Dr. Jay Goes to Washington: Reforming Science from the Inside at NIH

>> Peter Robinson: Just four months ago, the best place to find my guest today would have been in the office he had occupied for more than two decades in an out-of-the-way corner of the Stanford campus. And when he came to the door, he would have been wearing his favorite item of clothing, a Stanford hoodie.

Today, that man is the director of the National Institutes of Health, Dr. Jay Bhattacharya, on Uncommon Knowledge now. Welcome to Uncommon Knowledge, I'm Peter Robinson. A native of India, Jayanta Bhattacharya, did I get that close?
>> Jay Bhattacharya: I can't pronounce it myself, Peter.
>> Peter Robinson: Jayanta Bhattacharya moved to the United States with his family when he was a child.

After growing up in Southern California, Dr. Bhattacharya enrolled in Stanford University, where he earned his undergraduate degree, his master's degree, his MD, and his doctorate in economics. And then became a member of the Stanford faculty. During the COVID lockdown, Dr. Bhattacharya helped to write the Great Barrington Declaration.

A document that opposed the lockdowns, calling instead for focused protection, that is, concentrating efforts on those most at risk while reopening schools and places of work. For taking this position, Dr. Bhattacharya found himself censored on social media and under attack from public health officials. The then director of the National Institutes of Health, Dr. Francis Collins, referred to Dr. Bhattacharya as direct quotation, a fringe epidemiologist, close quote.

Then came the election of Donald Trump, and the new director of the National Institutes of Health is the fringe epidemiologist, Dr. Jay Bhattacharya. Jay, welcome back to Uncommon Knowledge.
>> Jay Bhattacharya: Thank you for having me, Peter.
>> Peter Robinson: In the interest of full disclosure, I suppose we may as well admit that we've been friends for a quarter of a century.

>> Jay Bhattacharya: A little longer than that.
>> Peter Robinson: Stop, stop there.
>> Jay Bhattacharya: We're both old, Peter.
>> Peter Robinson: Stop there. And for that matter, that you and I, I was with you when you picked up that- Very sooner. For your information, five days before Jay left Palo Alto to move to Washington, we had a conversation, and I discovered that he owned exactly two suits.

And that one was a suit his mother had bought for him when he was on the high school debate team, so we went to a shop and bought some suits. Okay, so, Jay, this leads to my very first overarching question, you arrived at Stanford University in 1985 at the age of 17, aside from a couple of very brief stints, you were at Rand for a while.

But aside from a couple of brief stints, you spent your entire life at Stanford University. I once asked you what was the biggest outfit you had ever overseen, and you thought for a moment and said, I had six researchers working on a project once. Here you sit in a suit, director of the National Institutes of Health, an agency with over 20,000 employees and a budget of $48 billion.

Jay, I say this as a friend, what do you think you're doing?
>> Jay Bhattacharya: Peter, the key thing I've learned since I've taken office is you have to get help, you have to get people who know how to do the things that I know I don't know how to do.

And that's been probably the best surprise for me, the number of amazing, excellent people that I've found to help me accomplish the impossible.
>> Peter Robinson: So step one in running an organization that large is to find good people and learn how to delegate.
>> Jay Bhattacharya: Yeah.
>> Peter Robinson: Okay, and that's been easy for you somehow.

You have no choice, when you're running an organization with 20,000 people, you have to delegate.
>> Jay Bhattacharya: But the key thing, I think, is to provide a vision, a clear direction about where I would like to see the organization go. And there are real challenges, I'm sure you're gonna ask me about them-

>> Peter Robinson: Yes.
>> Jay Bhattacharya: That the NIH faces in light of what happened during the pandemic. And, I mean, I viewed that as my primary job, to convey both to the organization, but also, it's not just a corporation or something like that, it's a government. The most important biomedical research institute in the world, it's a part of the federal government, it answers to the American people.

So I have to convey not just to the people who work there, but to the American taxpayers who fund us, whose interests we're supposed to be serving.
>> Peter Robinson: You have to defend that $48 billion to the American people. You and I have talked on this show half a dozen times about the COVID experience, so we needn't go into that at great length now.

But it forms the background of, as I understand it, but it forms the background of all your thinking about the NIH. So what I take as the central lessons of the lockdown is that the lockdown itself was an overreach. That the public health officials were acting, at least in large measure, on political calculation and not entirely on science, that much of what they portrayed as science wasn't science.

And that they got one big thing after another wrong. So you put up on X, you put up post shortly after you were nominated. I am honored and humbled by President Donald Trump's nomination of the next NIH director. We will reform American scientific institutions so that they are worthy of trust again.

How's the project going?
>> Jay Bhattacharya: We've had some progress, but there's still a long way to go. Let me just say I had actually been studying the NIH as a matter of my own research for a long while before the pandemic, and so I had identified some problems. I mean, this is not all that novel, because a lot of people identified the same problems.

The fact that the NIH is responsible for addressing a crisis in the scientific community of people being unable to replicate basic work. I'd worked on measuring the sort of inherent risk aversion of the NIH research portfolio, which often avoided investments in things that would potentially have enormous benefits but risk becoming failed projects.

The goal is to have every single project succeed. But if you have that, then the whole portfolio as a whole is a failure because you haven't made the big advances. This is all stuff I've worked on before the pandemic.
>> Peter Robinson: I want to come to all of that, this is the layman here, this is the layman sitting back in California watching NIH and watching you.

But before we depart from the COVID experience altogether, one of the things that always struck me. I don't think I ever asked you about this, actually. But you conducted a study, you got some donor to give you $5,000, the princely sum, as I recall, of five grand, wasn't that what it was?

>> Jay Bhattacharya: Actually, you're talking about the seroprevalence.
>> Peter Robinson: Yes, yes, so you conducted a study in March of 2020 asking, wait a minute, let's see if we can find out just how infectious this thing is. So you tested people in Santa Clara County, and you discovered that it was more infectious but less lethal than the public health authorities understood.

And it has always struck me right there, this strange failing NIH, CDC, We are talking about budgets of tens of billions of dollars a year. And yet it fell to Jay Bhattacharya and some donor who was willing to pop five grand to conduct the first such study. Why wasn't NIH conducting studies all over the country?

Why didn't they have good data by that point?
>> Jay Bhattacharya: That was a failure of the public health establishment in this country. They should have conducted that study.
>> Peter Robinson: Immediately, shouldn't they?
>> Jay Bhattacharya: In February 2020, they should have had measures of how widespread the disease was. Much earlier I wrote an op ed which actually you helped me design because I'd never written an op ed before to say that in the Wall Street Journal in March of 2020 to say, look, we don't know how widespread the disease is.

