DisInformation Chronicle: NIH Director Jay Bhattacharya End of Year Wrap Up
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💫 Summary
The video features NIH Director Jay Bhattacharya reflecting on his transformative year, addressing challenges in public health and research funding, and emphasizing the need for accountability, risk-based frameworks, and restoring public trust in science.
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Jay Bhattacharya discusses his journey to becoming NIH Director.
00:00He was contacted by Bobby's team after Trump's election win in November.
Initially, he thought the conversation went well but didn't express a strong desire for the position.
Friends intervened to clarify his interest in the role, which he had been contemplating for years.
Bhattacharya had been focused on NIH reform even before the pandemic.
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NIH Director Jay Bhattacharya addresses concerns about the agency's influence and policies.
09:56He clarifies that he does not control the CIA, DOJ, or DOD.
Bhattacharya expresses frustration over misunderstandings regarding the NIH's role in policy-making.
The discussion touches on the P3CO process established during the Obama administration.
He mentions confusion among his colleagues at the NIH regarding their perceived undermining of the White House.
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The NIH is working on a new accountability framework for grant evaluations to enhance safety in biomedical research.
19:52A risk-based approach will be implemented to ensure accountability for decision-makers.
The new process aims to evaluate potential risks of research that could lead to pandemics.
There will be penalties for failing to report risks, promoting thorough oversight among grant funding entities.
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NIH Director emphasizes the need for funding innovative research over outdated ideas.
29:48Advocates for investment in cutting-edge ideas rather than long-established ones that haven't improved health outcomes.
Highlights the importance of rigor and reproducibility in research funding.
Notes that the NIH fully allocated its budget of nearly $50 billion last year to research, countering claims of underfunding.
Critiques the stagnation of the NIH's funding approach, which favors older research proposals over new, promising ideas.
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Discussion centers on the prioritization of infectious diseases like measles and the role of vaccination.
39:41The speaker expresses concern over the focus on measles compared to other pressing health issues.
Emphasizes the importance of measles vaccination while acknowledging it is not their primary concern.
Clarifies that research and prevention of infectious diseases remain a priority for the NIH.
Addresses misconceptions about their stance on infectious diseases and vaccination efforts.
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Concerns are raised about the validity of long COVID studies due to lack of a clear definition.
49:37NIH funded long COVID research without a standardized medical definition for the condition.
A researcher noted that the definition for long COVID was established only halfway through a study.
There is skepticism about the value of data being collected, as different researchers define long COVID differently.
Questions are raised about the thoroughness of media coverage regarding these studies.
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The discussion focuses on the dynamics within health policy debates and the impact of political affiliations on public health issues.
59:33NIAID's focus is on patient reactions to pathogens, influencing the management of long COVID and other infections.
There is a noted division within HHS between Maha-aligned individuals and Maga-aligned individuals, reflecting broader political tensions.
The speaker identifies as a scientist rather than a politician, emphasizing their observational perspective on these dynamics.
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The speaker reflects on the loss of trust in scientific institutions during the pandemic.
01:09:26Experienced a crisis of faith due to the irrational behavior of respected figures in science during COVID-19.
Highlights the negative impacts of pandemic policies, including educational setbacks and increased mental health issues.
Emphasizes the need for reform in science to regain public trust, focusing on the importance of reproducibility and independent verification of research.
00:00Where are you at today when I'm when I'm
00:01calling you? Where are you?
00:02>> This is uh my home in California.
00:05>> Oh, you're back in California over the
00:07Christmas holidays.
00:09>> So, I I think the thing I want to, you
00:11know, this has been like a a huge year
00:14for you to change, you know, lots of
00:16change in your life this year and you
00:18know, now you're running NIH, but can
00:21just when did you because I don't think
00:22I've really read about how did you find
00:24out like where how did like were you
00:26down in Mara Lago? like did you get a
00:29call? Like what was your first inkling
00:31that I think I'm going to be nominated
00:34to run the NIH? Like how did that happen
00:36for you?
00:37>> It actually after the you know,
00:40President Trump won in November. Um I
00:43mean people had been talking some folks
00:45who were close to Bobby's campaign and
00:47other other folks have been talking and
00:49suggesting that I should reach out to
00:51people about wanting to be potentially
00:53an I dractor. Bobby reached out to me
00:55actually. He and his team reached out to
00:57me first in November and uh we had this
01:00conversation which I thought went really
01:02well. I wanted to be helpful as I said
01:05I'm happy to do whatever job Bobby
01:07wanted me to do including potentially
01:08being an I director. Apparently I'm bad
01:10at job interviews Paul because I I've
01:12only had like one in 25 years. So I I
01:14set the impression apparently that I I
01:16didn't I didn't want the job that and u
01:19it took an intervention by some friends.
01:21>> That's what you want to do. I mean,
01:23that's the best way to like get the date
01:25is pretend that you don't want to date
01:26and then like then you're like then
01:28you're desired. They start chasing you.
01:30>> I did I actually did want the job
01:32because I've been thinking deeply about
01:34how to reform the NIH for a long time.
01:36Even before the pandemic, I've been a
01:38subject of some of my scholarly work.
01:40Um, and then so a friend of mine uh
01:42reached out to Bobby's team and told
01:44them, "Oh, no, no, Jay. Jay definitely
01:46wants wants to help." Um, and they
01:49reached out to me and got that all
01:50cleared up. And then the the tweet from
01:52President Trump came out and I was just
01:54absolutely thrilled.
01:56>> Did you have to go fly like as part of
01:58your process? I mean, did you have like
02:00a just a phone conversation with Bobby?
02:02Cuz like he had already been nominated
02:04for HHS, right? And he was putting
02:05together a team. So, did you have like a
02:07conversation with him? Did you fly um
02:10out I mean he's he lives in California
02:12where you do. Did you fly down to meet
02:14him and talk to him in person? How did
02:15that whole thing work out?
02:17>> Yeah. So, there were there were
02:19in-person interviews in Palm Beach. they
02:20had like a nondescript office. It wasn't
02:23actually at Mara Lago, the meeting with
02:25Bobby. Uh the the the official second
02:28interview with Bobby that happened in
02:30this again this nondescript office in
02:32Palm Beach. There were it was folks from
02:34the presidential personnel office as
02:36well who interviewed me as well as a few
02:38others. But Bobby was the main interview
02:40there that happened after the the sort
02:42of the online interviews.
02:44Uh you know that's and it was after that
02:47that I got the official uh official
02:49tweet from the president. I did actually
02:50meet with the president in January, but
02:52that's that's a topic for another time
02:55in January 2025 where it wasn't clear
02:57that he realized how he had already
02:59offered me the job.
03:01>> Okay.
03:01>> But it was like at the end of it, it was
03:03like, Jay, you're hired. So that that I
03:04thought that that went okay, I guess.
03:06>> Did he did he look up and did he call
03:08you the wrong name? Did he say nice to
03:10meet you, Dr. Marty McCary or something
03:13like
03:16>> but uh it was I mean he's obviously very
03:18good at assessing people and we spent it
03:21an hour I spent an hour this was after
03:23the tweet where you had already hired
03:24me.
03:25>> Um I think just he wanted to get to know
03:27me a little bit better. Uh but the way
03:28he does that it's very interesting. That
03:31is a topic for another time. Paul this
03:32is but it was it was it was let's just
03:34say a nerve-wracking hour with the
03:35president uh where it was wasn't clear
03:37to me that he realized he'd already
03:38offered me the job. What what what what
03:41what why would it be nerve-wracking to
03:42meet the president of the United States
03:44like about potentially offering you a
03:45job? I have no clue.
03:47>> I mean
03:48>> I mean you know I I seriously have not
03:49had a job interview in decades. So this
03:51was this was uh this was baptism by
03:53fire.
03:54>> So how did you what kind of tell people
03:57because it's been you know again you
03:59came in in I want to say February and
04:01there were all these changes which we
04:02can get into about changes that had
04:04already happened at the NIH. you know,
04:06there had been a bunch of grants cut
04:08off, a whole bunch of changes that
04:10happened before you even came into the
04:11office. But so, but what was this first
04:14year like? I mean, you've gone from I
04:16mean, you're this, you know, six years
04:19ago, you know, you were this guy who no
04:22one really heard of outside of economics
04:23of health economics. Then you get, you
04:26know, you're getting more and more into
04:27the media throughout the pandemic
04:29because you're, you know, criticizing
04:31and pointing out problems with the way
04:32the pandemic was being handled. And then
04:35suddenly like now you're like the NIH
04:36director who's basically sitting on top
04:40of the biggest bucket of money on the
04:42planet for biomedical research, you
04:44know? So what how did this whole year
04:46kind of go? Like you've never been in
04:48federal service before. You've been a
04:50professor at you've been at Stanford
04:52since you were like 17 or 18 and now you
04:55have to move to Washington and you're in
04:57charge of this big bureaucracy. Like
04:59what has that been like? I I mean it was
05:01personally traumatic honestly because I
05:03I as you say I've been here this is
05:05we're recording on New Year's Eve I
05:07guess in um in in California. I'm in
05:10California. Um the the uh it was
05:12traumatic like I had to change my entire
05:14life. Like my move from a place where I
05:17lived for 25 years. All three of my kids
05:19went off were leaving the house anyways
05:21because they're headed to college or or
05:23doing other things with their lives. And
05:25uh you know I had to retire from my job
05:27at Stanford and enter this this job
05:29which and which was honestly was
05:32challenging at the beginning. It was
05:33April actually April 2025 when I started
05:36early April and it was the day that the
05:39government the doge announced the
05:40reduction in force the riff all across
05:43health and human services. So you know
05:453,000 some people I guess had just lost
05:47their job at uh at the NIH the day I I
05:50started. Um so it was it was it was
05:52challenging to say the least. Uh there
05:54was a lot of um a lot of anxiety at the
05:57NIH sort of understandably having to do
05:59with the the the you know the reduction
06:01forces riff uh as they call it um where
06:05and and and um you know the the fact
06:07>> I want to ask you how many people so I
06:09think it's around 15,000 people and that
06:12first riff let out about a thousand or
06:14something like that and
06:16>> 21,000 people at the NIH uh the day
06:19before I joined
06:21>> uh and at the day I joined about 30,000
06:24I forget the exact exact number but
06:25there were about 17,000 18,000 people
06:29after that riff. So a substantial
06:31fraction of the workforce
06:33>> 15% 20% something like that were let go.
06:36>> Yeah. On that order.
06:36>> Oh wow. Okay.
06:37>> And it was you know it was for me
06:39watching from the outside.
06:42I mean any organization has has
06:45inefficiencies you know you you want to
06:48uh assign people to the task that
06:50they're good at. you want to rethink
06:52processes so that you reduce paperwork.
06:54I mean, I'd read a lot about how to
06:56manage large organizations obviously in
06:57order to prepare. But it seemed to me as
07:00I walked in that there wasn't that
07:03process hadn't been gone through
07:05>> okay
07:05>> before in deciding how the rift. So I
07:07felt the pain of all the folks who lost
07:09their jobs. I mean it was I felt I I
07:11understood exactly why they were upset
07:13but it was frustrating because there was
07:14not much I could do about it from the
07:15outside. There's this thing called the
07:17vacancies act, Paul, that you're not
07:18allowed when you're appoint uh when
07:20you're uh promote appointed but not yet
07:23confirmed by the Senate to say anything
07:26or do anything or have any contact with
07:28people in the agency. Uh cuz you don't
07:30want to uh act as if you're leaving the
07:32agency before the Senate has confirmed
07:33you. Um and so I was frustrating to
07:36watch from the outside where I could say
07:37or do nothing while all these decisions
07:39were getting.
