Francis Collins: National Institutes of Health (NIH) #238

Transcript

00:00:00 The following is a conversation with Francis Collins, director of the NIH, the National

00:00:05 Institutes of Health, appointed and reappointed to the role by three presidents, Obama, Trump,

00:00:12 and Biden. He oversees 27 separate institutes and centers, including NIAID, which makes

00:00:18 him Anthony Fauci’s boss. At the NIH, Francis helped launch and led a huge number of projects

00:00:25 that pushed the frontiers of science, health, and medicine, including one of my favorites,

00:00:31 the BRAIN Initiative, that seeks to map the human brain and understand how the function

00:00:36 arises from the neural circuitry. Before the NIH, Francis led the Human Genome Project,

00:00:43 one of the largest and most ambitious efforts in the history of science. Given all that,

00:00:49 Francis is a humble, thoughtful, kind man, and because of this, to me, he’s one of the

00:00:54 best representatives of science in the world. He is a man of God, and yet, also a friend

00:01:01 of the late Christopher Hitchens, who called him, quote, one of the greatest living Americans.

00:01:08 This is a Lex Friedman podcast. To support it, please check out our sponsors in the description.

00:01:13 And now, here’s my conversation with Francis Collins.

00:01:18 Science at its best is a source of hope. So for me, it’s been difficult to watch, as it

00:01:23 has during the pandemic, become at times a source of division. What I would love to do

00:01:28 in this conversation with you is touch some difficult topics, and do so with empathy and

00:01:34 humility so that we may begin to regain a sense of trust in science, and that it may

00:01:39 once again become a source of hope. I hope that’s okay with you.

00:01:43 I love the goal.

00:01:45 Let’s start with some hard questions. You called for, quote, thorough, expert driven,

00:01:50 and objective inquiry into the origins of COVID 19. So let me ask, is there a reasonable

00:01:56 chance that COVID 19 leaked from a lab?

00:02:00 I can’t exclude that. I think it’s fairly unlikely. I wish we had more ability to be

00:02:06 able to ask questions of the Chinese government and learn more about what kind of records

00:02:11 might have been in the lab that we’ve never been able to see. But most likely, this was

00:02:17 a natural origin of a virus, probably starting in a bat, perhaps traveling through some other

00:02:22 intermediate, yet to be identified host, and finding its way into humans.

00:02:27 Is answering this question within the realm of science, do you think, will we ever know?

00:02:31 I think we might know if we find that intermediate host. And there has not yet been a thorough

00:02:37 enough investigation to say that that’s not going to happen. And remember, it takes a

00:02:42 while to do this. With SARS, it was 14 years before we figured out it was the civet cat

00:02:49 that was the intermediate host. With MERS, it was a little quicker to discover it was

00:02:52 the camel. With SARS COVID 2, there’s been some looking, but especially now with everything

00:02:58 really tense between the US and China, if there’s looking going on, we’re not getting

00:03:03 told about it.

00:03:05 Do you think it’s a scientific question or a political question?

00:03:07 It’s a scientific question, but it has political implications.

00:03:12 So the world is full of scientists that are working together, but in the political space,

00:03:17 in the political science space, there’s tensions. What is it like to do great science in a time

00:03:24 of a pandemic when there’s political tensions?

00:03:27 It’s very unfortunate. Pasteur said science knows no one country. He was right about that.

00:03:35 My whole career in genetics, especially, has depended upon international collaboration between

00:03:42 scientists as a way to make discoveries, get things done. Scientists, by their nature,

00:03:48 like to be involved in international collaborations. The Human Genome Project, for heaven’s sake,

00:03:55 2,400 scientists in six countries working together, not worrying who is going to get

00:03:59 the credit, giving all the data away. I was the person who was supposed to keep all that

00:04:04 coordinated. It was a wonderful experience, and that included China. That was sort of

00:04:08 their first real entry into a big international, big science kind of project, and they did

00:04:15 their part. It’s very different now.

00:04:19 Continuing the line of difficult questions, especially difficult ethical questions. In

00:04:26 2014, U.S. put a hold on gain of function research in response to a number of laboratory

00:04:32 biosecurity incidents, including anthrax, smallpox, and influenza. In December 2017,

00:04:38 NIH lifted this ban because, quote, gain of function research is important in helping

00:04:44 us identify, understand, and develop strategies and effective countermeasures against rapidly

00:04:49 evolving pathogens that pose a threat to public health. All difficult questions have arguments

00:04:56 on both sides. Can you argue the pros and cons of gain of function research with viruses?

00:05:03 I can, and first let me say this term, gain of function, is causing such confusion that

00:05:11 I need to take a minute and just sort of talk about what the common scientific use of that

00:05:16 term is and where it is very different when we’re talking about the current oversight

00:05:22 of potentially dangerous human pathogens. As you know, in science, we’re doing gain

00:05:28 of function experiments all the time. We support a lot of cancer immunotherapy at NIH. Right

00:05:36 here in our clinical center, there are trials going on where people’s immune cells are taken

00:05:41 out of their body, treated with a genetic therapy that revs up their ability to discover

00:05:46 the cancer that that patient currently has, maybe even at stage four, and then give them

00:05:52 back as those little ninja warriors go after the cancer. It sometimes works dramatically.

00:05:59 That’s gain of function. You gave that patient a gain in their immune function that may have

00:06:03 saved their life. We’ve got to be careful not to say, oh, gain of function is bad. Most

00:06:08 of what we do in science that’s good involves quite a bit of that. We are all living with

00:06:15 gains of function every day. I have a gain of function because I’m wearing these eyeglasses.

00:06:18 Otherwise, I would not be seeing you as clearly. I’m happy for that gain of function. That’s

00:06:25 where a lot of confusion has happened. The kind of gain of function which is now subject

00:06:30 to very rigorous and very carefully defined oversight is when you are working with an

00:06:36 established human pathogen that is known to be potentially causing a pandemic and you

00:06:43 are enhancing or potentially enhancing its transmissibility or its virulence. We call

00:06:50 that EPPP, enhanced potential pandemic pathogen. That requires this very stringent oversight

00:07:01 worked out over three years by the National Science Advisory Board on Biosecurity that

00:07:08 needs to be looked at by a panel that goes well beyond NIH to decide are the benefits

00:07:14 worth the risks in that situation. Most of the time, it’s not worth the risk. Only three

00:07:21 times in the last three or four years have experiments been given permission to go forward.

00:07:28 They were all on influenza. So I will argue that if you’re worried about the next pandemic,

00:07:35 the more you know about the coming enemy, the better chance you have to recognize when

00:07:40 trouble is starting. And so if you can do it safely, studying influenza or coronaviruses

00:07:47 like SARS, MERS, and SARS CoV2 would be a good thing to be able to know about. But you

00:07:53 have to be able to do it safely because we all know lab accidents can happen. I mean,

00:07:59 look at SARS where there have been lab accidents and people have gotten sick as a result. We

00:08:05 don’t want to take that chance unless there’s a compelling scientific reason. That’s why

00:08:09 we have this very stringent oversight. The experiments being done at the Wuhan Institute

00:08:16 of Virology as a subaward to our grant to EcoHealth in New York did not meet that standard

00:08:24 of requiring that kind of stringent oversight. I want to be really clear about that because

00:08:29 there’s been so much thrown around about it. Was it gain of function? Well, in the standard

00:08:34 use of that term that you would use in science in general, you might say it was. But in the

00:08:39 use of that term that applies to this very specific example of a potential pandemic pathogen,

00:08:48 absolutely not. So nothing went on there that should not have happened based upon the oversight.

00:08:55 There was an instance where the grantee institution failed to notify us about the result of an

00:09:02 experiment that they were supposed to tell us where they mixed and matched some viral

00:09:07 genomes and got a somewhat larger viral load as a result. But it was not EPPP. It was not

00:09:15 getting into that zone that would have required this higher level of scrutiny. It was all

00:09:19 bat viruses. These were not human pathogens.

00:09:22 So they didn’t cross a threshold within that gray area that makes for an EPPP?

00:09:29 They did not. And anybody who’s willing to take the time to look at what EPPP means and

00:09:34 what those experiments were would have to agree with what I just said.

00:09:39 What is the biggest reason it didn’t cross that threshold? Is it because it wasn’t jumping

00:09:43 to humans? Is it because it did not have a sufficient increase in virulence or transmissibility?

00:09:50 What’s your sense?

00:09:51 EPPP only applies to agents that are known human pathogens of pandemic potential. These

00:10:00 were all bat viruses derived in the wild, not shown to be infectious to humans. Just

00:10:07 looking at what happened if you took four different bat viruses and you tried moving

00:10:11 the spike protein gene from one into one of the others to see whether it would bind better

00:10:17 to the ACE2 receptor. That doesn’t get across that threshold.

00:10:21 And let me also say, for those who are trying to connect the dots here, which is the most

00:10:26 troubling part of this, and say, well, this is how SARS CoV2 got started. That is absolutely

00:10:32 demonstrably false. These bat viruses that were being studied had only about 80% similarity

00:10:40 in their genomes to SARS CoV2. They were like decades away in evolutionary terms. And it

00:10:46 is really irresponsible for people to claim otherwise.