It's a vitally important fact that we need to know to design the right policies. Yes.
>> Peter Robinson: And let's immediately learn that.
>> Jay Bhattacharya: Let's conduct a study to do that. That $5,000 by the way, was to Stanford, not to me. I saw zero dollars of it myself. The fact that the public health establishment failed to do that should have been a signal that there was something deeply wrong with how-

>> Peter Robinson: From the get-go.
>> Jay Bhattacharya: From the beginning.
>> Peter Robinson: Replication. This is one of the three big initiatives that you've spoken about that you intend to undertake at NIH. Couple of quotations. Again, this is me. You know what a layman I am. I'm just trying to figure out what is this business about replication?

Here's quotation number one. This comes from a 2005 paper. This is 20 years ago by your Stanford colleague and friend, John Ioannidis. Quote, it can be proven that most claimed research findings are false. Let me repeat that. It can be proven that most claimed research findings are false.

Close quote. From a 2021 article in Science, the Reproducibility project, Cancer Biology set out to reproduce experiments from 53 high profile papers published between 2010 and 2012. Consistent with replication efforts in other areas of science, original positive results could only be replicated 40% of the time. Only five of the 53 papers had results that could be fully reproduced.

Close quote. So Ioannidis says 20 years ago, the scientific establishment is letting colleagues get away with it. Nobody's repeating anybody else's experiments. And then a dozen, 15 years later, we get more studies saying, you know what, we've tried 53 studies. These results are all over the place, we can't replicate them.

This is the most basic work that the scientific establishment does. Science testing results, making sure that we know what we think we know. Am I losing my mind? This strikes me as obvious.
>> Jay Bhattacharya: Let me.
>> Peter Robinson: And it takes you to say so.
>> Jay Bhattacharya: Well, I mean brilliant people like John Ioannidis have been saying this, as you say, for decades.

Let me describe the fundamental problem. There's some very flashy things having to do with scientific fraud that are part of the problem, but are not the root problem.
>> Peter Robinson: So that Alzheimer's research is, for instance- That's obviously fraudulent.
>> Jay Bhattacharya: Yes, there's scientific fraud. But the root problem is that we have a scientific culture that doesn't recognize how difficult science actually is, and it punishes failure too sharply and has the wrong standards of truth.

Those are the fundamental reasons. So let me just tease that apart in just a bit. Yes. So first of all, start with standards of truth. A paper that is published in a peer reviewed journal, folks think that that means that if it's published in a top peer reviewed journal, therefore it must be true.

>> Peter Robinson: That's what I've always thought.
>> Jay Bhattacharya: And that's actually inaccurate, right? So the peer review process, what happens is I write a paper, I'll send it to a journal. If I'm lucky, the journal editor will send it out to two or three peer reviewers chosen by the editor.

There's games played to try to influence the editor. If they're friendly with the editor, they'll send it to friendly peer reviewers. The peer reviews themselves might read the paper, look for logical errors, maybe have some questions that they want addressed, but they won't actually replicate the results of the paper.

They won't have the data to produce the paper. They're just reading the paper, they're not looking at the actual data. It's very, very rare, almost unheard of in biomedicine for the peer reviewers to review the data themselves. And so then if the peer review sign off, the editor signs off, you get a publishing in a peer reviewed journal.

That doesn't mean that the result is right. It just means it's passed through this peer review process, which doesn't check to see if the results are reproducible.
>> Peter Robinson: It doesn't mean the results are correct. It just means that the establishment has signed off on it.
>> Jay Bhattacharya: Signed off on it.

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

>> Jay Bhattacharya: You absolutely should be much less impressed by not just my work, but by every. And now fundamentally, the scientific process is hard, right? So the published peer review literature then will have some results that are false positives. And when I say that, what I mean is that they're published.

You think they're true because they're published, but they're not true, right? Right, and that paper that you cited by John Ioannidis makes a very convincing claim, just based on the standards of how we decide what scientific research can get published, that a large chunk of the published peer reviewed literature is probably false, not intentionally.

It's just hard to do science. I may have a result, and I think it's true. I've done some investigation into it, but it might not be true because maybe I made some error that I didn't realize. Maybe the thing is just a lot of things just happen, and you haven't thought of everything.

The right standard of truth in science then is one paper making a claim, and it's peer-reviewed, and it's published in a top journal. The right standard of truth is do other independent research teams asking the same question, using different methodology, do they arrive at the same conclusion? And if lots and lots of research teams arrive at the same conclusion using-

>> Peter Robinson: Then we have something.
>> Jay Bhattacharya: Yeah, so you mentioned, for instance, that Santa Clara Syria problem study that I conducted. It was a very controversial result very early in the pandemic. But dozens of other research teams around the world asking the same question in different settings in different places found results that are roughly congruent with that result.

The fact that the paper was published in the International Journal of Epidemiology, I mean, I was glad it was published, but that's not what makes it true. What makes it true is the independent replication by dozens of other research teams that found very similar results. In places where people were older, they tend to get higher death rates.

In places where people are younger, they tend to get lower death rates. We were kind of right in the middle because we were looking at people who weren't in nursing homes. And so you have a basic thing where everybody learns science. And they first introduced science in fourth grade.

They learned about replication. But the entirety of the scientific infrastructure is set up to not have that as the standard of truth.
>> Peter Robinson: Okay, so that strikes me as mad, and it makes me, I mean, I'm here to represent the angry American public that billions upon billions of dollars get spent on this year in and year out and nobody does double-checking is essentially what you're saying.

But you're also saying to me, American public, calm down. Science is hard. Scientists are in some way or another, you could almost describe them as victims of a process, of a procedure, and we need to change the institutional approach of the research project throughout the country, is that correct?

>> Jay Bhattacharya: That's correct.
>> Peter Robinson: How are you gonna do that?
>> Jay Bhattacharya: Yeah, so a few things-
>> Peter Robinson: I like you so much, Jay, I almost believe that if anybody were, gonna do it it's you. Okay, so I- How can you take this on? It sounds huge.
>> Jay Bhattacharya: I think first, if there's going to be an institution that does, it's got to be the National Institute of Health.

>> Peter Robinson: So you're sitting in the right chair.
>> Jay Bhattacharya: Yeah, so first it funds a tremendous amount of science. And I don't want to paint too bleak a picture, there are real advances that science has made, funded by the NIH, for instance, that have improved human health, right? Within the pool of scientific papers, not everything is false, we just have systems that don't necessarily distinguish true from false often enough, right?

That's the fundamental problem. So here's what you do, first, you have to make it so that replication is a viable path for a career. Every scientist does-
>> Peter Robinson: Incentives.
>> Jay Bhattacharya: Yeah.
>> Peter Robinson: This is where your doctorate in economics comes in.
>> Jay Bhattacharya: Yeah, incentive structures.
>> Peter Robinson: Okay.
>> Jay Bhattacharya: And you create systems that provide the incentives the right direction, you'll get the results in the right direction, right?

That's basic economics, I guess. So you have to award high profile research grants to scientists who creatively do replication work. They identify what are the key claims in the literature that need replication. By the way, if you talk to drug developers, they'll tell you this, that they do this, they do private replication cuz they don't trust the published biomedical literature.

