The collapse in trust in public health continues to this day. We still are in the COVID hangover period. Grappling with that is the central question of this age.
You were attacked from so many directions. We just want you guys to do good for us. Could that be done?
What came before was politicization and what we're doing now is depoliticization.
There is a claim that you have some secret word bank 235 plus words that if a research paper is submitted with these words, it gets flagged. Is it true? Is there a secret word bank?
I am deeply against banned word lists. I don't believe in them. I will not have my institution embrace them.
Science should be about being disruptive. We want the Galileo. We want the disruptors.
I care if the project disrupts science for the good. If it results in better cures and treatments and better health for people.
Dr. Jay Bhattacharya. Okay. Jay, I know you want to call me. Okay. Jay, what a great honor it is to sit with you here. I think it's actually surreal. As we were sitting down, I was saying it's just it's such a testament to America, right? Americans and our bravery and our morality. The fact that we have watched you being attacked as you try to defend us against the COVID onslaught, if I may call that, and you attacked from so many directions, and now you're the head of this massive NIH.
I mean it's I sit back and I am in awe of this country. We just celebrated the 4th of July and I was just thinking about how did I get to this place? I mean I arrived in this country as a three-year-old and you know we were immigrants. I went to public schools and then I found myself as a professor at Stanford in 2020. I thought I had a nice career. And I realized that that career meant nothing when I saw what was happening during the COVID pandemic. I saw people locked away, kids not being allowed to go to school, huge huge sort of violations of basic standards of public health. You know when the COVID vaccine came out that I protested against the mandates and that led me to get cancelled as you said attacked by lots and lots of folks some of whom I respect and love that just I think just lost their way. And I thought my career was over and now I'm the director of the National Institute of Health.
Yeah, it is amazing. Where do you get that? Where do you get your values from? Because many physicians may have agreed with you quietly, silently, but you were pretty outspoken.
Well, I'm a Christian. And my faith is tremendously important to me. I don't believe my purpose is to put lines on my CV or to get accolades and awards. My purpose is to serve others, to love others. And my research before the pandemic was on vulnerable populations. I studied poor people. I studied disabled people. I studied children. I studied people who were faced starvation. And I studied those vulnerable populations because I wanted to make a difference in the lives of people who are really the least of us are in tough situations. I believe very firmly in science and math and economics and other statistics to make a difference if they're applied properly to these. And so when the pandemic happened and I was subject to some just crazy attacks, I had to decide I could have just stayed silent and I knew that if I stayed silent or just backed up then all my friends that were in academics would just forgive me and I could go back in and you know I would be fine.
But I couldn't do it, right? Because my obligation to the people I studied was more important than my obligation to making my career advance. And I think that's really the bottom line is like what do we do this job for? It's not for ourselves.
You know, now that somewhat the COVID era is somewhat over. And I say somewhat because we're many of us are still paying the price for what was done to us with the lockdowns. Many of us who have little kids who are behind on education and all kinds of major issues. So it's the COVID era is somewhat over. But do you feel like your colleagues ever walked up to you and said, you know, Dr. Jay, we were wrong, you were right, or we're sorry that we behaved in the way that we behaved. Did you ever get some sense of either an apology or even an act of remorse from some people?
But not I mean I think that most people, most scientists and people in public health, they just want to move on from the pandemic because I mean I think most of them many of them if they're honest recognize the colossal failures that happened of science and public health during that era and they recognize that the as you say the harm are still continuing like kids that were out of school for some kids out of school for up to two three years, they're way behind. We still have the economic hangover, all the people that suffered from vaccine injuries that were unacknowledged. And the collapse in trust in public health that continues to this day. So we still are in the COVID hangover period and so grappling with that is the central question of this age is trying to understand how we can learn those lessons. A lot of the public health establishment, a lot of the scientists just want to move on. They want to say, 'Okay, that was then, this is now just go back to old times.' I don't think that we can do exactly that. I do believe very fundamentally in reform. We have to do something about the fact and have to really learn the lessons of the pandemic era.