07:40>> So, so this is that time period between
07:42your nomination, you haven't been
07:43confirmed. I remember at the time you
07:45you were being blamed for things if I
07:47remember correctly. You were being
07:49blamed for things in the media when you
07:51actually you were actually legally
07:53disallowed from having any involvement
07:55at the time and the White House was
07:56sitting at your head making sure you
07:58didn't do anything.
07:59>> Yeah. I mean I mean because you know
08:01there's
08:02>> you don't want to violate the vacancies
08:03act. That that's a sure way to not get
08:05the nomination. Um because the Senate
08:07gets to decide before you before you get
08:09to do anything. And also the the the
08:11advice to all the nominees, this is
08:12between let's say January and March of
08:152025, um when I hadn't been appointed
08:17yet. Um the advice to all nominees is
08:20just stay quiet. Don't talk to the
08:21media. So all these like things
08:23happening. So I couldn't do anything
08:24internally and I also couldn't do
08:27anything. I couldn't like defend myself
08:29in the media because I will the advice
08:31was don't talk to media from the White
08:33House. So, it was kind after 5 years of
08:37of essentially being able to say what I
08:39think, you know, with with all this like
08:41suppression and censorship and all that,
08:42but the very least getting my my um uh
08:45being able to at least say without being
08:46a being um uh being like directly uh
08:51effectively self-censoring. I I I I had
08:54to self censor.
08:55>> So, Oh, well, you had Twitter like
08:57basically like no tweeting, no nothing.
08:59Just
09:00>> tweeting.
09:02How did you survive without Twitter? I
09:04mean,
09:04>> it was cold turkey at first. It was
09:06really frustrating because, you know, I
09:07see people say things that were like
09:08just not true, like straight up and I
09:11was like, you know, even friends and I
09:12was like, what the I can't I can't uh,
09:16you know, I can't.
09:18>> So, I want to go over some, you know,
09:20some of the big things that have been in
09:21the media that, you know, are well,
09:23okay, I want to this because this one
09:25was just so silly. You know, one of the
09:27big things that uh Trump put out was in
09:29May of this this year that he's going to
09:31kill off gain of function research.
09:32They're going to rein some of that in
09:35and you know, they've been working on
09:36this executive order. This is not a law.
09:38This is an executive order that Trump's
09:40putting out a policy. And and then this
09:42article came out in the Daily Caller
09:44that made all these accusations against
09:45the NIH. And what was amazing at the
09:47time is when I read that article, I knew
09:50it was wrong because I had already been
09:52leaked like two months prior some
09:54internal emails from what happened in
09:56the last process. And I looked at the
09:58emails and I was like, "Wow, there's a
10:00lot of people involved. You got DoD, you
10:02got HHS,
10:04you got CIA, you got FBI." And then I'm
10:06reading this Daily Caller story that
10:08basically says the NIH is trying to
10:10undermine the White House. I remember my
10:12first thought was how do they do that?
10:14So, like I just want to go through some
10:15questions here. I just want to make
10:16sure. Do you control the Department of
10:18Justice from the NIH?
10:20>> I do not, Paul.
10:21>> Okay.
10:21>> I do not.
10:22>> I want to make sure that because like do
10:24you control the CIA? Because they're
10:25also involved in this. Do you control
10:27the CIA?
10:28>> I do not control the CIA, Paul.
10:31>> How about the Department of Justice?
10:33>> How about the Department of Justice? Do
10:34you control the Department of Justice?
10:35>> No, I don't. I don't control the DOJ. I
10:37don't control the DoD.
10:39>> You don't control the White House
10:40either. Actually,
10:40>> I guess they're called the Department of
10:41War now. But yeah, I don't control them
10:43either. Right, right, right. So,
10:45basically the White House is in charge
10:47of this policy that's supposed to be
10:48coming out um sometime soon. What was
10:51that like dealing with I mean like
10:53there's still like stuff on Twitter
10:55about how why is the NIH trying to
10:58undermine what's happening and you're
11:00not in charge of this? The White House
11:02is in charge. Like I mean what do you
11:04>> I mean I I I have friends I have people
11:07inside the NIH that I was talking to at
11:08the time because I was confused at the
11:09time. They're like this makes no sense.
11:11I mean what were you making?
11:13>> It's actually quite frustrating. This
11:14this is part of the Okay, let me let me
11:16try let's back up and let me just make a
11:18defense about anxiety and worry about
11:21the NIH around this issue of gain of
11:23dangerous gain of function. Right. So
11:25>> the last process something weirdly
11:27called the P3CO process that was put in
11:30place in 2017 in the dying days of the
11:32Obama administration. So that's that's
11:34that's the emails that I have when that
11:37process came out and I was given those
11:39emails by someone inside the
11:40intelligence community. And you can see
11:42when that process came out, there's like
11:44it's four pages of emails of the people
11:46that were involved. And there's like
11:47only like I think six or seven of them
11:49are from the NIH, but there's people
11:51from all over just
11:53>> just to back up and give context, right?
11:55That's in 2017. What had happened was
11:57that there had been a pause put in place
11:59in all dangerous gain of function
12:02>> research during the during the Obama
12:04administration. Tony Fouchy and Francis
12:06Collins fought against that pause. It
12:08they you know they there was a famous
12:10Washington Post oped that they wrote
12:11together in I think it was 2011 or 2012
12:13with a title a flu risk worth taking
12:15where they made the argument that doing
12:18this kind of dangerous gain of function
12:19work was necessary to be able to predict
12:22and prevent future pandemics. So even if
12:25there was a risk of la of leaking of lab
12:27leak that it was a risk worth taking.
12:30They lost that policy fight. There was a
12:32pause but they put in place a new
12:34regulatory framework across the whole
12:36government not just the NIH
12:38>> not they like Tony the White House put
12:41together regulatory framework but across
12:43the whole government because it's not
12:44just the NIH where this kind of
12:46potentially dangerous research happens
12:49>> happens at the USDA potentially it
12:51happens to the DO it happens to a whole
12:53whole host of government agencies
12:55support research that potentially could
12:57fit in this bucket of if it leaks then
12:59you could cause a pandemic. Well, also
13:01the other the other thing that I found
13:03out from talking to people inside the
13:04intelligence community is it's not just
13:07the people funding and doing the
13:08research, you also have to have this
13:10agreement across the government because
13:12DoD is monitoring this stuff in other
13:14countries. State Department is
13:16negotiating um you know treaties on this
13:18issue. I didn't realize I did not
13:20understand like that it was so complex
13:23until actually I got these emails.
13:25>> Yeah, it is a it's a it's a it touches a
13:28very large number of agencies in the
13:30government. It has to be coordinated. It
13:31has to be carefully managed. It can't
13:33just be one. I mean the NIH is a major
13:36player in it. Absolutely. Because we
13:38fund biomedical research. Most of it the
13:41vast vast majority of it are not have no
13:42chance of causing. Uh the question is
13:45this the small sliver of of of research
13:47that has a chance of causing pandemic.
13:49that process that that 2017 P3CO process
13:52involved the whole government. But let
13:54me just make a defense of what what the
13:56some of the reporting. Um
13:58>> in 2017 what happened was that that
14:01process that was put in place this P3CO
14:04process involved checking from a list of
14:06pathogens says are you working on
14:08pathogen on Ebola? Are you working on
14:10some things that are dangerous?
14:11>> Right? And um and it relied on
14:14essentially a self-reporting process
14:16where like the agencies would would
14:19offer up a grant that looks like it
14:23checked the box on one of the lists and
14:25then there'd be a group of people like
14:27three or four of a few people with
14:30expertise in deciding whether this was
14:33actually dangerous or not.
14:34>> Right? whether in the entire history of
14:37the P3CO process from 2017 to 2025
14:41exactly four grants three or four grants
14:44it's I've heard different accounts went
14:46up to the the group of people that were
14:48deciding whether it was dangerous
14:50>> incl and and so including like the
14:52proposals to to do research in Wuhan on
14:55corona viruses that didn't go up the
14:57process that was never even considered
14:59in the process where where they where
15:00like a a group of experts got to decide
15:02whether or not the thing should go
15:04forward There was a policy in place and
15:07it was toothless and the NIH played a
15:10role not the only role but it played a
15:12role in making the process toothless.
15:16>> Right.
15:17>> Now, one of the things that I one of the
15:18things that I heard is that the NIH was
15:21giving a lot of passes to various grants
15:23instead of running them through the P3
15:25P3CO process. And apparently the sign
15:29off for allowing them to not go through
15:31the process. Senator Ran Paul has
15:34documents showing that this happened.
15:36He's sitting over it in his committee.
15:39I've been told this by um Senate
15:41staffers that he has the whole list. I
15:42don't know why he's not come out with
15:44this.
15:45>> Yeah, I mean it's defin it's definitely
15:46true. I mean I don't know. I wasn't
15:47obviously I was I was a a a Stanford
15:50professor. you say I was I was I was
15:52largely known among health economists
15:54then I wasn't paying I wasn't like part
15:55of any of these deliberations at the
15:57time in between 2017 and 2025. Um but
16:00you can see what the the outcomes of it.
16:02Only three grants went up or four grants
16:05went up to the pro to for consideration
16:07in this P3C process during the whole
16:09entirety of 2017 to 2025. And as far as
16:13I know, I don't think any DoD grants
16:15went up. No grants from USDA went up. It
16:18was it was it was basically a toothless
16:20process for the entire government even
16:22though the entire government spent a lot
16:24of effort trying to coordinate that
16:26process and and put it into place right
16:28before Obama left office.
16:30Right. Okay. So, all right. So, that's
16:32the backdrop of of what happened this
16:34year.
16:35>> Right. I think there were people who
16:37were very frustrated on the outside
16:40pushing for us for the government to not
16:43do this kind of research and to have a
16:46pro a regulatory process that oversaw
16:48it. And so and of course there's like a
16:51lot of distrust like once I learned of
16:54this uh you know in you know sometime
16:57around 2021 I was deep I became
17:00distrustful of the government on this
17:01like I didn't just between 2021 and 2025
17:06and and I'm sorry 2024 and President
17:08Trump's election I was deeply frustrated
17:10during the B administration because
17:11really clear to me they were not taking
17:13their obligation to do this to regulate
17:15this work seriously and there was a
17:17there was a renewed process to try to
17:19figure out to strengthen it right at the
17:21end of the Biden administration.
17:23>> Okay.
17:25>> And there were people that that had put
17:26together a process that looked that was
17:28supposedly going to work better than the
17:30P3CO process, but it took four years,
17:34>> right?
17:34>> And it was run by the White House just
17:36as it should be because the White House
17:37coordinates across all the different
17:39agencies. um the version of the
17:42regulatory process that had been put
17:43forward at the end of the Biden years to
17:45revise the PTCO process was this long
17:48complicated document with with and with
17:50with with like to my to my eyes obvious
17:54loopholes right so again it focused on a
17:57list of pathogens that said uh are you
18:00working on Ebola are you working on
18:02westnires or whatever and it was a
18:05listbased thing with like exceptions and
18:08it it looked just unworkable to The
18:10process that we've had now is more is a
18:14riskbased process. That's that's the
18:16idea that we that that the White House
18:18is more working on. Instead of saying
18:20are you working on a list of of one of a
18:23list of pathogens, the question is is
18:25the research you're doing does it pose a
18:27potential existential threat to to
18:30humankind? Does it does it pose a does
18:32it have a chance of causing a pandemic?
