandals brought down the former Stanford president uh the NI the NIH again just with all within Alzheimer's there was a director of neuroscience who had who 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 their where their 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've created produce those those behaviors. We created them is what you're saying. Yes. We said you will get advances in your career if you publish a lot of papers that 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 um Linda Buck, co-reient of the Nobel Prize with Richard Axel for the discovery of the molecular structure of alactory receptors, retracted, I think it was three papers from her laboratory. Uh a postoc either was sloppy or fudged data. She retracted the papers because the papers were wrong. People told her this stuff doesn't replicate. Not only did it not hurt her career, it helped her career. She was right about the alaction work that got her the Nobel Prize, but she was willing to admit a mistake. Someone in her laboratory made a mistake. Erggo, she needed to retract those papers. What happened in the case of our former colleague 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. Posttos talk, graduate students talk constantly and people know that work is solid and other work like there's something just gets said at meetings. It's like no nobody believes that when somebody says and that gets passed around so then no one follows up on it. But it's rare that somebody goes and whistleblows the way that those papers got whistleblown. And then the right thing to do in my opinion, okay, 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 Lasaskers, winning international awards as was the case in all these instances that they could admit that they were wrong. Andrew is all up and down the system. Imagine you're a posttock and you have to get your paper retract. You you retract your paper. Yeah. You you're essentially starting over or leaving science. Yeah. You're leaving science. So it's it's existential, right? The structure and so the fra the the problem of fraud in science then is a symptom of the broader problem of the replication crisis rather than the the main driver of it. Right? So the 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 uh volume and influence alone music to my ears. How do we how is NIH going to do that? So we were talking about the the the innovation crisis. That's a much more complicated crisis. This one actually I think is is doable within the context of the NIH. Uh I think you have to do three things. So first uh you have to make it a viable career path to engage in replication work in creative ways. To some extent there's some of this with like metaanalysis. Meta analysis is uh the science of analyzing uh the the the scientific literature to ask whether what the scientific literature as a whole says about a particular question. Right? That's that's what what meta analysis is. And so there are people who make careers on meta analysis. Um but and so that's in a sense a kind of replication work. Studying studies. Yes. Studying studies. Right. So um but it's really difficult to make a career out of doing replication work as a general matter within science. Uh you can't win a large grant at the NIH currently where you say I'm I'm going to do meta analysis. I'm going I'm going to do replication work. Which means then you're not going to get tenure at a top university. you're not uh because you can't win the large grant that require that you're required to get in order to win. So you're not going to focus on replication work as a as a young scientist even if you are very good at it even if you could think creatively of how to do it at scale. Um but it is discovery right like I think it you know we need to reframe it right replication is a kind of a dirty word it shouldn't be but you know years ago when uh gene arrays first became available where you could look at gene expression in cells or tissues now you do you know single cell sequencing and you can do deep sequencing and this has really evolved none of those dare I say are experiments you're not testing a hypothesis they are hypothesisgenerating experiments you get a bunch of genes you go well that one's much higher in the cancer cell and that one's much lower in a non-cancerous cell. I think I'm going to go do um like a knockout of that gene or overexpress that gene. I mean that's testing hypothesis but you there is work that's necessary but not sufficient. And what you're describing in terms of meta analyses aka rep replication maybe should be recast simply because branding matters. I it shouldn't but it does and incentivizes incentivize it as discovering whether or not discoveries are actually discoveries. What's more important than that? Yeah. Like essentially um saying is the scientific literature true? Like assessing the truth of the scientific literature, right? That's what that is. And that's a that's a real fundamental actual advance, right? Exactly the way you say. But we don't reward it. the NIH doesn't reward it. That that will change. Well, drug companies, it occurs to me, should be incentivized to do it because it will save them perhaps extensive well, 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'd like the funnel to be narrower. Yeah. I mean, that the the uh and right now they test it, they they do the replication work. Drug companies before they make those investments do the replication work, but it's private so that only they know which results are true and false in the literature. I see. Right. So if the NIH does it, the knowledge about which results are true becomes public which is makes the entire scientific literature much more reliable as a basis not just for drug discovery but also for individual behavior are which which of you know- which health behaviors should I mean what food should I eat uh to make myself healthier? Well that no one can agree on that. I know but part the reason why you can only agree on what you shouldn't eat and even there you know you mean I shouldn't be eating the Skittles with the within I heard that processed foods are bad but the other day I saw you're not going to believe this but there's a kind of a a emerging movement in one sector of the media uh that the demonization of highly processed foods is a conspiracy theory which is like like if if that so but that's a perfect example of of sort 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 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 that's a real advance in our scientific knowledge. Absolutely. without question. So the reason why we don't have consensus on what's 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 it is not replica replicable and those studies are really hard to get people to eat the same things. You know people people are probably sneaking Skittles people lie about what they eat. By the way I don't like Skittles. I've always I was more of an Eminem person just for the whatever. Let's just leave that aside. It's well it's clear that yeah that the new administration both champions healthy unprocessed foods but every once in a while you'll see one of them consume it. I've I've cut down the Skittles since the I've joined the Maha movement whatever so I mean whether the or the M&M's. Um okay so uh let's go back to we were talking about how do you asked how do you fix this right? So one is you give large grants to people in the scientific community who uh do replication work in creative important ways scalable ways. uh you you you farm out to the scientific community the question of what results in the scientific literature really need replication like the the key sort of rate limiting step kind of results that if we need to know if they're true to advance science and advance human knowledge about what uh about on questions of health right so you reward large scale large ro large grants for scientific scientists so now all of a sudden their status is lifted compared to where they were before which was down in the basement will there soon be an institute or a set of grants set aside specifically for meta analyses and uh to resolve this to to help resolve some of this so-cal replication. I'm planning to do that. Fantastic. I don't think you'll get any push back 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 reliable is money well spent. That is my belief as well. Second, you have to have a place where you can publish this work. Right now, if you send your a 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 science scientific paper you you ask yourself, is this is this something that other people have found? You can go to the the p 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 and and what do they find and get a summary of it. So this is a little bit like community notes on X in a way, but it's the scientific literature producing this community notes, right? These are formal papers with method sections and and credentials. Yeah. Like 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 uh so the point is that you'll have uh kind of a Cochran collaborative. Cochran is this is this group in the UK that uh that grades scientific evidence on on a whole bunch of different health questions in in a in a way where they they elevate uh rigorous you know randomized control studies is the highest level of evidence and then of one kind of studies is the lowest level and a whole bunch in between. Um and they'll they'll produce produce reports that say well there's weak evidence suggests this is true. Uh there's excellent evidence suggests this is true. there's no evidence to just uh one way or the other on this. They're very very nuanced in in summaries. You they you should be able to do that but with the published replication work as the core of it, right? Um 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 the journal could also publish negative results. I I tested this idea out. 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 statistic significant result in order to get your result published. You just publish the result because it's interesting and true even if it was a a negative result, right? Um uh the the journal then the NIH will stand up will plug a hole in the literature where we don't reward where we punish failure. Instead, we would re reward it where the constructive failures are published and communicated to the public to the scientist scientific community at large. We re reward replication work. Right? So fund replication work. Uh create a place where it's publishable and and essentially rewarded. And then third, this is probably the most important, measure pro-social behavior by scientists. make it part of the the suite of statistics we use to measure science scientific productivity. Not just publication, not just influence, but also do you share your data? Do you do you do you uh is your work has it been subject to replication? Do you cooperate with those replication efforts? Uh do you yourself engage in replication efforts of others? Um and make that part of the suite of statistics we measure for scientists to measure their productivity. And now all of a sudden replication becomes something you want to participate in even if you yourself are not doing it. Um it fundamentally alters the the culture of science so that rewards truth. Truth science 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 science like scientific truth as were you published in the 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. We need to reward the things that produce the ground truth rather than the things that reward just pure influence. Um and and we don't do that. It's hard and it's almost impossible as scientists that 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 I I think if we if we do these three things, it'll be it'll it'll completely transform the nature of science. You 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. You won't want to share your data with people because they'll find out you committed some fraud. All the incentives to commit fraud will just dissipate. It will it'll be liberating for scientists to be able to focus on the things we actually care about which is learning about the world. Uh true things about the world, the things that the reasons why we went into science to begin with rather than this s sort of like competitive process of trying to get uh 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 adviser who said um she said it was wild. uh she unfortunately passed away young as well, but she said, you know, why would any scientist 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 and to themselves in some sense, right? The other thing is I'll never forget um revising a paper with her and I remember thinking like ah well we have this 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. And 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 of journals. You know, I think the uh the pressure to publish in high-profile journals in order to get a really great job is so great that it leads some postocs 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. This 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 and nature but other papers in fine journals like the journal of neuroscience where the accuracy and it and in some sense the 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 only can have four figures. So I think everything you're saying is very reassuring and should be reassuring to people. Um it's music to my ears frankly and I think it will be music to the ears of graduate students and postocs 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 postoc you should hire them. That's like a 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 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 '9s, mid 80s, 90s, and that at some point something happened. Something changed. Um and I don't doubt that scientific fraud took place a long time ago. Oh, there wasn't replication. But I feel like some of the pure essence of science that you were alluding to earlier, people tackling new issues, that there isn't really uh 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 on this notion that we're sort of in a more careerist mode of science? I think part of it is just the the sheer funding levels have been been so high. I mean over the over the just just the you know I think over the time period you're talking about there was a doubling of the NIH budget there was all kinds of like increases uh and the sheer volume of research I think the the way that we man I think it's worthwhile investments to have those investments right but but to have such high volume relative to what what we had in the 80s to have such high levels of funding rel to what we had in the 80s um are you saying that we have too many scientists no I'm not saying 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 than we had in the 80s. Uh so the structures that we had in the 80s where we rewarded publication and peerreview journals as the measure of success it might have worked as a me as a to create incentives for pro-social behavior in the 