America’s Autism Crisis and How AI Can Fix Science with NIH Director Jay Bhattacharya

0:00:02 – The American people are not stupid.
0:00:03 In fact, they’re quite smart.
0:00:06 And when we talk to them in ways
0:00:10 where we show respect for their intelligence with data,
0:00:11 allow people to disagree,
0:00:14 but then have the evidence right there in front of people,
0:00:16 I think people will respond with trust
0:00:18 where the evidence actually leads.
0:00:20 We need kind of that Silicon Valley spirit.
0:00:22 We should stop punishing scientists who fail.
0:00:24 If they fail productively, let them publish in a journal
0:00:26 to explain what they learned from it.
0:00:28 That Silicon Valley spirit, I think,
0:00:31 needs to come to science a little bit more.
0:00:34 – Autism funding, old drugs with new promise,
0:00:36 and a reset on American science.
0:00:39 Today, we’re joined by Dr. Jay Bhattacharya,
0:00:42 director of the NIH with A16Z Health & Bio
0:00:45 general partners, Vinita Agarwalla and Jorge Conde.
0:00:49 We cover the NIH’s new $50 million autism initiative,
0:00:51 lucavorin’s potential,
0:00:54 and fresh scrutiny of Tylenol and pregnancy.
0:00:56 We also dig into the replication crisis,
0:00:57 bold funding models,
0:00:59 rebuilding public trust,
0:01:01 and how AI can transform healthcare
0:01:03 from drug discovery to clinical care.
0:01:04 Let’s get into it.
0:01:09 – Well, Dr. Bhattacharya,
0:01:10 thank you so much for coming on the podcast.
0:01:11 We’re stoked to have you.
0:01:12 – I’m delighted to be here.
0:01:13 So good to talk with you.
0:01:14 I’m a little jealous I’m not in Menlo Park
0:01:16 to be there with you on this.
0:01:20 – Yeah, exactly. And we’re talking Monday, September 22nd.
0:01:22 There’s big news coming out today.
0:01:24 The Times piece on you just came out.
0:01:25 I want you to reflect on that as well.
0:01:27 But maybe you could share with us the big news
0:01:28 and why it’s so impactful.
0:01:31 – Sure. So roughly six months ago when I first started this job,
0:01:36 Secretary Kennedy challenged me to help get answers for families with autistic kids.
0:01:39 I mean, the prevalence has been rising for decades.
0:01:42 Like one in 31 kids, I think is the CDC’s latest numbers on this.
0:01:43 That’s an incredible number.
0:01:44 And we don’t have answers.
0:01:49 A lot of times families, they have these behavioral therapies that don’t really work very well for a lot of their kids.
0:01:51 We don’t know the cause, so we don’t know how to prevent it.
0:01:55 And so I’d launched, worked really hard to launch this new initiative.
0:02:00 50 million new dollars, 250 teams applied for large research grants.
0:02:07 And we’re going to announce today that 13 teams are going to be granted, you know, these grants for this autism data science initiative.
0:02:11 The other thing, there’s two other things that are going to get announced today,
0:02:16 that sort of came out of this process of working with Mehmet Oz at the Center for Medicare and Medicaid Services,
0:02:20 and Marty McCary and Secretary Kennedy, Marty McCary is the FDA commissioner.
0:02:24 One is a drug, a very common old drug called Leucovorin.
0:02:30 It’s basically like a, it’s folinic acid, but it’s like, it serves almost like a way to deliver folate to the brain.
0:02:35 Where for when some kids have folate processing, folate is, you know, something you get in vegetables, right?
0:02:38 But some kids have this difficulty processing folate.
0:02:44 It turns out that a lot of doctors have experience using folinic acid, Leucovorin, in treating autistic kids.
0:02:49 And kids who have this folate deficiency in their brains, that actually, it actually works.
0:02:54 And 20% of the kids, I think to restore speech, up to 60% of the kids, they get much better.
0:02:56 Now, not every autistic kid is going to get better with this.
0:02:59 It’s, you have to have this specific thing that’s happening in your brain.
0:03:02 But, you know, making that more widely available, I think it’s a really good thing.
0:03:07 The other one is a sort of a caution on Tylenol and acetaminophen.
0:03:10 That is a, you know, obviously a very common pain reliever.
0:03:15 It’s used, it’s the only sort of pain reliever and fever reducer used, recommended during pregnancy.
0:03:21 But there’s been new evidence that’s emerged and what’s actually highlighted by a new study put out by the,
0:03:26 the Dean of the Harvard School of Public Health just recently, actually, that suggests that use in
0:03:31 pregnancy can correlate with subsequent autism diagnoses later on for the kids.
0:03:35 Now, I think there’s a lot of controversy still over that in the scientific literature.
0:03:40 But it’s enough, I think, to say to, to moms, look, just be careful.
0:03:42 I mean, you know, you don’t use it all the time.
0:03:47 Use it only really when you really need it for high fevers, just to think prudently about it.
0:03:48 I don’t want to panic anybody.
0:03:51 That’s not the kind of result that should panic anybody.
0:03:56 It’s just a reminder that you should use any medicine carefully, especially during pregnancy.
0:04:02 Will there be any revised guide guidelines around the use of acetaminophen in pregnancy
0:04:06 to help to help, you know, moms and parents sort of make a decision
0:04:08 or have a judgment call on what they should do?
0:04:09 There will be.
0:04:09 Yeah.
0:04:13 So that’s something that Dr. McCary, the FDA commissioner is working on.
0:04:17 And there’ll be also, you know, changes in, in like how Medicare pays,
0:04:20 Medicare, CMS, Medicare and Medicaid pay for leucovorin.
0:04:22 So it’s a cross-agency collaboration for all of that.
0:04:28 So both the guidelines for parents, as well as sort of payment for, for the new, for drugs.
0:04:29 And then we got the, I’m the most boring part.
0:04:33 I just get to launch vast, interesting science projects for the, for over the next,
0:04:36 that hopefully will produce answers over the next few years.
0:04:40 Well, and the, you’re also paying attention to preterm birth.
0:04:43 And you’ve launched a really fascinating initiative there to again,
0:04:49 you know, launch not only fascinating science projects, hopefully, but also science projects,
0:04:54 which lead to clinical insight into why that’s happening to moms across America.
0:04:59 And so, you know, that’s another really interesting adjacency, if you will, to some of the announcements
0:05:00 that you just made today.
0:05:01 Yeah.
0:05:03 I mean, the preterm birth thing is, it’s really interesting.
0:05:06 Like we have worse outcomes in the United States than Europe does.
0:05:10 And, you know, we don’t really have great answers for why.
0:05:12 I mean, there’s lots of contributors to preterm birth.
0:05:15 Of course, prenatal care is so important during pregnancy.
0:05:17 Making sure you have access to that is really important.
0:05:19 So that that’s part of it, but it’s not the whole answer.
0:05:23 And we have to, we need to get answers to families on all these things that concern us.
0:05:28 I’ve heard from so many people around the country telling me, asking me answers to these
0:05:29 questions hard without excellent science.
0:05:34 And that’s my job is to make sure that we have rigorous, excellent science to address these questions.
0:05:37 It’s hard because, you know, like it’s science is difficult, right?
0:05:39 You got an answer you think is right.
0:05:45 And then, you know, eggs were bad for me in when I was 18, it turns out like, but then like later,
0:05:46 it turns out eggs are great for you.
0:05:53 And I, you know, I was fearful of eating eggs forever because the science in 1985 told me that
0:05:54 eggs are bad for you.
0:05:56 And of course, now eggs are good for you.
0:06:00 Just, you know, it’s one of those things where like the science is difficult, but we have to hold
0:06:02 ourselves to higher standards.
0:06:07 We have to be, when we talk about people, about science has to be rigorous and reproducible.
0:06:11 Something I’ve been focused on really sharply as my time as NIH director is to make sure that
0:06:13 we invest in replication.