00:10:51 Speaking of people who claim otherwise, Rand Paul, what do you make of the battle of words

00:10:58 between Senator Rand Paul and Dr. Anthony Fauci over this particular point?

00:11:03 I don’t want to talk about specific members of Congress, but I will say it’s really unfortunate

00:11:09 that Tony Fauci, who is the epitome of a dedicated public servant, has now somehow been targeted

00:11:17 for political reasons as somebody that certain figures are trying to discredit, perhaps to

00:11:23 try to distract from their own failings. This never should have happened. Here’s a person

00:11:29 who’s dedicated his whole life to trying to prevent illnesses from infectious diseases,

00:11:35 including HIV in the 1980s and 90s, and now probably the most knowledgeable infectious

00:11:43 disease physician in the world, and also a really good communicator, is out there telling

00:11:49 the truth about where we are with SARS CoV2 to certain political figures who don’t want

00:11:54 to hear it, and who are therefore determined to discredit him. And that is disgraceful.

00:12:00 So with politicians, they often play games with black and white. They try to sort of

00:12:06 use the gray areas of science and then paint their own picture. But I have a question about

00:12:13 the gray areas of science. So like you mentioned, gain of function is a term that has very specific

00:12:19 scientific meaning, but it also has a more general term. And it’s very possible to argue

00:12:25 that the, not to argue, not the way politicians argue, but just as human beings and scientists,

00:12:31 that there was a gain of function achieved at the Wuhan Institute of Virology, but it

00:12:38 didn’t cross a threshold. I mean, there’s a, it’s a, but it could have too. So here’s

00:12:44 the thing. When you do these kinds of experiments, unexpected results may be achieved. And that’s

00:12:50 the gray area of science. You’re taking risks with such experiments. And I am very uncomfortable

00:12:58 that we can’t discuss the uncertainty in the gray area of this.

00:13:03 Oh, I’m comfortable discussing the gray area. What I’m uncomfortable with is people deciding

00:13:08 to define for themselves what that threshold is based on sort of some political argument.

00:13:14 The threshold was very explicitly laid out. Everybody agreed to that in the basis of this

00:13:21 three years of deliberation. So that’s what it is. If that threshold needs to be reconsidered,

00:13:27 let’s reconsider it, but let’s not try to take an experiment that’s already been done

00:13:32 and decide that the threshold isn’t what it was, because that really is doing a disservice

00:13:37 to the whole process.

00:13:38 I wish there was a discussion, even in response to Rand Paul, I know we’re not talking about

00:13:44 specific senators, but just that particular case, I’m saying stuff here. I wish there

00:13:48 was an opportunity to talk about, given the current threshold, this is not gain of function.

00:13:55 But maybe we need to reconsider the threshold and have an action. That’s an opportunity

00:13:58 for discussion about the ethics of gain of function. You said that there was three studies

00:14:02 that passed that threshold with influenza. That’s a fascinating human question, scientific

00:14:07 question about ethics, because like you said, there’s pros and cons. You’re taking risks

00:14:14 here to prevent horribly destructive viruses in the future, but you also are risking creating

00:14:24 such viruses in the future. With nuclear weapons and nuclear energy, nuclear energy promises

00:14:33 a lot of positive effects, and yet you’re taking risks here. With mutually shared destruction,

00:14:40 nations possessing nuclear weapons, a lot of people argue that nuclear weapons is the

00:14:49 reason we’ve prevented world wars, and yet they also have the risk of starting world

00:14:55 wars. And this is what we have to be honest about with the benefits and risks of science,

00:15:01 that you have to make that calculation. What are the pros and what are the cons?

00:15:06 I’m totally with you, but I want to reassure you, Lex, that this is not an issue that’s

00:15:10 been ignored. That this issue about the kind of gain of function that might result in a

00:15:16 serious human pathogen has been front and center in many deliberations for a decade

00:15:22 or more, involved a lot of my time along the way, by the way, and has been discussed publicly

00:15:28 on multiple occasions, including two major meetings of the National Academy of Sciences,

00:15:34 getting input from everybody and ultimately arriving at our current framework. Now, we

00:15:39 actually back in January of 2020, just before COVID 19 changed everything, had planned and

00:15:47 even charged that same National Science Advisory Board on Biosecurity to reconvene and look

00:15:55 at the current framework and say, do we have it right? Let’s look at the experience over

00:16:00 those three years and say, is the threshold too easy, too hard? Do we need to reconsider

00:16:06 it? Let’s look at the experience. COVID came along, the members of the board said, please,

00:16:10 we’re all infectious disease experts. We don’t have time for this right now. But I think

00:16:14 the time is right to do this. I’m totally supportive of that. And that should be just

00:16:18 as public a discussion as you can imagine about what are the benefits and the risks.

00:16:23 And if somebody decided, ultimately, this came together and said, we just shouldn’t

00:16:27 be doing these experiments under any circumstances. If that was the conclusion, well, that would

00:16:31 be the conclusion. But it hasn’t been so far.

00:16:35 If we can briefly look out into the next hundred years on this. I apologize for the existential

00:16:42 questions. But it seems obvious to me that as gain of function type of research and development

00:16:52 becomes easier and cheaper, it will become greater and greater risk. So if it doesn’t

00:16:59 no longer need to be contained within laboratories of high security, it feels like this is one

00:17:07 of the greatest threats facing human civilization. Do you worry that at some point in the future

00:17:12 a leaked manmade virus may destroy most of human civilization?

00:17:18 I do worry about the risks. And at the moment where we have the greatest control, the greatest

00:17:24 oversight is when this is federally funded research. But as you’re alluding, there’s

00:17:30 no reason to imagine that’s the only place that this kind of activity would go on. If

00:17:36 there was an evil source that wished to create a virus that was highly pathogenic in their

00:17:42 garage, the technology does get easier. And there is no international oversight about

00:17:49 this either that you could say has the same stringency as what we have in the United States.

00:17:55 So yes, that is a concern. It would take a seriously deranged group or person to undertake

00:18:03 this on purpose, given the likelihood that they too would go down. We don’t imagine there

00:18:10 are going to be bioweapons that only kill your enemies and don’t kill you. Sorry, we’re

00:18:16 too much alike for that to work. So I don’t see it as an imminent risk. There’s lots of

00:18:24 scary novels and movies written about it. But I do think it’s something we have to consider.

00:18:31 What are all the things that ought to be watched? You may not know that if somebody is ordering

00:18:36 a particular oligonucleotide from one of the main suppliers, and it happens to match smallpox,

00:18:44 they’re going to get caught. So there is effort underway to try to track any nefarious actions

00:18:51 that might be going on.

00:18:52 In the United States or internationally? Is there an international collaboration of try

00:18:55 to track this stuff?

00:18:57 There is some. I wish it were stronger. This is a general issue, Lex, in terms of do we

00:19:03 have a mechanism, particularly when it comes to ethical issues, to be able to decide what’s

00:19:09 allowable and what’s not and enforce it. I mean, look where we are with germline genome

00:19:13 editing for humans, for instance. There is no enforcement mechanism. There’s just bully

00:19:18 pulpits and governments that get to decide for themselves.

00:19:22 You talked about evil. What about incompetence? Does that worry you? I was born in the Soviet

00:19:26 Union. My dad, a physicist, worked at Chernobyl. That comes to mind. That wasn’t evil. I don’t

00:19:35 know what word you want to put it. Maybe incompetence is too harsh. Maybe it’s the inherent incompetence

00:19:40 of bureaucracy. I don’t know. But for whatever reason, there was an accident. Does that worry

00:19:44 you?

00:19:45 Of course it does. We know that SARS, for instance, did manage to leak out of a lab

00:19:50 in China two or three times. At least in some instances, people died, fortunately quickly

00:19:56 contained. All one can do in that circumstance, because you need to study the virus and understand

00:20:03 it in order to keep it from causing a broader pandemic, but you need to insist upon the

00:20:09 kind of biosecurity, the BSL 2, 3, and 4 framework under which those experiments have to be done.

00:20:17 Certainly at NIH, we’re extremely rigorous about that, but you can’t count on every human

00:20:22 being to always do exactly what they’re supposed to. There’s a risk there, which is another

00:20:27 reason why if we’re contemplating supporting research on pathogens that might be the next

00:20:34 pandemic, you have to factor that in, not just whether people are going to do something

00:20:39 that we couldn’t have predicted, where all of a sudden they created a virus that’s much

00:20:42 worse without knowing they were going to do that, but also just having an accident. That’s

00:20:47 in the mix when those estimates are done about whether the risk is worth it or not.

00:20:54 Continuing on line of difficult questions.

00:20:56 We’re going to get to fun stuff after a while.

00:20:58 We will soon, I promise. You are the director of the NIH. You are Dr. Anthony Fauci’s, technically

00:21:10 his boss.

00:21:11 Yep.

00:21:12 You have stood behind him. You have supported him, just like you did already in this conversation.