18:34Because for instance, the research that
18:36likely caused the pandemic was on a
18:38virus pulled out of a batcave in China
18:40that was not a no no list anywhere.
18:43>> Right. Right.
18:44>> Right. And so the question but was it
18:46risky? Yeah, it was risky. So the new
18:48process the focus is risk making sure
18:51that that the uh that there's a you have
18:54a sense of the expert eyes get to see
18:57and oversee other people's proposed work
19:00to assess the risk of causing a
19:01pandemic. Second uh accountability to
19:04make sure that that every part of this
19:07chain of deciding whether you get to do
19:09this research you have accountability
19:11right so the researcher if they don't if
19:13they fail to report up a risk they they
19:15potentially face severe penalties if
19:17exposted to people decide that there was
19:19they were taking a risk the institution
19:21that where the researcher is doing the
19:22work they're going to face severe
19:25penalties if they don't oversee the
19:26researcher to make sure that they report
19:28up the chain anything that's that
19:30potentially has a risk there's There's
19:32the institutions like the NIH. We also
19:34are going to have to face to to like be
19:36be overseen by uh by independent body,
19:39not us. It shouldn't be us checking our
19:41own home home
19:42>> because that last that last process
19:44basically was the NIH checking itself,
19:46right? I mean the NIH would decide
19:49whether we decide whether this grant
19:51looks risky or not and we'll run it
19:52through this process and we're
19:54controlling the process. That was a
19:55weird well I mean I don't think the NIH
19:58controlled the the people that were
20:00supposed to evaluate the grants at the
20:02pro but the NIH did decide whether to
20:04send the grant up to the process and the
20:06same thing for the DOW for USDA all the
20:08all the other entities of the government
20:09all they all get to they all get to
20:11decide but there was no accountability
20:13in that decision. Um the new process I
20:16mean it's still work the White House is
20:17still working on it but I have a lot of
20:18hope that it's going to be it's going to
20:21be riskbased. it's going to have
20:23accountability at at the core of it for
20:25every single decision maker as well as
20:27penalties for if they failed to report.
20:29The the key thing will be um as I said
20:32earlier Paul most of research biomedical
20:34research has no chance of no potential
20:36harm of causing a pandemic that it's
20:38only a small sliver of it. The key idea
20:40is uh report up more than the sliver.
20:44let the expert independent body um
20:47whatever it turns out to be do an
20:49evaluation of the risk and check the
20:51homework of all the different entities
20:53that are doing this kind of grant
20:54funding including the NIH um and then
20:57and then make a riskbased decision if
20:59there's any risk of causing a pandemic
21:01no you can't do it if there is no risk
21:03you've reported up things that that you
21:04think someone might think there's a risk
21:06but it turns out there isn't then you
21:08get permission to do it right it's going
21:09to be a riskbased framework where
21:11there's everyone's checking each other's
21:13homework work and there's penalties
21:15involved if you don't report. I want to
21:18ask you one of the other big things
21:19that's happened too at the NIH has been
21:21um I mean this is not just at the NIH
21:23it's been across the government um but
21:25is ending de um uh you know grants and
21:29stuff and so some of the grants that
21:31you've ended you know have you know that
21:33that that has gotten a lot of attention
21:34but one of the things that's not gotten
21:36attention is something that I've been
21:37told because I've had two people inside
21:40the NIH I don't know if you read them or
21:41not write anonymous pieces for my
21:43newsletter. um one is a was a is a very
21:47senior person inside the NIH and one is
21:49a little bit more junior but um and they
21:51didn't write this in the pieces they
21:53wrote for me but um they both told me
21:55and was speaking on the phone that one
21:57of the things they hated about the DEI
21:59stuff inside the NIH it wasn't so much
22:02the grants targeted for DEI or the fact
22:05that they you know minority or women get
22:08a little bit more of a bump to get a job
22:10or a grant or something like that that
22:11they were they were they didn't care
22:12that much about they hated did the
22:14teachings like the the sort of like one
22:17person described it as like communist
22:19like teachings in which you're told
22:21about microaggressions and all this kind
22:23of stuff and one person told me like
22:25he's like you just basically you knew to
22:27shut up because if you said anything you
22:29might be fired I mean how come that
22:31never came out the type of internal NIH
22:34processes with these you know that was
22:36that were going on that didn't come out
22:40>> I mean that that that was the case also
22:42in universities like Stanford like there
22:44were there were essentially at the NIH
22:47what I what I discovered was that that
22:49DEI principles were embedded into almost
22:53every aspect of decision-m inside the
22:56NIH including you say training for
22:59microaggressions you had to write what
23:02looks to me like a loyalty oath to the
23:04principles of DEI or else you you would
23:06face you know like in intramural
23:09scientists scientists who work as at the
23:11NIH in order to get renewed funding for
23:14the next 5 years would have to
23:15essentially write a loyalty note to DEI
23:17or else they get they get dinged.
23:19Including including Matt Mey, my my
23:21deputy director. He I he showed me a a a
23:23document that he was required to write.
23:25He actually ended up writing something
23:27saying that he you know he's he's a
23:28devout Christian doesn't believe in
23:30discriminating against other people that
23:32love is your neighbor is like the
23:33centerpiece of how he thinks in response
23:35essentially as an act of defiance
23:37because what they're looking for was
23:39essentially you know the the the normal
23:41mantra for what you would would say if
23:43you were a devote of DEI and the
23:45performance evaluations were all
23:47included things like did you include
23:50diversity elements and think and
23:53implement diversity in your research
23:55work which it was like every single
23:57aspect of the NIH functionality had DEI
24:00embedded in it and of course we were
24:02funding
24:04>> a very large number of grants that on
24:06DEI related sort of DEI focused sort of
24:10paradigms across the NI portfolio extra
24:12murally at the end of the year there's
24:14leftover money what would happen is that
24:16that program officer would go to people
24:19in the researchers in the community and
24:20say well look we have leftover money you
24:22should apply for a diversity supplement
24:24so if you're working on DEI, you could
24:25get the leftover money. If you were
24:27working on on some other something else
24:29potentially very important, you couldn't
24:30get the leftover money. DEI became
24:32embedded in every aspect of what we did.
24:34The thing I want to emphasize, Paul, is
24:36that it's very important that the NIH
24:40research
24:41the kinds of diseases and conditions
24:44that minority populations have by
24:47minority populations are are are
24:48American. Um, the mission of the NIH is
24:51to improve their health just as to
24:52improve everyone's health. If you look
24:54at the track record of DEI improving
24:56improving the health of people in the
24:58minorities in the country, it is
24:59abysmal, right? Since 2010, there's been
25:02no change in life expectance, no
25:04improvement in life expectancy for
25:06minority Americans in the United for
25:07black Americans in the United States.
25:08None. It's been flatlined. And of
25:10course, it collapsed during the
25:11pandemic. All of that DEI work that the
25:14NIH focused on for a decade and a half
25:17did not translate over to better health
25:18for minority populations.
25:21>> Let me ask you this. Did it provide good
25:23jobs for um DEI officials inside
25:25universities and academics research
25:27centers? I mean, I'll tell you something
25:29like I saw I think it was University of
25:31Michigan, the New York Times did a piece
25:32about it and it talked about how much
25:34money they spent on DEI stuff at which I
25:37think it was University of Michigan had
25:38like the biggest DEI program and I
25:40looked at this and I was like, "Oh my
25:43god, like what if they had taken that
25:44much?" I mean, think about how many like
25:46just, you know, poor like minorities
25:48there are who can't like maybe have good
25:50grades, maybe not excellent grades, but
25:52don't really just like I can't go to
25:53school because like I'm the first black
25:55kid in my family, you know, whatever
25:57trying to go to college and I just can't
25:59do it because of the money this and
26:00that. Why didn't they fund these kids to
26:02go to school? Give them a free ride
26:04scholarship instead of spending money on
26:06these, you know, these like $190,000
26:09salaries in Michigan for some DEI
26:12official. I've really enraged. I'm a
26:14first generation kid going to college.
26:16So when I saw that kind of stuff, I was
26:18like, are you kidding me? You wasted
26:19that kind of money on this stuff. I
26:22think I think that that that focus it
26:24what the it it may have made a lot a few
26:27people feel good about themselves
26:28because they felt like they were trying
26:30to do something to to write historical
26:32injustices, racial injustices in this
26:34country, right? No, no one's arguing
26:35that those historical injustices didn't
26:37exist. The issue is that the thing that
26:40you do, in this case DEI, does it
26:42actually make the lives of minorities
26:45better? And the answer is no. It did not
26:47make the lives of minorities better. Our
26:49mission at the NIH is to do research
26:51that improves the health and well-being
26:52of of and longevity of Americans. And
26:55yet minority populations face tremendous
26:57chronic disease problems along with the
26:59rest of the country. Frankly, chronic
27:00disease problems, life expecties has
27:03flatlined, tremendous health problems.
27:06and the NIH's work did not work,
27:09especially on DEI, did not actually have
27:11any chance of improving the health of
27:12minority populations. And you can see
27:14that it didn't. So I think that that the
27:16shift away from DEI is of a piece with
27:18the rest of what we're trying to do at
27:19the NIH which is to do research that
27:21actually makes the lives of people
27:23better cures diseases extends life
27:25shifting the portfolio away from DEI
27:27shifting all of the processes where DEI
27:29is no longer front and center but rather
27:31rigoring your research reproducibility
27:33of the research ideas that address the
27:35health problems of of the of the people
27:37of the country. I think that's going to
27:39pay dividends over over the next few
27:41years. It's interesting you bring that
27:42up because that that's what I noticed
27:44too, right? I mean, what you're doing is
27:45you're shifting a portfolio. We're
27:46focusing on different things. Yet, I
27:48will read story after story in the New
27:50York Times, the pharmaceutical
27:52industry's favorite media outlet, Stat
27:54News, in which you're killing science.
27:57You're killing and I'm like, I read
27:58this, I'm like, no, you're not killing
28:01science. We're just not funding that
28:03research anymore. We're going to fund
28:04other I don't see them doing stories
28:06about, hey, we started funding this new
28:09grant. And there's this like happy like,
28:10hey, look at this grant that got funded
28:12over here for this new thing that they
28:14couldn't get any money before. And I
28:16don't
28:18I like like where is the New York Times
28:20story on that? And I don't see it. I
28:23think it was a 60 Minutes piece uh about
28:25a researcher in Boston, like a 70 plus
28:28year old researcher in Boston um with
28:30the claim that like she lost a grant. I
28:33I think she actually lost her grant
28:34before before uh before the the um uh uh
28:39I forget exactly the details but like
28:40the like but but she lost her grant and
28:42somehow because she lost this grant
28:44she's been funded for 30 plus years um
28:46and because she lost this one this grant
28:48this time that uh we're not going to get
28:50a cure for breast cancer. If only we
28:52would funded her 35th first year then we
28:54would get a cure for breast cancer. I
28:56mean it's it's
28:57>> uh I mean I think the thing is if you
28:59look this is research that I did before
29:01the pandemic. Uh if you look at uh the
29:04age of ideas that re that NIH funded
29:08researchers working on in the 1980s NIH
29:11funed researchers were working on ideas
29:13and publishing ideas that were zero one
29:15or two years old really on the bleeding
29:17edge.
