Skip to content
Huberman LabHuberman Lab

Dr. Jay Bhattacharya on Huberman Lab: Why NIH Needs Reform

Bhattacharya argues NIH careerism and replication failures stalled U.S. health; he maps reform plans for funding and restoring scientific trust in medicine.

Dr. Jay BhattacharyaguestAndrew Hubermanhost
Jun 9, 20254h 26mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 6:56

    Jay Bhattacharya

    1. JB

      Since 2012, there's been no increase in American life expectancy. From 2012 to 2019, literally, uh, it was, it was, uh, well not literally, al- almost entirely flat life expectancy a- uh, whereas the European countries have advances in life expectancy during that period. During the pandemic life expectancy dropped very sharply in the United States and only s- just last year did it come back up to 2019 levels. Uh, in Sweden, it, the life expectancy dropped in 2020 for, uh, and then came right back up in, by 2021, 2022 to the previous trend of increasing life expectancy. Whatever those investments we're 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.

    2. AH

      'Cause 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, and we won't admit it. And they're not just pissed off, they're kind of, like, done. They, I hear it all the time. And again, this isn't the health and wellness supplement-taking, you know, uh, you know, anti-woke crowd. This is a big segment of the population that is like, "I don't wanna hear about it. I don't care if labs get funded. I wanna know why we were lied to or the scientific community can't admit fault." I just wanted to land that message for them because in part I'm here for them and get your thoughts on, you know, what you think about, let's start with 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?

    3. JB

      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, I'm, uh, otherwise I'm not the NIH director. So I was a very vocal advocate, uh, against the lockdowns, against the mask mandates, against the vaccine mandates, uh, and against the sort of anti-scientific, uh, uh, bent of public health throughout the pandemic. Uh, I've also a- argued that the scientific institutions of this country should, should come clean about our involvement in very dangerous research that potentially caused the pandemic.

    4. AH

      The so-called lab leak hypothesis.

    5. JB

      Yeah.

    6. AH

      Welcome to the Huberman Lab Podcast, where we discuss science and science-based tools for everyday life. (instrumental music plays) 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. Dr. Jay Bhattacharya is a medical doctor and a PhD and the director of the National Institutes of Health. Prior to that, he was a professor of medicine at Stanford University. And I should mention that he did all of his formal academic training at Stanford, his undergraduate, master's, PhD, and medical school training. Today we discuss the past, the present, and the future of publicly funded research in the United States. The National Institutes of Health is considered throughout the world the crown jewel of basic and medical research, explicitly because the basic and clinical research that it has funded has led to more treatments and cures for disease than any other scientific enterprise. Basic research is focused on making discoveries without any particular treatment or disease in mind when that work is done. It is absolutely clear, however, that basic research provides the knowledge base from which all treatments and cures for diseases are eventually made. Today, Dr. Bhattacharya shares his vision of which aspects of NIH are especially effective and which need revising and improvement. We discuss how scientific ideas are evaluated for funding and what can be done to create more funding for more ambitious projects leading to treatments and cures. This is a very timely issue because despite its strength, the NIH has gained a reputation over the last two decades for favoring safer and less bold work, and therefore leading to fewer discoveries. We also discuss what will be done about the so-called replication crisis. The replication crisis is, as the name suggests, the inability for certain findings to be replicated. Dr. Bhattacharya shares with us new initiatives soon to take place that are designed to verify findings early and to incentivize replication so the knowledge base built by NIH science is accurate. As some of you may know, Dr. Bhattacharya stepped into a very public role during the COVID-19 pandemic when he co-authored the so-called Great Barrington Declaration, which argued against lockdowns. He was also quite vocal against mask mandates, and he addressed vaccine efficacy versus safety, especially for young people. Those stances, of course, were very controversial and he explains the logic for his stance on those topics. That discussion leads into a very direct conversation about vaccines more generally, not just COVID-19 vaccines, but also measles, mumps, rubella vaccines, and the very public and controversial issue taking place right now about vaccines and autism. We also discuss drug prices and why Americans pay 10 times or more for the same prescription drugs sold in other countries and the relationship of that to public health. I want to emphasize that the issues we discuss today will impact everybody. If you're a scientist, they certainly impact you. If you're a physician, they impact you. And if you're young, if you're old, if you're a patient, if you're healthy, if you're American or if you're outside the United States, they will impact you. Dr. Bhattacharya was incredibly generous with his time and his answers, directly answering every single question I asked. Nothing was cut. As a consequence, it's a lengthy podcast, but I felt it was very important to get into the nuance of these issues so that you, the listener, can get real clarity on where things stand and where they are headed. As a final point, my graduate student training, my postdoctoral training, and my laboratory, first at the University of California San Diego and then at Stanford where it is now, were funded by the NIH. So you'll notice throughout today's episode that I'm very impassioned by the issues at hand. At the same time, I strive to include questions that I keep hearing from my followers on social media and from listeners of the Huberman Lab Podcast. Some of those come from ardent supporters of the NIH, and others, as you'll see, are more skeptical or even critical of the NIH. I strive to represent all those voices during today's conversation. I certainly have my own opinions and stance on many of those issues and I do voice some of those throughout today's episode, but again, I try to be thorough and broad encompassing. As you'll see, Dr. Bhattacharya cares deeply about basic science and the future of medicine and health in this country and throughout the world. He is our appointed leader in this science discovery public health enterprise and I'm grateful to him for taking the time to share his vision and for his willingness to listen to the many and wide range of voices, including those critical on these literally life-sustaining topics.Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public. In keeping with that theme, this episode does include sponsors. And now for my discussion with Dr. Jay Bhattacharya.

  2. 6:56 – 9:12

    National Institutes of Health (NIH), Mission

    1. AH

      Dr. Jay Bhattacharya, welcome.

    2. JB

      Thank you for having me, Andrew.

    3. AH

      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, uh, related to lockdowns, vaccines, et cetera. We'll talk about that. But now you are in the chief position of directing research dollars and, um, the initiatives of what is arguably the most important health organization in the entire world, not just in the United States. So thank you for taking the position. Thank you for being here. And 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?

    4. JB

      So, so let me start with the stated mission 'cause the stated mission is something entirely worthwhile. It's, it's, it, it, any, uh, anyone who listens to it should say, "Yeah, we should do this." Uh, 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, uh, health of the entire world. For a, a, a, a very long time, the NIH, the National Institute of Health, has been the premier biomedical organization supporting research, um, that translates into almost every drug that you take, the NIH has had some role in developing. Ev- almost every, you know, all, all the fights over, you know, what's, what's the right thing to do to, to, to get good sleep, what's the right thing to do for your diet, the NIH has played some role. Uh, and for, uh, American biomedicine, it's the essential institution. Um, it, it supports the, uh, the careers of a very large number of biomedical scientists around the world. Uh, and, and, and spec- specifically m- me. I mean, I had, I, I got NIH funding for most of my career. Um, I was a re- reviewer for the NIH, uh, sci- a scientific reviewer for g- for grants. Um, it's an absolutely essential organization.

    5. AH

      Yeah, I agree. My lab, um, ran on NIH money primarily, um, so thank you taxpayers, American taxpayers. And I think

  3. 9:12 – 18:22

    Funding, Basic vs. Applied Research

    1. AH

      for most people when they hear that word health, and what you just said about the, you know, 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 that are testing a particular drug, a dose response curve, you know, what's the lethal dose of this, what's the half-life of that? 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, maybe even the foggiest of ideas, that there could be a potential upside for human health, things like what controls the pigmentation patterns of the noses of Doberman pinscher dogs. I bet you we could find that grant.

    2. JB

      (laughs)

    3. AH

      So when we ... Uh, maybe not anymore. But when we step back and we look at basic versus applied, AKA clinical research, what percentage of the NIH budget, which we'll talk about in a moment, is directed toward basic research, and what percentage is directed toward clinical studies or the testing of some drug, what we call ple- pre-clinical trials, testing in mice or non-human primates, et cetera?

