Dr. Jay Bhattacharya on Depoliticizing the NIH and Ushering in a New Era of Scientific Innovation

What came before was politicization and what we're doing now is depoliticization.

I am deeply against banned word lists. I don't believe in them. I will not have my institution embrace them.

I care if the project disrupts science for the good. If it results in better cures and treatments and better health for people.

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 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 violations of basic standards of public health. You know, when the COVID vaccine came out, 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.

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 with 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, 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 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: what do we do this job for? It's not for ourselves.

From some people? But not many. 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 think most of them, if they're honest, recognize the colossal failures that happened of science and public health during that era, and they recognize that, as you say, the harm is still continuing. Like kids that were out of school for up to two or 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 grappling with that is the central question of this age: 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, I think first we have to go back. So we've been talking about the failures during the pandemic. But the fundamentals of the scientific institutions of this country, including the NIH, are in many ways incredible. If you go back to the history of the NIH, a century or more, almost every single major biomedical research advance of the past century has at its heart to some degree an investment by the NIH. Huge numbers of cures. Almost every drug that's on the market has the basic biology that we know from 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 serves the American people and the world very well. The idea is that who's going to invest in learning fundamental basic things that you can't monetize necessarily but are nevertheless fundamental for our health? 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 are several problems: 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 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. Okay. So first let me just say it's a $50 billion institution. It's a 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 go back decades. So shifting it is 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 so that you have the right direction. I mean, I've watched Dennis Prager for a long time, decades actually. I think I first heard of him in 2005. But the point is that kind of consistent pointing in the same direction, a direction where there's a sense of mission, is how you change an institution like this, and it doesn't happen overnight. At the same time, let me give you an example of the politicization in response to your question. So bluntly, the NIH, although the vast majority of its mission is to fund biomedical research that improves the health and longevity of the American people and the world, over the past 15 years had incorporated some political elements. During the pandemic, it became in many ways explicitly political. Some of the press criticisms you're seeing of the NIH now are saying that 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. 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, another example 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 health issues that are more acute than other populations. So what I've been doing as NIH director is removing a lot of this politicization. We've gotten rid of, as best we can, all of our support for these DEI initiatives. But now that looks like politicization because I have to say, look, you're not allowed to do these DEI initiatives.

I look political, which is really quite unfair. 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 kind of has political ramifications. If we're living longer, healthier lives, we spend less on Medicare and Medicaid. We worry less about Social Security being there because we can live longer in the workforce. We can educate our kids better. Those have tremendous political implications. Those are good, natural, organic political implications of us achieving our mission of improving health and longevity through biomedical research. But a narrow partisan political mission, like using DEI to solve all the race problems of the country, first of all, that doesn't actually end up helping minorities. 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 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 to me is depoliticization 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.

Right? I was subject to censorship.

Yes. Of a blacklist by Twitter at the order of the Biden administration. Essentially, their entire censorship regime was about banned words.

And so, I am deeply against banned word lists. I don't believe in them. I will not have my institution embrace them. 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. So people use tools which have words in them. Those tools then may identify a grant, and then you have a human review to decide if this is good science or not. Often what ends up happening is you identify a grant that looks like it might be DEI, you read the application, and it turns out it's not DEI. People just put it up there because that's how you used to be able to get a grant. In order to get a grant, you had to pretend to be doing DEI, and you'd secretly be doing good science underneath. So we just negotiate with the scientists, who are relieved to remove the political nonsense so they can focus on what they're good at, which is science.

So their tools to identify which grants are out there, the grant applications, to look for scientific opportunities, remove the politicization of it. But that's very different from a banned word list. Just because you say a word doesn't mean you're not going to get an NIH grant. You have to say lots of great words in order to get an NIH grant.