00:21:17 It is painful for me to see division and distrust, but many people in politics and elsewhere

00:21:25 have called for Anthony Fauci to be fired. When there are such calls of distrust in public

00:21:31 about a leader like Anthony Fauci, who should garner trust, do you think he should be fired?

00:21:38 Probably not. To do so would be basically to give the opportunity for those who want

00:21:47 to make up stories about anybody to destroy them. There is nothing in the ways in which

00:21:54 Tony Fauci has been targeted that is based upon truth. How could we then accept those

00:22:02 cries for his firing as having legitimacy? It’s a circular argument. They’ve decided

00:22:08 they don’t like Tony, so they make up stuff and they twist comments that he’s made about

00:22:14 things like gain of function, where he’s referring to the very specific gain of function that’s

00:22:19 covered by this policy, and they’re trying to say he lied to the Congress. That’s simply

00:22:24 not true. They don’t like the fact that Tony changes the medical recommendations about

00:22:31 what to do with COVID 19 over the space of more than a year. They call that flip flopping

00:22:36 and you can’t trust the guy because he says one thing last year and one thing this year.

00:22:40 Well, the science has changed. Delta variant has changed everything. You don’t want him

00:22:45 to be saying the same thing he did a year ago. That would be wrong now. It was the best

00:22:49 we could do then. People don’t understand that or else they don’t want to understand

00:22:53 it. So when you basically whip up a largely political argument against a scientist and

00:23:01 hammer at it over and over again to the point where he now has to have 24 seven security

00:23:06 to protect him against people who really want to do violence to him. For that to be a reason

00:23:11 to say that then he should be fired is to hand the evil forces the victory. I will not

00:23:17 do that. Yet there’s something difficult I’m going to try to express to you. So it may

00:23:27 be your guitar playing. It may be something else, but there’s a humility to you. It may

00:23:33 be because you’re a man of God. There’s a humility to you that garners trust. And when

00:23:45 you’re in a leadership position representing science, especially in catastrophic events

00:23:51 like the pandemic, it feels like as a leader, you have to go far above and beyond your usual

00:23:59 duties. And I think there’s no question that Anthony Fauci has delivered on his duties,

00:24:07 but it feels like he needs to go above as a science communicator. And if there’s a large

00:24:11 number of people that are distrusting him, it’s also his responsibility to garner their

00:24:20 trust to gain their trust as a person who’s the face of science. Do you, are you torn

00:24:27 on this? The responsibility of Anthony Fauci of yourself to represent science, not just

00:24:34 the communication of advising what should be done, but giving people hope, giving people

00:24:41 trust in science and alleviating division. Do you think that’s also responsibility of

00:24:47 a leader or is that unfair to ask?

00:24:50 I think the best way you give people trust is to tell them the truth. And so they recognize

00:24:55 that when you’re sharing information, it’s the best you’ve got at that point. And Tony

00:24:59 Fauci does that at every moment. I don’t think him expressing more humility would change

00:25:06 the fact that they’re looking for a target of somebody to blame, to basically distract

00:25:12 people from the failings of their own political party. Maybe I’m less targeted, not because

00:25:19 of a difference in the way in which I convey the information. I’m less visible. If Tony

00:25:25 were out of the scene and I was placed in that role, I’d probably be seeing a ratcheting

00:25:31 up of that same targeting.

00:25:34 I would like to believe that if Tony Fauci said that when I originally made recommendations

00:25:42 not to wear masks, that was given on the, on the, our best available data. And now we

00:25:48 know that is a mistake. So admit with humility that there’s an error. That’s not, that’s

00:25:54 not actually correct, but that’s a, that’s a statement of humility. And I would like

00:26:00 to believe, despite the attacks, he would win a lot of people over with that. So a lot

00:26:07 of people, as you’re saying, would use that, see that here we go, here’s that Dr. Anthony

00:26:13 Fauci making mistakes. How can we trust them on anything? I believe if he was that public

00:26:20 display of humility to say that I made an error, that would win a lot of people over.

00:26:28 That’s my, that’s kind of my sense to face the fire of the attacks from politics. You

00:26:34 have to, like politicians will attack no matter what, but the question is the people, to win

00:26:40 over the people. The biggest concern I’ve had is that there was this, this stress of

00:26:47 science that’s been brewing and I’m, maybe you can correct me, but I’m a little bit unwilling

00:26:53 to fully blame the politicians because politicians play their games no matter what. It just feels

00:27:00 like this was an opportunity to inspire people with the power of science. The development

00:27:05 of the vaccines, no matter what you think of those vaccines is one of the greatest accomplishments

00:27:11 in the history of science. And the fact that that’s not inspiring, listen, I host a podcast.

00:27:19 Whenever I say positive stuff about the vaccine, I get to hear a lot of different opinions.

00:27:25 The fact that I do is a big problem to me because it’s an incredible, an incredible

00:27:31 accomplishment of science. And so I, I, I, I, I’m sorry, but I have to put responsibility

00:27:38 on the leaders, even if it’s not their mistakes. That’s what the leadership is. That’s what

00:27:44 leadership is. You take responsibility for the situation. I wonder if there’s something

00:27:48 that could have been done better to give people hope that science will save us as opposed

00:27:56 to science will divide us.

00:28:00 I think you have more confidence in the ability to get beyond our current divisions than I

00:28:07 do after seeing just how deep and dark they have become. Tony Fauci has said multiple

00:28:14 times the recommendation about not wearing masks was for two reasons, a shortage of masks,

00:28:20 which were needed in hospitals and a lack of realization early in the course of the

00:28:26 epidemic that this was a virus that could heavily infect asymptomatic people. As that

00:28:34 changed, he changed. Now, did he make an error? No, he was making a judgment based on the

00:28:40 data available at the time, but he certainly made that clear over and over again. It has

00:28:45 not stopped those who would like to demonize him from saying, well, he just flip flopped.

00:28:51 You can’t trust a guy. He says one thing today and one thing tomorrow.

00:28:55 Well, masks is a tricky one. So I’m actually early on, I’m a coauthor on a paper, one of

00:29:02 many, but this was a survey paper overlooking the, the evidence. It’s a summary of the evidence

00:29:09 we have for the effectiveness of masks. It seems that it’s difficult to do rigorous scientific

00:29:17 study on masks.

00:29:18 It is difficult.

00:29:19 There’s a lot of philosophical and ethical questions I want to ask you, but within this,

00:29:26 it’s back to your words and Anthony Fauci’s words. When you’re dealing with so much uncertainty

00:29:33 and so much potential uncertainty about how catastrophic this virus is in the early days,

00:29:40 and knowing that each word you say may create panic, how do you communicate science with

00:29:47 the world? It’s a philosophical, it’s an ethical, it’s a practical question. There was a discussion

00:29:56 about masks a century ago and that too led to panic. So, I mean, I’m trying to put myself

00:30:06 in the mind, in your mind, in the mind of Anthony Fauci in those early days, knowing

00:30:10 that there’s limited supply of masks. Like, what do you say? Do you fully convey the uncertainty

00:30:17 of the situation of the, of the challenges of the supply chain? Or do you say that masks

00:30:23 don’t work? That’s a complicated calculation. How do you make that calculation?

00:30:32 It is a complicated calculation. As a scientist, your temptation would be to give a full brain

00:30:41 dump of all the details of the information about what’s known and what isn’t known and

00:30:46 what experiments need to be done. Most of the time that’s not going to play well in

00:30:51 a soundbite on the evening news. So you have to kind of distill it down to a recommendation

00:30:55 that is the best you can do at that time with the information you’ve got.

00:31:01 So you’re a man of God. And we’ll return to that to talk about some, some also unanswerable

00:31:08 philosophical questions. But first let’s linger on the vaccine because in the, in the religious,

00:31:15 in the Christian community, there was some hesitancy with the vaccine.

00:31:19 Still is.

00:31:20 There’s a lot of data showing high efficacy and safety of vaccines, of COVID vaccines,

00:31:27 but still they are far from perfect as all vaccines are. Can you empathize with people

00:31:33 who are hesitant to take the COVID vaccine or to have their children take the COVID vaccine?