    4. JB

      So there's big fights over exactly what that demarcation line is, so I'm not gonna commit to a single number. What I will say is that a substantial part of the NIH portfolio appropriately focuses on basic science, basic science meaning fundamental biological, uh, facts that, that can be used in many, many, many, uh, drug, drug studies, other, other, o- o- other research where you don't necessarily know specifically in advance when you're doing it what the, what the applications are going to be. Uh, the NIH very appropriately funds that work, uh, especially work that's not patentable, right? Because no drug company has an incentive to do that work, and yet it's vital. Uh, just, uh, just as a, let me give an example, uh, just to put some meat on the bone of it, um, of something that the NIH didn't fund but mi- but actually is within the mission of the NIH to fund, to have funded if it had. Uh, let's just take the research that led to the understanding of the, the, the, that the, the structure of DNA as a double helix, right? And that Watson, Crick, Rosalind Franklin, those, all those folks, uh, in, in, in England, in, in, uh, in n- like 1950s.

    5. AH

      Mm-hmm.

    6. JB

      Uh, well, that work is not patentable. It's hard to imagine, like, someone, uh, s- as, like, trying to patent the double helix structure of DNA, right? So that means that it's not going to be, uh, in the interest of any specific company to, to support those scientists that discovered that, and yet it's vital to almost everything we do in biology.

    7. AH

      Mm-hmm.

    8. JB

      Right? Uh, the NIH, uh, very appropriately funds that kind of work, work that is not in the interest of any particular company to do. It solves a market failure for, for, if you're thinking like an economist. Um, uh, the market failure is there's no incentive of the private sector to do that, that kind of basic work, and yet that basic work really advances human health, right, in ways that are sometimes unpredictable. Uh, and so it's, it's, it's correct and right that the NIH continues to fund that kinda basic science work, as well as the applied work where you take the advances and say, "Okay, well, does this ... Here's a drug that might work, uh, to treat this disease," right? That's, that also, that kind of work also is appropriate for the NIH to fund. Um, there's a interesting dividing line where, uh, the question is like, well, what should be left to the private sector to do?

    9. AH

      Mm-hmm.

    10. JB

      Right? So the private sector tends to fund large-scale clinical trials, uh, at sorta the tail end of, of the development process. Um, sometimes they'll fund earlier, earlier sch- uh, earlier clinical trials. Um, but the, uh ...... private sector has an incentive to fund those kinds of studies because it gives them exclusivity, patents, things. So, why should the, the taxpayer pay for that when there's already private actors that are, that are willing to pay for that? There's a, there's a, this, this interesting dividing line. Um, you want the NIH work to be translated just so that patients can have it, so that means that the private sector has to be involved to, to some degree. Certainly has to be using the, the, the products of the NIH, um, uh, research. But that dividing line is fuzzy and controversial. Same thing with between basic and applied. Um, as I said earlier, it's the f- uh, their huge, like, almost religious wars over where that (laughs) where that dividing line is. Are, are you a basic scientist or are you an applied, applied scientist? Um, so I, I, and, uh, all the numbers, like, don't make sense to me exactly given that religious war. But the fundamental thing, which is we have to fund basic work, that I, I believe in pretty strongly.

    11. AH

      Well, as a basic scientist, yeah, I'm not a clinician, um, but I worked on clinically relevant issues in my lab related to restoration of vision and blinding diseases like glaucoma, things like related to anxiety, et cetera. I also know that we have some beautiful cases, as you pointed out, of basic research leading to important, I will say, cures to serious diseases and there was no thought at the beginning of that basic research that the outcome would be related to human health. I'll just briefly mention a couple. Um, I wanna ask more questions than I wanna speak, but, um, my scientific great-grandparents, David Hubel and Torsten Wiesel did the early work defining the structure and function of the visual system first in cats, then in monkeys. Eventually, it, uh, was clear the same was true of their findings in human work, and early plasticity. Changes in the visual system if, say, there was a cataract or a droopy eyelid or divergent eye strabismus or convergent, you know, so what we call cross-eyedness. Things of that sort. And we know on the basis of that work that children need corrective surgeries early or else the brain is forever blind to the perfectly fine eyeball if the eyes aren't correctly aligned, okay? In other words, the, the old practice of, oh, you don't wanna put kids under anesthesia, it's too risky, et cetera, the work of Hubel and Wiesel saved the vision of millions and millions of children in the US and abroad. People with cataract have those cataracts removed early and on and on. And I would also say as a second example that much of the basic work on cell biology that took place in the second half of the last century, you know, where are the mitochondria, what's in the mitochondria, electron microscopy lights, let's talk about all the folds in the mitochondria, let's talk about the Golgi. All that basic cellular biology that is the stuff of textbooks was, as we say, necessary, perhaps not sufficient, but necessary for the development of essentially every existing cancer treatment. But the cell biologists that did that work weren't thinking about cancer until much later in that work. So those are ju- just two examples that I would argue NIH had funded a tremendous amount of. And 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 the research dollars that taxpayers provide to the NIH and the NIH to labs away from basic research, which understandably has some people concerned. That said, in order to translate things from the lab to the clinic, we also need to think about translational work. So I just put that out as kind of an offering, uh, to elaborate.

    12. JB

      So, A- Andrew, I have no intention of, do, uh, of implementing that, uh, of shifting the balance between b- I think ba- as I said, basic science work and applied work are both tremendously important parts of the NIH portfolio, uh, and the question is, to me, is what's scientifically important and interesting, uh, in terms of, uh, in term, in terms of accomplishing the NIH mission, which is again advancing the health and, and longevity of the American people. Both basic work and applied work can le- uh, contribute to that mission. Uh, and, and, and in fact, in fact, I think any, uh, large-scale scientific, uh, uh, institution that seeks to support the, the mission that the NIH has, has to have both in it.

    13. AH

      Mm-hmm.

    14. JB

      Uh, so I don't have any intention of gutting basic sci- I mean, I personally, I'm a, I do epidemiology, health policies-

    15. AH

      Mm-hmm.

    16. JB

      ... uh, uh, health economics, um, statistics. Um, that's very, very applied. But I have great admiration for my colleagues like you who do basic science work. I think it's what advances and fuels the next generation of advances, uh, so it's, uh, it's not, it's going to stay part of the NIH mission as long as I'm the director.

    17. AH

      Thank you. I and many others will be very relieved to hear that answer. I think there is this fear that, uh, the new administration is gonna eliminate basic research somehow and replace it with only applied research and clinical studies. And that somehow, and this is not my belief, that there's going to be, uh, some private interest related to that and it's all going to get co-opted in some kind of, um, cloudy way. Uh, what I'm hearing from you is that is not the direction that NIH is going to take.

    18. JB

      No, it's not. Uh, in fact, I've not heard anyone inside the administration tell me to do that or suggest that is the appropriate path. I just, I mean, it, there's, e- e- everyone I've spoken to about my vision has s- said, "Yes, that makes sense."

    19. AH

      Great.

  4. 18:22 – 21:20

    Sponsors: David & Eight Sleep

    1. AH

      I'd like to take a quick break and acknowledge one of our sponsors, David. David makes a protein bar unlike any other. It has 28 grams of protein, only 150 calories, and zero grams of sugar. That's right, 28 grams of protein and 75% of its calories come from protein. This is 50% higher than the next closest protein bar. David protein bars also taste amazing. Even the texture is amazing. My favorite bar is the chocolate chip cookie dough, but then again, I also like the new chocolate peanut butter flavor and the chocolate brownie flavor. Basically, I like all the flavors a lot. They're all incredibly delicious. In fact, the toughest challenge is knowing which ones to eat on which days and how many times per day. I limit myself to two per day, but I absolutely love them. With David, I'm able to get 28 grams of protein in the calories of a snack, which makes it easy to hit my protein goals of one gram of protein per pound of body weight per day and it allows me to do so without ingesting too many calories. I'll eat a David protein bar most afternoons as a snack and I always keep one with me when I'm out of the house or traveling. They're incredibly delicious and given that they have 28 grams of protein, they're really satisfying for having just 150 calories. If you'd like to try David, you can go to davidprotein.com/huberman. Again, that's davidprotein.com/huberman.Today's episode is also brought to us by Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. One of the best ways to ensure a great night's sleep is to make sure that the temperature of your sleeping environment is correct, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees. And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees. Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs. Eight Sleep has just launched their latest model, the Pod 5, and the Pod 5 has several new important features. One of these new features is called Auto Pilot. Auto Pilot is an AI engine that learns your sleep patterns to adjust the temperature of your sleeping environment across different sleep stages. It also elevates your head if you're snoring and it makes other shifts to optimize your sleep. The base on the Pod 5 also has an integrated speaker that syncs to the Eight Sleep app and can play audio to support relaxation and recovery. The audio catalog includes several NSDR, non-sleep deep rest, scripts that I worked on with Eight Sleep to record. If you're not familiar, NSDR involves listening to an audio script that walks you through a deep body relaxation combined with some very simple breathing exercises. NSDR can help offset some of the negative effects of slight sleep deprivation, and NSDR gets you better at falling back asleep should you wake up in the middle of the night. It's an extremely powerful tool that anyone can benefit from the first time and every time. If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to $350 off the new Pod 5. Eight Sleep ships to many countries worldwide, including Mexico and the UAE. Again, that's eightsleep.com/huberman to save up to $350.