29:18>> By the mid 2000s 2010s NIH researchers
29:22were working on ideas that were seven or
29:23eight years old.
29:25>> For many many many different reasons the
29:26NIH had become essentially a much more
29:29sort of risk averse in in its ideas. I
29:32that supported I kind of it was it was
29:34it was it was essentially funding older
29:36re so later career researchers that were
29:39working on older ideas and that needed
29:41to change that needs to change if we're
29:43going to get fundamental transformation
29:45of American health through research we
29:47need to fund research on ideas that are
29:50not currently in this that like widely
29:52accepted in the status quo because those
29:54status quo ideas haven't translated over
29:56to better health I mean there's some
29:58some things are worth investing in and
29:59continuing down the lines I mean of
30:01obviously genetics research. There's a
30:02whole bunch of other research lines that
30:04are so worth investing in. But I want
30:06cutting edge ideas. I want rigor and
30:08reproducibility at the core of what we
30:10do. I don't want just to fund research
30:13just because they've been funded for 30
30:14plus years, right? I mean, if if you're
30:16a 78-year-old researcher getting a big
30:19NIH grant, there's a 35year-old
30:22researcher who's not getting a big
30:24grant. I mean, it's like the but there's
30:27this weird thing like sudden like the
30:28money disappeared. I'm like, the money
30:30doesn't disappear. It just went in
30:31another direction. But you never see
30:33those stories.
30:34>> We spent we like there were all these
30:36stories over the course of the summer
30:38this summer this past summer about how
30:39the NIH wasn't going to spend its money
30:41that wasn't going to fund research. You
30:44know, we spent the full allocation of
30:46money that the NI that the Congress gave
30:48to the NIH last year, almost $50
30:50billion, and all of that money went to
30:52research, Paul. I mean so I I don't
30:55really understand these stories except
30:56to say that you know people are not the
30:58NIH as an institution hasn't really
31:01changed in decades right it's uh it's
31:04the like fundamental transformation of
31:06the NIH really hasn't happened in
31:07decades and so a lot of people who are
31:09used to to the old way of doing things
31:12where they would get money for seven or
31:14eight year old ideas for their entire
31:15career are are unhappy I'm not you know
31:19if that 70 researcher proposes a new
31:21idea that's really promising I I want to
31:23fund it. I I don't want I mean it's not
31:25the question directly of the age of the
31:27scientists. It's the question of the age
31:29of the ideas that the scientists are
31:30proposing,
31:31>> right?
31:32>> We want I want to fund research that is
31:34at the cutting edge. And to do that it
31:37there's a lot of change that has
31:39happened and will continue to happen at
31:40the NIH because we have to change the
31:42culture not just the NIH but of science
31:44of the biomedical sciences which has
31:46gotten to this position where if you
31:48have a new challenging idea it's very
31:50difficult to get support.
31:52>> Yeah. Um, you know, it's funny. There's
31:54a whole history of this kind of stuff.
31:57The guy who um discovered knockout mice,
32:00um, I'm blank out his name right now. He
32:01had an Italian last name and he was at a
32:03University of Utah and you I had just
32:06graduated from college in the '9s and he
32:08came and gave a talk at Emory and I
32:10remember I mean there's this is such a
32:12common theme I think with NIH
32:14researchers. He had an NIH grant. He he
32:16applied for an NH grant to study how to
32:18make knockout mice which became like I
32:20think in one year was like the top
32:22science magazine gave it like it was the
32:24top um discovery of that year or
32:26something but he he tried to get it
32:28funded by the NIH. They turned it down.
32:31He then took his NIH money from another
32:33thing basically stole it cuz like I had
32:35posttos were talking about this at
32:36Emory. They came out like, "Oh my god,
32:38he he stole his money." You know, like
32:40from the NIH grant, did the studies to
32:42get the initial data, then resubmitted
32:45back to the NIH, and then they funded
32:47him after he had taken NIH money to make
32:50due to the discovery that NIH wouldn't
32:51fund. It's just like I mean, and it's
32:54now I read found I I know he gave this
32:56talk, but then I found it in the New
32:57York Times, and I think this is very
32:59common that people do this all the time.
33:01>> Yeah. One of the things about uh study
33:03sections, study sections are review
33:05panels that look so we get 100,000
33:08applications a year and you can't fund
33:09all of them, right? You fund maybe 10%
33:11of them. So what we have is a scientific
33:13review panel that reviews every single
33:14grant, all 100,000 grants, grant
33:16applications. Is it is it scientifically
33:18rigorous? Is it is it is it a new idea?
33:21Is it is it is it cutting edge? How good
33:23is how good are the investigators that
33:25are doing it? How good is the
33:26environment where what they proposed to
33:28do? Um those study sections I can tell
33:32you as someone who want who were sat on
33:34study sections for decades um tend to
33:37emphasize will the grant application
33:40will the proposed idea does it have a ch
33:43does it is it is it rigorous is it
33:45likely to work
33:46>> it underemphasizes is it brand new if if
33:50it actually works out will it change how
33:51we think about how to manage type or or
33:54cure type two diabetes uh will is it if
33:57is was it a Would it if it works out
34:00would it be a major breakthrough in in
34:02how we think about this biological
34:03process? It underemphasizes innovation
34:06the study sections and overemphasizes
34:08methods. We put in place changes in the
34:10last six months to fundamentally
34:13transform that to put the focus of these
34:15scientific group panels on how
34:17innovative is the idea and if it worked
34:19out would it would be really would it
34:20would have big impact on on how we think
34:23about treating or or curing diseases
34:25rather than on does the proposed method
34:27is it likely to work right I would
34:29rather have a portfolio of 50 projects
34:31where 49 of them fail and the 50th cures
34:34type two diabetes than a project a
34:35portfolio where there's 50 projects all
34:38of succeed in publishing five papers and
34:40none of them improve the lives of any
34:42human being.
34:44>> So speaking of the grants, you know,
34:45there's there's there's a whole lot of
34:47drama right now over the grants because
34:49there's there's been Doge cut some
34:52grants I think when you came in, then
34:54you cut some grants um and then some
34:56grants got tied up in court in um one
34:59lawsuit and then some were tied up in
35:00another lawsuit. Can you just explain
35:02like where are these buckets of grants
35:04and like what happened what with when
35:06and where are we at with this process?
35:08>> Yeah, so there were a lot of those DEI
35:11grants that we talked about earlier,
35:12Paul, they were cut before I became
35:14director, including grants on on like
35:16transing kids, right? So some some of
35:19those grants were cut before I became
35:20director. Now, as I said, I I'm in favor
35:23of not funding research that has no
35:25chance of improving the health of
35:26people. So I was I was okay with that
35:28generally, but the courts essentially
35:32for many of those grants ordered the NIH
35:35to restore them,
35:37>> right?
35:37>> So So like a lot of and and in fact made
35:40it so that we couldn't actually cut
35:41them. I put out a priority statement
35:44right after shortly after let me a
35:46couple months after I became director
35:48where I said look DEI we're not going to
35:50we are interested in in improving
35:52minority health but we're not interested
35:53in funding DEI.
35:54>> Right.
35:58The courts essentially have said, I
36:00think as best I can understand the legal
36:01aspects of things that for those grants
36:04that that were paused that we that that
36:07they forced us to restore, we can't cut
36:09them. But when it comes to renewal,
36:13those those grants no longer meet NIH
36:16priorities. I put a put a director
36:18statement that says, look, uh, we are
36:20not interested in funding DEI anymore.
36:21So when they come up for renewal over
36:23the course of the year, we won't renew
36:24them. I see. Okay. So, these are grants
36:28that they were they were tried to be cut
36:30that they the court said, "No, you have
36:32to fund them." And so, the way that
36:34you're going to end those grants is by
36:35saying, "Well, we're taking a new
36:36direction. We're not funding this stuff
36:38anymore." Okay.
36:39>> Yeah. And then there are there were some
36:41grants where where the the courts didn't
36:43overturn them. We we terminated those.
36:45But we put a set up a appeals process
36:48because you know the like it's it's you
36:51want human eyes on these decisions. So,
36:53we set up an appeals process where if
36:55you had a grant terminated and you
36:57thought, well, this isn't DEI. Why did
36:59it get terminated? We set up an appeals
37:00process so you could get you could you
37:02could get that reversed or renegotiated.
37:04Often what would happen, Paul, is that
37:06you'd have grants that would have some
37:08good science in it and you'd also but
37:10they'd be larded up with a whole bunch
37:12of DEI verbiage in order to like uh
37:16where in order to like get it through
37:17the DEI filter that the NIH had.
37:21>> Right. Right. Right. So in other words,
37:23you're saying these were probably
37:24legitimate grants, but the people on the
37:26outside were like, "Well, NIH1's DEI.
37:28We're going to give them DEI."
37:30>> Yeah.
37:30>> And so a lot of that was just it wasn't
37:32actually part of the science, right? So
37:34>> we during the appeals process, we
37:36offered researchers the chance to to
37:39rethink what they were doing, focus on
37:41the scientific part and not on the
37:42political DEI part,
37:44>> right?
37:45>> And a lot of a lot of researchers took
37:46us up on that. So there were grants that
37:48were renegotiate that were that had DEI
37:50verbiage but were weren't central to the
37:52grant. They they they refocused the
37:54grant on the actual science that they
37:56were proposing rather than on sort of
37:57this politicized nonsense. And so the
38:00bunch of grants are in that bucket.
38:01Yeah. The the uh and then there was just
38:02the ones that were terminated and stayed
38:04terminated. Right. So those are the
38:05three buckets like the the stuff the
38:07courts that forced us to restore,
38:09>> right?
38:10>> But don't meet our priorities and aren't
38:12going to get renewed in a in a way
38:14because they don't we you know we change
38:16direction. were no longer funding
38:17politicized nonsense. A bucket of of
38:20grants with that got renegotiated to
38:21focus on the act with the act essential
38:23good science that was in the grants
38:25again with removing the politicized
38:26nonsense that was the superructure
38:28around it and then um bunch of grants
38:31that that that got that that got
38:32terminated that don't don't meet our
38:34priorities that the courts didn't didn't
38:35say we had to restore. There were also
38:37some some v so like as you've started to
38:39do this shift over to chronic disease
38:41there's also been quite a few of sort of
38:44vaccine and viology research related
38:47stuff that's cuz you're moving over from
38:49doing infectious diseases which has been
38:52a huge um push inside NIH to study
38:56infectious diseases and I mean to me
38:58when I looked at this I didn't
38:59understand it at first but then when you
39:00look to see what people are d I mean
39:02I'll give you an example I cannot like
39:05get up in the morning and read the New
39:06York Times or the news or whatever
39:08without seeing another story about
39:10measles, you know, measles this. And I
39:12looked and I'm like I was looking I was
39:14like, "Okay, so in the United States,
39:16three people have died of measles this
39:18year apparently." Although one sort of
39:21did they die of measles or did they die
39:23of an actual bacterial infection, right?