00:31:39 I can totally empathize, especially when people are barraged by conflicting information coming

00:31:44 at them from all kinds of directions. I’ve spent a lot of my time in the last year trying

00:31:50 to figure out how to do a better job of listening because I think we have all got the risk of

00:31:59 assuming we know the basis for somebody’s hesitancy. And that often doesn’t turn out

00:32:06 to be what you thought. And the variety of reasons is quite broad. I think a big concern

00:32:14 is just this sense of uncertainty about whether this was done too fast and that corners were

00:32:20 cut and there are good answers to that. Along with that, a sense that maybe this vaccine

00:32:28 will have longterm effects that we won’t know about for years to come. And one can say that

00:32:33 hasn’t been seen with other vaccines and there’s no particular reason to think this one’s going

00:32:38 to be different than the dozens of others that we have experience with. But you can’t

00:32:41 absolutely say, no, there’s no chance of that. So it does come down to listening and then

00:32:49 trying in a fashion that doesn’t convey a message that you’re smarter than the person

00:32:57 you’re talking to because that isn’t going to help to really address what the substance

00:33:02 is of the concerns. But my heart goes out to so many people who are fearful about this

00:33:09 because of all the information that has been dumped on them. Some of it by politicians,

00:33:16 a lot of it by the internet, some of it by parts of the media that seem to take pleasure

00:33:24 in stirring up this kind of fear for their own reasons. And that is shameful. I’m really

00:33:31 sympathetic with the people who are confused and fearful. I am not sympathetic with people

00:33:38 who are distributing information that’s demonstrably false and continue to do so. They’re taking

00:33:44 lives. I didn’t realize how strong that sector of disinformation would be. And it’s been

00:33:54 in many ways more effective than the means of spreading the truth. This is going to take

00:34:00 us into another place. But Lex, if there’s something I’m really worried about in this

00:34:06 country, and it’s not just this country, but it’s the one I live in, is that we have another

00:34:10 epidemic besides COVID 19. And it’s an epidemic of the loss of the anchor of truth. That truth

00:34:20 as a means of making decisions, truth as a means of figuring out how to wrestle with

00:34:27 a question like, should I get this vaccine for myself or my children, seems to have lost

00:34:33 its primacy. And instead, it’s an opinion of somebody who expressed it very strongly,

00:34:42 or some Facebook post that I read two hours ago. And for those to become substitutes for

00:34:51 objective truth, not just, of course, for vaccines, but for many other issues, like

00:34:58 was the 2020 election actually fair? This worries me deeply. It’s bad enough to have

00:35:06 polarization and divisions, but to have no way of resolving those by actually saying,

00:35:12 okay, what’s true here, makes me very worried about the path we’re on. And I’m usually an

00:35:18 optimist.

00:35:19 Well, to give you an optimistic angle on this, I actually think that the sense that there’s

00:35:27 no one place for truth is just a thing that will inspire leaders and science communicators

00:35:35 to speak, not from a place of authority, but from a place of humility. I think it’s just

00:35:39 challenging people to communicate in a new way, to be listeners first. I think the problem

00:35:46 isn’t that there’s a lot of misinformation. I think that the internet and the world are

00:35:59 distrustful of people who speak as if they possess the truth with an authoritarian kind

00:36:06 of tone, which was, I think, defining for what science was in the 20th century. I just

00:36:12 think it has to sound different in the 21st. In the battle of ideas, I think humility and

00:36:20 love wins. And that’s how science wins, not through having quote unquote truth. Because

00:36:27 now everybody can just say, I have the truth. I think you have to speak, like I said, from

00:36:34 humility, not authority. And so it’s just challenges our leaders to go back and learn

00:36:40 to be, pardon my French, less assholes and more kind. And like you said, to listen, to

00:36:48 listen to the experiences of people that are good people, not the ones who are trying to

00:36:52 manipulate the system or play a game and so on, but real people who are just afraid of

00:36:58 uncertainty of hurting those they loved and so on. So I think it’s just an opportunity

00:37:03 for leaders to go back and take a class on effective communication.

00:37:09 I’m with you on shifting more from where we are to humility and love. That’s got to be

00:37:14 the right answer. That’s very biblical, by the way.

00:37:18 We’ll get there. I have to bring up Joe Rogan. I don’t know if you know who he is.

00:37:24 I do.

00:37:25 He’s a podcaster, comedian, fighting commentator, and my now friend.

00:37:30 And Iver Mecton believer too.

00:37:32 Yes. That is the question I have to ask you about. He has gotten some flack in the mainstream

00:37:38 media for not getting vaccinated. And when he got COVID recently, taking Iver Mecton

00:37:44 as part of a cocktail of treatments. The NIH actually has a nice page on Iver Mecton saying

00:37:50 quote, there’s insufficient evidence to recommend either for or against the use of Iver Mecton

00:37:57 for the treatment of COVID 19 results from adequately powered, well designed and well

00:38:02 conducted clinical trials are needed to provide more specific evidence based guidance on the

00:38:07 role of Iver Mecton in the treatment of COVID 19.

00:38:12 So let me ask, why do you think there has been so much attack on Joe Rogan and anyone

00:38:17 else that’s talking about Iver Mecton when there’s insufficient evidence for or against?

00:38:24 Well let’s unpack that. First of all, I think the concerns about Joe are not limited to

00:38:30 his taking Iver Mecton. Much more seriously, his being fairly publicly negative about vaccines

00:38:37 at a time where people are dying. 700,000 people have died from COVID 19 estimates by

00:38:44 Kaiser or at least 100,000 of those were unnecessary deaths of unvaccinated people. And for Joe

00:38:50 to promote that further, even as this pandemic rages through our population is simply irresponsible.

00:39:00 So yeah, the Iver Mecton is just one other twist. Obviously Iver Mecton has been controversial

00:39:05 for months and months. The reason that it got particular attention is because of the

00:39:11 way in which it seemed to have captured the imagination of a lot of people and to the

00:39:16 point where they were taking doses that were intended for livestock and some of them got

00:39:21 pretty sick as a result from overdosing on this stuff. That was not good judgment. The

00:39:28 drug itself remains uncertain. There’s a recent review that looks at all of the studies of

00:39:35 Iver Mecton and basically concludes that it probably doesn’t work. We are running a study

00:39:41 right now. I looked at that data this morning in a trial called active six, which is one

00:39:47 of the ones that my public private partnership is running. We’re up to about 400 patients

00:39:52 who’ve been randomized to Iver Mecton or placebo and should know perhaps as soon as a month

00:39:58 from now in a very carefully controlled trial, did it help or did it not? So there will be

00:40:04 an answer coming back to Joe again. I don’t think the fact that he took the Iver Mecton

00:40:11 and hoping it might work, uh, is that big a knock against him. It’s more the conveying

00:40:16 of we don’t trust what science says, which is vaccines are going to save your life. We’re

00:40:21 going to trust what’s on the internet that says Iver Mecton and hydroxychloroquine really

00:40:25 do work, even though the scientific community says probably not.

00:40:28 So let me push back in that a little bit. So he doesn’t, he doesn’t say, let’s not listen

00:40:34 to science. He doesn’t say the vaccine don’t get vaccinated. He says it’s okay to ask questions.

00:40:44 I’m okay with that. How risky is the vaccine for certain populations? What are the benefits

00:40:50 and risks? There’s other friends of Joe and friends of mine, like Sam Harris, who says,

00:40:57 if you look at the data, it’s obvious that the benefits outweigh the risks. And what Joe says

00:41:04 is yes, but let’s still openly talk about risks. And he often brings up anecdotal evidence

00:41:11 of people who’ve had, uh, highly negative effects from vaccines. Science is not done

00:41:18 with anecdotal evidence. And so you could infer a lot of stuff from the way he expresses

00:41:24 it, but he also communicates a lot of interesting questions. Uh, and that’s something maybe

00:41:30 you can comment on this. You know, there’s certain groups that are healthy. They have,

00:41:36 they’re younger, they have, they exercise a lot. They get the all, you know, nutrition

00:41:41 and all those kinds of things. He shows skepticism on whether it’s so obvious that they should

00:41:48 get vaccinated. And the same is he makes this, he kind of presents the same kind of skepticism

00:41:55 for kids, for young kids. So with empathy and, uh, you know, listening my Russian ineliquent

00:42:07 description of what Joe believes, what, what is your kind of response to that? Why should

00:42:13 certain categories of healthy and young people still get vaccinated? Do you think?

00:42:18 Well, first just to say it’s great for Joe to be a skeptic, to ask questions. We should

00:42:22 all be doing that. But then the next step is to go and see what the data says and see

00:42:26 if they’re actually answers to those questions. So coming to healthy people, I’ve done a bunch

00:42:32 of podcasts besides this one. The one I think I remember most was a podcast with a worldwide

00:42:40 wrestling superstar. Very nice. He’s about six foot six and just absolutely solid muscle.