  5. 21:20 – 30:43

    Indirect Costs (IDC), Policies & Distribution

    1. AH

      I'd like to talk a little bit about, um, something that most people perhaps are not familiar with in terms of its acronym, but, um, is a very important issue, which is this notion of IDC, indirect costs. So my lab ran on NIH grants for many years, and my lab and other labs would apply for grants. If we were fortunate enough to get one of those grants funded, we might receive, let's say, a typical, a grant would be a million dollars over the course of four years, so 250 a year for four years. But then in addition to that, my home university, Stanford, would get some percentage above that, not a percentage of that million, I would still get the million to spend on mice, antibodies, graduate student salaries, et cetera, but some percentage of that one million, and I think at Stanford it's roughly 50X percent, you know, so let's say another 500,000 would be given to the university for so-called indirect costs. This is not something that just happens at Stanford. This is typical of every single NIH grant that I'm aware of. And the indirect costs pay, in principle, for administrative handling of the grant and the, uh, you know, the, the various, uh, infrastructure things related to the mouse care, um, keeping the lights on, having a janitor empty the trash at night, these sorts of things. IDC, as it's called, has become a hot button issue for two reasons. One, as soon as the new administration came in, the Trump administration came in and, uh, this, uh, just this last year, they cut the IDC rate across the board, not from say 55% at Stanford, other places were 75%, some places were as low as 30%. They said, "Nope, we're not paying this stuff anymore." The National Institutes of Health, in other words, the taxpayers will pay up to, but no more than 15, one five, percent above any given grant. I'd like your, uh, thoughts on that because this weaves into some bigger issues, uh, that relate to a lot of the sentiment that, you know, why should taxpayers be paying for these universities to run, especially when universities, some, not all have large endowments?

    2. JB

      Right. So actually I should preface my remarks by saying that, um, there was litigation against that 15%, which, uh, essentially said the government couldn't impose that 15%.

    3. AH

      So it's been blocked?

    4. JB

      Yes. Uh, so the, the... Right now, the, the rates are whatever they were. They're not, they're not, they're not the 15% based on that court order. Um, I can't comment on the litigation and I can't com- uh, as a result of... I'm now a member of the government. (laughs) It's like, I'm not allowed to do that. But I want to, I do want to talk about the broader issues related to indirect costs. Uh, and I want to put it in a, a broader context, right? So the context is this, right? So in the mid '40s, uh, uh, Vannevar Bush, who was like one of the main science administrators in the United States, he, he made, he made a, a, a, an argument that the, the, the federal government should partner with universities in co- in, uh, organizing the scientific infrastructure of the United States. That the universities were tremendously important parts of this scientific infrastructure and the federal government had an appropriate role in supporting the universities of the country to do scientific research, uh, of interest to the American people, right? So the indirect cost kind of structure came out of that, that commitment. Um, and frankly, it makes sense to me, right? It, it, it's appropriate that the federal government have some role in deciding how to support the universities of the country to, to be organized around research that's i- that is in the American interest. Um, the question is how... Uh, the question is how, how much should it be? How should it be structured? You know, in what way? Uh, those, those are the key policy issues that we're really talking about. We're not talking about how... Should there be, uh, some federal support for the universities? The question is how? Let me just step back and talk about like the, the current structure, the way it works, uh, 'cause it's really non-intuitive, right? So there's, there's... Uh, so, so first, you're, you're a brilliant scientist, you apply to the NIH, you get, uh, you know, a, a grant that gives you a million dollars a year. I'll just stick- make a clean number, right? So $1 million for the next five years, the federal government's gonna give you money to, to run your lab and do all this kind of stuff. Um, you, you work at Stanford. Stanford has a 55% indirect rate. So that's, uh, on top of the million dollars a year, the administrators at Stanford then will get $550,000.Right? So, that's, uh, so for the, for your million dollars of work, the taxpayers will pay one and a half million dollars, roughly, to Stanford, uh, a year, right? So, that's, um... Now, that, as you said, correctly, that, that, that f- that half a million dollars will go to the fixed cost of doing research, right? The stuff that's, like, not specific to the ro- your, you know, like the la- the lab you're running, the, the, the people you have to hire to do the w- the, the work that you propose. But the fixed cost, the building, the, the, the maintenance, the, uh, the, you know, the, uh, the, the, all the, all the stuff that's-

    5. AH

      Someone's got to take the biohazard stuff away, all that stuff.

    6. JB

      Yeah.

    7. AH

      Yeah.

    8. JB

      And it's not just you. Like, you're, there are other folks who are, like-

    9. AH

      Mm-hmm.

    10. JB

      ... using the, the same materi- like, radioactive materials. And so, it can support many, many research projects, not just one, right?

    11. AH

      Mm-hmm.

    12. JB

      So, it's, it's funding that kind of work, right? So, and again, that's a legitimate use of that money.

    13. AH

      Yeah.

    14. JB

      Um, the, the, so, right. Uh, l- the, e- here's the e- the, the way that the economics of this work. In order to get fixed-cost support, you have to have brilliant scientists like you that can win NIH grants, right? If you don't win NIH grants, Stanford doesn't get the 550, right? But in order to attract brilliant scientists, you have to have the infrastructure where the scientists can do their work. So, it's a ratchet, right? So, in order to have the money, the infrastructure support, the fixed-cost support, you have to have scientists. You, in order to have the scientists, you have to have the, the, the infrastructure. Uh, it's a ratchet that essentially makes it so that we concentrate the federal support for the money in the, uh, it, to, to a, a select few universities. They're winners and losers.

    15. AH

      Mm-hmm.

    16. JB

      And so, the, the, the scientific infrastructure of the country is concentrated in a relatively few uni- universities, mainly on the coast. Uh, and there are brilliant scientists in other places that are not at those select few universities that have trouble getting NIH grants, even though they're brilliant scientists. It, it's, it draws, um, the federal support, uh, away in a, in a, in a, in a structure that essentially says, uh, lots and lots of states, lots and lots of institutions are gonna have trouble getting the infrastructure support that they need in order to have the scientists come there.

    17. AH

      Mm-hmm.

    18. JB

      Uh, so it's, it's, that's the, that's the basic economics of the-

    19. AH

      Mm-hmm. I see.

    20. JB

      ... of the, the way ind- indirect costs actually, actually work. Uh, and so question, is that the right structure? Uh, there's also questions about, uh, you know, like, so for instance, your, your, your, your science involves your basic scientists. Your science involves lots and lots of fixed costs, right? The br- radioactive disposal, all, all this stuff. The research I did, you know, epidemiology, health policy, statistics, um, it's, it's basically a computer, me with a, with a (laughs) data set and a computer. I can hire some, you know, biostatisticians to help me, or, or, uh, you know, things that-

    21. AH

      We call that a carpet lab.