39:25Whatever. Something like 9,000 Americans
39:28die every day, you know? So you read
39:30this crazy headline measles and then
39:32you're like okay wait but like um three
39:35people died like I mean literally it's
39:37like hundreds of thousands of people die
39:38every year from chronic you know from
39:40chronic diseases and yet you guys are
39:43obsessed with infectious diseases and
39:46vaccines and I wonder to what degree do
39:48you think that is being pushed by the
39:50veriologist who we think may have
39:52started the pandemic. I mean, I see them
39:53on blue sky all the time. Anytime
39:55anything comes up about a vaccine
39:57related infectious disease that are
39:59they're freaking out about that and I'm
40:01fine. I I mean, we have to deal with
40:03measles, but like of the things that
40:05people are dying of, of the things that
40:07like I wake up in the morning and I'm
40:09worried about dying of, it's not
40:11measles. It's just not. I don't care how
40:13many times the New York Times runs a
40:15story or the Post runs a story about
40:16measles. I don't get up and worry about
40:18people dying of measles. I have other
40:21concerns.
40:22>> Okay. Okay. Well, so okay, there's a
40:23couple of things here. So, first let me
40:24just start with I do think measles is an
40:27important disease to prevent, Paul. So,
40:28I am very much in favor of measles
40:30vaccination. I think it's really
40:31>> I'm talking about ranking it on the
40:33issues that like
40:35I just want to throw it clear and get
40:36get that first. Right. So,
40:38>> okay.
40:39>> Yeah.
40:39>> Oh, so that you don't that you don't end
40:40up in the New York Times saying Jay Bach
40:43has denied that measles kills people.
40:46>> It's it's it's a
40:47>> Right. Right.
40:49>> Right. So I I I I also think it's
40:51important for us to do research on
40:52infectious disease. So I just want to
40:54start start by saying that
40:56>> right because it's it's important to
40:58remember that those are not those are
41:00those are still priorities for of mine
41:01and of the NIH. We want to prevent
41:03infectious disease. We want to treat
41:05patient develop treatments that better
41:08better for managing infectious disease
41:10once you get it. I think there that's
41:11still a priority for us. So there's a
41:14lot of misreporting on this Paul but I
41:15think the key thing is that we've done
41:17it with the institute that focuses on
41:19that is called the national institute of
41:20allergy infectious disease. is the old
41:21institute that Tony Fauci used to run,
41:23NIAD,
41:25National Institute of Allergy Infectious
41:26Disease. Under Tony Fouchy, he had
41:29structured NIAD with three pillars and
41:32the three pillars were HIV,
41:34>> right?
41:36>> Civilian biod defense and then other,
41:40>> right?
41:40>> Those are the three pillars,
41:42>> right?
41:42>> Just think about that. All of the
41:43infectious disease, the problem wasn't
41:45that we weren't we're looking too much
41:46at infectious disease. The problem was
41:47that we were so lopsided in how we
41:50thought about infectious disease. All
41:51other infectious diseases lumped
41:53together in other a whole pillar focused
41:55on civilian biodefense was essentially
41:57>> right
41:58>> with research that where most where that
42:02dangerous gain of function work happened
42:03was in that pillar and then right
42:06>> this is the thing this is the thing I
42:07don't think most people even realize I
42:10think very few people outside of the
42:12research community realize that you know
42:15the NIH does biodense research that like
42:18Tony Fouchy turned his institute at the
42:20NIH age into essentially a biod defense
42:23research um focus. You know, I I mean
42:26this happened in 2002. There was
42:28actually even a letter I think published
42:29in science about 15 years ago when there
42:31was a bunch of scientists were really
42:33upset about the way he refocused um NIAD
42:37to get more of this money coming in for
42:38biodefense. I don't think most people
42:40even realize that bragging about it in
42:42his memoir. He brags about it in his
42:44memoir.
42:44>> Tony Tony bragged about in his memoir.
42:46Anyways, uh we've changed the focus. So,
42:49the new director, the acting director of
42:51the NIDA, uh, Jeffrey Toenberg, a man
42:53who's been really unfairly vilified in
42:56the um in the
43:00>> because he runs CIA. I mean, he's he's
43:02basically telling the C, this is what
43:04I'm reading. It's like he's telling the
43:05government what to do on gain of
43:07function research. Apparently, I have no
43:09clue how a researcher like in NI who's
43:12not even in charge of the NIH. So, like
43:15but he's he's basically telling the NIH
43:17what to do. This is what the story this
43:19if you follow the the the logic of these
43:21people. He's running the NIH and running
43:24Department of War and the CIA and he's
43:26running the entire government just to do
43:27gain of function research is apparently
43:29what I read when I read the Daily
43:31Caller. I mean it's it's the okay I'm
43:33sorry quite frustrating but I'll just
43:36say but like in particular I think it's
43:38frustrating to me to because I've had a
43:40convers so many conversations with uh
43:42Jeffrey Toppenberger about his vision.
43:44Uh so first of all, you know, he he has
43:46done research in the past uh on the 1918
43:50flu. Now, we could we could argue over
43:53whether that was wise or not to do. I
43:56mean, I I think it was important because
43:57it helped us understand H1N1 better. Um
44:00but I don't think it was I don't think
44:02it was gain of function, but you know,
44:04people can argue about that. I I think
44:05in the new process, you'd have an
44:07independent body that would oversee that
44:08research before he did it, right? I'll
44:10just tell you Tom Ber is absolutely
44:13committed to the new process. He wants
44:14an independent body
44:17>> checking the research. He also wants to
44:19fundamentally transform NIAD in a much
44:21more reasonable way. Right? So instead
44:24of those three pillars, HIV,
44:26>> civilian biod defense and other, he
44:28wants to change the focus of NIAD where
44:31um the Okay, sit down for a second,
44:33Paul. You're gonna you're just going to
44:34be blown away. Uh the two he wants two
44:36pillars. He wants two pillars. He wants
44:38infectious disease and he wants
44:41allergies and immunology. Oh my
44:44goodness. I can't Are we allowed to like
44:47not focus on vaccines and viruses and
44:49focus on kids vaccines? I'm not I'm not
44:52saying there's not going to be vaccines.
44:53There's still vaccines.
44:54>> Is that is it allowed to have a little
44:56focus on allergies? Because there a ton
44:57of kids that have allergies. Many
44:59members of my family, you know,
45:02>> just so we're clear like they they
45:03they're not separate topics,
45:06>> right? They're they they they intersect
45:08and so like the philosophy is we're not
45:11just studying the bug, we're studying
45:12the interaction between the bug and the
45:14human being
45:15>> and how we react to the bug, right? That
45:18interaction is what produces disease.
45:20And so like having the two pillars
45:22allows us to focus on to study vaccines
45:24and in a because we're we're we're
45:26trying to understand how changes to the
45:28imunological profile caused by vaccines
45:31can improve our our reaction to bugs in
45:33a way that's not ideological but just
45:35purely science driven f but for HIV what
45:38we're going to do there was a big
45:39advance in HIV last year 2025 uh four
45:42where uh we there's now a drug that can
45:46if you take an injection for up to six
45:48months probably even up to a here you
45:50are not going to get HIV
45:52>> right it's called len capavir we've
45:56shifted the portfolio of HIV with the
45:59goal of reducing transmission of HIV to
46:01near zero by the end of President
46:03Trump's first term with this new tool
46:05the research that we need isn't like
46:07research to try to get a uh like to me
46:10like the key thing is we need to try to
46:11get to use this new tool that we have
46:14and apply it so that we reduce
46:16transmission. It's the first real hope
46:18I've seen in a long time for reducing
46:21transmission HIV to near zero. I'm I've
46:23focused refocus the HIV research on
46:25implementation science to improve the
46:27figure out how to use the tool this
46:29noncapir and and some of some of these
46:32other new prep tools as well as all of
46:34the existing tools for reducing for for
46:36improving the health of HIV infected
46:38people already and reducing transmission
46:40from them. those two tools together, we
46:42have a chance of actually eradicating
46:44HIV in this country if we just learn and
46:46do the research to apply those tools.
46:49We're still going to continue to do some
46:50research on like HIV treatment and all
46:52that. We we know we want to we still
46:54want to like maintain some focus on
46:56that, but that's not going to be the
46:57only focus of our research anymore. It's
47:00going to be focused on trying to
47:01actually reduce transmission in this
47:03country. So,
47:04>> it's funny. It's funny you bring that
47:05up. I feel like I feel like there's some
47:07researchers in the HIV field who like
47:10can't accept the victory. They just like
47:12they want to like and and I'm not trying
47:15I'm trying to not be too rude about
47:17this, but like what they really want is
47:19not so much a cure for HIV or a way to
47:22they just want more money coming. I
47:23mean, I'm not I'm not trying to poke too
47:25much at the academic community, but I am
47:27poking a little bit at the academic
47:29community because I mean, they're
47:30they're not so much they are focused on
47:33solving disease and stuff like that, but
47:35like when we have an actual possible
47:36solution that's going to, you know, fix
47:38a lot of stuff like this drug, their
47:40complaint is like, well, but don't cut
47:42off my funding to like do this other HIV
47:44stuff I'm doing. Oh, I mean, that's
47:45that's what I'm hearing a lot. What I
47:47get off Twitter, what I get off. No, I
47:49mean the thing is Paul is I think I
47:50think you do see the people that are
47:51used to getting money to do their
47:53research projects. They they
47:55understandably because they're the
47:57biggest advocates for their own research
47:58projects think the world is ending when
48:00they don't get money for their research
48:01projects. But as the NIH we we have to
48:03do is we have to look broadly and
48:05strategically about where the money is
48:06going and ask what is the best way to
48:09improve people's health with that money.
48:11right here at HIV, we now have this
48:14amazing opportunity with lenapir and
48:16other prep drugs as well as the the the
48:19existing drugs most much of which was a
48:21result of investments in some of these
48:23people in research by some of these
48:25people we're talking about. So I don't
48:26mean to dishonor them, but now that we
48:28have these tools,
48:30>> we need to fund research to figure out
48:32how to deploy them in ways that reduce
48:34transmission to near zero because these
48:36tools didn't exist before last year. If
48:40we didn't take advantage of that
48:42opportunity, we wouldn't be using the
48:44money in a way that actually improves
48:46the health of people the best,
48:48>> right?
48:48>> And so my job isn't to like make
48:50researchers happy. My job is to fund
48:53research that improves health of people.
48:55Um that's that's the philosophy behind
48:56HIV. We can we're going to but the point
48:58is like NIAD as a whole is shifting
49:00focus
49:02so that it addresses the actual health
49:04needs of people, right? uh rather than
49:07just the you know the the the sort of
49:09way the the old way of doing things.
49:11>> I want to talk to you about actually
49:13sent in some questions about this to NIH
49:15but then we hit the um shutdown and I
49:18you guys weren't able to respond to it.
49:20So um but I since I have you here what I
49:22sent in was there was a New York Times
49:24article about a study and it was in one
49:27of the Lancet journals. So it's I think
49:29it's Lanc's infectious diseases. So,
49:30it's a good journal and it talked about
49:33um long COVID and what it did was it
49:36what the study concluded was that if you
49:38were vaccinated, you were less likely to
49:40get long COVID. And so when I and and so
49:43this this appears in the New York Times
49:45and I already knew when I I I cuz so the
49:49NIH put out a bunch of funding for long
49:51co a friend of mine who's at one of the
49:53big research institutions on the east
49:55coast was a part of applying for that
49:57for that grant that their university
49:59won. They got a big study center grant
50:01and I was talking to this researcher
50:03later and I was like, "How are you
50:05studying long co because they haven't
50:07even defined what it means right now."