80s um but it doesn't work at the volume and and the levels that we have now. And so we have to change the structures we have so that given this volume of investments um people have the right incentives to have those those pro-social we have to change we have to change how we think about we structure the incentives in 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. I'm just kidding. You have a tough job my friend. Let's talk about some of the recent changes in NIH funding that most people have heard about and then we will segue to um the barbedwire 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 um eliminated some lines of funding to particular labs. I also saw on social media and I 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 um got flushed in that process so that maybe it wasn't a uh a clean vetting of transgender versus transgenic. Um, look, every every uh administration, every person makes mistakes. So, I'm not trying to uh highlight mistakes, but I think this blew up. Um, 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, and then we can talk about this um what appeared to be a a mistake. Yeah. So, uh, first let me just talk about the mistake. First, all a lot most of this happened before I became NIH director. There's like early April is when I started. I think much of the When did you start? Uh, April 2nd, I think. So, don't come after Jay for anything that happened prior to that. And it was actually quite frustrating to be on the outside looking in going I can I could just Yeah, they were waiting for you to step in so you could take responsibility. Yeah. Anyway, obviously. So, they could blame you for something. I don't mean I don't mean to say like I I I you know like this I'm still like responsible for like addressing this going like going forward. So um uh the so I don't I don't actually don't know specifically about the transgenic that's obviously a mistake. The transgenic mice are a key tool for discovery if if that was cut. I think we we maybe it might have been a wording in in a public address um from the president. I don't know that they actually uh eliminated grants simply for studying transgenic minds. I know that grants focused on um look I years ago I studied sex differentiation in the brain and body. So not all studies where you give a 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 there are a lot of grants that you can imagine that that got flushed that were uh studying hormones and sex differences. My sense is there were some false positives like this u 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 researchers were stuck in this with a false positive they can they there's a we we've restored a whole bunch of grants like this great uh where where they where it's good science but it got caught up in this DEI um kind of the focus on like of 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. Um, first and this is really important to me. I I I 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 of minority populations and and there are legitimate scientific questions that have that that where uh the somebody's race, sex matter pretty fundamentally to the biology. And so of course as the NIH we have to be able to look at that. Yeah. Some mutations only exist in certain races or or um I mean breast cancer and the brack mutation more common much more common in women. I mean you you can't pretend this stuff doesn't exist. Correct. And so and so like that's part of science and and and the NIH absolutely supports that kind of research still despite all of the the the changes in DEI. So I I I want to uh I mean give you another example of an NIH success is the is is the uh uh research on cickle cell cickle cell anemia right so the research on uh the strategy is this gene editing strategy essentially is to switch the the the cells so that they express the fetal hemoglobin rather than the adult hemoglobin that has this this problem that that causes sickling. That's a that's a fantastic result that's gonna I think result essentially and a cure for cickle cell anemia. Amazing. Right. So amazing. And that's a it's a it's a thing that affects African-Americans much more frequently than than uh than it does white Americans just based on the genetics of the thing. So so uh 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. Like if if the mission is to improve the health and longevity of the American people, that includes people uh African-Americans, it includes, you know, Native Americans, it includes uh you know, women, uh it includes minorities, it includes people of all different sexual orientation. All of that is still part of the of the portfolio of the NIH. I I want to distinguish that from DEI. DEI I think is something where just to give you a sense of this right so uh in 2020 I was quite upset with Stanford uh with the way that it was m that we can talk about this maybe maybe later in the podcast or a different podcast but um uh I I I'd gotten grown disillusioned with the the academic freedom kind of uh that that I as a scientist enjoyed at Stanford despite being a tenure professor and so I applied for for uh for a job outside of Stanford I applied to university and One of the things they had me fill out essentially was a DEI a loyalty oath, right, where uh where you had to say your essentially your commitment to the DEI ideology, which was I mean just maybe we put a as you would say a finer point on it just because I mean I think these word you know these words diversity um equality and inclusion um I think or equity and inclusion are you know they're words but what what are maybe what are they really talking about that you'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 that essentially is the heart and soul of the DI. So just to give you another again uh a concrete thing the idea that structural racism is responsible for the health outcomes of the of the minority populations primarily right that that now uh if you think about that you say okay well you know maybe true you may think it's true you may think it's not not true depending on you who you are what you're listening to but all I'll 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 okay well minorities live in are more likely to live in food deserts. So the food they get access to easily makes their health worse. That's a that's a a scientific hypothesis. You can test it. Uh you can imagine the result being not true or true depending on the data you find. Right? That's a scientific question. That's not DEI. That's a scientific question about the health outcomes of minority populations. You can you can test scientifically. Whereas the idea that structural racism is responsible for the health outcomes of the people of the the minority population country that's not actually scientific in the same sense. You mean there isn't a clear variable to uh to focus on? Well, you there are a lot of variables that that could support or or refute that idea. I don't I don't think so. I think I think the problem is one of of the demarcation between what is science and not science. I think it's I think I think it's like a structural um so like you know this Carl Pauper had this like demarcation uh he's a philosopher in the of science in the 20th century probably most important one of the most important philosophers of science in the 20th century he had this uh demarcation criteria that said look um is your scientific hypothesis in principle falsifiable right so uh the structure of the atom involves certain hypotheses about what you can and can't observe about the momentum and the and the and the and the uh the position of of of a of a electron at particular time kit is that like what's falsifiable now there's falsifiable questions you can do an experiment that in principle could have falsified the Heisenberg idea right um versus for instance Freudian psychology right he made the point that there was in principle no scientific experiment that was outside the system so that you could falsify the Freudian idea everything inside the system was so it's not scientific Yeah, I see exactly where you're coming from. The uh I will just push back a little bit um in service to the conversation um which is for descriptive work in science. There's no hypothesis. Billions of dollars of NIH money went to gene array 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? Not really. So, anything descriptive like an electron microraph for instance of a nerve cell, you see lots of stuff. Wow, the mitochondria are 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? Crystalallography to find the double helix structure. It's still a double helix. Thank thank goodness as of this morning. I think it's still a double helix. Um 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 scientific principles and 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, that'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 scientist coming to 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 lands squarely in your camp. And 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. Okay. So let me you have two two items there. Let me address them both as per usual. Yeah. So uh the question about uh about like hypothesis dri driven science, right? So like inductive versus deductive science. The NIH funds both and it should fund both, right? So um the idea of a scientific project demonstrating uh differences based on race or some other variable that's rel biologically relevant for some health outcome without necessarily having hypothesis. That's that is good signs. Often women get breast cancer more often than men. That's right. So there's nothing wrong with that and it's not there's no policy at the NIH not to fund that. Now in fact the NIH still funds and will continue to fund exactly that kind of science. Right? Because it's still science. It's part of the scientific method. Whereas like purely structural racism causes uh causes your health health problems for minority. I don't believe is science. That's more of a psychology question than a biosciences question. Right. I don't even think it's a I don't even if if it's a psychology question, not a scientific psychology question. Like there's that I don't think it's science. I just I think it fails the demarcation problem. It's again, right? So there's no problem then with hypothesisdriven science if it's actually, you know, sort of focused on health problems that matter rather than just purely trying to demonstrate, you know, sort of uh sociological outcomes that are outside the purview of the of the NIH to to try to address. Right. Um okay, that's so let's leave that aside. Um before we do that there's an old saying that I learned uh from a very famous excellent scientist also deceased uh he used to say great dead scientist my friend all my adviserss are dead so the joke in my field is you don't want me to work for you oh my gosh okay but um 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 so there you go you know um but I would do anything to have them back uh truly they were wonderful Well, 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 wild. An aspirin will do it. You know, I don't want to discourage anyone from taking aspirin, but it it's so easy to tease out effects when you just introduce a a dramatic variable. So, I think that's what you're referring to. Yeah. And it's not junk science. It's 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 looking for differences? You can publish a paper. Yeah. Okay. So, let's just leave that aside. So, some of it's good science, some of it's not good science, some of it's not science. The DEI shift has been in terms of like funded science has been to try to excise from the portfolio things that are purely ideological boondoggles. Can you give me an example of some of these grant titles because I'm that that no longer exist. I don't want to signal uh single anybody out. So I don't want to do but just sort of of a general flavor. it it I mean I'm I'm having a hard time like structural racism uh is is the is the cause of of uh worse um cardiovascular disease not in uh African-American populations right so something like that would be an example it's not actually a specific example I can I again I don't want to point thematic thematic exactly so that would be an example right so uh but um now let's talk about the support for underrepresented minorities uh and the set aides the the the the position of the administration is that we should follow the civil rights laws of the country. The civil rights laws of the country say that we shouldn't be discriminating against people based on race. When you have a a like 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 uh and actually I I should say like from the perspective of a of a minority student, it's it's it's actually quite condescending. Like I believe very fundamentally based on lots and lots of experience with with some excellent students I've had that minority students are are often if they make the the right investments in in like the time and effort they put in, they can become have become excellent scientists. Sure. There's no there's no there's no barrier to that in the scient of the structural problems with like uh uh with like what the incentive scientists had to to to like in make those investments in young 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 uh and not just at the at the level of the you know where they're like competing for NIH dollars but even even before where everyone has access to those those kinds of resources that the URM uh scientists used to used to differentially have first you're going to end up with better a set of scientists that that actually are more capable and you're also going to have uh minority scientists at represented in proportionally to the this the the kind of desire that people have to become scientists, right? There's no there's no um like there's no field of human endeavor where you say, "Well, uh I have to have exactly the right proportion of race." I mean, if that's true, then what you have to have is like Indians and Chinese uh represented all the time, right? That's like almost three billion people of the of the eight billion people of the earth. You don't the the the justice isn't that isn't that kind of like race essentialist representation. Justice is our people who want to make the investments to become scientists have the capacity the the resources that we as a society providing it so they can become excellent scientists, right? Uh that that has to be the case, right? And we're not by by um shifting the investment portfolio toward this race essentialist thing. Well, all that matters is you're is a U is a URM underrepresented minority. It doesn't matter if you're an excellent scientist. It doesn't matter so much. I It may matter some, but that but that's not the key thing. Uh that's that it it doesn't matter if you are if you have a fantastic, you know, uh idea that challenges entire fields, but all that matters is what's your race. It moves the the emphasis in science away from what really matters