Yeah. Well, I think it's really unfair to expect us to just want to move on because as we mentioned, we're still suffering. And I think the fact that there hasn't been an acknowledgment from the general scientific community that something was done, whether it was nefarious or accidental or maybe hubris, something was done. And I'm curious now that you're in this position here at the NIH, what do you think is fair to expect of the institutions? Right. I don't want to have unfair and unreasonable expectations. And by the way, I completely recognize that we can't maintain a country that doesn't believe in any of its institutions. Right? If you actually if you understand communism and there was a document that came out in 1958. It was translated in the '60s by Leon Clausen who said that the 45 ways to take America down the naked communist 45 ways to take America down is to create complete disbelief in Americans institutions. And so we don't want that right Dr. Jay. We don't want to be living in a country where we don't trust any of our institutions. We need to regain our trust in our institutions and we need to regain it very very fast because the communists are coming after us. And so what do you think is reasonable to expect? What should be done so that when we look at the NIH we can say okay we trust you guys?
Yeah I mean I think first we have to go back. So like we've been talking about the failures during the pandemic. But the fundamentals actually of the scientific institutions of this country including the NIH actually in many ways are incredible. And there's they're the if you go back to the history of the NIH you know century or more almost every single major biomedical research advance of the past century has at its heart to some degree some investment by the NIH.
Huge numbers of cures. Almost every drug that's on the market or pharmaceutical that's on the market has the basic biology that we know on the Nobel Prize winners that we've funded. All of these are NIH accomplishments. In a sense the NIH is a sound institution and it's an institution that serves the American people and the world very well. Right. The idea is that who's going to invest in learning fundamental basic things that you can't monetize necessarily but are necessary nevertheless fundamental for our health right it's going to it has to be an institution like the NIH in fact it has to be the NIH. So it's a fundamentally sound institution the problem is that there's several problems many problems but like the problem is that there's scientific hubris there's pharmaceutical monetary interests. There's the pandemic hangovers we've been talking about. All of which I think cloud the fundamental soundness of the NIH.
My job as I see it is to address those problems. And you know maybe I don't talk enough about how important the NIH is and I probably should do more of that because the reason I want to reform it is because it's a worthwhile institution. It can help. It's the core of making America healthy again. If we don't have real knowledge about what makes America healthy again, how can we get healthy?
Yeah, it makes total sense. We can't give up on our institutions, right? And so we do need you guys to be successful and we want to be able to trust you, right? And so I completely agree and I also think we need to be reasonable about our expectations. And you know, I fully admit I have unreasonable expectations. I'm known for having unreasonable expectations. It's why we've created PragerU and we've grown so much. But I, as I was driving in here today, I said to myself, you've only been on this job for 15 months, right? That's not a long time. I have still employees who've been around for 15 months, and I still think of them as someone new. And so, what do you think is reasonable? What do you think is reasonable? You know, the Maha community is very eager. They want to see massive change. And we'll talk about some of the changes that I've collected and the things that they've been very concerned about. But I also want to mitigate the expectations of what could one expect? What kind of change can we expect you to do? Let's start with one example. We don't want science to be politicized. We just want you guys to do good for us. Could that be done?
Yeah. Okay. So, first let me just say it's a $50 billion institution, right? So, it's a huge huge organization with 20,000 employees and almost every single university or research center in the country receives some funding from us relies on funding from us. And the policies that it has are I mean they go back decades, right? Some of them. So, shifting it's like moving a big ship. It's going to take a little while. The key thing is the sense of mission and purpose that you give to the institution like this so that you have the right direction. I mean I've watched Dennis Prager for a long time decades actually like I think I first heard of him in 2005. I mean it's been but the point is that like that kind of consistent pointing in the same direction in a direction of where there's a sense of mission is how you change an institution like this and it doesn't happen overnight.
So let me just give you an example of the politization in response to your question about politization. Right. So just bluntly the NIH although most the vast majority of its mission is to fund research that improves the biomedical research that improves the health and longevity of the American people and the world. In fact it had over the past 15 years had incorporated some political elements during the pandemic. It became in many ways explicitly political. Some of the sort of press criticisms you're seeing of the NIH now is they're saying that we're like we made the NIH political. They're missing the big picture, which is that over the last decade and a half, the NIH had entered politics in an explicit partisan way. And you know and I think you know their emails from former directors of the NIH essentially more or less strongly hinting about who they did or didn't want in the White House. For instance, I think another example of that is the commitment that the NIH had to DEI research. The idea was that you had to do DEI research as a way to improve the health of minority populations who actually suffer from many many health issues that are more acute than other populations. Right? So it's so what I've been doing as NIH director is removing a lot of this politization. Right? So we've gotten rid of as best we can all of our support for these DEI initiatives.