So they'll privately replicate the key results before they decide to invest tens of millions of dollars in development.
>> Peter Robinson: So replication is taking place, but it's in a haphazard and private way, it's not-
>> Jay Bhattacharya: Yeah.
>> Peter Robinson: Okay.
>> Jay Bhattacharya: Okay, so that's one, you have to incentivize replication by rewarding it with high profile grants from an institution with prestige like the NIH.

>> Peter Robinson: And you can do that at NIH?
>> Jay Bhattacharya: I'm gonna do that.
>> Peter Robinson: Okay.
>> Jay Bhattacharya: Second, you have to have a place to publish the replication work. Cuz right now, if you send your replication work to a top journal, there's no chance of being published, they'll say it's not original.

So you have to have a high profile place where people can publish the replication work. Where it's easily searchable so that people can get a sense of how many of these I have a result in the literature, I think I would hope is true. I can go check the journal or the literature and they'll give me a report back of how often it's been tested for replication, how often it's been replicated.

>> Peter Robinson: So you can fund? Can you establish the American Replication Review?
>> Jay Bhattacharya: Yeah, we'll stick on that.
>> Peter Robinson: In every medical library across the country?
>> Jay Bhattacharya: Yeah, and we'll make it searchable using these new AI methods that allow us to pull together what the literature is actually saying.

It's like a glorified, it's a huge search engine is what it turned out to be. And then third, and this is probably the most important, when scientists now are approached by somebody who wants to replicate their result, they view it as a threat. They say, my gosh, they're trying to undermine my reputation by trying to check my work.

>> Peter Robinson: Right.
>> Jay Bhattacharya: But it's not a threat, it's actually an honor. You have an idea that is worthy of some other scientist checking you. That's a mark of honor for you cuz you're making a claim that's important for science.
>> Peter Robinson: Nobody ever tries to replicate me, for example.

>> Jay Bhattacharya: People have tried to copy you all the time, Peter, they just all fail, that's the problem.
>> Peter Robinson: Its not worthy it. So how do you change that's a mindset.
>> Jay Bhattacharya: Yeah, so they're what you do, okay, so let's just talk about baseball, right? So suppose that all we measured was stolen bases.

>> Peter Robinson: Right.
>> Jay Bhattacharya: What you'd have is slow runners trying to steal bases all the time and get caught stealing in the hopes that they could have a few stolen bases.
>> Peter Robinson: If that's what you get paid on?
>> Jay Bhattacharya: Exactly.
>> Peter Robinson: All right.
>> Jay Bhattacharya: Right, but if you measure caught stealings and stolen bases, it'll only be the good.

So the people who are like, really fast, they'll try to steal bases, right?
>> Peter Robinson: Got it.
>> Jay Bhattacharya: Science, right now, the way it measures productivity for scientists are on two bases. How many papers you've published? And how many citations you've got to the papers you published? If you think what they are, it's how much volume of science do you produce?

And how much influence do you have in the scientific community?
>> Peter Robinson: So to put it crudely, that's rewarding pure self-promotion.
>> Jay Bhattacharya: I mean-
>> Peter Robinson: I'm putting it crudely.
>> Jay Bhattacharya: It does produce some scientists that are excellent, that produce real work that advances. But it doesn't do it, it doesn't aim the incentives in the right direction.

>> Peter Robinson: All right.
>> Jay Bhattacharya: So if you measure-
>> Peter Robinson: Calming down now, Jay?
>> Jay Bhattacharya: Well, if you measure pro-social behavior, if you approach me for to do replication, replicate my work, and I share my data with you, you should get credit for that. There should be like a, okay, I've hit a home run, right?

So if is my work being approached for replication at all, that's an honor. Let's measure that. Is my work actually replicated? That's another thing we potentially could measure. If you make measures like that and you reward that kind of pro-social behavior, you'll get it- You reward the effort, you reward the scientists who have the courage to take on hard problems and conduct experiments and have their work double checked, even if it does it all the time.

Even if it's wrong, so that's the other flip side, I assume you're gonna ask me about innovation cuz that's the part of, that's the flip side. It's common in Silicon Valley for people to start a company that fails.
>> Peter Robinson: Failure is rewarded in Silicon Valley.
>> Jay Bhattacharya: That is the key to the success of Silicon Valley, right?

We punish failure too much in science.
>> Peter Robinson: I see.
>> Jay Bhattacharya: The flip side of the replication problem.
>> Peter Robinson: Okay, so let's go on and talk about this. Here's another of your big three initiatives, as I understand it, is keeping NIH right at the scientific frontier. From a May 2023 paper by Paula Steven and Chiara Franzoni, to whom I apologize, I'm sure I mispronounced both names for the Building a Better NIH project.

Quote, a number of scientists have expressed concern that the National Institutes of Health is risk averse and becoming increasingly so. Some think the heavy emphasis placed on demonstrating feasibility of the proposed research is responsible for the risk aversion. More generally, there is the perception that the probability of success plays an important role in the evaluation process, close quote.

Okay, so in other words, as the American public has gotten sicker and sicker, we'll come to that. The increase in chronic disease NIH has become more and more risk averse. People only put put studies forward for funding that they're pretty sure will work. So what are you gonna do about that?

>> Jay Bhattacharya: Right, so that's gonna take a culture change in science cuz there's some concrete things you can do. So for instance, you mentioned how we evaluate grants, right? So in the 2010s the NIH would have as a requirement to evaluate grants, you had to have an active grant.

Now you say to yourself, well, why not? You have people with lots of expertise, you have to demonstrate expertise to evaluate grants. If you think about it, what that does is it makes people who have a vested interest in the current way of thinking into the position for deciding whether challenges to that way of thinking will be funded or not.

>> Peter Robinson: Making no sense.
>> Jay Bhattacharya: What you want is regular turnover in ideas in science, most of the ideas are gonna be wrong, science is hard. But if you don't have that regular turnover and the ability for early career investigators with bright new ideas to try their ideas out early, try their ideas out at all, you're not gonna Going to make progress in science.

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

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

Take a whack at it, give it a try. Now, that may be the wrong way to approach science. But the notion of youth constantly being funded, that portfolios of ideas being undertaken and funded, modest funding, but enough funding to get them enough funding to find out an answer.

Will this idea work? If that idea works, come back to us for more money knowing that 90% of any investment portfolio will go belly up. So that's because Silicon Valley makes a lot of money that way. That's because the incentives are quite clearly set up to. How do you do that in science?

>> Jay Bhattacharya: I mean, just to put a fine point on what you just said, if you have a portfolio of 50 projects that you funded and 49 of them failed, we're.
>> Peter Robinson: Talking about NIH now.
>> Jay Bhattacharya: We're talking about both science and Silicon Valley, and 49 of them fail, and the 50th cures type 2 diabetes.