50:09So like they were passing out money from
50:11the NIH to study something that did not
50:14even have a medical definition. So I
50:16knew this was going on. So when I read
50:17the New York Times piece, I pulled up
50:20the study and I looked at it and and
50:22here's what I found. When you look at
50:23the methods, what it tells you is is
50:25that they they studied longco in
50:28patients from people who were
50:29vaccinated, vaccinated, unvaccinated
50:31from January of of 2022 till January of
50:352024. Okay? And they were studying what
50:37they called PSC, which is way of
50:39defining long co, right?
50:42>> But that definition for long co was not
50:46even um put out until
50:49let me see what it was. May of 2023.
50:52more than halfway through the study. And
50:54I was, so I'm reading this, I'm like,
50:56how are you studying something that you
50:59don't even know what it is that you're
51:00studying until more than halfway through
51:03the study? What is the value of this
51:05study, first off? And then what is how
51:08did the New York Times not read this
51:10study the way I did and realize that
51:13this study is kind of bunk? And I feel
51:15like that a lot of we put out all this
51:18money to study long co. There are people
51:19that I know who have long COVID and from
51:22the beginning I and other people that
51:24I've spoken to, researchers have all
51:26been concerned about what the value is
51:28of the data we're getting back when we
51:29were like cuz this guy over here is
51:32studying long co that he think means
51:33this this other researcher is studying
51:36long co over here and they define long
51:38co with all these other things and it's
51:39not like depression where if you're a
51:41guy at University of Washington and
51:43you're studying depression and you're a
51:44guy at Yale University you're studying
51:46depression they're both studying the
51:48same things they know what it means
51:49because it has a definition. Everyone's
51:51just studying like their own particular
51:53idea of what they think long co is and
51:55so what is the value of all that data
51:56when you try to combine it together
51:58because everyone's studying a different
51:59thing.
52:01>> I mean so long co is one of those things
52:04where like uh we spent I think uh $1.5
52:08billion dollars or more. Um
52:10>> it was a lot of money.
52:11>> Yeah. I mean it's a it's a lot of money.
52:13Um, and we've not really made a lot of
52:15progress in in addressing the needs of
52:17so of longco patients. Um, and you know,
52:20it's it's one of those things where like
52:22there's patients are understandably
52:25frustrated. A lot of the money that was
52:27spent on longco and ah uh between 2020
52:30uh 2021 and 202 uh five um or 2024 was
52:35on trying to get uh a definition of
52:39longco is as you say that study that you
52:41you know like I looked at that study the
52:43lanca study um and it struggled with a
52:46definition of longco it it called this
52:48post-accute squella of co 19 past um it
52:52was like one of these it was like they
52:53they the they defined it based on
52:56symptoms and some of the symptoms are
52:58quite non-specific right do you have
53:00headaches
53:01>> um are you fatigued um the uh so the the
53:05definition of long co is uh it's still
53:08challenging I've seen now some recent
53:10work that uh that because what the key
53:13thing is like how do you distinguish
53:14long covid from other post postacute
53:18squella of of infectious diseases that
53:20there's things where you can get the flu
53:21and you can get longer term outcomes
53:23from the flu right Um there are other
53:26other disease conditions that that that
53:30sometimes produce symptoms that overlap
53:32substantially with long co
53:34>> right you know Lyme disease for instance
53:36I've heard right and others
53:38uh ME/CFS you know is another one like
53:41has they're very very you know someone
53:43that I know thinks they got ME/CFS
53:45because they got a viral infection they
53:47they think that's what triggered the
53:49whole thing. a old med school colleague
53:51of mine um just did a really interesting
53:53study using on Epstein bar virus and and
53:56some long some sort of long-term con
53:58consequence of epste anyway so the point
54:00is that it's very difficult to
54:02distinguish long co from some of these
54:03other things and it's important to be
54:04able to distinguish because the
54:06treatment that you might you might have
54:07might be different for for long co
54:09versus long flu or long eB right
54:15and we didn't we spent a billion half
54:16dollars we didn't that that billion half
54:18dollars did produce a clean definition.
54:22>> And people are still arguing over the
54:23definition.
54:24>> The person that I first spoke about this
54:26with on on the on the at the university
54:29on the East Coast, the the MDPhD
54:31researcher out there,
54:33>> he pulled out of this study specifically
54:35because he saw these problems coming. He
54:36helped to win the grant and he's like, I
54:38don't want to be involved in this. This
54:39seems like really messed up. I can't
54:41like I'm going to go back to my regular
54:42research.
54:44>> Yeah. Well, I mean, I read that study.
54:45There was there were lots of problems
54:46that study. one you identify as
54:48absolutely true like because they they
54:49didn't have a definition of longco until
54:522023 I think it was um and yet they use
54:55data from before based on clinical
54:57diagnosis somehow inferring long co
54:59before the definition ex like a clean
55:02code existed. So it it had some
55:05methodological problems like that. The
55:06bigger methodological problem with that
55:07study was that it it looked at kids, but
55:10it looked at kids who had who were like
55:13went to the doctor because they had
55:15COVID.
55:16>> Well, most kids I mean COVID infection
55:19was really mild acutely for most kids
55:23>> and so it wouldn't have necessarily
55:24produced a doctor visit.
55:26>> So they're missing a lot of people who
55:28never showed up to the doctor. A lot of
55:30kids who never show up to the doctor.
55:31The denominators are wrong. Anyways,
55:32there were a lot of methological
55:33problems with that study.
55:34>> Okay. So, I want to ask you something
55:35about this cuz I this gets into so like
55:37you've you agree with me that this this
55:39study had serious problems. But like
55:41here's the thing that happened. That
55:43study made it into a very prestigious
55:45journal, right? And then it made it out
55:48of that journal onto the page of the New
55:50York Times. And I just feel like so much
55:51of the discussion we've been having
55:52around long COVID, which you know
55:55there's apparently millions of people
55:56with this condition, tens of millions of
55:58people with this condition in the United
55:59States and we're have like we're not
56:01even studying it effectively and we're
56:03having these like weird like you know
56:06misinformed discussions about it like in
56:08the academic literature and in in the
56:11media. I think it's I think it's very
56:13frustrating like for people who have
56:14these who really are sick and we didn't
56:17spend I mean I'll tell you flat out I
56:19think we threw a bunch of money away
56:21from the NIH.
56:23>> Yeah. I think that that money did not
56:25produce
56:26>> we should have defined this condition
56:27first. When I first saw it like we
56:29should put out some money first so that
56:31the community agrees upon a definition
56:33of what they're going to study. Then we
56:34release more money. Once we agreed upon
56:36what we're studying we have a definition
56:38of what we're studying. Then let's start
56:40to study. even if the definition is
56:41wrong, let's agree upon a definition so
56:43we're all looking at the same thing and
56:46I just feel like then they just threw
56:47the money out and it's very frustrating.
56:50Well, I mean the money didn't produce
56:52the result I think that was anticipated
56:54like we didn't get a clean definition.
56:56We didn't get treatment. What I've
56:58decided with long co is that I don't
57:00want to wait for answers for patients
57:02and the patient patient community has
57:04developed a lot of ideas for what seems
57:07to work for some people.
57:09>> Right? So I'm I directed long what the
57:13remaining longco money to focus on
57:15testing treatments that seem that that
57:18show promise in making the lives of
57:20longco patients better. Um I think that
57:23sort of empirical focus is is sort of a
57:26better uh better use of the money. Now,
57:28we've learned a lot. Long co patients
57:31have suffered and and and that that
57:33suffering while terrible has produced
57:35some knowledge um about how how to
57:38manage the condition and potentially get
57:40better. Um I I want to I want to do
57:43rigorous assessments of that knowledge
57:45so that um that knowledge can be used by
57:47other people. I've also seen in the long
57:49co community, you know, I've seen lots
57:51of like companies try to take advantage
57:53of them, frankly, Paul, with things that
57:55are not well tested.
57:56>> Of course. Of course.
57:58So I just I think the best thing that we
58:00can do for them now is to assess
58:03rigorously the the things that are out
58:06there and take their lived experience
58:08seriously in forming hypotheses for how
58:11to how to how to u what which things to
58:13look at. It's going to be it's it's uh
58:15I'm actually kind of hopeful like we did
58:17a longco symposium with Secretary Kenny
58:20a few uh like a few months ago where
58:22some of the some of the you know some
58:25amazing researchers were sharing their
58:26ideas about what what we might take step
58:29forward. I'm I'm hopeful that within the
58:31in the in the next year um we will have
58:34some potential breakthroughs but I but
58:37you know we'll see. To me, the key thing
58:38is let's focus on things that things
58:40that look like they're promising and
58:42might work and test them rigorously so
58:44we can get good information out to the
58:45community
58:46>> because, you know, I think what you
58:47know, when the next pandemic comes
58:48along, we're calling it long co, but
58:50really it's just it's just, you know,
58:52extended effects of a viral infection,
58:53the next virus that comes along, we're
58:55going to see similar things. We're not
58:56going to call it long co, it's going to
58:57be long, whatever that virus is. So,
58:59this issue is not going away. It's going
59:01to keep coming up again and again. And I
59:03just feel like we we had a chance on
59:05really trying to define this issue and I
59:07think we just blew money out the door.
59:09So that's my take on it. I want to
59:10switch over to
59:11>> actually before you switch one one last
59:13idea on this long co
59:16I think is a imunological overreaction
59:19>> right but that's one theory of it that's
59:22one theory of it right and it shows you
59:25then the importance of studying
59:27immunology together with infectious
59:29disease by having that that the the
59:31pillars of the Niad be allergy
59:34infectious disease and allergy and
59:36immunology and then and infection having
59:38those things together those be the two
59:40primary uh primary things that NIAD is
59:43focused on. Having those focus be on the
59:45patient and the reaction of the patient
59:46to the pathogen that entire focus then
59:49reshifts how we think about managing
59:52long co as well as any other potential
59:54long-term effects of infections. Um I
59:57think that thinking about it in that way
59:59is going to be very productive not just
01:00:01for long co but for for many many other
01:00:03things in the future. I want to switch
01:00:05over and talk to you because this is
01:00:06something that, you know, it's being,
01:00:08you're seeing some of these discussions
01:00:10like pop up in the New York Times.
01:00:12There's some of the Maha activists that
01:00:14are, you know, really upset with the
01:00:16direction the Trump administration is
01:00:17going. And I just want to get your read
01:00:19on this. You know, I mean, what I've
01:00:20noticed is is that there's this sort of
01:00:23maja movement that like, you know,
01:00:24Kennedy sort of, you know, brought into
01:00:26the mainstream, brought you along,
01:00:29brought Marty McCary along,
01:00:32uh, brought Oz along, you know, like,
01:00:34you know, under his umbrella. But you
01:00:36also have, you know, the MAGA people,
01:00:38you know, so they're more like directly
01:00:40aligned with the Trump issue. And then
01:00:41you have the old school Republicans who
01:00:44are kind of like on their own, you know,
01:00:46some of them even like, you know, we
01:00:47hate all this stuff. Can you talk about
01:00:49that D because you deal with that
01:00:51dynamic inside HHS. I mean I know for a
01:00:53fact from sources inside NIH um HHS
01:00:56there are wars going on between the MA
01:01:00aligned people and the MAGA line people.
