Dr. Jay Goes to Washington: Reforming Science from the Inside at NIH | Uncommon Knowledge | Peter Robinson | Hoover Institution - Uncommon Knowledge

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>> Peter Robinson (00:00):
Just four months ago, the best place to find my guest today
would have been in the officehe had occupied for
more than two decades in an out-of-the-waycorner of the Stanford campus.
And when he came to the door,
he would have been wearing his favoriteitem of clothing, a Stanford hoodie.
Today, that man is the director ofthe National Institutes of Health,

(00:23):
Dr. Jay Bhattacharya,on Uncommon Knowledge now.
[MUSIC]
Welcome to Uncommon Knowledge,I'm Peter Robinson.
A native of India, Jayanta Bhattacharya,did I get that close?

>> Jay Bhattacharya (00:44):
I can't pronounce it myself, Peter.

[LAUGH] Jayanta Bhattacharya moved to the United States
with his family when he was a child.
After growing up in Southern California,Dr. Bhattacharya enrolled in
Stanford University,where he earned his undergraduate degree,
his master's degree, his MD,and his doctorate in economics.
And then became a memberof the Stanford faculty.

(01:08):
During the COVID lockdown, Dr.
Bhattacharya helped to writethe Great Barrington Declaration.
A document that opposed the lockdowns,calling instead for focused protection,
that is, concentrating efforts on thosemost at risk while reopening schools and
places of work.
For taking this position, Dr. Bhattacharyafound himself censored on social media and
under attack from public health officials.

(01:31):
The then director ofthe National Institutes of Health, Dr.
Francis Collins, referred to Dr.Bhattacharya as direct quotation,
a fringe epidemiologist, close quote.
Then came the election of Donald Trump,and the new director of
the National Institutes of Healthis the fringe epidemiologist, Dr.

(01:53):
Jay Bhattacharya.
Jay, welcome back to Uncommon Knowledge.

Thank you for having me, Peter.

In the interest of full disclosure,
I suppose we may as well admit that we'vebeen friends for a quarter of a century.

A little longer than that.

Stop, stop there.

We're both old, Peter.

Stop there.
And for that matter, that you and I,
I was with you when you picked upthat- [CROSSTALK] Very sooner.
For your information, five days beforeJay left Palo Alto to move to Washington,
we had a conversation, and I discoveredthat he owned exactly two suits.
And that one was a suit his mother hadbought for him when he was on the high

(02:30):
school debate team, sowe went to a shop and bought some suits.
Okay, so, Jay, this leads to myvery first overarching question,
you arrived at Stanford Universityin 1985 at the age of 17,
aside from a couple of very brief stints,you were at Rand for a while.
But aside from a couple of brief stints,

(02:51):
you spent your entire lifeat Stanford University.
I once asked you what was the biggestoutfit you had ever overseen, and
you thought for a moment and said, I hadsix researchers working on a project once.
Here you sit in a suit, director ofthe National Institutes of Health,

(03:12):
an agency with over 20,000 employees anda budget of $48 billion.
Jay, I say this as a friend,what do you think you're doing?

[LAUGH] Peter,
the key thing I've learned since I'vetaken office is you have to get help, you
have to get people who know how to do thethings that I know I don't know how to do.
And that's been probably the bestsurprise for me, the number of amazing,
excellent people that I've found tohelp me accomplish the impossible.

So step one in running an organization that large is to find
good people and learn how to delegate.

Yeah.

Okay, and that's been easy for you somehow.
You have no choice, when you're runningan organization with 20,000 people,
you have to delegate.

But the key thing, I think, is to provide a vision,
a clear direction about where I wouldlike to see the organization go.
And there are real challenges,I'm sure you're gonna ask me about them-

[CROSSTALK] Yes.

That the NIH faces in light of what happened during
the pandemic.
And, I mean, I viewed that as my primaryjob, to convey both to the organization,
but also, it's not just a corporation orsomething like that, it's a government.
The most important biomedicalresearch institute in the world,
it's a part of the federal government,it answers to the American people.

(04:35):
So I have to convey not just to the peoplewho work there, but to the American
taxpayers who fund us, whose interestswe're supposed to be serving.

You have to defend that $48 billion to the American people.
You and I have talked on this show halfa dozen times about the COVID experience,
so we needn't go intothat at great length now.
But it forms the background of,as I understand it, but
it forms the background of allyour thinking about the NIH.

(05:06):
So what I take as the centrallessons of the lockdown is
that the lockdown itself was an overreach.
That the public health officials wereacting, at least in large measure,
on political calculation andnot entirely on science,
that much of what they portrayedas science wasn't science.

(05:30):
And that they got one bigthing after another wrong.
So you put up on X, you put up postshortly after you were nominated.
I am honored and
humbled by President Donald Trump'snomination of the next NIH director.
We will reform Americanscientific institutions so
that they are worthy of trust again.

(05:54):
How's the project going?

We've had some progress, but
there's still a long way to go.
Let me just say I had actuallybeen studying the NIH as a matter
of my own research fora long while before the pandemic,
and so I had identified some problems.
I mean, this is not all that novel,
because a lot of peopleidentified the same problems.

(06:18):
The fact that the NIH is responsible foraddressing a crisis in
the scientific community of peoplebeing unable to replicate basic work.
I'd worked on measuringthe sort of inherent risk
aversion of the NIH research portfolio,

(06:39):
which often avoided investmentsin things that would
potentially have enormous benefits butrisk becoming failed projects.
The goal is to have everysingle project succeed.
But if you have that, then the wholeportfolio as a whole is a failure because
you haven't made the big advances.

(07:00):
This is all stuff I've workedon before the pandemic.

I want to come to all of that, this is the layman here,
this is the layman sitting back inCalifornia watching NIH and watching you.
But before we depart fromthe COVID experience altogether,
one of the things that always struck me.
I don't think I ever asked you about this,actually.
But you conducted a study,you got some donor to give you $5,000,
the princely sum, as I recall,of five grand, wasn't that what it was?

Actually, you're talking about the seroprevalence.

Yes, yes, so you conducted a study in March of 2020 asking,
wait a minute, let's see if we can findout just how infectious this thing is.
So you tested people in Santa ClaraCounty, and you discovered that it was
more infectious but less lethal thanthe public health authorities understood.

(07:50):
And it has always struck me right there,
this strange failing NIH,CDC, We are talking
about budgets of tens ofbillions of dollars a year.
And yet it fell to Jay Bhattacharya and
some donor who was willing to pop fivegrand to conduct the first such study.

(08:12):
Why wasn't NIH conductingstudies all over the country?
Why didn't they havegood data by that point?

That was a failure of the public health establishment in this
country.
They should have conducted that study.

Immediately, shouldn't they?

In February 2020,
they should have had measures ofhow widespread the disease was.
Much earlier I wrote an op ed whichactually you helped me design because I'd
never written an op ed before to say thatin the Wall Street Journal in March of
2020 to say, look, we don't knowhow widespread the disease is.
It's a vitally important fact that we needto know to design the right policies.