0:06:16 The standard for truth in science ought to be replication.
0:06:20 Independent teens, you don’t, just don’t believe me just because I haven’t, I say something is true.
0:06:24 You know, other people independently looking at the same thing should write the same answer.
0:06:28 Then we know we’re more likely, we have more confidence that it’s true rather than just,
0:06:30 you know, a high authority says so.
0:06:37 For the layperson listening to this, what’s sort of been the cause for the loss,
0:06:43 I’ll say the loss of vigor in science or the law or the challenges around being able to replicate
0:06:44 science?
0:06:46 What is the underlying cause for this trend?
0:06:50 I mean, the underlying problem is just that science is hard.
0:06:52 I mean, that’s really the bottom line.
0:06:56 And then the secondary cause is that there’s just a lot of it, a lot more than there was.
0:07:01 Like once upon a time, you know, you go back to 1900 or something, every scientist knew each
0:07:05 other or very, basically knew almost every other scientist and everyone was checking each other.
0:07:07 that was just a normal course.
0:07:10 Now you have vast fields where it’s very specialized.
0:07:14 And it’s hard to get people to check other people’s work.
0:07:15 There’s no return for it.
0:07:19 If I spend my career checking other people’s work, I’m not going to get a professorship at a fancy
0:07:20 university.
0:07:21 And science is hard, right?
0:07:25 It’s very easy for scientists to latch onto an idea and say, this is right.
0:07:28 I know this is right, but it may not be right.
0:07:32 And so what matters is other people looking at it, find the same thing.
0:07:36 But often when other people look at it, they don’t find the same thing, but we don’t learn
0:07:37 about that.
0:07:37 Right?
0:07:41 There’s been the last two decades, there’s been a replication crisis in science with increasing
0:07:42 realization.
0:07:46 The standards we hold ourselves to science in determining truth are too low.
0:07:50 We basically, you can get a paper published, a peer reviewed journal.
0:07:53 You know, I’ve had 180 of them myself, which I apologize for everyone.
0:07:58 But the thing is, the fact that it’s published in a journal doesn’t mean it’s right.
0:07:59 It doesn’t mean it’s true.
0:08:01 It’s useful.
0:08:04 That’s my expression of my belief about that scientific idea.
0:08:08 I think most of my things are true, but every scientist thinks that everything they publish
0:08:08 is true.
0:08:10 That’s not enough.
0:08:12 You have to have replication.
0:08:15 You have to have other people checking each other’s work because it’s so easy to convince
0:08:17 yourself in science that you’re right.
0:08:19 And so it’s really those two things.
0:08:23 The volume of science means that people are so specialized and there’s no returns.
0:08:26 There’s no, there’s no incentives to check each other’s work as much as we ought to.
0:08:30 And then the publication standards are too, because science is too hard.
0:08:33 Science is so hard and publication standards are not high enough really.
0:08:35 That’s really the reason for the replication crisis.
0:08:37 Well, first, I just want to comment.
0:08:42 There was a joke going around yesterday, sort of a quote tweet on Twitter in response to sort of any
0:08:47 potential reduction in autism that someone said, “This is a direct attack on Silicon Valley startup
0:08:47 productivity.”
0:08:49 And you know, what will this mean for startups?
0:08:53 But yeah, exciting news there.
0:08:56 Say more just in terms of maybe we could zoom out.
0:08:58 You mentioned, you know, took over six months ago.
0:09:02 What are your reflections so far in terms of your activity and achievements to date, and then what
0:09:03 you hope to achieve going forward?
0:09:05 Well, I mean, we’ve done a lot.
0:09:11 So like one of the first things I did was we looked at, you know, the way we fund foreign collaborations,
0:09:11 right?
0:09:16 So it turns out that we fund foreign collaborations, but it’s very difficult for the NIH to check that
0:09:17 the money’s going to the right things.
0:09:19 We couldn’t audit, like the Wuhan lab.
0:09:24 The NIH had sent money to the Wuhan lab, but we couldn’t audit it.
0:09:26 So we put in a new system.
0:09:29 Like I think foreign collaborations are really important for science, but we need to do it in a
0:09:34 way where I can look the American people in the eye and say, “Look, we’re actually tracking the money.
0:09:37 We’re checking to make sure things are going to the right place, doing the right thing.”
0:09:38 I put in a new system.
0:09:42 The frustrating thing about that is like we put that in and all of a sudden I’m seeing reports that I want
0:09:46 to end all foreign collaborations, which I mean, couldn’t be further from the truth.
0:09:49 I just want to make sure that we do it in a way that’s auditable.
0:09:53 I can go in front of Congress and say, “Yeah, I know we sent money to the Wuhan lab and here’s the lab
0:09:57 notebooks that they worked on,” which we couldn’t do under the old system.
0:10:01 We’ve changed the way that we evaluate grants.
0:10:06 So we have a fantastic, at the NIH we have a great way of evaluating grants called the Center for Scientific
0:10:08 Review. It’s the world’s best peer review organization.
0:10:12 Turns out that a bunch of the institutes, the 27 institutes, a bunch of the institutes
0:10:14 had their own parallel review system.
0:10:19 So we centralized that, made it so that everyone is viewed the same way.
0:10:22 The other thing, actually, this is related to Silicon Valley.
0:10:23 It’s something we’re working on right now.
0:10:26 Okay, you guys are going to tell me that I don’t know anything about Silicon Valley,
0:10:31 even though, because I didn’t work for A16Z, but I’ll just tell you, my view of this is like
0:10:37 the reason why you all are so successful is that if you as A16Z, you have a portfolio of 50 projects
0:10:43 and you fund 50 of them and 49 of them fail and the 50th is, you know, Google or something,
0:10:45 you view that portfolio as a tremendous success.
0:10:51 And the people that those 49 companies, they’re going to get a second chance, especially if their
0:10:52 failure was productive.
0:11:00 You don’t punish failure that much. You’re willing to have a portfolio where you think big, right?
0:11:06 That, I think that spirit needs to come to science. I did published work before the pandemic asking,
0:11:11 essentially, is the NIH willing to think big? And if too often, the answer in recent decades has been no.
0:11:17 If you look at back in the 1980s and 1990s, the NIH was funding ideas that were like zero, one,
0:11:22 two years old. The typical scientific project funded by the NIH in the early 2000s and 2010s was like
0:11:28 six, seven, eight years old. We just became too scared of trying new ideas out.
0:11:33 We need kind of that Silicon Valley spirit so that, and we should stop punishing scientists who fail.
0:11:36 If they fail productively, let them publish in a journal to explain what they learned from it.
0:11:40 Like that Silicon Valley spirit, I think, needs to come to science a little bit more.
0:11:46 And do you think that the, uh, that the mechanism for reviewing the grants, say at the NIH,
0:11:49 became overly cautious or did the scientists themselves become overly cautious?
0:11:53 Well, I mean, those are closely linked. It’s a peer review organization. I mean,
0:11:57 I sat on those scientific view panels for a decade, two decades, and I watched what happens, right? So,
0:12:04 um, let’s suppose a new idea comes in front of me, right? Well, I’m really good at methods and
0:12:09 especially methods related to the old idea that this new idea is not competing with my idea, right?
0:12:13 Um, and so like, I look at the new idea, I go, this, there’s no way it can work.
0:12:18 And I say that to this peer review panel and everyone says, yeah, there’s no way it can work.
0:12:24 It’s so easy to do, right? I’m sure you face the temptation too at A16. So you get, you get a
0:12:28 thing or you look at the thing, you’re like, this is a, this is, this guy’s a, obviously a genius,
0:12:31 but he has an idea that couldn’t possibly work. I mean, that temptation is very strong.
0:12:36 And too often in science, we say, yeah, in scientific funding, we say, yeah,
0:12:40 we don’t want to give the, we don’t want to try it out. Um, and yeah, most new ideas are going to fail.