    22. JB

      Yeah. And so, like, sh- uh, d- do the university, does the university need the same indirect cost support to support my fixed costs as it does yours? And the answer is obviously no, and yet, that's the structure we currently have, right? So, there are policy questions to be answered about are we... have we structured the indirect cost support in the right way? Are we inducing the right incentives, right? Uh, can we, can the, can the American taxpayer be sure that we're auditing the use of the indirect costs in the re- app- appropriately? Those are the policy questions I think that are at issue in the indirect cost fight. Um, again, I won't get into the litigation. I'm just, I'm not, not allowed to actually t- comment on that. So, I, and, uh, so I wanted to, I wanted to abstract it to a high- a higher level 'cause I think the policy question is, um, not should the federal government support universities to do this kind of research, to, to have th- sort of the facilities. The question is, how should it be distributed across the country? Uh, h- uh, to what extent should the researchers get it versus the, uh, the, the, the administrators get it? Uh, and then on the, on the back of that, there's also other research institutions that have very diff- different indirect cost recovery rates for the same university, right? So, like, uh, you know, I think Gates Foundation is, uh, I don't know the exact number, like, 15%, um, something on that order. Whereas, like, uh, y- the NIH is 50% to the same university. That's, the, it looks funny. The question is, I mean, sometimes, sometimes I've heard, well, uh, well, the, uh, the, uh, Gates Foundation puts more of the money, uh, into the directs, right? So, they, maybe they'll charge you for the, the, the rental cost of the building or something. I don't, I don't know exactly, but-

    23. AH

      I'm very familiar with foundation versus NIH money, and it differs by foundation. But typically, a university, and I've been at two, I'm tenured at Stanford, but my lab started off at uni- uh, University of California, San Diego, a public university. Typically, when foundation money comes in, there's, the university imposes a minimum of about 8% administrative costs just for handling, like, we're, just to do the paperwork, to pay the admins that do the handling. There's something

  6. 30:43 – 38:14

    Taxpayer Funding, Journal Access, Public Transparency

    1. AH

      very important in what, what you're bringing about. There, there are actually two issues, so I want to backtrack to one issue to make sure that we, um, that people really understand this 'cause I realize that some of this might sound a little bit down in the weeds, but it's just so important. The first thing that I really want to, um, draw from earlier in our conversation is you pointed out that the current model of NIH is that taxpayer dollars pay for the basic research and for the exploration of whether or not the findings from that basic research will benefit disease. If there's any technology, device, drug, whatever, that is brought to the public through the private sector. Put differently, the taxpayers fund the research and development, but they don't capture any of the upside from the private companies that make money selling you the SSRI, selling you the n- hopefully someday novel Alz- Alzheimer's treatment. We don't yet have a satisfactory treatment for Alzheimer's, as we'll get into. So, the general public, who are not basic scientists, uh, in other words, if I take off my hat as a basic scientist, and I say, "Yeah, I'm a taxpayer. I give a significant amount of my income to the State of California and to the federal government."... I like science. I certainly would like to live a long, healthy life and I hope some of that science helps me do that. But I'm gonna have to buy back the results of what I paid for. That's where I think a lot of the general public sit. And I'm not saying they don't like, appreciate, and respect science and scientists, but to any rational person, you don't need a degree in economics to say, "That kinda sucks."

    2. JB

      (laughs)

    3. AH

      "I'm paying..." And, and made worse, if I want to read a paper that was published with the work that I provided from my tax dollars, I have to buy that from the journal.

    4. JB

      By the way, that changes in July.

    5. AH

      Okay.

    6. JB

      Yeah, that's a, that's-

    7. AH

      I mean, this is a huge issue. Like-

    8. JB

      ... that's one, that's one of the decisions they made.

    9. AH

      Yeah, it's $34.

    10. JB

      Not anymore.

    11. AH

      Listen, I've been grateful to publish in Nature and Science, you know, these are like Super Bowl rings for scientists. I'm sure it's part of the reason I got tenure at Stanford. And I had great fun doing the work and I believe in the work, it stood the test of time. But were I not an employee of Stanford that pays for the subscriptions to those journals, I have to buy the work back using my tax dollars that funded the work. This is crazy. This is like me giving you the money for the supplies to build a home. I get to, you get to live in the home. I don't even get to see the home. I have to purchase a ticket to see the home. That's how irrational it is from the perspective of somebody who's just not understanding the pipeline and they sh- uh, of, of basic to applied research. So, let's just, I wanna return to that briefly 'cause this relates, in my opinion, directly to IDC. So, that's a crazy picture for anyone that doesn't understand how one piece relates to the next, relates to the next. And now that I'm in public, I'm in media, I'm public-facing, what I've come to learn is that the general public is very smart. Max Delbruck was right. You know, assume infinite intelligence and zero knowledge, but it's very hard for people to connect more than two or three dots. They're busy. So, we could talk all day about how this leads to that leads to this, leads to that, the brick-on-the-wall model, and then there's this treatment, eh. And they're like, "I'm paying for this stuff and I can't even read the paper about it, let alone glean the positive benefits without paying out the nose."

    12. JB

      Yeah. So, so a couple of things. Let me go backwards 'cause you had two, two major issues you brought up.

    13. AH

      Yep, yep.

    14. JB

      So, first the, the journal thing. Um, uh, the, my predecessor, Moni- Monica Bertagnolli, the, as the, who was the NIH director, the National Institute of Health director before me, she made a decision, a really, a, a great decision essentially to say if the NIH supports a scientist's work and then that work leads to a journal publication, that, uh, that, that publication ought to be available free to the public immediately upon publication. You're not allowed as an NIH sci- funded scientist to publish in a journal that doesn't have that as a policy.

    15. AH

      Mm-hmm.

    16. JB

      Uh, that policy was due to go into effect in December of this year. I think it's a great policy 'cause I agree with your analysis entirely. If the American taxpayer pays for the research, why shouldn't the American taxpayer be able to read the research for free? Uh, because they already paid for it. Why did I pay a second time on the back end after the research sh- is, is, you know, is published?

    17. AH

      And it's not like it's free if you're a university employee. The university has to purchase a very costly subscription to the journal-

    18. JB

      Yeah.

    19. AH

      ... in order to, for a faculty member to read the papers. Now, I'm lucky enough I can access pretty much any paper in the world, but that's because Stanford spends millions and millions of dollars and it's made worse. I forgot the one real stinger in this. When you publish a paper, you use taxpayer dollars to pay the journal.

    20. JB

      (laughs) That's correct.

    21. AH

      Thousands of dollars to publish it, then they sell it back-

    22. JB

      I, I think Nature-

    23. AH

      ... to the general public.

    24. JB

      Nature charges $12,000 for, like, the major

    25. NA

      Oh, my goodness.

    26. JB

      ... pieces. It's, uh, but okay, so-

    27. AH

      It, so that's a racket.

    28. JB

      Right. Yeah. (laughs)

    29. AH

      Sorry. I, I, I realize I'm talking more than I'm asking questions, but yeah.

    30. JB

      No, no, this is, I mean, like, I'm, I'm agreeing with you. So, like, so I, um, the, uh, Monica Bertagnolli, the fr- previous NIH director, in December of this year was go- the, she made a policy that those papers have to be available to the public for free. I made a decision, one of my first things I did was I said, "Why wait till December? Let's just do it in July."

  7. 38:14 – 48:50

    Taxpayer Funding, Patents; Drug Costs in the USA vs Other Countries

    1. AH

      when people start to understand how the NIH works a bit and they understand this IDC thing, this indirect cost thing, the question comes to mind, you know, how much of the cost of running science at a university, public or private university, should the public be responsible for? I mean, that's a kind of really interesting question.

    2. JB

      Yeah. I mean, I think, uh, so let me tie it back. As you said, these are all interlinked, uh, topics. Let me tie it back to something else you just said earlier, which is, uh, okay, so the NIH funds your work. Your work then, uh, results in, uh, uh, maybe not necessarily you, but somebody else who uses your work to like create a product-

    3. AH

      Mm-hmm.

    4. JB

      ... that they patent and they make a lot of money off of. They, they sell, g- can sell it to the public. Uh, at least indirectly or sometimes directly, those patents are funded by American taxpayers, right? Uh, well, the NIH also has a big intramural program. There, that is like scientists who work directly for the NIH. They make some advances and sometimes those advances result in patents, right? So, and those patents then result in products that are, that are sold, uh, that a- above marginal costs, i- a- and then so the question is like, by, by, again, by American taxpayers 'cause the patent protects, uh, you know, entry into those markets. So, so the question is, w- how much should the American taxpayer be funding for this kind of work? Should there be private actors to be allowed to like have, uh, to make, to make money off of this, this, this research the American taxpayer funded? And, and the question I, uh, as, as an economist, I'll say the question is complicated. And the reason it's complicated is you, you might say, "Okay, well, there should not be a patent at all," right? Shouldn't be a patent at all. Um, the, there was a law called the Bayh-Dole Act in the mid '80s, so that's how... I can't... I forget the exact date, uh, that essentially said that NIH-funded work ought to be patentable.

    5. AH

      Mm-hmm.