That's a successful portfolio.
>> Peter Robinson: You've done something for humanity.
>> Jay Bhattacharya: Yes, I don't care that the 49 projects failed. They were, in fact.
>> Peter Robinson: Congratulations to them for trying.
>> Jay Bhattacharya: Exactly.
>> Peter Robinson: They will have learned something.
>> Jay Bhattacharya: Yeah, right, now what happens is the evaluation of grants. You have to demonstrate with preliminary data.

If you're gonna get a big investment from the NIH, you have to demonstrate preliminary data that the idea that you're proposing is likely to work. How do you do that in advance before you actually do the work? So what happens is scientists, and this is something I learned as part of the grantsmanship tools of becoming a successful scientist.

Do some work that you know that ends up working, then propose to do that work, get the funding, support for that proposed work that you know already succeeded, and then try to work on the next project with the funding you get. It's fundamentally, a system designed to reward incremental progress.

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

You were too risk averse in what you invested in. And so you have to have a tolerance for failure. And for young scientists, contrary to Silicon Valley, where you said like, as you said like, very young, early career people can get investments early to test their ideas out.

In biomedical sciences, it is commonplace for a researcher to be in their mid-40s before they can have any chance of getting a large NIH grant. You have postdoc after postdoc after postdoc, where you're essentially doing the bidding of a senior scientist for, for a decade or more of your youth.

And that wasn't always like this.
>> Peter Robinson: I'm sorry, but this is, again, I'm just being the layman. That sounds like a medieval guild. That sounds like a closed shop. Protecting itself, I'm sorry to say, protecting itself.
>> Jay Bhattacharya: It's broken and I want to fix it. And people have recognized this as broken for a long time.

But I think the NIH.
>> Peter Robinson: There have to be all kinds of good people within the system who in some sense, know better.
>> Jay Bhattacharya: Yeah, I mean, but again, the incentives are set up to reward a successful project rather than to reward successful portfolios. It's set up just to create vast sort of hierarchies where people at the bottom of the hierarchy are feeding into your ideas rather than allowing young researchers, might even be older researchers with brand new ideas, brand new ways of thinking to try their ideas out.

>> Peter Robinson: Okay, this is the third of your big initiatives, is related to everything we've been talking about chronic disease. Here's a paper last year published by the center for Chronic Disease Prevention and Health Promotion. No short, snappy titles, by the way.
>> Jay Bhattacharya: In science and science we're bad at PR.

>> Peter Robinson: Quote, an estimated 129 million people in the US have at least one major chronic disease. That's, that is heart disease, cancer, diabetes, obesity, or hypertension. Five of the top ten leading causes of death in the US are or are strongly associated with preventable and treatable chronic diseases.

Over the past two decades, the prevalence of chronic disease has increased steadily, and this trend is expected to continue. About 90% of the annual 4.1 trillion healthcare expenditure is attributed to managing and treating chronic diseases close quote. So I put it to you, Dr Bhattacharya, you're in trouble if I call you doctor.

Over the past 20 years, the NIH alone has spent some $700 billion. And over the past 20 years, the American people have gotten sicker, not healthier. What's going on?
>> Jay Bhattacharya: Let me just emphasize your point. Put an exclamation mark on it. Since 2012, between 2012 and 2019, there was no increase in American life expectancy.

I had grown up with this idea that modern medicine, the sort of.
>> Peter Robinson: We were going places.
>> Jay Bhattacharya: Yeah, science was advancing our health. And the hallmark of that is year after year after year, life expectancy kept getting longer and longer and longer. American children born today are not likely to live longer than their parents.

That is a scandal, because the mission of the NIH is to do research that improves the health and increases the longevity of the American people. That's the mission of the NIH. In that sense, the NIH has failed in its mission. Europe actually has seen improvements in life expectancy over the same period.

And, 2019, 2020, of course, there was a huge. You remember the event, what happened 2020. But there was a huge drop in American life expectancy that didn't come back up to 2019 levels until 2024.
>> Peter Robinson: By the way, so are we still seeing in this suppressed or at least flat life expectancy, are we still seeing damage done during COVID people who didn't go into for their cancer checks?

>> Jay Bhattacharya: The life expectancy is back to 2019 levels now. Okay, only now. But there's still the ongoing lingering problems with making kids miss up to two years of schooling. I mean, there's a whole host of, like, damage, psychological damage we did to the populations. But there's drug abuse deaths that are, I mean, they're still like, on the level, like 80,000 Americans are still dying a year, 70,000 Americans are dying a year from drug overdoses.

Before the pandemic, it was like a fraction of that. There were hundreds of thousands. What we did during COVID was a catastrophe. And that's partly why I'm in this job, because I was trying to call out that catastrophe, the policy catastrophe, not the catastrophe of COVID which itself was a catastrophe.

But the point is that the job of the NIH is to To do research that fixes the problems you just said addresses those problems directly and we have not done a good job of doing that. There have been a tremendous number of actual scientific advances, which I can point to, the NIH played a large difference since we now have, I think, a cure for sickle cell anemia.

>> Peter Robinson: Fantastic.
>> Jay Bhattacharya: Huge advances, what we don't have is a way to manage the colossal chronic disease problem that Secretary Kennedy and President Trump has pointed to, and to use the NIH to solve the scale of the problem of heart disease, we don't have a way to solve the scale of the problem of type 2 diabetes, obesity, autism.

With autism, that's like 1 in 31 kids is the latest numbers from the CDC have it a huge increase from past years and so what you have is a chronic disease problem at scale affecting the health and well being of almost every American.
>> Peter Robinson: Everybody, every family, whether you're ill or not, you've got a cousin who's ill or a brother.

>> Jay Bhattacharya: And science isn't the whole of the solution, but science needs to be a fundamental part of the solution.
>> Peter Robinson: And for sure, if we're spending $50 billion a year on NIH, there ought to be something, again, I speak as a taxpayer, we ought to be getting something from this.

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

Ideological boondoggles don't belong in the portfolio of the NIH and that's something that we actually, even before I arrived in office, the Trump administration worked to remove and we've made some progress on that as well.
>> Peter Robinson: Okay, so now we come to what I imagine is, I don't want to put words in your mouth, but I will, I imagine that in some ways it's your least favorite subject, which is money, how much should we spend, how much should we cut and so forth?

Actually, let me begin with a threshold question, maybe I should have begun the whole show with this because it is just the basic question. NIH comprises, if I have it right, 21 institutes ranging from the National Institute of Biomedical Imaging and Bioengineering to the national cancer institute, six centers, 20,000 employees, and an annual budget of 48 billion that's big.

On the other hand, the American pharmaceutical companies employ even more people and they have a Combined annual research budget of 150 billion three times as big as NIH, why do we need NIH?, why don't we just rely on the research that takes place in pharma companies? If we need more research, we can fund pharma and let them carry it out seriously, it's a threshold question, what does NIH do that we cannot rely upon the private sector to do?