in science. Like what are your ideas? Are they are they advance are they are they advancing human knowledge? Are they translating into uh health for like a large populations? Are they are they true? Are they are you are you working in things that that advance uh our our uh knowledge and reliability of the entire scientific literature? Are I mean those are the things that matter really for scientists, right? Why are we caught up then in this this idea that somehow we can um address I mean I want to be very very clear. There are real problems in that that minority populations have faced based on the history of the country. Uh there are real injustices that have happened as a consequence of them. But we're essentially asking the scientific like the scientific institutions of the country to somehow solve these like deeper problems of of essentially cosmic injustice in ways that we don't actually have the capacity to do and in some ways d a distort the investments we make and b uh cause 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 in so in sort of cosmic justice rather than rather than actual science, I I I think it's 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 there's I don't believe there's any place for this sort of race essentialism in it. So you've talked about the DEI topic slash issue from the perspective of which science does or does not get funded. Okay. So um like testing race as a theory a nonfalsifiable theory um is not something that the NIH is going to continue to support. We are also discussing DEI 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 race or 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 let's fund those proposals when we talked about earlier we talked about early career scientists and providing support to them that that's essentially along the same lines right so we're saying we're going to deemphasize the track record of scientists uh in deciding what which scientific projects to fund uh that's essentially what you're saying when you say we're going to fund early career scientists because early career scientists tend to have less less of a track record. Um I I I agree with that. I think the key thing is the ideas. Are the ideas powerful? Are they promising? Are they are they are they worthwhile in terms of being able to translate to improved health for for for uh for populations, right? So um I don't know if it's possible to get rid of some elements of identity like you know you kind of want to make sure that they've had training as a scientist. Sure. Well, they could check some boxes. I I I'm not here to solve the every aspect of the mechanics, but I guess be relevant identity like relevant like your race is not relevant to whether you have excellent scientific ideas. I fun 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 ele the key element in deciding whether they knew had a great idea or not. What was really mattered was the idea. Um now it may be the case that some people have like based on their background will have an idea more likely have an idea an an idea in a particular field than a different with a different background right so allowing people of lots of different backgrounds to have their say uh matters right but rather than focusing on the race focus on the idea is the idea important is it likely to translate improved 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 um feeling in the room or anyone explicitly saying we need to fund this grant because it comes from somebody who's an underrepresented minority. There were grants that came from underrepresented minorities, some of which are were terrific grants and some of which didn't get funded because they weren't as terrific. So, are you telling me, and it's been a little while for me, um, not a long while, but, um, that there has been a recent pattern. I'm not trying to, you know, seed the the question, but are you telling me that some grants were getting funded 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 I I never saw that to not be the case. I I mean, I think there were markers of that that were increasingly emphasized. You already mentioned one actually, Andrew. You said like you could call up your your uh uh your program officer and say look I've got a great uh um a great postoc who's a who's a URM which essentially means a minority uh and would you like to fund him and the answer would be yes there was a pool of money it was it was always 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. Yeah, that that was a there was a state I think there was a website it told us this and you know um okay well it's clear that uh NIH as it stands now in the new administration it's it's clear where their stance on DEI is I am relieved to hear that grants that might have been caught in the filter um of this change can be that did not qualify for what you're describing people that there's an appeal process because I think that shocked some of us in the science community were like oh goodness, there could be terrific grants that just got the axe. Yeah. You know that that So, there's an appeals process to fix that. Um I think um let me just make an analogy something that happened during my my uh career in I think it was around 2010. The NIH put out a a priority statement that said they was not going to fund health economics research more or less. The it was in the wake of Obamacare. uh there was a whole fight over uh cost effectiveness research and cost effectiveness research became this like political football uh where and the NI said look we're not going to fund this kind of work anymore actually impacted my career some of the work I'd done previously had had to do with like the the the relative cost effectiveness of of various uh you know drugs or whatever um and so the question was so I had to like I had to pivot away from that research if I wanted re research support from the NIH actually impact my cure quite negatively there's there's priorities and and and um the thing is uh I I don't want to argue the wisdom whether that was right or wrong to do. I personally think it was wrong, but like let's just leave leave that aside. Um I I I think the the thing is is like it's normal for the NIH to put out priorities that reflect the the the sort of social circumstances that that are around us here. I think what we have is a shift to priorities that focus on the the quality of the ideas the scient science has done rather than the racial identity of the people doing the science. And I think fundamentally it's more healthy both because we'll end up having a a a set of scientific ideas that are more likely to be replicated and more likely to be able to translate it into uh uh into advances for health and also it's better from a sort of social social uh racial social point of view because it deemphasizes things that are irrelevant to the progress of mostly irrelevant in terms of the progress of science. Right? It shouldn't matter if you're if you're a minority 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. It shouldn't make any difference whether you're minority or not. Um and for the American public at large, I mean that a lot of there's a sense of like unfairness, right? like why are you uh like I just let's leave let's move aside from the United move to like Harvard University and it and the case that it lost over the admissions right you I'm sure you remember this case right where Asian Asian students uh were found to be at a disadvantage in admissions into to Harvard they had actually the the facts of this case are really shocking right so what happened was Asian students who applied to Harvard they and non-Asian students would be evaluated by alumni interviews where the alumni would evaluate their personality. Asians and and and African-American kids were both had roughly the same average my personality score as evaluated by an interview with with alumni. Then the Harvard admissions officers would find similar kinds of of of scores based on essentially personality, but the admissions officers had never met the kids. and Asian kids routinely had much lower personality scores than than African-American kids that applied. That's what led the Supreme Court to say that was that was an illegal act of discrimination by this by Harvard against Asian kids. Um I I think this focus on race I can I can understand it because we have a history where race is a uh has been a the crux of so much pain and suffering uh and injustice in this country. You know we have a legacy of slavery that that goes back you know centuries. We have uh uh you know laws against that that that discriminate against African-Americans in in uh you know you know like the Jim Crow laws. uh we have this painful legacy of of the and slow progress in civil rights that goes back you know generations um centuries. So I understand that that's the backdrop of I'm not naive about that. What I'm saying is that these kinds of scientific the these kinds of like you 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 than better. Uh and and in particular and for me for for me as the director of the NIH is the most important thing. It doesn't allow me to to meet my mission. The mission is to do research 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. Um, and that means to me I I I don't I shouldn't be using the NIH for these sort of cosmic justice purposes for 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 advances the health and wellbeing of the American people. Yeah, I can see the parallels to something like, you know, the space program where, you know, the space program is incentivized to try and figure out the best way to meet the the uh the specific goals of the program that year and in subsequent years. And um if the public thought that taxpayer dollars were being diverted according to a social uh justice issue in order to uh try and advance the space program in that way as opposed to getting onto Mars or whatever it is. Maybe that's a bad example. It's so specific to Elon, but but you get the idea. Um so it's very clear based on what you've 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 the uh the devices and therapeutics for those discoveries and behavioral tools um that will allow for the health of all Americans. And anytime someone says all Americans, it sounds like a political statement. I I realize that. But and to leave aside social justice issues in route to that goal. That's what I'm hearing. Yeah. I mean except except to the extent that there the social justice issues can be uh articulated as clean scientific hypotheses that actually matter. Right? So like you know race differences in biological variables. It's fact that matters. Sure. Certain mutations run in certain population still supports that kind of research. But again, that's be in service of the scientific goal, not in service of some social justice goal that that that the NIH is ills suited to achieve. Yeah. As somebody who worked on vision science for many years, glaucoma is much much more common in darker skin races. There's certain areas of the world where glaucoma is at an outrageously high percentage of the population. Um, and it's not lost on people that there's a genetic inheritable component and some of the treatments might be uh need to be tailored to those specific populations. My grand my grandfather went blind from glaucoma. So get your pressures 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 um aka COVID and the lockdowns or whether or not we focus on um public health issues that are are more relevant now. I 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 one the replication crisis we talked about this and by the way I I think your plans to deal with that are are fantastic I love this idea and I think many students and postocs will excited to be part of the correction process that will evolve science. And the second one is it an admittance of error in our past. I want to be very clear not to protect myself. I have plenty of work to do uh no matter what. But these are not my words, but the words were the scientific community did us wrong. The lockdowns were unfair to in particular working-class populations. We were told one thing about masks, then told another. We got a kind of uh loop-de-loop of of uh foggy speakak 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 side, but also a lot of stated Democrats and people are 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. And I have friends trying to cure blindness, cure Alzheimer's, use brain machine interface to cure epilepsy, and get paralyzed people to walk. And you're talking to me about something that happened. But I I finally had to just stop and listen. And they 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 and as scientists and we won't admit it. And they're not just pissed off, they're kind of like done. They I hear it all the time. And again, this isn't the health and wellness supplement taking, you know, uh, you know, anti-woke crowd. This is a big segment of the population that is 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. I just want to land that message for them because in part I'm here for them and get your thoughts on kind of 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 uh against the lockdowns, against the mask mandates, against the vaccine mandates uh and against the sort of anti-scientific u uh bent of public health throughout the pandemic. I've also argued that the scientific institutions of this country should should come clean about our involvement in very dangerous research that potentially caused the pandemic, the so-called lab hypothesis, right? So uh le let's just uh let's just stay focused on on lockdowns and just just to I want to make the scientific case that they were a tremendous mistake and that that was known at the time they were tremendous mistake and let me just focus on one aspect of it we can broaden out to other lockdowns just the school closures right so uh what what the what the public at large uh now sees is that American kids especially minority kids are are are two years or more behind in their schooling. We we decided during the pandemic that children ought to learn to read as five year olds or six year olds remotely from in Zoom. Uh we decided that uh in-person schooling m didn't matter anymore. My kids in California were kept out of school, public school, for a year and a half where they they they if they saw the inside of a classroom, it was uh with with plexiglass, separated from their friends, eating lunch, isolated alone, right? U the 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. That was not a policy of the Swedish Anders Technel, the the Swed the the the head of Swedish public health explicitly made that a priority. In the summer of 2020, the Finns and the Swedes compared their results. Uh the Finn had closed schools in the in the spring of 2020 and uh the the the Swedes had not and they found there was no difference in health outcomes for COVID. the teachers in the schools at in the Swedish schools actually uh they had they had no worse outcomes than