01:01:02I don't see this you know in the New
01:01:03York Times or anything but I know what's
01:01:04going on because I get phone calls from
01:01:06people inside and HHS explaining this to
01:01:08me. Explain that kind of dynamic to
01:01:10people. I mean it it's it's interesting
01:01:13because well I mean first of all Paul
01:01:15now you're talking about a topic where I
01:01:17am just frankly an amateur like I'm not
01:01:18a politician I'm a scientist primarily
01:01:21right so but I I have watched carefully
01:01:23now over the last year internally and
01:01:25there's definitely so so first of all
01:01:27why is the alliance happened in the
01:01:29first place right you have you President
01:01:31Trump who is an absolutely unique
01:01:33political figure
01:01:34>> like he used to be a Democrat I think
01:01:37>> right
01:01:37>> but he his focus is he's not he's
01:01:40certainly not a traditional Republican
01:01:42and in fact he went to war on the
01:01:44traditional Republican party
01:01:46>> and won what he's done is he's
01:01:48transformed the co the Republican
01:01:49coalition to now include a very large
01:01:51number of working-class people that pre
01:01:54that that were previously more aligned
01:01:56with Democrats. But what I what I
01:01:58explained it as is that like when this
01:01:59happened in 2016, you had the forces of
01:02:03Trump, you know, Bernie Sanders was the
01:02:06same thing. He was like an outsider
01:02:07trying to the Democrats blocked him
01:02:09effectively. the Hillary Clinton wing
01:02:11blocked him effectively. Trump somehow
01:02:13or another like just burst into the
01:02:15Republican party, grabbed a hold of the
01:02:17controls and he won. He did what Bernie
01:02:19Sanders tried to do inside the
01:02:20Democratic party but couldn't get done
01:02:22because the Hillary Clintons were just
01:02:24they were too powerful and they they
01:02:26blocked him off.
01:02:27>> The Democratic Party is left with
01:02:28essentially they're they're party of the
01:02:30university class, the elite, right? They
01:02:32they've lost a large part of the working
01:02:34class that used to be part of their
01:02:35coalition. Um and um the Democratic
01:02:39party tried, I think, to address the
01:02:41needs of the working class by offering
01:02:43them health insurance, Obamacare, where
01:02:46the promise was this insurance is going
01:02:47to make you healthier,
01:02:49>> right?
01:02:49>> But but the working class honestly, if
01:02:52you look at the health trends in the
01:02:54United States, have gotten less healthy
01:02:56over time. As we said earlier, life
01:02:58expecties flatlined, chronic disease
01:03:00problems at scale, all the all these
01:03:02like health problems that have made the
01:03:04the lives of working-class Americans and
01:03:07regular people worse.
01:03:09>> Maha essentially says, look, what we've
01:03:12been doing in health has not worked to
01:03:14make you healthier,
01:03:15>> right? And so it's completely natural
01:03:19that there be this alliance between
01:03:20MAGA, the President Trump's coalition,
01:03:23because in order to meet the health
01:03:25needs of the United States, who are now
01:03:28like part of the of of of the who voted
01:03:31for President Trump potentially, voted
01:03:33President Trump in much larger numbers
01:03:35than they previously had for previous
01:03:37Republicans. In order to meet their
01:03:38needs, you have to help. You have to
01:03:39have an idea for making them healthier,
01:03:41>> right?
01:03:42>> That's a essential part of their lives.
01:03:44So the MAGA Maha Alliance makes complete
01:03:46sense, right? Because essentially
01:03:48>> there's still there's still fractures
01:03:50within it. I know there's wars going on
01:03:51inside HHS over this.
01:03:53>> I was just I was just setting it up,
01:03:54Paul. I'm just setting it up. Let me let
01:03:55me start just like I think I think the
01:03:58alliance alliance structurally makes
01:04:01sense. So all the all this all the like
01:04:03fissures we're talking about are are
01:04:05fissures that are surface level because
01:04:07the the the fundamental is fundamental
01:04:10uh sort of political dynamics. Again,
01:04:12I'm an amateur, so correct me if I'm
01:04:13wrong, but the seems like fun political
01:04:15dynamics is is how do you meet the needs
01:04:17of this these new members of the
01:04:19Republican party who who were previously
01:04:22uh they were been failed by Democrats
01:04:24who offered them insurance as a way to
01:04:26make them healthier. Well, didn't didn't
01:04:28make them healthier,
01:04:29>> right? A lot of them a lot of them that
01:04:31I know that I interact with are former
01:04:33Democrats. I mean, honestly.
01:04:34>> Yeah. So, like the again the maga lines
01:04:36makes complete sense. Democratic party,
01:04:38Democratic Party activists, by the way,
01:04:40not just like sitting on the sidelines
01:04:42Democrats, like they were actively
01:04:43involved in Democratic Party and they're
01:04:44like, "No, I'm done with this."
01:04:46>> Yeah. Yeah.
01:04:47>> Okay. So, so, so that's the structural.
01:04:49So, now the fissures, of course, you'd
01:04:51expect fissures. These are
01:04:54these were not like allies from from 500
01:04:57years. These were like relative like
01:04:592016 allies that that and um in 2024
01:05:04>> you have people who were at you know
01:05:07with President Trump in 2016 that are
01:05:10looking at the people who have come into
01:05:11the President Trump's movement through
01:05:12Maha and saying well how come they
01:05:15they're getting a seat at the table
01:05:16we've been with the president all along
01:05:19>> right
01:05:19>> that's what you're seeing that so you're
01:05:21seeing people who are like we got to
01:05:22have more you know u I mean uh like ju
01:05:26just for to to to uh uh we want to make
01:05:30sure that the people that that that
01:05:31we're bringing in the movement are
01:05:32really aligned with the movement is what
01:05:33what maybe some MAGA people are saying.
01:05:36Um
01:05:36>> right.
01:05:37>> And I I I mean it's frustrating. Um it
01:05:40makes for some nice political gossip,
01:05:42but to me it's not that's not actual
01:05:45major structural problem. The major
01:05:47structural problem has been solved by by
01:05:50the alliance in the first place. It's
01:05:51and the alliance happened because the
01:05:54needs of the working-class populations
01:05:56that were brought into the coalition by
01:05:58President Trump need to be met somehow
01:06:00and ma ma is the idea that will meet
01:06:03that actually is is driving a lot of
01:06:06that coalition building that President
01:06:08Trump has done.
01:06:09>> Yeah, it's crazy like I mean I was just
01:06:11talking to uh friends in the
01:06:12environmental movement and just a couple
01:06:14of stories that have popped up in the
01:06:16last month and I'll send them over to
01:06:17them. I'm like, could you ever imagine a
01:06:20Republican even considering something
01:06:21like this? Like I mean it's just like
01:06:23the weirdest thing. I like I'm like what
01:06:24is going on? Like I can't believe that
01:06:26this stuff is happening.
01:06:29>> Can I give you an example? Right. So I
01:06:31wrote a paper in 2011 I think it was
01:06:35>> right
01:06:35>> uh where I was asking if you uh what
01:06:38would happen to type 1 di or type two
01:06:40diabetes rates for kids if you took uh
01:06:44sugar sweetened beverages out of SNAP
01:06:45the food stamps program
01:06:47>> right um and with this like simulation
01:06:49model was like okay yeah it's it's going
01:06:50to have it'll actually improve improve
01:06:52the health of kids by some some bit I
01:06:54wrote the paper in 2011 I honestly
01:06:56forgotten I'd written it I wrote it kind
01:06:58of hopeful that like some governor ers
01:07:00would pick this up and you remove that
01:07:02that you get rid of like sugar soda pop
01:07:05out of uh out of like SNAP programs,
01:07:07>> right?
01:07:07>> And I've completely forgotten about it.
01:07:09It last year the the governor of
01:07:12Arkansas, Sarah Huckabe, cited my
01:07:15article as a reason to get rid of sugar
01:07:17sweetened beverage. If you'd asked me in
01:07:192011, was it going to be someone like
01:07:21Sarah Huckabe doing this? I would have
01:07:22been But it makes complete sense now,
01:07:26right? Yeah. No, it's just weird. I
01:07:28still have sometimes like wrapping my
01:07:29head around it, you know, like when I
01:07:31see some of this stuff I'm like I mean
01:07:32I'm getting more and more into it and I
01:07:35realize it's still shifting like it's
01:07:36still kind of fluid and moving around
01:07:38but it's just it's very bizarre. I want
01:07:40to ask you about um I mean something
01:07:43that like the reason I you and I even
01:07:45got to even know who each other is is
01:07:48because of the pandemic and COVID and
01:07:51you know it's been very weird you know I
01:07:54mean I'll just give you I have a I had a
01:07:57um a reporter this is about it's kind of
01:07:59related but a reporter that we both know
01:08:01send me a a message the other day just
01:08:05like obviously just depressed about the
01:08:06current state of the media and just like
01:08:08I can't believe this And I and I
01:08:11responded back. I said, "Look, I get up
01:08:13every morning and I put out tweets about
01:08:15some crappy story that's like factually
01:08:17inaccurate, that's completely
01:08:19politically biased, that I've read in
01:08:20the Times or the Post. I do it pretty
01:08:22much every morning." And every time I do
01:08:24it, I hate it. I'm just like, I don't
01:08:26want it to be this way, but it is the
01:08:28way it is. And I feel like you know co
01:08:31this pandemic fundamentally changed the
01:08:34way so many people I think look at
01:08:37academia at research at journals. I mean
01:08:41the way I think about like you know
01:08:43professional societies the AMA totally
01:08:46sh I mean I never really liked the AMA
01:08:47and I a lot of people like you know
01:08:49younger people have been leaving the AMA
01:08:51for years and going to more specialized
01:08:54physician groups but just the way I look
01:08:57at these people with just like so little
01:09:01trust now which wasn't the way I thought
01:09:03before it certainly I mean in the first
01:09:05year of the pandemic I did everything
01:09:07that I was being told to do I followed
01:09:09all along and then And I just started
01:09:10seeing that like things weren't making
01:09:12sense and I expected you know this shift
01:09:14to happen and people doubled and tripled
01:09:17down on the lies and I I just want to
01:09:20get your read like what is your I mean
01:09:22you're a guy who went to Stanford at 18
01:09:25lived there his whole life you know
01:09:27undergrad medical school grad school
01:09:29you've done nothing but you know
01:09:31academic research your whole life I mean
01:09:33what is your read on on this thing? It's
01:09:36like it's like waking up one day and
01:09:37you've been a baseball player your whole
01:09:38life and you realize like oh my god
01:09:40everyone's been cheating and doing
01:09:41steroids and you were like didn't
01:09:43realize it you know I mean what what's
01:09:45your read on this whole thing now? I
01:09:47mean I I went through a real crisis of
01:09:51faith I guess is the right word in 2020.
01:09:53A lot of people I admired really just
01:09:55frankly lost their minds like they they
01:09:57lost their capacity to reason when the
01:09:59pandemic hit. Um and worse they powerful
01:10:03some of the most powerful people in in
01:10:04science you abused their power to try to
01:10:07si silence all discussion and and and um
01:10:10and consideration of alternate points of
01:10:12view during the pandemic. Um and the
01:10:15results were terrible. Like kids were
01:10:17out of school for a year and a half.
