Since 2012 there had been no increase in American life expectancy from 2012 to 2019; it was almost entirely flat, whereas European countries had advances. During the pandemic, life expectancy dropped sharply in the United States and only just last year did it come back up to 2019 levels. In Sweden, life expectancy dropped in 2020 and then came right back up by 2021-2022 to the previous trend of increasing life expectancy. Whatever investments we are making as a nation in research are not actually translating into meeting the mission of the NIH, which is to advance health and longevity of the American people.
They kept saying 'We don't care.' And so it's almost like big segments of the public feel like they caught us in something and as scientists we won't admit it, and they're not just pissed off, they're kind of done. I hear it all the time, and again this isn't the health and wellness supplement taking anti-woke crowd; this is a big segment of the population that is like 'I don't want to hear about it, I don't care if labs get funded, I want to know why we were lied to or the scientific community can't admit fault.' I just want to land that message for them because in part I'm here for them. Get your thoughts on what you think about lockdowns, masks, and vaccines just to keep it easy, and what do you think the scientific community needs to say in light of those to restore trust?
So first let me just say I don't think I'm the NIH director unless that were true unless what you said is true; otherwise I'm not the NIH director. I was a very vocal advocate against the lockdowns, against the mask mandates, against the vaccine mandates, and against the sort of anti-scientific bent of public health throughout the pandemic. I've also argued that the scientific institutions of this country should come clean about our involvement in very dangerous research that potentially caused the pandemic, the so-called lab leak hypothesis.
Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life. I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Jay Bhattacharya, a medical doctor and PhD and the director of the National Institutes of Health. Prior to that he was a professor of medicine at Stanford University. Today we discuss the past, present, and future of publicly funded research in the United States. The NIH is considered the crown jewel of basic and medical research. Dr. Bhattacharya shares his vision of which aspects of NIH are especially effective and which need revising. We discuss how scientific ideas are evaluated for funding and what can be done to create more funding for more ambitious projects. We also discuss the replication crisis and new initiatives. Dr. Bhattacharya stepped into a public role during the COVID-19 pandemic when he co-authored the Great Barrington Declaration which argued against lockdowns. He was also vocal against mask mandates and addressed vaccine efficacy versus safety. That discussion leads into a conversation about vaccines more generally, including measles, mumps, rubella vaccines and the issue of vaccines and autism. We also discuss drug prices and why Americans pay 10 times more for the same prescription drugs. I want to emphasize that these issues will impact everybody. Dr. Bhattacharya was incredibly generous with his time. As a final point, my graduate and postdoctoral training were funded by the NIH, so I'm very impassioned by these issues. I strive to include questions from my followers. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. Now for my discussion with Dr. Jay Bhattacharya.
Dr. Jay Bhattacharya, welcome. I've been wanting to do this for a very long time. We are colleagues at Stanford although now you've formally moved to Washington to be the director of the National Institutes of Health. But you've played such an essential role in shining a light on certain aspects of public health mostly that happened during the time of the pandemic related to lockdowns, vaccines, etc. We'll talk about that but now you are in the chief position of directing research dollars and the initiatives of what is arguably the most important health organization in the entire world. So thank you for taking the position, thank you for being here. The first question I have is for those that are not familiar, what is the not just stated mission of the NIH but what is the really essential mission of the National Institutes of Health?
So let me start with the stated mission because the stated mission is something entirely worthwhile. It is that to support research that advances the health and longevity of the American people and of course the research that we do doesn't just advance American health, it advances the health of the entire world. For a very long time the NIH has been the premier biomedical organization supporting research that translates into almost every drug that you take. The NIH has had some role in developing almost everything. For American biomedicine it's the essential institution. It supports the careers of a very large number of biomedical scientists around the world. I got NIH funding for most of my career, I was a reviewer for grants. It's an absolutely essential organization.
I agree. My lab ran on NIH money primarily, so thank you taxpayers. I think for most people when they hear that word health and the mission statement for NIH, there is this assumption that most of the work being done at or funded by NIH is human clinical studies or even mouse studies testing a particular drug. But as you and I both know, much of what NIH does is fund basic research, research for which we don't have any clear idea that there could be a potential upside for human health. Things like what controls the pigmentation patterns of the noses of Doberman pinscher dogs. When we step back and look at basic versus applied research, what percentage of the NIH budget is directed toward basic research and what percentage toward clinical studies or preclinical trials?
There are big fights over exactly what that demarcation line is, so I'm not going to commit to a single number. What I will say is that a substantial part of the NIH portfolio appropriately focuses on basic science, meaning fundamental biological facts that can be used in many drug studies. The NIH very appropriately funds that work, especially work that's not patentable because no drug company has an incentive to do that work and yet it's vital. For example, the research that led to the understanding of the structure of DNA as a double helix is not patentable, and yet it's vital to almost everything we do in biology. The NIH appropriately funds that kind of work that solves a market failure. There's also applied work where you take advances and test a drug that might work to treat a disease. There's an interesting dividing line where the question is what should be left to the private sector. The private sector tends to fund large-scale clinical trials at the tail end of development. The private sector has an incentive to fund those studies because that gives them exclusivity and patents. So why should the taxpayer pay for that when there are private actors willing to pay? So there's a fuzzy dividing line between basic and applied. The fundamental thing is we have to fund basic work, which I believe in pretty strongly.