other workers in the population and on the basis of that evidence and and the fact that we know that closing schools harms the future uh health and well-being of kids even short interruption school we 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 school the closure of schools and kids was a tremendous mistake. And yet when I wrote the Great Barington Declaration with Sinetra Gupta of Oxford University and Martin Culdorf of Harvard University in October 2020, I I faced uh vicious attacks by the scientific community and the medical community for being unscientific about school closures. Were there threats to your job at Stanford? Yes. And that like real threats or just people saying we're going to take away your job? Okay. In March of 2021, I was part of a round table with Governor DeSantis, a policy round table where he asked me whether there was any evidence that masking children had any impact on the 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 was the age. There were no there were no studies. In response to that, a hundred of my colleagues signed a secret petition essentially effectively asking the the president of the university to silence me. Were you contacted by the university administration? No. I found I found out about the the 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 he then he had to say that uh that he had this mely mouth statement about academic freedom but also essentially that we that that that it's really important that we obey public health authorities or something. So like political like like boilerplate speaking. Yeah. And and in 2020 I'd been subject to uh all kinds of sort of uh attacks on on on me. I mean it just I don't want to re religate this history but I'll just say that Stanford failed the academic freedom. It it didn't hold a scientific conference on COVID with alternative viewpoints with with viewpoints that were anti-lockdown until 2024 when I organized it even though I asked to have a conference in in 2021 and 2022. But your job security wasn't threatened in a in a direct sense. No. Like no one came along and said, "Hey, like quiet down or else you're going to lose your job." So in that sense, you had academic freedom from the top. That's not true. So I was asked to stop going on the press in 2020. I was out I was I was by by the dean of the univers dean of the medical school, right? I was my my academic freedom was pretty directly threatened there there like I I I I wrote and published a study on on um measuring antibodies in the population. A study that now replicated doz was replicated dozens of times in around the world. Um and uh I was I was essentially ordered to redo that study. they they interfered even before I had put sent the the the paper in for publication. When I say they, I mean the the the the um administration of the medical school. Uh I mean my my academic freedom was pretty directly attacked. Um and I wrote a piece with uh uh how Stanford failed the academic freedom test. You can go read about read read folks who want to read about it. Again, I don't want to relitigate the pastor. No, I ask I listen I'm not trying to dig for dirt. I I asked because um well I I never saw a petition cross my email path. I did see a petition pass my email path about Scott Atlas who is um was in our department of radiology. He's a physician as you know and um was appointed Trump's coronavirus task force head of 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 that passed through. But I see a lot of petitions pass through my email. And as everybody knows and the the press has pointed out, I'm not great at email and communications. Um, but but I guess the reason I ask is, um, academic freedom means many things. Um, like can you tweet what you want to tweet? I guess I don't call them tweets anymore at the time. Could you tweet what you wanted to tweet? Could you um continue to do the science that you were doing? Could you um did 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 the the the issue here is one of like uh Okay. imagine what a UN there's a sense of like positive and negative academic freedom. A negative academic freedom means um there's no active attack on me and my capacity to do work. I think Stanford failed that as well. Like there was an active attack on me. So for instance, there was a a poster campaign all around campus with my face on it essentially accusing me of killing people in Florida for advising President Dant Governor DeSantis that there was no evidence that masking children benefited anybody, right? Uh and essentially was a threat. It's like I I I at the same time I was getting death threats from people. uh the former head of the NIH wrote an email to Fran Tony Fouchy four days after we wrote the Great Branch Declaration calling for a devastating takedown of the premises of of the declaration. And uh and and then that resulted in essentially press propaganda pieces, the New York Times and elsewhere. Uh essentially uh mischaracterizing what the Great Branch Declaration said, which is was to protect older people better and open schools, let kids let kids go to school. um essentially mischaracteriz mischaracterizing is in a propagandist 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 the campus police I told the department uh uh the the folks in the department the medical school that this was happening and they result they their response was to send me to a counselor to reduce my online presence um so Stanford absolutely failed during the pandemic it uh In 2020, um the former president uh the um John Hennessy approached me wanting to like organize a a discussion like a some some sort of like panel where different perspectives about how to manage the pandemic the lockdowns elsewhere uh could could be had and even he couldn't get this organized. Hennessy couldn't no and is one of the most um beloved presidents of Stanford. I I have tremendous admiration for him, but the the pressure was absolutely enormous. Like he the fact that he approached me at all was actually a credit to him. He's one of the few officials at Stanford who approached me during the pandemic to try to like get allow me to have I mean, you know, I might have been right or wrong. It turns out I was right, but I in principle that that you that with Stanford should have had those debates in 2020. We had prominent faculty, people like Johnny and Editi, Scott Atlas, uh, and and others, Michael Levit, who were opposed to the lockdowns, and yet we couldn't get a hearing. Yeah. Levit reached out to me at one point. I I, you know, as I've been criticized for before, you know, with this podcast, I mainly focused at that time on we launched in 2021 on ways to deal with anxiety, circadian rhythm, sleep, because people were dealing with those issues. I'm not a viologist so I couldn't talk about viology or epidemiology but I Andrew it wasn't on you to like uh put us uh on a platform. It was on the Stanford University um uh administration to organized discussions and debates on the top on the most important topics of the day and that included in 2020 were school closures the right approach. I read comments enough and and get calls and emails that I do read enough to know that when people hear this, their minds will go to um 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 um for a a you know a panel a discussion about these issues to to be um to be held. Well, we have a health policy department. what what's the purpose of it if not to like uh impanel the most important debates about health policy of the day. So so what do you think was going on? I mean the vac the the the vaccine technology was developed at multiple sites right I think Stanford had something to do with the development of the technology um 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 everyone that this is 2020 this 2020 right but eventually there was a vaccine mandate if you wanted to keep your job unless you had a religious or other what was medical reason, religious or medical reason, you were told you had to take the the vaccine. People did what they did. Some people did. Some people I know colleagues that falsified cards. I know colleagues got nine vaccines. I everything in between, right? Um but there there was a there were mandates. So to be clear, you were opposed to the lockdowns. Yes. Um and you were opposed to vaccine mandates. Were you also vocal about that? Yes. Because that's even I mean that's even touching. I was an expert witness in a number of cases on the vaccine mandates including one that uh reached the Supreme Court and overturned the OSHA vaccine mandate. Um so yeah, I mean I was I was vocally opposed to the vaccine mandates. I was vocally opposed to the mask mandates on the lockdowns. I am I was vocally opposed to the school closures. I emphasized the harm that the lockdowns did to the world's poor. Right? Right. So in April of 2020, there was a UN report uh that's that calculated that a 100 million people would would be subject to starvation as a consequence of the economic dislocation caused by the lockdowns. I I was opposed to that. Uh I I think the idea um idea that uh that the lockdowns were the right strategy. Well, they're unique in world history of having lockdowns at the scale we had. Um and they were no part of previous pandemic plans where the such a lockdown of such a length of such a at at you know at at of such a scale were no part of any previous pandemic plan or any any previous pandemic management uh experience. Um and it was very clear to me with my background in uh in um health policy that we we were going to harm the poor, we were going to harm children and we're going to harm the working class at scale. It was a the lockdowns were a luxury of the laptop class. Uh and that's what I was advocating at the time. Um the university wasn't just Stanford, you're right, but the the uh in fact there were almost no universities that that impanled these kinds of of discussions into 2022. So what do you think happened? Do you think that that there was a fear I'm not I'm not seeding the question leading the witness whatever but do you think that there was a fear among the academic and science community that if anyone if if it were allowed for people to to speak out or consider different aspects uh positive or negative about lockdowns or vaccine mandates that somehow their existence would be at risk like that this got to to an issue bigger than the lockdowns um 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. The word expert has become a very touchy thing like who gets to be called an expert? Um who 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 uh card is taken away even if they hold a position in a given area that they've I've been a a tenure faculty member at this at Stanford School of Medicine for uh for decades right I've been a full professor uh with a long scientific back like history of of published papers in some of the top medical journals the top like statistics journals health policy journals and so on economic journals um and that wasn't enough Right. Uh the pro the problem is like you have okay let me just say one one version of this that you can you can go uh there other other aspects of play for uh 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 that clouded the way they thought about especially since there a lot of older scientists I'm not trying to pick on older but there are a lot of them. Yeah. Yeah. And older people were dying more. Correct. Yeah. I mean there's I mean that was actually the the most important epidemiological fact about COVID was that was this very steep age gradient in the mortality profile. Young people very low low mortality risk older people much higher mortality risk. What was the rate of mortality among people 70 to 85 years old roughly 5 to 7% somewhere 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 not some some right. So um uh so so okay. So um but I want to leave aside the personal fear although I do think that played a tremendously important role in the in the thinking about of scientists especially since scientists as a class tend to be part of the laptop class right people who have the the economic resources to shield themselves from uh for extended periods of time without any threat to their their livelihood. That's not true for most of the world but that's true for for for scientists. Um so let's leave that aside and let's just focus on on the on the what I think was was a core dynamic right so um there's two norms two ethical norms in science it it and 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 to decide between us and whatever the experiment says we'll say okay you're right and I'm wrong and you know I'll buy you dinner or something right um that's good that's that's how science advances like through this kind of like uh this process of people talking to each other having free speech the ability to like come up with ideas and and articulate them uh defend them is absolutely fundamental to the progress of science public health has a different ethical norm public health has an ethical norm of unonyimity of messaging the the the the this this ethical norm has as its moral basis that the that the communications that public health puts out are grounded in consensus science, right? So for instance, if I were as a former professor at the stmeritus professor at Stanford, I go out and say and the director of the NIH, I go out and say smoking is good for you. Well, I've committed an ethical sin. I had 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 in in concrete ways. Um that's I mean that's just like rock solid in science. So the the 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. Mhm. The idea that closing schools is good for you. The idea that you wearing a cloth mask prevents you from getting getting COVID. The idea that immunity after CO recovery doesn't exist. The idea that uh 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 enforce the same kind of ethical approach the e sort of ethical constrictions about that 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? Literally no science. So for instance, the idea that cloth masks prevent you from getting and spreading respiratory diseases. There were a dozen randomized trials on flu before the pandemic and none of there was a Cochran report looking at the literature the random at on on masking and influenza and they and they concluded that the evidence was weak at best that these kinds of cloth masking at at in population settings actually prevent anyone the spread of influenza. I heard a number of people say like what's the big deal about wearing a mask there. There was also that argument. It's not the same thing as a vaccine. It's like it's a mask. Well, you could argue over inhaling excess carbon dioxide. You're not, you know, you're not getting smiles. You're not social inter. Listen, I'm I'm just opening this up for sake of of consideration. Why did the masks become such an issue? Was it because it was a mandate? Is that what it's really? The mandate mattered. Um, but I I'll say there there