    6. JB

      And the reason was that it, it's the last mile problem. Like you have some fantastic basic science research, um, that has some like fantastic, uh, uh, biomedical results, uh, you know, that, that, uh, that there's no way for it to patent, right? Then there's no interest to develop into a product that then advances health. The, the wisdom of the Bayh-Dole Act was to say, "Well, look, if you allow there to be patent on the last mile, the, then now there's, we've created a, a commercial interest to take the basic science advances and translate them into something, uh, that actually benefits people." Now the price is gonna be higher, at least while the patent is still in place. Um, but then eventually the patent will go away and then the price will... the, the thing will be available to the public at large to accelerate the transition from the basic science investments we make to, uh, things that actually benefit the public very directly. That's the, that... so it's... in, in a sense, there's a trade-off there, right? So you, you're trading off the fact that for a while there's products funded by the American taxpayers that are at higher prices than it kind of would be in a, in a purely competitive market for the fact that you get a, uh, more rapid access to the benefits of the... of, of that investment, right? So that's, that's-

    7. AH

      Mm-hmm.

    8. JB

      ... the basic trade-off at, at play. That's why I say it's complicated.

    9. AH

      Well, when I joined UCSD and when I joined Stanford, I signed something saying if I make a discovery here that translates to an important device or drug, uh, that the university is gonna capture some of that upside. And, you know, Stanford is a place where there's, uh, let's just say a history of, uh, of people going into biotech and to neurotech and, um, because of the influence of the engineering school. There's actually a great joke about Stanford, that a former president of Stanford told me, to the... which is there's only two kinds of Stanford faculty, Stanford faculty with companies and Stanford faculty with successful companies.

    10. JB

      (laughs)

    11. AH

      A discussion for another time. But it's commonplace for faculty at Stanford to have companies, to split their time between the university and their companies. But most places, like most of the NIH grants that I reviewed when I was on study section reviewing grants, most of the great work I would hear about at meetings came from people at universities who were really focused on, you know, charting the cell types in the retina, understanding the activity patterns in the brain during sleep and how it relates to neuroplasticity. Very few of them were involved with companies in a serious way, let alone had their own companies. So for the taxpayer who make up the majority of our, our listenership, who's giving money to universities and the universities are spending that money making discoveries, I think most of the time the, the university and the scientists who do that work are not capturing the upside. The general public isn't capturing the upside. They're actually paying for the upside. So it's a little bit like the journal situation. That's why I brought that up. It's a little bit like the journal situation all over again where we're as taxpayers funding a lot of this and then have to buy it back over and over again.

    12. JB

      Okay, so there's one other, one other, uh, complication, uh, about the United States versus the rest of the world.

    13. AH

      Mm-hmm.

    14. JB

      So let's just put that aside for just a second. Um, let, let's get back to that. Uh, before I get there, I want to say in response that, that, uh, that they, that in fact when you take a medication or when you have some health advice, um, that actually works, the, the... often NIH research was, was somewhere in the path leading up to that, uh, involved. And there are huge returns to that, right? If you've, if you have, uh, a drug that, uh, that, that, that treats your disease well, um, you know, you have... you have, uh, you have congestive heart failure and now you have a drug that, that, that, that allows you to live longer, more health... you know, in a, in a way that, that allows you to live more f- fully or, or, uh, if you have, uh, you know, diabetes and you, you slow the progress of the disease so it doesn't result in your kidneys failing, your eye, your eye... you're going blind or what not, those are... those are advances that are really worthwhile.

    15. AH

      Mm-hmm.

    16. JB

      And, uh, even if the price is higher than marginal cost, it's, uh, it still could be very worthwhile. Right? So, you take Metformin, it's a very cheap drug now, but it, once upon a time was a patented drug, and you prevent this, the progress of diabe- type 2 diabetes. That's a, that's a big advance, right?

    17. AH

      Right. I agree.

    18. JB

      For, for patients, right? So, um, the value that you get from the NIH sponsored research then is potentially very, very high in terms of improving your health, even more than the marginal price for the drugs that you, you end up paying, or the, or the products, or the advice, or whatever it is. Right?

    19. AH

      So, you're saying it was a good investment for the taxpayer.

    20. JB

      Yeah. It was good, even, even for the taxpayer, right?

    21. AH

      Mm-hmm.

    22. JB

      Now, I s- I wanted to put aside the, the, the, the business about international, uh, the, like, in, like, the US versus the rest of the world. I now wanna bring that to the forefront. It is also true that American taxpayers and Americans pay s- somewhere between two to 10 times more for the same product, the same drug product, as people in Europe pay, pay.

    23. AH

      Why is that?

    24. JB

      Uh, there's a l- again, a lot of complicated (laughs) reasons around t- to, to do that, but let me just ... It's a very, very simple observation. There's something in economics called the law of one price, right? When you have one country is charging 10 ... uh, there's a market in one country where the price is 10 times more than for another country, what you'd expect is somebody to go buy the goods from the other country, uh, from, from the, the cheap country that pay the, pay the, pay the, the cheap price, then go resell it in the country with, that has the high price. Um, and th- and now, what would end up happening is that you'd get an equalization of the price, that you'd get, uh, you know, so the, the ... As long as there's sort of, like, the capacity to, like, m- m- move across, um, and, and, you know, essentially close this arbitrage opportunity through competition, you'd see those price differences collapse. And yet, for decades, Americans paid two to 10 times more for the same product, often made in the same manufacturing facility, uh, than Europeans do. And that, uh, it's, again, a complicated reasons why, but it has to do partly with, uh, the way that American health insurers interact with drug companies. Drug companies essentially use Americans as a way to fund their research and development efforts. Right? That's what they say. The higher prices that we pay fund the, the last mile research that the drug companies do to test the new products.

    25. AH

      Are you saying the last mile research is the most expensive because it's the, the Stage 4 clinical-

    26. JB

      Yeah, the Stage 4 clinical

    27. AH

      ... sa- the safety stuff.

    28. JB

      ... yeah. Stage 2 clinical trials.

    29. AH

      So, right before we go into humans at large-

    30. JB

      Yes.

  8. 48:50 – 1:00:01

    Reducing Medication Prices; R&D, Improving Health

    1. AH

      Okay. What is being done to bring drug prices down in the United States? I heard this recently as a press release from President Trump that drug prices in the United States are sh- soon to come down. Knowing what I know now, based on what you just told us, the immediate question becomes who's going to pay for that late stage safety research? I mean, it's not expensive because it's, uh, fun to do expensive research. It's not expensive because they're still exploring the basic chemistry of these molecules or, or functioning of the devices. It's expensive because you have to make sure that people aren't gonna drop dead or form some other worse pattern of illness through the use of these drugs, and that means a lot of human subjects and many, many measures. It's not just one endpoint, like did it lower blood sugar? It's like did it lower blood sugar, and also did you blow a gasket in here, you know, some capillary in a critical part of your brain?

    2. JB

      Yeah.

    3. AH

      (laughs) So, I mean, this is a very expensive work. So, who ... It still needs to be done is what I'm saying. Who's gonna pay for it?

    4. JB

      Okay. So, um, let me just take a couple of, uh, cuts at this. So first, um, like that, that Phase IV surveillance, that happens after the drug's been marketed. That's typically the, the FDA that conducts that work. The, the, uh, NIH can fund some, some of it, but is mostly, it's mostly the FDA that tracks the safety and efficacy of drugs in, uh, in broader populations a- after the drug has been approved for use. Um, so again, American taxpayers are paying for that. Uh, the Phase III studies, the studies of large scale clinical studies to see, to check the effectiveness of a drug-... check the sa- again, the, like, safety profiles of, for the larger populations. Um, that's typically the drug companies paying, paying for that, right? Uh, in principle. But then American taxpayers pay for that with, like, higher, higher, uh, drug costs. Uh, President Trump, uh, in the last couple of weeks issued an executive order essentially saying we have to, we have to make the other countries of the world pay their fair share-

    5. AH

      Mm-hmm.