0:12:46 That’s just normal. You expect that to happen. Uh, but if you don’t leave room for people to try
0:12:50 them out, you’re never going to make big advances. Um, and I think that’s what happened to the culture
0:12:55 of biomedical science the last few decades is, is too focused on like incremental progress,
0:13:01 not enough on enormous. Now, of course there have been big improvements, uh, big, big scientific
0:13:06 discoveries, right? That I don’t want to downplay that. That’s true. But we spend a lot of money
0:13:11 and per dollar we spend a whole bunch of like science, uh, of economists who’ve looked at this
0:13:15 and the science of science folks who looked at this say that we are getting too few advances per dollar
0:13:21 that we spend. That’s because the culture is too conservative. Yeah. It’s interesting. It’s sort of
0:13:27 why many great venture partnerships, um, you know, ourselves included are not consensus driven.
0:13:33 You can’t drive, you can’t require unanimous consent to fund a big, bold idea because
0:13:38 someone’s going to say, “Hey, no, there’s no way that’s going to work.” Um, and someone has to be
0:13:44 willing to take that bet. Um, I’m curious if, and correct me if this is kind of not how you think
0:13:50 about the NIH structurally, but it occurs to me kind of as an outside observer of the organization,
0:13:57 you know, again, for listeners, our country’s and the world’s largest federally funded, you know,
0:14:04 federal funder of biomedical research across 27 different institutes, over 35 billion in funding.
0:14:09 You know, there’s a massive organization funding essentially across multiple
0:14:14 sub-disease categories, the most important research that we believe will advance
0:14:19 our health as a population. And it seems to me that there are two
0:14:22 big categories in which the NIH has to get decision-making right.
0:14:29 One is allocation and sort of how you decide how much should go to immunology versus infectious
0:14:35 disease versus maternal health and, you know, versus autism and behavioral health. And, you know,
0:14:42 there’s kind of this fundamental values-based, you know, population input-based, you know,
0:14:48 citizenship input-based, whatever it might be. There’s some, you know, risk-return-based methods
0:14:53 that you have to do to decide how do you allocate funds across these different areas.
0:14:57 And then there’s an execution challenge. Okay, once you’ve decided you’re going to allocate
0:15:04 this quantum of capital in research funding to this area, how do you pick the right investigators?
0:15:09 How do you keep them honest? How do you drive data return? How do you measure productivity on an
0:15:15 ongoing basis? How do you incentivize ongoing risk-taking in a multiple-year project? How do you
0:15:20 get your agreement straight with an international, you know, funding, you know, research partner?
0:15:24 All of these are sort of all in the bucket of execution. Is that a reasonable way for people
0:15:29 to think about the NIH? Like, you got a nail allocation and then nail execution and you’re in it to reform both?
0:15:36 So, okay. First of all, you are like, you’re, you’re very well-trained as an economist. That’s very,
0:15:38 very clear to me because that’s exactly the right way how an economist would talk about this.
0:15:39 It was your class.
0:15:45 I’m not, yep. I mean, but no, I mean, that’s exactly right, right? So first,
0:15:49 there’s a decision about where, which diseases should we focus on?
0:15:56 That’s in, it’s not only a scientific problem. It’s also a political problem. Like the,
0:16:01 and it, I, it ought to be a political problem for the reasons you just articulated, right?
0:16:07 It, it, um, the, the things that we focus on to reflect the, uh, the, the real needs of the people
0:16:13 that fund us. If we’re just doing science for science’s sake and we’re just wandering around
0:16:16 without producing answers or improvements for people’s lives, well, the question is why should
0:16:22 they fund us? And the, and it’s actually Congress that decides this. Congress and the president
0:16:28 together in the budget decide where does the money go? You know, how much to infectious diseases,
0:16:34 how much to heart disease, how much to cancer, how much to pediatric disease conditions, you know,
0:16:41 like there’s a whole allocation, um, that reflects the political will of the people as well as the
0:16:46 scientific need, uh, opportunities, right? So it’s a, it’s a, it’s a mix of the two that decides that.
0:16:49 And I think it’s so completely appropriate that, that, that, that be the case.
0:16:56 So let me, let me push back on that. Why? Why, why, why do people know enough about science and our
0:17:01 ability to make progress in important disease areas? They may not even know the names of the diseases.
0:17:06 They may not know anything about the true prevalence. They may, they’ve, they’ve, we’ve enabled them to
0:17:12 be productive in careers entirely outside biomedical science expressly so that the experts can weigh in
0:17:17 on where science is going to improve their health on an ongoing basis. And so you may say, oh, that’s,
0:17:23 you know, um, that’s an overly paternalistic view. Or you could say, well, that’s what people decided
0:17:28 they wanted. They didn’t want to have to worry about exactly what research needed to be done.
0:17:34 They decided to offload that cognitive load to you, um, at the NIH. And they, they may not want a voice
0:17:40 in that, or, you know, you know, at least that’s kind of one argument I’d make, uh, in response to the
0:17:45 idea that allocation should be political. How do you, how would you respond to that?
0:17:49 Well, I think, so somebody, let me, let me get back to the second half of your characterization,
0:17:55 because that’s where the scientific sort of, uh, expertise comes in, right? So within each area,
0:18:00 it is absolutely vital that scientists have their say, right? That they can, they can say, well,
0:18:07 this idea for addressing Alzheimer’s is promising. This idea for, for addressing, you know, autism is
0:18:12 promising. And then they can, and then scientists can check themselves and say, well, is this, is this
0:18:18 actually promising, right? So, um, it’s, and the NIH’s role is to mediate that, take that scientific
0:18:23 input, um, and, uh, make portfolio decisions that will actually advance health in those areas,
0:18:30 right? That’s, that’s, that’s basically my job. Um, and so, so that I think the scientists have their say,
0:18:36 but in the, the question of where should the money go, right? So let me just go back to the HIV epidemic,
0:18:43 just to give us some sense of what can go wrong, right? So it, the early rise in HIV did not,
0:18:50 was not met with a sufficient response by the NIH, but we’re talking very, very early in the early 80s
0:18:58 of money going to research on this vital topic. And, and it was the political movement of HIV patients
0:19:04 coming together saying, look, it’s really important that we address this, that led to the NIH actually
0:19:12 taking that real public health threat seriously, right? Um, this, if you leave it to scientists
0:19:17 themselves or our, I should say ourselves, I’ll say two things. One is we don’t reflect the will of
0:19:23 the people. Like we, we’re not good at mediating between different population groups. I mean, and it’s,
0:19:30 it’s not right, right? There’s no philosopher king that can decide, uh, well, this much money should
0:19:35 go to HIV. This much money should go to cancer. This much money should go to pediatric conditions.
0:19:42 It’s the will of the people. And so really I don’t see any other way to do it. You know, I wasn’t like
0:19:47 Winston Churchill said that democracy is the, is the, is the worst, uh, worst system of government on earth,
0:19:51 except for all the others. I mean, we don’t have a philosopher king leaving it to scientists is not
0:19:56 an answer. Like the people really should have some say in where, where that allocation happens. I
0:20:02 think, um, the other part of it is that frankly, I mean, this is something related to the, to the,
0:20:07 what we just talked about for scientists. If you ask us, we’re not actually good at predicting the future
0:20:14 of the future in terms of like our, uh, will this investment result in productivity? I mean, actually,
0:20:19 frankly, neither is Silicon Valley, right? You can’t say, you can’t promise me that every single
0:20:25 project you pick is going to work for your portfolio. You cannot, right? Um, and so scientists
0:20:30 play a vital role in deciding what scientific opportunities there are, letting us know, and then
0:20:35 we can decide, make decisions, but the portfolio decision, that’s a, that’s, that’s not exactly
0:20:42 the scientific decision. That’s an economic, small, microeconomic, small, small e kind of decision. And then
0:20:47 the, the macroeconomic decision is where there’s these areas we should go to. It really shouldn’t just be
0:20:51 scientists that decide that. Of course, there’s an interplay, right? So if there’s a scientific
0:20:55 opportunity in a particular area, I want to be able to reflect back to Congress and say, well,
0:20:59 this is a great area. You should fund this right now. Cause you know, there’s huge advances in cell-based
0:21:03 therapy for sickle cell disease. We definitely need to fund that. Right. And they’ll, and then,
0:21:08 then Congress can move based on that scientific opportunity, but that’s an exchange between,
0:21:12 uh, you know, the people and, and the scientists, not just a one-way street.