were harms, some of which were recognized, some of which were not. So like for instance I heard from parents of autistic kids that the wear that that or I'm sorry hearing impaired kids that the that the maskearing impaired the ability of the kids to learn to lipre right so it seems logical um I heard um but but it's also true that you adop if you adopt and 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. They're asking for the exact message that you're delivering now, which is um I I'll uh say it differently. They want to hear the scientific community say we messed up. Yeah. They and we should we should absolutely say that, right? So, for instance, uh 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 protects people from getting and spreading CO. Wow. Like everyone could see that. You don't need to be a scientist to see that. That was obviously uh ridiculous public health messaging. It it was a weird time. And and let's just say is it you asked is could could this public health messaging be dangerous? Well, yeah. Imagine someone who's like 80 years old. They're not they're they have a lot of chronic conditions. It's the height of the pandemic like July 2020 or something or June 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 t taken on the idea that they're safe wearing a cloth mask and they get co the recommendation not rooted in science actually could end up killing people and probably did right so it's not none of these things are just basically well it's low cost I mean it may be low cost to to to somebody who's like you know uh uh who's who's who's not particularly uh I mean particularly bothered by mask wearing but they and still nevertheless end up causing harm. And I think it kind of did. Why weren't there panels of scientists as opposed to one individual? Uh Tony Fouchy, by the way, I invited him on the podcast. Um did not get a response. This was a long time ago. Um I thought it would if I was going to hear about it, you know, these issues from anybody at that time it made sense to contact him and uh he apparently wasn't interested. We would have of course done it remotely. um 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 kind of like the United States and this isn't for like diversity reasons per se. This is about um just a a collection of smart people is way better than one person always in my opinion and they could come to some sort of consensus or maybe even disagree publicly. I think um panels would have been better. Well, I think I uh let's leave aside Tony Fouchy uh the like because I don't I think he was the a a very important figure and of course was a ma basically a major spokesperson for the public health point of view but there was essentially a group think at scale. Um it was impossible to organize a panel with that kind with the kind of diversity of opinion that was needed. There 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. Um there's there's not it's not an accident that Stanford didn't allow a scientific panel with this kind of of uh of of point of my point of view about the about the efficacy of lockdowns until 2024. Right? The idea was that uh we needed to have unonymity messaging and if you had prominent professors in Stanford, Harvard, Oxford or elsewhere saying that the lockdowns were a bad idea which they were right uh that then you were going to undermine public compliance with the orders that were being put out. Um you know just actually just a quick quick uh diversion uh how do I know the scient that that the lockdowns are a bad idea? If you look at if you ask which country had the the lowest all cause excess deaths in all of Europe. All cause excess deaths 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. Um it which country in Europe had the lowest all-c cause excess deaths? It turns out it's Sweden which didn't follow the lockdown. So the lockdowns were not a necessary uh uh ne necessary policy in order to protect human life and they weren't sufficient to protect human life either. Right? So you had locked down sharply locked down countries um like Peru that had tremendous deaths there. So the lockdowns were neither necessarily sufficient and they cause collateral harm at scale to the poor to the working class to children that we're still paying for that we still that that people are still suffering from the long tale like the like the for years in the United States from 2020 2021 2022 the deaths from overdoses of drugs were like in the in a 100,000 100,000 people died a year this past year was it was 80,000 we declared success we went down 20,000 before the the lockdowns But it was, you know, maybe 20,000 deaths a year and that was a that was a catastrophic failure, right? Um, so what the problem here is that the scientific community embraced an ethical norm about unimity of messaging and then enforced it on fellow scientists and then cooperated with the Biden administration to put in place a censorship regime that made it impossible for even for legitimate conversations to happen. Like so after the vaccines co vaccines came out there are community of people who were vaccine legitimately vaccine injured. The bid administration went to Facebook and told them essentially ordered them that you need to shut down the the patient groups that are discussing their vaccine injuries or else what the the threat was usually implied or else essentially destruction of your company. President Biden goes on national TV says and he is completely right to do this. His he is a he has the right to do this as president to say look the uh Mark Zuckerberg is killing people. He did that. He actually did that. Um and then he uh and then quietly behind the scenes they they pressured Facebook to censor patient groups that were discussing their vaccine injuries even in private groups and 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 Bington Declaration. The day I joined Twitter, I was put on a blacklist to suppress the spread of my ideas on Twitter. And almost certainly not. That's confirmed. I mean, I'm not I'm not questioning the validity of what you're saying. I saw it with my own eyes, but that was confirmed by the so-called Twitter files. Yeah. So the Twitter when Elon bought Twitter, he opened he opened up the the databases, invited me to go see them at the Twitter headquarters. I saw with my own eyes, I saw my face and it said the word blacklist on it. Um, which meant what? That when you would post, no one would see your post. Well, shadowban type. It was a trends blacklist. So, yeah, it was a shadowban. It would make sure I didn't know I was on this. 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 I joined Twitter in the first place was to to engage with people that didn't know my ideas and the blacklist made sure that that my ideas were not seen by those people. So, this is part of the reason why I think um podcasts like the Joe Rogan podcast um were uh became such a lightning rod for for this discussion. Um what's interesting is that uh remember they used to put a little tag on podcasts, you know, it would say this may contain misinformation. What they forgot uh whoever was it imposing that cuz I I don't think it was um from from the podcast houses themselves, but whoever directed that, the federal government, yeah, forgot about the '9s when there were explicit lyrics in 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. That's the beauty of the American people. We We are We like rebels. Yeah. Exactly. Um it's so pinheaded it's almost unimaginable. Like we basically the public health authorities of the country and the and the and the and the uh and the government around it decided that it knew best that it was going to it was going to control the conversations of the of the of the public at large essentially propagandize them. The real question is why? And you know, people are probably thinking, ask him about big pharma. Ask him about the amount of money that, you know, Tony Fouchy was made. You hear these theories, right? But like most biomedical scientists running labs at universities aren't going to make a dime from pharma. Most their if you saw their salaries, most people would 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 what so the question becomes why? Why all this suppression? Why all this group think? What were people so darn afraid of? I I think um just put yourself back in 2020 2021. I I I think that while again I'm not naive. I do think monetary factors played a tremendously important role. I don't think that was making money. I don't think I don't think they were the central central reason. Okay, I agree with you about that. I think the central reason is is is that the scientists that supported the censorship efforts, the scientists that uh embraced the sort of omea around uh opposing lockdown that supported that that the the 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 I think essentially what happened was that that that uh rather than thinking like scientists, they were thinking like propagandists like and in this case they were public health propagandists. They thought that their job as scientists was to was to echo public health propaganda rather than act like scientists and ask questions about the the the messages that science that the that the public health authorities were putting forward. I'm going to push back a little bit in fairness. uh perfectly valid hypothesis and you were at the center of this and I wasn't. Um but many of these people are very very smart people. I mean 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 at these places some of them are truly brilliant people and they are dare I say enough on a on a sort of a left leftrainish spectrumy type phenotype where where they're not pulled into emotional issues the same way that we might think they are. and and so it's hard for me to imagine that really smart people would join a dialogue that didn't consider all aspects and and yet that's exactly what happened Andrew like think about that right so like I mean I've thought about that quite a bit um I don't think it had anything to do with being smart or not smart I I I think it um there were a lot of really smart biologists in the Soviet Union when Lysenko got to and told Stalin that uh that Mandelian genetics was a was a capitalist plot and that Lysenko was the 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 his fear of um being ostracized and shamed by one's community and it took just a few examples like so uh you mentioned I think I mentioned earlier Scott Atlas uh who was a colleague of mine and friend um in 2020 the faculty senate of Stanford voted to censure him. Stanford has a history of of censuring three professors ever in his history. M one was a man named Edward Ross who was a who was a who's a eugenicist in the in the early part of the 20th century. U he was uh you 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 Mhm. or resigned or left. I'm not sure exactly but it was he was he was let go. Um I think he was assistant professor. Uh then Bruce Franklin who was a uh English professor at Stanford. I think you like worked on science fiction, but he was a antivietnam act war activist and he brought essentially a terrorist group to campus and he was given he was like just just like there had 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 st by Stanford for being antivietnam war for bringing for bringing the terrorists on the campus. Yeah. I mean bring terrorists on the campus and back. Well in any case there was kind of due process around both of those things like they got they got their say. Scott, his major sin was that he advice advised President Trump during the pandemic and he advocated for for keeping schools open again consistent with what was happening in Sweden and for protecting older people better because they were higher risk of dying if they got COVID. That was that was his sin. that he was seen next to President Trump and that led the faculty senate of Stanford for something they haven't taken back to issue a censure of him that that has if you look at it religious language. They declared him anathema. They effectively excommunicated him. His family is essentially was ostracized by their neighbors. He lives on campus. Um, it was it was a absolutely disgusting act and it was meant not just at at Scott but generally to send a signal to anyone who agreed with Scott to keep their head down and it succeeded. Um, not not Hoover, right? Hoover Hoover, but he was formerly the medical school as the head of neuroraiology. He's a very accomplished scientist and uh has a textbook on neur leading textbook in neurology. For a decade, he'd been adviser to presidential candidates on health policy. So, he understood from a broader point of view, he's also comes from a working-class background. So, it was guilt by adjacency. Yeah. But it was aimed at silencing opposition to the lockdowns. And it worked in large part. I I can't I can't I like lost count of people from inside Stanford and around the country who 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 completely alone. So, Levit has a Nobel Prize and uh and you had you had some buddies who were pretty smart and pretty powerful. I mean, they don't give Nobel prizes to anybody. No, Mark Mark uh Mike is incredible. He's a very brilliant man. But um u Stanford in that sense was better off, right? It we had a a sort of underground that opposed the lockdowns. very prominent scientists like Johnny Enites uh Mike Levit uh Scott uh uh there were people at places like Harvard and Oxford Harvard there was Martin Kuldorf at Oxford there was Sinatra Gupta there were folks all over the the world um but uh institutionally these in uh the the universities of the world made it almost impossible you had to b 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 owed it myself to preserve my career. And that's why I continue to speak even after even with the death threats, even with the the vilification that uh and even with the the essentially the the failure of of of uh my own institution to protect my academic freedom, I did decide I I was willing to give all of that up. That's why I kept speaking. So 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 to I mean you have the opportunity to address the entire world here you're doing some of this obviously um but will this be part of the messaging of of the NIH like we need to revise uh what we think of when we talk about academic freedom we need to revise what we actually do and um you know god forbid there's another pandemic we need to really uh be ready for the kind of discourse that um is going to unify people as opposed to to divide people. You know, after after a patient dies, uh often in a hospital, there'll be a conference, you know, where the doctors who manage the patient um will have will say will'll bluntly say to each other, often behind closed doors, what went wrong? And the the goal isn't to like actually point fingers. The goal is to figure out what happened so you don't make the same mistakes. we haven't really had that conversation as a