>> Jay Bhattacharya: I'll make a very really simple economic point. There are research projects that it is not in anyone's financial interest in the private side to do because the ideas are not patentable, so i suppose it's 1950 or something, and you're Cambridge University and you're trying to figure out, should I fund Watson and Crick?, will their project on the structure of DNA being a double helix, will it make any money for me?

And the answer is going to be no, as soon as they discover that DNA has this double helix Rosalind Franklin, everybody, don't want to slide anything.
>> Peter Robinson: Complicated story, but yes.
>> Jay Bhattacharya: But as soon as that's discovered that there's this double helix structure, everyone can use it, it's a common pool idea, fundamental, transformative, utterly transforms biomedicine, the private companies have an interest in ideas that are patentable, can be protected, and you need licenses to use, not on return to their shareholders.

>> Peter Robinson: Yes, right.
>> Jay Bhattacharya: Whereas the NIH, it can and should and has funded projects that result in those kinds of common pool ideas that make the whole of science and biology better, that's the primary reason for the existence of the NIH, in my view, From an economic perspective, it solves a market failure for promoting and supporting ideas that are common pool ideas of that sort.

>> Peter Robinson: And in this great, rich, noble democracy, that is a worthy use of public money.
>> Jay Bhattacharya: Yeah, I think it's among the most useful uses of public money if you compare it to some of the other things we spend our money on.
>> Peter Robinson: Okay, so how much money?

And here we come to the question of indirect costs, which I'm sorry to say I can't ask you now that you're Director of NIH. We've talked about this many times over coffee back at the Stanford campus, but now you're wearing a suit, Jay, so, on February 7th, the Office of the Acting Director of NIH announced that the NIH would begin capping indirect costs at 15% of research budgets.

According to the directive, quote, indirect costs are by their very nature not readily assignable to the cost objectives specifically benefited and therefore difficult for NIH to oversee. Yet the average indirect cost rate reported by NIH has averaged between 27% and 28% over time, and many organizations are much higher, charging indirect rates of over 50%, in some cases 60%.

There's a lot there, but basically, when the NIH awards University X a grant of $100 million to do this, that or the other research, it includes indirect costs of some percentage, let's say 40%, in other words, another $40 million to fund, loosely speaking, the overhead associated with keeping a lab heated and air conditioned and all the things you need to do to be able to perform that research and universities have gotten used to that.

And now the NIH has said, we're going from here to here, and across the land if we put our ears to the window we will still hear university administrators screaming at the top of their lungs, Jay.
>> Jay Bhattacharya: Okay, so let me.
>> Peter Robinson: And they're screaming at you, as you well know.

>> Jay Bhattacharya: I've heard from many of them, as a threshold matter, I should say that this, I can't directly comment on the 15% action because it's subject to litigation and.
>> Peter Robinson: Happened before you took charge.
>> Jay Bhattacharya: Yeah, but nevertheless.
>> Peter Robinson: And it's subject to litigation.
>> Jay Bhattacharya: And so I cannot directly comment on that, but I do want to set up the actual policy debate because I think people have missed what the policy debate.

So you've described the actual thing, the mechanics, Right? If I as a researcher win a million dollar grant from the NIH, they'll pay the university,which will let me use the money for my research projects, the million dollars, but also the university will get, let's just take the case of Stanford, I think they'll get $550,000 on top of that.

>> Peter Robinson: Over 50%.
>> Jay Bhattacharya: Right, that will then go to the administrators to fund the light bulbs, upkeep of the building, whatever.
>> Peter Robinson: Real expenses.
>> Jay Bhattacharya: Like the fixed cost of doing research.
>> Peter Robinson: Right.
>> Jay Bhattacharya: So you need to have institutions that have that fixed cost of doing research, this, by the way goes back to.

A policy decision in the mid-1940s by Vannevar Bush. The idea was that the universities of this country are partners with the federal government in the research enterprise. And that the government has an interest in having universities that actually function for research priorities of the nation, right? And so that's gone back a long ways.

The rates being as high as they are, that's within the last, I don't know, 50 years. There were scandals around that in the 1980s, for instance.
>> Peter Robinson: By the way, the Gates Foundation, when they make a research grant to a university, they include an indirect cost rate of 10%.

>> Jay Bhattacharya: Right. And so there's some issues-
>> Peter Robinson: Well below what the-
>> Jay Bhattacharya: Like what goes in the directs versus indirects, I don't wanna get into that. So let me just say what I think the policy issue actually is.
>> Peter Robinson: All right.
>> Jay Bhattacharya: The policy issue actually is that the amount of money that we give to universities for the fixed costs, it's to maintain the ability to do excellent research projects.

The question is, where should that money go? Should it go to a few universities that have excellent researchers? Or should it go to a broader group of universities where excellent researchers might be but aren't attracted to go because they don't have the fixed cost support to maintain the infrastructure?

The system we have now in order to gain access to the fixed cost support from the federal government, you have to have a lot of excellent researchers that win grants.
>> Peter Robinson: You've gotta go to a big established place.
>> Jay Bhattacharya: But in order to attract a lot of excellent researchers, you have to have the infrastructure where the those researchers can do their work.

It's a ratchet, to get the money for the fixed cost, you have to get the researchers, and you have to have the researchers to get the fixed cost support. And it's a system that makes guarantees that relatively few universities will have the lion's share of NIH money.
>> Peter Robinson: And it perpetuates those few universities in that very position.

>> Jay Bhattacharya: Yeah, and now, I've heard arguments, I'm not honestly disagreeing with them, that having an agglomeration of excellent research is one a single place is a really important thing for the advance of science. But what cuts against that is that you can also get scientific groupthink from that kind of concentration.

That's really the question. The sort of returns to having people concentrated physically, geographically, in a few places as a way to share knowledge versus having the scientific talent of the country spread out across the country to avoid scientific groupthink. And we saw during the pandemic, I think, some of the problems of scientific groupthink, right?

>> Peter Robinson: So, Jay, can I, again, layman, so correct me on this, but as I recall, we have between four and five thousand universities and colleges across this country, and I believe the number is 60 that receive funding from NIH. It's a tiny number as a proportion of the entire educational establishment.

And many of them are undergraduate institutions that don't want to engage in research, it would change the nature of the institution. But still, it's a very small proportion of the overall enterprise, correct?
>> Jay Bhattacharya: Yeah, I don't know if it's 60 exact number, but I'll say that the distribution of NIH support to the universities in this country is incredibly concentrated.

>> Peter Robinson: All right.
>> Jay Bhattacharya: And that's just a fact, it has been for a very long time.
>> Peter Robinson: Okay, okay, so the question of managing NIH itself, again, I've got a gobbledygook of numbers and cuts and people screaming. And I just want to hear your, you have a lovely way of summing things up and explaining the larger issue, all right.