0:21:18 I like that. That’s insightful. I mean, it seems like a more interdisciplinary approach to allocation
0:21:26 and execution, um, that includes an understanding of how much we’re spending, how much it costs on a go
0:21:33 forward basis, what the economic impacts might be of getting the research right. Um, no, thanks for,
0:21:37 thanks for sharing that view. I think it’s important for people to understand that you’re trying to bring
0:21:46 more voices to the allocation question and more rigor to the execution question, but both
0:21:51 are not as straightforward as it may seem. Yeah. It’s a, it’s a, this is a weirdly
0:21:55 complicated job. Uh, I thought being a professor was complicated, but this turns out this is a little
0:22:00 more complicated than that. Are there certain areas you feel were under allocated or over allocated if,
0:22:05 if you could, uh, you know, just wave a wand? Oh, we’re all, every area is under allocated,
0:22:13 of course. I mean, I think, um, the thing is about the under allocation is I don’t know if it’s a
0:22:20 question of money. Um, but if you look at, uh, the trends in public health over the last decade
0:22:27 and a half, the United States has seen no increase in life expectancy. Um, we have enormous overhang of,
0:22:32 of, of patients, people with heart disease, uh, uh, the, the, the, the, the, actually cancer,
0:22:37 we’ve seen big improvements in, in life expectancy or sort of, uh, life expectancy after getting cancer,
0:22:43 but, but huge increases in the incidence of cancer, uh, type one, uh, type two diabetes, autism. We’ve
0:22:48 talked about a whole host of other chronic conditions. I mean, uh, and we’ve made big advances
0:22:54 in other places, right? So the question is like, uh, how can we address the biggest health needs of the
0:23:00 country? Right. It seems like we’re really good at like, and we should be good at, um, some of the,
0:23:04 some, some, some conditions that have lower prevalence. Like we’ve made tremendous advances
0:23:10 in HIV. It’s a huge cause for celebration, right? Uh, we can still have some way to go. 40,000 people
0:23:15 got HIV last year. We can end the HIV epidemic. We should still invest in that. But at the same time,
0:23:18 what about all the people that died of heart attacks? What are all the people that died,
0:23:24 died, have, have, you know, type two diabetes that are suffering from, you know, blindness because
0:23:28 they’re, uh, they, you know, cause they have, uh, you know, a bleeding in their eyes or in their
0:23:31 retinas. I mean, like, so you have, uh, what, what about the, the people with kidney failure that,
0:23:36 that the prevalence is rising? What about all we have to, we have to look at the practical health
0:23:41 needs of the country that are people are, where people are suffering and make sure that we address
0:23:45 our science to those things. It’s, and we, I don’t think we’ve done that as much as we ought to. And
0:23:49 just look at the macroeconomics. You don’t have any increase in life expectancy in this country in over
0:23:55 a decade. Um, science isn’t the only reason why. Like the, the, the fact that the NIH, I mean, the NIH
0:24:00 contributes to that, but, but it’s not the only answer. Obviously it’s very complicated. Um, but the NIH ought
0:24:04 to contribute to that. Things with science we do should translate over to better health for people.
0:24:08 And so really those areas where people are suffering the most, that’s where I want,
0:24:11 are, are, are sort of, I would say is under allocated.
0:24:17 I love this idea of, of comparing, uh, or, or analogizing the NIH to almost like a portfolio
0:24:22 manager, right? Where, and you know, similar to what we do as, as venture capitalists in Silicon Valley.
0:24:27 And if I really wanted to abuse your analogy, which I will, if you’ll allow me for a second,
0:24:30 you know, the people are almost like your limited partners are the ones that tell you,
0:24:34 these are the sort of the theses and the fund areas we want you to go after.
0:24:38 And you all are the, the investors, the venture capital investors that have to do the portfolio
0:24:44 management and picking and all of that. You said a few minutes ago that a lot of the grants in the NIH
0:24:49 are going to older ideas. And there’s, you know, lots of data that shows they’re also going to,
0:24:54 you know, more established, you know, older scientists, you know, at, at the very high,
0:24:59 you know, uh, highly regarded institutions. Um, the equivalent of that would be if we only funded,
0:25:05 um, 30 year executives that came out of, you know, large established companies and ignored,
0:25:09 you know, the young up and comers, you know, coming right out of the university or, or dropping out of
0:25:14 school or whatever. Um, you’ve talked a little bit about, you know, that question. Like, how do you
0:25:22 reform the process, the, you know, the execution to use Vanita’s, uh, phrasing on selecting for
0:25:25 the, the innovation that if you will, bubbles up from the bottom?
0:25:30 And it’s a hard question, actually. It’s something that’s the top of my mind. Um,
0:25:34 and actually the, what you just described is exactly what we’ve been doing in science for a
0:25:40 long time. So in the, the, the data out of the NIH is that from in the 1980s, if you were 35,
0:25:45 you actually had a chance of getting a large NIH grant. Like that was the, the, the, the median age
0:25:51 of the first large NIH grant, you were 35 years old. Now you’re in your mid forties. We tell young
0:25:56 investigators you got to do. Which by the way is super young to be clear. Mid forties, super young.
0:26:02 I just want to be clear about that. I mean, I’m, I’m 57. So like, I don’t, I mean, they’re all seem
0:26:10 like babies to me, but, um, but the thing is you have, um, the, the, just like as, as in Silicon Valley,
0:26:15 the new ideas come from younger, younger investigators, right? So I did a study a few years back where I
0:26:20 looked at, uh, it turns out that the age of the ideas in your published work ages by every,
0:26:27 by, by one year for every year of chronological age. So my ideas get one year older every year
0:26:32 that I age, uh, the, the very best scientists fight like crazy to stop that. So every two years
0:26:36 of chronological age for Nobel prize winners, their ideas in their papers age by a year.
0:26:43 If you want the newest ideas, you have to let the young people have their, have a try.
0:26:48 Um, and we just, just bad at that. Like young people, we fund, we fund them and then they drop out
0:26:53 and they leave for, for other places. Uh, that wasn’t true back at like the back, back in the
0:26:57 seventies and eighties. The, the culture of biomedicine says you have to have one, two,
0:27:03 three postdocs before you have a shot at assistant professor job. Um, and as a result, the ideas that
0:27:08 we, um, support are just, uh, they’re just older. I mean, that’s not necessarily a bad thing. I mean,
0:27:13 of course you should in the portfolio have some support for older ideas that were, that are still
0:27:19 promising, but if you don’t also fund, uh, some of the newer ideas, the portfolio is going to produce
0:27:25 fewer advances as a whole. Then if you, then if you do right, you have to have a, uh, you have to
0:27:30 diversify in that sense, uh, to solve that problem is hard. So the NIH has been trying to solve this
0:27:36 now for, for two decades and we made no progress. Um, so first, uh, we have to, we have to, I think,
0:27:42 um, I mean, I just give you some sense of where we’ve gone backwards. Uh, you know, uh, we, uh,
0:27:49 used to have a, uh, a system of peer review where in order to be a peer reviewer, you had to have a large
0:27:59 grant. Now think about that. I got a large grant. I’m in my fifties and, uh, I see an idea that challenges
0:28:05 my 30 years of work and I’m on this, I’m a reviewer on a panel. It’s really hard to like
0:28:11 open your mind and say, well, I might’ve been wrong. Um, that system that got changed,
0:28:16 but now that so that we don’t longer have that rule, but like it’s the, it’s the mindset you,
0:28:23 you have to allow. Um, uh, uh, so what I’ve done is I’ve, I’ve asked the, uh, institute directors,
0:28:28 I’ve given them the authority essentially to expand what they can do in terms of the portfolio.