Yeah. 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. So if you do an analysis, take all of the words that were published in every single paper in biomedicine in 1940, list them out, every single word and word phrase. 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 based on the words that were published in the biomedical research literature. We did this, me and my colleague Miko Pacalin when I was a Stanford professor. What we do then is 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 introduced every year. From that you can do all kinds of interesting things. 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 to 40 years. In the 1980s, the NIH was funding researchers who were publishing papers with ideas that were zero, one, or two years old at the bleeding edge. By the 2000s and 2010s, NIH was funding researchers who were publishing research that typically were 7 or 8-year-old ideas instead of zero-year-old ideas. There are lots of reasons for this. Partly it coincides with a collapse in support for young researchers over the last three or four decades. Now it takes much longer for young researchers to be able to get large NIH grants. 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 think there's small-p politics behind it. If you're a successful researcher and you've had a great 30s and 40s and you've developed your new ideas and reputation, it's much easier to get large grants even though your next idea isn't as disruptive as when you were younger. Sometimes it's not what you know, it's who you know. Well, it's just easier. So bluntly, at a very high level, my job is to look at 100,000 applications that we get every year. I can't personally do it, that's why we have 20,000 people to help, and we have to pick 10,000 of them to fund. Which of the 10,000 from the 100,000 will we pick? We have scientific peer review panels that read every single application. Every application gets three reviewers to look at them. At some point during the 2000s and 2010s, what happened was that in order to be a permanent reviewer on the NIH study section, you had to already have a large NIH grant. Well, if you have a 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.' 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, it's just how you think about the world. In order to create space for new ideas, you have to have a culture and institutions and incentives to allow that to happen. 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. It's just 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 we decide which grants are funded. It's called the uniform funding strategy. Kind of boring sounding title, but it's actually revolutionary. First of all, we still get the 100,000 applications. We still have the peer reviewers, three peer reviewers read every single one. We still have fantastic peer review committees. We've started to inject more young people into them so they have a fair chance. They get to do reviews as well as submit articles. The peer reviewers give the applications two major scores. They say, 'Okay, can this project work?' That's a methods score. And then they give another score on innovation: 'Is this a disruptive project?' The overall score is a mishmash between those two scores, methods and innovation. There are 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 100,000 applications, rank them best to worst from the peer reviewers, and then based on how much money was available, they would draw a line. Maybe 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? The overall score very strongly correlates with how likely it is to succeed and much less strongly correlated with how likely it is 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's very un-American actually because it goes against innovation. I used to teach 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. And the people who did those 49 projects that failed, they're not failures. If they had a constructive understanding of why they failed, they can get a second chance. At the NIH, we've shifted toward a strategy that's more like that now for deciding what gets funded. We still do peer review, but now the people who decide what the portfolio looks like, the institute directors, are encouraged very strongly to look at the entire review, not just the overall score which correlates with 'will this succeed?' I fundamentally don't care if a project gets a paper in a journal. I care if the project disrupts science for the good, if it results in better cures and treatments and better health for people.

AI can help, but you really fundamentally need somebody who can look at it and say, you need someone to look and think. So you have a portfolio that includes disruptive ideas. Not sure if they're going to work, but they're worth trying out. And the goal of the portfolio is not to make a gazillion dollars like a venture capital fund. The goal of the portfolio is to disrupt science, to improve health, to achieve the mission of the NIH, which is to improve health and longevity. And that's how people are going to get judged here. It's not did you produce a scientific paper and win a Nobel Prize, as fun as that might be. It's did you actually improve the lives of people? 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.

Sure. Okay. So I keep saying I was a professor, but it helps establish that I actually know something about this. I've conducted peer reviews of thousands of papers. The way it works is you're a scientist, 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 we're actually competing. I look at the paper, I go, 'Oh my god, she has a good idea.' And then I write all kinds of reasons why it's a bad idea. It's like an experiment in human nature and everything that's bad about it. But in defense of this, it's not necessarily bad. Most ideas when a scientist thinks they have a good idea, they're almost always wrong. That's fair. So you want their colleagues to hold them to account. So peer review by itself is a good thing. I send this to the editor. I send a letter that says here are the things I'd like to see checked on the idea before I recommend publication. That editor sends the list to you. Then you sit there and you yell, 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 make it be you try to address all the criticisms, revise it, and then eventually the editor might accept it.

Um peer review's worst is what you just said. Right. It's like some I see your paper. I'm jealous of you. I said just 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.

I don't have an answer to that question. I think we should I think the pro but let me step back. Um 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? The how do you decide who has the epistemological power, right? So the first scientific revolution, the big scientific revolution of the uh you know the Galileo of the world, right? That um the 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. Um, 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.' Uh, 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. Yeah. Um what we have now is a situation exactly what you said. A relatively small number of people, powerful people get to decide what was true or false in science. Does the COVID vaccine stop you from getting and spreading COVID? Well, I can see and you can see that it doesn't, but the peer review journal says that it does. I mean, so now it does because society has to admit that it does because the high ecclesiastical scientific authority got to decide, right? Instead of the scientific reality which is that the COVID vaccine doesn't stop you from getting and spreading COVID. Right? So the problem then is epistemological one. Why is it that a relatively small number of people in a very non-transparent way get to decide for all of society what's true or false about physical reality?

And then you add that on top of that then there's all kinds of other things that are added on top of it. Right. So, there's scientific reality and then what do you do with that fact? Those are often personal preferences, values, there's all kinds of other tradeoffs that you care about and the scientists that get to decide empirical truth don't necessarily have a lot of expertise in those areas and yet they often step into those areas, right? So like you have top scientific journals making recommendations for who should be president.

Well their scientific authority doesn't tell you who should be president. Right. But they're using this epistemological power they have to trespass in areas of things that are of tremendous import to people that they have no expertise in.