    6. JB

      ... of this. So, um, he put an executive order in place with various mechanisms, uh, may- if you want to, we can talk about some of those mechanisms, um, that will reduce, uh, the difference in price between what the US pays and what the rest of the world pays. What will likely happen is that Europe will pay a, a, a high- a slightly higher price, again funding the research and development efforts to do that last mile of research. Uh, the US will pay a lower price. And so the world will share that R&D burden more equally than we currently do. Currently, it's American taxpayers w- on whose shoulders that burden of R&D currently falls. What President Trump has said is that, that, uh, that's not, that's not a equilibrium that should hold, that, that there ought to be policies that allow us to equalize those prices. Um, uh, and, uh, the, the kind of mechanisms used, uh, uh, uh, include things like, uh, including drug price discussions in trade negotiations, um, the, the so the tarri- linking it to the tariff policies he's implemented, um, the, to, to allowing reimportation of drugs. So the idea is that, uh, let's say you're, you're, uh, I'm, uh, I'm in Europe and I'm charging basically nothing for some drug and you're a, you're the United States. Um, someone can come to, to me, buy the drugs from Europe or Canada or wherever, bring them to the United States, resell them, uh, at a much cheaper price, m- and, and, you know, make a little bit of money, but that, that then would equalize the price, and various other mechanisms to try to bring the United States much more close to where the price of the rest of the world. It's not that the R&D won't happen, it's just that the prices everywhere will be e- more equal so that the burden of R&D is shared more equally across the, the developed world.

    7. AH

      What is to say that these other countries will simply say, "No, we're not gonna a- absorb more of the cost"? People, uh, don't like to see prices go up. Um, they're comfortable with seeing prices go down for obvious reasons. Um, and I can think of one example, maybe not the most critically important example in the, in most people's minds. There's a class of drugs that was released last year or about last year called the DORAs. These are, um, drugs that encourage sleep, uh, by suppressing the wakefulness mechanism as opposed to promoting the sleepiness mechanism, in loose terms. Um, they have much lower abuse potential than a lot of other sleep medications. And given the essential role of sleep in mental and physical health for s- you know, and, and I'm a strong believer that behavioral tools, sunlight, et cetera are critical, but some people truly struggle with, you know, clinical grade insomnia and it's extremely detrimental, it's widespread. These drugs are very expensive, $300 a month or more in the United States. Knowing what I know now, just the idea that some of that $300, let's say, let's make up a number, 200 of those dollars is to cover the research costs so that in Northern Europe it can be available for $50 a month? I mean, that borders on upsetting for me.

    8. JB

      Yeah, it is upsetting, uh, and I think I understand, um, why President Trump issued that executive order. It's upsetting for me too. Like I, it makes no sense, um, that the American taxpayer should bear the burden, uh, w- uh, this R&D expenditures when, you know, there are lots of rich countries in the world. Why shouldn't it be more equally distributed? Uh, the question is like, what will, will happen? It's, um, how the drug companies respond to the executive order and how our, our allied nations respond to the executive order is open still. I don't know the, I don't know what it's going to look like. But what I can say is that the current equilibrium is not sustainable.

    9. AH

      Mm-hmm.

    10. JB

      Right? Uh, the Amer- American taxpayers, once they understand what the, what, what's actually been happening, this is decades long, uh, they're gonna say no, right? And so the way that it plays itself out, uh, it's hard to project exactly. Uh, but what, what I do know is that, um, every effort... the government is currently, uh, is making every effort to make sure that those prices get more e- equalized. Um, I, I think just take it from the perspective of a, of a, a European, uh, uh, citizen, right? Someone, someone, uh, this French citizen or, or, or a, uh, Spanish or, or, or a Portuguese or, or English citizen, right? Or, uh, you know, citizen of Great Britain. For them, uh, l- raising... allowing these prices more equalized in a way that so they share the burden, uh, essentially creates an interest of the drug companies to focus on the kinds of health conditions that they have. Most of the research now, since it's paid for by Americans, the, the, the drug companies are focused on problems that Americans have. It, it alli- it, it aligns the in- interests of the drug companies to think more broadly about what they should be investing in to include the health problems that Europe has.

    11. AH

      Is it true that, I've heard this before, 90% of the psychoactive drugs, like the antidepressants, the SSRIs and related things, um, in the world are prescribed and consumed in the United States?

    12. JB

      Again, I don't know the specific number, but it is a pretty, pretty substantial. I think, um, as far as like drug profits go, I think it's like two-thirds or three-quarters of all drug profits are, are ha- are had in the United States.

    13. AH

      And are most of those for the sort of Adderall and psychotropic type stuff?

    14. JB

      No, so the whole, the whole...

    15. AH

      And I'm sorry, I don't know if psychotropic is the, the correct term right now. I'm gonna, I'm gonna get beaten up by people if I don't get this right. Uh, let's just say psychoactive. Excuse me, I meant to say psychoactive, uh, drugs like SSRIs. Which by the way, in, in my view of the literature, they're not always bad, but we hear that they are bad in some instances or many instances, but in like for the treatment of clinical grade OCD-... the SSRIs have been a tremendous tool. They haven't cured OCD in every case, but they've been a tremendous tool. So, I don't wanna ... I wanna make sure not to demonize them.

    16. JB

      Uh, so I don't know the specific numbers for, for, for psychoactive drugs, um, but I, but, um, as a industry as a whole, it's the United States that drives drug company profits, that pays for drug company profits. I think, I, I think it's, like, two-thirds or three-quarter ... I forget the exact number of the profits.

    17. AH

      And so what are these American problems? So it's obese ... Are they obesity-related issues?

    18. JB

      Yeah. Obese, op- yes. Obesity, depression. I mean, those are ... Look, a lot of the, uh, obese ... I mean, the U- the United States is, is, uh, I, I think it's, like, Mexico is now above us, but, like, w- for a long time was the, the most obese nation in the world. Um, you know, big nation in the world. Uh, the, the, uh, the, the ... So, like, the diseases related to obesity ... Now, admittedly, the European countries have those problems too, but just to a lesser degree. The drug companies, their research and development efforts naturally go to where they're making the most money-

    19. AH

      Mm-hmm.

    20. JB

      ... and so what this will end up doing is it'll, it'll a- a- align the drug company incentives to focus on the problems that Europeans have at a, at a slightly higher, at, at higher levels than the Americans have, relative. Now, these are all rich countries, so it's not like, uh, there are unique diseases that happen in Europe that, uh, that don't also happen in the US. It's a question of relative levels of investment, right? Uh, and so, you know, I, I, I don't think that's necessarily bad. Like the, the, like an excessive investment in just the things that Americans have at scale don't necessarily translate to better health for Americans, right? So you can see this in the, in ... Since 2012, there's been no increase in American life expectancy. From 2012 to 2019, literally, uh, it was, it was, uh, uh, well not literally, all- almost entirely flat life expectancy, and, uh, whereas the European countries had advances in life expectancy during that period. During the pandemic, life expectancy dropped very sharply in the United States, and only s- just last year did it come back up to 2019 levels. Uh, in Sweden, it, the life expectancy dropped in 2020 for, uh, and then came right back up in, by 2021, 2022 to the previous trend of increasing life expectancy. Whatever those investments we're making as a nation in the research are not actually translating into meeting the mission of the NIH, which is to advance health and longevity of the American people, right? It ... It ... We've had some tremendous biomedical advances have j- now allowed us to treat diseases that were previously un- untreatable, but ... Which is great. That's a good thing, but it's not ... Actually, as far as the, the broad health of the American public address the chronic disease crisis that we face or address the, uh, f- crisis in lo- in longevity that we face. Um, the next generation of kids, our kids, are likely to live shorter, less healthy lives than we have lived as parents, uh, and, and as, as, as American parents. And I think that that's, uh, that, that, I think, is an indictment on this entire, uh, uh, entire industry. Like, we focused on managing illnesses and treating illnesses and try to hold on, uh, uh, you know, cr- especially chronic diseases, uh, a- a- a- as, and as a result, uh, and we're failing at it, right? Eur- Europe, on the other hand, is seeing ex- ex- expanded life expectancy. Um, this, I think, this change of, of trying to equalize drug prices, aligning our, our portfolio of NIH investments to meet the health needs of the American people, it's a long-needed corrective. Uh, w- you asked if will it succeed? I hope so. That's, that's m- that's, that's the reason I took this job.