As published in STAT, one of the leading science news publications, on April 3rd, so this is recent. Early last week, the Trump administration's federal government shrinking task force, known as DOGE, directed the NIH to reduce contract spending across each of its 27 institutes and centers by roughly 35%, that's a lot.

The cuts are likely to further paralyze an agency that just lost 1,200 employees, including the directors of five institutes and the heads of several labs. And has had key grant making, research, training and science communication functions severely limited since Trump's return to the White House, close quote. That doesn't sound like a publication that's friendly to this administration.

So we set that to one side, but the facts are the facts, Jay, what's going on at NIH from an administrative point of view?
>> Jay Bhattacharya: Right, so the President, the White House, asked the entire government to operate more efficiently.
>> Peter Robinson: We run a deficit of $2 trillion a year.

>> Jay Bhattacharya: And we have $37 trillion of federal debt.
>> Peter Robinson: Correct.
>> Jay Bhattacharya: It's not unreasonable to ask that, right? And the question is, are there operations run by contracts? These are not generally contracts for scientific projects that most of that money is through grants and also direct intramural research done inside the NIH campus itself.

Most of those contracts are for administrative activities, many of which are essential. But the question is, can you do those things more efficiently, right? So, for instance, the NIH had, you said, 21 institutes and 6 centers. I think what happened, I mean, that's correct actually. But it turns out that most of the centers had their own communication shop.

>> Peter Robinson: I see, okay.
>> Jay Bhattacharya: Most of the centers had their own legislative affairs shop.
>> Peter Robinson: There are administrative efficiencies to be found.
>> Jay Bhattacharya: Yeah, so that's how we've implemented those contract demands. The priorities that I've had in implementing them have been no cuts that will result in any patients being harmed.

Cuz we run randomized clinical trials where patients are enrolled, you can't just cut them without, you have to have some plan to make sure the patients are cared for. Don't cut contracts that result in scientists being let go if at all possible. There were some errors, actually, in the classification codes of what scientists had for their occupation, where they were misclassified.

So there were early mistakes around that having to do with problems dating back decades and where scientists were, and we've addressed as many of those, I keep finding some of those. But we've not let scientists go intentionally. And then third, no cuts to anything that harms the mission of the NIH, which is to do research that advances the health and longevity of the American people.

Those are the priorities. We used to do the cuts, we found a lot of places where we could just do stuff better without duplicative contracts that don't actually serve anyone's interests.
>> Peter Robinson: So, Jay, you sound like a man who loves the National Institutes of Health.
>> Jay Bhattacharya: I do love the NIH.

>> Peter Robinson: I mean, what kind of MAGA man are you? I thought I would be interviewing somebody who was attempting to suppress his Viking impulses to slash and burn and pillage. You love the institutions. You love the scientific project.
>> Jay Bhattacharya: The MAGA movement is not opposed to the NIH, it isn't.

What it's supposed to is using and corrupting an institution that should do good for the public and instead becomes hijacked for ideological things that fails during crises like the pandemic. Will potentially even cause the pandemic or contributed to causing a pandemic, right? So what the MAGA movement wants is not that we have zero government.

What the MAGA movement wants is that the government works for the interests and, in this case, the health and well being of regular people. That's what the MAGA movement wants.
>> Peter Robinson: So you fit, you fit. We used to joke, although I wasn't really joking, that my friend Jay Bhattacharya is one part Mahatma Gandhi, one part Dr. Albert Schweitzer.

And one part Saint Francis of Assisi, in other words, humanitarian, gentle, kind, and you fit within this rough, tough, elbows out administration, you feel comfortable in the Trump administration?
>> Jay Bhattacharya: I do, I've had conversations with President Trump and he's curious about science. He wrote a letter to the science advisors, his main science advisor, Michael Kratsios committing the United States to being the preeminent nation in the world in biomedical research in the 21st century.

We're competing with China, China has actually made tremendous advance using, by the way, American technologies. And it's absolutely vital that we maintain that world leadership, and that is President Trump's goal.
>> Peter Robinson: Donald Trump wants us to be number one.
>> Jay Bhattacharya: Yes.
>> Peter Robinson: And so does Jay Bhattacharya.
>> Jay Bhattacharya: Yes.

>> Peter Robinson: All right.
>> Jay Bhattacharya: Secretary Kennedy, the same.
>> Peter Robinson: All right, can I ask here, this takes us back to COVID for just a moment, but there's a piece of news that I want to ask you about. And if I'm catching you unaware, just say so, yesterday CDC Director Marty Makary, you mentioned him earlier, I believe your friends.

>> Jay Bhattacharya: We are.
>> Peter Robinson: All right, you're colleagues within the administration, but you're also friends of some standing. Marty Makary and FDA vaccine advisor Vinay Prasad published an update to the government's guidelines on COVID-19 vaccine boosters. They published this in the New England Journal of Medicine, a big time journal.

In that article, they wrote, although the rapid development of multiple COVID-19 vaccines in 2020 represents a major scientific, medical and regulatory accomplishment. Big deal what we did and how quickly we did it, the benefit of repeat dosing, particularly among low risk persons who may have had previously received multiple doses of COVID-19 vaccines had multiple COVID-19 infections or both, is uncertain.

So we're backing away officially, formally from advice to get repeat boosters, is that what's going on?
>> Jay Bhattacharya: Not just boosters, but also the recommendation, for instance, that kids as young as six months old be given the COVID-19 vaccine. If you look at other countries, no country other than the United States, I think, maybe you'll find some exception.

But no country in Europe, for instance, I think, has a recommendation where kids as young as six month olds get the COVID vaccine, that's unique to the United States.
>> Peter Robinson: So this is a long time coming, actually.
>> Jay Bhattacharya: Yeah, and I read that paper, actually, and I think it's a fantastic paper.

What that paper says is that if a drug company wants to have COVID boosters and COVID shots for kids as young as six months old. They need to produce excellent scientific evidence, randomized studies where they demonstrate an actual benefit to those people getting those shots, right? Not just did you produce antibodies, but did you prevent dying from COVID, did you reduce the risk of hospitalization, did you at least prevent getting COVID for six months?

And this is a minimum you would ask in order to market a product. If you're gonna market a product, you should be able to demonstrate that kind of benefit.
>> Peter Robinson: Niggling little question, does it work?
>> Jay Bhattacharya: Yes, and are there side effects, are we looking at those side effects carefully?

This asks the question to the manufacturers of COVID vaccines, says, please demonstrate to us that this product actually does good for the people that we're giving it to. Actual clinical good not just productions of antibodies.
>> Peter Robinson: Okay, now I have one other question here that's mandatory and that is UN Bobby Kennedy Jr. couple of quotations.

The most frequent line of attack on him, as you very well know, is that he's some kind of anti-vaxxer, RFK Jr. and this comes from his confirmation hearings, he's speaking himself. News reports have claimed that I am anti-vaccine or anti-industry, I'm neither, I am pro-safety. All of my kids are vaccinated, and I believe vaccines have a critical role in health care.