(08:48):
Yes.

And let's immediately learn that.

Let's conduct a study to do that.
That $5,000 by the way,was to Stanford, not to me.
I saw zero dollars of it myself.
The fact that the public healthestablishment failed to do that should
have been a signal that there wassomething deeply wrong with how-

From the get-go.

From the beginning.

Replication.
This is one of the three big initiativesthat you've spoken about that you
intend to undertake at NIH.
Couple of quotations.
Again, this is me.
You know what a layman I am.
I'm just trying to figure out whatis this business about replication?
Here's quotation number one.
This comes from a 2005 paper.
This is 20 years ago by your Stanfordcolleague and friend, John Ioannidis.

(09:36):
Quote, it can be proven that mostclaimed research findings are false.
Let me repeat that.
It can be proven that most claimedresearch findings are false.
Close quote.
From a 2021 article in Science,the Reproducibility project,
Cancer Biology set out to reproduceexperiments from 53 high profile papers

(09:59):
published between 2010 and 2012.
Consistent with replicationefforts in other areas of science,
original positive results couldonly be replicated 40% of the time.
Only five of the 53 papers had resultsthat could be fully reproduced.
Close quote.
So Ioannidis says 20 years ago,the scientific

(10:20):
establishment is lettingcolleagues get away with it.
Nobody's repeating anybodyelse's experiments.
And then a dozen, 15 years later,we get more studies saying, you know what,
we've tried 53 studies.
These results are all over the place,we can't replicate them.
This is the most basic work thatthe scientific establishment does.

(10:44):
Science testing results, making surethat we know what we think we know.
Am I losing my mind?
This strikes me as obvious.

Let me.

And it takes you to say so.

Well, I mean brilliant people like John Ioannidis
have been saying this,as you say, for decades.
Let me describe the fundamental problem.
There's some very flashy things having todo with scientific fraud that are part of
the problem, but are not the root problem.

So that Alzheimer's research is, for
instance- That's obviously fraudulent.

Yes, there's scientific fraud.
But the root problem is that we havea scientific culture that doesn't
recognize how difficultscience actually is, and
it punishes failure too sharply andhas the wrong standards of truth.
Those are the fundamental reasons.
So let me just teasethat apart in just a bit.
Yes.
So first of all,start with standards of truth.

(11:42):
A paper that is publishedin a peer reviewed journal,
folks think that that means that if it'spublished in a top peer reviewed journal,
therefore it must be true.

That's what I've always thought.

And that's actually inaccurate, right?
So the peer review process,what happens is I write a paper,
I'll send it to a journal.
If I'm lucky, the journal editorwill send it out to two or
three peer reviewers chosen by the editor.
There's games played to tryto influence the editor.
If they're friendly with the editor,
they'll send it tofriendly peer reviewers.

(12:13):
The peer reviews themselves might readthe paper, look for logical errors,
maybe have some questionsthat they want addressed, but
they won't actually replicatethe results of the paper.
They won't have the datato produce the paper.
They're just reading the paper,they're not looking at the actual data.
It's very, very rare,almost unheard of in biomedicine for
the peer reviewers toreview the data themselves.

(12:35):
And so then if the peer review sign off,the editor signs off,
you get a publishing ina peer reviewed journal.
That doesn't mean thatthe result is right.
It just means it's passed throughthis peer review process,
which doesn't check to see ifthe results are reproducible.

It doesn't mean the results are correct.
It just means that the establishmenthas signed off on it.

Signed off on it.

Wow. >> Jay Bhattacharya
that's how you advance in science, is you,
you get a CV filled withpeer-reviewed papers.
You can look at my CV,it's filled with peer-reviewed papers.
That's why I have a position at Stanfordor had a position at Stanford University.
So you're telling me I should be much less
impressed by your work?

You absolutely should be much less impressed by not just my
work, but by every.
And now fundamentally,the scientific process is hard, right?
So the published peerreview literature then will
have some results thatare false positives.
And when I say that,what I mean is that they're published.
You think they're true because they'republished, but they're not true, right?

(13:33):
Right, and that paper that you cited byJohn Ioannidis makes a very convincing
claim, just based on the standardsof how we decide what scientific
research can get published, that a largechunk of the published peer reviewed
literature is probably false,not intentionally.
It's just hard to do science.
I may have a result,and I think it's true.

(13:55):
I've done some investigation into it, but
it might not be true because maybe Imade some error that I didn't realize.
Maybe the thing is just a lotof things just happen, and
you haven't thought of everything.
The right standard of truth in sciencethen is one paper making a claim,
and it's peer-reviewed, andit's published in a top journal.

(14:17):
The right standard of truth is do otherindependent research teams asking the same
question, using different methodology,do they arrive at the same conclusion?
And if lots and lots of research teamsarrive at the same conclusion using-

Then we have something.

Yeah, so you mentioned, for instance,
that Santa Clara Syria problemstudy that I conducted.
It was a very controversial resultvery early in the pandemic.
But dozens of other research teams aroundthe world asking the same question in
different settings in different placesfound results that are roughly congruent
with that result.
The fact that the paper was published inthe International Journal of Epidemiology,

(14:51):
I mean, I was glad it was published,but that's not what makes it true.
What makes it true is the independentreplication by dozens of other research
teams that found very similar results.
In places where people were older,they tend to get higher death rates.
In places where people are younger,they tend to get lower death rates.
We were kind of right in the middlebecause we were looking at
people who weren't in nursing homes.

(15:12):
And so you have a basic thingwhere everybody learns science.
And they first introducedscience in fourth grade.
They learned about replication.
But the entirety of the scientificinfrastructure is set up to
not have that as the standard of truth.

Okay, so that strikes me as mad, and it makes me, I mean,
I'm here to represent the angryAmerican public that billions upon
billions of dollars get spenton this year in and year out and
nobody does double-checking isessentially what you're saying.
But you're also saying to me,American public, calm down.

(15:49):
Science is hard.
Scientists are in some way or another,you could almost describe them as
victims of a process, of a procedure,and we need to change the institutional
approach of the research projectthroughout the country, is that correct?

That's correct.

How are you gonna do that?

Yeah, so a few things-

I like you so
much, Jay, I almost believe that ifanybody were, gonna do it it's you.
Okay, so I- How can you take this on?
It sounds huge.

[LAUGH] I think first, if there's going to be
an institution that does, it's got tobe the National Institute of Health.

So you're sitting in the right chair.

Yeah, so first it funds a tremendous amount of science.
And I don't want to painttoo bleak a picture,
there are real advances that science hasmade, funded by the NIH, for instance,
that have improved human health, right?
Within the pool of scientific papers,not everything is false, we just have
systems that don't necessarily distinguishtrue from false often enough, right?