country or as a world uh o over the pandemic and yet the harms from it still persist. I I I think um the what what I would love to do as NIH director is uh I mean is I want to reform the scientific community so that it it uh the the the values that I thought it had which is the values of free discourse and and and an academic inquir you know curiosity um those are central to our the the way we we function going forward right we want to make sure that that that that that those values are the center because you can't do science if you don't have that, right? So you you you just think about science in the Soviet Union under Lysenko, right? There was no real biology going on if you couldn't say Mandelian genetics was was was real. No, I I actually can imagine that the smallcale 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, make helpful suggestions and sometimes sadly at the end of that meeting you end up sitting there with a posttock or 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. But you can't have a a a culture in a laboratory where people can't um 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 um has gotten away from that ideal. Uh and in fact it has this weird this this ironically weird thing where like on small matters you can have that kind of a discussion but on large m matters you cannot. Um and that's that's that actually is anathema to science like that actually means that we cannot as scientists address the most important questions of the day uh without fear of essentially getting our heads cut off. Right? We had this conversation about DEI earlier. Uh, wasn't it uncomfortable? Like it was I I felt myself being uncomfortable saying what I believe is true because I know it'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, I, you know, in part because I see them through the a lot of different lenses. uh the audience lens, my role as a basic scientist, my um my role as a podcaster, you know, that the quote unquote field of podcasters completely transformed this kind of discussion and public health. I mean, it's really healthy. We can have these conversations openly and in public. Um I mean, maybe I'll get my head chopped off again, but like you know once once you've had once I think you're safe. You're I mean maybe I have to remind you you are the director of it is it is an incredible thing if you really think about it, right? Given your position in 2020 and 2021, 22, 23, etc. You're now at the top of the pyramid, it is hierarchical, and I believe you I believe your intentions are are pure and good. I do. Uh I think it's important to have checks and balances, but I really believe that you want to do right by people. I I I feel that's a felt thing. Um but yeah, it's a remarkable arc that you're now in the position to make uh major decisions for the 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 on developing truth rather than uh obeying hier 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 for the NIH. Uh 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 um in the context of analyzing data and certainly the the revision of the entire structure of the science enterprise as you point out is sociological, it's financial, there are a lot of uh a lot of different aspects to this. Vaccines are a very hot button issue these days in part because Bobby Kennedy uh has been associated with the antivax movement. I've heard him say with his own words that he's not antivax, but he's suspicious or very concerned about certain vaccines. Let's just start with a very basic question. You're an MD. Uh 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. Um do 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. Do you believe that some vaccines are known to be harmful and yet still given? Let me let me say the specific one. I think the COVID vaccine for children in particular, I don't think is net 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 especially for young men. C 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 uh I don't know some between age 12 and 30 or something for me for boys and men young men the co vaccine is probably not harmful again with boys who have no other uh underlying conditions and all that there there's not obese no heart condition. Well, I mean, even obese, you have to like look at the numbers. I mean, I there's lots of debates and fights over this in the scientific literature. So, I I I like I hesitate to like actually give you a specific age threshold, but I think just as a general matter, there exists groups for whom the COVID vaccine was net harmful spec specifically young men. Do you think there's any reason to think that the adgiants the essentially what the vaccines are suspended in, not the vaccines themselves, are potentially harmful? I've heard this. I don't I am personally not aware of any uh strong evidence for it. I I I think these are one these are the kind of things that ought to be investigated but it's very difficult to investigate just because of the the sort of like political aura around vaccines where if you ask if you are if you really do investigate it and find something that's the the the public health authorities don't like you're going to you're going to have trouble. Um I think there 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 slashmandated certainly was mandated at Stanford um but was promoted as the best line of defense for avoiding infection and reducing the symptoms of infection and reducing the probability of death. That's what I heard. um 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. Cuz uh then then I'll answer your question, I promise. Um uh answer all the other questions you had. Uh so um in December of 2020 there were uh a couple of of really important randomized trials published regarding the co mRNA vaccines. Can could you describe what one of these looks like because I'm not trying to slow 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. Uh yeah, basically so so um the the large scale randomized trials uh flipped a coin said 20,000 people I forget exact numbers uh get the vaccine. 20,000 people get a placebo or some something you know placebol like um and then um you follow them for a certain number of months and you ask uh which group's more likely to get COVID have a have a diagnosed version of COVID. um which group's more likely to die, which group's more likely to be hospitalized. And if the vaccinated group is less likely to get COVID, you report that. If if not, then you report that. Um there were randomized trials then published for several high-profile vaccines that were used during the pandemic in December of 2020. I guess November of 2020, right? So um uh the mRNA vaccines for Madna and Fizer, the Johnson and Johnson vaccine, the the um the uh Astroenica vaccine probably the four most uh important ones in the in used in England in the United States or Great Britain in the United States, uh Europe. Okay. So um what did those studies show for the mRNA vaccines? The in fact all of these studies they were run they were run these are studies that were done again randomized like high quality studies large large numbers of patients um but they were tracked for about two months right so you can't say from the randomized trials in December of 2020 what's going to happen after two months because the trials themselves only track patients for about two months. Um what they showed was that among patients who had never before had COVID, right? because they they excluded them from the analysis of of of efficacy. Among patients who never had CO before, the patients who were randomized to the vaccine had lower rates of getting COVID in the in those two months, I'm sorry, symptomatic COVID in those two months than the the people who were randomly assigned to placebo. Okay. The mRNA vaccines had more deaths in the in the treatment arm than in the placebo arm, but the size of the samples were such that you couldn't say that that was a statistically meaningful result. Okay? Couldn't say it, right? Because it's and 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 in in the in the hundreds of thousands or millions in order to get a significant result about deaths and age range really matters here. Yeah. So that 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, I what I would have argued for is to have uh the older population more represented because that's who was dying from COVID and then having the prevention of death or hospitalization is the primary endpoint. Instead, the end point was prevention of symptomatic COVID for two months. Okay? Now, they didn't ask whether you got COVID actually because there are people who got CO 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 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. Compare the household members and ask. They didn't ask that. So what you could what could you infer from the trial? You could infer that for two months people who had lower who had the vaccine were likely to have much less likely to get COVID for those two months symptomatic COVID for those two months. That's all you could say. You couldn't say they reduced death rates because it it didn't actually in the point estimate and there was not again any statistically significant difference in the Astroenica and the J&J vaccines. If you combine those, it turns out that you actually did get lower death rates in the in the vaccinated arm than the placebo arm. The J&J vaccine had lower death rates, statistically significant once you combine the trials. Was the J&J vaccine an mRNA vaccine as well? No, it was an adn noirus vector vaccine, right? And it was the single shot. Yeah. And it was like the Astroenica vaccine, similar technology, adn noirus vector vaccine. Um, okay. So, but again, those were only two months long. And the the the death rate difference was like you know it's hard to not stat it was it was not statistically powered to find one although it happened to find one in the in the adn noirus vaccines not the adn no virus vector vaccines in the mRNA vaccines you 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 2020 with Sinetra Gupta where where I arg argue that that is sufficient to say we should give the vaccine or recommend that older people get the vaccine, but that we shouldn't give it necessarily to young people. The reason was was that young people died at very low rates relative to young older people from if they got COVID and so the thing you were protecting them from was a less of a risk to them than was for older people. And so the benefit harm calculation was would would tilt toward if you have something that's a big threat and you have something that is known to prevent it for two you if it doesn't if it prevents 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 but it's extrapolation right um seemed like a reasonable extrapolation in December 2020. Um then it makes sense to give it even if there are side effects which are not known in the trial. the trials only, you know, tens of thousands of people. If you give it to billions of people, you're going to have very you're going to find out side effects you didn't know about, right? So, but there are these unknown side effects. But it seems like based on the benefit harm expectation, older people, it makes more sense to give it to whereas younger people, the benefit harm calculation runs in the opposite direction. They're unknown harms. Some harms actually you saw in the trial itself, but you know, you don't know once you give it to billions. Um, and the and the benefits small. So you I would what I wrote is you should you should recommend it for older people and then lift the lockdowns. That's the that's the oped I wrote and published in the Wall Street Journal. Um, 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 very very they would say things like well if 80 70 80 90% of the population gets the vaccine then we will have achieve her 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 immune versus the the uh you know that's that's a herd immunity is a very is a clear mathematical construct in epidemiological models of disease spread. They were the public health authorities were talking about 70 80 90% were using it as a essentially a synonym for disease eradication which it is not. Was this message only in the United States or was this message kind of uniform across the world? Yeah. The the now just consider the uh not I don't know if she's uniform like for instance uh I don't think Sweden never mandated the vaccine right with the exception of Sweden. I I just a few other places because for one public health science system to kind of collaborate in in a in this um let's let's assume that they the public messaging was was they were about a bit out over their skis so to speak. But for Northern Europe to do that and for Brazil to do that and for Australia to do that sounds like there there had to have been a a a collaboration of kind of massive scale. It's a little hard to imagine everyone collaborating in some sort of, you know, secret agenda that extends across international borders. Which just puts us back in December of November 2020 when the news about the vaccine came out, right? I like there was it was like a sense of joy that we've been a liber like this science had delivered us from this deadly plague. It was definitely exciting. Yeah. And and so like and there was this this sense of hope, right? that that that that that sort of like large numbers of people around the world I think shared um public 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 to 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? Uh I think Astroenica is a UK company. J&J is American. Fizer I think is an American company. Yeah. Merc for some reason I thought Madna is has German roots I think. I'm not sure. Bioentech is German. Madna is American. I'm not sure exactly because many of the people that are suspicious about vaccines or skeptical about vaccines um argue that it it's all financial incentives. I mean was a lot of money generated from the billionaires were created out of this. Uh and a lot of in fact the NIH uh is collecting patent royalties on the on the from the the licensing for the technology that went into the vaccines still now. Yeah. But project warp speed the development of the vaccine aka project warp speed um was a Trump program right? Yeah. President Trump authorized uh the the program in order to uh 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 in MA are are diametrically opposed in some sense that you know Maha is and Bobby Kennedy are to my knowledge it's first time that anyone's uh forcing a look at vaccines with the kind of level of detail that they they are um doing it or going to do it. Um people assume that um the Trump administration is not aligned with vaccines, but the Trump administration initiated Project War, correct? Yes. Okay. Yeah. I The idea that Bobby or or President Trump is antivax is ridiculous. This is frankly at odds with what the data actually show. Um okay, let's go back to the COVID vaccine because I think the story is