00:42:48 And he got COVID and he almost died. And recovering from that, he said, I’ve got to let my supporters

00:42:57 know because you can imagine worldwide wrestling fans are probably not big embracers of the

00:43:04 need for vaccines. And he want, he just turned himself into a spokesperson for the fact that

00:43:13 this virus doesn’t care how healthy you are, how much you exercise, what a great specimen

00:43:18 you are. It wiped him out. And we see that, you know, the average person in the ICU right

00:43:26 now with COVID 19 is under age 50. I think there’s a lot of people still thinking, Oh,

00:43:31 it’s just those old people in the nursing homes. That’s not going to be about me. They’re

00:43:35 wrong. And there are plenty of instances of people who were totally healthy with no underlying

00:43:40 diseases, taking good care of themselves, not obese exercising who have died from this

00:43:46 disease. 700 children have died from this disease. Yes. Some of them had underlying

00:43:54 factors like obesity, but a lot of them did not. So it’s fair to say younger people are

00:44:00 less susceptible to serious illness, kids even less so, and then young adults, but it

00:44:07 ain’t zero. And if the vaccine is really safe and really effective, then you probably want

00:44:15 everybody to take advantage of that. Even though some are dropping their risks more

00:44:20 than others, everybody’s dropping their risks. Some, are you worried about variants? So looking

00:44:26 out into the future, what’s your vision for all the possible trajectories that this virus

00:44:33 takes in human society? I’m totally worried about the variants. Delta was such an impressive

00:44:40 arrival on the scene in all the wrong ways. I mean, it took over the world in the space

00:44:47 of just a couple months because of its extremely contagious ability. Viruses would be beautiful

00:44:53 if they weren’t terrifying. Yeah, exactly. I mean, this whole story of viral evolution

00:44:58 scientifically is just amazingly elegant. Anybody who really wanted to understand how

00:45:03 evolution works in real time, study SARS CoV 2, because it’s not just Delta, it’s Alpha,

00:45:09 it’s Beta, and it’s Gamma, and it’s the fact that these sweep through the world’s population

00:45:16 by fairly minor differences in fitness. So the real question many people are wrestling

00:45:23 is, is Delta it? Is it such a fit virus that nothing else will be able to displace it?

00:45:30 I don’t know. I mean, there’s now Delta AY4, which is a variant of Delta that at least

00:45:37 in the UK seems to be taking over the Delta population as though it’s maybe even a little

00:45:43 more contagious. That might be the first hint that we’re seeing something new here. It’s

00:45:49 not a completely different virus. It’s still Delta, but it’s Delta Plus. You know, the

00:45:55 big worry is what’s out there that is so different that the vaccine protection doesn’t work.

00:46:07 And we don’t know how different it needs to be for the vaccine to start working. That’s

00:46:12 the terrifying thing about each of these variants. It’s like, it’s always a pleasant surprise

00:46:18 that a vaccine seems to still have efficacy.

00:46:21 And hooray for our immune system, may I say, because the vaccine immunized you against

00:46:27 that original Wuhan virus. Now we can see that especially after two doses and even more

00:46:35 so after a booster, your immune system is so clever that it’s also making a diversity

00:46:42 of antibodies to cover some other things that might happen to that virus to make it a little

00:46:47 different. And you’re still getting really good coverage. Even for beta, which was South

00:46:54 Africa B1351, which is the most different, it looks pretty good. But that doesn’t mean

00:47:00 it will always be as good as that if something gets really far away from the original virus.

00:47:06 Now the good news is we would know what to do in that situation. The mRNA vaccines allow

00:47:11 you to redesign the vaccine like that and to quickly get it through a few thousand participants

00:47:19 in a clinical trial to be sure it’s raising antibodies and then bang, you could go. But

00:47:23 I don’t want to have to do that. There will be people’s lives at risk in the meantime.

00:47:28 And what’s the best way to keep that from happening? Well, try to cut down the number

00:47:32 of infections because you don’t get variants unless the virus is replicating in a person.

00:47:37 So how do we solve this thing? How do we get out of this pandemic? What’s like, if you

00:47:44 had a, like a wand or something, or you could really implement policies, what’s the full

00:47:51 cocktail of solutions here? It’s a full cocktail. It’s not just one thing. In our own country

00:47:56 here in the US, it would be getting those 64 million reluctant people to actually go

00:48:01 ahead and get vaccinated. There’s 64 million people who didn’t get vaccinated? Adults.

00:48:05 Yes. Not even counting the kids. 64 million. Isn’t that astounding? Get the kids vaccinated.

00:48:13 Hopefully their parents will see that as a good thing too. Get those of us who are due

00:48:18 for boosters boosted because that’s going to reduce our likelihood of having breakthrough

00:48:22 infections and keep spreading it. Convince people that until we’re really done with this,

00:48:27 and we’re not now, that social distancing and mask wearing indoors are still critical

00:48:32 to cut down the number of new infections. But of course, that’s our country. This is

00:48:39 a worldwide pandemic. I worry greatly about the fact that low and middle income countries

00:48:45 have for the most part, not even gotten started with access to vaccines. And we have to figure

00:48:50 out a way to speed that up because otherwise that’s where the next variant will probably

00:48:56 arrive. And who knows how bad it will be. And it will cross the world quickly as we’ve

00:49:01 seen happen repeatedly in the last 22 months.

00:49:05 I think I’m really surprised, annoyed, frustrated that rapid at home testing from the very beginning

00:49:14 wasn’t a big, big part of the solution. First of all, nobody’s against it. That’s one huge

00:49:20 plus for testing. Everybody supports. Second of all, that’s what America is good at is

00:49:28 mask manufacturer stuff, like stepping up, engineers stepping up and really deploying

00:49:33 it. Plus, without the collection of data is giving people freedom, is giving them information

00:49:39 and then freedom to decide what to do with that information. It’s such a powerful solution.

00:49:44 I don’t understand. Well, now I think the Biden administration is, I think, emphasized

00:49:49 like the scaling of testing manufacturers. But I just feel like it’s an obvious solution.

00:49:54 Get a test that costs less than a dollar to manufacture, costs less than a dollar to buy.

00:49:59 And just everybody gets tested every single day. Don’t share that data with anyone. You

00:50:03 just make the decisions. And I believe in the intelligence of people to make the right

00:50:08 decision to stay at home when the test is positive.

00:50:11 I am so completely with you on that. And NIH has been smack in the middle of trying to

00:50:15 make that dream come true. We’re running a trial right now in Georgia, Indiana, Hawaii.

00:50:25 And where is the other one? Oh, Kentucky. Basically blanketing a community with free

00:50:32 testing.

00:50:33 That’s beautiful.

00:50:34 And look to see what happens as far as stemming the spread of the epidemic and measuring it

00:50:39 by wastewater because you can really tell whether you’ve cut back the amount of infection

00:50:43 in the community. Yeah, I’m so with you. We got off to such a bad start with testing.

00:50:50 And of course, all the testing was being done for the first several months in big box laboratories

00:50:55 where you had to send the sample off and put it through the mail somehow and get the result

00:50:59 back sometimes five days later after you’ve already infected a dozen people. It was just

00:51:04 a completely wrong model. But it’s what we had. And everybody was like, oh, we got to

00:51:08 stick with PCR because if you start using those home tests that are based on antigens,

00:51:13 lateral flow, probably there’s going to be false positives and false negatives. Okay,

00:51:18 sure. No test is perfect. But having a test that’s not acceptable or accessible is the

00:51:24 worst setting.

00:51:26 So we, NIH, with some requests from Congress, got a billion dollars to create this program

00:51:32 called Rapid Acceleration of Diagnostics, RADx. And we turned into a venture capital

00:51:39 organization, and we invited every small business or academic lab that had a cool idea about

00:51:42 how to do home testing to bring it forward. And we threw them into what we called our

00:51:47 shark tank of business experts, engineers, technology people, people who understood how

00:51:52 to deal with supply chains and manufacturing. And right now today, there are about two million

00:51:59 tests being done based on what came out of that program, including most of the home tests

00:52:05 that you can now buy on the pharmacy shelves. We did that. And I wish we had done it faster,

00:52:10 but it was an amazingly speedy effort. And you’re right, companies are really good. Once

00:52:15 they’ve got an FDA emergency use authorization, and we helped a lot of them get that, they

00:52:20 can scale up their manufacturing. I think in December, we should have about 410 million

00:52:28 tests for that month ready to go. And if we can get one or two more platforms approved,

00:52:34 and by the way, we are now helping FDA by being their validation lab. If we can get

00:52:39 a couple more of these approved, we could be in the half a billion tests a month, which

00:52:44 is really getting where we need to be.

00:52:47 Wow. Yeah, that’s a dream. That’s a dream for me. It seems like an obvious solution,

00:52:52 engineering solution. Everybody’s behind it, at least to hope versus division. I love it.

00:52:57 Yeah.

00:52:58 A happy story.

00:52:59 A happy story.

00:53:00 I was waiting for one.

00:53:02 Yeah. All right. Well, one last dive into the not happy, but you won’t even have to

00:53:07 comment on it. Well, comment on the broader philosophical question. So NIH, again, I said,

00:53:15 Joe Rogan is the first one who pointed me to this. NIH was recently accused of funding

00:53:20 research of a paper that had images of sedated puppies with their heads inserted into small

00:53:25 enclosures containing disease carrying sand flies. So I can just say that this story is

00:53:32 not true, or at least the… I think it is true that the paper that showed those images

00:53:40 cited NIH as a funding source, but that citation is not correct.

00:53:45 That was not correct.

00:53:46 Yeah. But that brings up a bigger philosophical question, that it could have been correct.

00:53:54 How difficult is it as a director of NIH or just NIH as an organization that’s funding

00:53:59 so many amazing deep research studies to ensure the ethical fortitude of those studies when

00:54:07 the ethics of science is… There’s such a gray area between what is and what isn’t ethical.

00:54:14 Well, tough issues. Certainly animal research is a tough issue.