(16:50):
That's the fundamental problem.
So here's what you do, first,you have to make it so
that replication is a viable path fora career.
Every scientist does->> Peter Robinson: Incentives.
Yeah. >> Peter Robinson
doctorate in economics comes in.
Yeah, incentive structures.

Okay. >> Jay Bhattacharya
systems that provide the incentivesthe right direction,
you'll get the results inthe right direction, right?
That's basic economics, I guess.
So you have to award highprofile research grants to
scientists who creativelydo replication work.
They identify what are the key claims inthe literature that need replication.

(17:30):
By the way, if you talk to drugdevelopers, they'll tell you this,
that they do this,
they do private replication cuz they don'ttrust the published biomedical literature.
So they'll privately replicate the keyresults before they decide to invest tens
of millions of dollars in development.
So replication is taking place, but it's in a haphazard and
private way, it's not->> Jay Bhattacharya: Yeah.
Okay.

Okay, so that's one, you have to incentivize replication by
rewarding it with high profile grants froman institution with prestige like the NIH.

And you can do that at NIH?

I'm gonna do that.

Okay. >> Jay Bhattacharya
you have to have a place topublish the replication work.
Cuz right now, if you send yourreplication work to a top journal,
there's no chance of being published,they'll say it's not original.
So you have to have a high profileplace where people can publish
the replication work.
Where it's easily searchable sothat people can get a sense of how many of
these I have a result in the literature,I think I would hope is true.

(18:25):
I can go check the journal orthe literature and
they'll give me a report back of howoften it's been tested for replication,
how often it's been replicated.
So you can fund?
Can you establishthe American Replication Review?

Yeah, we'll stick on that.

In every medical library across the country?

Yeah, and we'll make it searchable using these new AI methods
that allow us to pull together whatthe literature is actually saying.
It's like a glorified, it's a huge searchengine is what it turned out to be.
And then third, andthis is probably the most important,
when scientists now are approached bysomebody who wants to replicate their

(19:05):
result, they view it as a threat.
They say, my gosh,
they're trying to undermine myreputation by trying to check my work.

Right.

But it's not a threat, it's actually an honor.
You have an idea that is worthy ofsome other scientist checking you.
That's a mark of honor for you cuz you'remaking a claim that's important for
science.

Nobody ever tries to replicate me, for example [LAUGH].

[LAUGH] People have tried to copy you all the time, Peter,
they just all fail, that's the problem.

Its not worthy it.
So how do you change that's a mindset.

Yeah, so they're what you do, okay, so
let's just talk about baseball, right?
So suppose that all wemeasured was stolen bases.

Right.

What you'd have is slow runners trying to steal bases all
the time and
get caught stealing in the hopes thatthey could have a few stolen bases.

If that's what you get paid on?

Exactly.

All right. >> Jay Bhattacharya
if you measure caught stealings andstolen bases, it'll only be the good.
So the people who are like, really fast,they'll try to steal bases, right?
Got it. >> Jay Bhattacharya
the way it measures productivity forscientists are on two bases.
How many papers you've published?
And how many citations you'vegot to the papers you published?

(20:20):
If you think what they are, it's howmuch volume of science do you produce?
And how much influence do youhave in the scientific community?
So to put it crudely, that's rewarding pure self-promotion.

I mean- >> Peter Robinson
It does produce some scientists that are excellent,
that produce real work that advances.
But it doesn't do it, it doesn't aimthe incentives in the right direction.

Calming down now, Jay?

Well, if you measure pro-social behavior,
if you approach me for to do replication,
replicate my work, and I share my datawith you, you should get credit for that.
There should be like a, okay,I've hit a home run, right?
So if is my work being approached forreplication at all, that's an honor.
Let's measure that.
Is my work actually replicated?

(21:09):
That's another thing wepotentially could measure.
If you make measures like that and youreward that kind of pro-social behavior,
you'll get it- You reward the effort,you reward the scientists who have
the courage to take on hard problems andconduct experiments and
have their work double checked,even if it does it all the time.

(21:29):
Even if it's wrong, so that's the otherflip side, I assume you're gonna
ask me about innovation cuz that'sthe part of, that's the flip side.
It's common in Silicon Valley forpeople to start a company that fails.

Failure is rewarded in Silicon Valley.

That is the key to the success of Silicon Valley, right?
We punish failure too much in science.

I see. >> Jay Bhattacharya
the replication problem.
Okay, so let's go on and talk about this.
Here's another of your big threeinitiatives, as I understand it,
is keeping NIH right atthe scientific frontier.
From a May 2023 paper by Paula Steven andChiara Franzoni, to whom I apologize,
I'm sure I mispronounced both names forthe Building a Better NIH project.

(22:14):
Quote, a number of scientistshave expressed concern that
the National Institutes of Health is riskaverse and becoming increasingly so.
Some think the heavy emphasis placedon demonstrating feasibility of
the proposed research is responsible forthe risk aversion.
More generally, there is the perceptionthat the probability of success plays

(22:37):
an important role in the evaluationprocess, close quote.
Okay, so in other words, as the Americanpublic has gotten sicker and
sicker, we'll come to that.
The increase in chronic disease NIHhas become more and more risk averse.
People only put put studies forward for
funding that they'repretty sure will work.

(23:00):
So what are you gonna do about that?

Right, so that's gonna take a culture
change in science cuz there'ssome concrete things you can do.
So for instance, you mentionedhow we evaluate grants, right?
So in the 2010s the NIH would haveas a requirement to evaluate grants,
you had to have an active grant.
Now you say to yourself, well, why not?

(23:22):
You have people with lots of expertise,
you have to demonstrateexpertise to evaluate grants.
If you think about it, what that doesis it makes people who have a vested
interest in the current way ofthinking into the position for
deciding whether challenges to thatway of thinking will be funded or not.

Making no sense.

What you want is regular turnover in ideas in science,
most of the ideas are gonna be wrong,science is hard.
But if you don't have that regularturnover and the ability for
early career investigators with brightnew ideas to try their ideas out early,
try their ideas out at all, you're notgonna Going to make progress in science.

So, Jay, I'm very struck.
You and I both live.
In some ways, neither you nor well,neither you nor I is a venture capitalist,
but we both live surroundedby Silicon Valley.
And your comparison to Silicon Valleya moment ago, I found very striking.
So in the Valley right now,what's happening is AI, and
we have a new crop ofStanford students graduating.

(24:24):
You andI both have friends among the students.
We live and work among these kids.
And I'm struck at howastonishingly easy it is for
some bright kid to geta degree in computer science.
If you've got a doctorate in computerscience and an idea, you can get $100,000
like that from a VC firm, they'rejust saying, go ahead, you're smart.

(24:47):
Take a whack at it, give it a try.
Now, that may be the wrongway to approach science.
But the notion of youthconstantly being funded,
that portfolios of ideas being undertakenand funded, modest funding, but
enough funding to get them enoughfunding to find out an answer.
Will this idea work?
If that idea works, come back to us for

(25:08):
more money knowing that 90% of anyinvestment portfolio will go belly up.
So that's because Silicon Valleymakes a lot of money that way.
That's because the incentivesare quite clearly set up to.
How do you do that in science?