  9. 1:00:01 – 1:02:55

    Sponsors: AG1 & Levels

    1. JB

    2. AH

      I'd like to take a quick break and acknowledge our sponsor, AG1. AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens. As somebody who's been involved in research science for almost three decades and in health and fitness for equally as long, I'm constantly looking for the best tools to improve my mental health, physical health, and performance. I discovered AG1 back in 2012, long before I ever had a podcast, and I've been taking it every day since. I find it improves all aspects of my health, my energy, my focus, and I simply feel much better when I take it. AG1 uses the highest quality ingredients in the right combinations, and they're constantly improving their formulas without increasing the cost. In fact, AG1 just launched their latest formula upgrade. This next-gen formula is based on exciting new research on the effects of probiotics on the gut microbiome, and it now includes several clinically studied probiotic strains shown to support both digestive health and immune system health, as well as to improve bowel regularity and to reduce bloating. Whenever I'm asked if I could take just one supplement, what that supplement would be, I always say, "AG1." If you'd like to try AG1, you can go to drinkag1.com/huberman. For a limited time, AG1 is giving away a free one-month supply of omega-3 fish oil along with a bottle of vitamin D3 plus K2. As I've highlighted before on this podcast, omega-3 fish oil and vitamin D3 K2 have been shown to help with everything from mood and brain health to heart health to healthy hormone status and much more. Again, that's drinkag1.com/huberman to get a free one-month supply of omega-3 fish oil plus a bottle of vitamin D3 plus K2 with your subscription. Today's episode is also brought to us by Levels. Levels is a program that lets you see how different foods affect your health by giving you real-time feedback on your diet using a continuous glucose monitor. One of the most important factors in both short and long-term health is your body's ability to manage glucose. This is something I've discussed in depth on this podcast with experts such as Dr. Chris Palmer, Dr. Robert Lustig, and Dr. Casey Means. One thing that's abundantly clear is that to maintain energy and focus throughout the day, you want to keep your blood glucose relatively steady without any big spikes or crashes. I first started using Levels about three years ago as a way to try and understand how different foods impact my blood glucose levels. Levels has proven to be incredibly informative for helping me determine what food choices I should make and when best to eat relative to things like exercise, sleep, and work. Indeed, using Levels has helped me shape my entire schedule. I now have more energy than ever, and I sleep better than ever, and I attribute that largely to understanding how different foods and behaviors impact my blood glucose. So if you're interested in learning more about Levels and trying a CGM yourself, go to levels.link/huberman. Right now, Levels is offering an additional two free months of membership when signing up. Again, that's levels.link, spelled of course L-I-N-K, /huberman to get the additional two free months of membership.Well,

  10. 1:02:55 – 1:12:29

    Lowering IDC?, Endowments, Monetary Distribution, Scientific Groupthink

    1. AH

      I really appreciate that you explained so clearly what's going on with this drug price differential and who's paying for it. I was not aware of that. Perhaps I should have been, but I was not aware of that. And as we talked about a little bit earlier, most of the general public, even the science and engineering, mathematics trained, they can connect two or three dots, but they're also very busy and the general public, like I said, I believe are smart, but has to be spelled out very clearly the way you did for people to really understand.

    2. JB

      I'm, I'm a health economist, okay? (laughs)

    3. AH

      Right.

    4. JB

      That's my job

    5. NA

      That's what...

    6. AH

      Well, I think it... And, um, I mentioned that in my introduction, but I think it is very important for people to understand that you look at things through the lens of science and medicine, but also epidemiology and economics. Uh, you know, there's a saying in laboratories which is that, you know, just adding more money, uh, doesn't improve the science, but it certainly allows you to take bigger risks in service to health and discovery. And without money, no science gets done. I mean, no money, no science. You can't pay graduate students, post-docs, et cetera. I don't want to spend too much time on the, the structure of basic laboratories, although that's my leaning. I, I could spend hours talking to you about what's going to happen with the universities, et cetera. We'll come back to that. But there is one piece that we opened up earlier that I think it's important that we close the hatch on, which is the notion of, uh, indirect costs being now... Well, it's pending litigation, but leveled to a lower number, 15% if the administration has their way, um, back to the variable rates depending on, um, the university if the, uh, this lawsuit ha- has its way. Um, and here's what I hear a lot, to just put it in the simplest of terms. Stanford, Harvard, UT Austin, big universities, often the private universities, have big endowments. So, money that's been given by donors, some might have come in through tuition, it's been invested. They sometimes will spend the interest, but as you and I both know, no university likes to spend the endowment. Just like no one really likes to spend their savings, right? People like to spend the interest they make on their investments from their savings. Nobody likes to spend their savings. Universities included. The general public tells me all the time, not just on X, but on all platforms and whenever I interact with a public, "Why should we pay for research at these universities that have these large endowments?" To which I say, now it's true Stanford has a very large endowment, Harvard as well, UT Austin and other places, but many universities, fine universities, superb universities throughout the United States do not have extremely large endowments. And as you pointed out, there's excellent work, important work I should say, being done those places. So, to cut the IDC to 15% for everybody, I can see where I'd say, "Well, why don't they just dip into their savings, the endowment?" But if you're... I'm not gonna name names, but if you're at a smaller, uh, public university, in, in particular in certain areas of the country, not on the coast, unless you're at like a Wash U in St. Louis, or UT Southwestern and they got riches, if I'm honest, they have a lot of money, there isn't a savings account to go into. The buildings don't look the way they do at these other universities. You don't have these impressive lawns and thousands of gardeners which we're so blessed to have at places like Stanford and Cal Tech that have tons of money. So, to cut the IDC across the board for everybody isn't just, um, sort of trying to restore order to the, to the rich. I do think it potentially punishes the less wealthy universities and important research. I say that in service to them, and frankly, just ha- being at Stanford, it wouldn't be right for me to be like, "Oh, yeah, 15% will dip into the savings." It doesn't quite work that way if you're just a public university.

    7. JB

      Well, I think you're, you're hitting on the exact policy question, the right policy question. The pol- the question is how should the federal investment in, in fixed cost of research be distributed? Um, right now, it's distributed in a very unequal way where the top universities have ac- uh, have access to that money because they have scientists that can win NIH grants. It's a funny thing 'cause like if, if you think of it as like a fixed, support for the fixed cost of research, you have to have scientists who are good at getting support for the marginal cost of research in order to get the fixed cost of research, but if they're fixed, why would you do that? Why wouldn't you have the money go more, more, more equally spread across, right? Uh, uh, the, the, um, the endowment, uh, money is a, is another, is another more complicated question. Uh, it, it, I think that, that, um, endowment monies often are like focused on particular projects. There are restrictions on it, but you're absolutely right that, that it does make a buffer for some of the bigger universities, uh, that allow it to like survive, you know, the vicissitudes of, of, of, um, of NIH funding or the economy, uh, more so than for, uh, universities that don't have that endowment. Uh, the... But from the federal perspective, the key thing is, um, how should the f- the funds be distributed across universities? There's a program called Ideas, uh, Program that the NIH, the National Institute of Health has, and I apologize that I don't remember the, the acronym, but I'll tell you what it does. It says for, um, research institutions in the, uh, in, in the 25 states that are in the bottom half of the distribution of NIH funding, it gives them a leg up in being able to get access to this federal funding for the, for the, for the fixed cost of research. I think that's a great program because what it does, it says, look, uh, the federal government shouldn't just be funding the top universities. Uh, it, it doesn't make sense from, from, uh, from the point of view of, of trying to get the, the, the biggest bang for the buck in scientific knowledge. Uh, just like a, just a very narrow... Uh, like this isn't a narrow thing, it's like an important thing. Um, I think scientific groupthink happens when scientists are all just on the coast and they... And you, the on- only scientist you interact with or scientists that already agree with you. Geographic dispersion of scientific support, uh, allows, uh, more...... uh, riche- richer conversations about science that allows, uh, diff- different scientific ideas to develop, um, j- just simply because it's more geographically dispersed. It, uh, it combats scientific groupthink. Uh, there's other reasons too, as you said, like there are excellent scientists, uh, in universities that aren't on the, in the, you know, like the Stanfords, Harvards, or whatever. Um, th- that, that, that if you gave them more, uh, a environment where they could do their work, they would have, you make tremendous advances, right? So, I think for lots of reasons it makes sense to do that. Um, I, I don't wanna comment on the specific 15%. I'm more subject to litigation. Uh, I will, I will say that the key policy issue is exactly the thing you said. How should the money be distributed, the, for fixed cost of research across universities? Uh, like one system you could imagine would be where, where like different universities compete on costs, right? So, uh, a university that's able to more, more inexpensively provide, you know, a square foot of lab space, uh, fully supported with, you know, radioactive disposal and all their stuff, maybe the N- the NIH ought to be giving money to that university more than a co- a, a university that has to provide it at much more expensive rates, right? That, th- that's not the current system but you can imagine a system like that, right? So, um, I, I think this fight over this 15%, um, it's, it, I think it's, it's a great time now to rethink how the NIH and the federal government supports the research infrastructure of the country. Uh, it's, it's for the first time in-

    8. AH

      Mm-hmm.