00:54:19 I was going to bring up as a good example of that tough issue is in 2015, you announced

00:54:26 that NIH will no longer support any biomedical research involving chimpanzees. So that’s

00:54:32 like one example of looking in the mirror, thinking deeply about what is and isn’t ethical.

00:54:39 And there was a conclusion that biomedical research on chimps is not ethical.

00:54:45 That was the conclusion. That was based on a lot of deep thinking and a lot of input

00:54:49 from people who have considered this issue and a panel of the National Academy of Sciences

00:54:54 that was asked to review the issue. I mean, the question that I wanted them to look at

00:55:00 was, are we actually learning anything that’s really essential from chimpanzee invasive

00:55:06 research at this point? Or is it time to say that these closest relatives of ours should

00:55:14 not be subjected to that any further and ought to be retired to a sanctuary?

00:55:19 And that was the conclusion that there was really no kind of medical experimentation

00:55:24 that needed to be done on chimps in order to proceed. So why are we still doing this?

00:55:29 Many of these were chimpanzees that were purchased because we thought they would be good hosts

00:55:36 for HIV AIDS, and they sort of weren’t. And they were kept around in these primate laboratories

00:55:43 with people coming up with other things to do, but they weren’t compelling scientifically.

00:55:48 So I think that was the right decision. I took a lot of flak from some of the scientific

00:55:52 community said, well, you’re caving in to the animal rights people. And now that you’ve

00:55:57 said no more research on chimps, what’s next? Certainly when it comes to companion animals,

00:56:05 everybody’s heart starts to be hurting when you see anything done that seems harmful to

00:56:12 a dog or a cat. I have a cat, I don’t have a dog. And I understand that completely. That’s

00:56:18 why we have these oversight groups that decide before you do any of that kind of research,

00:56:24 is it justified? And what kind of provision is going to be made to avoid pain and suffering?

00:56:32 And those have input from the public as well as the scientific community. Is that completely

00:56:39 saying that every step that’s happening there is ethical by some standard that would be

00:56:47 hard for anybody to agree to? No, but at least it’s a consensus of what people think is acceptable.

00:56:54 Dogs are the only host for some diseases like leishmaniasis, which was that paper that we

00:57:02 were not responsible for, but I know why they were doing the experiment, or like lymphatic

00:57:06 filariasis, which is an experiment that we are supporting in Georgia that involves dogs

00:57:13 getting infected with a parasite, because that’s the only model we have to know whether

00:57:16 a treatment is going to work or not. So I will defend that. I am not in the place of

00:57:23 those who think all animal research is evil, because I think if there’s something that’s

00:57:28 going to be done to save a child from a terrible disease or an adult, and it involves animal

00:57:33 research that’s been carefully reviewed, then I think ethically why it doesn’t make me comfortable,

00:57:39 it still seems like it’s the right choice. I think to say all animal research should

00:57:45 be taken off the table is also very unethical, because that means you have basically doomed

00:57:50 a lot of people for whom that research might have saved their lives to having no more hope.

00:57:58 And to me personally, there’s far greater concerns ethically in terms of factory farming,

00:58:03 for example, the treatment of animals in other contexts.

00:58:06 There’s so much that goes on outside of medical research that is much more troubling.

00:58:12 That said, I think all cats have to go. That’s just my off the record opinion. That’s why

00:58:17 I’m not involved with any ethical decisions. I’m just joking internet ethic. I love cats.

00:58:22 You’re a dog person.

00:58:23 I’m a dog person. I’m sorry.

00:58:24 Have you seen the New Yorker cartoon where there are two dogs in the bar having a martini

00:58:29 and one is saying they’re dressed up in their business suits and one says to the other,

00:58:34 you know, it’s not enough for the dogs to win. The cats have to lose.

00:58:39 That’s beautiful. So a few weeks ago, you’ve announced that you’re resigning from the NIH

00:58:47 at the end of the year.

00:58:48 I’m stepping down. I’m still going to be at NIH at a different capacity.

00:58:53 Right. And it’s over a decade of an incredible career overseeing the NIH as its director.

00:59:02 What are the things you’re most proud of, of the NIH in your time here as its director

00:59:07 may be memorable moments?

00:59:12 There’s a lot in 12 years. Science has just progressed in amazing ways over those 12 years.

00:59:22 Think about where we are right now. Something like gene editing, being able to make changes

00:59:28 in DNA, even for therapeutic purposes, which is now curing sickle cell disease. Unthinkable

00:59:35 when I became director in 2009. The ability to study single cells and ask them what they’re

00:59:42 doing and get an answer. Single cell biology just has emerged in this incredibly powerful

00:59:48 way. Having the courage to be able to say we could actually understand the human brain

00:59:57 seemed like so far out there. And we’re in the process of doing that with the Brain Initiative.

01:00:04 Taking all that we’ve learned about the genome and applying it to cancer to make individual

01:00:09 cancer treatment really precision. And developing cancer immunotherapy, which seemed like sort

01:00:15 of a backwater into some of the hottest science around. All those things sort of erupting.

01:00:22 And much more to come, I’m sure. We’re on an exponential curve of medical research advances,

01:00:28 and that’s glorious to watch. And of course, COVID 19, as a beneficiary of decades of basic

01:00:35 science, understanding what mRNA is, understanding basics about coronaviruses and spike proteins

01:00:41 and how to combine structural biology and immunology and genomics into this package

01:00:46 that allows you to make a vaccine in 11 months. Just I would never have imagined that possible

01:00:52 in 2009. So to have been able to kind of be the midwife, helping all of those things get

01:00:57 birthed, that’s been just an amazing 12 years. And as NIH director, you have this convening

01:01:05 power and this ability to look across the whole landscape of biomedical research and

01:01:10 identify areas that are just like ready for something big to happen. But it isn’t going

01:01:16 to happen spontaneously without some encouragement, without pulling people together from different

01:01:21 disciplines who don’t know each other and maybe don’t know how to quite understand each

01:01:24 other’s scientific language and create an environment for that to happen. That has been

01:01:29 just an amazing experience. I mean, I mentioned the Brain Initiative as one of those. The

01:01:35 Brain Initiative right now, I think there’s about 600 investigators working on this. Last

01:01:41 week, the whole issue of Nature magazine was about the output of the Brain Initiative basically

01:01:46 now giving us a cell census of what those cells in the brain are doing, which has just

01:01:51 never been imaginable. And interestingly, more than half of the investigators in the

01:01:59 Brain Initiative are engineers. They’re not biologists in a traditional sense. I love

01:02:04 that. Maybe partly because my PhD is in quantum mechanics. So I think it’s really a good idea

01:02:10 to bring disciplines together and see what happens. That’s an exciting thing. And I will

01:02:16 not ever forget having the chance to announce that program in the East Room in that White

01:02:23 House with President Obama, who totally got it and totally loved science and working with

01:02:29 him in some of those rare moments of sort of one on one conversation in the Oval Office,

01:02:35 just him and me about science. That’s a gift.

01:02:38 What’s it like talking to Barack Obama about science? He seems to be a sponge. I’ve heard

01:02:44 him. I’m an artificial intelligence person. And I’ve heard him talk about AI. And it was

01:02:49 like, it made me think, is somebody like whispering in his ear or something? Because he was saying

01:02:54 stuff that totally passed the BS test, like he really understands stuff.

01:02:58 He does.

01:02:59 That means he listened to a bunch of experts on AI. He was explaining the difference between

01:03:04 narrow artificial intelligence and strong AI. He was saying all this, both technical

01:03:08 and philosophical stuff. And it just made me, I don’t know, it made me hopeful about

01:03:14 the depth of understanding that a human being in political office can attain.

01:03:18 That gave me hope as well, and having those experiences. Oftentimes in a group, I mean,

01:03:24 another example was trying to figure out, how do we take what we’ve learned about the

01:03:28 genome and really apply it at scale to figure out how to prevent illness, not just treat

01:03:34 it, but prevent it, out of which came this program called All of Us, this million strong

01:03:40 American cohort of participants who make their electronic health records and their genome

01:03:45 sequences and everything else available for researchers to look at. That came out of a

01:03:50 couple of conversations with Obama and others in his office, and he asked the best questions.

01:03:58 That was what struck me so much. I mean, a room full of scientists, and we’d be talking

01:04:03 about the possible approaches, and he would come up with this incredibly insightful penetrating

01:04:09 question. Not that he knew what the answer was going to be, but he knew what the right

01:04:12 question was.

01:04:13 I think the core to that is curiosity. I don’t think he’s even like, he’s trying to be a

01:04:19 good leader. He’s legit curious.

01:04:22 Yes.

01:04:23 Legit.

01:04:24 That he, almost like a kid in a candy store, gets to talk to the world experts. He somehow

01:04:29 sneaked into this office and gets to talk to the world experts. That’s the kind of energy

01:04:35 that I think leads to beautiful leadership in the space of science.

01:04:40 Indeed. Another thing I’ve been able to do as director is to try to break down some of

01:04:45 the boundaries that seem to be traditional between the public and the private sectors.