I mean, just to put a fine point on what you just said, if you
have a portfolio of 50 projects that youfunded and 49 of them failed, we're.

Talking about NIH now.

We're talking about both science and Silicon Valley, and
49 of them fail, andthe 50th cures type 2 diabetes.
That's a successful portfolio.

You've done something for humanity.

Yes, I don't care that the 49 projects failed.
They were, in fact.

Congratulations to them for trying.

Exactly.

They will have learned something.

Yeah, right, now what happens is the evaluation of grants.
You have to demonstratewith preliminary data.
If you're gonna get a big investmentfrom the NIH, you have to
demonstrate preliminary data that the ideathat you're proposing is likely to work.
How do you do that in advancebefore you actually do the work?
So what happens is scientists, andthis is something I learned as part

(26:14):
of the grantsmanship tools ofbecoming a successful scientist.
Do some work that you know that ends upworking, then propose to do that work,
get the funding, support for that proposedwork that you know already succeeded,
and then try to work on the nextproject with the funding you get.
It's fundamentally, a system designedto reward incremental progress.

(26:39):
At best, its aim is to say, look,all 50 projects I funded worked, and
therefore it's a successful portfolio.
But a portfolio where all 50 projectsyou funded worked is not a successful
portfolio.
Even though every single project worked.
It's a failed portfolio in the sensethat ex ante didn't take sufficient.

(26:59):
You were too risk aversein what you invested in.
And so you have to have a tolerance forfailure.
And for young scientists, contrary toSilicon Valley, where you said like,
as you said like, very young,
early career people can get investmentsearly to test their ideas out.
In biomedical sciences, it is commonplacefor a researcher to be in their

(27:23):
mid-40s before they can have anychance of getting a large NIH grant.
You have postdoc after postdoc afterpostdoc, where you're essentially
doing the bidding of a senior scientistfor, for a decade or more of your youth.
And that wasn't always like this.

I'm sorry, but this is, again, I'm just being the layman.
That sounds like a medieval guild.
That sounds like a closed shop.
Protecting itself,I'm sorry to say, protecting itself.

It's broken and I want to fix it.
And people have recognized thisas broken for a long time.
But I think the NIH.

There have to be all kinds of good people within the system who
in some sense, know better.

Yeah, I mean, but again, the incentives are set up to reward
a successful project rather thanto reward successful portfolios.
It's set up just to create vast sort ofhierarchies where people at the bottom of
the hierarchy are feeding into your ideasrather than allowing young researchers,

(28:27):
might even be older researcherswith brand new ideas,
brand new ways of thinkingto try their ideas out.

Okay, this is the third of your big initiatives,
is related to everything we've beentalking about chronic disease.
Here's a paper last year published by thecenter for Chronic Disease Prevention and
Health Promotion.
No short, snappy titles, by the way.

In science and science we're bad at PR.

Quote, an estimated 129 million people in the US have at least one
major chronic disease.
That's, that is heart disease, cancer,diabetes, obesity, or hypertension.
Five of the top ten leadingcauses of death in the US are or
are strongly associated with preventableand treatable chronic diseases.
Over the past two decades, the prevalenceof chronic disease has increased steadily,

(29:13):
and this trend is expected to continue.
About 90% of the annual 4.1trillion healthcare expenditure
is attributed to managing andtreating chronic diseases close quote.
So I put it to you, Dr Bhattacharya,you're in trouble if I call you doctor.

(29:34):
Over the past 20 years,the NIH alone has spent some $700 billion.
And over the past 20 years, the Americanpeople have gotten sicker, not healthier.
What's going on?

Let me just emphasize your point.
Put an exclamation mark on it.
Since 2012, between 2012 and 2019,
there was no increase inAmerican life expectancy.
I had grown up with this idea thatmodern medicine, the sort of.

We were going places.

Yeah, science was advancing our health.
And the hallmark of that isyear after year after year,
life expectancy kept getting longer andlonger and longer.
American children born today are notlikely to live longer than their parents.
That is a scandal, because the missionof the NIH is to do research

(30:28):
that improves the health and increasesthe longevity of the American people.
That's the mission of the NIH.
In that sense,the NIH has failed in its mission.
Europe actually has seen improvements inlife expectancy over the same period.
And, 2019, 2020, of course,there was a huge.
You remember the event,what happened 2020.

(30:48):
But there was a huge drop inAmerican life expectancy that
didn't come back up to2019 levels until 2024.

By the way, so are we still seeing in this suppressed or
at least flat life expectancy, are westill seeing damage done during COVID
people who didn't go into fortheir cancer checks?

The life expectancy is back to 2019 levels now.
Okay, only now.
But there's still the ongoinglingering problems with making kids
miss up to two years of schooling.
I mean, there's a whole host of,like, damage,
psychological damage wedid to the populations.
But there's drug abuse deaths that are,I mean, they're still like, on the level,

(31:29):
like 80,000 Americansare still dying a year,
70,000 Americans are dyinga year from drug overdoses.
Before the pandemic,it was like a fraction of that.
There were hundreds of thousands.
What we did during COVIDwas a catastrophe.
And that's partly why I'm in this job,
because I was trying to call out thatcatastrophe, the policy catastrophe,

(31:51):
not the catastrophe of COVIDwhich itself was a catastrophe.
But the point is that the job ofthe NIH is to To do research that fixes
the problems you just said addressesthose problems directly and
we have not done a good job of doing that.
There have been a tremendous numberof actual scientific advances,

(32:12):
which I can point to, the NIH playeda large difference since we now have,
I think, a cure for sickle cell anemia.

Fantastic.

Huge advances, what we don't have is a way to manage
the colossal chronic diseaseproblem that Secretary Kennedy and
President Trump has pointed to, andto use the NIH to solve the scale
of the problem of heart disease,we don't have a way to solve
the scale of the problem of type2 diabetes, obesity, autism.

(32:45):
With autism, that's like 1 in 31 kidsis the latest numbers from the CDC
have it a huge increase from past yearsand so what you have is a chronic disease
problem at scale affecting the health andwell being of almost every American.

Everybody, every family, whether you're ill or not,
you've got a cousin who's ill ora brother.

And science isn't the whole of the solution, but
science needs to be a fundamentalpart of the solution.

And for sure, if we're spending $50 billion a year on NIH,
there ought to be something,again, I speak as a taxpayer,
we ought to be gettingsomething from this.

Actually, if you look at the portfolio before I arrived,
15% of it was DEI initiatives,we should be spending the money on
science that translates toimproving the health and
well being of every American minorities,no matter who you
are the NIH should be supportingresearch that advances your heath right?

(33:41):
Ideological boondoggles don't belongin the portfolio of the NIH and
that's something that we actually,even before I arrived in office, the Trump
administration worked to remove andwe've made some progress on that as well.