The but now that looks like politization because I have to like say look you're not allowed to do these DEI initiatives. I'm doing the politics now you're considered political. I look political right which is really quite unfair right. I think the key thing is that if the NIH focuses on its essential mission biomedical research that improves the health and longevity of people that's kind in a sense that has political ramifications if we're living longer healthier lives we spend and less on Medicare and Medicaid. We worry less about social security being there because we can live a longer time, you know, in being healthy and in the workforce. We can educate our kids better. Those are have tremendous political implications. Those are like good natural organic political implications of us achieving our mission of improving health and longevity, right, through biomedical research. But a narrow partisan political mission, right? Let's use DEI to solve all the race problems of the country.
Well, that's first that doesn't actually end up helping minorities. Like if you look at life expectancy of minorities over the last 15 years, it's flatlined. From 2010 to 2019, there was almost no improvement in minority longevity. Actually, this is true for all every group in the United States. There was a collapse in life expectancy during the pandemic, and only now we're getting back to roughly where we were in 2019. There's no evidence that this commitment to this politicized DEI agenda actually helped minority health at all.
What I'm interested in doing is doing research that actually does improve the health of minority populations as well as everybody else. That's to me is depolitization of the NIH. It's unfortunate that the NIH had become politicized in this way and it's unfortunate that a lot of the press doesn't seem to recognize that what came before was politicization and what we're doing now is depoliticization.
Yeah. Well, since you mentioned the attacks on you, I'm not going to mention the publication because I don't want to give them air. But there is a claim that you have some secret word bank where there are 235 plus words that if a research paper is submitted with these words it gets flagged somehow for some sort of review and maybe even a rejection of the research because it's laced in DEI. So can you just be transparent with me and clear what is it true? Is there a secret word?
So there's no secret word bank at all. So, first of all, I've ordered throughout the NIH that there never be a banned word list, right? I was subject to censorship, blacklist. Yes. Of like a blacklist by Twitter at the order of the Biden administration. Essentially, their entire censorship regime was about banned words. Yes. And so, I am deeply against banned word lists. I don't believe in them. I will not have my institution embrace them. Now but in order to decide whether something is good research or just politicized DEI you do need to have tools to identify potentially what they are and so people use tools which have words in them right that those tools then may identify a grant and then you have a human review to decide is this good science or not often what ends up happening is you identify a grant that has some that looks like it might be DEI you read the application and it turns out it's not DEI is people just put it up there because that's how you used to be able to get grant up. In order to get a grant, you had to pretend to be doing DEI and you'd secretly be doing good science underneath.
And so we just negotiate with the scientists who are like relieved to remove the political nonsense so they can focus on what they're good at which is science.
So I you know their tools to identify which grants are out there that the grant applications to look for scientific opportunities remove the politization of it. But that's very different than a banned word list. Just because you say a word doesn't mean that you're not gonna get an NIH grant. You have to say lots of great words in order to get an NIH grant.
Yeah, you would hope. Yeah, you would hope. So, so much what you do is actually decide how to allocate funding for research that is worth researching. And one of my fears is that often times researchers will submit for grants that they think that they're more likely to receive funding for because it's safe, right? But science should be about being disruptive, right? I mean, we want the Galileo. We want the disruptors. And I'm curious, how are you able to shift the old ways of giving grantees the marching orders to play with the consensus rather than break the consensus and actually come up with new?
Yeah. I mean I think so let me flesh that out because there's actually an empirical case for what you just said that I researched before I became NIH director.
And it's actually very surprising, right? So if you if you do an analysis, okay, let's take all of the words that were published in every single paper in biomedicine in 1940. Just take them list them out every single word in every single paper and you know or word phrases and just list them all. And then you do the same thing in 1941 and subtract off all the words you found in 1940. What you're left with are all the new words and word phrases that were introduced in 1941.
You do this every single year 1942, 1943 all the way up to the present. And you have a history of biomedicine that based on just the words that were published in the literature in the biomedical research literature. We did this, me and my colleague Miko Pacalin when I was a Stanford professor, we did this. And what we do then is you go back to the papers and ask how new are the ideas in every single paper.