0:28:32 I’m not going to judge them to make, just like within Silicon Valley, I’m not going to judge them
0:28:38 to, uh, on the, does every single grant succeed? I’m going to judge them on the portfolio as a whole.
0:28:41 Does it translate over to better health for the, for the people that they’re, for the disease that
0:28:46 they’re like trying to address or the diseases they’re trying to address. Does it result in big
0:28:49 advances in biological knowledge, right? I’m going to assess the portfolio as a whole.
0:28:54 And then the other thing is that is, is that does it match the strategic vision of the incident?
0:28:57 The institutes, they have these like fantastic strategic plans. Like, you know, you go look
0:29:01 at them and say your, your eyes will say, you look at them, you go like your eyes will get big with the
0:29:05 science that they’re proposing. And yet what they actually end up funding based on their peer review
0:29:11 panels is often you’ll get 10 great proposals on one part of the strategic plan and like nothing on
0:29:16 another part of the strategic plan. Um, and so like you, I’m going to encourage them to be able to pick
0:29:22 the portfolio so that matches the strategic plan. Um, uh, I’m going to reward them for,
0:29:29 for rewarding and empowering early career investigators more, right? So, uh, I’m going to
0:29:34 build incentives into the, uh, the decision-making at the, at the, by the institute directors so that
0:29:39 they have incentives to solve these longstanding problems. We have to solve the new investigator
0:29:45 problems. And I’m going to start to evaluate, um, long established investigators. Cause I think,
0:29:49 I do believe that they play a pretty fundamental role still, uh, but in the, in, in, in like,
0:29:53 how well do they advance the careers of the early career investigators that work with them?
0:29:57 Right. So if they’re good at that kind of mentorship and career advances, I’m going to,
0:30:01 I’m going to reward them, um, in the, in their grants, I’m going to start evaluating the grants for
0:30:07 that, for that too. So, cause the, the, the grant portfolio has to be, uh, sustainable in the long run
0:30:11 and producing new ideas. I mean, just that’s, we should, we need to just, and if we don’t have
0:30:15 the early career investigators, uh, sort of getting the support they need, uh, we’re, we’re going to
0:30:21 start to stagnate. I love to hear the interest in advancing early career investigators, but we can’t
0:30:27 have that conversation without talking about the universities from where they tend to come. And so,
0:30:36 you know, I was a product of NIH MSTP funding. I did my MD-PhD, um, with the generous support of the NIH. And
0:30:44 my peers and colleagues, um, you know, in my class and, you know, decades, um, behind coming up,
0:30:54 get trained on those grants today. How, how can you work with, um, you know, with the administration
0:31:01 to ensure continuity for the training grants that, you know, NIH does believe are going to
0:31:09 fuel the pipeline of early career investigators who, as you say, you know, are perhaps most likely
0:31:13 to bring change, big ideas, you know, and take big swings.
0:31:20 Yeah, I mean, we, we, as you know, uh, you are, you’re biophysics, right? So we have, we have a range of,
0:31:24 a range of like ways that we support early care investigators, right? So there’s, um, there are
0:31:30 these awards for pre-docs, pre-docs meaning undergrads. Um, and, uh, that’s really important.
0:31:35 Like we want to make sure that the undergraduate, uh, um, the, the very talented undergraduates who are
0:31:40 interested in biomedicine and research biomedicine have, have the support to do this. Um, uh, if, if,
0:31:47 if, uh, if, uh, there’s also like, uh, support for, uh, for postdocs, right? So for, for, for people
0:31:52 who are getting their PhD and then postdocs, um, I want to, it’s going to be hard, but we have to
0:31:59 structure things so that, um, uh, that, uh, the, um, uh, the range of investments we make actually
0:32:04 translate over to people wanting to stay in biomedicine. I mean, that we have a lot of people who drop out,
0:32:09 but I think the RAID problem isn’t that that support for the early, I think we have a lot of
0:32:14 portfolios pretty good on that. We could do better, but, but that’s pretty good. The problem is like,
0:32:20 after you’ve had this career in biomedicine, how do you like, do you have this research training,
0:32:26 or do you have support to like make the next leap into an assistant professor job? And too often,
0:32:32 um, it’s too hard to do that. You can’t get the support you need to do that. There’s these K awards
0:32:36 that we have that, uh, it’s really difficult to get them. Um, I think we have to do better at that,
0:32:43 and we have to reward universities that are better at that. Um, it, there’s problems all across the
0:32:48 system, but I think that miss, that missing link is really the, you know, you finish your MD and your
0:32:53 PhD, and then can you get that assistant professor job? Or are you going to be asked to do 17 different,
0:32:58 uh, postdocs before you have a chance? Uh, right now that system is set up to make it difficult.
0:33:03 So you, you mentioned earlier that we’re not making advancements in, in life expectancy.
0:33:08 Um, why are we lagging? What, why, why are some European countries doing better? And,
0:33:12 and, um, what are the highest leverage points you think to, to, to get back to improving there?
0:33:16 Well, I think, I think the key thing is we have to, a lot of our sciences is, is, you know,
0:33:21 this replication question we talked about earlier is very important. Um, we have to solve that, uh,
0:33:26 uh, that, that, uh, that will help a lot. Um, and then this portfolio thing, I think both of,
0:33:30 both of those things actually will, will, will, will, will address the sort of scientific rigor
0:33:36 problem and the sort of conservatism problem. Um, as far as like addressing life expectancy,
0:33:41 um, that, that really needs to be, it’s in a sense, not just a scientific problem. Like we have to,
0:33:46 we have to essentially get a message from the people that we want, that they want scientists
0:33:50 to address those problems. Like that’s just, we talked about earlier, the political, political, um,
0:33:56 nature of, of, of that kind of allocation decision. Um, but you know what, that’s exactly what the
0:34:01 Mahabru movement represents. The Mahabru movement is a, it’s basically a cry for help from the American
0:34:05 people saying, look, all these crime and disease problems, all these problems with our, that with
0:34:11 our kids and we’re sick, we’re much, doing much worse than folks in, in Europe, um, in terms of our
0:34:17 health with, you know, it’s, it’s, and that essentially is a, a call for the NIH to reform itself,
0:34:21 to address those problems. It’s a, uh, and to me, it’s a tremendous opportunity. Um,
0:34:25 and, uh, you know, this, this is why I agreed to take this job. I mean, I was perfectly happy
0:34:30 being a professor. Uh, um, but it’s, uh, but it’s, you know, once in a lifetime opportunity to make the
0:34:36 NIH really work for the American people. Um, you know, and I think having that political movement behind me,
0:34:43 behind us is really important for that. Last week, you announced, um, some really interesting
0:34:50 initiatives around academic freedom. And many folks know your voice kind of reached the national
0:34:56 stage, uh, in part because of your ardent, um, desire to see academic freedom respected, protected across
0:35:03 the country. And, you know, it sounds like you’re looking for ways to improve publishing fundamentally,
0:35:10 so that people feel freedom at all levels, including early career investigators, um,
0:35:14 to share their view on science that they think might be interesting. And we need to figure out,
0:35:20 to your point earlier, uh, how to make the point that anything published is not necessarily fact,
0:35:25 but it’s one opinion backed by one set of data and one set of analysis and one set of perspectives.
0:35:30 And you’d like more of those to flourish in the public arena. Say more about, um,
0:35:34 the role that you want NIH to play in protecting academic freedom.