The New York Times on May 1st, just a couple weeks ago, Health Secretary Robert F Kennedy Jr. on Thursday announced plans to require all new vaccines to be tested against placebos. And to develop new vaccines without using mRNA technology, moves that extend his reach deep into vaccine development.

The New York Times is always leery of deep reaches and raise questions about whether Covid boosters will be available in the fall. Okay, what's going on here? You like this man, I know, because I've heard you speak admiringly of him.
>> Jay Bhattacharya: I like him and admire him, I think he's not anti-vaccine, so lemme step back.

>> Peter Robinson: All right.
>> Jay Bhattacharya: So what's happened is we have a regulatory framework where vaccines are treated in a special and different way. I very fundamentally believe, for instance, that the measles vaccine is quite important for child health, I've said that multiple times, I believe it fundamentally. I've also heard Bobby Kennedy say that in the face of the measles outbreaks that have happened, that children should get the measles vaccine, right?

That's not a man that's anti-vacc.
>> Peter Robinson: Right.
>> Jay Bhattacharya: Right, what he said is exactly true, every conversation I have with him reinforces this. He cares about making sure that people understand what they're getting. Because of their successful history of vaccines going back centuries, the scientific community treats vaccines with kid gloves.

But nevertheless, the regulatory bodies of this country have an obligation to make sure that the products we recommend that especially children take have a proven track record of safety behind them, and in many cases, they do. And in some cases, like the COVID vaccine for children as young as six months old, they do not, the fact is-

>> Peter Robinson: That's incredible to me, but those who are rushed through without the usual FDA.
>> Jay Bhattacharya: Normally the safety testing of vaccines takes decades.
>> Peter Robinson: Got it, and we didn't have time.
>> Jay Bhattacharya: Yeah, so I'm not trying to indict anybody over this, I'm just a fact, right? In April 2021, I wrote a op-ed with Martin Kulldorff, of then Harvard University arguing that healthy children should not be recommended to get the COVID 19 vaccine.

And the reasoning was there was a very limited evidence of benefits for children because they die of COVID at such low rates that you don't really have much to gain from the vaccine for kids. You're not preventing deaths, no randomized study had demonstrated prevention of deaths for children given the COVID vaccine.

That's not a randomized study, does not exist that shows that. And there was a possibility of risks of side effects, so the benefit harm balance tilted against recommending children to get this. To put yourself back in early 2021, COVID was killing older people at very high rates. And there was some evidence that the COVID vaccine might prevent those deaths.

>> Peter Robinson: I know this, Jay, because you told me to go ahead and get vaccinated.
>> Jay Bhattacharya: I got the COVID vaccine myself cuz I'm an old guy, right, so the balance was different for older people, right, so the right policy advice then.
>> Peter Robinson: Based on the science.
>> Jay Bhattacharya: Yes was no for children, yes for older people, especially for older people who are high risk with multiple chronic conditions that put them at high risk, that's a reasonable balance given the uncertainty.

>> Peter Robinson: And so all that Bobby Kennedy is saying is let us not claim to know more than we know.
>> Jay Bhattacharya: Correct.
>> Peter Robinson: And let us know what we need to know.
>> Jay Bhattacharya: Right, and then let make people make their decisions.
>> Peter Robinson: So he's fair as far as you were concerned?

>> Jay Bhattacharya: My experience with him is that the press has treated him tremendously, unfairly in part because they believe that he is threatening financial interests in the pharmaceutical industry and elsewhere.
>> Peter Robinson: By the way, so let's face it, he is. And so are you. If you want to rearrange the way the scientific enterprise in this country is conducted and you have just eloquently described ways in which you would like to shift incentives have.

If there's a settled order that's very comfortable and there is a settled order and people within that scientific establishment are very comfortable people by comparison with average American incomes, they will scream. This is politics.
>> Jay Bhattacharya: I mean, the problem here is that I believe very firmly in capitalism.

I believe very firmly in the ingenuity of American companies to address the problems of the American people. I mean I just, that's like, I'm an economist that, I mean that's just a fact. But the idea that requiring drug manufacturers to actually do honest safety testing or having regulators of the country, they're supposed to do honest safety testing and report it honestly to the American people, that's not anti-capitalist.

>> Peter Robinson: It's no outrage.
>> Jay Bhattacharya: In fact, it protects the companies.
>> Peter Robinson: Okay.
>> Jay Bhattacharya: Right, it makes it so that people trust the products of the companies more. It allows there to be a private sector that people view as addressing their needs. It directs the companies of the country to activities and products that actually advance the health and well being of the American people rather than simply improve the bottom line without actually translating to improved health.

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

This is a historic day. The conduct of this research does not protect us against pandemics as some people might say. It doesn't protect us against other nations. There's always a danger that in doing this research, it might leak out just by accident and cause a pandemic, close quote.

Well, now, hang on. Gain of function research has been going on for decades. We have military labs and scientific labs that are constantly trying to figure out what the bad guys might do. Tweaking viruses to make them more and more lethal and then rushing to figure out what antidotes.

I thought this was a fixed part of the scientific slash military establishment. And you're saying no, do away with all of it.
>> Jay Bhattacharya: Well, so first of all, there's a bioweapons convention that President Nixon signed in 1973 that binds the United States. So we don't do offensive bioweapon research.

>> Peter Robinson: Okay, right.
>> Jay Bhattacharya: So that's.
>> Peter Robinson: Details first.
>> Jay Bhattacharya: That's the first, right?
>> Peter Robinson: So we really don't.
>> Jay Bhattacharya: We don't.
>> Peter Robinson: And we've held to that.
>> Jay Bhattacharya: Okay, right. Well, I mean, I've been in the government six weeks. I hope we've held to that. Well, I hope I don't find out we haven't.

If I find out we haven't held to that, I'll go public with that.
>> Peter Robinson: All right.
>> Jay Bhattacharya: But I will say this. What we have done is we've done. We, including the NIH, has supported a research program with the utopian vision of preventing all pandemics. The way the research program has worked is that we fund people, the Eco Health alliance, once upon a time, to go out into the wild places, partner with foreign countries, including China, go out in the wild places collect the pathogens in the bat caves or wherever.

>> Peter Robinson: Picking up bat droppings.
>> Jay Bhattacharya: Right, so that we can catalog all of the viruses and pathogens out there.
>> Peter Robinson: Right.
>> Jay Bhattacharya: Even if there's very unlikely that many humans will come in contact with those things. Bring those viruses and pathogens into labs, often in city centers, often not necessarily in high-security environments, do research on them to see if it's easy to manipulate them and cause them to become more transmissible among humans.

And the idea is, if we can identify those viruses and pathogens that are more likely to make the leap into humans, then we can prepare in advance. We can create vaccines, antivirals, or whatever before they make the leap in the population, so that when they make the leap, we are already ready.

