How does it feel to go from pariah to powerful? Dr. Jay Bhattacharya has lived that whiplash. He spent most of his life in the quiet, insular world of academic medicine until he rose to national infamy during the COVID pandemic when he co-authored the Great Barrington Declaration, a viral open letter signed by hundreds of public health experts denouncing lockdowns as an ineffective, unscientific catastrophe. Jay was roundly denounced as a crank. Francis Collins, the head of the National Institutes of Health, called him a fringe epidemiologist. Then Jay took his job. He now runs the NIH, a $46 billion behemoth that's the engine of medical innovation in America. How does Jay think he can restore the public's trust? 'I as a scientist should not get to decide whether I can do an experiment that puts the entire human population at existential risk. That there should be some other people having oversight over that, right?'
What is the replication crisis and why does it matter?
It's actually at the heart and soul of how we decide what's true and false about physical reality in our society.
And most importantly, can you please tell me if it's okay to keep using Zyn? Do you use the nicotine pouch?
I don't, I don't. I'm not a big fan of them, Rob.
Let's talk about that sense of whiplash. Right. Again, a lot of people know you for your breakthrough, prescient, 100% vindicated work related to COVID policy, which I would say led to a lot of name calling and branding and marginalization, including from some of the institutions you're now responsible for. Not to get into too much, right? And then within a matter of months, you go from someone who was widely decried as running a death cult to running the NIH, a $46 billion operation and the essential source for basic scientific research in this country. Like what was that like, man? How's it going? I mean, what's your stress level?
This is an absolutely crazy job. It's not a job I ever expected to have. And in fact, if a student were to ask me, 'Jay, how do I prepare to become the NIH director? What do I have to do?' I don't have an answer for that question. But I do feel that I had been preparing for this job all my life in some ways, and the pandemic specifically. The experience of being so public on such a vital issue put me in contact with, not always the most fun contact, with some very prominent politicians, people high in the world of science. It was kind of an education that prepared me for this job.
Okay. Specifically though, getting to and you've talked about this on other platforms, rebuilding public trust in these institutions, right? I would say you don't need to editorialize if you don't want to. That there was a justified collapse in public trust in places like the NIH because of the way the establishment engaged in some suboptimal ideological inflexibility during a once in a generation pandemic. Right. But I want to ask you, there's been this collapse, but there almost feels like an overcorrection in the other sense where now people their primary source of medical advice is whatever nootropics Joe Rogan recommends, right? That's not great. There is such thing as medical expertise. There is such thing as objective scientific fact. How do you think about balancing those two things towards this mission of rebuilding trust?
I think to me, first I completely agree with you about the failure of the scientific establishment during COVID. They guaranteed there was no debate, made it so that you couldn't question whether the schools should close. I know you were a big issue for you and me as well. So many people were hurt, still hurting as a result of those decisions: the vaccine mandates, the school closures, all that. And then just petty things like you have to put a mask on when you walk into a restaurant and you sit down you can take it off, and of course COVID doesn't touch you because you're sitting down or something. That engendered a deep distrust in the scientific establishment, that's just a fact. But I also agree with you, Rob, that it is really important what science, like real science, honest science, can do that can make your life better, that can help you make decisions for difficult things in your life. Significant power medical treatments that actually make you better, that are grounded in reality. My job is to try to figure out how to both acknowledge the harms and the lack of trust, the legitimate lack of trust, while also trying to help reform the institutions so we focus on the real good things and set up guardrails so we never have what happened to us during the pandemic ever again.
Right. But I think it's interesting to get into the specifics like what are specific things that might even sound a little bit wonkyish but that are concrete steps towards doing that.
Okay. So first, let me just take one big thing actually. It's not a wonky detail. I believe that it is possible that scientific research sponsored in part by the NIH but also lots of other entities including the Chinese government may have been the cause of the pandemic. A lot of people have fights over this. I'm not going to get too deep into the fights. What I will say is that the kinds of biological exercises people did in order to try to prevent a pandemic – go find viruses in weird bat caves, bring them into city centers, and then augment their capacity to infect humans – the reason why they did that was they were arguing that we needed to do that in order to prepare just in case a pandemic happens. But I think no matter what you believe about whether the cause of the pandemic was this kind of research, I think everyone can agree that that kind of research is potentially very dangerous.
And another thing I think we can all agree is that the regulatory structure around that research was very poor before. The president issued an executive order a couple months back putting in place a regulatory structure which I'm helping to develop around that kind of research where the idea is if I as a scientist should not get to decide whether I can do an experiment that puts the entire human population at existential risk. There should be some other people having oversight over that, right? It's not theoretical. If we don't fight over the pandemic, let's just talk about the experiment that launched the nuclear age. Enrico Fermi, when he started that nuclear reaction on the squash court at the University of Chicago, he did a calculation: would this nuclear chain reaction envelop the earth? Luckily that calculation was pretty close to zero before he did this.