0:35:41 Well, first at the NIH, um, I found out that a lot of folks at the internal investigators in the NIH,
0:35:47 in order to publish their work, had to seek permission from their supervisors. I changed that. Like, no more,
0:35:51 no more permission. You, if you’re an NIH researcher, you have a scientific paper, you don’t have to get
0:35:55 permission from me. If I, you, people are going to publish research that I don’t agree with. That’s,
0:36:00 that’s wonderful. Um, they should be able to do that. Um, also the, the, the, the places that,
0:36:05 uh, like the universities, I think need to be absolutely committed to academic freedom for
0:36:10 excellent science to happen. Um, and, uh, you know, like there’s been a lot of like, uh, uh, angst over
0:36:17 the, the administration’s actions with the universities over the last, uh, few months, um, uh, regarding
0:36:22 holding them to high standards regarding, you know, anti-Semitism and so on. Um, uh, but there’s also
0:36:27 been a mission message that we really do want academic freedom at the universities. Scientists
0:36:32 really able to say what they think and be, and, and, and explore where they will, uh, or else they’re not
0:36:38 good environments for research. Um, uh, as far as journals, that’s a complicated question, but there’s,
0:36:43 the problem right now is that the scientific journals, there’s essentially a, a duopoly, a very,
0:36:48 very few number of scientists, uh, companies, for-profit companies control very large number
0:36:55 of journals and they charge tens of thousands, $10,000 per article for science that they didn’t
0:37:00 do, that the American people paid for. They, they want, they actually had a, uh, a, a, a sort of a,
0:37:06 uh, if you, a policy where, uh, if a regular person wanted to go find a scientific article,
0:37:12 um, they had to go, there was a paywall where they pay like 50, $100. Uh, we got rid of that
0:37:17 paywall for NIH funded research. Um, there’s still a lot to do in this area. We need more
0:37:22 academic freedom. We need more openness in scientific publishing and I’m working on policies to do that.
0:37:27 So Jay, you know, one of the, one of the key questions of, you know, for the, for the American
0:37:32 public, they’re looking for, for better, uh, outcomes, better health. One of the big avenues
0:37:37 that of course this country uses and has really had as a gold standard in the past is, um, you know,
0:37:40 having this extraordinary public health infrastructure. But I think what’s also true
0:37:47 is over the course of the last several years, there’s a lot of, of mistrust now in terms of
0:37:53 public health. Um, how do you sort of rebuild that trust for the public? Because obviously,
0:37:57 you know, if there’s no trust, the, the, the, the message can only be so effective.
0:38:02 And so how do, how do we build those bridges back, uh, to the extent that you think they need rebuilding?
0:38:08 You know, I think the problem with public health, uh, and lack of trust in it, you have to point
0:38:12 to the pandemic. You have no choice, right? If you look at, you think back to the, the pandemic,
0:38:16 and you remember the plexiglass that was everywhere. There’s still, every time there’s see a plexiglass,
0:38:21 it makes me, fills me with rage, but that’s another story. Um, and there was no science behind that,
0:38:25 right? There was the, there was like the, you wear a mask when you walk into a restaurant and you take
0:38:30 it off when you sit down, you know, you, uh, again, no science behind it. Um, a whole host of like
0:38:34 things. And especially they were really damaging things like closing schools where again, the science
0:38:40 was so weak that it, that, uh, uh, and it’s, and yeah, now kids are like years behind in their,
0:38:44 in their education as a result of where, and they’ll be paying the price for that for years.
0:38:49 Um, and so a lot of pop, the American people have lost trust in public health for reasons I can
0:38:56 completely understand. Um, and so the question then is, what can we do about it? Uh, and to me,
0:39:00 the, the key thing is there’s two things that have to happen, like two, two very broad things.
0:39:05 Like one, um, I, I think we have to restore gold standard science. Like that, that presidential
0:39:11 EO on gold standard science is so important because what it says is it articulates things that we
0:39:16 thought all science already knew, uh, and are committed to. Like replication is really important,
0:39:22 uh, the unbiased peer review, humility, and how we talk about the limitations of our scientific findings.
0:39:26 Uh, there’s a whole host of things where you read it and go, wow, this is, this is, I thought science
0:39:31 already did that. And, um, so if we actually do that, I think that that’s a major part of this.
0:39:36 The second thing is we have to, just like we talked about earlier about the role of the people
0:39:42 and the politics and deciding what scientific priorities, what, what, like areas of science to fund,
0:39:47 and then scientists to decide what priorities within the science areas to fund and the portfolio analysis.
0:39:55 Um, we have to convey to the, to people that, that we are their partners in scientific investigation
0:40:00 and in public health. Um, public health, folks in public health are servants of the people.
0:40:05 And too often during the pandemic, it came across like we were, we were sitting above people, right?
0:40:10 Telling you what to do, uh, telling you, if you don’t take this vaccine, you can’t go to work,
0:40:15 you can’t get a job, but you, you know, I mean, it was, it was, um, it was heartbreaking to watch.
0:40:22 Because if, uh, I believe very fundamentally that when science, uh, works as partners with people,
0:40:27 like, and has this app, this almost servant attitude toward people, you can do a lot of good.
0:40:32 You can do a lot of good. Um, but I think really that kind of humility and a return to sort of, uh,
0:40:36 gold standard science, that’s the way to solve the problem of trust. It’s going to take a long time,
0:40:41 though. Um, because I mean, I’ve talked to so many people around the country and it’s, it’s not, um,
0:40:43 we’re nowhere near solving that public trust problem.
0:40:50 Dan, I think it’s, it’s an especially challenging thing as you look forward. Um, uh, and I’d love to
0:40:56 hear your thoughts on, you know, how do you convey, uh, you know, uh, recommendations and guidance
0:41:02 in the face of uncertainty and incomplete information, right? Because going back to your point, like,
0:41:06 in an ideal world, you’re always resting on top of gold, of, you know, gold standard science,
0:41:11 you know, but, you know, a lot of times science, you know, there’s a lot of unknowns in the science.
0:41:15 Science is hard, going back to what you were saying earlier. And so, how do you communicate to,
0:41:22 you know, a population, a nervous, a nervous populace, you know, a sense of, of, of a recommendation
0:41:26 or, or even guidance in a, in a world where you yourself have incomplete information?
0:41:32 I think you just have to be honest, right? So if I, um, asked a question about,
0:41:37 I mean, God forbid, there’s another pandemic during my watch and then, and then I’m asked,
0:41:44 okay, how should we manage, uh, is, is it right to wear a mask or something, right? Um, and I don’t,
0:41:48 there’s no good scientific evidence. I’m going to just say that. I, I, you know, the, well, it’s,
0:41:52 the analogy I, I, I was a medical student once, I have an MD. So like, I can tell you this from
0:41:56 firsthand experience. You’re at the first two years of med school, you do a bunch of class work.
0:42:02 The third year, you finally get to see patients, right? So you go walk into a patient room and,
0:42:07 uh, you’re wearing a white coat and you know, nothing or very little. I mean, you know, all,
0:42:11 you could fill with knowledge about biochemistry. You can like write, you know, chemical equations.
0:42:16 So your, um, your fingers get tired, but what you can’t do is understand what a patient really needs.
0:42:20 Um, and so you hear, you sit down in front of the patient, they tell you their stories.
0:42:25 It’s wonderful. Like they’re big. They put their trust in you. Um, and you are tempted to tell them
0:42:31 things, uh, to answer their needs that they’re asking you, but you don’t know the answer. You
0:42:34 just don’t because you’re a third year med student. Of course, you don’t know the answer.
0:42:39 And there’s a, there’s a, like, because you’re wearing the white coat and because you have someone
0:42:44 looking at you, wanting the answer, um, putting their trust in you, you can feel this urge to like,
0:42:50 say things you don’t know. You know, you, you start like freelancing. Um, and that’s just a terrible
0:42:54 mistake, right? As a third year med student, you learn that you should just say, I don’t know. I’m
0:42:58 going to look it up. I’ll look, they’ll look the answer for you. I’ll get back to you. Um, I’ll consult
0:43:05 with people who know more than I do. You have to be humble. And especially in the face of new things,
0:43:10 you know, new, new, new pandemic or new or, or genuine scientific uncertainty.