Okay, so now we come to what I imagine is,
I don't want to put words in your mouth,but I will,
I imagine that in some ways it'syour least favorite subject,
which is money, how much should we spend,how much should we cut and so forth?
Actually, let me begin with a thresholdquestion, maybe I should have

(34:16):
begun the whole show with thisbecause it is just the basic question.
NIH comprises, if I have it right,
21 institutes ranging from the NationalInstitute of Biomedical Imaging and
Bioengineering to the nationalcancer institute, six centers,
20,000 employees, andan annual budget of 48 billion that's big.

(34:41):
On the other hand, the Americanpharmaceutical companies employ even more
people and they have a Combinedannual research budget of 150 billion
three times as big as NIH,why do we need NIH?,
why don't we just rely on the researchthat takes place in pharma companies?
If we need more research,we can fund pharma and

(35:02):
let them carry it out seriously,it's a threshold question,
what does NIH do that we cannotrely upon the private sector to do?

I'll make a very really simple economic point.
There are research projects thatit is not in anyone's financial
interest in the private side to dobecause the ideas are not patentable, so
i suppose it's 1950 or something,and you're Cambridge University and
you're trying to figure out, should I fundWatson and Crick?, will their project

(35:37):
on the structure of DNA being a doublehelix, will it make any money for me?
And the answer is going to be no, as soonas they discover that DNA has this double
helix Rosalind Franklin, everybody,don't want to slide anything.

Complicated story, but yes.

But as soon as that's discovered that there's this double helix
structure, everyone can use it,it's a common pool idea,
fundamental, transformative,utterly transforms biomedicine,
the private companies have an interestin ideas that are patentable,

(36:16):
can be protected, and you need licenses touse, not on return to their shareholders.

Yes, right.

Whereas the NIH, it can and should and has funded projects
that result in those kinds of common poolideas that make the whole of science and
biology better, that's the primaryreason for the existence of the NIH,
in my view, From an economic perspective,it solves a market failure for

(36:45):
promoting and supporting ideas thatare common pool ideas of that sort.

And in this great, rich, noble democracy,
that is a worthy use of public money.

Yeah, I think it's among the most useful uses of public money
if you compare it to some of the otherthings we spend our money on.

Okay, so how much money?
And here we come tothe question of indirect costs,
which I'm sorry to say I can't askyou now that you're Director of NIH.
We've talked about this many times overcoffee back at the Stanford campus, but
now you're wearing a suit,Jay, so, on February 7th,

(37:24):
the Office of the Acting Director ofNIH announced that the NIH would begin
capping indirect costs at15% of research budgets.
According to the directive, quote,indirect costs are by their very nature
not readily assignable to the costobjectives specifically benefited and
therefore difficult for NIH to oversee.
Yet the average indirect cost ratereported by NIH has averaged between 27%

(37:47):
and 28% over time, andmany organizations are much higher,
charging indirect rates of over 50%,in some cases 60%.
There's a lot there, but basically,when the NIH awards University X
a grant of $100 million to do this,that or the other research,
it includes indirect costs ofsome percentage, let's say 40%,

(38:10):
in other words, another $40million to fund, loosely speaking,
the overhead associated with keepinga lab heated and air conditioned and
all the things you need to do to beable to perform that research and
universities have gotten used to that.
And now the NIH has said,we're going from here to here, and

(38:33):
across the land if we put our earsto the window we will still hear
university administrators screamingat the top of their lungs, Jay.

Okay, so let me.

And they're screaming at you, as you well know.

I've heard from many of them, as a threshold matter,
I should say that this,I can't directly comment on
the 15% action because it'ssubject to litigation and.

Happened before you took charge.

Yeah, but nevertheless.

And it's subject to litigation.

And so I cannot directly comment on that, but
I do want to set up the actual policydebate because I think people have missed
what the policy debate.
So you've described the actual thing,the mechanics, Right?
If I as a researcher win a milliondollar grant from the NIH,
they'll pay the university,whichwill let me use the money for

(39:23):
my research projects,the million dollars, but
also the university will get,let's just take the case of Stanford,
I think they'll get$550,000 on top of that.

Over 50%.

Right, that will then go to the administrators to fund the light
bulbs, upkeep of the building, whatever.

Real expenses.

Like the fixed cost of doing research.

Right.

So you need to have institutions that have
that fixed cost of doing research,this, by the way goes back to.
A policy decision inthe mid-1940s by Vannevar Bush.
The idea was that the universities of thiscountry are partners with the federal
government in the research enterprise.

(40:13):
And that the government has an interestin having universities that
actually function forresearch priorities of the nation, right?
And so that's gone back a long ways.
The rates being as high as they are,that's within the last, I don't know,
50 years.
There were scandals around thatin the 1980s, for instance.

By the way, the Gates Foundation, when they make a research
grant to a university,they include an indirect cost rate of 10%.

Right. And so there's some issues-

Well below what the-

Like what goes
in the directs versus indirects,I don't wanna get into that.
So let me just say what I thinkthe policy issue actually is.

actually is that the amount of moneythat we give to universities for
the fixed costs, it's to maintain theability to do excellent research projects.
The question is,where should that money go?
Should it go to a few universitiesthat have excellent researchers?

(41:12):
Or should it go to a broader group ofuniversities where excellent researchers
might be but aren't attracted to gobecause they don't have the fixed cost
support to maintain the infrastructure?
The system we have now in order togain access to the fixed cost support
from the federal government,
you have to have a lot of excellentresearchers that win grants.

(41:35):
You've gotta go to a big established place.

But in order to attract a lot of excellent researchers,
you have to have the infrastructure wherethe those researchers can do their work.
It's a ratchet, to get the money forthe fixed cost, you have to get
the researchers, and you have to have theresearchers to get the fixed cost support.
And it's a system that makesguarantees that relatively few
universities will havethe lion's share of NIH money.

And it perpetuates those few universities in that very
position.

Yeah, and now, I've heard arguments, I'm not honestly
disagreeing with them, that having anagglomeration of excellent research is one
a single place is a really importantthing for the advance of science.
But what cuts against that is that youcan also get scientific groupthink
from that kind of concentration.
That's really the question.

(42:26):
The sort of returns to havingpeople concentrated physically,
geographically, in a few places asa way to share knowledge versus having
the scientific talent of the countryspread out across the country to avoid
scientific groupthink.
And we saw during the pandemic, I think,
some of the problems ofscientific groupthink, right?

So, Jay, can I, again, layman, so correct me on this, but
as I recall, we have between four and fivethousand universities and colleges across
this country, and I believe the numberis 60 that receive funding from NIH.
It's a tiny number as a proportion ofthe entire educational establishment.
And many of them are undergraduateinstitutions that don't want to engage in

(43:09):
research, it would changethe nature of the institution.
But still, it's a very small proportionof the overall enterprise, correct?

Yeah, I don't know if it's 60 exact number, but
I'll say that the distribution of NIHsupport to the universities in this
country is incredibly concentrated.