Really easy to do because you just have a set of words introducing, you know, every year they were introduced. From that, you can do all kinds of interesting things, right? So, for instance, how old were the ideas for NIH supported researchers? How old were they in the 1980s? How old were they in the 2000s 2010s and so on. It turns out that the NIH has become exactly as you say more and more conservative in a bad way over the last 30 years in the 40 years. In the 1980s the NIH was funding researchers that were publishing papers that were like with ideas that were zero one or two years old at the bleeding edge.
By the 2000s 2010s, NIH was funding researchers that were publishing research that typically were 7 or 8 year old ideas instead of zero year old ideas. There's lots of reasons for this. Partly that it coincides with a collapse in support for young researchers over the last three four decades. Now it takes much longer for young researchers to be able to get large NIH grants.
Wait, why don't we want that kid with the hoodie and the backpack to invent the next great thing? It's usually the young people with those young minds. Why would the NIH support that?
I mean, I think there's small P politics behind it, right? So if you're a successful researcher and you've had a great you know 30s and 40s and you've like developed your these new ideas you've developed a reputation it's much easier to get large grants even though that your next idea isn't as disruptive so as they were when you were younger sometimes.
Because it's not what you know it's who you know.
Well it's just you know it's just easier. So like just bluntly we have my like in a very very high level my job is to look at a 100,000 applications that we get every year I can't personally do it that's why you have 20,000 people to help and then we have to pick 10,000 of them to fund right. Which of the 100,000 from the 100,000 will we pick. So we have scientific peer review panels that read every single application right so every application gets three reviewers to look at them.
In at some point during the 2000s and 2010s, what would happened is that in order to be a reviewer, a permanent reviewer on the NIH study section, you had to have already have a large NIH grant.
Well, if you read a suppose you have your reviewer of a grant application, you're reading it, you go, gosh, this young person has an idea that would overturn my idea. Oh, no. You're going to give it a bad score, right? Now you recognize it's innovative, but you're like, 'Oh, this will never work.' And you may not be doing that as something bad. You're just this is just how you think about the world, right?
In order to create the space for new ideas, you have to have a culture and institutions and incentives to allow that to happen. And increasingly over the last three or four decades, American biomedical sciences, especially the NIH, became more restrictive. It emphasized will this project work over will this project disrupt in decision-making over grants. And you know, it's just again small politics of scientific politics, not partisan politics that led to this.
What we've done in the last 15 months is change the way that we decide which of the grants are funded. It's called the uniform funding strategy. Kind of not really good at marketing so it's kind of a boring sounding title but let me just say so like but it's actually revolutionary. Okay so first of all we still get the 100,000 applications. We still have the peer reviewers three peer reviewers read every single one of them. We still have fantastic peer review committees. We've started to inject more young people under them. So that they have a fair chance. They get to the reviews as well as submit the articles. The peer reviewers they tend to they give the applications sort of two major scores, right? They just say okay is this can this project work? Right? That's a method score. And then they give another score on innovation. Will this is this a disruptive project?
The overall score is a sort of a mishmash between those two scores methods and innovation. There's some other criteria but those are the two major ones. It used to be the case for many NIH institutes that they would take the overall scores for all these 100,000 applications and rank them best to worse from the peer reviewers and then based on how much money there was available, they would throw do a line maybe 10 8 10 11% of the applications would be above the line and everything else wouldn't get funded.
Was the ranking based on how likely they are to succeed or how likely they are to disrupt?
That's it. The overall score very strongly correlates with how likely it is to succeed and much less strongly correlated how likely they are to disrupt.
And so when you did the ranking, you picked things that were going to produce an article in some peer-reviewed journal.
But it would just be a tiny advance relative to the.
It's like only safe bonds with very low yield would get an investment. But it is very un-American actually because it goes against innovation.
I mean it's so I used to teach again at Stanford in Silicon Valley. The ethos in Silicon Valley venture capital is you have a portfolio of projects 49 of them fail and the 50th is Google. You're a great portfolio manager, right? And the people who did those 49 projects that failed, they're not failures, right? If they had a constructive they understood why they failed then they can get a second chance.
Right. At the NIH we've shifted toward a strategy that's more like that now for deciding which what to get funded.
Now we still do their peer review. You get all but now we have the people who decide what the portfolio looks like the institute directors they are encouraged very strongly to look at the entire review not just the overall score which correlates with will this succeed will can you will this get a paper in some journal I don't fundamentally don't care if a project gets a paper in journal I care if the project disrupts science and for the good if it results in better cures and treatments and better health for people.
Well, I'd imagine you can use AI for a lot of this streamlining.