We owe the public, we scientists owe the public that kind of calculation before we take any risk of that sort. The public should have a say. The regulatory structure needs to take at its heart the idea that we are working for the public and we don't take risks without the public getting to say one way or the other. That's what we're working on: a regulatory structure that will allow us to tell the public honestly that we're not taking risks like that on your behalf.
The key thing is people's lives are still affected. Kids whose schooling has been delayed for years, that may be permanent, with long-term effects, psychological harm, depression, drug abuse – all these lingering effects of the decisions made during the pandemic. Of course, the fact is that all of those measures – if you look at Sweden, they did better than we did by far. They had almost no excess mortality through the entire pandemic. It's incredible. The best in Europe and they didn't do the lockdowns. So the question is what can we do to fix things? I think the constructive thing is let's make plans for the next time that are more human, that take into account the lessons we learn. The most important thing isn't putting people in jail or whatever. The most important thing is if we have signals that there are viruses afloat, new viruses afloat, we have lots of tools to try to understand them better, to address them, to develop countermeasures. All that biological stuff is great. We should keep doing some of it, not all of it. What we don't have is a social structure that responds to that information in a rational way. It's very clear that our societies are prone to panic, and when we panic, we sacrifice children. We sacrifice the poor. We sacrifice the working class. We have to structure our pandemic response plans to not ever do that again, because none of that helps protect anybody and it causes tremendous lingering damage. We're going to need to have that honest conversation as a society. I don't know that we're ready yet. I naively wrote an op-ed in 2021 in the Wall Street Journal calling for a COVID commission, saying we're ready for an honest discussion. That was four years ago, and I don't think we have – now in retrospect, that was way premature. We're starting to head into a moment I think we can start to have that conversation, but maybe not quite yet.
I think it's very hard for a lot of people to actually have to fully face the fact that much of the painful sacrifices they made were unnecessary. It's hard to embrace the reality of something like that. Let's move on to how do you describe the replication crisis to the broader public in a way that makes it clear that this is a big deal.
Okay, so this is the thing about the replication crisis. Whenever I start to talk about it, I think in my head, this is really boring, but it's not really boring. It's actually at the heart and soul of how we decide what's true and false about physical reality in our society.
Just very broadly, the scientific revolution happens when arbitrary authority, ecclesiastical authority, is overthrown. Its capacity to make truth is overthrown by ground reality. Galileo looking at the moons of Jupiter and saying that the moons move. You don't get to claim truth just because you have high authority. That's the base of the scientific revolution: an overthrowing of authority with ground truth. What we had during the pandemic was the same kind of structure but a different authority. High scientific authority decided it could say what is ground truth even though the reality was very different. Tony Fauci famously saying if you criticize me, you're criticizing science itself. That is indicative of a mindset that says science is what the top authorities say it is. You publish a paper in a top scientific journal that's truth. It's peer-reviewed, top scientific journal, that's truth. Actually the scientific evidence says that's not correct. The replication crisis – people have been cognizant of it for at least 20, 25 years – is an indicator that just because something is published in a top scientific journal does not mean it's true. When independent people try to repeat the experiments published in top scientific journals, half the time they find that that doesn't repeat. You can get an indicator of this by the prevalence of scientific fraud at very high places: people at top universities, famous scientists brought down because they had a photoshopped gel in their paper.
The reason is because you get social benefits from publishing in top scientific journals. You get to decide what's true. But the fact is that people don't check that. The replication crisis is fundamentally an epistemological crisis: how do we determine what's true and false in society? The right way to determine what's true and false isn't the director of the NIH says A, B, or C. I may be right, I may be wrong. Even if I publish in a top scientific journal, I might be wrong. It's independent people looking at the same question from different ways find the same thing over and over again. That's how we determine truth in science. The replication crisis has its solution in changes in the incentives of science. You don't get advances in your career just by publishing in top scientific journals. You get advances by identifying things that turn out to be true by other people checking them. There's a whole sociology of science involved. But fundamentally, it's an inversion akin to what happened during the scientific revolution of the 16th and 17th centuries. We have to restore ground reality as the basis for truth making in society rather than authority.
So I just want to put a point on this. You're saying of the published results in established medical journals, the gods on high telling us this is an accurate picture of reality, fully half the time when someone else tries to replicate their experiment to get the same results, it fails.
Yeah, I mean, there's different estimates of this, but something on that order. I can give you a concrete manifestation of this that everyone will recognize. When I was a kid in the 70s and into the 80s, my family was scared to death of eggs because my dad was diabetic and they read this literature that eggs have cholesterol which cause heart attacks. Absolutely scared to death of eggs. Didn't eat an egg until I was in my teens. Then all of a sudden egg whites were okay, so we had these horrible egg white omelets. And now eggs are superfood.