There's two major problems with that. One, it working, which it doesn't, and then one of its safety, which it's not. First, if you make a study of a pathogen you found in the wild places that have never really ever infected humans before, and you create vaccines or whatnot to combat it when they actually make the leap, evolution still works, right?

It's not going to be the same virus you cataloged. These viruses.
>> Peter Robinson: Evolve very quickly.
>> Jay Bhattacharya: All the time, and so you have a snapshot from ten years ago when you went to the bat cave, but you don't know what they look like now. And the vaccines and things that you've produced to try to prepare, you've never tested them on human populations before because no human had ever gotten the disease.

So this is a foolhardy way to you pretend to yourself that we've protected ourselves against a pandemic when we haven't. Second, the actual conduct of this research is very dangerous. And I think it's very likely that the COVID pandemic was the result of this kind of research agenda because it's not possible to guarantee even in high security labs.

>> Peter Robinson: Are you prepared to say that the preponderance of evidence now is that Covid arose from a leak from gain of function lab in Wuhan?
>> Jay Bhattacharya: Yes.
>> Peter Robinson: Is that the position?
>> Jay Bhattacharya: That's my position, and I believe it's also the position of various intelligence agencies of the government as well as other governments as well, that have looked into this.

>> Peter Robinson: We were funding gain of function research in a lab of China, something went wrong and the world shut down?
>> Jay Bhattacharya: Yeah, dangerous, now, I want to make a distinction. There's only a small fraction of the portfolio of biological experiments that people do that meet this category of dangerous gain-of-function research that have the potential to cause a pandemic.

>> Peter Robinson: Right.
>> Jay Bhattacharya: It's a tiny fraction. There are gain-of-function activities that people do that actually advance human health, right. I'll give you an example. We produce human insulin using a gain of function experiment. What we do is we take E Coli, put a gene in. I'm not sure exactly what the current manufacturing process is, but this was.

You put a gene in that produces human insulin and the E Coli, then you grow them and they make human insulin. That's a gain of function that has no chance of causing a pandemic.
>> Peter Robinson: Got it.
>> Jay Bhattacharya: What we want is to make sure that researchers understand that they should not be doing research that has the chance of causing a pandemic.

It's not, don't work on Ebola, don't work on a list of pathogens. Are you doing an experiment where even if you think you have a benign virus of that Virus from the middle of nowhere that doesn't seem to infect humans. And are you doing experiments that augment them in ways that might infect humans and cause a pandemic?

Then you shouldn't be doing that. And the institutions that fund that work, that support that work, universities, NGOs should understand that if they allow that kind of work to go and they don't have it as part of the regulatory process where, say, let's evaluate it from the point of view of the risk of causing a pandemic.

If they don't say that that work is going on, they sort of surreptitiously do it and it's discovered ex post they did, they're gonna face essentially existential threats.
>> Peter Robinson: Got it.
>> Jay Bhattacharya: Right, it's so dangerous. It's like allowing everyone in the United States to have their own home nuclear reactor.

Right, are you doing-
>> Peter Robinson: Unwise.
>> Jay Bhattacharya: Yeah, it's not most of scientific. Most of it's a tiny, tiny part of science. We regulate it. We have a comprehensive Nuclear Testing Ban Treaty to make sure that we don't test nuclear weapons routinely because it doesn't actually improve the security of anybody, but does pose- Would you like to see an international treaty like the Nuclear Test Ban Treaty on gain of function?

I would. I think that, it's not in any country's interest to invest in this kind of research. It doesn't give them any advantage in any geopolitical sense and it does pose potentially existential risk to human populations. Just look at what happened during the pandemic. You can have an experiment like this that causes literally trillions of dollars of damage, killing tens of millions of people with not just the virus itself.

But the sort of outsized, inappropriate damaging response to the virus, you really should be not doing that kind of research.
>> Peter Robinson: So this is one on which the planet ought to be able to come together in your.
>> Jay Bhattacharya: Yes.
>> Peter Robinson: All right, Jay, last couple of questions here.

>> Peter Robinson: The last time we saw each other, we went to buy you some suits because you were wearing your Stanford hoodie. Actually, I will state this for our viewers. You were wearing khaki trousers with a tear at the knee. And I said, Jay, you're an important professor. Why are you wearing torn trousers?

And you said, I had a biking accident. I said, Jay, when did that bicycle accident take place? I think about two years ago. All right, that was your life and you loved it. You even loved that crazy office you had. You loved wearing hoodies and khakis that were torn at the knee.

And now here you are in a suit, sitting in front of cameras. You're getting yanked up to the Hill to testify again and again. I've seen you over and over again standing with President Trump in the Roosevelt Room or with President Trump and Bobby Kennedy Jr in the Oval Office and you're coming under attack.

This is a different life for you, are you enjoying it?
>> Jay Bhattacharya: I'm not, I was a professor for a very long time. I really love that life. I'm here not for my own personal enjoyment, but for whatever reason I've been called to do this, Peter.
>> Peter Robinson: Okay, so let's be explicit about this.

You are a deeply believing Christian,
>> Peter Robinson: So explain that. Explain to people who may not understand what it means to have a sense of a call. Just explain how you think about it.
>> Jay Bhattacharya: The actions that I take are not for myself. That's what a Christian is supposed to do.

That's what Christ calls us to do, is to say the way we behave is for the good of others. We're called to love our enemies. We're called to love others and to sacrifice self for others.
>> Peter Robinson: Yes. By the way, for the record, I've known you a long time and I've known boards you could have sat on and didn't, and enterprises, startups you could have joined and didn't.

In fact, it's driven me mad that you didn't take some of the money that was offered to you. But go ahead, because I'm not as good a Christian as you are.
>> Jay Bhattacharya: I don't know about good Christian, I'm not a particularly good Christian either. I think that the point is that this is a once in a lifetime opportunity to actually make the scientific institutions of this country work for the American people and frankly, for the world, better than they have.

How could I say no? So it's not about having fun. It's about using whatever talent I have, which is not a lot, to advance that goal.
>> Peter Robinson: What has the experience taught you about the United States of America?
>> Jay Bhattacharya: It's a great country. I mean, I'm an immigrant to this country.

I arrived when I was 4. I lived in public housing when I was little, actually in Cambridge, Massachusetts before we went to California, I went to public schools. The fact that I can be the director of the NIH, especially after all of the controversy over the pandemic where I was essentially shunned aside.

The United States is a system where it can elevate people who have that background is remarkable. I mean, I'm never gonna forget that.
>> Peter Robinson: Jay Bhattacharya, 18th director of the National Institutes of Health. Thank you.
>> Jay Bhattacharya: Thank you, Peter.
>> Peter Robinson: For Uncommon Knowledge, the Hoover Institution and Fox Nation, I'm Peter Robinson.