All right.

And that's just a fact, it has been for a very long time.

Okay, okay, so the question of managing NIH itself, again,
I've got a gobbledygook of numbers andcuts and people screaming.
And I just want to hear your, you havea lovely way of summing things up and
explaining the larger issue, all right.
As published in STAT, one ofthe leading science news publications,

(43:48):
on April 3rd, so this is recent.
Early last week, the Trumpadministration's federal government
shrinking task force, known as DOGE,directed the NIH to reduce contract
spending across each of its 27 institutesand centers by roughly 35%, that's a lot.
The cuts are likely to further paralyzean agency that just lost 1,200 employees,

(44:09):
including the directors of fiveinstitutes and the heads of several labs.
And has had key grant making, research,training and science communication
functions severely limited since Trump'sreturn to the White House, close quote.
That doesn't sound like a publicationthat's friendly to this administration.
So we set that to one side,but the facts are the facts,
Jay, what's going on at NIH froman administrative point of view?

Right, so the President, the White House,
asked the entire governmentto operate more efficiently.

We run a deficit of $2 trillion a year.

And we have $37 trillion of federal debt.

Correct.

It's not unreasonable to ask that, right?
And the question is,are there operations run by contracts?
These are not generally contracts for
scientific projects that most ofthat money is through grants and
also direct intramural researchdone inside the NIH campus itself.
Most of those contracts are foradministrative activities,

(45:08):
many of which are essential.
But the question is, can you do thosethings more efficiently, right?
So, for instance, the NIH had,you said, 21 institutes and 6 centers.
I think what happened, I mean,that's correct actually.
But it turns out that most of the centershad their own communication shop.

I see, okay.

Most of the centers had their own legislative affairs shop.

There are administrative efficiencies to be found.

Yeah, so that's how we've implemented those contract demands.
The priorities that I've had inimplementing them have been no cuts that
will result in any patients being harmed.
Cuz we run randomized clinicaltrials where patients are enrolled,
you can't just cut them without,
you have to have some plan to makesure the patients are cared for.

(45:56):
Don't cut contracts that resultin scientists being let go if at
all possible.
There were some errors,actually, in the classification
codes of what scientists had for theiroccupation, where they were misclassified.
So there were early mistakes aroundthat having to do with problems
dating back decades andwhere scientists were, and

(46:17):
we've addressed as many of those,I keep finding some of those.
But we've not let scientistsgo intentionally.
And then third, no cuts to anything thatharms the mission of the NIH, which is
to do research that advances the healthand longevity of the American people.
Those are the priorities.
We used to do the cuts, we found a lotof places where we could just do stuff

(46:39):
better without duplicative contracts thatdon't actually serve anyone's interests.

So, Jay,
you sound like a man who lovesthe National Institutes of Health.

[LAUGH] I do love the NIH.

I mean, what kind of MAGA man are you?
I thought I would be interviewingsomebody who was attempting to
suppress his Viking impulses to slash andburn and pillage.
You love the institutions.
You love the scientific project.

The MAGA movement is not opposed to the NIH, it isn't.
What it's supposed to is using andcorrupting an institution
that should do good for the public andinstead becomes hijacked for
ideological things that failsduring crises like the pandemic.

(47:25):
Will potentially evencause the pandemic or
contributed to causing a pandemic, right?
So what the MAGA movement wants isnot that we have zero government.
What the MAGA movement wants isthat the government works for
the interests and, in this case, thehealth and well being of regular people.

(47:45):
That's what the MAGA movement wants.

So you fit, you fit.
We used to joke, although I wasn'treally joking, that my friend
Jay Bhattacharya is one part MahatmaGandhi, one part Dr. Albert Schweitzer.
And one part Saint Francis of Assisi,in other words, humanitarian,
gentle, kind, andyou fit within this rough, tough,

(48:09):
elbows out administration, you feelcomfortable in the Trump administration?

I do, I've had conversations with President Trump and
he's curious about science.
He wrote a letter to the science advisors,his main science advisor,
Michael Kratsios committingthe United States to being the preeminent
nation in the world in biomedicalresearch in the 21st century.

(48:38):
We're competing with China, China hasactually made tremendous advance using,
by the way, American technologies.
And it's absolutely vital that wemaintain that world leadership,
and that is President Trump's goal.

Donald Trump wants us to be number one.

Yes. >> Peter Robinson
does Jay Bhattacharya.
Yes.

All right.

Secretary Kennedy, the same.

All right, can I ask here, this takes us back to COVID for
just a moment, but there's a piece ofnews that I want to ask you about.
And if I'm catching you unaware, just sayso, yesterday CDC Director Marty Makary,
you mentioned him earlier,I believe your friends.

We are.

All right, you're colleagues within the administration, but
you're also friends of some standing.
Marty Makary and FDA vaccine advisorVinay Prasad published an update to
the government's guidelineson COVID-19 vaccine boosters.
They published this in the New EnglandJournal of Medicine, a big time journal.
In that article, they wrote,although the rapid development of multiple

(49:39):
COVID-19 vaccines in 2020represents a major scientific,
medical and regulatory accomplishment.
Big deal what we did and how quickly wedid it, the benefit of repeat dosing,
particularly among low risk persons whomay have had previously received multiple
doses of COVID-19 vaccines had multipleCOVID-19 infections or both, is uncertain.

(50:04):
So we're backing away officially,formally from advice
to get repeat boosters,is that what's going on?

Not just boosters, but also the recommendation, for instance,
that kids as young as six monthsold be given the COVID-19 vaccine.
If you look at other countries,no country other than the United States,
I think, maybe you'll find some exception.
But no country in Europe,for instance, I think,
has a recommendation where kids as youngas six month olds get the COVID vaccine,

(50:37):
that's unique to the United States.

So this is a long time coming, actually.

Yeah, and I read that paper, actually, and
I think it's a fantastic paper.
What that paper says is that if a drugcompany wants to have COVID boosters and
COVID shots forkids as young as six months old.
They need to produce excellentscientific evidence,

(51:02):
randomized studies where theydemonstrate an actual benefit
to those people getting those shots,right?
Not just did you produce antibodies,but did you prevent dying from COVID,
did you reduce the riskof hospitalization,
did you at least prevent getting COVID forsix months?

(51:24):
And this is a minimum you wouldask in order to market a product.
If you're gonna market a product,
you should be able to demonstratethat kind of benefit.

Niggling little question, does it work?

Yes, and are there side effects,
are we looking at thoseside effects carefully?
This asks the question tothe manufacturers of COVID vaccines, says,
please demonstrate to us that thisproduct actually does good for
the people that we're giving it to.
Actual clinical good not justproductions of antibodies.

Okay, now I have one other question here that's mandatory and
that is UN Bobby Kennedy Jr.couple of quotations.
The most frequent line of attack on him,as you very well know,
is that he's some kind of anti-vaxxer,RFK Jr.
and this comes from his confirmationhearings, he's speaking himself.