really important. um public health 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 that they would not ever get CO again. That was that was that was the implicit public health messaging. You can you can you can become free. Just take this shot. You become free. you no longer have to worry about lockdowns and uh ma mask mandates or not or whatnot. It very quickly became clear that that was not true. Right? So I remember seeing uh uh the outbreak of cases in Gibralar which was like 95% vac% vaccinated. Uh and I look at them going why is Jibralter like they were using I think they were using the Astroenica vaccines like like why why are they seeing this huge spread of of COVID? Um I saw data from um well I forget which country there it was mostly using this the Chinese vaccine the syoparm which which had a more traditional technology again uh with a huge outbreak of cases in like February or March of 2021 um than Israel uh country 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 2 months from getting COVID and spreading COVID was not true. That the instead of acknowledging that fact, public health officials decided that the problem was the unvaccinated and they embraced the idea that you have to force people to get vaccinated for the public good. So they doubled down on their on their high like July August 2021 that the uh that the the the Biden administration decided to use OSHA to use CMS. OSHA is the uh the safety safety and then there's uh then there's 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? Just lose your job. Yeah. You 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 uh 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 other universities made it much more difficult. So for instance, my colleague and friend Martin Kuldorf 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 CO and recovered. He he is currently still fired. Yeah. So there were consequences for not getting it. Yes. Because we hear this word mandates, right? But I don't recall anyone coming around to my house like you know uh and insisting. I just recall that if I need to go certain places, I needed a vaccine card. um signed and so I mean essentially is a widespread restriction on your basic liberties, civil liberties. That's that was a consequence including potentially uh your employment in other countries were even worse like so Canada you couldn't go on public transportation you couldn't fly uh if you weren't vaccinated you couldn't you couldn't go to a a restaurant if you weren't vaccinated that's true in New York City by the way you had to bring a vaccine card yeah and if you could didn't have one you couldn't go in um essentially the the regime was essentially to 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 that demonstrated that if you had the COVID vaccine, you were less of a threat to other people as far as spreading COVID than uh 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 from studies in Israel especially that uh that you were that you were not less of a threat for someone who never had CO and was vaccinated. It's been three or four or five months since the vaccine. Evidence out of Qatar showed a pretty sharply sharp reduction in the efficacy of the vaccine against getting COVID by four, 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 as old as 35 40 years old there was evidence of of heart inflammation myocarditis. Transient myocarditis. Yes. But also more severe myocarditis in um post the vaccine. There was I mean that was that was clear clear evidence. Why just boys? Do we know? I don't fully understand the biology of that. A reason to do sex specific Yeah. studies and I'm in favor of that. Pass up the opportunity. Uh interesting. So, um was there any evidence that the vaccine had long-term uh detrimental effects that we're still looking at now? You know, you hear this stuff, you see it circulating, you hear more about long co. we should talk about long co but um is there any evidence that the vaccine caused long-term issues for people? I think they're likely likely that there's some people uh who have particular imunological responses or uh that there's there's also like evidence that the production process for some of the vaccines involved using um DNA plasmids which may persist uh in producing some of the products of the vac the the the the vaccine. I'm not I'm not actually frankly not I I I mean I've looked at the at the literature and it's there's a lot of like controversy around the literature and I have not made up my mind fully on on the on the 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 you you can't run a randomized trial that's done right that that the 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 uh observational studies where you need to like have a real control group uh constructed properly. Um and uh it's been difficult to to get the public health authorities who were supposed to do this to 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 or seizures at slightly higher rates. I think there's a report in 2022. Um there's there's claims online I've seen about cancer but I haven't seen anything where they've done a very careful people have done careful control groups. I don't know. It's I I I'm not leaving out the possibility. I'm just saying that um the kind of studies that I would like to see done vigorous studies that have have you know control groups even in observational settings is it's hard to find them um in the literature and whatever they're they're in the literature they seem to get attacked uh sometimes for reasons that make sense and sometimes reasons that don't. Um it's very difficult to like address this from a purely scientific point of view because the literature itself seems like it's poisoned. Do you believe long co is a real thing or is this something that people have constructed? Uh no I think it's I think it's real. I think there's um so uh I do think that the extent of it is again unclear uh but the but it's very clear that there are some so so for instance I saw a study uh I think it was in 2021 um from France where uh they looked at people who previously had COVID and previously never had CO and in among kids uh and then they were measuring subsequent long COVID rates after after infe at at long CO rates comparing the the the match match people who previously never had CO versus who who did and in kids the rates of measured long CO which back in that study I think was like a did you have one of some number of symptoms in the WHO list of long CO symptoms 3 months after the COVID infection in the match study were roughly the same rate for kids but for adults it was higher for the people who'd had CO before then uh and it was I I mean, so I I don't know the exact rate, but it's certainly a is a certainly a real phenomenon. I mean, I've met people who've had it. Same thing with vaccine injuries. Like, I've had I've met people who have vaccine injuries who who report having had concrete discreet injuries after they've been vaccinated. And I believe them. I mean, I think that uh I I generally tend to believe patients when they say things uh about themselves and um you know, especially when they have no incentive to to dissemble about it. And yeah, so I think that these are these are real phenomena that we need to address, you know, with open minds. Will the NIH andor CDC be making public statements about some of what you just described that uh the the messaging around vaccines was um in your view inaccurate? Well, I'm still saying this and I've been saying this. I I think that um but in your new I mean you're saying it here and I I um and we hear you but in your in your new role like at the at the level of you know a country of 300 plus million people like like hey folks you know we we've looked at this and you know I wasn't in charge then but here's the deal. I mean I I in my role have to like focus on stuff going forward more than like I mean the past I think is worth addressing but uh it has to be a a broader look than just me coming out saying my opinion about it. This podcast is fun but that's not the the purpose is um so I'll just give you a specific thing. Um uh my colleague Martin uh Marty McCary who runs now the the is a commissioner of the FDA he has issued a new framework for evaluating covid booster shots. Okay. So rather than just requiring to show that the co booster the new variant co booster whatever it is in the future produce antibodies in in either in lab animals or in humans in order to approve the the vaccine for use. Now going forward, the boosters have to show some efficacy against preventing COVID and preventing deaths and hospitalizations. I see. In order to get approved, that's a that's an evidence-based framework to say to essentially say if you're going to 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 why why recommend it or why why approve it? Some people might want to take the vaccine to reduce symptom severity, not just to avoid death. There's now at this point not there's not evidence if you've already had COVID and recovered. Uh there's no evidence that it that it would do that at this point for the boosters. I mean again like I want to distinguish when that's why I wanted to start with December 2020 like this was like you know we knew about these large scale studies from the the the vaccines that were new and we we knew I wanted to distinguish what we knew and didn't know. The boosters are are different vaccine and they don't have the same large scale studies behind them. They've been approved on the basis of relatively small-cale 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? Is it going to prevent me from dying? The boosters don't have that kind of evidence behind it. And so I think it was 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 uh approve them. It shouldn't just be a routine thing. This is not a flu shot. The framework, the regulatory framework that governs flu shots are are are based on decades of experience with with with flu vaccines. Are you a fan of the flu shot? I mean, I've had lots and lots of flu shots in my life. Uh, do you get it every year? Generally, yeah. And it's designed to guard against most of the the most common strains of flu that year. Does that help? Yeah. I mean, sometimes they guess wrong, it doesn't do much, and sometimes it gets right. Uh, and it does better. But, uh, I generally gotten I mean, I don't think I got it last year. Too busy, I guess. But, but you don't um it sounds like you don't have any specific concern, safety concerns about the flu shot for otherwise healthy adults. Is that right? Yeah. I mean there's if as a scientist I want to the the safety of these vaccines evaluated in a rigorous way. So I'm not I wholeheartedly support that and if the data show that I that that they're bad outcomes I'm going to say that right. Um but as a general matter the flu shot the technology used for it is le I mean it's it's a traditional technology that has a long history behind it and the regulatory framework while I do think that like the production of antibodies is is I think that's actually still the standard for the flu shot um it makes some sense right the flu strain that circulates uh is a different one every year and if you required the this like long-term clinical trial for the flu strain that's currently circulating by the time you actually recommend it would be it would be useless. Um now you can say that's true for COVID as well but we don't have decadesl 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 um what we need is an an excellent universal flu vaccine which you know there's still a lot of research to try to get uh but I don't I think I think the key thing is what I want to convey is what if you are in favor of vaccines you should not be treating this as is a religious matter where vaccine is good therefore and you believe that therefore you're a good person. Vaccine's bad therefore if you believe that you're a bad person. You 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. Uh understand patient nuances that 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, right? Or else you risk losing the pro the trust of the public, especially the public that would most potentially most benefit from the thing. Um, what you what I'm arguing for is a an actual honest evidence-based evaluation of vaccines. And that's essentially what Bobby Kennedy's asking for, right? So that's what he's asked me to do uh for not for vaccines generally but but for um uh but for but for for the the COVID vaccine that's essentially the policy. Uh now um the problem that we have in public health is that there was you asked me earlier about do I think there are certain vaccines that are worthwhile and the answer is yes. I do think that um I I I think that if we have a public health authority that's gotten it so deeply wrong about this one vaccine where people lost their jobs over it, people got injured and they were silenced over it. people people essentially felt, you know, uh felt like they were made to feel like, you know, you remember like in 2021 where people would disinvite family members from Thanksgiving if they weren't vaccinated. Yeah. Or worse. Or people were kind of excommunicated from families and workplaces. Yeah. Essentially, we we created a 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 and spreading COVID, why should I trust you on anything else? That that's where we currently are. The 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. So in keeping with that, uh 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 um 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 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 uh the the frequency of autism is is vastly increased in recent years in ways that cannot just be attributed to um improved sensitivity of tests, etc. One in 32 births is the current number. Um, and so you can understand why parents who love their kids more than anything and would do anything for their kids 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. And I don't think they should be resurrected, right? If I mean, unless there's something I'm not aware of, he said too many things that weren't true. And whatever happened are uh, you know, is 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 new administration going to take a serious uh second look at this? Yeah. So, uh I don't want to comment on the Wakefield um situation because I don't know the ins and outs of it. All we know is what happened. He lost his medical license. I just say like that like it's we're talking about one study, right? I I believe that replication matters. Um and so like there are I think on the MMR vaccine some excellent studies that fail to find a correlate a a correlation even or a causal link between vaccin MMR vaccination measures mella a vaccine that's really I think important for for the childhood for for kids um and autism like there's a massive Danish study uh that tracks patients who were vaccinated, kids who are vaccinated, matched with patients, similar patients who were not, tracks them for for for a year or longer, and f years, and finds no difference, okay? Or fails to find a diff a difference in autism rates. Um, there's people who I mean, there's all kinds of you look in on the on the online and elsewhere, there's all kinds of fights over over that, but to me, that's pretty pretty good evidence. It's it you know for for for the mR vaccine for some of the other vaccines there's there's there has been less of a focus to to ask that whether it correlates vaccine such as polio vac the I don't I don't know this literature so I shouldn't comment but I don't I I don't I don't remember seeing a study specifically asking whether the polio vaccine is linked to autism. Um when I was growing up every kid got the polio vaccine. Yeah. measles, mumps, rebella, I think, DPT. Yeah. Yeah. And and a couple others like there were probably four or five vaccines as I recall. I think that 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 I don't what when I've looked I' I haven't seen quite the same level of evidence for some of the other vaccines failing. that just haven't again they just haven't looked. Uh as a as a general matter I I think it's an unlikely just from a biological point of view unlikely to be the main reason why you autism the the rise in autism which is now well documented. You you talked about has has occurred. So to me the question then is thinking about autism you're asking you you want to tell parent answer for parents well what does cause it what what does has led to the rise in in the prevalence of autism the the honest answer is is I don't know you focused on we focused now in this con conversation on just one potential cause vaccines to me it's unlikely that that they are the reason for the rise in in the cause of autism Um but there are many other potential hypotheses for the rise in in the prevalence of autism that I've seen you know alterations the gut microbiome I've seen I've seen retinoids um there was a paper out of Pashkco Rushia's lab at Yale years ago looking at the migration of cells in the cerebral cortex and developing fetuses primate fetuses but it's a great model um and 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 it that would be wild. 