01:04:49 When it comes to areas of science that really could and should be open access anyway, why

01:04:54 don’t we work together? That was obvious early on. After identifying a few possible collaborators

01:05:03 who are chief scientists of pharmaceutical companies, it looked like we might be able

01:05:08 to do something in that space.

01:05:10 Out of that was born something called the Accelerating Medicines Partnership, AMP. It

01:05:16 took a couple of years of convening people who usually didn’t talk to each other. There

01:05:21 was a lot of suspicion. Academic scientists saying, oh, those scientists in pharma, they’re

01:05:27 not that smart. They’re just trying to make money. The academic scientists getting the

01:05:32 rap from the pharmaceutical scientists, all they want to do is publish papers. They don’t

01:05:36 really care about helping anybody.

01:05:38 We found out both of those stereotypes were wrong. Over the course of that couple of years,

01:05:44 we built a momentum behind three starting projects, one on Alzheimer’s, one on diabetes,

01:05:50 one on rheumatoid arthritis and lupus. Very different, each one of them trying to identify

01:05:54 what is an area that we both really need to see advance and we could do better together.

01:06:00 It’s going to have to be open access, otherwise NIH is not going to play. Guess what, industry?

01:06:05 If you really want to do this, you got to have skin in the game. We’ll cover half the

01:06:08 cost. You got to cover the other half.

01:06:10 I love it. Enforcing open access, resulting in open science.

01:06:16 Millions of dollars gone into this and it has been a wild success. After many people

01:06:21 were skeptical, a couple of years later, we had another project on Parkinson’s. More recently,

01:06:27 we added one on schizophrenia. Just this week, we added one on gene therapy, on bespoke gene

01:06:35 therapy for ultra rare diseases, which otherwise aren’t going to have enough commercial appeal.

01:06:41 If we did this together, especially with FDA at the table, and they have been, we could

01:06:45 make something happen, turn this into a standardized approach where everything didn’t have to be

01:06:51 a one off. I’m really excited about that.

01:06:54 What began as three projects is six and it’s about to be seven next year with a heart failure

01:06:59 and all of us have gotten to know each other. If it weren’t for that background when COVID

01:07:06 came along, it would have been a lot harder to build the partnership called ACTIV, which

01:07:11 has been my passion for the last 20 months, accelerating COVID 19 therapeutic interventions

01:07:17 and vaccines.

01:07:18 We just had our leadership team meeting this morning. It was amazing what’s been accomplished.

01:07:23 That’s pretty much 100 people who dropped everything just to work on this, about half

01:07:28 from industry and half from government and academia. That’s how we got vaccine master

01:07:34 protocols designed. We all agreed about what the endpoints had to be and you wondered why

01:07:40 are there 30,000 participants in each of these trials? That’s because of ACTIV’s group mapping

01:07:46 out what the power needed to be for this to be convincing.

01:07:51 Same with therapeutics. We have run at least 20 therapeutic agents through trials that

01:07:58 ACTIV supported in record time. That’s how we got monoclonal antibodies that we know

01:08:02 work. That would not have been possible if I didn’t already have a sense of how to work

01:08:12 with the private sector that came out of AMP. AMP took two years to get started. ACTIV took

01:08:17 two weeks. We just kept the lawyers.

01:08:20 Wow, to get 100 people over?

01:08:21 Yeah, kept the lawyers out of the room and away we went.

01:08:25 Now you’re going to get yourself in trouble. I do hope one day the story of this incredible

01:08:34 vaccine development of vaccine protocols and trials and all this kind of details, the messy

01:08:38 beautiful details of science and engineering that led to the manufacturing, the deployment

01:08:44 and the scientific test. It’s such a nice dance between engineering in the space of

01:08:48 manufacturing the vaccines. You start before the studies are complete, you start making

01:08:53 the vaccines just in case that if the studies proved to be positive, then you can start

01:08:59 deploying them just like so many parties, like you said, private and public playing

01:09:05 together. That’s just a beautiful dance that is one of the, for me, the sources of hope

01:09:11 in this very tricky time where there’s a lot of things to be cynical about in terms of

01:09:20 the games politicians play and the hardship experience of the economy and all those kinds

01:09:24 of things. That to me, this dance was a vaccine development was done just beautifully and

01:09:31 it gives me hope.

01:09:33 It does me as well. And it was in many ways the finest hour that science has had in a

01:09:38 long time being called upon when every day counted and making sure that time was not

01:09:44 wasted and things were done rigorously, but quickly.

01:09:50 So, you’re incredibly good as a leader of the NIH. It seems like you’re having a heck

01:09:56 of a lot of fun. Why step down from this role after so much fun?

01:10:02 Well, no other NIH director has served more than one president after being appointed by

01:10:09 one. You’re sort of done. And the idea of being carried over for a second presidency

01:10:14 with Trump and now a third one with Biden is unheard of. I just think, Lex, that scientific

01:10:20 organizations benefit from new vision and 12 years is a really long time to have the

01:10:26 same leader. And if I wasn’t going to stick it out for the entire Biden four year term,

01:10:33 it’s good not to wait too late during that to signal an intent to step down because the

01:10:39 president’s got to find the right person, got to nominate them, got to get the Senate

01:10:43 to confirm them, which is an unpredictable process right now.

01:10:47 And you don’t want to try to do that in the second half of somebody’s term as president.

01:10:52 This has got to happen now. So, I kind of decided back at the end of May that this should

01:10:56 be my final year. And I’m okay with that. I do have some mixed emotions because I love

01:11:04 the NIH. I love the job. It’s exhausting. I’m traditionally for the last 20 months anyway,

01:11:13 working 100 hours a week. It’s just, that’s what it takes to juggle all of this. And that

01:11:19 keeps me from having a lot of time for anything else. And I wouldn’t mind because I don’t

01:11:24 think I’m done yet. I wouldn’t mind having some time to really think about what the next

01:11:30 chapter should be. And I have none of that time right now. Do I have another calling?

01:11:35 Is there something else I could contribute that’s different than this? I’d like to find

01:11:40 that out.

01:11:42 I think the right answer is you’re just stepping down to focus on your music career.

01:11:49 That might not be a good plan for anything very sustainable.

01:11:54 But I think that is a sign of a great leader as George Washington did stepping down at

01:11:59 the right time.

01:12:00 Ted Williams.

01:12:01 Yes.

01:12:02 He quit when I think he hit a home run on his last at bat and his average was 400 at

01:12:07 the time.

01:12:08 No one to walk away. I mean, it’s hard, but it’s beautiful to see in a leader. You also

01:12:15 oversaw the human genome project. You mentioned the brain initiative, which has, it’s a dream

01:12:22 to map the human brain. And there’s the dream to map the human code, which was the human

01:12:29 genome project. And you have said that it is humbling for me and awe inspiring to realize

01:12:34 that we have caught the first glimpse of our own instruction book, previously known only

01:12:41 to God. How does that, if you can just kind of wax poetic for a second, how does it make

01:12:48 you feel that we were able to map this instruction book, look into our own code, and be able

01:12:55 to reverse engineer it?

01:12:59 It’s breathtaking. It’s so fundamental. And yet, for all of human history, we’re ignorant

01:13:06 of the details of what that instruction book looked like. And then we crossed a bridge

01:13:13 into the territory of the known. And we had that in front of us still written in a language

01:13:19 that we had to learn how to read. And we’re in the process of doing that and will be for

01:13:23 decades to come. But we owned it, we had it. And it has such profound consequences. It’s

01:13:31 it’s both a book about our history. It’s a book of sort of the parts list of a human

01:13:38 being, the genes that are in there and how they’re regulated. And it’s also a medical

01:13:43 textbook that can teach us things that will provide answers to illnesses we don’t understand,

01:13:51 and alleviate suffering and premature death. So it’s a pretty amazing thing to contemplate.

01:13:57 And it has utterly transformed the way we do science. And it is in the process of transforming

01:14:03 the way we do medicine, although much of that still lies ahead. You know, while we were

01:14:09 working on the Genome Project, it was sort of hard to get this sense of a wellness, because

01:14:17 it was just hard work. And you were getting, you know, another mega base, okay, this is

01:14:21 good. But when did you actually step back and say, we did it? It’s the profoundness

01:14:29 of that. I mean, there were two points, I guess. One was the announcement on that June

01:14:33 26, 2000, where the whole world heard, well, we don’t quite have it, but we got a pretty

01:14:37 good draft. And suddenly, people are like realizing, oh, this is this a big deal. For

01:14:45 me, it was more when we got the full analysis of it, published it in February 2001. And

01:14:50 that issue of Nature paper that Eric Lander and Bob Waterston and I were the main authors,

01:14:55 and we toiled over and tried to get as much insight as we could in there about what the

01:15:01 meaning of all this was. But you also had this sense that we are such beginning readers

01:15:07 here. We are still in kindergarten, trying to make sense out of this 3 billion letter

01:15:13 book. And we’re going to be at this for generations to come.

01:15:19 You are a man of faith, Christian, and you are a man of science. What is the role of

01:15:25 religion and of science in society and in the individual human mind and heart like yours?