0:43:15 We in public health have to be humble and say, look, I’m, we’re not sure, but here’s how we’re
0:43:20 working to try to get an answer. Um, we’re gonna, and we have to convey that uncertainty and we can’t
0:43:25 blame the public. I’ve, I’ve gone around and talked to lots of folks, uh, in, in public health and
0:43:30 science. And they’re like, well, what we have to do is we have to teach the public more about science
0:43:34 and makes them make sure they understand that science isn’t always perfect. And science like
0:43:39 moves, you know, you may have eggs are great one day and eggs are terrible one another day. That’s
0:43:45 because we have new science. To me, that’s like blaming the public. It’s not the public doesn’t
0:43:50 understand that science is hard. They understand it fundamentally. Like they just, this is not a
0:43:55 complicated thing in the sense of like, um, I mean, it’s every, everyone knows within the public,
0:44:00 the science is hard. The problem is that scientists conveyed certainty about things
0:44:04 they had no business conveying certainty about, and then changed people’s lives for the worst as
0:44:10 a result of it during the pandemic. And say, I acknowledge that there, you know, that the pandemic
0:44:15 was a particular challenge, um, with respect to both communication and certainty in the midst of
0:44:27 uncertainty. But how do we acknowledge that challenge and not lose trust in some of the bedrocks of public
0:44:33 health advancement that we’ve made over the last several decades, whether that’s newborn vaccinations,
0:44:41 you know, HHS held, um, held a listening tour and, uh, an advisory update on hep B vaccination in,
0:44:48 in babies. And it’s great that we’re looking at all of the data holistically there. But in some of those
0:44:54 cases, you know, some folks would argue there is substantially less uncertainty than there was
0:44:59 in the wake of a new pandemic with a new virus, with no data, with new, you know, completely new
0:45:04 infections, you know, than there is in the context of something like a hep B. So how do we, you know,
0:45:10 and please don’t feel the need to respond to that specific, um, vaccine example, but how do we not
0:45:15 make it so that even when you do have relative certainty and you come out and say, “Hey, we really,
0:45:21 this is not perfect, but we’re pretty darn sure this is a good idea.” Um, how do you then make it so
0:45:26 that people don’t say, “Well, you know, last time you said you didn’t know, so I don’t know.”
0:45:30 Right. So I, I think, um, I don’t know is a good answer when you don’t know.
0:45:36 When, when you have a little more evidence, a lot more evidence, like just take the MMR vaccine.
0:45:40 Like the, I mean, if you want to prevent measles, take the MMR, MMR vaccine. I mean,
0:45:44 it’s the best way to prevent measles and measles can be a deadly disease. Like I vaccinated my kids
0:45:51 with MMR. I was really happy I did. Um, uh, and I think that that, um, you know, I, I think that that
0:45:57 kind of, um, certainty, it’s, it, you know, it’s science, right? So you’re, nothing is known that
0:46:01 tomorrow that someone might come along and they overturn, you know, Newtonian physics and all of
0:46:04 a sudden you’re talking about relativity or something, right? That, that, it’s probably,
0:46:08 you’ll always leave open that possibility. Um, but some things we do know with certain,
0:46:15 with like much more certainty. Um, I, I, I’m, I’m not saying that we should all have false humility.
0:46:19 I think we should have humility for the things we just should actually have humility about.
0:46:26 Right. Um, uh, but at the same time, when we have an area of more scientific certainty,
0:46:31 we have to leave open room for academic freedom so that people can have their say that, that, that,
0:46:36 that, that think differently. Um, we don’t cancel them. We don’t, we just, we reason with them.
0:46:40 And we say, look, you, you think, you think you say X, Y, Z, but look at all this other evidence
0:46:44 for MMR is a good example. Look at all the evidence that, that, um, that, that shows you
0:46:48 differently and they’ll just have a public discussion. It’s okay. I mean, it’s okay to
0:46:53 have that contradiction. Um, and then, and then, um, and then I think what we’ll come across is
0:47:01 when there is actual excellent science replicated, um, I, I, maybe I’m naive, maybe I’m, uh, maybe,
0:47:05 but I don’t think so. I, I think that wins scientific debates and you can look,
0:47:10 there’s evidence for this, right? So the uptake of MMR in this country, the MMR vaccine is like 95%
0:47:16 of American parents vaccinate their kids with MMR. The evidence is that, and, and I think it’s like
0:47:22 13% of American parents vaccinate their kids for the COVID vaccine. I think that reflects the scientific
0:47:28 evidence regarding the relative merits of those vaccines. Uh, the American people are not stupid.
0:47:34 In fact, they’re quite smart. And when we talk to them in ways where we show respect for, for their,
0:47:40 their, their intelligence with, with data, allow people to disagree, but then have the evidence
0:47:46 right there in front of people. I think people, people will respond with trust, uh, where, where the
0:47:50 evidence actually leads. Um, I mean, I just, I got, maybe that’s just a matter of faith for me,
0:47:55 but I, I don’t see any other way forward. You mentioned that the, the three priorities of NIH
0:48:00 that you have are nutrition, chronic disease, and integrating AI. Maybe can you, uh, flesh out a
0:48:05 little bit on, on the last two, where, where you see as most promising in terms of reducing the disease
0:48:11 burden, and then also in terms of integrating AI. I, I’ve seen some like fantastic new ideas regarding,
0:48:16 uh, Alzheimer’s disease, for instance. A colleague of mine at Stanford did a, has this like fantastic paper,
0:48:23 a set of papers he published using an old shingles vaccine called Zostavax. Um, he found that, uh,
0:48:29 in excellent observational studies that it would, that if you had Zostavax, it reduces the likelihood
0:48:33 of developing cognitive decline for Alzheimer’s disease by up to 20%, 30%. I mean, it’s pretty
0:48:38 substantial for a, a pretty innocuous safe vaccine that’s no longer used actually, because it didn’t
0:48:45 work for shingles. Um, I mean, imagine if you had a very simple, cheap way to prevent 30% of Alzheimer’s
0:48:50 cases or delay Alzheimer’s for, for years. There’s a, there’s all these like huge advances, uh, I’ve
0:48:56 seen, uh, that, that, you know, just need a little bit of scientific love. Uh, I, I think we just need
0:49:02 to focus on those, have the, do, make our portfolios focused on those, be willing to take risks in terms
0:49:07 of like, um, on things that look like they’re, they’re new ideas. Um, and we’re gonna, we’re gonna make a lot
0:49:11 of progress. And AI, by the way, I think is gonna play a tremendous role in that. I just, you know,
0:49:17 everyone knows about the protein folding and alpha fold that has done an amazing job in, in
0:49:22 turbocharging biomedical, uh, drug development. Cause now you, you don’t need to like sit there
0:49:28 and wait and, uh, uh, for, you can just do your, your, uh, uh, your computations, figure out what the,
0:49:34 the, how the protein folds, what the target sites will look like, and then ask which of these drug
0:49:39 products are like more likely to actually work, um, without having to do very expensive biological,
0:49:44 you know, in, in, you know, lab work. Um, you still have to do the lab work, but they focus on lab work in
0:49:51 more promising ways. Um, in, in, in the way that we deliver medicine, right? So you can have AIs help, uh,
0:49:57 radiologists do a better job at, at making sure they catch things, make, catch everything. Um, uh, uh,
0:50:02 even simple things like, you know, you go to your doctor, the doctor sits there looking at the
0:50:06 computer the entire time rather than you, because they’re like filling out their, their electronic
0:50:11 health records, have an AI assistant, listen to the conversation, fill, fill out the form for the
0:50:14 doctor. So they’re just checking afterwards for taking them a couple of minutes and they’re spending
0:50:19 all their attention on you. Right. Um, all of this needs research, by the way. I mean, does it,
0:50:24 does this going to help patients? We have to ask those questions, but to me, that’s a tremendous
0:50:29 promise. Like those simple things can transform biomedical research and how patients are treated.