    9. JB

      ... since like I think in 40 years, it's now part of the public consciousness, uh, this, this, this, this, this thought. Uh, and I don't think ... I've, I've not seen anybody who says that we shouldn't have federal support for universities. The question is how should it be structured and, uh, and to what extent? Those are I think legitimate questions for a health policy debate.

    10. AH

      Yeah. Well, before moving on from funding and the relationship between tax dollars and universities, I wanna ask one more question then we'll, we'll move into issues of public health, um, specifically. But having been on study section, I realize I never explained what study section is. Study section is when a group of scientists convene, um ... it used to be in different cities or virtually, and they review grants. Typically, the people who review the grants are expert or near expert in a given area, typically three primary reviewers. A bunch of people vote on the grant. And to make a long story short, whether you get money to do research from the federal government, AKA the taxpayers, is voted on by a jury of your peers. This has distinct advantages in my opinion, because real experts or close to experts are evaluating your work, and they either have to advocate for it or they actively try and kill it. Uh, the, though from the perspective of a reviewer, you're given, uh, you know, 12 grants and you know that only three of those can be funded or so. And so you literally have to advocate for the, the one or two that you feel most strongly about, and you find ways to legitimately make sure that the other grants are, um, not scored as well, and you evaluate each one on the basis of its merits. But you go into those study sections knowing like, "Goodness, like this grant, I sure would like to see this funded. This other work is kind of pedestrian, it's kinda like, like all the others." Now this is a great model in principle. However, it ... You talked about groupthink. It lends itself very well to, um, people who are very good at grant writing, which is important, grantsmanship is important, uh, continuing to get money, and in particular new ideas,

  11. 1:12:29 – 1:21:43

    Grant Review Process, Innovation

    1. AH

      ideas that are outside the vein of what a researcher has been doing for the last five, 10 years, um, promoting the i- of doing new ideas, of, of chasing new, new concepts, new hypotheses. It, it tends to make science move very slowly and very, and very incrementally. And so that's one issue. However, uh, I realize I'm weaving two questions, but there's what you described before that the, the, the majority of science that's funded at these universities on the coast has this geographic effect, groupthink effect. What about the rest of the country and these other places? The study sections, the people who review the grants intentionally include people from throughout the country. It's related, in fact, I, I think to, um, the distribution of, uh, the electoral bodies and, and people, uh, who lobby in Congress. So in other words, there's no study section on a given topic, say Alzheimer's, where you don't see people from the coast, but where you also don't see somebody from the Midwest, somebody from the, uh, desert Southwest. There, there's always been geographic coverage in the, in the people who decide which grants get funded. So I just, um ... Th- this is a historical component here, but so the question is a very straightforward one, which is given that a jury of peers decides what gets funded, that checks off the box of are they experts? Yes, more or less, but it also means that nothing really that new can get funded.

    2. JB

      Yeah, I mean, I think you've, you've hit on a, a real problem, um, which is, I think ... Uh, it ... Let me, let me contrast it with Silicon Valley, right? So, uh, in Silicon Valley, um, uh, you're, you're an angel investor or VC or something and, uh, you know, venture capitalist and you, you invest in a portfolio of 50 projects and 49 of them fail and the 50th succeeds. It, it becomes Google or Apple or something. That's a very successful portfolio. Um, the process of how, uh, we at the NIH review grants embeds in it a certain conservatism, in, uh, a, a desire to make sure that every grant that's funded succeeds. You can have a portfolio where every grant succeeds but then the portfolio as a whole is not as productive as it ought to be, because how do you make every grant succeed? Well, you just fund incremental work that you know will work.

    3. AH

      We call that turning the crank. There was a, a professor at, at the Salk Institute, a very, a f- a superb institution down at, um, in San Diego, uh, said to me, "There are two kinds of science. There's the kind of science where you really test a really bold hypothesis and most of the time it will be wrong, but if you hi- if you hit something, it's apt to be spectacular, maybe even open up an entire field, maybe cure a disease." This has happened before many times over. Or there's the science that will get you funded where you turn the crank, you, you, uh, look at a different protein in a pathway that is marginally interesting, but is predictable in terms of its ability to create papers. Students need papers, postdocs need papers. Most of them don't want to go on to be lab heads, so they just kinda need papers and a PhD. And you learn something along the way. And hey, you might stumble on something really interesting, but it's kinda like stand on one foot, stand on the other, spin around.

    4. JB

      Yeah.

    5. AH

      And without money, there is no science, so you could understand why people would be incentivized to do this kind of more incremental, I'll just call it pedestrian, kinda like, "Really? They're showing this again?" You go to meetings and it's like they've been doing this stuff for, like, 15 years, but they keep their NIH grants. And then at the end, they go, "They were, we were funded for 30 years. I've had this..." When people brag about having the same grant for 30 years, I just go, "Oh my goodness. That's, you should be embarrassed." You, now how about seven different grants over the course of 30 years-

    6. JB

      Yeah.

    7. AH

      ... and tell me that one of them led to something interesting? But don't kid yourself into thinking that having a grant, an RO1 that lasted 30 years with five renewals, it's like, I look at a lot of those careers of some of my senior colleagues and I'm like, "You made the interesting discovery in the third year of the first iteration of the grant. The only thing you've proven is that you can, that tenure keeps people around too long."

    8. JB

      (laughs)

    9. AH

      And this is coming from a tenured professor.

    10. JB

      Yeah. I-

    11. AH

      So, like-

    12. JB

      Well, I was form-

    13. AH

      ... what gives?

    14. JB

      I was formerly a tenured professor until, until recently, um-

    15. AH

      But you gave it up by choice.

    16. JB

      I did, yes.

    17. AH

      We should point that out.

    18. JB

      Okay.

    19. AH

      Um, uh-

    20. JB

      I- I- okay. So, uh, before the, before the pandemic in 2020, it was ac- I, for, actually for a decade before, I'd been working on measuring the innovativeness of scientific portfolios.

    21. AH

      Hmm.

    22. JB

      Um, uh, I had a, a paper that was published on the eve of the pandemic a- asking, "How innovative is the NIH portfolio in particular?"

    23. AH

      Oh my.

    24. JB

      Uh, and so, so like, let me just describe the, the, the methodology 'cause it's, it's re- it's easy to understand, right? So take every single published paper published in biomedicine in 1940. Take all the words and word combinations in it and just list them. Okay? Then you do the same th- and then you do the same thing for all the papers published in 1941 and subtract off all the 1940 words and word combinations. What you're left with are the uni- unique words that were introduced into the biomedical literature in 1941. You do this for '42, '43, '44, into 2020 and what you, what you get is a history of biomedicine.

    25. AH

      Mm-hmm.

    26. JB

      It's in, it, it, uh, c- that comes right out of the words that were actually published, and you can do this 'cause computers, right? Um, and, and so, uh, you take, so you have an age for every single idea that was introduced in biomedicine that just comes out of this automatic process. You go back to the papers and ask, "How new are the newest ideas in the papers when they were published?" Right? So, uh, just to take a concrete example, polymerase chain reaction in 1982, '83 was a new idea. Um, and so if you were Kary- Kary Mullis publishing a paper with the words polymerase chain reaction in 1982, that's a paper that's relying on new ideas. If the newest idea in your paper in 2020 is, uh, polymerase chain reaction, well, that's a idea that's, you know, almost 40 years old, f- 40-plus years old, right? So-

Episode duration: 4:26:33

Install uListen for AI-powered chat & search across the full episode — Get Full Transcript

Transcript of episode 2Y_PxTxLFVg

Get more out of YouTube videos.

High quality summaries for YouTube videos. Accurate transcripts to search & find moments. Powered by ChatGPT & Claude AI.

Add to Chrome