01:15:35 Well, I was not a person of faith when I was growing up. I became a believer in my 20s,

01:15:42 influenced as a medical student by a recognition that I hadn’t really thought through the

01:15:48 issues of what’s the meaning of life? Why are we all here? What happens when you die?

01:15:55 Is there a God? Science is not so helpful in answering those questions. So I had to

01:16:01 look around in other places and ultimately came to my own conclusion that atheism, which

01:16:07 is where I had been, was the least supportable of the choices because it was the assertion

01:16:12 of a universal negative, which scientists aren’t supposed to do. And agnosticism came

01:16:20 as an attractive option but felt a little bit like a cop out, so I had to keep going

01:16:24 trying to figure out why do believers actually believe this stuff? And I came to realize

01:16:30 it was all pretty compelling, that there’s no proof. I can’t prove to you or anybody

01:16:34 else that God exists, but I can say it’s pretty darn plausible.

01:16:39 And ultimately, what kind of God is it that caused me to search through various religions

01:16:45 and see, well, what do people think about that? And to my surprise, encountered the

01:16:51 person of Jesus Christ as unique in every possible way and answering a lot of the questions

01:16:58 I couldn’t otherwise answer. And somewhat kicking and screaming, I became a Christian,

01:17:06 even though at the time, as a medical student already interested in genetics, people predicted

01:17:12 my head would then explode because these were incompatible worldviews. They really have

01:17:18 not been for me. I am so fortunate, I think, that in a given day, wrestling with an issue,

01:17:27 it can have both the rigorous scientific component and it can have the spiritual component. COVID

01:17:33 19 is a great example. These vaccines are both an amazing scientific achievement and

01:17:39 an answer to prayer. When I’m wrestling with vaccine hesitancy and trying to figure out

01:17:45 what answers to come up with, I get so frustrated sometimes and I’m comforted by reassurances

01:17:53 that God is aware of that. I don’t have to do this alone.

01:17:58 So I know there are people like your friend, Sam Harris, who feel differently. Sam wrote

01:18:05 a rather famous op ed in the New York Times when I was nominated as the NIH director saying,

01:18:12 this is a terrible mistake. You can’t have somebody who believes in God running the NIH.

01:18:21 He’s just going to completely ruin the place.

01:18:23 Well, I have a testimonial. Christopher Hitchens, a devout atheist, if I could say so, was a

01:18:31 friend of yours and referred to you as, quote, one of the greatest living Americans and stated

01:18:37 that you were one of the most devout believers he has ever met. He further stated that you

01:18:41 were sequencing the genome of the cancer that would ultimately claim his life and that your

01:18:46 friendship, despite their differing opinions on religion, was an example of the greatest

01:18:52 confirmed truth in modern times.

01:18:55 What did you learn from Christopher Hitchens about life or perhaps what is a fond memory

01:18:59 you have of this man with whom you’ve disagreed, but who is also your friend?

01:19:05 Yeah, I loved Hitch. I’m sorry he’s gone. Iron sharpens iron. There’s nothing better

01:19:13 for trying to figure out where you are with your own situation and your own opinions,

01:19:19 your own worldviews, than encountering somebody who’s completely in another space and who’s

01:19:24 got the gift, as Hitch did, of challenging everything and doing so over a glass of scotch

01:19:30 or two or three.

01:19:33 We got off to a rough start in an interaction we had at a rather highbrow dinner. He was

01:19:41 really deeply insulting of a question I was asking. I was like, okay, that’s fine. Let’s

01:19:48 figure out how we could have a more civil conversation. Then I really learned to greatly

01:19:53 admire his intellect and to find the jousting with him. It wasn’t all about faith, although

01:20:00 it often was. It was really inspiring and innovating, energizing.

01:20:05 Then when he got cancer, I became his ally, trying to help him find pathways through the

01:20:13 various options and maybe helped him to stay around on this planet for an extra six months

01:20:19 or so. I have the warmest feelings of being in his apartment downtown over a glass of

01:20:28 wine talking about whatever. Sometimes it was science. He was fascinated by science.

01:20:35 Sometimes it was Thomas Jefferson. Sometimes it was faith. I knew it would always be really

01:20:42 interesting.

01:20:43 He’s now gone. Do you think about your own mortality? Are you afraid of death?

01:20:51 I’m not afraid. I’m not looking forward to it. I don’t want to rush it because I feel

01:20:55 like I got some things I can still do here. As a person of faith, I don’t think I’m afraid.

01:21:02 I’m 71. I know I don’t have an infinite amount of time left. I want to use the time I’ve

01:21:08 got in some sort of way that matters. I’m not ready to become a full time golfer, but

01:21:17 I don’t quite know what that is. I do feel that I’ve had a chance to do amazingly powerful

01:21:25 things as far as experiences, and maybe God has something else in mind.

01:21:31 I wrote this book 16 years ago, The Language of God, about science and faith, trying to

01:21:37 explain how, from my perspective, these are compatible. These are in harmony. They’re

01:21:44 complementary if you are careful about which kind of question you’re asking. To my surprise,

01:21:50 a lot of people seem to be interested in that. They were tired of hearing the extreme voices

01:21:56 like Dawkins at one end and people like Ken Ham and Answers in Genesis on the other end

01:22:02 saying, if you trust science, you’re going to hell. They thought there must be a way

01:22:07 that these things could get along, and that’s what I tried to put forward.

01:22:10 Then I started a foundation, BioLogos, which then I had to step away from to become NIH

01:22:16 director, which has just flourished, maybe because I stepped away. I don’t know. It

01:22:21 now has millions of people who come to that website and they run amazing meetings. I think

01:22:26 a lot of people have really come to a sense that this is okay. I can love science and

01:22:31 I can love God, and that’s not a bad thing. So maybe there’s something more I can do in

01:22:36 that space. Maybe that book is ready for a second edition.

01:22:39 I think so. But when you look back, life is finite. What do you hope your legacy is?

01:22:47 I don’t know. This whole legacy thing is a little bit hard to embrace. It feels a little

01:22:54 self promoting, doesn’t it? I sort of feel like in many ways, I went to my own funeral

01:22:59 on October 5th when I announced that I was stepping down and I got the most amazing responses

01:23:05 from people, some of whom I knew really well, some of whom I didn’t know at all, who were

01:23:10 just telling me stories about something that I had contributed to that made a difference

01:23:16 to them. That was incredibly heartwarming, and that’s enough. I don’t want to build

01:23:21 an edifice. I don’t have a plan for a monument or a statue. God help us.

01:23:27 I do feel like I’ve been incredibly fortunate. I’ve had the chance to play a role in things

01:23:33 that were pretty profound from the Genome Project to NIH to COVID vaccines, and I ought

01:23:39 to be plenty satisfied that I’ve had enough experiences here to feel pretty good about

01:23:46 the way in which my life panned out.

01:23:50 We did a bunch of difficult questions in this conversation. Let me ask the most difficult

01:23:54 one, that perhaps is the reason you turned to God. What is the meaning of life? Have

01:24:03 you figured it out yet?

01:24:07 Expect me to put that into three sentences.

01:24:09 We only have a couple of minutes. At least hurry up.

01:24:15 Well that’s not a question that I think science helps me with, so you’re going to push me

01:24:19 into the faith zone, which is where I’d want to go with that. What is the meaning? Why

01:24:25 are we here? What are we put here to do? I do believe we’re here for just a blink of

01:24:30 an eye and that our existence somehow goes on beyond that in a way that I don’t entirely

01:24:37 understand despite efforts to do so. I think we are called upon in this blink of an eye

01:24:43 to try to make the world a better place, to try to love people, to try to do a better

01:24:50 job of our more altruistic instincts and less of our selfish instincts, to try to be what

01:25:01 God calls us to be, people who are holy, not people who are driven by self indulgence.

01:25:12 And sometimes I’m better at that than others. But I think that for me as a Christian is

01:25:17 a pretty clear, I mean, it’s to live out the Sermon on the Mount. Once I read that,

01:25:24 I couldn’t unread it. All those beatitudes, all the blessings, that’s what we’re supposed

01:25:32 to do. And the meaning of life is to strive for that standard, recognizing you’re going

01:25:37 to fail over and over again, and that God forgives you. Hopefully to put a little bit

01:25:44 of love out there into the world. That’s what it’s about. Francis, I’m truly humbled and

01:25:51 inspired by both your brilliance and your humility and that you would spend your extremely

01:25:58 valuable time with me today. It was really an honor. Thank you so much for talking today.

01:26:02 I was glad to. And you asked a really good question. So your reputation as the best podcaster

01:26:08 has borne itself out here this afternoon. Thank you so much. Thanks for listening to

01:26:13 this conversation with Francis Collins. To support this podcast, please check out our

01:26:17 sponsors in the description. And now let me leave you with some words from Isaac Newton

01:26:22 reflecting on his life and work. I seem to have been only like a boy playing on the seashore

01:26:29 and diverting myself in now and then finding a smoother pebble or prettier shell than ordinary.

01:26:35 Whilst the great ocean of truth lay all undiscovered before me. Thank you for listening and hope

01:26:43 to see you next time.