01:10:19They're still far behind the depression
01:10:21and anxiety at scale uh economic harm to
01:10:25the the poorest of the pe of people in
01:10:27the world. Um I can completely
01:10:29understand why a lot of people lost
01:10:30their faith and confidence in the
01:10:33scientific institutions and the public
01:10:34health institutions of this country. Um
01:10:36our results were terrible during co and
01:10:38we were essentially following the advice
01:10:40of some of the most powerful people in
01:10:42in public health and in science. Um to
01:10:45me my job is partly is is is in part to
01:10:49like uh it it to reform science so it
01:10:53becomes worthy of the trust of the
01:10:54public again. Um this is why I focused
01:10:57so much on reproducibility, right? The
01:10:59the re the one of the major uh ideas
01:11:02about reproducibility sort of that
01:11:04undergirds it is that look just because
01:11:06you publish a paper in Lancet Paul
01:11:08doesn't mean you're you you have the
01:11:10right answer.
01:11:12>> It's just a paper,
01:11:13>> right?
01:11:13>> Truth in science comes from other people
01:11:15independently checking your work. And if
01:11:18they find the same thing as you, they
01:11:20they they they assess your methods and
01:11:22they find it rigorous, then
01:11:25then you have some confidence that what
01:11:27you say is true.
01:11:28>> Well, that's what we're taught, right,
01:11:29as undergrads in high school. That's
01:11:31what you're told in high school. That's
01:11:32what you're told like in in when you're
01:11:34in undergrad taking a biology course or
01:11:36whatever, you know, lower division
01:11:38science course. But that's that's not
01:11:40what really happens. That's not how the
01:11:42system really works. That we have this
01:11:44>> I want to change the system, Paul. I
01:11:46want to change the system. And so that
01:11:47is how it really works in a sense. I I
01:11:49want I want to fundamentally transform
01:11:51how we evaluate truth in science. Truth
01:11:54in science is not I got a paper
01:11:55published in Lancet. That is not truth.
01:11:57That's just a hypothesis. Truth in
01:11:59science is you have an idea that you
01:12:02bring data and test it. You your idea
01:12:05passes your test. Then other people look
01:12:07at it and they try to test your idea and
01:12:09they find the same thing as you or
01:12:11similar things as you. You come at from
01:12:12a different angle, you find the same
01:12:14answer. That's how you determine truth
01:12:15in science. I want to I want to
01:12:17establish replication as the standard of
01:12:20truth in science in reality, not just
01:12:22what we tell fourth graders.
01:12:24>> Okay? But the only way you're going to
01:12:25do that is if there's right and we know
01:12:28how this works in science. If you want
01:12:29people to do certain things, then you
01:12:32have to they're chasing the money.
01:12:34>> You got
01:12:35>> where's the money? Where's the money
01:12:36going to come from?
01:12:37>> This is the beautiful thing about the
01:12:38NIH, Paul. I mean you there's it's the
01:12:41single biggest as you said single
01:12:42biggest public source of funding for
01:12:45biomedical research in the world by far
01:12:48>> right and it has tremendous influence
01:12:50just a few ideas one one will start to
01:12:52like fund research on replication
01:12:54research on on like the
01:12:56>> so specifically specifically for you'll
01:12:58be able to apply for a fund to just for
01:13:01replicating other studies.
01:13:03>> Yes. And the idea would be to let the
01:13:04scientific community decide what's
01:13:06what's the most important studies to
01:13:07replicate rather than having the
01:13:08government decide. I don't want the
01:13:09government saying replicate this this
01:13:11and this. Replication shouldn't be
01:13:12punitive. It should be be something
01:13:14that's collaborative.
01:13:16>> Right. Right. Just because you have a
01:13:17study and hypothesis that turns out not
01:13:19to replicate. That's not doesn't mean
01:13:20you did anything wrong. Science is hard.
01:13:22>> You just you reached the the conclusion
01:13:25didn't generalize. Right? That's fine.
01:13:27Even a failed replication effort is an
01:13:29advance in science scientific knowledge.
01:13:32Um, second, I want to put replication
01:13:34really up up above did you get it
01:13:37published in a top journal. So, we're
01:13:38we're going to start having um, you
01:13:40know, you you'll search for a paper and
01:13:42there'll be button a replication button.
01:13:44You click the replication button and
01:13:46there'll be a summary of all of the
01:13:47other relevant studies that sought to
01:13:51replicate the research result that you
01:13:53had.
01:13:53>> The same the same as like where you have
01:13:54a citation or an almetric score, you'll
01:13:58have a replication score also. That's
01:14:00just the score. You'll have you'll have
01:14:01the links to all the papers so you can
01:14:03do your own assessment, right? Um and
01:14:05then and then we'll have uh as well as
01:14:07the rep. So the replication and then the
01:14:09the last thing is is the metrics, right?
01:14:12So uh rather than just evaluating
01:14:14scientists based on how many citations
01:14:16you have which is essentially a measure
01:14:18of influence and how many papers you
01:14:19publish a measure of volume it'll be do
01:14:22you share your data how often do you
01:14:23share your data make it available how
01:14:25how effectively do you do you describe
01:14:27your method so that other people can
01:14:29replicate your work a whole other range
01:14:31of metrics that better measure what we
01:14:34actually want scientists to do what I'm
01:14:36looking for is a transformation of sc
01:14:38the culture of science so that
01:14:40replication becomes something that
01:14:41people want to have happen to them
01:14:43because you won't get credit for your
01:14:45work unless you it's been replicated,
01:14:47>> right?
01:14:47>> Rather than something that's a threat to
01:14:49you. Oh, because if you replicate my
01:14:50work, I might have to retract my paper.
01:14:52If fail to replicate my work, I might
01:14:53have to retract my paper. I'm going to
01:14:55change the mindset of scientists to want
01:14:57replication rather than to to view it as
01:15:00a threat.
01:15:01>> Okay. I I have um like a last question
01:15:04here, which is kind of a big one.
01:15:07I want you to critique my profession.
01:15:09You know, I mean, I do it every day. I
01:15:11get up and I'm just like, "Oh my god,
01:15:13this again." Like, just so you
01:15:15know, my morning starts after I drop my
01:15:18daughter off in the morning. Usually,
01:15:19it's I'm dropping her off in the
01:15:20morning. I go and sit in a cafe. Like, I
01:15:22did that today. I didn't drop my
01:15:23daughter off today cuz we're on
01:15:24vacation, but I get up in the morning,
01:15:26take a shower, I go down to a cafe, open
01:15:28my I have my phone in my hand. Here I
01:15:30am, and I'm reading. I pop up in the
01:15:33post and I pop up the times and I just
01:15:36like I scroll through and I click open
01:15:37things. And then from what I can
01:15:40complete reading with having something
01:15:43to eat, sometimes I don't need anything,
01:15:44but two cups of coffee, usually an hour,
01:15:47and then I'm done. And I try to like
01:15:48close everything down. And every day I'm
01:15:51reading stuff that's just terrible. It
01:15:53didn't used to be like this. I can tell
01:15:54you, I mean, I talk to conservatives
01:15:57who've always, you know, felt the
01:15:58media's biased. Maybe I'm wrong. I
01:16:00didn't think the media was biased. I
01:16:02thought the media was center left, you
01:16:04know, but like fair. I don't feel that
01:16:06way anymore. I have a lot of friends who
01:16:08don't feel that way anymore that there's
01:16:09been a huge shift and I honestly don't
01:16:11trust the media. And you tweeted out the
01:16:13other day that Science magazine is fake
01:16:16news. So like what has been your
01:16:18experience like how have you transformed
01:16:21you know not just from your starting
01:16:23with COVID when you began getting hit by
01:16:25the media? Like how has that changed and
01:16:27altered your idea of the media and
01:16:29journalists?
01:16:30I mean, it's it's um it's frustrating
01:16:33because a lot of the I've met just to
01:16:35again just a throw clearing, I've met a
01:16:37lot of really good faith people who want
01:16:39to get it right in the media. Um and a
01:16:41lot of there people I met that I admire
01:16:43in the media. Um but uh like just let's
01:16:47just stay with that that tweet about
01:16:48Science magazine is fake news. It's been
01:16:50tremendously frustrating because I had a
01:16:51lot of respect for Science magazine as a
01:16:53as a scientist. Um, but the news arm of
01:16:56it essentially engages.
01:16:58>> When I first when I first published a
01:17:00news piece in Science magazine, I was so
01:17:02excited. I was so excited to put that on
01:17:03my CV about a couple decades ago, but I
01:17:06was very excited to put that on my CV.
01:17:08Now I'm just like,
01:17:10>> well, I think the pro the problem is
01:17:12just bad faith engagement, right? So
01:17:14like you have reporters in Science
01:17:16magazine who essentially will not report
01:17:19what we're doing at the NIH in any fair
01:17:21way at all ever, right? It's they're
01:17:24going they're going to go find political
01:17:25enemies to try to look at in the worst
01:17:27and they won't have a they won't have a
01:17:28response. They won't like just earlier I
01:17:31try I changed how we manage our uh
01:17:34funding of foreign collaborations and
01:17:37they somehow misreported it as saying
01:17:39we're going to end all foreign
01:17:40collaborations just just straight fake
01:17:42news. you had uh you have a reporter at
01:17:44the at the science magazine who will not
01:17:46give people who think that the vac that
01:17:48the the pandemic potentially was caused
01:17:50by research a fair hearing ever
01:17:53>> in any of his reporting.
01:17:55>> Right? And so you end up with like a lot
01:17:57of scientists who get their news or
01:17:59science news from science magazine
01:18:01completely misinformed about what the
01:18:03actual nature of of what uh the the
01:18:05what's happening at the NIH, what what
01:18:07the scientists are actually saying and
01:18:09thinking regarding the evidence
01:18:11regarding a lab leak on topic after
01:18:13topic. Essentially, you have a science
01:18:15magazine taking the sides of a certain
01:18:17group of people and will not treat
01:18:20others in any good faith way. It's quite
01:18:23frustrating because they have a major
01:18:25magazine that many scientists rely on
01:18:28for news and science and they misreport
01:18:30things all the time and I can see it
01:18:32firsthand because I, you know, I I
01:18:34firsthand knowledge about what for
01:18:36inance the NIH is doing and I read
01:18:37Science magazine. I don't recognize what
01:18:38they're talking about. Um,
01:18:40>> right.
01:18:40>> So, it's it's it's quite frustrating. I
01:18:43I I I don't know how to fix that. Uh uh
01:18:46I do think that having other alternative
01:18:48ways of reaching people like podcasts or
01:18:51or uh or Twitter or what whatnot does
01:18:54help. Um and so I'm going to keep doing
01:18:55that even if even if uh people try to
01:18:57make fun of me by calling me podcast J
01:18:59or something.
01:19:00>> You are podcast J. You're on a podcast
01:19:01right now. Your name's Jay. So you're
01:19:03podcast Jay.
01:19:05>> Sure.
01:19:06>> All right. Well, we'll end on that. Um
01:19:08happy new year's to everyone. Happy New
01:19:09Year's to you. Happy New Year to your
01:19:11family.
01:19:12>> Happy New Year, Paul. So good to talk
01:19:14with you.
01:19:15>> Okay. Thanks so much. All right. And I'm
01:19:18going to end with that. I'm going to
01:19:20call you.