As a basic scientist, I worked on clinically relevant issues related to restoration of vision in blinding diseases like glaucoma and anxiety. I know that basic research has led to important cures. For example, the work of Hubel and Wiesel on the visual system led to corrective surgeries for children with cataracts or strabismus, saving the vision of millions. Also, basic cell biology work was necessary for the development of essentially every existing cancer treatment. The reason I'm setting it up this way is because I think nowadays part of the reason you're here is that we are potentially looking at a redirecting of a significant amount of research dollars away from basic research, which has some people concerned. That said, we also need translational work.
I have no intention of implementing that shift. Basic science work and applied work are both tremendously important parts of the NIH portfolio. The question to me is what's scientifically important and interesting in terms of accomplishing the NIH mission. Both basic and applied work can contribute. I think any large-scale scientific institution that seeks to support the mission has to have both. I don't have any intention of gutting basic science. I do epidemiology, health policy, health economics, statistics, which is very applied, but I have great admiration for my colleagues like you who do basic science work. It's going to stay part of the NIH mission as long as I'm the director.
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I'd like to talk about something that most people perhaps are not familiar with in terms of its acronym but is a very important issue: indirect costs (IDC). My lab ran on NIH grants for many years. If we got a grant for a million dollars over four years, Stanford would get some percentage above that for indirect costs, roughly 50% at Stanford. That money goes to administrative handling, infrastructure, etc. IDC has become a hot button issue because the new administration cut the IDC rate across the board to 15%. I'd like your thoughts on that because it weaves into bigger issues about why taxpayers should pay for universities to run, especially when some have large endowments.
There was litigation against that 15% which blocked it, so the rates are whatever they were. I can't comment on the litigation as a member of the government. But I want to talk about the broader issues. In the mid-40s, Vannevar Bush argued that the federal government should partner with universities to organize scientific infrastructure. The indirect cost structure came out of that commitment. It makes sense that the federal government have some role in supporting universities. The question is how much and how it should be structured. The current structure is non-intuitive. If you get a million dollars a year, Stanford gets $550,000 on top for fixed costs. That money goes to building maintenance, biohazard disposal, etc. The economics work as a ratchet: to get fixed cost support you need brilliant scientists who win NIH grants, but to attract scientists you need infrastructure. This concentrates federal support in a few universities mainly on the coasts. Brilliant scientists in other places have trouble getting grants. There are also questions about whether the same indirect cost rate is appropriate for different types of research. For example, my epidemiology research has low fixed costs compared to a wet lab. So there are policy questions about whether we have structured indirect cost support correctly and whether we are auditing it appropriately. The policy question is not whether the federal government should support universities, but how it should be distributed across the country and to what extent researchers versus administrators get it.
There's something very important in what you're bringing up. I want to backtrack to one issue. You pointed out that the current model is that taxpayer dollars pay for basic research and exploration, and if there's any technology or drug brought to the public through the private sector, the taxpayers fund the R&D but don't capture any upside. The general public has to buy back the results of what they paid for. That's where I think a lot of the general public sit. To any rational person, that kind of sucks. And made worse, if I want to read a paper published with work I funded, I have to buy it from the journal. That changes in July, right? That's a huge issue.
Yes, that's one of the decisions I made. My predecessor Monica Bertagnolli made a policy that NIH-funded papers must be available free to the public immediately upon publication. That policy was due to go into effect in December, but I decided to accelerate it to July. So starting in July, Americans will have free access to papers they already paid for. Thank you. On the journal issue, it's insulting that the public has to pay again. It impedes the progress of science and transparency. During the pandemic we saw the folly of that model. So it's a small step forward but an important one. Also, regarding patents, the Bayh-Dole Act allowed NIH-funded work to be patentable to solve the last mile problem. There's a trade-off: higher prices while the patent is in place, but eventually the drug becomes available to the public. That's the basic trade-off.
Thank you very much. I guess thank you to Monica as well for initiating this, but thanks for accelerating that.
Let me tie back to something else you said earlier. The NIH funds your work, and then that work results in patents that make money. Those patents are funded by American taxpayers. The question is how much should the taxpayer be funding this work, and should private actors be allowed to make money off it? The Bayh-Dole Act created a commercial interest to translate basic science into products. There's a trade-off: for a while products are at higher prices, but you get more rapid access to benefits. That's why it's complicated.
When I joined UCSD and Stanford, I signed something saying if I make a discovery that translates to an important device or drug, the university captures some upside. Stanford has a history of faculty going into biotech. But most NIH grants go to people focused on basic research, not involved with companies. For the taxpayer, they are paying for discoveries and not capturing the upside. It's like the journal situation all over again.
In response, when you take a medication or health advice that works, often NIH research was somewhere in the path. There are huge returns. If you have a drug that treats your disease, even if the price is higher than marginal cost, it can still be very worthwhile. For example, metformin is cheap now but once was patented. The value from NIH-sponsored research is potentially very high in terms of improving your health.
I wanted to bring to the forefront that American taxpayers pay two to ten times more for the same drug product as people in Europe. Why is that?