AI can help, but you really fundamentally you need somebody who can like look at and say, 'Yeah, you need your I mean the AI is like a tool to help with that. You still need someone to look and think.'
And so you have a portfolio then that includes disruptive ideas. Not sure if they're going to work, but they're worth trying out, right? And the goal of the portfolio is not to make a gazillion dollars like a venture capital fund. It's the goal of the portfolio is to disrupt science. It's to improve health. It's to achieve the mission of the NIH which is to improve health and longevity, right? And that's how people are going to get judged here, right? It's not did you produce a scientific paper and you win a Nobel Prize as fun as that might be. It's did you actually improve the lives of people that were that I mean taxpayers give us $50 billion. It's a great responsibility and we have to return that and turn it into better health and better lives for people. That's our job.
Yeah. I mean your return ROI is not return on investment. It's really return on influence, right? Can you influence the health care system for the better? And so I you use the words peer-reviewed which triggers me. Actually brings me back to this shouting match that I had with one of my brilliant surgeon friends during I think it was during the lockdowns where he kept quoting peer-reviewed journals and I just said I just who are these peers that are reviewing these journals? I don't trust them anymore now. I grew up hearing that, well, you would have this journal and it's very respected and you should trust it because it's peer-reviewed, but they have made so many mistakes and never showed remorse. And so, I'm not sure if they're to be trusted or are they a mafia that all peer reviews each other? Can you help somebody like me just discern how to think about the peer-reviewed journals?
Sure. Okay. So I again I keep saying I was professor as if I'm bragging but just because it helps me like establish I actually know something about this. And in fact I've myself conducted peer reviews of thousands of papers. Right? So the way it works is you're a scientist, right? You have a great idea. You write it up. You send it to a journal. The journal editor looks at it and says, 'Well, this might be okay. Let's find out.' Then they select three or four people to send your paper to. Maybe I get the paper and you and I are friends, but like we're actually competing. And I look at the paper, I go, 'Oh my god, she has a good idea.' And then I write all kinds of like reasons why it's a bad idea.
Well, it's like an experiment in human nature and everything that's bad about it.
Well, no. What's Okay, just in defense of this, it's not necessarily bad. Like most ideas when a scientist thinks they have a good idea, they're almost always wrong.
That's fair, by the way. That's fair. So you want their colleagues to like hold them to account. So if peer review by itself is not necessarily it's a good thing actually it's actually a good thing. Right? So I send this to the editor. I send a letter that says here are the things I'd love the checks I'd like to see on the idea before I recommend publication. Okay.
That editor sends the list to you. Then you like sit there and like you yell at you don't know who I am because it's anonymous but you like who is this reviewer number two and why are they
making my life miserable? And you do all the hundred different checks. This is peer review at its best. You revise the paper. You try to address all the criticisms, revise it, and then eventually the editor might accept it.
Right. That's peer review at its best. Peer review's worst is what you just said. Right. It's like I see your paper. I'm jealous of you. I said reject the paper and you don't even know I said it. Or the editor looks at your claim, realizes it has some political impact that they don't like and they just reject it out of hand. Right.
Right. Well, that's what I'm worried about. The group thinking, the consensus thinking.
There's so it's not transparent. Right. So, nobody sees the peer reviews other than the editor and you the public doesn't see it. They just see the finished paper, right? And there's no way to know if the peer review process was good. Now some journals have a great reputation like they're highly ranked and so you assume the peer review has none of those problems in it, but that's just not true.
That's a lot of power to whoever the editor is. Why isn't that transparent? Why can't we see the peer reviews?
I don't have an answer to that question. I think we should, but let me step back. Fundamentally the question is it's not even about peer review. It's how do you decide what is true in science, right? It's a big fancy word, epistemology, right? How do you decide who has the epistemological power, right? So the first scientific revolution, the big scientific revolution of the Galileo of the world, right? What was at issue there was whether ecclesiastical authorities had the power to decide what was true or false in physical matters. Do the moons of Jupiter move? Right. And the first scientific revolution said, 'No, no, the ecclesiastical authorities don't get to decide that. Clever people with telescopes get to decide that. If you look in the moons of Jupiter, you see they move, then they move. And no matter what anybody says, they move, right? Because you can see with the telescope that they move.' Essentially it was a democratization of the power to determine what was true or false in matters of physical reality, right? That's the first scientific revolution.