(52:13):
News reports have claimed that Iam anti-vaccine or anti-industry,
I'm neither, I am pro-safety.
All of my kids are vaccinated, and
I believe vaccines havea critical role in health care.
The New York Times on May 1st,just a couple weeks ago,
Health Secretary Robert F Kennedy Jr.on Thursday announced plans to
require all new vaccines tobe tested against placebos.

(52:36):
And to develop new vaccineswithout using mRNA technology,
moves that extend his reachdeep into vaccine development.
The New York Times is alwaysleery of deep reaches and
raise questions about whether Covidboosters will be available in the fall.
Okay, what's going on here?
You like this man, I know, because I'veheard you speak admiringly of him.

I like him and admire him, I think he's not anti-vaccine, so
lemme step back.

All right.

So what's happened is we have a regulatory framework
where vaccines are treated ina special and different way.
I very fundamentally believe,for instance,
that the measles vaccine is quiteimportant for child health,
I've said that multiple times,I believe it fundamentally.
I've also heard Bobby Kennedy say that inthe face of the measles outbreaks that

(53:25):
have happened, that children shouldget the measles vaccine, right?
That's not a man that's anti-vacc.

Right. >> Jay Bhattacharya
what he said is exactly true,
every conversation I havewith him reinforces this.
He cares about making sure that peopleunderstand what they're getting.
Because of their successful historyof vaccines going back centuries,

(53:52):
the scientific community treatsvaccines with kid gloves.
But nevertheless, the regulatory bodiesof this country have an obligation to
make sure that the products we recommendthat especially children take have
a proven track record of safety behindthem, and in many cases, they do.

(54:13):
And in some cases, like the COVID vaccinefor children as young as six months old,
they do not, the fact is->> Peter Robinson: That's incredible to
me, but those who are rushedthrough without the usual FDA.

Normally the safety testing of vaccines takes decades.

Got it, and we didn't have time.

Yeah, so I'm not trying to indict anybody over this,
I'm just a fact, right?
In April 2021,I wrote a op-ed with Martin Kulldorff,
of then Harvard Universityarguing that healthy children
should not be recommended toget the COVID 19 vaccine.

(54:56):
And the reasoning was there was a verylimited evidence of benefits for
children because they die ofCOVID at such low rates that you
don't really have much to gainfrom the vaccine for kids.
You're not preventing deaths,no randomized study had demonstrated
prevention of deaths forchildren given the COVID vaccine.

(55:18):
That's not a randomized study,does not exist that shows that.
And there was a possibilityof risks of side effects, so
the benefit harm balance tilted againstrecommending children to get this.
To put yourself back in early 2021,
COVID was killing olderpeople at very high rates.

(55:42):
And there was some evidence that the COVIDvaccine might prevent those deaths.

I know this, Jay,
because you told me to go ahead andget vaccinated.

I got the COVID vaccine myself cuz I'm an old guy, right,
so the balance was different forolder people, right, so
the right policy advice then.

Based on the science.

Yes was no for children, yes for older people,
especially for older people who are highrisk with multiple chronic conditions
that put them at high risk, that's areasonable balance given the uncertainty.

And so all that Bobby Kennedy is saying is let us not claim
to know more than we know.

Correct.

And let us know what we need to know.

Right, and then let make people make their decisions.

So he's fair as far as you were concerned?

My experience with him is that the press has treated him
tremendously, unfairly in part becausethey believe that he is threatening
financial interests in the pharmaceuticalindustry and elsewhere.

By the way, so let's face it, he is.
And so are you.
If you want to rearrange the way thescientific enterprise in this country is
conducted and you have just eloquentlydescribed ways in which you would
like to shift incentives have.
If there's a settled order that's verycomfortable and there is a settled order
and people within that scientificestablishment are very comfortable people

(57:04):
by comparison with average Americanincomes, they will scream.
This is politics.

I mean, the problem here is that I believe
very firmly in capitalism.
I believe very firmly in the ingenuityof American companies to address
the problems of the American people.
I mean I just, that's like, I'm aneconomist that, I mean that's just a fact.

(57:32):
But the idea that requiring drugmanufacturers to actually do honest safety
testing orhaving regulators of the country,
they're supposed to dohonest safety testing and
report it honestly to the American people,that's not anti-capitalist.

It's no outrage.

In fact, it protects the companies.

Okay.

Right, it makes it so
that people trust the productsof the companies more.
It allows there to be a private sectorthat people view as addressing their
needs.
It directs the companies of the countryto activities and products that actually
advance the health and well being ofthe American people rather than simply

(58:13):
improve the bottom line without actuallytranslating to improved health.

Okay, Jay Bhattachary, on May 5,
I'm about to ask you about somethingthat has actually happened.
Most of this in prospect, but
this is most of what we've beendiscussing is what you hope to do.
Here's something that's happened.
J Bhattachary on May 5 after the WhiteHouse announced new restrictions on gain
of function funding, quote, this is you.

(58:38):
This is a historic day.
The conduct of this research does notprotect us against pandemics as some
people might say.
It doesn't protect usagainst other nations.
There's always a danger thatin doing this research,
it might leak out just by accident andcause a pandemic, close quote.
Well, now, hang on.

(59:00):
Gain of function research hasbeen going on for decades.
We have military labs and
scientific labs that are constantly tryingto figure out what the bad guys might do.
Tweaking viruses to make them more andmore lethal and
then rushing to figure out what antidotes.
I thought this was a fixed part of thescientific slash military establishment.

(59:22):
And you're saying no,do away with all of it.

Well, so first of all, there's a bioweapons convention that
President Nixon signed in 1973that binds the United States.
So we don't do offensivebioweapon research.

Okay, right.

So that's.

Details first.

That's the first, right?

So we really don't.

We don't.

And we've held to that.

Okay, right.
Well, I mean,I've been in the government six weeks.
I hope we've held to that.
Well, I hope I don't find out we haven't.
If I find out we haven't held to that,I'll go public with that.

All right.

But I will say this.
What we have done is we've done.
We, including the NIH,has supported a research program with
the utopian vision ofpreventing all pandemics.
The way the research program hasworked is that we fund people,
the Eco Health alliance, once upon a time,to go out into the wild places,

(01:00:13):
partner with foreign countries,including China,
go out in the wild places collect thepathogens in the bat caves or wherever.

>> Peter Robinson (01:00:21):
Picking up bat droppings.

>> Jay Bhattacharya (01:00:22):
Right, so that we can catalog all of the viruses and
pathogens out there.

Right. >> Jay Bhattacharya
very unlikely that many humans willcome in contact with those things.
Bring those viruses and pathogensinto labs, often in city centers,
often not necessarily inhigh-security environments,
do research on them to see ifit's easy to manipulate them and

(01:00:47):
cause them to become moretransmissible among humans.
And the idea is, if we can identify thoseviruses and pathogens that are more
likely to make the leap into humans,then we can prepare in advance.
We can create vaccines, antivirals,or whatever before they make the leap
in the population, so that when theymake the leap, we are already ready.