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 uh explored. Well, so the point the point is that unless you know the ideology, it's very difficult to talk about the treatment. Now, of course, autism is a has a very wide range of clinical presentations, right? you have kids who have uh you know some some social awkwardness but otherwise are well adjusted you know have no no problems you know think you know uh Sheldon from Big Bang Theory or something right um or many of our colleagues our colleagues maybe me I don't know um and then you also have kids who have very severe disabilities a lot of biologically uh um uh sort of driven co-occurring conditions apexia uh you know difficulty to toilet training for it will never live system right and so you have a very wide range of outcomes it's very possible the biology is very different for folks along the spectrum um and unless you understand the ideology and might be different ideology for for for kids in different parts of the spectrum um then then uh then you're never going to have good answers both for prevention and also for for uh for therapies right so um It's it's that question that Bobby Kennedy has asked me to answer or try to get an answer. Uh and it's that President Trump has asked to get an answer and and because 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 is open um 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 as someone who's now like tried to wait into it some just to just to get a sense of it. But um but as I've waited into it, it's very very clear that there is not a scientific question, a consensus answering the question of what causes the rise in autism or what the what is the ideology of autism. But it seems that encouraging a spirit of open discourse about these other potential causes, right? I mean, and I'm not suggesting, by the way, that ultrasound causes autism. I want to be very clear, but there if you read scientific papers focused on brainwiring, and you make the uh not so outrageous leap that autism has something to do with brain wiring, maybe gut and brain and a bunch of other things, but you come across a number of very interesting pre-clinical model hypotheses that hopefully will be tested at some point. Well, things there's like environmental exposures to various various kinds of chemicals. Uh tens of thousands of chemicals in the in the in the in the uh in the environment. Um there there's uh uh events that happen in uterero potentially. There's you know uh there there's nutritional issues potentially. There's I I mean I've seen a you name the hypo I mean I'm just trying to wade this literature um from someone from the outside and it's just it's it's bewildering. I and I can't even imagine what a parent looking at this would look like with oh it's got to be right so so and to me um when there is no scientific question to an important thing that actually impacts health that what we the the answer is let's do excellent science on it now the question I've seen a lot of excellent science about how to manage autism and lots of fights over is it should I is it psycho is like psychotherapy the right approach behavioral modification is there's lots of fights over that do we address the co-occurring bi you know biological conditions how do we do address that is is it different I mean I've seen lots of like uh of literature around that which strikes me as more more advanced um uh and and sort of closer to sort of the right sort of you know answers although again there's lots of controversies even there um on the ideology 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. Um, you know, I can I I could if I could give you my most promising one, but they would mean nothing really. Um, the the the the the right thing to do in that setting is to have an open-minded investigation to try to address this problem that and now question is 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 science the scientific community at large on the ideology that we that the 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 antivaxer and that's the end of your scientific career. that kind of of of sort of suppression of scientific curiosity means that we don't we won't have an answer to this question like now so right so I've organ what I've done is I've organized a an initiative inside the NIH to address this question of the ideology of autism not limited to vaccines no wide ranging uh it it includes um uh basic science work it includes epidemiological ical work that uh it'll includes envir environmental exposure work includes all all and and we'll bring together uh data sets that we'll make available to the researchers. We'll have a competition among scientists just like the normal NIH way with peer reviewview panels to to ask who's who's who should get the the the awards. We'll have a dozen or more scientific teams asking the question what is the 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 like an open competition for these scientific projects. And uh you know, you can't rush science, but I'm hoping within a relatively short period of time, you know, who knows how long exactly, depends on how science works. We'll we'll have a much better understanding of the ideology of autism than we had uh at this current moment. Fantastic. I mean, just fantastic. I mean, regardless of where one sits on the vaccine discussion on on vaccines, can I say one thing? If so now I don't want to as the NI director I don't want to put my thumb on the scale on any part of these ide potential ideologies right as I already said I'm not particularly an expert in this area and so you know if we were to put my thumb on the scale would be from not from the point of view of expertise it would just be the point of view of like I just happened to read the literature and I was impressed by X Y or Z. Um, 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 NIH director or something and then b 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 why would you allow that people to ask that as a part of the the the research agenda? My answer is there are a lot of people uh especially in in in the public but that and even some scientists who disagree with me and I want them to have their say. I want an honest convers I 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 it's going to be something much more uh fundamental and complicated. But but I don't want the results to be uh disbelieved because I put my thumb on the scale. I eagerly await the results of the unbiased studies. Yeah, I I really do. And and thank you for um spending that time, you know, explaining what that initiative is going to look like. And I'm um delighted to hear that it's not emphasizing one particular hypothesis. The other thing about the about the initiative, it's very important to understand like we're working with autistic parents. We're working with the autism community, right? It's um a lot of times scientists when they study things, we we put ourselves above and we like it's like we're like examining amoeba or something on a on a on a slide. Uh when you do population research, you have to work with the communities that you were actually trying to help. And that's exactly the spirit of this. uh we're going to work with with communities of autistic kids and parent and parents. Um and we're going to apply uh rigorous research methods with control groups and you know just the normal uh uh sort of uh uh like high quality the the term of art now it is gold standard science like we'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 um NIMH mental health national eye institute etc uh will be restructured in some way um 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 a I'm I'm politically uh in I'm a free agent um because the budget is limited. There's it's not an infinite budget. Um depending 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, uh you can't 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 it's really Congress that determines that. Uh there's a process. Uh the administration has put forward its suggestion for a reorganization. I think it's down to eight institutes from 27 or institutes and centers. Um, uh, Congress over the past decades have had several suggestions for how to do this. It's one of these things like I could focus my re my efforts on things that I think are going to make big big changes. Um, or I could focus my efforts on like reorganization efforts. I'll I'll do what Congress the administration asks asks of me. Um but from 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. I think the key thing is not uh the structure of the institutes to me the key thing is the content of the research and the standards we we hold ourselves to in the research um th those are the things I want restructured. That's really the fundamental uh question for me as a NIH director. And if I can accomplish um some of the things we've talked about during during this podcast, uh having replicability be the core of deciding what scientific truth is, refocusing the portfolio so that we're we enable young early career scientists uh to test their ideas out. Uh that that we aim big for trying to and we address the key health problems that that that Americans face. If we can do those things that I'll I'll consider myself a success. Well, Dr. Badacharia, 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. Those aren't just words. You are extremely busy to come here and have this discussion and to uh tackle head-on questions that were not all uh easy questions. Some of them 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 uh you've been in the position of of um that's been always true. Okay. Well, yeah, it's it sounds like it's in your nature. I didn't know that the younger you, but um I love that you encourage disscent. I do believe that great science emerges from discourse that includes sometimes even just outright arguments provided it doesn't you get physical or or cruel uh where that are aimed at getting at the truth if if it's possible getting at the truth and it's also very clear that you care about exploration and I am 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 I think I'm not trying to speak in nomenclature this is so important it's it's vital that it's so important um 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 this country it's so key and so I just really appreciate you coming here to share I do want to check back with you in a year or two um see how things are going and uh 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 um 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 Bacharia. 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 and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zerocost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a fivestar review. And you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comment section on YouTube. I do read all the comments. For those of you that haven't heard, I have a new book coming out. It's my very first book. It's entitled Protocols: An Operating Manual for the Human Body. This is a book that I've been working on for more than 5 years, and that's based on more than 30 years of research and experience. And it covers protocols for everything from sleep to exercise to stress control protocols related to focus and motivation. And of course, I provide the scientific substantiation for the protocols that are included. The book is now available by pre-sale at protocolsbook.com. There you can find links to various vendors. You can pick the one that you like best. Again, the book is called Protocols, an operating manual for the human body. And if you're not already following me on social media, I am Huberman Lab on all social media platforms. So that's Instagram, X, Threads, Facebook, and LinkedIn. And on all those platforms, I discuss science and science related tools, some of which overlaps with the content of the Hubberman Lab podcast, but much of which is distinct from the information on the Hubberman Lab podcast. Again, it's Huberman Lab on all social media platforms. And if you haven't already subscribed to our neural network newsletter, the neural network newsletter is a zerocost monthly newsletter that includes podcast summaries as well as what we call protocols in the form of 1 to three page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure. We have a foundational fitness protocol that covers cardiovascular training and resistance training. All of that is available completely zero cost. You simply go to hubermanlab.com, go to the menu tab in the top right corner, scroll down to newsletter, and enter your email. And I should emphasize that we do not share your email with anybody. Thank you once again for joining me for today's discussion with Dr. Jay Bacharia. And last, but certainly not least, thank you for your interest in science. [Music]