0:50:34 Um, so that’s why AI is so, so important to me as a, as a potential tool. We does need research.
0:50:38 I mean, I don’t want to, uh, we can’t have AI hallucinating on us and, and then, then treating
0:50:42 patients based on hallucinations. But, um, you know, that’s, uh, that’s, that’s a matter of research
0:50:48 to fix those kinds of, those kinds of problems. We heard that HHS, um, rolled out across, you know,
0:50:57 agency-wide, um, an enterprise-secure version of ChatGPT, which is, um, seems like a, a terrific
0:51:03 achievement from the perspective of internal HHS and NIH operations even, right? To be able to look up
0:51:10 internally how new is an idea. Um, simple, simple queries and, and data kind of fluidity of that kind
0:51:20 seems important. What’s the future? Is an AI going to write the Institute’s strategic roadmap and an AI
0:51:25 submit a grant and an AI review panel review the grant? And, you know, where, where are we going to
0:51:33 play a role as scientists? I mean, I, I don’t, I, okay, so to that question. The answer is no.
0:51:39 Yeah. I mean, I think AIs are really good at summarizing existing knowledge. The, the training
0:51:46 data you give it helps it, it gets, it’s fantastic at that kind of thing. Um, really developing brand
0:51:51 new ideas that, that, that, that challenge existing paradigms. I don’t, I mean, I don’t, your, your
0:51:55 experience with AIs, but they’re not quite as good at that. Um, it’s really, it’s, uh, we have,
0:52:00 just to put a new policy in place where, um, I’m limiting the number of new public applications
0:52:06 you can have to, we can have, you know, six, six, a cycle or something. We have people writing 60
0:52:13 applications and very clearly AI generated. And then we have, you know, that it’s, it, it, it’s,
0:52:19 I mean, what it does is overwhelm the system of noise. Yeah. Yeah. So, I mean, I think AI is really
0:52:23 important. I thought, as I said, I think it’s, but it has to, we have to do research to understand
0:52:29 how it can be used to help people. Um, and I think people, scientists are still have a tremendously
0:52:34 important role. Um, the, the, uh, the new AI system rollout in age is just exciting. We’re
0:52:39 actually been working on a new system also at, at specific to NIH, again, to protect, uh, in ways
0:52:45 that the protect patient privacy and all that, but, uh, uh, rolled out across the NIH so that people can,
0:52:52 like, interact with it in, with, with, uh, uh, in ways that help on NIH specific tasks as well. Um,
0:52:57 so, I, I mean, I think that’s all very exciting, but it’s an augmentation of capacity rather than a
0:53:03 substitution of capacity. Uh, it’ll make people way more productive. It’ll help us address some of the
0:53:08 key problems, but scientists are still gonna, I mean, we, we still have work to do as scientists.
0:53:15 We do. If I could just end on one, one last question. If you had one message for the rising
0:53:21 star scientist contemplating a career in science where they can bring the best of their abilities
0:53:30 to making science better, smarter, faster, you know, a scientist embarking on a new PhD in a, in a brave new
0:53:36 field, um, a scientist thinking about starting a new company to advance the work that they’re doing,
0:53:44 a scientist at the NIH running a lab. What is your one message to the individual scientist who’s out
0:53:48 there? Um, you know, hoping, hoping to make the biggest impact they can.
0:53:56 I mean, science is incredible. Like it has almost limited capacity to, to advance human well-being.
0:54:02 Um, and, uh, it’s the, it’s the individual scientist who believes in their idea.
0:54:08 It keeps knocking on the door even when the door is closed over and over again until it opens.
0:54:13 That’s, that’s who really makes a big difference in this world. Uh, I would say, please stay,
0:54:18 stay in science, keep knocking on that door, um, and make, and, and change the world with it.
0:54:20 Cause that’s the only, that’s only, the only way the scientists can, can do that.
0:54:25 I, I love this story of Max Perutz. I don’t know if you’ve heard of him. He was a University of Cambridge,
0:54:29 uh, researcher in the, I think his fifties. And he had this idea that he could figure out the
0:54:32 structure of myoglobin. It sounds like a very geeky kind of thing. It’s like, but it’s, uh,
0:54:37 but back then there was no protein folding field really. I mean, it was like,
0:54:42 like, and he was a student and all his professors kept telling him, pick an easier problem, Max.
0:54:45 This is crazy. Why are you spending all your time? You’re never going to finish.
0:54:48 And for a decade at the University of Cambridge, you wandered around, everyone knew he was a genius,
0:54:54 but he was like, got nowhere. He’s not just working at it until finally he figured it out.
0:54:59 And it’s just transformed like a whole host of things in biomedicine. Um, and, uh, you know,
0:55:04 eventually won the Nobel prize. It’s, it’s, um, you know, it’s the kind of thing where I asked myself,
0:55:09 do we have a scientific, uh, sort of infrastructure today that would allow a Max Peretz to do what he
0:55:14 did back then. And, and I would love to, that the, to make that happen through the, the,
0:55:18 the sort of the power of the NIH to allow the Max Peretz of the world, the, the new ones who are now,
0:55:24 uh, uh, uh, sitting there with great ideas to be able to, to, to, to have, to like, try them out and,
0:55:26 and, and, and change the world with them.
0:55:28 Fantastic.
0:55:32 So maybe on, on that, on that note, just looking to the future,
0:55:39 um, if we, if we end where we started, where, you know, uh, you talked about the NIH’s highest
0:55:45 ambition is to improve the health of the American people, whether that’s measured in life expectancy
0:55:50 or, or the, or the rate of chronic disease, um, that, that, that Americans suffer from,
0:55:54 if you had to guess where we’re going to see the biggest and best gains,
0:55:58 is that going to come from, you know, how we manage patients?
0:56:06 So the management of disease, um, you know, new molecules for treating disease or modifications
0:56:07 in terms of how we all live?
0:56:08 Yes.
0:56:10 Yes, yes, yes.
0:56:11 Yes to all of the above.
0:56:17 I mean, you know, I, I, I am a big believer in portfolios when I have uncertainty.
0:56:21 So I don’t know how to answer your question, uh, because I, I see promising advances in all
0:56:23 three of those, all three of those topics.
0:56:28 And I think we have to invest in all of the above in order to see where the most promising things go.
0:56:32 Like who would have predicted that the GLP ones, you know, the, the, the, would, would actually,
0:56:37 we had, we saw a reduction in average body weight in the, in this country the first time in,
0:56:45 you know, decades last year because of, of GLO, GLO monster molecule that somehow turns out to,
0:56:47 you know, when you, if you just do the right biology.
0:56:51 There was a scientist knocking on some kind of door to make that happen, right?
0:56:52 Yeah.
0:56:56 I just, I, I mean, you know, it’s, that’s the only sad thing about science.
0:56:59 It’s, it’s hard, it’s hard to predict where, where the, where the best things are going to happen.
0:57:02 And so you have to like have a portfolio, but all of those areas to me sound, look like they’re
0:57:06 very promising. And as I’ve gone around the country, talked to people, I’m, I’m excited about all of it.
0:57:08 So I can’t wait to see what we produce.
0:57:11 Do either of you have a prediction to that question or is it also, uh,
0:57:16 well, this is the debate we have every week in terms of where we want to invest, you know, that.
0:57:17 Our answer is yes, yes, yes, too.
0:57:18 Correct. All of the above.
0:57:22 Uh, well, it’s a great place to, to close, uh, Dr. Bhattacharya.
0:57:23 Thanks you so much for coming on the podcast.
0:57:24 Thank you.
0:57:24 Thank you.
0:57:25 Thank you so much.
0:57:25 Thanks for being here.
0:57:26 Have a great day.
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