(01:01:11):
There's two major problems with that.
One, it working, which it doesn't, andthen one of its safety, which it's not.
First, if you make a study ofa pathogen you found in the wild
places that have never reallyever infected humans before,
and you create vaccines orwhatnot to combat it when they

(01:01:33):
actually make the leap,evolution still works, right?
It's not going to be the samevirus you cataloged.
These viruses.
Evolve very quickly.

All the time, and so you have a snapshot from ten years ago
when you went to the bat cave, butyou don't know what they look like now.
And the vaccines and things thatyou've produced to try to prepare,
you've never tested them on humanpopulations before because no human
had ever gotten the disease.
So this is a foolhardy way to youpretend to yourself that we've protected

(01:02:05):
ourselves againsta pandemic when we haven't.
Second, the actual conduct ofthis research is very dangerous.
And I think it's very likely that theCOVID pandemic was the result of this kind
of research agenda because it's notpossible to guarantee even in high
security labs.

Are you prepared to say that the preponderance of evidence now is
that Covid arose from a leak fromgain of function lab in Wuhan?

That's my position, and I believe it's also the position
of various intelligence agencies of thegovernment as well as other governments
as well, that have looked into this.

We were funding gain of function research in a lab of China,
something went wrong andthe world shut down?

Yeah, dangerous, now, I want to make a distinction.
There's only a small fraction of theportfolio of biological experiments that
people do that meet this category ofdangerous gain-of-function research
that have the potentialto cause a pandemic.

Right.

It's a tiny fraction.
There are gain-of-function activities thatpeople do that actually advance human
health, right.
I'll give you an example.
We produce human insulin usinga gain of function experiment.
What we do is we take E Coli,put a gene in.
I'm not sure exactly what the currentmanufacturing process is, but this was.
You put a gene in that produceshuman insulin and the E Coli,

(01:03:33):
then you grow them andthey make human insulin.
That's a gain of function that hasno chance of causing a pandemic.

Got it.

What we want is to make sure that researchers understand that
they should not be doing research thathas the chance of causing a pandemic.
It's not, don't work on Ebola,don't work on a list of pathogens.
Are you doing an experiment where evenif you think you have a benign virus
of that Virus from the middle of nowherethat doesn't seem to infect humans.

(01:04:02):
And are you doing experiments that augmentthem in ways that might infect humans and
cause a pandemic?
Then you shouldn't be doing that.
And the institutions that fund that work,that support that work,
universities, NGOs should understand thatif they allow that kind of work to go and
they don't have it as part ofthe regulatory process where, say,

(01:04:26):
let's evaluate it from the point ofview of the risk of causing a pandemic.
If they don't say that that work is goingon, they sort of surreptitiously do it and
it's discovered ex post they did,
they're gonna face essentiallyexistential threats.

Got it.

Right, it's so dangerous.
It's like allowing everyonein the United States to have
their own home nuclear reactor.
Right, are you doing->> Peter Robinson: Unwise.
Yeah, it's not most of scientific.
Most of it's a tiny, tiny part of science.
We regulate it.

(01:05:02):
We have a comprehensive NuclearTesting Ban Treaty to make sure that
we don't test nuclear weaponsroutinely because it doesn't actually
improve the security of anybody, butdoes pose- Would you like to see
an international treaty like the NuclearTest Ban Treaty on gain of function?

(01:05:25):
I would.I think that,
it's not in any country's interestto invest in this kind of research.
It doesn't give them any advantagein any geopolitical sense and
it does pose potentially existentialrisk to human populations.
Just look at what happenedduring the pandemic.
You can have an experiment like this thatcauses literally trillions of dollars

(01:05:48):
of damage, killing tens of millions ofpeople with not just the virus itself.
But the sort of outsized, inappropriatedamaging response to the virus,
you really should be notdoing that kind of research.

So this is one on which the planet ought to be able to come
together in your.

last couple of questions here.

The last time we saw each other, we went to buy you some suits
because you were wearingyour Stanford hoodie.
Actually, I will state this forour viewers.
You were wearing khaki trouserswith a tear at the knee.
And I said, Jay,you're an important professor.

(01:06:35):
Why are you wearing torn trousers?
And you said, I had a biking accident.
I said, Jay,when did that bicycle accident take place?
I think about two years ago.
All right, that was your life andyou loved it.
You even loved that crazy office you had.
You loved wearing hoodies andkhakis that were torn at the knee.

(01:06:56):
And now here you are in a suit,sitting in front of cameras.
You're getting yanked up to the Hillto testify again and again.
I've seen you over and over againstanding with President Trump in
the Roosevelt Room orwith President Trump and
Bobby Kennedy Jr in the Oval Office andyou're coming under attack.

(01:07:18):
This is a different life foryou, are you enjoying it?

[LAUGH] I'm not, I was a professor for a very long time.
I really love that life.
I'm here not formy own personal enjoyment, but for
whatever reason I've beencalled to do this, Peter.

Okay, so let's be explicit about this.
You are a deeply believing Christian,>> Peter Robinson: So explain that.
Explain to people who may not understandwhat it means to have a sense of a call.
Just explain how you think about it.

The actions that I take are not for myself.
That's what a Christian is supposed to do.
That's what Christ calls us to do,is to say the way we behave is for
the good of others.
We're called to love our enemies.
We're called to love others andto sacrifice self for others.

Yes. By the way, for the record,
I've known you a long time and I've knownboards you could have sat on and didn't,
and enterprises,startups you could have joined and didn't.
In fact, it's driven me mad that youdidn't take some of the money that was
offered to you.
But go ahead, because I'm notas good a Christian as you are.

I don't know about good Christian,
I'm not a particularlygood Christian either.
I think that the point is that this isa once in a lifetime opportunity to
actually make the scientificinstitutions of this country work for
the American people and frankly, forthe world, better than they have.
How could I say no?
So it's not about having fun.

(01:08:51):
It's about using whatever talent I have,which is not a lot, to advance that goal.

What has the experience taught you about
the United States of America?

It's a great country, [LAUGH].
I mean, I'm an immigrant to this country.
I arrived when I was 4.
I lived in public housing when Iwas little, actually in Cambridge,
Massachusetts before we went toCalifornia, I went to public schools.
The fact that I can be the directorof the NIH, especially after all

(01:09:21):
of the controversy over the pandemicwhere I was essentially shunned aside.
The United States is a systemwhere it can elevate people
who have that background is remarkable.
I mean, I'm never gonna forget that.

Jay Bhattacharya,
18th director ofthe National Institutes of Health.
Thank you.

Thank you, Peter.

For Uncommon Knowledge, the Hoover Institution and Fox Nation,
I'm Peter Robinson.
[MUSIC]

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Dr. Jay Goes to Washington: Reforming Science from the Inside at NIH | Uncommon Knowledge | Peter Robinson | Hoover Institution